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A Discussion On A Clinical Encounter Using The Principles Of Therapeutic Engagement And Reflective Models

4312 words - 17 pages

OVERVIEWThis essay will discuss a clinical interaction involving a service user and myself, a student nurse, in terms of the principles of therapeutic engagement. It will highlight key issues within the interaction that affected the outcome of the situation and, by using a reflective model, will analyse the engagement process.INTRODUCTION OF THE SERVICE USERIn order to respect the service user's confidentiality in concordance with the Nursing & Midwifery Council (2004) code of professional conduct - point 5.1, the author shall refer to her as Ms X throughout this essay.Ms X is a 36 year old, single, English white female. Her diagnosis is paranoid schizoaffective disorder (American Psychiatric Association, 2000), but she has little insight into her condition. Ms X is currently prescribed a depot injection of clopixol 40mg, to be administered once every two weeks, (Dunitz, 2001). She has four children, all of which have been taken into care due to her inability to cope, although she adamantly denies this claim. Her social support network consists of her mother and three close female friends.Ms X is currently living in temporary accommodation due to her property being uninhabitable due to fire damage. She has had three admissions to an acute ward over the past two years. Ms X has a history of illicit drug use and this has been a prodrome to all three of her admissions (Birchwood, Spencer & McGovern, 2000), causing her to become paranoid, to display unusual behaviour such as writing numerous letters of complaint to famous people and extreme anxiety symptoms such as pacing, aggressive outbursts and tense posture.CONTEXT OF CLINICAL INTERACTIONPrior to the interaction about to be discussed, the author had previously met Ms X during her second admission on an acute ward, approximately a year ago. During this period the author spent a lot of time building and developing a therapeutic relationship with her.A year later Ms X was discharged from her third hospital admission, where she was held under Section 3 of the Mental Health Act (1983), (DoH & Dobson, 1999) and referred to the community mental health team where the author was working on placement. Ms X was not under Section at the time of the interaction.Prior to Ms X's discharge, the author accompanied a member of the community team to visit Ms X on the Ward twice a week for 3 weeks in order to establish a relationship with her. This relationship would ensure that Ms X would experience a smooth transition into community care and a strong therapeutic relationship has been seen (Priebe and Gruyters 1993) to determine the actual success of that community care.Ms X remembered the author from previous meetings, the author and her mentor also attended the Tribunal and Hospital Manager's Appeal meetings with Ms X, to show Ms X that the community team wanted to offer her support and gain her trust.Ms X had been a client of the community team for 2 weeks before the interaction took place. The team...

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