Reflection and Reflexivity Are Essential for Responsible and Ethical Practice - Essay Example

?REFLECTIVE ASSIGNEMENT Reflection and reflexivity are essential for responsible and ethical practice (Gillie Bolton, p.5). In this assignment,I reflect on the situation that took place during my clinical placement to develop and utilise my interpersonal skills in order to maintain the therapeutic relationships with my patient. In this reflection, I am going to use Gibbs (1988) Reflective Cycle. This model is a recognised framework for my reflection. Gibbs (1988) consists of six stages to complete one cycle, which is able to improve my nursing practice continuously and learning from the experience for better practice in the future. The cycle comprises six stages namely, description, feelings, evaluation, analysis, conclusion and final stage is an action plan to prepare if the situation arose again (NHS, 2006). Baird and Winter (2005, p.156) give some reasons why reflection is required in the reflective practice. They state that a reflect is to generate the practical knowledge, assist an ability to adapt to new situations, develop self-esteem and satisfaction as well as to value, develop and professionalizing practice. However, Siviter (2004, p.165) explains that reflection is about gaining self-confidence, identify when to improve, learning from own mistakes and behaviour, looking at other people’s perspectives, being self-aware and improving the future by learning the past. In my context with the patient, it is important for me to improve the therapeutic relationship, which is the nurse-patient relationship. In the therapeutic relationship, there is the therapeutic rapport to establish from a sense of trust and a mutual understanding existing between a nurse and a patient that builds in a special link of the relationship (Harkreader and Hogan, 2004, p.243). (Peplau 1952, cited in Harkreader and Hogan 2004, p.245) note that a good contact in a therapeutic relationship builds trust as well as raises the patient’s self-esteem, which could lead to new personal growth for the patient. Besides, (Ruesch 1961, cited in Arnold and Boggs 2007, p.200) mention the purpose of the therapeutic communication is to improve the patient’s ability to function. Therefore, in order to establish a therapeutic nurse-patient interaction, a nurse must show up caring, sincerity, empathy and trustworthiness (Kathol, 2003, p.33). Those attitudes could be expressed by promoting the effective communication and relationships by the implementation of interpersonal skills. Johnson (2008) defines that the interpersonal skills is the total ability to communicate effectively with other people. Chitty and Black (2007, p.218) mention that communication is the exchange of information, thoughts and ideas via verbal and non-verbal communication processes. They explain that verbal communication consists of all speech whereas non-verbal communication consists of gestures, postures, facial expressions, tone and level of volume. In this assignment I discuss my development of therapeutic relationship in the circumstance of the nurse-patient relationship using the interpersonal skills. My reflection is about a patient, Mary (not the real name) whose real name is confided to protect the confidentiality of patient’s information (NMC, 2004). DESCRIPTION: (What happened ?) In this paragraph, I would describe on the event that took place during my clinical placement. I was on the female psychiatric ward. Once I noticed one woman was still sitting on her bed trying to take something from the cupboard. She was Mrs. Mary, 76 years old who had been diagnosed with schizophrenia. She was unable to control her muscle movement due to tremor. She was having a side effect of anti psychotic medication which was a Parkinsonism (Sahelian, 2005). She could not walk herself and need to be assisted if she wanted to stand or walk. This old woman was unable to feed on her own. Therefore, I checked her diet chart and served a cup of milk from her cupboard. To confirm that Mrs. Mary was actually wanting some milk I had to involve in a lengthy process of communication with her; because I was not knowing what language she was speaking. Besides, she could not understand my language. The only expression she could deliver at beginning was that she was stunned to face an unknown face. FEELINGS: (What I felt ?) In this paragraph, I would discuss my feelings or thoughts during the episode. Before I started to feed her milk, I introduced myself and approached Mrs. Mary. I tried to build a good rapport with her as I did not want her to feel strange, as I was not her family members or her relatives. My first approach to her was