reflective essay health and social care

• Research article
• Open access
• Published: 22 July 2021

Health professionals and students’ experiences of reflective writing in learning: A qualitative meta-synthesis

• Giovanna Artioli   ORCID: orcid.org/0000-0002-1810-0857 1 ,
• Laura Deiana 2 ,
• Francesco De Vincenzo 3 ,
• Margherita Raucci 1 ,
• Giovanna Amaducci 1 ,
• Maria Chiara Bassi 1 ,
• Silvia Di Leo 1 ,
• Mark Hayter 4 &
• Luca Ghirotto 1  

BMC Medical Education volume  21 , Article number:  394 ( 2021 ) Cite this article

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Reflective writing provides an opportunity for health professionals and students to learn from their mistakes, successes, anxieties, and worries that otherwise would remain disjointed and worthless. This systematic review addresses the following question: “What are the experiences of health professionals and students in applying reflective writing during their education and training?”

We performed a systematic review and meta-synthesis of qualitative studies. Our search comprised six electronic databases: MedLine, Embase, Cinahl, PsycINFO, Eric, and Scopus. Our initial search produced 1237 titles, excluding duplicates that we removed. After title and abstract screening, 17 articles met the inclusion criteria. We identified descriptive themes and the conceptual elements explaining the health professionals’ and students’ experience using reflective writing during their academic and in-service training by performing a meta-synthesis.

We identified four main categories (and related sub-categories) through the meta-synthesis: reflection and reflexivity, accomplishing learning potential, building a philosophical and empathic approach, and identifying reflective writing feasibility. We placed the main categories into an interpretative model which explains the users’ experiences of reflective writing during their education and training. Reflective writing triggered reflection and reflexivity that allows, on the one hand, skills development, professional growth, and the ability to act on change; on the other hand, the acquisition of empathic attitudes and sensitivity towards one’s own and others’ emotions. Perceived barriers and impeding factors and facilitating ones, like timing and strategies for using reflective writing, were also identified.

Conclusions

The use of this learning methodology is crucial today because of the recognition of the increasing complexity of healthcare contexts requiring professionals to learn advanced skills beyond their clinical ones. Implementing reflective writing-based courses and training in university curricula and clinical contexts can benefit human and professional development.

Peer Review reports

Education of healthcare professionals supportstheir transformation into becoming competent professionals [ 1 ] and improves their reasoning skills in clinical situations. In this context, reflective writing (RW) is encouraged by both universities, and healthcare training providersencourage reflective writing (RW) since its utility in helping health students and professionals nurture reflection [ 2 ], which is considered a core element of professionalism. Furthermore, the ability to reflect on one’s performance is now seen to be a crucial skill for personal and professional development [ 3 ]. Writing about experiences to develop learning and growth through reflection is called ‘reflective writing’ (RW). RW involves the process of reconsidering an experience, which is then analyzed in its various components [ 4 , 5 ]. The act of transforming thoughts into words may create new ideas: the recollection of the experience to allow a deeper understanding of it, modifying its original perception, and creating new insights [ 6 ]. RWis the focused and recurrent inspection of thoughts, feelings, and events emerging from practice as applied to healthcare practice [ 7 ].

Reflection may be intended as a form of mental processing or thinking used by learners to fulfill a purpose or achieve some anticipated outcome [ 2 ]. This definition recalls Boud and colleagues’ view of reflection as a purposive activity directed towards goals [ 8 ]. For those authors, reflection involves a three-stage process, including recollection of the experience, attending to own feelings, and re-evaluating the experience. This process can be facilitated by reflective practices, among which RW is one of the main tools [ 9 ].

Between reflection-on-action (leading to adjustments to future learning and actions) and reflection-in-action (where adjustments are made at the moment) [ 10 ], RW can be situated in the former. It involves theprofessional’s reflections and analysis of experiences in clinical practice [ 11 , 12 ]. Mainly,RWinvolves the recurrent introspection ofone’s thoughts, feelings, and events within a particular context [ 13 ]. Several studies highlight how RWinfluencespromoting critical thinking [ 14 ], self-consciousness [ 15 ], and favors the development of personal skills [ 16 ], communication and empathy skills [ 4 , 17 ], and self-knowledge [ 3 ]. Thanks to the writing process, individuals may analyze all the components of their experience and learn something new, giving new meanings [ 5 ]. Indeed, putting down thoughts into words enables the individual to reprocess the experience, build and empower new insights, new learnings, and new ways to conceive reality [ 6 , 18 , 19 , 20 ].

Furthermore, RW provides an opportunity to give concrete meaning to one’s inner processes, mistakes, successes, anxieties, and worries that otherwise would remain disjointed and worthless [ 21 , 22 ]. The reflective approach of RW allows oneself to enter the story, becoming aware of our professional path, with both an educational and therapeutic effect [ 23 ].

Reflection as practically sustained by RW commonly overlaps with the process of reflexivity. As noted elsewhere [ 24 ], reflection and reflexivity originate from different philosophical traditionsbut have shared similarities and meanings. In the context of this article, we adopt two different working definitions of reflection and reflexivity. Firstly, we draw from the work of Alexander [ 25 ]: who explains reflection as the deliberation, pondering, or rumination over ideas, circumstances, or experiences yet to be enacted, as well as those presently unfolding or already passed [ 25 ]. Reflexivity at a meta-cognitive level relates to finding strategies to challenge and questionpersonal attitudes, thought processes, values, assumptions, prejudices, and habitual actions to understand the relationships’ underpinning structure with experiences and events [ 26 ]. In other words, reflexivity can be defined as “the self-conscious co-ordination of the observed with existing cognitive structures of meaning” [ 27 ].

Given those definitions,a philosophical framework for helping health trainees and professionals conduct an exercise that can be helpful to them, their practice, and – ultimately – their patients can be identified. There is a growing body of qualitative literature on this topic – which is valuable – but the nature of qualitative research is that it creates transferrable and more generalizableknowledge cumulatively. As such, bodies of qualitative knowledge must besummarized and amalgamated to provide a sound understanding of the issues – to inform practice and generate the future qualitative research agenda. To date, this has not been done for the qualitative work on reflective writing: a gap in the knowledge base our synthesis study intends to address by highlighting what connects students and professionals while using RW.

This systematic review addresses the following question: “What are the experiences of health professionals and students in applyingRWduring their education and training?”

This systematic review and meta-synthesis followed the 4-step procedure outlined by Sandelowski and Barroso [ 28 , 29 ], foreseeing a comprehensive search, appraising reports of qualitative studies, classification of studies, synthesis of the findings. Systematic review and meta-synthesis referto the process of scientific inquiry aimed at systematically reviewing and formally integrating the findings in reports of completed qualitative studies [ 29 ].

The article selection processwas summarized as a PRISMA flowchart [ 30 ]; the search strategy was based on PICo (Population, phenomenon of Interest, and Context),and the study results are reported in agreement with Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines [ 31 ].

Selection criteria

Inclusion criteria for the meta-synthesis were:

Primary qualitative studies published in peer-reviewed English journals.

With health professionals or health studentsas participants.

UsingRW in learning contexts (both pre-and in-service training).

Mixed methods where the qualitative part can be separated.

Articles should report the voice of participants (direct quotations).

Given the meta-synthesis indications, we excluded quantitative studies, non-primary research articles, meta-synthesis of qualitative studies, literature and systematic reviews, abstracts, unpublished reports, grey literature. In addition, we also excluded studies where participants were using RW in association with other learning tools and where the personal experience was not about using RW exclusively.

Data sources and searches

An experienced information specialist (MCB) performed the literature search on Medline, Embase, Cinahl, PsycInfo, Eric, and Scopus for research articles published from Jan 1st, 2008 to September 30th, 2019,to make sure we incorporated studies reflecting contemporary professional health care experience. Additional searchinginvolved reviewing the references or, and citations to, our included studies.

We filled an Excel file with all the titles and authors’ names. A filter for qualitative and mixed methods study was applied. Table  1 shows the general search strategy for all the databases based on PICo.

Four reviewers (GAr, MR, GAm, LD) independently screened titles and abstracts of all studies, then checked full-text articles based on the selection criteria. We also searched the reference lists of the full-text articles selected for additional potentially relevant studies. Any conflict was solved through discussion with three external reviewers (LG, MCB,SDL, and MH).

Quality appraisal

We used the Critical Appraisal Skills Programme (CASP): it provides ten simple guiding questions and examples to examine study validity, adequacy, and potential applicability of the results of qualitative studies. Guided by the work of Long and colleagues [ 32 ] and previously used in other meta-synthesis [ 33 ], we created 30 items from the 10 CASP questions on quality to ensure we could provide a detailed appraisal of the studies. FDV and LD independently assessed the quality of included studies with any conflicts solved by consulting a third reviewer (MCB and LG). Researchers scored primary studies weighingthe proposed items and ranking the quality of each included study [ 34 ] on high ( n  > 20 items positively assessed), moderate (10 <  n  < 20), or low quality ( n  < 10).

Analysis and synthesis

MCB created a data extraction table, GAr, GAm, and MRdescribed the included articles (Table  2 ). Quotations were extracted manually from the “results/findings” sections of the included studies by GAr, MCB, LDand inserted into adatabase. GAr, GAm, MR, and FDVperformed a thematic analysis of those sections, along with participants’ quotations. Then, they inductively derived sub-themes from the data, performing a first interpretative analysis of participants’ narratives (i.e., highlighting meanings participants interpreted about their experience). The sub-themes were compared and transferred across studies by adding the data into existing sub-themes or creating new sub-themes. Similar sub-themes were then grouped into themes, using taxonomic analysisto conceptually identify the sub-categories and the categories emerging from the participants’ narratives. This procedure allowed us to translate the themes identified from the original studies [ 28 ] into interpretative categories that could amalgamate and refine the experiences of health professionalsor health students on the use of RW [ 29 ]. The final categories are based on the consent of all the authors.

Literature search and studies’ characteristics

A total of 1488 articles were retrieved. Duplicates ( n  = 251) were removed. Then, articles ( n  = 1237) were identified and reviewed by title and abstract. We excluded n  = 1152 articles because they did not match the specified inclusion criteria, based on the title and abstract. Consequently, we assessed 85 full-text articles. Sixty-eight records did not meet the inclusion criteria. At the end of the selection process, 17 reportsof qualitative research were selected. Figure  1 illustrates the search process.

