Nursing Reflective Essay

This nursing reflective essay discusses a video about a GP seeing a patient with a depressive disorder and reflects on the lessons learned from the Mental State Examination (MSE). The essay highlights the importance of building rapport with the patient, conducting a comprehensive MSE, and addressing sensitive topics. It also emphasizes the significance of recapping, risk assessment, and providing explanations to the patient. The essay provides insights into the practical application of theoretical knowledge in the field of nursing.

Running head: NURSING REFLECTIVE ESSAY 1
Nursing Reflective Essay
Name
Institutional Affiliation

NURSING REFLECTIVE ESSAY 2
NURSING REFLECTIVE ESSAY
In this paper, I will be reflecting on the video about a GP who is seeing a patient (Alison,
38-yeard-old woman with a low mood) with a depressive disorder. The reflection covers how the
patient describes her low mood, reduced energy, decreased motivation, loss of appetite, early
morning awakening, weight loss, reduced enjoyment, poor concentration, and decreased self-care
interest. It also reflects on how the GP explores the symptoms’ effects on other people in the life
of the patient, exploring the low mood past history, assessing the risk of suicide and how the GP
explains about depression to the patient. The paper, therefore, reflects on lessons I learned while
watching the video of a patient needing completion of a Mental State Examination (MSE).
In order to outline what I have learned in this video, I will be relating the theoretical
knowledge I have learned about MSE to the practical application as presented in the video. My
expectation is that the video should display the actual MSE as a structured means of observing
and describing a patient’s present state of mind, under such domains as appearance, behavior,
mood, and affect, speech, thought process, thought content, perception, cognition and insights. I
will analyze this video based on whether the GP asked questions that comprehensively captured
all the domains of MSE. I will also reflect on whether the main purpose of MSE which is to
obtain a detailed cross-sectional description of the mental state of the patient that when combined
with historical and biographical information of her psychiatric history, would permit the GP to
make accurate diagnosis alongside formulation (Arnfred et al., 2018).
The first lesson I learned is the value of welcoming a patient and introducing GP to the
patient before starting the MSE. The GP welcomed her patient and even gave her the seat. I have
come to appreciate that the GP not only welcomed the patient, but also introduced herself to the
patient. The GP also inquired from the patient how she would like her to call her. I believe this is

NURSING REFLECTIVE ESSAY 3
why the GP managed to build a rapport with the patient through a therapeutic relationship. This,
in my view, explains why the patient was willing to talk to the GP. I also learned from the video
that MSE can be threatening to the patient and hence requires a lot of cooperation from the
patient. This is because I realized that the GP was keen to building a therapeutic relationship and
rapport with patient. She needed to first establish this rapport before engaging in the actual MSE.
I have also learned from the video that mental state of a patient colors the sensitivity and
accuracy of the whole medical history. This is why the GP chose to perform the MSE as preclude
of the rest of medical history. This would allow the GP have the assessment as a template against
which she can measure the accuracy of other history. Therefore, I learned that the GP wanted to
be successful by developing a style whereby she performs much of MSE via relatively
unstructured observation made in the course of routine physical and history. This is seen when
she begins by taking medical history of the patient and using the therapeutic communication
(verbal) and upholding professionalism to ensure that the patient fully cooperates (Otte et al.,
2016).
Specifically, GP says, “would you like to tell more about it.” This is a polite request
rather than a command to the patient because of the importance the GP puts on the way the
patient relates her history of her present low mood/depressive disorder (University of
Nottingham, 2012). I acknowledged that how a patient relates the history of her present low
mood is significant to the GP because it reveals much information about the overal appearance
alongside behavior, speech, alertness, affect, activity, and attitude all of which are important
domains in MSE. Therefore, I learned that GP imposed certain structure on such observations
and raised them from the subliminal impression level to clinically valuable behavior description.

