Communication Skills in the Delivery of Care - Essay Example

?Reflection Introduction This assignment aims to reflect on an achievement from the Module 9 outcome, which specifically is on: demonstrating effective communication skills in the delivery of seamless care: making referrals to members of the multi-professional team. This reflection aims to evaluate the importance of learning through experience. It is a reflection of an incident which required a referral to the occupational therapist to secure patient safety in the home and to improve the patient’s quality of life. This essay shall discuss an overview of the reflection and its overall impact on the nursing practice. This paper is based on an actual experience during my community placement with a patient I shall refer to as Mr. Smith (not his real name). To protect his identity and in accordance with patient confidentiality, his real name shall not be used in this reflection (Nursing and Midwifery Council, 2008). Reflective practice is the process of thinking about one’s actions in the clinical setting and taking responsibility for improving one’s professional skills. Taylor (2006) mentions that reflection allows a person to review the positive aspects of one’s actions in the clinical setting and to build on such achievements in order to identify areas which require improvement. The nursing profession is a dynamic and ever-changing profession and according to the Department of Health (DOH, 2004) and the Welsh Assembly Government (WAG, 2002), nurses have to expand their knowledge in order to improve their practice. A discussion by Jasper (2003), pointed out that knowledge gained from reflection fills in the gaps between theory and practice. This is crucial to nurses because continuous development is an important part of clinical governance (Royal College of Nursing, 2003). In effect, reflective practice helps improve the quality of care delivered to patients. The topic was chosen in order to demonstrate professional development in the communication skills seen in the delivery of patient care. This development would assist in evaluating patient advocacy in the multi-professional team. It would also help ensure that a nursing practitioner is able to identify the gaps in her communication skills with the patient. Gibbs, reflective cycle There are different reflective frameworks which were considered for this assignment; these frameworks also provide useful guidance in reflection. However, the Gibbs Reflective Cycle was chosen because it is familiar and helps provide a structured and simplistic cycle. Bulman (2008) however argues that the Gibbs Reflective Cycle is too broad and it implies an incoherent reflective process. Nevertheless, this reflective cycle is the most appropriate cycle to apply because it includes specific elements of the experience which allow reflective processes to change and improve clinical practice (Johns, 2004). In establishing a framework for reflection, it is important to note that the reflective process is an intellectual and an affective experience which involves the process of exploring one’s experience in order to successfully initiate change (Bulman, 2004). It is therefore important for a reflection to lead to change in one’s behavior and clinical practice. Without adequate guidance in the process, the student or learner might not be able successfully learn from the reflective process (Benner, 1994). With the guided help of my mentors and more experienced clinical practitioners they would help ensure that I would be able to pass through the reflective process and learn from his reflection. 1. Description of the event During my placement with the District nursing team, my mentor asked me to accompany her to a gentleman’s house in order to carry out an assessment and to explain what services were available. Before the interview, I dressed professionally and appropriately, making sure that my uniform was crisp and clean and my hair was arranged properly. The referral came from his wife, and not from the patient, as the patient was recently discharged from the hospital. The patient, Mr. Smith, is 76 years old and was recently diagnosed with lung cancer which had metastasized to other parts of his body. He lived in a large house in an affluent area with his wife and his daughter. However, there has been some recent deterioration in his condition and this has affected his coping levels within the house. I first asked him how he was coping with his daily activities, including his grooming, bathing, dressing, feeding, and in getting to and from the toilet. He said that he was finding it hard to get in and out of the toilet and was often too exhausted in taking just a few steps to the bathroom. He also had difficulty in bathing himself, he found out that he got tired and out of breathe too easily from just the simple act of bathing. He also suffered occasional bouts of weakness which made it difficult to carry out simple activities like eating and dressing. When asked how if his wife and daughter assisted him in his daily activities, he said that they volunteered to help him at times, but he did not want to be a burden to them. So he tries his best to do the activities himself; those he could not do, he just stopped doing. As a result, there were times when he failed to bathe himself and days when he just opted to wear the same clothes even when soiled. I also asked him if he received any forms of holistic care, including therapeutic massages and meditation and prayer with a religious or with the family. He said that every week his wife sometimes gives him a back rub, especially when his muscles are aching. A pastor from their church visits every Sunday, along with other church members. He gets his spiritual guidance from his pastor and from church mates. Based on the above interview, I thought an occupational therapist assessment would be beneficial to him as the OT would teach him how to carry out his daily activities. An OT would teach him how to work around his condition and to relearn how to bathe, feed, groom, and dress himself even with his bodily weakness and easily fatigability. The services of an OT are crucial to this patient because he manifests a risk for falls; an OT would help teach him how to carry out his activities safely. He needs the referral because the OT can also teach the wife and the