PRISMA flow diagram

Table 2 shows the characteristics of the included studies. Eleven studies involved healthcare students (58%, including nurses, midwives, physiotherapists, doctors, dentists, and oral health students), and six (32%, including doctors, occupational and radiation therapists) were referred to health professionals. In thirteen studies, participants were trained on RW before using it: this information could not be retrieved from the remaining articles.

Five articles reported studies conducted in the US, three in Australia, two in Canada, and two in Israel. The other studies were carried out in Italy, UK, Korea, Taiwan, and Sweden.

Critical appraisal results

We critically evaluatedall 17 studies to highlight the methodological strengthsand weaknesses of the selected studies. No article was removed on a quality assessment basis. Results of the quality appraisal are reported in Table 2 .

Meta-synthesis findings

Through the meta-synthesis, we identified four main categories (and related sub-categories): (i) reflection and reflexivity; (ii) accomplishing learning potential; (iii) building a philosophical and empathic approach; (iv) identifying reflective writing feasibility (for the complete dataset, please refer to supplemental material , where we have listed a selection of meaningful quotations of categories and sub-categories).

Given such categories, we developed an interpretative meta-synthesis model (Fig.  2 ) to illustrate the commonalities of the experience of using RW according to both students and professionals: RWas a vehicle for discovering reflection and allowing users to enter personal reflexivity to fulfillone’s learning potential, alongside the building of a philosophical and empathic approach. In their experience, reflection and reflexivity generate different skills and competencies: reflection matures skills such as professional skills and the ability to activate change and innovation. Reflexivity allows students and professionals to reach higher levels of competencyconcerning inner development and empathy reaching. Finally, from our analysis, participants, while recognizing the value of RW, also defined factors that could encourage or limit its use. Differences among participants’ groups are also outlined.

Meta-synthesis model: RW as experienced by health professionals and students

Reflection and reflexivity

Within this category, we collected the users’ narratives about the experience of applying RW and its disclosing capacity. By using RW, participants confronted themselves with both reflection and reflexivity. This category includes two sub-categories we named: discovering reflection and entering personal reflexivity.

Discovering reflection

The sub-category shows that experiencingRW deepened their reflection on experiences, practice, and profession. Thanks to RW, professionals, and students could explore previously unexplored topics and learn more about themselves.

“ Writing initiated me to think about my experiences … ” (professional) [ 46 ]. “ I think it’s good for physicians to reflect on what we’re doing ” (professional) [ 50 ]

The analysis showed that RW was considered reflective when it provided an opportunity for those who applied it to stop, reflect and conduct an inner discourse on topics never considered before [ 44 , 46 , 50 ]. Some students affirmed:

“ Helped (me) reflect on positive aspects ” (student) [ 40 ]. “ I don’t usually think too much about what happens to me, but through critical reflective journaling, I was able to think carefully about things happening around me. This activity helped me to look into my mind ” (student) [ 44 ]

This sub-category explains transversal meanings coming from uniformly professionals and students.

Entering personal reflexivity

This sub-category includes data about RW enabling users’reflexivity. In this context, RW was considered training for reflexivity as it enabled participants to question themselves more often [ 48 ], reflect on their experiences [ 35 ], attitudes, actions [ 38 , 45 ], and also reconsider their actions and identify their strengths and weaknesses [ 40 , 44 ].

“ The questions in this study do make me stop and think about things – how I feel about what I’m doing in residency ”(professional) [ 46 ]. “ Helped me ID (identify) my strengths and weaknesses ” (student) [ 40 ] RW also helped eradicate the background noise that my mind does not yet know how to filter out [ 51 ] .

Interesting to note that this sub-category is more present in students’ narratives. While professionals referred to self-reflection practices (probably already acquired in other contexts), students often reported how RW helped them discover reflexivity.

Accomplishing learning potential

Our analysis showed how users RW used the technique to “Accomplish learning potential.”

According to the studies’ participants, RWcan enable a learning performancethat would be difficult to reach otherwise. In this context, participants addressed RW as a tool for“accomplishing learning potential.”Within this category, three sub-categories were highlighted: the improvement of skills, personal and professional growth, and assisting the change and development process.

Improvement of skills

Participants agreed that the development of skills and abilities through RWwas aimed at their clinical skills and –in relevant areas such as question asking – encouraged reflection and research [ 35 , 46 ]. Communication skills were also enhanced, as were their relationship with patients, family,colleagues, and friends [ 35 , 38 , 46 ].

Participants said:

“ Through reflective journal writing, my attitude towards learning has changed. I have been encouraged to be a proactive learner. (...) I have been able to identify necessary places for improvement and through research, question asking, goal-setting (...). I have improved my skills in relevant areas” (student) [ 35 ]. “I feel that it [participation in the study] has been a positive experience by motivating me to improve on my clinical, communication skills, and also my relationships with colleagues, patients, family, and friends ” (professional) [ 46 ]

Participants also reported that,in their experience, RWprovided an opportunity to assess and improve themselves and to enhance their self-confidence [ 38 , 40 ]. Cognitive skills, includinggaining more profoundknowledge and problem-solving, along withtime-management [ 35 , 40 , 46 , 49 ], were also enhanced: RW,therefore,represented a learning mode [ 45 ].

“ Without reflection, I absolutely believe these skills would be more unattainable for me ”(student) [ 35 ]

This sub-category applies more to students’ narratives. Health students mentioned the tools helping them most to develop their skills. Professionals focused principally on what RWcould improve (communication skills or organizational skills).

Personal and professional growth

Participantsidentifiedthat RWhad promoted personal [ 51 ] and professional growth [ 35 , 46 ]. RW meant for participants:an ameliorated attitude towards work [ 46 ]; a development path for one’s job potential [ 38 ]; an enhancement of their introspective knowledge [ 51 ]; an enrichment of their expressive capability [ 38 ];an improvement of their interpersonal relationships with patients and colleagues [ 50 ] and developed their use of critical and reflective thinking [ 38 ].

“ Reflecting introduces a new aspect to clinic that focuses on the individual’s learning experience ” (student) [ 35 ]. “I think that it does change the way that you think about the practice of medicine and your own personal tendencies and your interactions with your patients and colleagues. And I think it can be a really powerful driver of culture change ” (professional) [ 50 ]

This sub-category is more represented among students than professionals. Students are ‘surprised’ at how important RW was to their learning. Professionals still recognized how RW was an essential driver of change for their clinic activities.

Assisting the change and development process

We labeledthe third sub-category“assisting the change and development process.”The changeinvolvedintroducing modifications tothe way of working [ 48 ], assessing what needed to be changed to achieve a work-life balance [ 51 ], understanding elements that did not allow change, and how to act on them in the future, and also considering new and important issues [ 46 ], further information [ 51 ] and new ways of thinking. This sub-category equally explained the meaning given to RW by students and professionals.

“ I think writing answer to some of these questions has allowed me to reflect back on the year and think about specific important topics that I might not have thought about again.” (professional) [ 46 ]. (Reflective journaling encouraged) “Assessing and focusing on the changes that need to be done to achieve the balance in my life and being able to integrate that with my family and in my work as a nurse.” (Student 16/RJ2) [ 51 ]

However, thischange process could not be possible without witnessing change and becoming aware of it [ 38 , 46 ]. This allowedparticipants to ‘see one’slearning history and path of growth,‘have a picture of the problem, handle things differently, and broadening their vision of the problem [ 48 ].

Building a philosophical and empathic approach

The “Reflection and reflexivity” category is closely aligned with the “Building a philosophical and empathic approach” category. Participants defined RW as a means for nurturing an intimate and profound level of learning, i.e., a philosophical and empathic approach towards real-life professional issues. The third category consists of three sub-categories: the ability to find benefits in negativity/adversity, assuming an empathetic attitude, and the awareness of things, experiences,emotions.

Finding benefits in negativity/adversity

According to participants, RWexerted a therapeutic effect by encouraging professionals and students to focus on the present (43)strictly. It seemed that RWeventually reduced their emotional stress [ 44 , 51 ]. Likewise,in the contextofnegative experiences [ 49 ], its practice acted as a catharsis [ 46 ] that could even allow them tolook back at those experiencesafresh – enabling a change in perspective [ 39 ].

“While writing the journal entry, I felt like I was unloading something from inside myself and being set free. This process made me feel better ” (student) [ 44 ]. “It is always good to pause to reflect on my experiences. The most cathartic question was a few months back when I got to describe my really bad experience.” (professional) [ 46 ] “Very therapeutic. I wrote on a bad experience, but at the end, we were laughing at it.” (professional) [ 49 ]

This specific approach allowed the practitioner/trainee to improve their self-care and focus on work objectives [ 51 ]:

“Self-reflection and reflective journaling promote self-understanding and is another part of self-care.” (Student 5/RJ3) [ 51 ]

Even if more emerging from students’ voices, professionals appeared genuinely amazed at how learning can be generated out of negativity.

Assuming an empathetic attitude

Study participants stressed the fact that RWhelped them develop empathetic attitudes. It seems that RWemphasized the importance of sensitivity and empathy by trying ‘to be in someone else’sshoes,’ especially that of patients or colleagues [ 36 , 37 , 44 ].

“How reflecting on patient encounters through field notes allowed her to “take a walk in someone else’s shoes ” (student) [ 36 ]. “It helps you see the humanity... ” (professional) [ 50 ]

This approach also applied in contexts outside of work and helped the practitioner take off his/her‘white coat’ and understand that before being a professional,he/shewas a person and a human being [ 36 , 37 , 46 , 50 ].

“ Which has made me more open to other’s ideas and thoughts ” (professional) [ 46 ]

As previously mentioned, according to the participants’ statements, awareness was the cornerstone to effective personal and professional growth [ 40 , 51 ].

This sub-category is equivalently present among the participants’ groups. Nonetheless, different meaningscould also be highlighted. Students appreciated RWby stressing its value of allowing them to enter deeply ‘into the other’ inner world (mainly patients). Professionals claimed they could recognize the profession’s human and relational aspects, whichcould also be helpful for their extra-professional relationships (family members, friends).

Awareness of things, experiences, emotions

Impartially balanced among professionals and students, awareness was cited in terms of ‘how things have affected me rather than simply continuing to work in a robotic manner’ [ 46 ], the awareness of who one was and who one has become thanks to the process of change [ 51 ]. This professional and relational awareness made it possible to think clearly about one’s practice and the health resources present in the context of belonging [ 50 ].

