The issue of therapeutic relationship - Essay Example

For a therapeutic relationship to become successful, it is critical that the patient and the health professional create and maintain channels for open communication. Open communication along with trust and honesty greatly enhances the goal of a helper in accomplishing the first step of the Skilled Molder Helper. A helper is entrusted with the responsibility of helping patients solve their problems by effectively guiding them using the Skilled Helper model that was proposed by Egan and Schroeder in 2009. In most cases, an obstacle to good storytelling is the identity of the interviewer since the clients are not comfortable with revealing sensitive information about themselves or their disease to a stranger (Egan & Schroeder, 2009). Stage one of the skilled helper model is used for the purpose of this interview. I interviewed one of my neighbors, Mrs. White, a 48-year old woman who was diagnosed with diabetes six months ago. I thought she would be an ideal person to interview as she is visits a diabetic clinic on a regular basis, and has had many experiences with healthcare professionals. I went to Mrs. White’s house, introduced myself and addressed her by the name she prefers. This is an important step in establishing cordial relations. Respect for clients is the foundation on which all helping interventions are built (Egan & Schroeder, 2009). Once I informed her of the purpose of this interview, she agreed to participate and told me that she would like to share the wonderful experience she had with her nurse Meera. We agreed upon a mutually convenient date and time for the interview and I promised to finalize the venue later. I then, booked a room in the community centre which was about a five minute walk from Mrs. White’s house and notified her about the decision. The venue was chosen due to its proximity to the interviewee’s house and also as it is located in a quiet neighborhood. Since I did what I could to fulfill my commitment, it helped me gain Mrs. White’s trust, respect and establish the beginnings of a therapeutic rapport with her that I would build on later. As it is considered courteous, I reached venue ten minutes before the fixed time and waited outside to greet her. When she arrived I asked her how she was doing. She smile and replied that she was well. Together we walked to the room and I tried to ensure that she felt comfortable. Appropriate light was maintained in the room according to the client’s wishes and I closed the door for privacy and to shut out distractions. Before starting the interview, I told her that the information she provided would be kept confidential and she was allowed to stop and withdraw her participation from the interview at any point of time. It is important not to disclose information about a client to other family members and/or friends without the client’s consent; even after the nurse-client relationship has ended (CNO, 2006). In order to establish a good visual rapport with the client, I was aware of my non-verbal behavior that I knew would affect the interview. According to Egan and Schroeder, the acronym SOLER - which stands for facing client Squarely, adopting an Open posture, Leaning towards the client, making Eye contact and being Relaxed during the interview - is useful to remember (2009). I began with an open posture and leaned towards Mrs. White but I felt uncomfortable sitting squarely, so I sat at an angle facing her. I checked with her if she was comfortable with my position and distance from her and she said she was fine. It helped me set the stage for the next part of the interview. Welcoming patient, introduction, providing privacy and removing any barriers to communication helps to set the stage for next steps for patient centered communication (Lien & Wills, -insert year of publication here-). I started with an open-ended question asking her how she felt about her experience at the diabetic clinic. I tried to avoid judgmental questions like “How good was the experience?” Regardless of the type of question, an implied value judgment should always be avoided (Scriabina et al., 2009). Her reply was as follows: I was very nervous during the first visit when diagnosed with Diabetes 2. I don’t know how it happened. I was always careful of what I ate. I was very scared until my nurse Meera cared for me that provided me with the information and emotional support I needed to get over the initial shock. I nodded in between, maintained eye contact and added empathetic phrases like “That must have been hard” at appropriate points to let her know I was attentive. Scriabina et al. (2009) maintains that, “People who make eye contact while speaking, are judged to be friendly, self-confident, mature and sincere” (Scriabina et al., 2009). Mrs. White continued with her story while I listened actively. To further explore Mrs. White’s experience I asked probing questions like why she thought Meera was a better nurse for her than the others. Probing question help to elaborate and clarify the experience better. According to Egan & Schroeder (2009), “Use of probes help clients engage as fully as possible in the therapeutic dialogue” and helps “to open new areas of discussion”. Mrs. White opened up and replied: Well, she was not like other nurses; she really cared for me, spent time with me in educating me about the disease. She had a lot of patience; spent hours and hours with me to make me feel comfortable [Pause]. You know, the hardest part for me was taking insulin shots myself. I don’t think I could have done that without her support [Facial expression of satisfaction]. She was such an angel to me. [Pause] I used to have another nurse and she was so busy and always seemed in a rush. She didn’t even listen to my concerns properly - didn’t even ask how I was doing. [Frowns and nods] I don’t think I could have coped with the disease without Meera. I listened for the core message (Egan & Schroeder, 2009). I was happy that the probers had helped explore and expand her story further. I also