Creating Therapeutic Patient-Nurse Relationship: Analytical Essay

This assignment will discuss the importance of being self-aware as a health professional and identify approaches to reflective practice. Gibbs model of reflection cycle, learning by doing; has been chosen to reflect on an experience during my placement in a stroke and neurological rehabilitation ward (Adult unit). The model has six stages which are description, feelings, evaluation, analysis, conclusion and action plans (Gibbs, 1988). The model highlights detailed understanding of reflection and analyses the event, allowing conclusion of, what has happened, what has been done or could be done in the future and, what has been learnt. Reflection practice is thinking back on an experienced event, examining and improving on it (Bulman, 2013). Thompson (2018) emphasised on reflection practice as an essential factor in improving in continuous professional development. The assignment will reflect on communication skills and emotional empathy used in building a therapeutic relationship while assisting a patient with personal hygiene. For the purpose of confidentiality, all names have been anonymously replaced (Diamond, 2002).

Description:

Felicia, who was my practice supervisor for the shift, and I were assisting John by hoisting, to go for a shower which has been requested by his wife from the previous shift. John has suffered with cerebrovascular accident and therefore has left sided weakness however, he can utilise his right side very effectively. Though John cannot communicate verbally, he uses facial expressions and gestures in response occasionally. According to his care plan, he suffers from confusion and can be resistive and aggressive towards nursing care therefore should be nursed with assistance of two or more.

Feelings during the event:

I felt nervous from the beginning though I have a caring background, the knowing of John can be aggressive and being supervised was making me anxious, yet I did not disclose it to my supervisor. Caregiving can be a channel of creating therapeutic patient-nurse relationship through constant interaction (Myerscough and Donald, 1992 pp.50-65), however it can also be frustrating and stressful without the caregiver being prepared morally, emotionally and educationally (Fagin, 2001). The nursing and midwifery code (NMC) of conduct requires the student or professional nurse to work within their competences and be accountable for their own actions (NMC, 2018).

I was confident with my manual handling and patient care as I have experience whilst working as a health care assistant prior to becoming a student. I, therefore, organised all the equipment’s such as commode, hoist, sling and prepared the bathroom arranging the towels and toiletries prior for the task. With my supervisor’s guidance to assess the patient, I introduced myself to John to seek his consent. Patient should consent to their care unless there is lack of capacity which has been assessed by a qualified practitioner (Mental Capacity Act, 2005; Peate, 2006 pp. 68-69). I explained the task my supervisor and I were about to perform in order to involve him in his own care. According to Arnold and Boggs (2011 p. 471) patients feels respected and dignified when nurses place them at the center of their care and recorganise them as a person and not just an object getting treatment. I pulled the curtains around the patient’s bed to protect his dignity. Professionals are required to protect patient’s dignity and adhere to confidentiality (Birrell, Thomas and Jones, 2006). We followed the manufacturer’s instructions for that hoist and proceeded whilst I comforted John and explaining to him what is happening on every stage of the task.

Evaluation:

I can say we performed the task very well without John becoming agitated and complied throughout his care. With supervision I was able to combine most of communication method such as facial expression, eye contact, hand gestures and verbal communication considering my tone of voice, and space thereof which allowed John to understand and giving feedbacks in similar expressions. Communication is shared between the sender and the receiver through various methods (Boyed and Dare, 2014), verbal and non-verbal allowing each communicator to take in turns processing the information they have receive and response to it ( Shepherd et al, 2010; Nolan, 2008) therefore it is important for the caregiver to recorganise any signs of discomfort through effective communication (Carpenito-Moyet, 2009). Finke, Light and kitko, (2008) confirms good communication as an essential tool in providing effective quality care. In agreement, Arnold and Boggs (2011) states effective communication ensures a suitable interaction between the professional and the patient and this promotes person- centered care. In order to achieve good communication with my patient I avoid the use of jargon as it can mean differently to both patient and the nurse. Language and terminology can have a positive or negative impact on communication (Graham and Brookey, 2008). Complex medical terms can be confusing to the patient while using short sentence makes communication easier for the patients to understand (Pechmann and Reibling, 2000) Due to John’s poor cognition I made sure to check his understanding using paraphrasing and the use of short sentence (Fine and Rouse-Bane,1995). Communication encompasses more than the spoken word (Mallett and Dougherty, 2000). The NMC requires all professionals and student nurse to able to communicate in a manner that the patient will understand (NMC, 2018). McCabe and Timmons (2006) state that, therapeutic communication integrates understanding in the context of patient’s wellbeing. Through communication therapeutic relationship can be developed allowing patients to open and to express their emotions in building trust with the professional (Kennedy-Sheldon and Foust 2014).