“Just being aware of what I know now and what I’ll know by the end of the semester … is a great way to learn who I am and what I can change about me for the better.” (Student 9/RJ1) [ 51 ]

The process of awareness that was facilitated by how their RW allowedthem to transform shapeless and straightforward ideasinto words and givethem a specific value and emotional charge [ 36 , 47 , 51 ]: it wasan authentic opportunity to turn emotions and feelings into something tangible –a journey of discovery and personal acceptance [ 43 ].

“ After two years or so, when you look back, it’s like, oh,that’s how I was feeling at the time, and right now, I feel differently. There is also this level of satisfaction. Like you have matured out of this thinking ” (professional) [ 47 ]

Identifying RW feasibility

The fourth category consists of three sub-categories: perceived barriers/impeding factors, facilitating factors, and when and how to use RW. Students and healthcare professionals who had the experience of practicing the RW in their work identified both limitations and facilitating factors and indications about when and how to use RW.

Perceived barriers/impeding factors

Some study participants (almost entirely students) identified several barriers to their activity. Some students could not see the benefits and thought RW was a waste of time [ 35 , 38 , 51 ]. However, others, who did see the potential benefits still felt that they lacked the time needed to devote to RW [ 42 ] or, sufficient mental space to report and describe a work situation, an excessive similarity of this activity to the regular working practice and, consequently, a lack ofmotivation to write [ 47 , 51 ]. In addition, some described the strainthey felt in writing down personal/professional experiences [ 47 ]. A lack of privacy was another problem, both for the concern about sharing the reflection and for the respect of confidentialityin writing itself [ 51 ]. Taken together,it appeared that some study participants did not recognizeRW as an effective means of help [ 39 , 50 ]. Althoughrealizing the potential of RW,others felt that their tutors did not provide noticeably clearexplanations of the aim of RW– which they would have found useful and motivating [ 45 ].

“ To be honest, not a great deal ( … ) it wasn’t really some revelation ” (professional) [ 50 ]. “ I got a hard time referring it [my experience] to citations … I could have sat and cried yesterday when I did my essay … when I actually read it [my essay] I thought, oh I don’t know what it means, myself ” (Female 2 - student) [ 42 ]

Facilitating factors

This sub-category was exclusively interpreted from students’ narratives. They valued the perspectives to use RWin their practice seeing it as a valuable tool to be applied throughout their career [ 35 , 45 ],with many students reporting that they would continue with this technique [ 38 ]. Studentssaw RW as a valuable means of staying focused on their own goals and needs [ 40 , 51 ]. They remarked that it helped them reduce stress, gain clarity in one’s life and practice [ 41 ], and spiritually connect with themselves [ 45 , 51 ]. Furthermore, RW enabled studentsto discover more information about their health and well-being, ‘it also helped me tie in ideas and beliefs from different sources and relate it to my own’ [ 51 ]. RWhelped maintain awareness and recall the medical being/human being dichotomy [ 37 ]. It remindedstudentsof the difference between studying literature and refining manual skills and the ability to learn from experience and mistakes [ 35 ].

“ During the interview, I felt an element of being more like a ‘normal person’ having a ‘normal conversation’ with another human being. This was a strange realization because it reminded me of the dichotomy that physicians may experience, being doctor versus human ” (student) [ 37 ]

When and how to use RW

Health professionals (a few) and many students finally mentioned the time considered most appropriate to use RW, underlining its usefulness primarilywas during hardship rather than daily practice [ 47 ].Moreover,RWshould not be forced onto someone in any given moment but instead left to individual choice based on one’s spirit of the moment [ 40 , 46 ].

“. .. like if you had a patient die; that would be the only time you might write it down ” (professional) [ 47 ]

Otherparticipantsconsidered instructions on RW to be too forceful and notapplicable to their own experience of reflection [ 40 ]. ‘Reflection wasn’t just signing on the line.’ It allowed constructive feedback for the trainee or the professional. Constructive feedback could be positive or negative, but it was a powerful tool for thinking and examining things [ 45 ].

In this meta-synthesis of qualitative studies, we have interpreted the experiences of health professionals and students who used RWduring their education and training. Given the number of studies included, RW users’ experience was predominately investigated in students. This result, although not surprising, raises the question of whether RW in professional training is being used. RW is not used in professional training as often as it is in the academic training of healthcare students.

As to this review’s aim, we could highlight continuities and differences from study participants’ narratives. Our findings offer a conceptualization of usingRW in health care settings. According to the experience of both students (from different disciplines) and health professionals, RW allows its exponents to discover and practice reflectionas a form of cognitive processing [ 2 ] and enablethem to develop a better understanding of their lived situation. We also interpreted that RW allows users to make a ‘reflexive journey’ that involves them practicing meta-cognitive skills to challengetheir attitudes, pre-assumptions, prejudices, and habitual actions [ 24 , 26 ]. This was particularly true for students: “entering personal reflexivity” appears to be newer for them than for the professionals who are likely to acquire reflexivity during academic training. Students seemed more focused on tools than RW-related results. This consideration makes us affirm that reflective capacity is in progress for them.

Challenging pre-assumptions and entering reflexivityenabledRWusers to realize how RW may develop their learning potential to improve skills and personal/professional growth. Skills to be enhanced are quoted mainly by students. Conversely, professionals could comprehend the final purpose of learning, achievable through RW, in terms of communication or organizational abilities. Professionals interpreted skills from RW as abilities to apply in the clinical activities to find new solutions to problems.

The category “Accomplishing learning potential”confirms what many authors highlight: putting thoughts into words not only permits a deeper understanding of events [ 6 ], enhances professionalism [ 52 ] but also improves personal [ 16 ], communication, and empathy skills [ 4 , 17 ]. In this context, RW fulfills its mandate by letting human sciences [ 53 ] and evidence-based health disciplines affect clinical practice. As noted [ 54 ], students and health professionals’RW training allowed integrating scientific knowledge with behavioral and sociological sciences to supporttheir learning [ 55 ].

Users understood that RWcould be a powerful means of developing empathy and developing their philosophy of care: this consideration is in line with a recent study from Ng and colleagues [ 24 ]. Additionally, some authors [ 4 , 17 ] stressed these empathetic skills and “humanistic”competencies as essential to care for patients effectively [ 56 ]. Professionals were amazed how negativity could generate learning through RW. On the other hand, by recognizingand writing experienced negative situations, students could free themselves from feelings impeding empathy.

By employing RW, users reported factors that could encourage or limit its use. These findings further illustrate that RW is not always a tool that is easy to use without adequate training [ 57 ]. Almost exclusively, students reported hindering factors (limited time, difficulty in writing and understanding assignments, privacy issues, feeling bored or forced). As to professionals, few describedRW as a very stressful activity. Although students could identify impeding factors, they also recognized many positive ones. For professionals, RW was not to be used every day but in ‘extreme’ situations, requiring reflection and reflexivity to be applied. In general, enhancing motivation to write reflectively [ 58 ] should be the first goal of any training to make the process acceptable and profitable for trainees. If this first stage is not accomplished, it will reduce RW’sapparent professional and personal effectiveness among health professionals and students substantially.

Strengths, limitations, and research relaunches

This review may enrich our knowledge about providing RW as an educative tool for health students and professionals. However, the findings must be applied,taking into account some limitations. We focused our attention only on recent, primary, peer-reviewed studies within the time and publication limits. Qualitative studies often are available as grey literature: considering it may result in a different interpretation of students’ and professionals’ experience in using RW. Therefore, our conceptualization should be read bearing in mind a publication bias and the need to expand the literature search to other sources. Besides limiting the risk of missing published qualitative studies, we reviewed the reference listsof included studies for additional items. Our meta-synthesis is coherent to the interpretation of the included studies’ findings.

At least two reviewers have conducted each step of this systematic review. We purposely did not exclude studies based on a quality assessment to maintain a robust qualitative study sample size and valuable insights.

During analysis, all possible interpretations were screened by authors, and an agreement was reached. Nonetheless, we did not cover all the possible ways to interpret the voices of students and professionals.

Since RW is not used in professional training as often as it is in the academic training of healthcare students, a research relaunch could be investigatingwhether and to what extent RW is being used in in-service training programs. Moreover, the studies included in this review were conducted within Western countries. Students’ and professionals’ perspectives from Africa and Asia are underrepresented within the qualitative literature about experiences of using RW. Therefore, geographicalgeneralizations from the present meta-synthesis should be avoided, and our paper reveals the necessity for RW research in other cultures and settings. Nonetheless, authors of primary studies have paid little attention to cultural and regionaldiversity. Therefore, we recommend furtherinvestigations exploring the differences between cultural backgrounds and howRW is recognized within training programs in different countries. Finally, additional qualitative and quantitative research is required to deepen our understanding of RW’s clinical and psycho-social outcomes in high complexity health practice contexts.

Our analysis confirms the crucial role of RW in fostering reasoning skills [ 59 ] and awareness in clinical situations. While its utility in helping health students and professionals to nurture reflection [ 2 ] has been widely theorized, this meta-synthesis provide empirical evidence to support and illustrate this theoretical viewpoint. Finally, we argue that RWis even more critical given the increasing complexity of modern healthcare, requiringprofessionals to develop advanced skills beyond their clinical ones.

Practical implications

Two important implications can be highlighted:

students and professionals can recognize the potential of RW in learning advanced professional skills. ImplementingRW in academic training as well as continuing professional education is desirable.

Despite recognizing the effectiveness of RW in healthcare learning, students and professionals may face difficulties in writing reflectively. Trainers should acknowledge and address this.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Critical appraisal skills programme

Enhancing transparency in reporting the synthesis of qualitative research

Population, phenomena of interest and context

Preferred reporting items for systematic reviews and meta-analyses

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Artioli, G., Deiana, L., De Vincenzo, F. et al. Health professionals and students’ experiences of reflective writing in learning: A qualitative meta-synthesis. BMC Med Educ 21 , 394 (2021). https://doi.org/10.1186/s12909-021-02831-4

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Reflective Practice (Key Themes in Health and Social Care)

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David Wilkins, Reflective Practice (Key Themes in Health and Social Care), The British Journal of Social Work , Volume 44, Issue 3, April 2014, Pages 787–788, https://doi.org/10.1093/bjsw/bcu026

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Reflective practice, as noted by the authors of this book, is generally accepted as being a ‘good thing’, certainly in social work, but also in other areas of health and social care more generally as well. However, somewhat refreshingly for a book on the topic, the authors also make a case for the relative paucity of evidence we have as to why reflective practice is a good thing and how reflective practice might make a difference, either in terms of the professional engaging in reflective practice or, more importantly, in terms of outcome for the ‘service user’. One potential problem with this contention is that, via Google Scholar, it is relatively easy to find over half a million results for the search phrase ‘reflective practice social work’, which suggests that it is hardly a topic that has gone unnoticed.

