Reflection on Patient-Centred Communication - Essay Example

Patient Centred Communication Introduction Communication in health care is considered as one of the most fundamental elements in health care (Moore & Steelman, 2012). This is because every aspect of healthcare interaction is highly dependent on effective communication. From making an appointment, registering with a health care facility, description of symptoms, discussion in interventions and treatment depend on effective communication for both parties involved to be able to develop a common understanding and the necessary solutions (Mazor 2012). In nursing effective communication is considered possible when it is responsive to the needs, values and preferences of the patients. Inasmuch as patient-centred communication is often described in terms of individual nurse-patients interaction, there are different ways through which health care facilities can enhance this approach to communication. This is considered a possibility when such facilities incorporate patient centred strategies in reaching patients who may not have the ability of understanding standard communication (Chewning et al 2011). It is possible for patients to be a satisfied with other elements other than communication such as wait times (Chewning et al 2011). The demonstration of behaviour such as active listening, nodding head, effective response in the provision of detailed information and the demonstration of high-level affective behaviour helps in improving the possibility of patient satisfaction in patient- centred communication (Moore & Steelman, 2012). The main objective of this essay is to provide detailed reflection on patient-centred communication. This will include the selection of a scenario in one of the local tertiary hospitals. The people involved in this sceneries are a 53 year old patients and I. To realize the objective of this reflection essay and uphold the confidentiality of the patients, the patient’s name will be kept anonymous. This is in accordance with the Oman Nursing and Midwifery Council Guidelines (ONMC 2011). The Oman Nursing and Midwifery Council Guidelines state that the health practitioner has the responsibility of ensuring that any kind of information concerning the patients or client is kept confidential. Patients centred communication The definition of patient-centred communication can be in terms of the processes and outcomes of nurse-patient interaction. The objective of this approach to communication is to elicit an understanding that validates the perspective of the patient. This includes the concerns, feelings and expectation of the patient (Levinson et al. 2010). Through patient centred communication, it is also possible for the nurse to develop an understanding an understanding of the patient with his or her own psychological and social setting. This will facilitate the process of reaching a shared understanding of the problems faced by the patient and in the development of effective interventions. In the process of building, a stronger patient-clinician relationship, patient centred communication also helps a patient in sharing power. This is because it offers the patient a platform for meaningful involvement in making decisions that relate to his or her health (Levinson et al. 2010). The development of the patient-centred communication approach was a based on the understanding that for communication to play a contributory role in healing and the reduction of suffering among patients, health care providers and the patient must have the ability of engaging in communication behaviour that contribute to the objectives of patient-centred care (Levinson et al. 2010). During the communication process, the patients are often motivated to interact and this increase their ability to develop sufficient knowledge, high level self-awareness and understanding on that which is required for effective communication (Levinson et al. 2010). Being a humanistic approach to psychology, patient centred approach as propounded by Carl rogers must always focus on the experiences of the client as opposed to hat of the health care provider who uses his or her expertise in telling the patient what to do or explaining their problems. The effectiveness of any healing process according to Carl Rogers is highly dependent on effective communication between the patient and a health care provider (McCabe & Timmins 2013). The role of the health care provider during this process is to provide an explanation of that which uses the patient’s understanding and prevailing conditions in the development of an all-inclusive solution to the existing problem. For Carl Rogers, in patient centred care and communication, the healthcare provider has the responsibility of demonstrating empathy to the needs of the patient (Saha and Beach 2011). This will help in the development of effective solutions because he or she will develop an understanding of the situation from the patient’s perspective. The health care provider must also be genuine by demonstrating congruence. In addition, he must also demonstrate unconditional positive regard by being non-judgemental (Roberts and Bucksey 2007). The benefits of patients centred approach over other approaches to communication is that it provides the patient with the power of harnessing natural self-healing especially when making decisions about their lives (Lown and Manning 2010). In addition, it is also a platform of demonstrating the power and the abilities of the patient to the development of self-generated solutions to personal problems (Epstein et al 2005). Patient centred communication is also essential in enhancing the quality of health care received by patient considering that the nursing practitioner has the ability of making health decisions according to the prevailing conditions and an understanding of the needs and concerns of the patients. This will ensure that the resulting interventions are tailor made to fit the requirements of the patient (Epstein et al 2007). Aim This assignment is a reflection essay that aims at reviewing an experience of practice to provide a description, analysis and evaluation as a way of informing learning about the practice. Reflection is a methodology used in changing individuals and their activities by encouraging extensive thoughts on possible alternatives and solutions to existing problems (Chong 2009; Pearson 2012; Howatson-Jones 2013). This approach promotes individual and proficient skills. Furthermore, it provides organised examination of perceptions, knowledge and skills. This explains why it is the foundation of continuous professional development. The essay will use Driscoll’s reflection model. This approach seeks answers to three questions that define its three stages: What? So what? Now what? In “what” the study will provide a detailed description of the situation. In “so what” the study will engage in an in depth analysis of the medical context describe (Howatson-Jones 2013). In “now what” the study will address new information airing from the medical situation that could be used in enhancing patient-centred communication in future (Howatson-Jones 2013). This will involve a description of the positive and negative elements that occurred during a practice and the development of an action plan based on the practice. The selection of this model was based on the understanding that it provides a critical platform of evaluating the selected screener during the practice by providing sufficient answers to the three questions. This reflection essay will evaluate the essence of patient centred communication in nursing through the incorporation of different communication approaches that can be used by nurses and other health care workers when communicating with patients. The study will use Carl Rogers, John Heron and Egan approaches on communication. This is because they provide a platform of understanding a patient through different perspectives that are derived form a problem solving approach to the challenges that patients face. Scenario The selected scenario occurred in one of the local tertiary hospitals. People involved in the scenario are a 53 years old patient and I. For the purposes of this assignment, and to maintain patient confidentiality, the patient’s name will be kept anonymous according to the Oman Nursing and Midwifery Council Guidelines (ONMC 2011). The patient will be called ‘Mr. Ali’. Mr. Ali had been operated for right toe amputation two days back. Currently he is receiving antibiotics (Tazocine injection). He had been recommended for a transfer to the regional hospital for continuation of antibiotic. However, he refused to be transferred to any other hospital and wanted to stay in the local tertiary hospital without stating a clear reason. Before approaching him, he looked restless and agitated. I was able to notice his restlessness because he was trying to make a telephone call but the receiver was not responding. From the way he was holding his mobile phone it was possible that he would throw it away considering that it was not serving his intended purpose. The agitation and restlessness resulting from his ability to communicate while on the wheelchair meant that there was something he wanted to say but there was no one to speak to and that why the person on the phone could have been the best option. His facial expression conveyed anxiety while his voice while trying to speak to himself indicated disappointment and agitation. He was trying to make a call. I became anxious at the beginning, but then I controlled the anxiety and stood quietly in one of the corners observing his next move.as I was standing I thought of my responsbility as a nursing practitioner to calm him down and help in developing solutions to the problem that he was facing. As was thinking of the best approach that I could use he suddenly said, “I hate mobile phones, when you need someone to help you they are never available.” Immediately I knew that Mr. Ali was in need of urgent help and I had to act fast in reducing the tension that he had about the seemingly unknown scenario. I approached him with a calm tone of voice greeting him, and put one of my hands on his shoulder. You: How are you today Mr. Ali? Mr. Name is Malik Hassan and I am one of the nurses in this hospital. Mr. Ali: I am fine but my mobile phone is inhibiting my ability to communicate. You: Oh sorry, I have just noticed that we are standing on the way, allow us to move to a safer place then you can tell me more about the mobile phone, maybe I can help I took Mr. Ali to one of the rooms as a way of ensuring privacy and creating an environment where we could engage in an open conversation. The environment in the room was relatively quiet and I pulled one of the chairs and sat in front of Mr. Ali to start a conversation. My closeness to Mr. Ali was an attempt of demonstrating that I was empathetic enough and that I understood his situation. I sat in front of him and listened nicely and actively as I used both open-ended and closed questions to try to get him to speak about the real cause of his restlessness and anxiety. You: what is it about