In this essay, I have applied the reflection guide of Gibb’s cycle (1988). Based on this, I will reflect on a significant incident from my placement area. Using this reflection model will look at the description of the situation, Feeling, Evaluation, Analysis, Conclusion and action plan. My reflection will therefore focus on the communication tool and interpersonal skills to promote therapeutic relationships through the analysis of principles.
Here, I make an emphasis on the importance of ethical consideration, by not exposing the name of the patient concerned in the scenario (NMC 2015). Therefore the patient will be referred to Jack and his aged is 40. I was working with my mentor and have been given few patients to look after including Jack and mentor ask me to carry out observation an ECG on Jack as he was suffering from chest pain. It became clear during the handover that the patient labeled as a difficult behavior and it was apparent that all staff did found hard to take care of him. The nurse in charge also explained that the patient had been very difficult not allowing any observation and not taking his medication. Throughout the remaining three weeks of my placement, I frequently witnessed Jack shouting and insulting the healthcare staff, including his family members during a visit him.
I initially felt nervous about approaching Jack as I had not previously cared him before I gathered all the apparatus I required from the treatment room and proceeded to his room. When I enter Jacks seemed alright and I started trying to talk to him to carry out the observation. However, as we spoke I interpreted his response to the agreement and I continued to carry out the observation. When the ECG machine started, he suddenly pushed me away and takes out all cables and stickers from his body. I was really frightened and wanted the help of my mentor telling to her all that had happened.
I returned to the patient with my mentor. My Mentor approached him at a close range in his bed and dropped herself to his eye level. She began a conversation with him marked with a soft tone of voice and she moderately heartened his arm requesting him if he wants a hot drink, and he appeared too calm. After that, my mentor starts to explain him very well why we need to do the observation on him. Then she begins to introduce me to him again as a student nurse and she asks him if I can check the observation and he agreed. I instantly realized that how much Jack’s impact his pain to his behavior and no-one seems to help him as they think that got aggressive behavior. I felt that Jack might not have been able to handle his emotions about his current situation, so he took out his frustrations on both the healthcare staff and his own family. Even thought i do not agree with how his deal all this situation, however, I understand that he was going through a hard time with and fear, which influenced his hostile behavior.
The most significant factor was the fact that there was a lack of proper communication from me to the client. My initial evaluation was the way I interconnected with the patient had an undesirable consequence for both of us.
Collins (2019) indicates that Communication is a crucial element in developing a therapeutic relationship. Besides, Barbara et al. (2013) inform the simple skills secrets model. This model is a useful approach for nurses and all responsible healthcare professionals. This model has expressed effectiveness in dealing with complex situations with increased confidence in healthcare staff and willingness to participate to minimising the patient’s distress.
Kourkouta and Papathanassiou (2014) demonstrate that good communication between nurses and patients is important for an individualized patient care outcome. This can be achieved by showing sincerity confidentiality, kindness, and not forgetting the person surrounding the sick through our patient’s good understanding.
Having good communication and therapeutic relationship are important between patients and nurses this could also involves verbal communication (Mitchell, 2014). If the nurse do not communicate well however they may find more difficult to deal with patient difficult behavior. In this case for example I wanted to interact with Jack more often after my mentor introduced me and giving him the chance to explore his social and psychological needs
Bach and Grant (2011) indicate that non-verbal communication is very important. It allows nurse to provide care equally to the patients in achieving wellness, resulting in good adherence to treatment (Moreno-Poyato et al., 2017). In addition effective communication allow the nurse to understand the patients situation emotionally and this formed a good bond between nurse and patients.( Wright and Davis, 1994). Peate (2010) further supported this by the fact that effective communication provides ongoing healing, understanding.
My mentor responded to Jack through touch in a non – verbal and empathetic way. By gently held his hands and gave him stroke so that he could calm down. Hessel concept analysis (2009) discovered that in the patient’s case studies in which therapeutic touch helped to patient calm by holding their hands or sitting on the bedside. Sometimes also refers to as relaxation, reduction of anxiety. Reports have been made from research studies that therapeutic touch has the ability to reduce anxiety in burn patients and the elderly (James L, 2016).
Donnelly and Neville (2008) suggested that effective communication helps to cope for vulnerable patients with their care and treatment and make better decisions. This is because effective communication is the first step in patient management and care (Charons, 2008). Furthermore by further supported of Roberts Jet al (2015) shows that listening to patient stories would help nurses to take out information as a tool for diagnosis, because patient sometimes storytelling and this can give for both parties the opportunity to tell something that has some meaning for the patient. Just listening includes not only the different forms of talking therapy, but also the patient’s ability to look deeper into the problems, worries and feelings that the patient has, particularly family, and other people (NHS,2018). In addition provides ongoing long – term care for the patient with an intermittent conversation. In this scenario as seen, Jack expressed his reason for the nurse after both had long conversation
Therapeutic communication skills used by nurses must be confident and patient-centered in order for nursing care to be useful (Robert J et al., 2015). Centered patient care is described as care that respects and responds to the needs and values of individual patients. Person-Centered Care places the patient and family in a respectful, coordinated and efficient decision – making process together with the healthcare team as an integral part of the care team. Respect for patient preference promoting concordance and autonomy of the patient (NMB, 2015).
Treating the patient in a person-centered manner contributes to a therapeutic alliance that can give the patient a self – directed and connected character to attain personal goals and improve compliance and medical treatment ( Baughan and Smith 2009). In this case Jack had a chest pain and this can cause to blockage in the heart blood vessels that reduces blood flow which can leads him to death. Therefore need good communication with cardiac specialists and adequate resources, including psychological treatments for better management outcome.