Nevertheless, it does appear to be the case that much of this work, if not all, is written with the starting premise that reflective practice is a good thing rather than examining whether it is, why and how. Understandably, the authors of this book do tentatively conclude that, despite the absence of a strong evidence base either way, reflective practice is a skill-set worth developing for social workers and they also highlight the necessity of reflective practice being demonstrated ‘through doing’ rather than perhaps being seen as a mindset or ‘only’ as a way of thinking to be used in particular settings or contexts, such as supervision.

As well as highlighting the limited nature of the research base regarding reflective practice, this book also traces the history of reflective practice as an idea and why it is now seen as so central to the social work task. Naturally, this brief history draws heavily on the work of Schön but, through the use of exercises and other pedagogical techniques, the reader is invited to consider how these ideas might apply to their own area of practice and, indeed, this is a strong feature of the book throughout. After this introductory chapter, the rest of the book focuses primarily on practical ways to apply the concept of reflective practice, with a particularly strong chapter on the use of individual writing (Chapter Four), which is perhaps unsurprising when one considers that one of the authors (Page) is a playwright. The book also includes ideas about how to enable collective reflective, which is surely an aspect often overlooked when considering the typical model of one-to-one supervision that most social workers will have experience of. Indeed, given the growing recognition of the importance of peer and group supervision, it is timely that Hargreaves and Page have considered how reflective practice may have an influence within those forums as well.

Overall, it is easy to recommend this book to students and practitioners, including managers. For those of us who are conscious of the need to ‘be more reflective’, this book is likely to offer some firm ideas as to how to demonstrate this in practice and, importantly, via potentially different behaviours as well. The only difficulty I had with the book is that it struggles at times to deal with the problem of how reflective practice might be better reflected in case recordings. As a local authority practitioner, I am often reminded of the mantra ‘if it isn't written down, it didn't happen’ although, from my experience, Hargreaves and Page are not the only ones who have been unable to clearly define how reflective practice can be recorded. Indeed, perhaps it cannot and perhaps in the end it is unimportant. This minor complaint aside, this is a very good book, clearly written, easy to read and definitely worth a place in any social worker's collection.

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Reflective Practice in Health Care Essay

Introduction, the description/ event, evaluation and analysis, recommendation and action plan.

Reflection refers to an approach used to comprehend the personal practice process nature, which results in escalated knowledge as well as proper application in healthcare work, which eradicates the chances for medical errors (Walker, 1996). Reflection allows a person to think about an action and through this way, engage in a continuous learning process (Hendricks, Mooney and Berry, 1996: 100). Therefore, reflective practice is the most key source of personal improvement and professional development. As a result, the concept has become popular globally (Price, 2004: 470).

An evidence-based tool of practice applies the best care a patient can afford. The principal goal of evidence-based practice is clinical expert opinion or expertise, caregiver/ patient/ client perspectives (Pattinson, 2011). For the purpose of this assignment, the Gibbs reflective model is vital. A summarized model will offer reflection guidance as structured in the six stages. The stages are; event or description, feeling or thoughts, evaluation, analysis, conclusion, and the action plan. This paper presents a case scenario where the practitioners involved in the care of the patient did not have effective communication, which impacted negatively on the patient. It also emphasizes the need for proper communication in health care.

Several years ago, as a senior anesthesia technician was just about to release an ODA for the lunch break, a boy who was approximately 5 years old and a pediatric cardiac patient was undergoing a dental clearance. After the dentist was thorough, the inhalation agent got terminated so as to allow the patient to recover prior to the removal of the endotracheal tube. The long extension set for intravenous use had already been closed as the short procedure was taking place. The boy began breathing again and tried to open his eyes. The reverse drugs were about to be given when the anesthetist requested the ODA to flush the intravenous line using 5ml of normal saline. However, the patient stopped breathing suddenly because of the boule that forced the residual muscle relaxant back into the patient. Consequently, the anesthetist began ventilating the patient, and it took approximately thirty minutes for the patient to recover. The patient did not experience considerable harm.

The shock was one of the feelings that overcame me first. The anesthetist was impatient in treating the patient and seemed to be in a hurry (Boud et al, 1985). He ought to have waited before flushing the intravenous line so as to avoid the formation of a boule, which forced the residual muscle relaxant back into the patient. Maybe he wanted to have finished all his duties before releasing the ODA for lunch. Moreover, there seemed to be miscommunication between the ODA and the anesthetist. Both of them should have deep knowledge of the process and, therefore, there should be no errors as was the case (Rolfe, Freshwater and Jasper, 2001). It was extremely sad to see the suffering young boy lying down. I was torn between many negative emotions; sorrow, pity, empathy, and blame on the healthcare professionals (Davies, 2012).

As mandated by healthcare policies and standards, I strongly feel that healthcare professionals should adhere to them to prevent adverse effects on patients (Pattinson, 2011). Professionals ought to realize that there are countless areas where there can be a resultant detrimental impact on the well-being of the patient if there is miscommunication or inadequate communication between providers (Walker, 1996).

In the mentioned occasion, the patient should have taken the residual muscle relaxant out first before flushing the intravenous vein with normal saline (Molyneux, 2001). The anesthetist seemed not to be patient enough. Moreover, the anesthetist went beyond his obligation’s limit by authorizing the ODP to flush without thinking of the repercussions (Schon, 1991). In essence, the anesthetist failed to adhere to the protocol expected during patient management (Mac Suibhne, 2009: 434). Regardless of how long healthcare professionals have been in practice, they should always realize that they are dealing with human life and, therefore, be extremely keen (Mann and Gordon, 2009: 617).

In my reflection, I realized that there are numerous issues that are preventable if there is proper and effective communication within the settings (Schon, 1991). These include drug reactions and interactions, increased care cost and hospitalization time, untimely medications and procedures, and inappropriate treatment. All these can be prevented if professionals adhere to the protocols of effective communication (Asper, 2003: 45). If the anesthetist and ODP were communicating effectively and were aware of the proper guidelines to follow, the patient would have recovered normally from the procedure done.

It is imperative for the anesthetist to be aware of his vital role in the patient’s life. Hence, he should have adhered to the set protocol, guidelines, and standards, and ensured effective and timely communication between himself and the ODP. Flushing the IV after muscle relaxation ensures the patient recovers normally (Mann and Gordon, 2009: 617). Healthcare research indicates that approximately eighty percent of all grave medical errors are a result of miscommunication (Price, 2004: 47). It has been noted that when handing over patients to other professionals for specialized procedures, there is always incomplete information handover (Schön, 1991). Moreover, healthcare professionals lack adequate time to discuss the patients’ issues in detail, which results in negative impacts on the patient (Brown et al, 2003: 40).

In my opinion, the anesthetist was not sufficiently accountable and responsible. A medical practitioner who is responsible and accountable enough has a keen interest in a patient’s outcome. In this case, the anesthetist was impatient, which almost led to detrimental effects on the patient. He ought to have been accountable and waited for the muscles to relax before administering the drug. On the same note, the anesthetist and ODP ought to have ensured that proper medication is given to the patient. Price (2004: 40) asserts that this is because giving a patient the wrong medication is unethical and can result in detrimental patient effects.

It is worth noting that ineffective communication goes with other human factors. For instance, there might be differences among the various departments (Molyneux, 2001: 30). When professionals from these departments meet for a procedure, grudges they hold against each other may result in the patient suffering. This is ethically unacceptable and contrary to the patient’s rights (Bolton, 2010). Moreover, it is imperative that professionals go through the guidelines of the procedures they are to perform. This reduces the chances of errors. According to Schön (1991), another ethical measure is to seek the client’s consent.

It is worth noting that many patients suffer as a result of the failure of healthcare professionals to adhere to effective communication. Mostly, healthcare professionals do not dedicate adequate and quality time to patients (Larrivee, 2000: 293). They perform most of the procedures in a hurry, which affects patients negatively (Mann & Gordon, 2009: 620). If the anesthetist was not in a hurry and dedicated to the patient’s result, he would have allowed adequate time before flushing the IV. This would have ensured that the patient responded successfully after the procedure.

Ineffective and inadequate communication has been reported to be the vital contributing factor to inadvertent patient harm and medical errors (Welsh Assembly Government, 2008). It does not only result in emotional and physical inconveniences to all those concerned but also adverse happenings, which are extremely costly. For instance, the resulting cost from medical errors in Victoria’s hospitals is approximately a billion dollars every year (Boud, Keogh & Walker, 1985: 34). It is worth noting that today, healthcare is extremely diverse and complex, and improving communication amidst professionals in healthcare would considerably support safe patient care delivery (Asper, 2003). It is extremely vital that managements in hospitals stimulate action and discussion, as well as raise awareness in regard to the units, divisions, and organizations where more teamwork and improved communication is essential (Brown et al, 2003). Mostly, ineffective communication is particularly the known cause that leads to sentinel events. Ineffective communication which is ambiguous, incomplete, inaccurate, untimely, and where the recipient does not comprehend clearly, increases the results and errors, for poor patient safety (Welsh Assembly Government, 2008).

There exists immense evidence linking poor and ineffective communication between teams in healthcare (Mac Suibhne, 2009: 430). The stated results are extremely negative patient impacts (Brown et al, 2003: 96). For instance, according to America’s Joint Commission, the key cause of more than seventy percent of sentinel occurrences is a communication failure. Moreover, America’s Veterans Affairs Department National Centre for Patient Safety acknowledges that failed communication in healthcare is the chief root foundation of seventy-five percent negative patient impacts (Leitch and Day, 2000: 157).

When the patient sees too many patients, miscommunication may result (Brown et al, 2003: 103). Usually, patients make efforts to ensure the best treatment choices (Larrivee, 2000: 293). However, the treating doctor may be unconcerned about other experts caring for the patient. In most cases, physicians are usually unaware that their patients are being treated for disease complications (Hendricks, Mooney & Berry, 1996: 100). The spectrum of poor communication included services and medication being duplicated, the patient being given more medication than is necessary, and wrong surgery sites (Asper, 2003).