your mobile phone? Mr. Ali: I really need to speak to a doctor in my village about my condition and the best alternatives he may use to facilitate my healing process You: is that why from your facial expression you look anger and worried? Mr. Ali: Yes. You see before I was admitted and later my right toe amputated here, that doctor used to treat me and from his works was fine. Right now, I have been informed that I have to be transferred to the regional hospital to continue with treatment. You: so what worries you the most? Mr. Ali: The fact that I will be transferred to the regional hospital and you know the popular notion is that the Tazocine injection given at the regional hospital is of low quality unlike the one given here at the tertiary facility. You: So how was the doctor in the village going to help you acquire the high quality Tazocine injection? Mr. Ali: He knows his ways around the hospitals and he knows people who can supply the right medicine to his health care facility. I trust him more than the regional hospital. As Mr. Ali was speaking, I was nodding and maintaining eye contact to ensure that I captured his attention and I had the time to listen to more of his concerns You: Have you ever heard of the Ministry of Health? Through its team of qualified medical personnel and extensive research, they provide high quality medication to all public and private medical facilities in the country. This means that all the medicine including the Tazocine injection is produced form one source. The antibiotic you receive here and the one you will receive at the regional hospital are the same in terms of high quality and efficiency Mr. Ali: How can I know that you are telling the truth? You: I am a nurse and part of my mandate is to understand how drugs are produced, the production point, and usage. This is the only way that that I can know how to administer the right drug to a patient. Mr. Ali was nodding and from his sitting position, he seemed relaxed. Furthermore, as I was explaining issues about my mandate, I could see that he was smiling as an assurance that he was getting solutions to his concerns. In summarizing the conversation, I had demonstrate that he was convinced You: Do you have any more questions? Mr. Ali: No actually, I was worried because initially I did not have the information that you gave me about the drug and the ministry of health You: Ok, I see. Then what is your decision? Mr. Ali: I will go further on the process of transfer. Analysis and Evaluation (So what) From the practice scenarios, it is noticeable that the client was concerned about the nature of treatment and health care that he would recover if transferred from the tertiary facility to the regional hospital. This was based on a misplaced assumption that the quality of Tazocine antibiotic injection that he would receive in the regional hospital would be of lower quality compared to that provided in the tertiary facility. Issues surrounding the referral of patients to other hospitals for better care often cause some form of anxiety and discomfort among patients because it raises questions on the level of care that they will receive and the ability of doctors in the referral facility to understand the problems and concerns of that patient. Failure by the nurses in a hospital facility to provide patients with sufficient information on matters related to their health care can be considered as a negative reflection of patient-nurse communication (Pearson 2012). The main role of nurse-patient communication in any healthcare facility is top understand the situation, and problem by engaging in an all-inclusive solution finding initiative. This approach to communication is only possible after the development of a rapport between the parties concerned (Brown et al 2008). A rapport is important in the development of any form of relationship because it helps patients in the development of the element of trust towards a nursing practitioner such that become comfortable enough to share important details about their worries and concerns (Levinson W, Pizzo 2011). Through the development of a rapport, it becomes easier to engage in effective communication since there is a reduction of tension in the patient’s environment. In any field of communication the development of an effective communication relationship between a nurse and patients can be developed through verbal and non-verbal communication characterized by vocal behavior, eye contact, body language and facial expression when interaction with patients (Baerheim et al 2007). Inasmuch as patient centered communication requires the creation of a rapport between a nursing practitioner and a patient, it is important to note that there are other factors that must be considered prior to engaging a patient in any form of interaction (Morrissey and Callaghan 2011). These include the patient's health conditions, existing hospital routine procedures and the prevailing socio-cultural factors and psychological factors. These are important because they define a patient's mood, understanding, and ability to accept the involvement of other individuals in his or her affairs (Levinson et al 2010). I was able to build a good rapport with Mr. Ali because of my ability to identify that the restlessness and anxiety that had characterized his behavior could be used in defining the prevailing circumstances. Through self-awareness, I understood that just like any other person, Mr. Ali has his own problems but he can be helped through the provision of platform for communication and sharing of ideas. The