to ask whether she wanted some milk. She was on soft diet as she was having a difficulty in swallowing or dysphagia. Then I asked her permission to feed her. She simply blinked at me as if I was blurred in her vision. In this situation, I showed up my emphatic listening as I put myself in her shoes and assumed I was having a hearing problem. According to Wold (2004, p73) the emphatic listening is about the willingness to understand the other person not just judging the person’s fact. Then, I touched her shoulder, kept saying, and raised my tone a bit, because I was afraid if she had a hearing trouble. At the same time, I did some bodily gesturers which could be interpreted an action of drinking. I paused, repeated my actions but this time I was using some simple words in the patient’s dialect. Then she looked at me again and nodded. Fortunately, the bodily gesturers helped me in the conversation with her. In the meantime, I was thinking whether the first language was not her mother tongue but I kept myself communicating verbally with her simultaneously including my gesturers and facial expression. Body gesturers and facial expressions are referred to as a non-verbal communication (Funnell et al, 2005, p.443). I was thinking of speaking louder and to know more words in her language so that she could understand and interpret my actions were towards her. I thought of the language barrier that broke our verbal communication. Castledine (2002, p.923) mention that the language barrier arises when there are individuals coming from a different social background using their own slang or phrases in the conversations. Luckily, those particular gesturers could make her understand that I came near her to give her something to drink. During the feeding, I maintained the eye contact, as I did not want her to feel shy. This was because; my eye contact could show up my interest to help her in feeding. This is supported by Caris-Verhallen et al (1999) which mentioned that the direct eye contact could express a sense of interest in the person to the other person involved in communication. In the meantime, I communicated at my best with her so that she felt comfortable. As a result, she gave a good cooperation and enjoyed the milk, which I fed. EVALUATION: (What was good and bad about the experience?) In my evaluating, I feel I make the right decision to accompany and assist Mrs. Mary in feeding. Furthermore, I could develop my nurse-patient relationship. Although McCabe (2004, p.44) describes it as a task-centred communication lacking the element of communication among nurses, I believe my communication involved both a good patient-centred aspect and task-centred aspect. In my personal opinion, I attended to Mrs. Mary as a patient to show my empathy because she was unable to feed herself. It was also my duty to feed her so that I could make sure the patient got the best care in the ward. So my involvement in this nurse-patient relationship was not only restricted to the task-centred communication. Burnard (1990), and Stein-Parbury (1993), as cited in McCabe (2002: p.44), defined involving in a patient-centred process fulfilled the basic conditions as a nurse to provide the genuineness, warmth and empathy towards the patient. I was able to improve my non-verbal communication skills in my conversation with her during the feeding. As she was having a hearing problem and could not communicate in the first language properly, the non-verbal communication played a nice role. Caris-Verhallen et al (1999, p.809) state that the non-verbal communication becomes important when communicating with the elderly people who develop a hearing problem. Hollman et al (2005, p31) suggests some effective ways to maximize the effectiveness of communication with hearing impaired people. They enlist modalities such as gaining the person’s attention before speaking, keeping oneself visible to prevent them feel frightened and trying to use some sensitive touch. I felt this was a good experience to me because I learnt to develop my non-verbal communication. I used mostly gesturers because the language barrier was a gap in my conversation with Mrs. Mary. She could speak very limited in the first language so I tried to speak in her dialect. Furthermore, Wold (2004, p.76) mention that gesturers are one specific type of non-verbal communication intended to express ideas and are useful for people who cannot use much words. However, I also used my facial expressions to advise her to have some milk for her energy replenishment. After drinking two or three mouthful of the milk, in a fit to withdraw from my feeding, she expressed discontentment of taste or the quantity or the like. I withdrew