The Nursing Care of Jane Smith - Personal Statement Example

The Nursing Care of Jane Smith: Using the Rolfe et al (2001) Reflexive Practice The answer to what appears to be the problem why we cannot get along is basically rooted in the difficulty in establishing communication. Jane Smith appeared reserved at all times. She does not readily respond to greetings and this made it very difficult to break the ice. My role in the situation is try to be a friend and confidant. For some health workers, this role is beyond my concern. For them a nurse must only minister to a patient's needs. But according to the Florida Hospital College of Health Sciences (FHCHS) "caring for a patients emotional well-being can have just as beneficial an impact on patient care." As a friend, I can minister to her emotional needs. Sometimes we just need somebody to talk to so that we can unload what has been bothering us. Once, I have gained her trust then she can tell me more personal things -- things that may have a direct or indirect relation to what caused or is causing her illness. It is an established fact that cases of abuse in the home, school or workplace has been discovered due to the incident reports, record keeping, and even private journals of nurses. The primary requisite to become a confidant is to win the patients trust. FHCHS has observed that "for a patient to disclose private or embarrassing details about their physical or mental condition, they need to first trust that their nurse will treat them with dignity and respect." Knowing my role and what I have to achieve, I had to act within the indeterminate time that I have been given. There is no certainty how long Ms. Smith will be staying in the hospital so I had to act immediately. The first task is to break the ice between us. This proved to be quite difficult because of her unresponsiveness. I tried to spend more time in her room to check on her, straighten her beddings, move the curtains to allow a patch of sunlight in the mornings, at times just to say "hi!" or to ask if she needed anything. I had even gotten into the habit of passing by the minute I started my rounds and even at the end of my shift. I had hoped that this would break the ice. But nothing happened. I tried to make a connection through the visitors that came. But even when she saw that her family and I were in good terms, she still remained unresponsive. Her family welcomed my sincerity and advice. They would even call or pass by during my break hours to just talk. For me, these talks gave me a deeper understanding of Jane. I felt relieved to find out from her relatives that she was just reserved because she was the cautious type and not because she was judgmental of other persons. I also found out that we shared certain commonalities that I know could be points of conversation that can make our friendship work if she just reaches out. She made the first move today. Today she smiled as I entered her room. I smiled back and instantly knew that things were going to be different. As I straightened the covers of her bed, she asked that I sit next to her. I cracked a joke to keep the happy atmosphere afloat. Perhaps she just wanted to say farewell since the Consultant has given approval for her to go home. I was surprised that she suddenly opened up. She had started to tell me of her situation at home. But as sudden as she started she also suddenly clammed up when the ward nurse asked for my assistance. I excused myself for I had to first see to the task at hand. I tried to finish fixing the beddings in the ward as fast as I could so that I can continue with my conversation with Jane. I was excited to go see her again hoping that I have finally gained her trust. But when I came into the room, she was again reserved. I tried to coax a conversation out of her by again starting a joke but she did not respond to that. It appears I have lost the momentum. I lost the opportunity to be a friend, to be a confidant and to help her emotionally. I felt so sad because I know that I could have helped her. My feeling of sadness became worse when I realized that she may leave at any time and there would be no more opportunity to revisit our conversation. The second phase of Rolfe et al (2001) Reflexive Practice is the "So What." Faced with the current state of affairs, answers to the "so what" provides the evaluation of actions I have taken, my attitudes, the patients attitude, and the state of our relationship. Ms. Jane Smith taught me that there are persons who do not easily befriend others. They are cautious and are reserved. There is nothing wrong with that. It made accept that each patient is different. It made me realize that I am approaching not just patients with no-names but individuals. Individuals that come from different situations in life, having different concerns and thus the approach for each one is never the same. The experience with her proved that showing physical presence is important. The non-verbal act of smiling and just being there showed empathy and support for her. The Book on Psychiatric Mental Health Nursing (PMHN) is right when it emphasized that the facial expression, touch, body movements and eye behavior are means of nonverbal communication. These can be effectively used to reach out to patients. I used it and it worked. I followed it up with their "Therapeutic Communication Techniques" on silence, giving recognition and offering self. As applied to Ms. Jane, I was initially silent to allow her time to get used to me and to make the first move. Accordingly this is good for the patient does not fear or feel intimidated. She was given the control on whether to pursue a friendship or not. I also gave her due recognition. I made her feel important by straightening her bed and the small acts of concern like letting the sunlight stream in for additional comfort and sense of rejuvenation. I also offered myself to her. I made myself available to her. I passed by as often as I can thus giving her the opportunity to call if she wanted to talk. Finally, the casual words of greeting and offer of assistance done as often as possible did help in