approach that I gave to Mr. Ali was essential in reduction of the tension that existed and introduction of a platform that allowed for openness in communication. This was possible because I was empathetic enough to assure Mr. Ali that I understood that he had a problem, I was only there to listen to the problem, and together we would develop a solution. In any form of communication, active listening plays an essential role with regard to improving the nature of relationship between the parties involved in the communication process (Weiner et al 2013). This explains why in a hospital setting, the nurse has the responsbility of understanding the psychological and physical needs of the patients before making any decisions on matter related to their wellbeing (Ayanian et al 2005). One way by which a nurse can demonstrate some level of attention to these needs is by appearing to be listening to the patient and showing concern by responding to these needs. An attempt to ignore these needs will affect ability of the patient to acquire satisfaction and healing since it interferes with nurse-patient relationship by isolating the patient (Chewning et al 2012). As soon as I was able to that the patient was in distress and was in need of urgent help as was revealed by his restlessness and agitation, I decided apply patient centred communication approaches on Mr Ali by using Egan’s three states in solving the problem. To establish a conversation, I approached whim with a clam tone of voice and greeted him. The use of a calm voice was to build a rapport. A clam voice is an essential tool that can be used in the provision of comfort and some sense of security to a patient (Tallman et al 2007). I did not use touch as an elements of rapport creation and in developing a rapport with the patient based on the belief that as a nurse I have the obligation of respecting and upholding a patients cultural and religious preferences (McEwen and Kaszewski 2010). In some religions, the use of touch is prohibited and therefore took my approach relatively safer and highly effective I used voice to bring the patient to attention and ensure a reduction in his anxiety levels (Arnold and Boggs 2007). Rogers style of empathy and genuine According to Carl Rogers the relationship between a patient and a healthcare practitioner, I can only be effective when the latter is congruent, unconditionally positive and accurately empathetic with regard to understanding. Congruence Rogers considers congruence as the most essential attribute because it implies that the health care provider is genuine when interacting with a patient. According to Rogers, a congruent nurse is authentic but not self-actualized. This is based on the understanding that in patient-centred communication, the relationship between the patient and the nurse in the communication process exists in a continuum (Riley 2012). In my practice setting, I was able to demonstrated high-level congruence by approaching the patient in a calm tone of voice and creating and explaining to him that I had noticed his anxiety and discomfort. My congruence was also demonstrated when I told the patients the truth about the manufacture and distribution of the antibiotic by the government. This was one way of instilling confidence in the patient concerning the quality of health care and provided by the Ministry of Health. Accurate empathetic understanding This refers to the ability of the health care provider to understand accurately and sensitively the feelings and experiences of a client in context (Roter et al 2006). This approach to understanding implies that the health care provider will sense the feelings of the client as if they were his own without losing focus (Ley et al 2009). To demonstrate that I was empathically concerned about the wellbeing of the patient I stood as a close as possible to him and listened carefully to his concerns without being judgemental on the possible cause of his worries and concerns. Heron’s style of authoritative and facilitative John Heron’s framework of communication provides a technique of analgising the process of delivering help. The model operates on the categories of authoritative and facilitative (Stickley 2011). Delivering help using authoritative approach means that the person helping is giving information or suggesting what the person being helped should do. In facilitative intervention, the helping person is instilling self-confidence, drawing ideas and solution from the other person as a way of helping him solve his problems (Stickley 2011). When I was interacting with Mr Ali, I was able to employ both the authoritative and the facilitative approaches as propounded by Heron. In the nursing field, I have the authority of communicating information to a patient. This explain why while using the authoritative approach I applied the prescriptive intervention by advising Mr Ali on the whereabouts of the drug in terms of its manufacture and distribution. While using the informative techniques, I was able to help Mr Ali get a better understanding of the quality of health care provide in different hospitals by explain the role of the government and the nurses in ensuring that he acquires the best services available. Heron’s facilitative approach was also important in enhancing the communication process with Mr Ali. When using the cathartic intervention technique I approached Mr Ali in a clam tone to express my concern and help him in expressing his feelings and fears about leaving the tertiary hospital for the regional hospital. I was also able to use the