the cup immediately from her mouth in an assumption that I might have given more than a mouthful of her requirement. Mrs. Mary expressed her contentment by way of a senile smile. After a few seconds, I once again tried to feed her milk showing a facial expression that considerable quantity of milk was remaining to be fed. Wold (2004, p.76) viewed facial expressions were most expressive and were not limited to certain cultural and age barriers. Therefore, my facial expression worked out to encourage her to finish the milk. Although I could not explain in detail to her about the importance of nutrition in her diet that she should take, I was able to advocate her to finish the milk served because the quantity of the milk that I poured from the bottle was as per the prescription. ANALYSIS: (What sense I make of the situation?) In this section of analysis of the event, I could evaluate that, my communication skills were very important to provide the best nursing care to Mrs Mary. My communication with her was the interpersonal communication, which took place between we two only (Funnell et al 2005, p.438). I realized that my nonverbal communication did help me a lot in my duty to provide the nursing care to Mrs. Mary. Even though she could understand few simple words of mine during the communication process, I noticed that one of the problems occurred within the communication was the language barrier. As the patient was not using the official language and the second language, I tried to speak in her language. I still could manage the communication in our conversation. However, it was quite difficult to promote the effective verbal communication with the patient. Besides, White (2005, p.112) recommended that a nurse should learn a few words or phrases in the predominant second language to put a patient at ease for better understanding. Although it was quite difficult but using the nonverbal gestures simultaneously with the verbal communication methods, it encouraged her to speak on her best to make me understand her words. There was a response from Mrs. Mary when I was asking her questions. Funnel et al (2005, p.438) points out that a communication would occur when a person responds to a message received and assigns meaning to it. She nodded her head to assign that she agreed with me. Delaune and Ladner (2002, p.191) explain that the channel is one of the component of the communication process which act as a medium during the exchange of message. In addition, Mrs. Mary also gave me a feedback that she understood my message by transmitting the message via her gesturers and eye behaviour. Thus, I could consider that the communication channels used in my conversation were visual and auditory. Delaune and Ladner (2002, p.191) state a feedback is a receipt of information by the sender of the message back from the receiver of the message. However, Chitty and Black (2007, p.218) define feedback is a response to a message. In my situation, I was a sender who conveyed the message receiving the information from Mrs. Mary, the receiver who agreed to take lunch and allowed me to feed. Consequently, I could analyse that my communication with her comprised five component of communication process namely, the sender, the message, the channel, the receiver and finally the feedback (Delaune and Ladner, 2002, p.191). CONCLUSION:(What else could I have done) This event explores about on how the communication skills played a role on the nurse-patient relationship in order to deliver the nursing care towards the patient especially an impaired adult. She needed quite some time to adapt to the changes in her daily activities at a place other than her normal dwelling place, where I was trying to help her in feeding. I was concerned with my feelings and thoughts during the feeding so that I could improve more skills in my communication process. I successfully communicated with her effectively as she enjoyed finishing the meal. Therefore, it was vital to build rapport with her to encourage her ability to speak up verbally and non-verbally. Moreover, this ability could help her to communicate effectively with other staff nurses also. Later, she would not be neglected because of her age or her disability to understand the information given about her treatment. (Hyland and Donaldson 1989, cited in Harrison and Hart 2006 p.22) mention that communication expresses what the patients think and feel. In order to communicate with adult, it is important to assess her common communication language and her ability to interact in the other languages. As I used some words in her dialect, I essentially encouraged the patient to speak out verbally and communicate in non-verbal mode so that