breaking the ice between us. As I did all these, I was focused on my goal to become a friend and confidant. I read on communication techniques and applied those that I think would work with persons having the same personality as Ms. Jane. As I read, I combined what I had observed in the previous patients that I have handled. The experience I had with them enabled me to make a general classification of patients. One of these is the patients that are reserved and would not easily open up such as Ms. Jane. But of this general classification and the possible techniques that would apply to them, I made a deviation. This is a minor change to make the technique more applicable to Ms. Jane's needs. I knew she liked the sunlight so I let it stream in the room in the mornings. I also knew she liked to read the news paper so I made sure I brought it into her room everyday. All these small touches of caring did work. Aside from using the scientific approach by doing readings on communication and adding my experiences with other patients, I also used my personal observations on the reactions and facial expressions that Ms. Jane shows regarding my actions. I was able to obtain feedback and which help me find out what she liked and did not like. I also prepared for our eventual conversation. I followed the advice embodied in the PMHN book on active listening. I remembered how I should act using the acronym SOLER ( S- sit squarely squarely facing the client; O- observe an open posture; L- lean forward toward the client; E- establish eye contact; R- relax). In the short time that we had our conversation, I felt this worked. I could tell if she was telling the truth for I could look her in the eye. I had easy access to hold her hand or lend a shoulder if she needed one to cry on. I could lean forward to establish interest and maintain the air of confidentiality. Perhaps what I should have done was to read also on how to react in the event that the conversation was disrupted. Honestly, I was not prepared. I just stood up and I was at a loss for words. I did not know what to say but just to convey that I will be back as soon as I can to continue with our conversation. I thought I was ready but this situation suddenly arose. I think I should have held her hand or patted her shoulder to establish a contact of sincerity. Sometimes we need that human contact to get approval or affirmation that what we have said is alright and is acceptable. I should have reached out and extended that nonverbal contact to give reassurance. Then, perhaps conveyed that we will talk about that again. At least by doing so, I could have conveyed genuine interest and concern. This is the correct response to the situation as affirmed in the Communication in Nursing of the University of Villanova. Accordingly part of communication strategies are "strategies that insure mutual understanding" which includes acts meant to clarify, validate, implied thoughts and feelings which are exemplified in a nod, a touching of the hand or shoulder. I failed to give that reassurance and now all the work I have put to gain her trust might just go to waste. But, I am hoping that we will again have the time to revisit our conversation. The third and final stage of Rolfe et al (2001) Reflexive Practice is the "Now what." I still feel sad because all the effort might have been in vain. I can continue to try and make contact with her. While she is still in the hospital, I will continue with the non verbal communication that I have started. I will make myself available to her more. By living in my hope of still being able to reach to her, I will feel better knowing that I at least did not give up. I will continue to pray for her as prayer is a mightier force. God can reach out to her more than my human efforts. My continued prayer is for God to continue to use me as a tool to help others especially my patients. God can make my patients see that they can trust me. They can trust me to treat them with dignity and respect. According to FHCSH, only when I have obtained my patients trust can they tell me the all the details about their physical or mental condition. And, if they trust me, then they will follow my advice and value my opinion. "This careful balance of trust and professional respect is the founding principle for a healthy nurse-patient relationship." This is what all nurses aim for. According to Conceptual Framework of the Nursing Program at the Community College of Rhode Island, "the nurse-patient relationship is the foundation for caring practice. Caring is a force for protecting and enhancing patient dignity. The nurse affirms patients as persons rather than objects, and assists them in making choices, and finding meaning in their illness experience." I now fully understand the totality of our profession in that we give "comfort and healing, health and medication teaching, listening and psychological and spiritual support." After the experience with Ms. Smith, I have truly found the calling and embrace it wholeheartedly. Sources: Communication in Nursing. University of Villanova. Retrieved on 7 July 2010 at http://www06.homepage.villanova.edu/elizabeth.bruderle/1103/communication.htm Consensus Statement on Emerging Nursing Knowledge A Value-Based Position Paper Linking Nursing Knowledge and Practice Outcomes USA Nursing Knowledge Consensus Conference, 1998 Boston, Massachusetts. Retrieved on 7 July 2010. Pdf file. Conceptual Framework of the Nursing Program. Community College of Rhode Island. Retrieved on 7 July 2010 at http://www.ccri.edu/nursing/concept.shtml Nurse-Patient Relationship. Florida Hospital College of Health Services. Retrieved on 7 July 2010 at http://onlinenursing.fhchs.edu/news/nurse-patient-relationship/ Rolfe, Freshwater and Jasper (2001) Framework for reflexive Practice. University of Cumbria. Retrieved on 7 July 2010 at http://www.cumbria.ac.uk/AboutUs/Faculties/FacultyofHealth/Schools/SchoolofNursingandMidwifery/LearningBeyondInitialRegistration/LBIR/Camhs/Reflective%20Practice.aspx Therapeutic Communication, Chapter 8. Psychiatric Mental Health Nursing (2009), 6th Edition. F.A. Davis Company. Read More