The negative drug interaction is another potential danger. This is mostly because the patient is ignorant of the medication being given and may not identify cases of over medication. Such a situation threatens life and should be prevented at all costs (Boud, Keogh & Walker, 1985: 91). Patients also have a role to play in their health care. They have the right to ask questions and confirm procedures (Davies, 2012: 7).

In order to ensure such a case never repeats among ODPs and anesthetists, the case will be reported to the head of the department. Discussing it will ensure that all professionals handle their patients with extra keenness and that they follow procedures and guidelines well (Ministry of Justice, 2006). Consequently, it will be discussed during the monthly meeting of the department. During the meeting, all health care professionals will be present, including the ODP and anesthetist in mention. Both will be requested to elaborate on what and why it happened. This will be aimed at reviewing their role in every procedure (Leitch and Day, 2000: 154). Moreover, the anesthetist will have to apologize to the family and elaborate on the issue to them. This will ensure accountability. These grave measures will be geared towards ensuring that all patients receive adequate, timely, and proper treatment (McSherry, Pearce and Tingle, 2011).

According to Davies (2012, 10), the main reason for writing and addressing the incident in detail is to prevent and avoid such an occurrence again. It is vital that the ODA enquires and double checks every detail with the anesthetist. Moreover, all drugs and syringes should be labeled to avoid using the wrong ones on the patient. The anesthetist should be the only one who handles them to avoid confusion.

An incident like this happens often in the UK. According to the Health and Care Professions Council (HCPC), such a case happens 109 times annually (Brown et al, 2003: 96). There is, therefore, a need to address issues surrounding it so as to reduce its incidence and prevalence.

In my opinion, failure to dedicate adequate time for patient care and miscommunication are the key causes of this incident. Following the HPC guidelines would have prevented the incident from occurring (Ministry of Justice, 2006). In the mentioned case, an efficient leader who could adhere to the use of a checklist and the structured plan was absent. This would guarantee patient safety before conducting the anesthesia as recommended by WHO.

In the light of this discussion, health care professionals should be trained adequately to ensure their effective communication and accountable participation (McSherry, Pearce and Tingle, 2011). I recommend that a structured documentation checklist, good teamwork, effective communication be made the key targets for a quality improvement plan which ensures patient safety in all departments (Asper, 2003). The majority of hospitals’ managements are unaware of the miscommunication pervasiveness that exists (Davies, 2012: 11). Moreover, miscommunication goes unnoticed in many healthcare settings. Factors that affect the quality of communication are usually ignored, which results in detrimental health impacts on patients (Schön, 1983).

In order to ensure effective communication between healthcare teams, there is the need to consider intercultural communication between staff, the circumstances and content of communication, various discourse modes, presence of resources and opportunities for creating a common body of understanding, and linguistic and cultural distances (Welsh Assembly Government, 2008). The management should ensure strategies where all these are incorporated towards effective communication (Asper, 2003: 34).

Asper, M 2003, Beginning Reflective Practice (Foundations in Nursing and Health Care) , Nelson Thomas Ltd., Cheltenham.

Bolton, G 2010, Reflective Practice, Writing and Professional Development (3rd edn), Sage Publications, California.

Boud, D, Keogh, R & Walker, D 1985, Reflection, Turning Experience into Learning , Routledge, New York.

Brown, G et al, eds., 2003, Becoming an Advanced Health Practitioner, Butterworth Heinemann, Edinburgh.

Davies, S 2012, “Embracing reflective practice”, Education for Primary Care, vol. 23, pp. 9–12.

Hendricks, J, Mooney, D & Berry, C 1996, “A practical strategy approach to the use of the reflective practice in critical care nursing”, Intensive & critical care nursing, vol. 12 no. 2, pp. 97–101.

Larrivee, B 2000, “Transforming Teaching Practice: Becoming the critically reflective teacher”, Reflective Practice, vol. 1 no. 3, pp. 293.

Leitch, R & Day, C 2000, “Action research and reflective practice: towards a holistic view”, Educational Action Research , vol. 8, pp. 179.

Mac Suibhne, S 2009, “’Wrestle to be the man philosophy wished to make you’: Marcus Aurelius, reflective practitioner”, Reflective Practice, vol. 10 no. 4, pp. 429–436.

Mann, K & Gordon, M 2009, “Reflection and reflective practice in health professions education: a systematic review”, Adv in Health Sci Educ, vol. 14, pp. 595–621.

McSherry, R, Pearce, P & Tingle, J 2011, Clinical governance: a guide to implementation for healthcare professionals (3rd ed.), Wiley-Blackwell, Oxford.

Ministry of Justice 2006, Making sense of human rights: a short introduction. Web.

Molyneux, J 2001, “Interprofessional teamworking: what makes teams work well”, Journal of Interprofessional Care , vol. 15 no.1, pp. 29-35.

Pattinson, S 2011, Medical law and ethics ( 3rd ed ) , Sweet & Maxwell/Thomson Reuters, London.

Price, 2004, “Encouraging reflection and critical thinking in practice”, Nursing Standard, vol. 18, pp. 47.

Rolfe, G, Freshwater, D & Jasper, M 2001, Critical Reflection for Nursing and the Helping Professions , Palgrave, Basingstoke, U.K.

Schön, D. A 1983, The Reflective Practitioner, How Professionals Think In Action , Basic Books, London. Schon, D. A 1991, The reflective practitioner: how professionals think in action , Arena, London.

Walker, S 1996, “Reflective practice in the accident and emergency setting”, Accident and emergency nursing, vol. 4 no.1, pp. 27–30.

Welsh Assembly Government 2008, Reference guide for consent to examination or treatment. Cardiff: Welsh Assembly Government. Web.

• Chicago (A-D)
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IvyPanda. (2022, May 9). Reflective Practice in Health Care. https://ivypanda.com/essays/reflective-practice-in-health-care/

"Reflective Practice in Health Care." IvyPanda , 9 May 2022, ivypanda.com/essays/reflective-practice-in-health-care/.

IvyPanda . (2022) 'Reflective Practice in Health Care'. 9 May.

IvyPanda . 2022. "Reflective Practice in Health Care." May 9, 2022. https://ivypanda.com/essays/reflective-practice-in-health-care/.

1. IvyPanda . "Reflective Practice in Health Care." May 9, 2022. https://ivypanda.com/essays/reflective-practice-in-health-care/.

Bibliography

IvyPanda . "Reflective Practice in Health Care." May 9, 2022. https://ivypanda.com/essays/reflective-practice-in-health-care/.

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Reflective Practice

Reflective practice is important not only to do our work but to understand why we do it in a particular way.

Doing a job for a long time does not necessarily make us competent. Some people are in fact skilled at being incompetent!

To be competent and to work responsibly we need to understand the influence which our thoughts and beliefs have over what we do. We need to be aware of the impact of our words and actions on others. We need to be able to plan and apply our knowledge of how to undertake tasks in a way that upholds Social Care Values. For example, there are several ways we can assist a person to move, some ways may preserve the persons dignity and maximise their independence. This is the option we need to be aware of and choose.

We need to be able to think through the consequences of what we do, intend to do, so that we protect peoples dignity, promote independence and operate safely in line with best practice modules and company procedures.

How Reflecting on Practice Helps Improve your Knowledge, Skill and Understanding

Reflective practice is a process which enables us to achieve :

• A clear understanding of the impact we have when going about our work
• Identify what we have done well,
• Identify where our skills, knowledge and understanding need to improve
• The ability to give and receive constructive criticism and to adjust what we do in the light of it
• Continuous improvement, this means identifying how to improve what we do in order to maximise the quality of the services we provide.
• Focus not only on the outcome but also on the process which took us to the outcome

People who do not analyse what they have done or who do not think about the possible consequences of their actions can actually put themselves, the people they support and, in some instances colleagues too, at risk.

Your supervisor can enable you to improve your reflective practice and learning by encouraging you to reflect on what you have done and learned during one-to-one supervision and asking you questions about why you did something and what might have happened had you tackled it differently.

Use to answer question 2.2d of the Care Certificate

There are a number of methods for reflective learning here is one example which is often used in health and social care settings.

Here is a representation of Gibbs’ Reflective Cycle (also known as Gibbs’ Model of Reflection) (1988)

This is a model for reflective learning and practice

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Health & Social Care Workforce:

Welcome to the blog of the nihr policy research unit in health and social care workforce at king's college london, toolkit for reflection on human rights in the context of social care.

During the COVID-19 pandemic, the importance of human rights for people needing care and support in care homes or at home, their carers, families and friends became evident. Care home residents, especially people with dementia, were one of the groups who were and still are most severely affected by the virus, with thousands of deaths from a COVID-19 infection not only in England but many countries around the world. The need to protect people requiring care and support and to balance infection control – thus the basic rights to health and life – with the right to a private and family life and to social participation was but one of many examples of a human rights issue that we as a society had to face during this pandemic. Conversations around these topics are often difficult.

Human rights as enshrined in international and national law, notably the Human Rights Act, are directly relevant to people requiring care and support, service providers and care workers. Not only is every human being entitled to have his or her rights respected, protected and implemented but the English legal and regulatory system for care providers also makes them directly relevant in care settings. However, human rights are more than a legal concept. They are also a moral concept, which can help to build a social care system and determine the way care is provided. Human rights in social care is therefore a broad topic, with many different ways of approaching it in conversations, training and research.

In order to help you start or pick up your own reflective journey on human rights in conversation or learning by yourself or with others, we are making available a toolkit comprising a personality test, a pocket card game and a creative page to be downloaded or ordered as physical copies.

In each case, the tools below are available as a pdf and online.

These exercises can be used prior to any training, meeting or workshop to start a conversation on the topic of human rights in social care and/or care homes. They can also be completed privately, for example before embarking on research.

The tools were co-produced by ARC South London’s social care Post-doctoral fellow Dr Caroline Green together with Dr Edel Roddy at My Home Life Scotland, Dr Belinda Dewar at Wee Culture, Carlyn Miller at the British Institute of Human Rights and Dr Kritika Samsi of ARC South London. The tools are based on the findings of Caroline’s PhD study on human rights in care homes for older people and particularly her findings that there are many ways of approaching the topic ( the PhD study is available to read here ).

The co-production was funded by the ESRC Impact Acceleration slingshot fund. They are available for anyone working with, teaching or talking about human rights in social care and beyond to download and use.