the message could be understood and did not break the nurse- patient communication. In my opinion, I evaluated that it did not a matter whether it was a patient-centred communication or task-centred communication; because both the communications mentioned by McCabe (2004) actually represent communication to the patients. Therefore, it will not be nice to argue which type of communication involved in my conversation with my patient. After analysing the situation, I could conclude that I was be able to identify the skills for effective communication with the patient. I had found out that approaching the patient, asking questions, being an active listener, showing empathy and supporting the patient’s emotions were the important elements of the communication (Walsh, 2005, p.34). Actually helping the adult was a good practice in delivering the nursing care among adults. ACTION PLAN:(What I would do if the situation arose again) My action plan for the clinical practice in the future, if there were patients that I need to help in the course of my nursing procedures , I would prepare myself better to handle with the patients who would have some difficulty in communication. This is because, as one of the health care worker, I want the best care for my patients. Therefore, I prefer to deliver the best care to my patients, I need to understand them very well. I have to communicate effectively as this is important to know what they need most during my supervision as a nurse. According to my experience, I knew that communication was the fundamental part to develop a good relationship. Wood (2006, p.13) expresses that a communication is the key foundation of relationship. Therefore, a good communication is essential to know the patient’s individual health status (Walsh, 2005, p.30). Active listening could distinguish the existence of barriers in communication during the interactions with the patients. This is because, active listening means listening without making judgement of the patients’ opinions or complaints which give me chances to be in the patients’ perspective (Arnold, 2007, p.201). It is also crucial to avoid the barriers encountered in the communication with the patients. I could detect the language barriers by interviewing the patients about their health or asking them if they needed any help in their daily activities. However, I would see that my communication is free from barriers such as using of the open-ended questions, avoiding non-verbal cues, and being criticising and judging, and interrupting (Funnell et al, 2005, p.453). Walsh (2005, p.31) too summarises that stereotyping and making assumptions about patients, affixing perceptions and first impression of patients, lacking awareness of communication skills are the main barriers to communications. I must not judge the patients by making any prior impression and assumption about the patients but I have to make patients feel valued as an individual. I should be capable of respecting their fundamental values, beliefs, culture, and individual means of communication (Heath, 2000, p.27). I would be able to know on how to build rapport with the patients. There are eleven ways suggested by Crellin (1998, p.49) which are as follows: becoming visible, anticipating needs, being reliable, listening, staying in control, self-disclosure, caring for each patient as an individual, using humour when appropriate, educating the patient, giving the patient some control, and using gestures to show some supports. These ways could help and give me some guidelines to improve my skills in communication with the patients. Another important capability to add to my action plan list is to identify which disabilities the patients suffer from such as hearing disability, visual impairment and mental disability. Once I identify the disability of the patient has, I could well devise my method of communication effectively as Heath (2000, p28) mention that communicating with people who was having some hearing impairment, sight impairment and mental disability requires the particular skills and considerations. Nazarko (2004, p.9) suggest not to repeat if the person could not understand but try to rephrase and speak a little more slowly when communicating with the hearing disabled people. Hearing problem commonly occurs among adults because of ageing process (Schofield, 2002, p.21). To summarize for my action plan, I would start my communication after establishing a good rapport with the patients. I will try to elicit what affects the patients’ ability to communicate well and avoid barriers in effective communication in future. Tail end: - In conclusion of my reflective assignment, I mention the model that I chose is