NURSING REFLECTIVE ESSAY 4
I also learned that when performing MSE, it is desirable to politely ask the patient if she
would allow the GP to ask her a few more details about how she is feeling. This is important in
assessing the mood of the patient. Also, I realized that every time the GP wants to ask the
question, she first tells the patient what they will now be dealing with. For example, when she
was questioning her about her feelings, the GP says, “we start by asking some questions about
your mood (University of Nottingham, 2012)”. I have learned that this is important in telling the
patient where you are heading to and what you are dealing with at each particular time rather
than mixing and throwing questions at the patient without telling her what particular issue is
being dealt with. Also, I have learned that the importance of a GP giving the patient ample time
to respond to questions uninterruptedly. I came to appreciate this as an important concept when
performing MSE since it allows the GP to get as much details from the patient without asking
leading questions. Such detailed information are valuable for the GP to make accurate analysis
and interpretation in diagnosis.
Another important lesson I learned is the importance of follow-up on what the patient had
said. I realized that the GP could follow-up with the patient when she raised something which
was not clear to the GP so that she gets accurate and clear information. For example, when the
patient was describing her mood and feeling and she said that things were just blurred, the GP
followed up and inquired what exactly that meant. This helped the GP to conclude that the
patient was feeling miserable and low. I have also realized the need to empathize with the
patient. For example, the GP empathized with the patient when she was describing why she was
much tearful. The GP empathized with her and gave her something to wipe her tears (University
of Nottingham, 2012).

NURSING REFLECTIVE ESSAY 5
I also learned that the GP was sensitive when asking questions that might be viewed
embarrassing. However, I learned that before asking such questions, it is important to first
explain to the patient why it is significant to ask it even though it might appear embarrassing.
This was evidenced when the GP asked about the changes in the patient’s sex life. She had to be
creative enough to ask the question about sex without embarrassing the patient and ensuring that
she gets an answer.
I also learned about the importance of recapping during the MSE session. This was
evident when the GP asked the patient if they could recap so that she could ensure that she got
everything right. This was important because there is a need for the patient to confirm that
whatever the GP noted or recorded from the history was accurate. Getting such an approval from
the patient would mean that the GP was accurate and hence would come up with accurate
findings. I also learned about the importance of taking the past psychiatric history. This
important to know what kind of the medication the patient has used before and how she felt
about them (Matuszak, McVige, McPherson, Willer & Leddy, 2016).
I also learned about the significance of undertaking a risk assessment of the patient.
Making a risk assessment was effective so that the GP would come up with ways to mitigate the
risk. She asked about whether the patient had thought about her situation as being so bad that she
could decide to harm or kill herself and even take her children with her. I further learned about
the need to ask the patient about positive things about life and what she believed are the reasons
she still lives. I believe this important since it will the GP recommend that the patient maximize
on her positivities so as to help come out of her depressive disorder (Asghar-Ali & Boyle, 2018).
I have also learned the importance of asking the patient about her support system or people who
are supportive to her so that the GP could know the kind of persons she could work together with

NURSING REFLECTIVE ESSAY 6
towards the patient’s recovery. The need to ask the patient whether she thinks she can keep
herself safe from hurting herself at the moment is also an important lesson I learned from this
interview.
I also learned the need to give full explanation about the patient’s condition towards the
end of the evaluation. The nurse explained what depression is all about based on the MSE to the
patient and I have learned that this is important since it helps the patient know that the condition
can be addressed using some options. Also, I realized that it is always important to ask the
patient for her approval of anything the GP intends to do to help her recover from her low mood.

NURSING REFLECTIVE ESSAY 7
References
Arnfred, S. M., Gefke, M., Høegh, E. B., Hansen, J. R., Fog-Petersen, C., & Hemmingsen, R.
(2018). Mental status examination training for medical students: the development of an
educational video library with authentic patients. Academic Psychiatry, 42(3), 432-433.
Asghar-Ali, A. A., & Boyle, L. L. (2018). Mental Status Examination. In Psychiatric Disorders
Late in Life. Springer, Cham, 11(2), 75-77.
Matuszak, J. M., McVige, J., McPherson, J., Willer, B., & Leddy, J. (2016). A practical
concussion physical examination toolbox: evidence-based physical examination for
concussion. Sports health, 8(3), 260-269.
Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., ... & Schatzberg, A.
F. (2016). Major depressive disorder. Nature Reviews Disease Primers, 12(2), 16065.
University of Nottingham. (2012, Jan 31). Psychiatric Interviews for Teaching: Depression
[Video File]. Retrieved from https://www.youtube.com/watch?v=4YhpWZCdiZc