The purpose of this paper is to allow me, the learner to analyze and reflect on a video created between an actor and themselves. Using my knowledge obtained I was to effectively incorporate trust, respect, honesty and effective communication, as they are key principles in establishing a relationship with a client (RNAO, 2002). During this experience, I encountered an issue that I believe is significant in my development as a nurse. I was placed into a scenario involving a 47 year old patient named John, who was waiting to be discharged after suffering his first heart attack. Finding the patients quietly sitting in a chair watching the floor as I entered the room, I felt the need to be in the moment with him. The issue that seemed significant to pay attention to in this scenario was my patient’s feelings of being overwhelmed by his medical condition and the changes that needed to be made (Appendix A). Sitting within good distance and showing respectable body language showed him respect, while acknowledging he had my full attention was displayed to the patient by making comments such as yes and I understand (Appendix A). Through the use of open-ended questions, I was able to identify what was meaningful and concerning to john.
John showed a lot of concern around his ability to care for himself so this doesn’t happen again, and being able to support his family (Appendix A). Knowing his concerns, I was then able to acquire the necessary knowledge needed to participate effectively in our nurse-client relationship (RNAO). This experience has allowed me to develop further in my role as a nurse. My patients comment on how our encounter gave him more encouragement to face his challenges was proof that my communication methods were effective in developing a therapeutic relationship (Appendix A). The opportunity to set aside my own concerns and focusing on the patients, allowed me to be in the moment with the patients. In those moments, the experience helped me become a better nurse as my actions made me feel more confident after each successful encounter. Watching his facial expressions and drawing in his positive responses allowed me to watch him develop confidence in my ability to care and in turn, allowed me to develop confidence in myself (Appendix A).
The significant actors in this experience were the individual playing the part of “John” and myself, the nurse attending to the patients needs. My role in the scenario was to identify the concerns of the patient and help them to obtain knowledge. Providing resources for my patient gave him options that were specific to his concerns such as a well balanced diet and proper exercise. The options of meeting with a nutritionist to help make healthy meal choices, and with a physiotherapist to help develop custom exercises to take with him on the road encouraged John to change his routines (Appendix A). Taking note of my patient’s feelings of being overwhelmed by his heart attack, I was able to give him some comfort when offering to find an individual recovering from a heart attack that would be willing to sit down and share their life stories and methods of coping (Appendix A). The patient’s role in this experience was to help create a therapeutic relationship.
I first observed my patient with her arms and legs crossed and staring down at the floor with concerned look on his face (Appendix A). Comparing the first image to the end of the scenario showed an individual that was interested in making a change, a smile on his face and as he stated, an “encouraged” perception of his health (Appendix A). The client was in need of direction and help with making the appropriate changes to ensure a healthy lifestyle after having his heart attack. I was able to provide her with resources such as a nutritionist, physiotherapist and social support to adjust to life changes (Appendix A). While meeting the needs of my patient, I was successful in completing my own personal needs. Coming into the experience with knowledge of possible resources available, the anxiety present upon introduction had disappeared after gaining acceptance from my patient through effective communication. The development of a therapeutic relationship allowed both the patient and I to gain from the experience. The patient left feeling encouraged and satisfied, as I felt successful and confident in how I handled the situation (appendix A).
Before the taping of the scenario began, I was trying to achieve the perfect scenario while presenting a professional image of a nurse. I acted the way I did due to the lack of experience in the spotlight and I allowed my nerves affect my thought process. This is demonstrated throughout the entire video as I kept returning to the same question “are there any concerns you have”, and trying to solve the patients problem instead of helping them understand and cope with the emotions that are attached to the experience (Appendix A). My feelings, thoughts and responses during this experience were influenced by my personal view and the presence of my preceptor placed me in a nervous state to which I became unsure of how to respond properly to my patient’s thoughts. This experience allowed me to feel capable of my skill levels and feel confident as a nurse. Overall this scenario showed perception of my growth through the friendly gestures and facial expressions of the patient.
Anxiety and stress diminish communication, interpersonal effectiveness and empathy within a nurse-patient relationship (Beddoe and Murphy, 2004). Lack the knowledge and understanding of why I am feeling this anxiety, even with positive reflections on my experience, allowed me to evaluate what I did wrong. Future encounters will help me to reflect on the scenario and blindside my anxiety before it has an effect on my actions. Having a limited amount of empirical knowledge made it challenging to let the patient know exactly what to expect after having a heart attack and what daily routines have to be adjusted. Obtaining empirical knowledge from my education regarding the components of a nurse-client relationship reminded me that I needed to place the power into my patient and develop respect and trust within the relationship (CNO, 2004).
Personal knowledge was limited in this scenario as it was my first time being placed in the spotlight with a patient and I was unsure of how everything would unfold. Introducing my aesthetic knowledge was shown when I offered to find John an individual recovering from a heart attack that he could speak with (Appendix A). Throughout the experience, I became more aware of the patients feelings as I picked up on Johns overwhelmed feelings and concerns around providing for his wife and son (Appendix A).
This perception of the experience is seen as John believe that he should have seen the heart attack coming before it occurred (Appendix A). He stated the he felt encouraged by this experience and felt he had more options to seek. The wife was more of a background actor, but was said to be a “sweet woman”, who has helped a lot throughout the experience (Appendix A). Valuing ones beliefs and concerns based on an experience is something all nurses should consider. Giving John multiple options and resources to consider instead of telling him what he has to do, have given him the power to make all the necessary changes within his life with the help of his wife and son (Appendix A).