daughter on how to assist the patient in his daily activities and for them to know what adjustments in the home can be made in order to ensure the patient’s safety, holistic care, and comfort. I then checked with my mentor and she agreed that a referral would indeed be necessary. One of the things I also noted during my interview was that the patient appeared anxious and nervous. When I asked him if he was feeling anxious about anything, he replied with a negative. During the communication process, I tried to listen attentively; I sat on a couch facing the patient; and I tried to pace myself and not hurry or rush through the interview. He was uncomfortable with touch, so I tried my best to be professional at all times and maintain a professional but still therapeutic distance. Before I arrived at the house, I discussed with my mentor that I had to demonstrate effective communication in referring a patient to the multi-professional team and my mentor agreed that this was a chance for me to do this. My mentor also empowered me and gave me autonomy by letting me 1 refer the patient. She observed how I questioned the patient and how I gained the patient’s consent for care. The referral form was checked after completion by my mentor to ensure that the form was correctly filled out. I documented in the patient’s notes that a referral was carried out. I then explained to Mr. Smith that the aides he needed would take a few days to be delivered. Feelings I felt satisfied with the trust mentor had in me; I felt apprehensive about the procedure because I was afraid I might make mistakes in the process. I did not want to fill in the form incorrectly or ask inappropriate questions. I felt anxious and tense about the process because I was being observed, but I also knew that I might not be able to carry out the procedure on my own, and I needed my mentor to guide me throughout the process. I also wanted to show my mentor that I would be able to carry out a high standard of care for the patient. I was confident that I demonstrated effective communication skills when working with other health care professionals. There were times when I found it difficult to communicate with the patient because he was not honest and forthcoming in his answers. He said one thing, but it was obvious that he was feeling the opposite. I felt that the patient did not trust me yet, and that if he does not trust me, I would not be helpful to him and I would not be an effective nurse. Moreover, I would not be able to get accurate information about the patient which can serve as basis for his diagnosis and subsequent treatment. While listening to the patient speak about his family, I felt that he was protecting them too much from the burden of his illness. From what he could tell me about his family, they were very supportive, but they were given limited opportunities to assist in his care. I felt that there is a way that they would also need the services of a counselor to assist them in bridging communication gaps. In communicating with the OT, I found it intimidating at first to talk with him because he was a health professional and an expert in his field. I found his status a bit intimidating. But he had a welcoming and open attitude which made the communication process easier and less intimidating. I felt that by specifying the issues I saw in the patient that I was more effective in communicating with the OT, giving him more accurate data about the patient’s needs. Evaluation The positive aspects about the experience were that I was able to gain more experience in interviewing and referring patients (Jasper, 2006). I found out on a first-hand basis the technicalities of carrying out an interview and what can actually happen during the interview. During my interview with the patient, I found out that communication is an important element of nursing (Sully and Dallas, 2006). When done appropriately, it eases the therapeutic processes of nursing into easier and adequate processes of treatment. Nursing is considered to be a caring profession and is evidenced by its application in practice. Since the scientific aspects of nursing are increasing as caused by the complicated technological advancements in medicine and machinery used in patient care, it is still nevertheless, the nurse who is the first person and often the last person to care for the patient. Caring is therefore an important element of nursing care, and it is an important quality which the entire health profession must also possess (Kimmel, 2007). With caring, it is important for the nurse to also facilitate therapeutic communication. According to Wilson, et.al., (1995), communication is the “process of transmitting messages and interpreting meaning”. Through communication, the sender, in this case – the nurse – seeks a logical response from the receiver (the patient), a response which must be beneficial to the patients’ mental and physical health. In this case, I sent the message and the patient received such message; the patient also sent a message to me and I became its receiver. I determined that this is a complete cycle of communication with an appropriate feedback process manifesting in the patient-nurse interaction. In most situations, most everyone uses communication (Kimmel, 2007). It is part of the natural social process of humans; and in the correct application, it can achieve therapeutic ends. It is important for a nurse to be aware of the emotions which a patient is manifesting because these emotions and expressions will be able to indicate what is going on physically and emotionally with the patient (Rosdahl and Kowalski, 2008). This is the so-called non-verbal communication where a patient is saying one thing, but feeling another. The nurse has to learn to detect and interpret such non-verbal cues in order to be an effective nurse. The non-verbal communication was seen several times during my placement. I often encountered patients who said one thing, but actually meant another. While interviewing Mr. Smith, I asked him if he was feeling anxious and he said he was not; but I could sense from his actuations that he was experiencing anxiety over his condition. I wanted to draw out a more honest answer from him, but I did not know how. Nevertheless, I noted in the patient’s chart the non-verbal cue that I observed from the patient. The negative aspects