The current essay focuses on an incident I experienced in my area of placement at a medical institution. To properly elucidate the reflection essay, I shall use Gibb’s Cycle reflection guide (1988) to describe the situation succinctly. The structure shall be as follows: feelings, evaluation, analysis, conclusion and action plan. My reflection, in addition, will focus on communication tool and interpersonal skills required while handling patients to promote therapeutic relationships as needed in the nursing profession.
Regarding the reflection essay, there is the inclusion of ethical considerations. According to ethical consideration on a patient-medical professional relationship, the name of the patient shall remain hidden, and a pseudonym is used instead. In this case, the patient’s name shall be Jack who is forty years of age. During my placement, I worked alongside my mentor who assigned a handful of patients to look after including Jack. I was tasked with the duty of caring for Jack including carrying out observations such as ECG monitoring since Jack was suffering from chest pains. The initial assessment indicated that Jack was a problematic patient due to his unpredictable, hostile behaviour and the staff in the area of placement found it very difficult to handle Jack during his stay. The nurse-in-charge accounts that Jack did not let anyone care for him including taking observations as well as difficulty in taking medication. I can attest that Jack was a problematic patient throughout my three-week tenure including insulting his relatives when they visited and the healthcare staff.
My initial feelings about handling Jack were nervousness. The nervousness arose from the fact that I have never taken care of a patient before and this was evident throughout the process of picking the apparatus need for the patient to walking towards his room. In the beginning, Jack was calm and responsive, and we spoke for a brief period. But, as we talked, I interrupted our conversation by confirming with him that I was about to take his ECG readings. When the ECG machine started, Jack became hostile and began pushing me away while ripping the cables off his body. At that moment, I was frightened and ran to my mentor to explain to him what was happening.
I returned with my mentor to the patient’s room, and my mentor approached Jack politely, sat down next to him on the edge of the bed and started eyeballing him. She started reassuring Jack through a genuine conversation using a soft tone voice which quickly calmed him down. At one point my mentor offered a hot beverage for him. Gradually, my mentor began explaining to Jack why the test reading is necessary and why I was the one to do it. She introduced me to him as a student nurse and asked John whether I should take the observations which he quickly agreed upon. I immediately realised the impact of pain on Jack’s behaviour which no one was determined to understand his aggressive behaviour towards others. In my observation, I deduced that Jack might not have been able to follow his situation and this caused him to have erratic behaviour. Therefore, Jack would take out his aggressions on the staff and his family members. Despite not agreeing with his methods, I now understood what he was going through and how it influenced his hostile behaviour.
The significant factor when it comes to handling such patients is lack of proper communication from the nurse to the client. My evaluation was that the current relationship between Jack and I would not end well. According to Collins (2019), communication is a fundamental element in developing a therapeutic relationship. Barbara et al. (2013) concur stating that the use of simple skills secrets model can be a useful approach for nurses as well as other medical professionals. The model determines that effectiveness in dealing with the complicated situation is improved through enhanced confidence among healthcare professionals and the willingness to participate with the patient to minimise distress.
Kourkouta and Papathanassiou (2014) clarify that good communication between nurses and patients is necessary for individual care for patients. The process can be achieved by presenting confidence, kindness and showing the patient a good understanding of their needs. Having good communication and therapeutic relationship is essential and is expressed through verbal communication (Mitchell, 2014). A nurse who does not communicate properly can enhance the patient’s challenging behaviour, and this has serious consequences. In this scenario, I decided to interact with Jack as often as possible after my mentor introduced me which gave me the chance to explore his psychological and social needs. Bach and Grant (2011) further indicate that non-verbal communication is crucial. It allows nurses to provide quality care to patients equally achieving wellness which results in good adherence to treatment (Moreno-Poyato et 1l., 2017). Also, effective communication permits the nurses to comprehend the client’s emotional status which improves on the nurse-patient relationship (Wright and Davis, 1994). Pete (2010) supports the approach stating that effective communication provides proper healing and understanding from the nurse’s perspective.
In the scenario, my mentor responded to Jack through touch as well as expressing empathy. She held his hands and stroked them lightly which appeared to calm him. According to the Hessel Concept Analysis (2009), it was discovered through patient’s case studies that therapeutic touch aided the patient to calm by holding their hands and sitting beside them. The concept is known as relaxation which tends to reduce anxiety. James (2006) reports that studies on therapeutic touch can reduce concern in patients including burnt patients and the elderly.
Effective communication, as Donnelly and Neville (2008) report, can help nurses cope with vulnerable patients under their care and aid in making better decisions. The reason is useful communication is the first step towards patient management and supervision (Charons, 2008). Roberts et al. (2015) support the approach indicating that listening to patients’ stories, for instance, can help nurses gather information about the patient- as a tool for diagnosis- since storytelling can provide more medical information about the patient. Listening entails different forms of therapy including looking more in-depth into a problem, defining worries and feelings of the patient and in particular those of the family as well (NHS, 2018). Moreover, talk therapy enhances long-term care for the patient through intermittent conversations. For example, in the scenario, Jack expressed his reasons for his behaviour through my discussions with him during my placement.
Therapeutic conversations between nurses and patients need to be confidential and patient-centred to improve nursing care (Robert et al., 2015). Centred-patient care is the care provided to patients concerning their rights, needs, and values. It involves individualised decision-making together with the patient which promotes concordance and autonomy of the patient (NMB, 2015). Caring for a patient under the patient-centred care contributes significantly to the therapeutic alliance which gives a patient direction and connection of character to attain their personal goals and improve on compliance to medical treatment (Baughan and Smith, 2009). In this case, Jack required good communication which allowed the professional including cardiac specialists to discuss with him the physiological treatment for better management outcome. Jack has chest pains, and this resulted in blockage to the heart vessels reducing blood flow which if untreated, would have resulted in his death.