If I was given the opportunity to be placed in a similar situation in the future, I believe that my anxiety would still be present, but more control over the situation would be noticeable due to the knowledge I have developed on therapeutic relationships. The relationship skills that I could have performed differently during this experience, was my self-awareness of human emotions. My nerves had played a role in distracting my train of thought when trying to be in the moment with the patient. Repeatedly asking the patient if he had any other concerns he would like to address may have given him the feeling of being rushed and that I was not interested in how he was feeling emotionally (Appendix A). On a few occasions, I would finish my patients sentence for him as I felt he was stuck for words, this may have allowed the patient to know I was listening to what he was saying, but also might have given him the idea that I was being rude (Appendix A).
During the introduction stage of the experience, my patient told me he was in the hospital due to a heart attack. Empathy is the appreciation of the patient’s emotions and expression of awareness of what they are presenting (Haslam, 2007). My nerves caused me to overlook his feelings and just right into asking him about any concerns he might have with his state of health (Appendix A). It is possible to slip into a task-and time-orientated way of thinking to get jobs done, thereby neglecting effective communication with patients (Cocker, 2008).
Consequences that may have developed from overlooking the patients feelings was the challenge of developing a closer relationship with the client as I was interested in obtaining information to help me solve his problems. Rushing my patient through the experience may have caused him to close himself off from the relationship as he may have felt that I was not listening to what he was truly feeling. This would leave the patient in the same state he had entered the experience with. The sources of knowledge that I could use to enhance my relational skills in these areas, is to take the time to practice with a partner a variety of scenarios that would help me develop my communication skills and place more focus on the patients feelings.
The outcome of this experience was positive as my patient left feeling more encouraged and had obtained multiple resources to help him incorporate any changes that he may need to adjust within his daily routines (Appendix A). Looking back at this experience I was able to reflect on all of the positive and negative aspects of a therapeutic relationship. I feel that the next time I am placed in a similar experience, I will be able to blindside my anxiety and personal thoughts and feelings. In turn, I would have the ability to be in the moment with my patients and address not only how I can help solve his problems, but also the feelings and thoughts being experienced. I have learnt that having self awareness identifies what skills I possess and those I need to learn and develop on. Self awareness provides nurses with knowledge of their thoughts, feelings and what they do to become awareness of issues that may affect their ability to intervene effectively (Parsons & White, 2008). There will always be room to learn and improve my skills, and with practice, I will get the chance to watch them become second nature to me.
This experience has taught me to avoid all the barriers such as the presence of anxiety in new situations. With confidence in creating an effective therapeutic relationship, I can focus on being in the moment with the patient. I have learnt that my anxiety can affect my interactions with patients, and that it is more than trying to solve the patients problems, it is about showing you care and being there in the moment to listen. This experience has allowed me to realize how a nurse’s action can affect the development of a therapeutic relationship. My ethical knowledge allowed me to recognize my patients overwhelmed feelings due to his health condition and by following my values and beliefs, I knew that he was in need of someone to care and help guide him in the right direction. Using my aesthetic knowledge, I was able to think of possible resources for my patient, and the creative idea of finding a previous heart attack patient showed my patient that I was willing to take that extra step and comfort his feelings.
The knowledge gained from this experience can be incorporated into future situations and will allow for proper adjustments and better relationships to be developed. Lacking empirical knowledge before entering the scenario was a barrier that challenged my patient care. Knowing more information on heart attacks would have allowed me to present the patient with more options and what he could expect in the future (RNAO, 2002). Acknowledging my personal knowledge gathered from previous experiences, I considered how I would like to be treated and that anxiety would be present. Knowing this helped me to reduce my fidgeting and respect my patient by actively listening and keeping eye contact (Appendix A). This experience will influence my future practice as a nurse because I have learnt that nursing is more than working on fixing the patients physical needs, but is more of an ethical interaction where you can take the time to be there in the moment with them. Looking at each experience as a stepping stone toward my success as a nurse and with each successful hurdle crossed, I can confidently await the next.
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Cocker, J. (2008). Patient dignity. Nursing Standard, 22(25), 59-60. Retrieved April 4, 2008, from ProQuest Nursing & Allied Health Source database. (Document ID: 1440306621).
College of Nurses of Ontario (CNO), (2004, January). CNO Practice Standard: Therapeutic Nurse-Client Relationship. Retrieved February 15, 2008, from http://cno.org/docs/prac/41033_Therapeutic.pdfHaslam, N. (2007). Humanising medical practice: the role of empathy. Medical Journal of Australia, 187(7), 381-2. Retrieved April 4, 2008, from ProQuest Nursing & Allied Health Source database. (Document ID: 1374608891).
Parsons,A., and White, J. (2008). Learning from reflection on intramuscular injections. Nursing Standard, 22(17), 35-40. Retrieved April 4, 2008, from ProQuest Nursing & Allied Health Source database. (Document ID: 1413949861).
Registered Nurses of Ontario (RNAO), (2002, Novemeber). Best Practice Guidelines: Establishing Therapeutic Relationships. Retrieved January 15, 2008 from http://www.rnao.org/bestpractices/completed_guidelines/BPG_Guide_C2_TR.asp
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