Embracing the lived experience of Mental Health Service Users

Student Narratives - Julia Turner

First-Person Media Products - Gary Morris

The Simulated Patient - Anne Lawton

(understanding self)

(understanding others)

(engaging with others)

Empathy: Connecting with the felt experience

Self Other

Appraisal of others’ felt experience

Conveyance of understanding

Empathy - the ability of the therapist to sense the client's private world as if it were their own.(Rogers 1957)

Embracing the lived experience of Mental Health Service Users

Ten Essential Shared Capabilities (NIMHE 2004) working in partnership

The National Dementia Strategy (DOH 2009) - Raising awareness and understanding

NMC Code (2008)Individualised collaborative care

O’Connor and Seymour (1990)

ExternalBehaviour

Internal Response

Internal response External

Behaviour

Self Other

(understanding self)

(understanding others)

(engaging with others)

Embracing the lived experience of Mental Health Service Users

A) Understanding Self

Student Narratives - Julia Turner

Introduce understanding self approach

Importance of approach

- Working in partnership- Valuing learner’s personal experience- Encouraging self-reflective skills- What are their values and how have they been informed- Appreciation of how internal response influences external behaviour

Why start with self

• Student narrative provide opportunity to reflect upon aspects that influence how we feel and the subsequent impact that certain experiences have upon our own mental health.

• This approach encourages students to develop their own personal stories and share them with peers, thereby promoting self-reflection and learning from differing perspectives.

Students need a chance to:• hear each others stories• learn about each other perspectives • develop critical thinking

Helping people to describe, explore and come to appreciate where they are in their life path is important for recovery approaches in mental health nursing.

Understanding Self

Examples

1) Road Map

2) Core Values

3) External presentation – self report

B) Understanding Others

First-Person Media Products - Gary Morris

How do we learn about a person’s lived and felt experience of dementia ?

• Research into dementia gives us some valuable understanding, for example with regards to carers :

• stress• burden of care • depression • guilt

- what do these words and terms mean ?

• Potency and resonance of personal accounts

News reports may inform us of notable world events including disasters (i.e. earthquakes, tsunamis, hurricanes, plane crashes, acts of terrorism etc) or events such as travel disruption caused by volcanic ash clouds

With events such as these there is the potential for them to become reduced to a set of numbers and statistics. Exposing us to personal accounts changes the whole understanding of what these events actually mean in terms of feelings and experience

First-person Media Resources:

• Feature Film

• Internet Sites

• Autobiography

• Television documentary

Watching feature films

IrisAway from HerThe Notebook

The Road to Galveston

• Films such as Iris provide very emotive and powerful account of the dementia experience

• Especially poignant bearing in mind the contextual issues – impact upon Iris (loss of expressive ability) and her husband John

A) Alzheimer’s Society:

• Talking Point Forum• Living with Dementia Magazine

B) Healthtalkonline

C) Youtube

D) Facebook

Surfing the Internet

Alzheimer’s Society

A) Living with Dementia

monthly magazine (also available online) covering:

• News items• Personal stories • Articles • Research• Reader’s Questions • Letters

B) Talking Point Forum

Reading Books

Dancing With Dementia My Bonnie: How Dementia Stole the Love of my

LifeLiving In The Labyrinth

My Journey Into Alzheimer’s Disease

Robert Davis – My Journey Into Alzheimer’s Disease

Making mistakes

“I live with the imminent dread that one mistake in my daily life will mean another freedom being taken away. Each freedom taken places me in a smaller playpen with a tighter ritual to maintain myself. For example most people could forget a pan on the stove and burn dinner – the family can laugh about it and get a can of something else out for supper. If a person with Alzheimer’s gets caught burning something, it is a severe tragedy, another marker of the progress of their incompetency. In all likelihood it will take away forever their ability to cook and be the end to a whole line of productivity.”

(Davis 1989 : 103)

Accessing inner thoughts and feelings has enabled students to be more aware about the types of underlying issues that impact upon a person’s subsequent presentation.

The importance of this for practice is in helping clinicians to better contextualise a person’s behaviour especially with regards to reframing 'challenging behaviours'

Watching TVDocumentaries

News featuresSoaps

Drama

• Watching clips i.e. documentaries featuring the lived experience can be very emotive as we engage much more closely with the lived experience of those featured

• This is where certain 'terms' take on a much more powerful and impactful meaning:

• Loss

• Isolation

• Affection

C) Engaging with others

The Simulated Patient – Anne Lawton

Rationale

• gives a strong message re the value base of mental health nursing

• SPs are flexible and realistic – give the 'as if' factor

• students get instant feedback

• links theory to practice effectively – able to observe and make sense ofthe skills and approach and apply in their own practice

• raises students’ confidence, improves their awareness and developstherapeutic approaches

• use of simulated patient in the role of the same client over 7 sessions

• actor briefed by teachers, based on real client

• serial counselling, 10 minutes per student with other students in groupand teacher/s observing

• followed by immediate feedback after each 10 minutes, from actor, in role, from peers and from teachers, plus links made with theory

• video recordings made for students’ private viewing and reflection

Issues re SPs

• background of SP unknown (actor, health professional, service user or carer)

• briefing of SP

• congruence of SP to role

• feedback (in-role, level of criticality)

• support for SP (effects of the role, can trigger their own issues)

• SPs’ level of understanding of mental health problem – should we use‘expert patients’?

Issues re Students

• use of video (performance anxiety, reliability of equipment)

• students switch from ‘nursing’ to ‘counselling’

• students’ perception of ‘upsetting’ the client

• level of engagement of students – requirement of module/course

• group size and timings

• briefing of student

• quality of peer feedback and personal review of video

Concluding thoughts

It is recognised that in terms of empathy, each person’s experience is unique and cannot simply be transferred and applied to others.

All of the featured approaches promote understanding and encourage more reflective, sensitive and questioning approaches to care.