displayed active listening by being careful and attentive to whatever Mrs. White said. I noticed that her face changed from looking satisfied when she spoke of Meera and bitter when she mentioned the other nurses. It made me happy to be able to identify the client’s key experiences, behavior and key feelings and emotions during the conversation. According to Shipley (2010), “The nurse must make a conscious effort to listen with the purpose of understanding everything that patient conveys.” Shipley defines active listening as “giving free and undivided attention to the speaker” and proposes that it goes beyond “simple information gathering”. I was also able to make use of the pauses she made during the conversation. I conveyed my empathy by nodding and changing my facial expression appropriately and by simply saying things like “I see” during the pauses, while we waited for her to continue. The moment of silence worked to continue the conversation. Effective listening involves the ability to be silent, which allows patients the freedom and time to fully express their perceptions of experiences (Shipley, 2010). The use of verbal and non-verbal prompts in this way was useful to push her to talk more about the experience. After she was finished, I repeated the highlights of the interview by saying: You think that Meera is better nurse than others because she supported you emotionally with the diagnosis and spent enough time with you to help you train in getting insulin shots by yourself. She replied, “Yes, exactly that’s what I mean”. This tool of Empathetic Highlighting helped me understand Mrs. White’s experience better, by reinforcing her core message. Definition of empathy involves understanding emotional meanings of client from broad perspective (Clark, 2010). Mrs. White continued to air some of her grievances: Nurses should understand client’s perspective and is important to listen to their concerns. I asked one nurse about what kind of food I shouldn’t eat or eat. Nurse didn’t pay attention to my question and said she will come back later and didn’t come back. At this point of the conversation, I felt uncomfortable in maintaining eye contact, so I jotted down some notes for few seconds, instead. I resumed later to lean forward and make eye contact for rest of the conversation. I suspected for a while that she may have felt offended at my seemingly inattentive gesture, but she didn’t seem upset. According to Scriabina et al. (2009), “Sometimes you break the visual connection; to reestablish eye contact, lean forward as you ask your next question”. I also used Paraphrasing to assist Mrs. White in expanding her views on proper nursing with phrases like, “Since you didn’t get your question answered, you found them less caring”. This technique indicates that you are listening to your client, creates empathy and helps to convey the shared meaning clearly (Scriabina et al., 2009). She replied with, “No, no, that is not what I mean. It is not about the answering of questions, this is about caring for the client. Nurses need to understand how the needs of patients can be fulfilled.” In order to clarify it further, I asked, “What kind of needs do you think were not met? What should they have done to meet the needs of patients?” Mrs. White paused before answering; she looked confused and later asked me to repeat the question. I realized that I’d asked her two questions at once, which was confusing her. I apologized and repeated clearly, “What kinds of needs were not met?” She then began to speak about needs like proper education, guidance regarding diet, emotional support, and reference to proper community supports. This helped me fully understand her experience at the clinic with different nurses. I asked her if she wanted to discuss her experience with other healthcare professionals at the clinic. She replied, “I have no problems with other healthcare professionals in the clinic; they were good to me”. As I was anticipating ending the interview session, I asked her about the overall experience at the clinic. Mrs. White summarized the main points of the interview here. By knowing from Egan and Schroeder that helper does not always have to provide summary, it is better sometimes to ask client to pull together the major points (2009). It worked for me as Mrs. White summarized the significant points and ended by saying that nurses need to have caring attitude towards patients; much like what Meera did for her. The interview taught me a lot of valuable lessons, especially about our ways of communication. We often overlook the fact that communication plays a vital role in establishing therapeutic relationships. It is not enough to simply listen to the clients’ complaints about their illness or ailments. A far more important aspect is trying to understand what the client is trying to say through verbal and non-verbal clues. In this regard, I appreciated the value of silence as an effective means of deepening rapport by respecting the client’s recollection of experiences. Moreover, I had done my best to ask the right open-ended and close-ended questions that led me to certain important discoveries about the patient’s perspective. Aside from being an empathetic listener, it is also important to be objective and refrain from passing any judgment on the client’s perspective. The right amount of probing, the balance of speech and silence, and the relaxed but focused manner of interviewing the client eventually yields satisfying results. Overall, I learned from the mistakes I made during the interview. I learned the importance of maintaining proper eye contact and the refined skill of asking questions. Two questions asked simultaneously can confuse the client and act as a barrier towards therapeutic communication. This interview has facilitated me to understand the first stage of the Skilled Helper Model. Accepting these small drawbacks as part of the learning process is important in building a stronger future as a registered nurse and professional helper. 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