Get in touch with Caroline at [email protected] if you would like further information. We would also highly appreciate your feedback on the tools, which are still a work in progress. Please note the tools are subject to copyright and may not be reproduced without acknowledgement.

Green, C. (2020) ‘The potential role of human rights and the right to privacy in the context of English care homes for older people’ , King’s College London, London.

Study Like a Boss

Health And Social Care Reflection Essay

Step 1 Thave been asked to compare and contrast my own definitions of health and illness compared to the definitions I would provide for a group of low socio-economic people living with a disability. I was told to use the Gibbs Reflective Cycle (1998), for this exercise. I decided to focus on Indigenous Australians living with a disability for an example of a low socio-economic class. Step 2 My first thought on this reflection task was that I the definition of health and illness that I would provide for myself compared to what I would provide for a disabled indigenous person would be the same.

Defining health seemed very simple to me. I see it as being free from disease and being emotionally well. I strongly believe in human dignity and treating all people equally, so for me, providing different definitions of health and illness for different groups of people seemed unethical. What was good about this this reflection task was that reinforced in me the idea of treating all people, no matter what background or social status, with dignity and respect . It was also good in that it eventually began to get me thinking about how | came to have the definition of health and illness that I do.

What was not so good was that, initially, I was failing to see the full picture. I was thinking about the situation very theoretically and looking at it from only my perspective, not looking at it from the point of view of an indigenous person. What I was failing to see was that my definitions of health and illness have largely been shaped largely by my upbringing, family life, culture and social structure . Reflecting on this matter has shown me that I really need to be more aware of what factors have played a role n my definitions of health and illness.

I also need to think about whether or not my own definition of health an illness is actually suitable for an indigenous person living with a disability. Maybe my own is definition which may be centred around my western culture is not entirely suited to all cultures. Next time I would I would like to try think about how and why Thave certain definitions for health and illness so I can then analyse whether or not those definitions are suitable for other groups of people.

By using the sociological imagination template from Germov (2014), in step four, I was really helped to come to a better understanding of how sociological issues can impact our definitions of health and illness. Step 3 One of the readings from e Module three on ethnicity, health and multiculturalism by Julian (2014), helped me to expand on my original reflections. It made me realise that defining health and illness is much more complicated than I had first thought. The chapter talks about How the definition of health and illness will vary from culture to culture and even over time.

One example is how the biomedical definition of health and illness is very prominent in Australian society but not necessarily in other cultures. I realised that my definitions of health and illness are based largely on this model. Like the biomedical definition, my definition is centred around the absence or presence of disease and what the “medical experts” of our day are promoting (Weiss & Lonnquist, 2015). It also highlighted to me how defining health and illness is often centred around what is considered “normal” to us.

This is something that can change overtime. The reading talks about how there are diseases that were once considered normal in Australia but are now seen as serious illnesses. I began to think that maybe the way we define health is a lot more subjective than I had first thought. After reading this chapter I began to reflect again about my definitions of health and illness and I started to see that, subconsciously, I actually have much more complicated definitions than I had realised.

In the first step I stated a very imple definition of health but I realised that even that definition could mean different things to different people. Being emotionally well could mean one thing to me and another thing to someone else. Step 4 Using the sociological imagination template that Germov (2014) recommends, I was able to look at the historical, cultural and structural factors that have shaped my definitions of health and illness, as well as look at what could be improved in my definitions and practices. I think historical factors have played a bigger role in my definition of health than I first realised.

I mentioned earlier that | would provide the same definition of health for myself as for an indigenous person. This indicates that I have the attitude that my western definition of health is the ultimate definition and should, therefore, be provided for everyone. It is probably because historically in Australia, the western biomedical approach to health and illness has had pre-eminence above any traditional approaches (Thompson, 2014). This model primarily focuses on the biological aspects of health and illness (Ravindran, & Myers, 2012).

The traditional Aboriginal approach to health, however, incorporates cultural, social, emotional and spiritual wellbeing into the definition of health (Thompson, 2014) . Besides emotional wellbeing, I have never really considered these issues when defining health. Cultural factors also strongly influence the way we define and perceive health (Wade & Halligan, 2004). One example in my case is how diet is a part of my definition of health. My cultural background has played a role in what I think is actually a healthy diet.

My background is entirely British and I grew up on a traditional British diet of meat and two veg (Childs, & Storry, 2013). Although I am aware that the traditional British diet may not be the healthiest one, it has been such a big part of my life that when I think of a good healthy meal it is nearly always meat and two veg that comes to mind. It is easy to think that a healthy western diet is based on science and therefore healthier than most other traditional diets. Although other cultures have not had as much access to scientific information as the western world, they have other ways of developing healthy diets .

For example, a traditional Aboriginal diet is vastly different from mine, but not necessarily less healthy. Through trial and error, Aboriginal people discovered foods that made them stronger and healthier and passed that down through the generations. Their food was also normally very fresh and unprocessed (Albala, 2011). It is clear from this that it would not be a good idea for me to force my ideas of a healthy diet on an Aboriginal person as they may want a different diet that is just as healthy. There are also structural factors that have played a role in my views of health.

My family life, school life and church life have all influenced the way I would define and perceive health and illness. Partly due to my family life, the way I define health is somewhat different to the way I perceive it. For example, I would define health as being free from illness and pain, however, I do consider myself healthy even though I am quite prone to illness and I live with chronic pain. This is probably due to the influence of growing up in a robust family where none of us would complain about illness or pain. In my family life and school life, I grew up doing a lot of sports such as hiking, tennis and volleyball.

I feel like if I could not do these things I would not consider myself healthy. The ability to be active and independent is a huge part of being healthy for me. From the point of view of a disabled Aboriginal person though, they actually might not have the ability to be active in this way and might have a different perception and expectation of what health is. The primary critical factor I identified was that I need to develop an understanding of how and why my definition of health and illness may not be suitable for an Aboriginal person living with a disability.

I had originally thought that providing a different definition of health for someone from a different socioeconomic class would not be ethical. However, with more research and reflection on the issue I realised that there are many factors in my personal life that have influenced my perception and definition of health. In most cases, an aboriginal person living with a disability would have had quite different historical cultural and structural factors in their life that have influenced their perception and definition of health.

The more I reflected on and researched this topic, the more | began to see that the biomedical and the traditional Aboriginal approach to health both have benefits . I also realised that the mistake I originally made is common in Australia and could be negatively impacting the health of many indigenous people (Wikander, 2002). I began to think that I and others in the healthcare sector, need to be more proactive in promoting Aboriginal cultural awareness and trying to incorporate their perceptions of health and illness into healthcare delivery.

Wikander (2002), believes that Aboriginal health will not improve until their beliefs on health are merged with western beliefs in healthcare delivery. I believe that I can benefit from incorporating some of the Aboriginal perceptions of health into my life and likewise, Aboriginal people could benefit from aspects of the western biomedical approach to health. Step Five The graduate attribute I think I developed most by completing this question is graduate attribute 1. This attribute is about demonstrating respect for the dignity of each individual person and for human diversity.

Showing respect for the dignity of each person is something I always try to follow and believe is very important . However, having completed this question, I can see that respecting human diversity is something I have overlooked. I said at the beginning of this assignment that I would provide the same definition of health and illness for a group of low socioeconomic people as I would for myself. I mentioned that this was largely because I strongly believe in respecting human dignity and treating all people equally.

I think my heart was right in the right place but I was failing to understand how important it is to also respect human diversity. As I continued to reflect on the topic I began to see that a low socioeconomic group of people might have a different perception and definition of health and that my own definition, therefore, might not be suited to them. From now on I want to treat all people fairly and respect their dignity while recognising that they might not want to be treated exactly the same way as I want to be treated. This will help me to demonstrate true respect for human diversity.

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Celebrating a Storied History: Moscow Preobrazhenskaya Mental Hospital Marks its 245 th Anniversary

Larisa a. burygina.

Mental-health Clinic No. 4 named after P. B. Gannushkin

Sergey A. Golubev

Oksana v. filipchenko, associated data.

• 1876. 217. 1. 76. [On the 100th anniversary of the Preobrazhenskaya hospital which takes place 13th of July 1877] Central State Archive of Moscow (Moscow)

Figure S2 . «About the centenary anniversary».

In 2022, Mental-health Clinic No. 4 named after P. B. Gannushkin, one of the oldest mental health institutions in Russia known as Preobrazhenskaya Hospital before the October Revolution of 1917, celebrated its 245 th anniversary. The history of the hospital reflects all stages of the evolution of the basic principles and aspects of mental health care in Russia. On many occasions, the institution served as a platform for eminent researchers and clinicians to achieve scientific breakthroughs and their application in practice. This article is a review of the major milestones in the history of the hospital. It highlights the great achievements of its psychiatrists and presents some previously unpublished archival documents that offer a new perspective on the history of Preobrazhenskaya Hospital.

INTRODUCTION

In 2022, Mental-health Clinic No. 4 named after P. B. Gannushkin, one of the oldest mental health institutions in Russia known as Preobrazhenskaya Hospital before the October Revolution, celebrated its 245 th anniversary. This represents the number of years since Catherine the Great signed a decree establishing the Moscow House of Invalids, where several dozen beds were set aside for the mentally ill. The document, issued in 1777 [1] , laid the foundation not only for Moscow’s first specialized institution that could accommodate patients with mental disorders, but also, without exaggeration, for the entire field of Russian psychiatry.

The implementation of the Pinel reform in Russia, the introduction of the concept of “moral treatment”, the first scientific conferences and open clinical discussions, all these stages in the evolution of the basic principles and aspects of mental health care have found their reflection in the history of Preobrazhenskaya Hospital over the past 245 years. This is why Vasily Gilyarovsky poetically referred to the Hospital as “the cradle of Russian psychiatry” [2] .

Each page in the history of Preobrazhenskaya Hospital is not only an impressive list of achievements and innovations, but also a unique gallery of distinguished names [3-7] . It served as a basis for the greatest medical luminaries of the time, such as V. F. Sabler, V. R. Butzke, V. A. Gilyarovsky, N. N. Bazhenov, A. V. Snezhnevsky, D. E. Melekhov, T. I. Yudin, S. G. Zhislin, and G. Y. Avrutsky, from which to make their scientific discoveries and validate them in practice; this was also the place where such luminaries of Russian psychiatry as S. S. Korsakov, A. U. Frese, E. K. Krasnushkin, P. E. Snesarev, A. S. Tiganov, and I. Y. Gurovich, and many others, began their medical careers.