were that that it exposed me to a situation for which I was ill prepared I had to confront my inexperience and this challenged my training as I felt unprepared. I discovered the importance of communication and the need to ascertain all of the facts. Interview skills are one of the most important elements of an effective interview process is the establishment of rapport with the patient. Rapport is largely based on respect for one’s patient (Basavanthapa, 2003). When a healthcare professional has respect for his patient, he would treat him accordingly – greet him at the start of the interview, call him by his first name, shake his hand, carries out casual conversation with him, etc. By applying these activities in the interview process, the patient is able to relax and to be more open and trusting with the health practitioner (Basavanthapa, 2003). A trusting and open patient would be easier to communicate with and would be more cooperative about the important, even the embarrassing or private details about his life or his health. Analysis What sense I could make out of the situation is the fact that there is a major difference between the theoretical and the actual clinical setting. It is one thing to be taught about the elements of the nursing practice in the classroom setting, and it is another thing to actually apply these elements in the clinical setting. I found sense in Jasper’s (2006) statements when he claimed that professional development is a continuous process that starts in the first year as a student and continues throughout a nurse’s career. In the process of all these procedures unfolding in the actual setting, communication is a crucial element in the nursing practice. Aside from what the patient is communicating verbally or non-verbally, the nurse has also to be highly aware of the messages she is putting across to the patient in terms of both verbal and non-verbal cues. In effect, a nurse who appears to be rushing through the nursing care with a patient would appear disinterested in the patient’s eyes (Kimmel, 2007). The patient narrated how a previous nurse seemed to be hurrying through her interview with him, and this prompted him to ask me if I had somewhere else I had to go. I assured him that my complete attention was on him. I noted how he was pleased by that; he said that he felt that the other nurse did not give him enough attention and in effect did not really understand his condition. I learned through this interaction that disinterest may significantly turn off the patient and make him uncooperative to the therapeutic processes being carried out in his favor. I found out that I must therefore take her time with her patient – enough to ensure the establishment of a therapeutic relationship with the patient, and not too much as to cause discomfort and awkward moments. I also found out how powerful and therapeutic simple gestures are and that I could be as therapeutic to the patient by simply holding his hand, gently touching his shoulders, or just simply listening to him. I was also aware that how I looked to the patient was also as important as what I said and did for the patient (Rosdahl and Kowalski, 2008). A harried and rushed looking nurse may appear exhausted to the client; this can cause doubt in the patient as regards the nurse’s ability to render effective care. In this case, there is nothing that the nurse can say to the patient which the latter would believe (Kimmel, 2007). And so I endeavored to look my best when I met with the patient – with my hair in order and my uniform clean and properly ironed. I found out through my appearance that I could display qualities of professionalism, confidentiality, courtesy, trust, availability, empathy, and sympathy (Potter, et.al., 2003). In the multi-professional practice, communication is also a crucial part of the nursing and medical practice (Pollard, 2005). Therapeutic communication with other health professionals can be secured through an open and engaged relationship. In my communication with the other health professionals, especially with the occupational therapist, I did my best to demonstrate professional respect and awareness. I accomplished this by understanding the nature of occupational therapy and identifying his professional responsibilities and the boundaries of his responsibilities (Docherty and McCallum, 2009). I also tried my best to be assertive when I saw an imbalance in the power and responsibilities between myself and the occupational therapist (Ellis, et.al., 2003). I knew that a nurse cannot allow herself to be dominated by other health professionals, including the OT because the consequences for the patient would not be beneficial. I also knew that it was important for me to be aware of the jargons being used by the occupational therapist (Docherty and McCallum, 2009). I had to review these technical jargons in order to ensure that I could follow the discussion and the actions being suggested by the OT. I was aware that I must be able to give appropriate responses to these actions in behalf of the patient and with the patient’s best interests in mind. I knew that I cannot be a patient advocate if I cannot protect the patient from inappropriate interventions from the other health professionals. I also became highly aware of the fact that it is important for me to become familiar of the local channels of communication between the different health professions, which may include paper, electronic, and telephone systems (Docherty and McCallum, 2009). This process would help make the communication process faster and more orderly. I found out that different health professionals had different processes in making referrals. Among the OTs, it was important to get in touch with the OT’s supervisor through a face-to-face meeting, discussing with the OT what the patient needs are and the referral for an OT. The formal referral form had to be submitted to the OT supervisor who would now assign an appropriate OT to the patient. It was important for me to fill up all the referral forms completely and correctly. In the process, the OT supervisor could make proper recommendations, diagnosis, and assessments of the patient’s condition. There are protocols and standards for different professions when communicating with each other. Knowing how such standards are applied would help ensure that the nurse