This essay is a reflective account on my experience within the introductory period of my practice when caring for a patient. The essay will give the definition of reflection. This reflective essay will help me demonstrate how my experience in practice has helped me achieve one of the learning outcomes in my learning plan, (appendix 1). Driscoll (2000) will be used as a reflective model. The essay will explore what (description of events) so what (analysis) and now what (action plan). This essay is going to reflect on the importance of good communication with patients.
Names in this essay have been changed, to respect the confidentiality of the patient and other healthcare professionals (NMC 2008). Reflection is ‘reviewing experience from practice so that it may be described, analysed, evaluated and consequently used to inform and change future practice’ (Bulman and Schutz, 2008: page 6). I was placed in an acute admissions ward at a Mental hospital. The ward is an admission ward for assessment and it admits all patients between 16-65 years for psychiatric treatment.
What happened was one morning in this ward a male patient, Joe was brought in by the police, detained under Section 2 of the Mental Health Act 1983. I was assigned to admit the patient; NMC 2010a states that it is a requirement of nurses to have up-to-date and accurate records of patients. When my mentor Sarah, asked me to admit the patient, I agreed to do the admission process even though I felt I was not confident to do it, I had only observed Sarah admit a patient once.
I felt I would be deemed incompetent if I turned down the opportunity to admit this patient even though I was not really confident in doing so I did not want to allow anything to work against me on this placement. I went to Joe and attempted to inform him that I was to take him through the admission process as well as to check his baseline observations. He looked at me and as if taking no notice of what I had just said started talking about how his wife betrayed him, he went on and on talking about his wife. I repeated myself but he kept on talking about his wife.
In my head I thought he was just being difficult and it was time for me to check the observations of other patients. I repeated myself again telling him what I intended to do and this time Joe jumped from his sit and came very close to my face. Whilst standing very close to my personal space he shouted loudly saying “I am not going to talk to you monkeys until I speak with my GP and my Lawyer”, he then pushed me to the side and he walked off. In a state of shock I went back to Sarah and explained everything that had happened.
This incident left me feeling confused and incompetent; I blamed myself for failing to perform what appeared like a simple task that my mentor had asked of me. Sarah sat down with me and explained to me that the patient was well known having been admitted on the ward several times before and is familiar to most of the staff. She thought Joe was behaving in such a way because I was new to him and also the fear of just being in a hospital away from his family contributed to his presentation.
According to Chapman and Kimberly B. (2009) most patients experience the stress of being hospitalized and good communication has been identified as one of the tactics which will relieve them. Sarah took me with her to Joe, she wanted me to observe how closely she communicated with him and made him to relax. When we approached him he pointed at me and asked, ‘who is she? ’ Sarah introduced me to Joe then she asked him to come to a separate room with us.
Surprisingly to me Joe did not refuse, Sarah spoke with him in an assertive but calm manner, she stated to him the importance of having his physical observations checked, this was to ensure that Joe understood the procedure for him to be able to give us his consent (NMC 2008). Joe was very co-operative and the admission process went on smoothly. I made sure I documented the procedures clearly. The second stage of Driscoll (2002) is the analysis of the events. Looking back at the way I had communicated with Joe and realized that might have contributed to the way he reacted.
According to Sheldon (2004) ‘communication in nursing is a sharing of health-related information between a patient and a nurse, with both participants as sources and receivers’. Sully and Dallas (2010) also points out that communication is not just one way, it is a two way process. I realised that my communication with Joe was just one way. He was saying something to me, instead of listening I was telling him something and vice versa. No one was receiving information we were both encoding words that were not being decoded by any one.
Sully and Dallas (2010) highlight how communication has need for a sender, a messenger, a receiver and a channel. When Joe asked Sarah, who I was, I realised that I had not introduced myself to him; this could be one of the reasons why he did not want to cooperate. Delvaux et al. 2004 states that to promote patient satisfaction ensure that the patient understands who you are and your specific role. Also Joe might have not understood me because when l said I wanted to check his physical observations he looked puzzled, he might not have known what an admission is nor what physical are.
It was important for me to establish mutual understanding; this would have improved the outcome and help reduce his stress, (Fellowes et al 2004) From this experience l learnt that listening is an important skill to have in communication. Joe perhaps became angry about not being listened to, he did not feel valued. I realised that I should have listened to him and shown him some empathy. According to Rogers (1967) ‘empathy is the ability to feel a continuing desire to understand the client’s feelings and communications as they seem to him at the moment’.
Roger (1967) also highlights that communication occurs when we listen with understanding. Just listening and trying to understand what Joe was saying could have helped me establish a therapeutic understanding with him. When Sarah was communicating with Joe she showed she was not only listening but also empathizing with him. When he mentioned about his wife betraying him Sarah was nodding her head to show she understood what he was saying. Words and language that we use sometimes only play a small part in passing on any message compared to body language, facial expressions and gestures.
These will have an impact on the total sum of communication. (Hargie and Dickson 2004). Thirds stage of Driscoll is the Now what, which is my action plan, Since effective communication is extensively regarded as a key determinant of patient satisfaction, compliance and recovery it is important for me to have the suitable communication skills and to be adequately confident to use them in my clinical practice. From now when I am a student to the time I qualify my responsibility lies in improving my knowledge and skills on good communication and to be a good role model to others.
Communication is a skill that I have to learn and it requires me to continually improve. In order for me to improve on my communication skills when I get back to my placement I need to have the commitment to listen more to what the patients are saying and to understand them fully. I also need to show them that I am listening and understanding them I must communicate this understanding to the patient. (Sully and Dallas, 2010). In my learning plan I stated that in order to improve my communication skills I must learn from my mentor and other health care professional as well as to research by reading more on communication.
This incident has taught me that I can never say because I have been reading and learning from my mentor my communication skills are perfect. I am still learning on communication, it’s an ongoing process so I will still need to use my learning plan as well as all the information I have learnt from this incident as my primary plan. If my communication skills are well developed I will be able to manage situations now as a student as well as in the future when I qualify.
Being able to manage situations can provide greater job satisfaction and it also reduces stress. (Dougherty, L. and Lister, S. 2011) In conclusion my experience taught me that communication is not just about talking, it involves, listening, looking and understanding what’s being said. Good communication builds confidence and understanding between nurse and patients and works well in improving their relationship. Communication is the basis of the relationship between the nurse and other members of the multi disciplinary team.
If ever I get another opportunity to admit a patient I will start off by introducing myself and make sure that the patient understands what I am saying by giving him the opportunity to ask questions. I also learnt that if I am not confident in doing something I should talk to my mentor or any senior member of staff present and be sure on how to proceed with the allocated task. What I liked is on the same day another patient came and I was asked to do admit another patient again and I managed to do it confidently and the patient was very co operative.
Courtney from Study Moose
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