It is a well-known and undisputed fact that Preobrazhenskaya Hospital was the first (and almost only one until the end of the 19 th century) psychiatric hospital to appear in Moscow. But historians and researchers in psychiatry have spent more than 100 years trying to dig up documents that could allow them to determine the exact year of its founding.

Starting in the second half of the 19 th century, the question has frustrated many eminent physicians of Preobrazhenskaya Hospital, including S. I. Steinberg [8] , I. V. Konstantinovsky [9] , N. N. Bazhenov [10] , M. A. Dzhagarov [11] , and A. B. Alexandrovsky [12] . Their work can now help us to form a fairly comprehensive view of how the State and society gradually, step by step, developed an awareness of what such an independent institution as a psychiatric hospital was all about. They painstakingly assembled scattered documents and facts to finally pinpoint with certainty the day it all began and the events that could be considered key milestones in the hospital’s history.

FROM FIRST MENTIONS TO 19th CENTURY REFORM

The first building that hosted Preobrazhenskaya Hospital, originally known as Moscow Dolgauz, opened its doors on June 15, 1808. In the 20 th century, it became routine to trace all anniversaries of the institution back to that date. But is that right? Could the mere fact that the hospital acquired its own building be considered the seminal event of the first inpatient psychiatric hospital in Moscow?

On July 13, 1777, Catherine the Great signed a decree mandating the opening of the House of Invalids in Moscow, with one of its “wards” dedicated to the care of the mentally ill. This is the date that, 100 years later, the doctors at Preobrazhenskaya Hospital referred to as the starting point in the history of their institution [8] . One of their main arguments was the fact that, on May 17, 1792, Catherine the Great issued a decree [1] establishing for the first time the position of Special Doctor at the mental health hospital. Hence, this decree confirms that this type of social institution for people with mental disorders already existed in 1792.

According to the decree signed by Catherine the Great, the primary role in the observation of patients was assigned to the warden, who was in charge not only of the guards (retired soldiers), but also of the doctor responsible for the professional supervision of patients. In reality, however, the staff physician had to juggle work at the mental health hospital with his duties in the nursing home, the hospice, and the almshouse. As a result, his attention was limited to those patients who had a chance of recovery [13] .

When assessing the efforts of the first doctors at the mental health hospital, such as F. Raschke, then C. Pouliard, A. Blimmer, J. Karas (and all this happened long before the hospital had its own building), N. N. Bazhenov wrote in his book about Preobrazhenskaya Hospital: “It is important to note that even then there was a firm belief that the insane person was a patient, with all that such a conclusion entailed, including examination by a physician, admission to the mental health hospital for treatment (no matter how crude and primitive that treatment might have been), and finally discharge when the physician was satisfied that the goal of admission (a cure) had been achieved” [10] .

Other doctors at Preobrazhenskaya Hospital also left their mark in the history of Russian psychiatry of the 19 th century. For example, Zinovy Ivanovich Kibalchich, Chief Doctor of the hospital in 1811–1828, left us a documented description of the prevailing realities in a mental hospital at the beginning of the 19 th century. In his 1821 article “Report on the House of the Insane in Moscow and the Methods of Treatment Used There” published in the Journal of the Imperial Philanthropic Society (issue No. 11, 1821), he not only described in detail Moscow Dolgauz and the methods of treatment used there, but he was also one of the first to point out the existence of mental disorders that are now referred to as “borderline conditions” [14] .

Vasily Fedorovich Sabler, chief doctor of Preobrazhenskaya Hospital in 1828–1871, was a true “revolutionary” in the early history of psychiatric care in Russia ( Figure 1 ).

A brilliant clinician and talented scientist, V. F. Sabler provided evidence for the nosological independence of progressive paralysis, described its accompanying mental and neurological disorders, and developed humanistic principles of individual approach to patients. He was one of the first to hypothesize that some forms of illness can evolve into others, and that severe somatic illness accompanied by high body temperature (fever) can contribute to the cure of psychosis.

In the history of Preobrazhenskaya Hospital, V. F. Sabler played an equally prominent role as an outstanding manager. With a radical reform of the hospital’s management system, he ensured that the Chief Doctor would become the actual head of the institution. He supervised all areas of the hospital’s activities and prepared reports on the clinic that were published in the press (including in Europe).

This administrative reform marked a dramatic shift in attitudes toward the mentally ill. V. F. Sabler was greatly influenced by Philippe Pinel’s concept, which led him to completely overhaul the patient management system, finally replacing the chains used on violent patients with straitjackets and restraint chairs with straps.

It was the first instance when treatment was given priority over charity. This included the first patient histories (known as “case sheets”, see Figure S1 in the Supplementary File 1 ) and prescription books. Depending on the course of their disease, patients were categorized as acute or chronic and treated using a different therapeutic approaches.

The new emphasis was not only on the medical observation of the patients, but also on their moral challenges and re-education. Patients were no longer seen as “dangerous madmen” but as “unreasonable children” who needed proper care and exercise. That is why occupational therapy was considered so important. According to the instruction “On the Exercises for the Sick People Placed at the Mental Health Hospital” published in 1834, each patient was assigned a strictly individual occupation. It was then that Preobrazhenskaya Hospital established a sewing shop, a tailor’s shop, a shoemaker’s shop, a dyer’s shop, a paint shop, a plasterer’s shop, and a vegetable garden. The women could also knit socks and embroider canvas.

V. F. Sabler initiated the effort to draft legislation on the mentally ill, which provided the impetus to address a long overdue problem in the patient examination process. For centuries, medical matters had been handled by officials with no expertise in diagnosing mental illness, and during the reign of Nicholas I, the authorities began committing patients to institutions “pending further orders” rather than “pending recovery”, as had always been the case. It was not until February 18, 1835, that a decree was issued establishing a procedure for forensic psychiatric examination that required convincing evidence of mental illness from credible medical experts.

In 1841, the so-called “special patient examination procedure” was introduced and implemented for the first time at Preobrazhenskaya Hospital. If in St. Petersburg the “lunatics” continued to be transported to the Provincial Board, in Moscow the “subjects” were now sent to Preobrazhenskaya Hospital for “expert examination” and placed in a ward specially purposed for such subjects in a section of St. Catherine’s Almshouse. Membership in the Patient Examination Committee was also established at that time and did not change until 1917. It included the hospital doctor, his/her assistant, the provincial marshal of the nobility, the chief of the district police or the head of the city. Patients were discharged only after a new examination, which could take place at the end of a two-year “observation” period, and this period could be shortened only by special decision of the Senate.

The hospital owes both its name, Preobrazhenskaya, and the confirmation of its new official status as a medical institution to V. F. Sabler. It was he who on May 31, 1838, petitioned Emperor Nicholas I to sign a decree renaming the Moscow Dolgauz as the Preobrazhenskaya Mental Hospital.

Assessing the changes that took place in the hospital during the first hundred years of its existence, historians of psychiatry are quite right to note that as early as the middle of the 19 th century Preobrazhenskaya Hospital had made the transition from a “charity house” to an in-patient psychiatric institution and had evolved into “the center of not only practical but also scientific psychiatry, which became the tradition of the Moscow psychiatric school, distinguishing it from the St. Petersburg psychiatric school” [7] .

These changes, most of which were introduced during V. F. Sabler’s leadership, allowed Samuil Ivanovich Shteinberg (the hospital’s chief doctor in 1872–1877) to begin work on the institution’s first collection of scientific papers in the run-up to the centennial of Preobrazhenskaya Hospital in 1877. The preserved documents (“Preobrazhenskaya Hospital Office File on the Centennial Anniversary...”) show that the preparations for this anniversary had begun well in advance. As early as in February 1876, the chief physician, S. I. Shteinberg, wrote a letter to the trustees of Preobrazhenskaya Hospital with a detailed plan of the celebration. A circular letter was sent to the staff instructing S. S. Korsakov, N. I. Derzhavin, and V. R. Butzke to begin preparing articles identifying the major milestones in the history and development of the hospital (Figure S2 in the Supplementary File 1 ).

In the 1870s and 1880s, the hospital attracted a cadre of brilliant and exceptionally gifted young physicians who introduced the most advanced methods of patient care into existing medical practice. First of all, this applies to Sergey Sergeyevich Korsakov, the founder of the nosological branch of psychiatry, the creator of the Moscow scientific school and the author of a classic course in psychiatry [4,5] . His name is closely connected with the history of the “therapeutic revolution” at Preobrazhenskaya Hospital. The energy and reputation of S. S. Korsakov helped to complete and irretrievably establish “moral treatment” at the hospital and the “open door” policy (from 1889), followed by out-of-hospital care, which radically changed the entire approach to patients.

20 th CENTURY: TRANSFORMATIONS AND ACHIEVEMENTS

Looking back, it is impossible to ignore one obvious fact: almost all the chief doctors of Preobrazhenskaya Hospital in the period before the Russian Revolution of 1917 acted as reformers of the entire Russian psychiatric care system. An honorable place in this gallery of illustrious figures is occupied by Nikolai Nikolaevich Bazhenov, chief doctor of the hospital in 1904–1917 ( Figure 2 ).

Preobrazhenskaya Hospital owes its vast expansion and the introduction of the then — revolutionary system of “advanced care” to this fascinating figure of Russian psychiatry, outstanding clinician, ingenious manager, and respected teacher.

In the new “advanced care” system, the uneducated wardens and nannies were replaced by young medical interns and sisters of mercy. The doors to the wards were unlocked, the bars on the windows were replaced with tempered glass, and the straitjackets were displayed as museum pieces [15-17] . To ensure that patients were under continuous and competent supervision, the interns were required to live in the hospital, rotate on round-the-clock duty, welcome new admissions, and complete patient histories and observation diaries. All direct patient care was assigned to mid-level medical staff. Thirty-two sisters of mercy washed and fed the patients, gave them baths, accompanied them on walks, etc. Each ward had a head nurse who distributed medications, served lunch and dinner, was in charge of laundry, and performed other household duties. Nannies and servants were assigned only janitorial duties. In the spirit of those times, the hospital widely applied a system of moral influence, a prototype of today’s psychosocial therapy that included respectful treatment and support of patients, their socialization, and involvement in various activities.