would be entertained and would not interfere with the normal work patterns of other health professions. Furthermore, I discovered that it was important for me to share information appropriately with other health professionals, including the OT (Doyle, et.al., 2005). I knew that informed consent would apply in this situation and so I sought the patient’s consent to share his information with the occupational therapist. In considering Benner’s novice to expert model, I was able to review my development from a novice nurse at the beginning of my clinical placement as a student nurse until my growth as an expert nurse at the end of my placement. At first, I had no experience in dealing with patients, and I mostly had to refer and look to my mentor for guidance while carrying out the interview process with the patient. As I was immersed more into the interview processes and patient interactions, I became an advanced beginner. An advanced beginner is someone can demonstrate a marginally acceptable performance; who notes change but does not know how to cope with it; and needs help setting priorities (Registered Nurses Association of Ontario, 2005). With more exposure and experience, I advanced a step further into a competent nurse, someone who is more aware of the important elements of a situation, who sees actions in terms of long-term goals, who can set priorities, and who is more conscious of deliberate planning (Registered Nurses Association of Ontario, 2005). As the clinical placement progressed, I was able to register proficient skills as a nurse. I now saw things in a larger setting and to evaluate what was important in any situation. My decision-making was less labored and I was able to use various guidelines for guidance (Nurses Association of Ontario, 2005). By the end of my placement, I was able to advance to an expert status. As an expert, I did not anymore have to rely on rules and guidelines, instead, I had a more intuitive understanding of situations founded on my deeper understanding of the situation. I was also able to envision now what was possible in any situation – not only did I see the bigger picture, I could predict and project possibilities in any situation as well. In circumstances when a client is receiving therapeutic communication from the nurse, he would be able to establish a deeper trust with the nurse and their physiological symptoms can be improved, including their blood pressure, heart rate, breathing, and levels of stress (White, 2005). In these instances, the nurse can then gain a better perspective of the patient and his feelings and the adjustments which can be made to ensure that adequate care can be delivered to the patient. This reflective practice with the assistance of a mentor was emphasized by Spouse (as cited by Bulman, 2004) who pointed out that “student nurses require the support in relating theory to practice and that it is the mentor who is essential in helping the student to make connections between the two components of patient care”. By helping the student through the clinical experience, he can also help the student make sense of his responses and emotions during the clinical encounter with the patient (Jasper, 2006). Conclusion I found out that there is much which I should have done. I should have been tried to build more rapport with the patient during the interview process. I know that building rapport would have assisted me and the patient in making the interview process easier and less stressful. As was previously discussed, rapport can be built in the following ways: greeting the patient, using his first name, casually talking with patient before actual interview; it may also include listening to the patient, empathizing with the patient, and maintaining eye contact when necessary (Blais, 2006). Establishing a less intimidating stance with the patient can also assist in establishing rapport. Being too close can make the patient close up and be defensive, this can happen too when the nurse is too far away from the patient (Blais, 2006). An arm’s length distance is the ideal distance which can be adopted in order to ensure therapeutic communication. When the patient is seated, it is best for the nurse to also be seated; when he is standing, the nurse must also stand; and when the patient is lying down, the nurse can sit by the bed (Blais, 2006). This would help make the communication process less intimidating and less distant from the patient’s point of view. Communicating with the OT could be accomplished by applying important protocols and by respecting the OT as a health professional. Action plan I demonstrated how working with my mentor has resulted in my achievement of the module 9 outcome for future practice. I was also able to establish my strengths and weaknesses and the moves I can make in order to improve my weaknesses and maintain my strengths. In the future, if the situation would arise again, I think I would take more time to establish rapport with the patient. I would do this by approaching the patient smiling and extending my hand for a handshake. Then I would sit with the patient and call him by his first name, discuss the weather or some other casual topic. When I feel the patient is able to relax and is feeling more comfortable, I would then slowly ease into questions which are essential to his care. I would ask him how he is doing with his daily activities – if he is having difficulty performing them and which activity he is finding the hardest to carry out. After gathering data about the patient’s daily activities, I would then make a recommendation to the occupational therapist – narrating to the latter what the patient needs may be and what the patient needs in order to regain control of these activities. I would coordinate with the occupational therapist in planning the patient’s care based on my observations and my patient interview. By applying these processes in the future, I would be able to ensure that a therapeutic process is ensured before and after the communication with the patient. Works Cited Barrett, D. Sellman and J. Thomas (Eds.) Interprofessional working in health and social care: Professional perspective. Basingstoke: 2005. Ch. 1, pp. 7-17. Basavanthappa. (2003). Medical Surgical Nursing. New York: Jaypee Brothers Publishers. Benner, P. (1994). 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