Analysis:

During the task there was another aspect of therapeutic relationship that enhanced our success in performing the task which was empathy. Hogan (1969) defines empathy as being able to envision anxiety of a person’s condition or how an individual feel emotionally. I imagined myself in John’s stead in the process of hoisting him which made me extra careful and compassionate with him. I thought what he might be going through emotionally as person with very active background and now need my assistance to get through life. It made me very humble as the taught occurred to me. I made sure he was comfortable throughout the whole process. Empathy is crucial to patient-nurse interpersonal relationship enabling the nurse gain understanding and to provide good quality of care (Williams and Stickley, 2010). According to McCormack and McCance (2017) and Mottram (2009) therapeutic interpersonal relationships seeks to respect patient’s wishes and preference holistically without imposing any personal beliefs or values on the patient in all circumstances.

The therapeutic relationship is person centered rather than tasks- focus; employing listening techniques, showing empathy and supporting form a helping relationship (Bach and Grant, 2015). In healthcare profession, having emotional attachment can become common and patient may perceive it differently therefore, the NMC advice that professional boundaries to be maintained at all course (NMC, 2018). John held my hand and began to pull me towards him after we have finished with his care and was comfortable in bed however immediately pulled away from him. Halpern, (2007) states that professionals who can empathise with patient’s inappropriate behaviours emotionally, can manage their rage and frustration increasing their therapeutic impact. Overall therapeutic interpersonal relationships amongst health care professionals and patients is core to patient satisfaction, improving quality of care and mental health wellbeing which enhance the general economy (Step et al 2009; Shay et al 2012)

Nurses cannot achieve therapeutic relationship without being aware of the self (Rawlinson,1990). Self-awareness is knowing yourself and getting the understanding about your feelings, your strength and weakness, judgements, experience and capabilities (Rasheed, (2015). It is the tool an individual use to examine own emotional, beliefs and values in human life span (Goleman, 1995). In healthcare, the professional been self-aware is vital in developing professional relationship with patients and their relatives. Being able to understand oneself contributes to understanding others (Eckroth-Bucher, 2010). self-awareness is not something that can be achieved in one go, It is however a constant process whereby a person reflects on feelings during an event and actions taking and the ability to improve (Burnard 1988) To develop awareness of one’s self is integral to own wellbeing (Freshwater 2002); we are able to resilience from been venerable when situations arise. As professionals, being self-aware can helps to control of our feelings and behave professionally in a challenge situation within any environment we found ourselves (Rowe, 1999). It involves recognising what we know, what skills we employ and what are our limitations.

Conclusion:

In conclusion, I have learnt that good communication is transactional (Barnlund, 2017); it involves listening, observing and giving feedback from both communicators and it is fundamental for patient care. Listening to patients and showing understanding to their concerns, emotions, fears and prospects creates interpersonal relationship between the nurse and the patient. Through effective communication, I establish therapeutic nurse-patient relationship and made me observant of my patients’ discomforts (Trevithick, 2011). I was able to build therapeutic relationship with John by continuously being aware of my interactions throughout the task. Being self-aware of my communication skills was the key to deliver a successful task.

Action plan:

I have learnt that my feelings can impact on my thinking and can affect how I perceive others. In the future I will not make any judgment before performing my own assessment when given a task. I must be more open about my concerns of any fears to my supervisor or any team member to get the right support. I need to continue to improve my understanding of the use of body language in communication. According to Crystal, (2007) people communicate through body language to express a kind of meaning. Example people can use some bodily behaviour to show appreciation, affection, gratitude, aggression and seeking of attention. I realised I failed to interpret John’s action when he tried pulling me towards him however his wife made me to understand that he wanted to give me a hug.

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