At the beginning of the 20 th century, with N. N. Bazhenov’s contribution, the hospital was transformed into a research and treatment institution, which became a center of advanced psychiatric knowledge. The scope of N. N. Bazhenov’s innovations is quite impressive: in just a few years the clinic, where at the turn of the century treatment of patients resembled more that in a prison than in a medical institution, was transformed into a modern hospital, on par with the best that Europe could offer [15-17] .

Preobrazhenskaya Hospital was also the place where the Law on the Mentally Ill, a revolutionary act for its time, was proposed 80 years before the adoption of the Russian Federal Law on Psychiatric Care in 1992. The legal principles outlined by N. N. Bazhenov at the first congress of the Russian Union of Neuropathologists and Psychiatrists in 1911 are still relevant today:

“The following issues need to be brought to the forefront of mental health care and legislated:

• The principle of extending state care to all mentally ill people in the country, and specifying the measures to implement this task and the central and local authorities responsible for these tasks.
• Conditions for allowing treatment at home in the patient’s own family.
• Sufficient safeguards must be in place to ensure that the principles of inviolability of the person and individual liberty can only be violated when the mental illness of the person in question makes this imperative” [18] .

N. Bazhenov is also connected with the first commemoration of the foundation of the hospital celebrated in the 20 th century. In December 1909 the 100 th anniversary of the opening of the first building hosting Preobrazhenskaya Hospital on Matrosskaya Tishina Street was commemorated in gushing but solemn fashion, with the participation of the general public.

By that time the clinic had already received a plot of 11 dessiatins of land with the two and three-story buildings of the former Kotov factory (known as “Kotov’s Half”) ( Figure 3 ).

The factory buildings were refurbished, and a dormitory for the staff was equipped with ventilation, plumbing, and even central heating, which allowed N. N. Bazhenov to write proudly that “now Preobrazhenskaya Hospital has such premises for the staff that few Russian or even Western European hospital institutions can boast of” [10] .

However, the problem of overcrowding could be solved only by the construction of new buildings on Kotov’s Half, which required additional funds. So, N. N. Bazhenov decided to organize a gala evening for the city’s dignitaries on the former Kotov estate.

The day of the anniversary celebration was packed with events, including a solemn liturgy and breakfast for 300 guests; in the afternoon, there was a large concert by professional musicians from Moscow; a festive tea ceremony for patients, distribution of anniversary souvenirs, such as cups with the hospital insignia; and in the evening a banquet for 200 guests was held at the Kotov’s cottage located in a picturesque setting on the border of the Preobrazhenskaya and Sokolnicheskaya groves.

In addition to the concert, the highlight of the “cultural program” was the exhibition, for which N. N. Bazhenov selected not only everyday objects from psychiatric hospitals of different centuries (straitjacket, restraint chair, and “case sheets”), but also the creative works of patients (paintings and caricatures, wood and paper crafts, embroidery, and knitting). The models of Preobrazhenskaya Hospital and the Eiffel Tower were particularly popular with the public, because of their size and resemblance to the originals.

In addition to the gala dinner, the guests were treated to a theatrical performance, which included an act from the play “The Marriage of Krechinsky”, with a reference to Preobrazhenskaya Hospital, and, at the end of the evening, fireworks from an area near the buildings in Kotov’s Half — N. N. Bazhenov did not miss a single opportunity to draw the attention of the patrons and city authorities to the matter of financing the future construction. In 1910–1914, his work culminated in the successful completion of three new buildings and repairs to the old factory facilities on Kotov’s Half.

But let’s take a closer look at the year of this anniversary: Why was it celebrated in 1909? For a long time, 1809 was mistakenly considered the year in which the first specialized hospital for the mentally ill was opened. It was mentioned both in the Historical Essay on the Imperial St. Catherine’s Almshouse by V. Molnar [13] and in the Historical Essay on Preobrazhenskaya Hospital by I. V. Konstantinovsky [9] . For this reason, the anniversary was celebrated in 1909 and the following plaque was installed on the facade of the building: “1809–1909: To the centenary of the Preobrazhenskaya Mental Hospital, the first in Moscow designed specifically for psychiatric purposes”.

Only later, while working on the manuscript of his book “The Moscow Dolgauz” or “Essays on the History of Preobrazhenskaya Hospital” did N. N. Bazhenov study the documents in the hospital archives and found out that the new mental health hospital in Preobrazhenskoye was opened earlier, in June 1808, when 53 patients from the house of the former Secret Expedition were transferred to the building on Matrosskaya Tishina 1 [10] .

By the beginning of the 20 th century, the records had cemented all three major milestones in the history of the establishment of Preobrazhenskaya Hospital: 1777, 1808, and 1838. One might think that this would have settled the question of the first dates for future celebrations once and for all.

However, the revolution of 1917 and the subsequent division of the hospitals sowed confusion into the “question of anniversaries”. In the spirit of Soviet traditions, Preobrazhenskaya Hospital was stripped of its former name in 1920 and became Moscow City Hospital No. 1. What’s more, in 1931, it was divided into two independent medical institutions with different goals and missions. The hospitals kept changing names, numbers, internal organizational structure, and overall scope of activities, and only relatively recently, in 2017, did the two hospitals return to their historical roots by merging under the name of P.B. Gannushkin Mental-health Clinic No. 4 ( Figure 4 ).

Over the next 100 years, Kotov’s half of Preobrazhenskaya Hospital acquired a different, but equally illustrious, name — Gannushkin Hospital. In the second half of the 20 th century, it maintained its position as an advanced center of research and practice, with many pioneering milestones in the history of Russian psychiatry:

• It developed the system of maintenance therapy, which is so important in preventing relapses.
• For the first time in the USSR, it began to use insulin shock therapy (under the direction of M. Y. Sereisky), as well as electroconvulsive therapy (with the contribution of G. A. Rotshtein).
• It also marked the beginning of the “psychopharmacological treatment era in psychiatry” with the trials of many medications that were subsequently integrated into mainstream clinical practice.

RECENT DEVELOPMENTS

Reflecting on the title of this article, “Celebrating a Storied History”, one may note that in 2022 the institution historically known as Preobrazhenskaya Hospital will celebrate its anniversary for the first time in more than a century since that memorable evening organized by N. N. Bazhenov at the former Kotov estate. How does Gannushkin Hospital, the illustrious heir to the great traditions established by Preobrazhenskaya Hospital, look at the new generation in the year of its 245 th anniversary?

More recently, just 3–4 years ago, it got a facelift after extensive repair and construction work to restore the buildings dating back to the early 20 th century. Most importantly, the reorganization allowed for more streamlined psychiatric care, created a common information space, rationalized territorial localization, and brought patient treatment and routing patterns into a consolidated format.

With four specialized clinics in operation since 2020, the hospital now has several new structural units, including a clinic for affective and suicidal disorders, a clinic for borderline conditions, a clinic for first psychotic episodes, a clinic for pharmacoresistant conditions, and a clinic for mental disorders that are compounded by substance abuse. The Mental Health Counseling Center, opened in 2021, provides outpatient care for individuals suffering from various mental disorders including somatoform, stress-related, and neurotic disorders.

Today Gannushkin Hospital boasts a center for complex diagnostics, a clinical and diagnostic department with specialized clinics (such as dentistry, ophthalmology, gynecology, ENT, ultrasound), an anesthesiology and intensive care unit, a clinical and diagnostic laboratory, a psychological and psychotherapeutic center, a social and legal assistance center, as well as a physiotherapy department (including a transcranial magnetic stimulation room and xenon therapy room), pharmacy, X-ray rooms, and a physiotherapy room.

At the moment, the hospital has 9 outpatient branches known as Psychoneurological Dispensaries (PNDs), some of which have a history spanning more than 100 years. 2 Three Memory Clinics were founded on the basis of PND. These medical and rehabilitation units are designed to help elderly patients with early signs of dementia and mild cognitive decline.

The staff of the oldest psychiatric hospital in Moscow has carefully passed down to younger generations traditions that combine the utmost sense of humanity and the highest level of professionalism in helping patients with mental disorders. These traditions are the cornerstone that enables the team at Mental-health Clinic No. 4 named after P. B. Gannushkin to live its mission every day by providing personalized and comprehensive mental health care based on the principles of partnership and trust, with the aim of restoring and maintaining a high quality of life for its patients.

Authors’ contribution

All the authors made a significant contribution to the article.

The research was carried out without additional funding.

Conflict of interest

The authors declare no conflicts of interest.

Supplementary data

Supplementary material related to this article can be found in the online version at doi: 10.17816/CP3704

Supplementary File 1

Figure S1 . «Case sheets».

1 The house on Myasnitskaya Street, formerly owned by the Secret Expedition, was transferred to the Public Charity Office in the early 19 th century. This is where the patients of the House of Invalids and the Madhouse were accommodated in 1801.

2 PND No. 8, for example, was founded in 1919 and made psychiatric history as the prototype of the emerging district-level psychiatric care in Soviet Russia.

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Healthcare in Moscow

This guide was written prior to Russia's 2022 invasion of Ukraine and is therefore not reflective of the current situation. Travel to Russia is currently not advisable due to the area's volatile political situation.

Healthcare in Moscow is organised by the Moscow Health Department. While public healthcare facilities are available, most expats seek out private healthcare at international medical centres. Expats are advised to take out private medical insurance if it is not provided to them by their company.

Subsidised healthcare is provided to everyone living in the country, paid for by the state and the mandatory health insurance system. That said, professionals in the state system are likely to speak little to no English. 

There are several private medical centres in Moscow where English is spoken and where the healthcare is on par with expat standards. These clinics are generally very expensive, so it is highly recommended that expats take out private medical insurance to cover medical costs in Moscow. Most insurance coverage plans will also include evacuation cover for emergencies or life-threatening situations. 

Recommended hospitals in Moscow

Alliance medicale.

www.alliancemedicale.ru Address: Kutuzovsky Ave, 1/7

Intermed Center American Clinic

www.en.intac.ru Address:  4 Monetchikovsky Lane, 1/6, Building 3

International Clinic MEDSI

www.medsi.ru Address:  26 Prospekt Mira, Building 6

European Medical Center

www.emcmos.ru Address:   5 Spiridon'yevskiy Pereulok, Building 1

Further reading

►For more on the Russian healthcare system see our Healthcare in Russia page.

Expat Interviews " The standard is high, but health insurance is essential − both international and local cover tend to be adequate and similar for routine things." Read more about Stephen, a British expat, and his  experience living in Moscow . 

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