supportive technique by telling Mr Ali that he was highly valued by the hospital such that it would be impossible to transfers him to hospital with low quality of services and medication. In addition, through this approach I was also able to show him that he has my support and commitment towards ensuring that he receives the best services even when in the regional health facility. Egan's style (blind spot) Egan developed a three stages approach to an effective counselling process. According to Egan, the three stages approach, which was based on flexibility and simplicity, could be essential in helping both the health care provider and the patient in the determination of the best interventions while addressing a problem (Bre´dart et al 2005). This model provides a framework for a health care provider to work with a patient in a more structured and effective way. The first stage is the exploration and clarification of the existing problem (Bre´dart et al 2005). This involves telling the story, breaking through the blind spot and choosing the right problem to work on (Bre´dart et al 2005). In my engagement with Mr Ali, I applied Egan’s blind spot. This was meant to prevent Mr Ali from seeing himself, his problems and unused opportunities as they really were since this prevented him from successfully realizing the objective of the treatments that he was scheduled to continue with at the regional hospital. According to Egan for a patient to overcome his or her blind spot, it is important to challenge them into understanding the situation form an objective perspective. It is however important to challenge the patient on their strengths rather than their weakness. For Egan effective use of blind spot is possible through the identification of five challenging skills (Bre´dart et al 2005). Confrontation is one of the most essential challenging skills, which requires the client to develop a new perspective in the development of some change in their internal and external behaviour (Smith et al 2011). In the case of Mr Ali, the challenge he had to confront was fear of leaving the tertiary facility for a regional hospital. Providing him with information on high quality health care in the regional hospital was an assurance that provided a platform of confronting his fear and instated embracing courage and resilience which is essential in the healing process. Information sharing in the view of Egan is an essential skill in the development of novel perspectives on solving problems. In the case of Ali, this was achieved by the provision of the correct information and correcting misinformation concerning the quality of antibiotic administered in the Regional hospital. Self-disclosure is an additional skill that can be used in helping a patient understand and develop solutions to problems. The health care provider the use of this approach to patient centred communication is only essential when it helps the patient to self-disclose and ensure high-level openness in the communication process (Smith et al 2011). In the case of Mr Ali, I was able to encourage him into airing his concern by telling him that I understood that he was anxious because of the problems associated with different aspects of life. This enabled him to develop a sense of comfort and willingness to share his problems Advanced empathy in the view of Egan is an essential skill because it allows a nursing practitioner to share with the client-educated hunches concerning his or her worries. This approach to addressing problems allows a client to perceive his is or her problems in a different and solution oriented perspective. This approach also helps a patient in moving on to develop new objective sand in setting smart goals (Smith et al 2011). Immediacy is an additional challenging skill, which in the view of Egan helps in the development of open and honest communication between a patient and a health care provider (Smith et al 2011). In the case of Mr Ali, I was able to embrace immediacy by understanding the urgency in addressing the prevailing problem. This was by hesitating to strategize and approaching the patient in a clam voice. Action plan This assignment provided a platform of developing knowledge and skills essential in the development of patient-centred communication. However, I need to engage in-depth reading of literature about communication skills, which will be essential in my current and future profession as a nurse. Continuous engagement in nursing related activities will provide a platform of demonstrating my communication skills. Conclusion Patient-centred communication has been essential in the development of an understanding on the essence of employing different strategies while communication to a patient feeling angered or worried about maters of their health. The provision of high quality care is defined by the communication approach defining the relationship between a health care provider and a patient. Focusing and prioritizing on the needs of the client forms the most important part of in enhancing the healing process. Patient centred communication provides an assurance to the patient that a health care facility through its professionals be focused on the provision of the best available care. References 1. Ayanian JZ, Zaslavsky AM, Guadagnoli E, Fuchs CS, Yost KJ, Creech CM. 2005. Patients’ perceptions of quality of care for colorectal cancer by race, ethnicity, and language. J Clin Oncol. 23(27):6576–6586. 2. Baerheim A, Hjortdahl P, Holen A, Anvik T, Fasmer OB, Grimstad H. 2007. 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