Gibbs (1988) Reflective Cycle as my framework of my reflective presentation. I have stated the reasons why I am chose this model. I have also discussed the importance of doing reflection in nursing practice. I am able to discuss every stage in the Gibbs (1988) Reflective Cycle about my ability to develop my therapeutic relationship by using my interpersonal skills with a patient for this reflection assignment purpose. = end = Reference list – Arnold E.C, 2007, “Developing Therapeutic Communication Skills in the Nurse-Clients Relationships”, in Eds. Arnold E.C and Boggs K.U, “Interpersonal Relationship: Professional Communication Skills for Nurses”, Saunders Elsevier, Missourie. Baird M and Winter J. 2005, “Reflection, Practice and Clinical Education”, in Eds. Rose .M and Best .D, 2005, “Transforming Practice through Clinical Education, Professional Supervision & Mentoring, Elsevier, Churchill Livingstone, Philadelphia. Burnard P. (1990) Learning Human Skills; an Experiential Guide for Nurses. Oxford: Butterworth Heinemann in McCabe. C. (2004) Nurse–patient communication: an exploration of patients’ experiences. Journal of Clinical,Nursing, 13 (5), 41–49. Caris-Verhallen, W. M. C. M., Kerkstra, A. and Bensing, J. M. (1999) Non-verbal behaviour in nurse-elderly patient communication. Journal of Advanced Nursing, 29 (4) 808-818 Castledine G. (2002) How we use language and its value in nursing. British Journal of Nursing, 11 (3) 923 Chitty K.K and Black B.P (2007) “Professional Nursing and Challenges”, 5th edition, Saunders Elsevier, Philadelphia. Crellin K. (1998) 11 Easy ways to Build Rapport, Journal of Nursing, 28(11) 48-49 Delaune, s.C and Lander P.K (2002) “Fundamentals of Nursing: Standard and Practice”, 2nd edition, Thomson Learning, New York Example of a reflective practice tool (online) Funnel R, Koutoukidis G and Lawrence (eds) 2005, “Tabners’s Nursing Care 4E: Theory and Practice, Churchil Livingstone, Australia. Gillie Bolton, 2010, pp.5, “Reflective Practice: Writing and Professional Development”, 3rdEdition, Sage Publications, London. Harkreader H and Hogan M. A, 2004, “ Fundamental of nursing: Caring and Clinical Judgement”, 2nd edition, Saunders, Missourie. Heath, H.(2000) Assessing older people. Journal of elderly care, 11 (10) 27-28. Holman, C., Roberts, S. and Nicol, M. (2005) Promoting good care for people with hearing impairment. Nursing older people, 17(2) 31. http://www.raysahelian.com/antipsychotic.htm retrieved on 16.01.11 http://www.wipp.nhs.uk/tools_gpn/toolu4_eg_reflective.php retrieved on 16.01.11. Hyland, M.E. and Donaldson, M.L (1989) Psychological Care in Nursing Practice. Middlesex Scutari Press, in Harrison A. and Hart, C. (2006) Mental Health Care for Nurses. United Kingdom: Blackwell Publishing Ltd. Johnson, D. (2008) Interpersonal Skills (Online) http://www.mtsu.edu/-jsanbom/iskills/interpersonal.htm retrieved on 16.01.11 Kathol. D. D. (2003) Communication in Kockrow, E. O. and Christen, B. L (eds) “Foundation of Nursing”, Missouri: Mosby. McCabe, C. (2004) Nurse –patient communication: an exploration of patients’ experiences. Journal of Clinical Nursing. 13(5). 41-49. Nazarko, L. (2004) Developing Skills to perfect art of communication. Journal of Nursing & Residential Care, 6(1) 8-12. Nursing & Midwifery Council (2004) “The NMC code of Professional Conduct: Standards for Conduct, Performance and Ethics”, Nursing and Midwifery Council, London. Peplau H. (1952), Interpersonal relations in nursing. New York: McGraw-Hill in Harkreader, H and Hogan, M. A (2004) Fundamental of Nursing: Caring and Clinical Judgement. Missouri: Saunders. Reusch, J. (1961) “Therapeutic Communication” in Eds Arnold E.C, and Boggs K. U, 2007, “Interpersonal Relationship: Professional Communication skills for Nurses, Saunders Elsevier, Missourie Sahelian R. (2005) Antipsychotic Drugs (online) Schofield I. (2002) Caring for Older People who have a hearing Disability, Journal of Nursing Older People, 13 (10) 20-26 Siviter . B (2004) “The Student Nurse Handbook”, Baillere Tindal, USA Stein-Parbury J. (1993) Patient and Person: Developing Interpersonal Skills in Nursing, Churchill Livingstone, Melbourne, in Eds. McCabe C. (2004) Nurse-Patient Communication: an Exploration of Patients Experiences, Journal of Clinical Nursing, 13(5), 41-49 Walsh M (2005) “Watson’s Clinical Nursing and Related Sciences”, 6th Edition, Baillere Tindall, China. White .L (2005) “Foundations of Basic Nursing”, 2nd Edition, Thomsan Delmar Learning, USA Wold G.H (2004) “Basic Geriatric Nursing”,3rd Edition, Mosby, USA Wood J.T (2006) “Communication in Our Lives”, 4th Edition, Thomson Wadsworth, USA Read More

 

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