The nursing skills
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This reflection is going to focus on the nursing skills that I have developed while on practice placement, I will be using (Gibbs 1988, cited in Jasper 2003, p73). Using this model, I was able to reflect in structured and effective way. The theme of this reflection will cover the development and application of care, showing empathy, communication and interpersonal skills to create and maintain therapeutic relationship. It will outline the fundamental aspects of clinical nursing skills that I have begun to acquire.
This will also highlight the learning processes which took place and how it helped me to enhance my knowledge, and ethical values to deliver quality and safe care. Using sources of literature, I will use a reflective model to discuss how I have achieved the necessary level of learning outcome. Reflecting on my initial interview, I have learnt how to listen and talk to patients, family members and staff. As a first-year student this was a daunting task at the beginning, but I developed my confidence as the days go by.
I wished I had the opportunity to nurse patients from pre-operation assessment, observe them in operative theatre, nurse them in recovery and continue care in the ward, but because I was spending few weeks and time constraint I was not able to fulfil that goal. Learning needs I would like to take up in next placement is to continue to Improve communication skills and how the 6c`s relate in practice, building therapeutic relationships with my patients, as well as working as part of a team to improve care.
To improve my knowledge on drugs and medication for analgesics, pre-medications which are given before surgery and anti -emetics after surgery. How to observe patient’s fluids intakes and output linking them to renal function. The importance of putting on anti-embolism stockings after surgery to prevent deep vein thrombosis. To identify and have good background information and feedback about patients’ mental health problems before providing care to them. Reflection is defined as a process of reviewing an experience which involves describing, analysing and evaluation to improve learning in practice (Gibbs, 1988).
It enables the individual to critically assess self and their approach to practice. Building therapeutic relationship with the patient is important in gaining trust and respect (Jacobs, 2008). McCabe (2004) argues that the use of effective interpersonal skills, a basic component of nursing, must be patient centred. If I had been tensed and negative, my patient would not have enjoyed the conversation and would have felt uncomfortable and rushed (Kozier, et al 2008. Elliss, Gates and Kenworthy (2003), states that good communication is essential to effective nursing practice.
As healthcare professional I need to identify and improve my interpersonal skills to efficiently understand patient’s needs. Communication is an open two-way where by patients are informed about the nature of their disease and treatment and are encouraged to express their anxieties and emotions (Kluijver et al, 2000). Sheldon, (2009) defines communication as sharing of health-related information between a patient and a nurse, with both participants as sources and receivers.
The nature of health care demands expertise in interviewing, explaining, giving instructions and advising (Williams, 1997). In this instance, this was exactly what I did with my mentor. The use of therapeutic communications in nursing, particularly empathy, is what enables therapeutic change and should not be underestimated (Norman and Ryrie, 2004). Egan (2002) argues that empathy is not just the ability to enter and understand the world of another person but also be able to communicate this understanding to the person.
Poor communication by a nurse can be profound and often increases the vulnerability experienced by patients. As a nurse, it’s crucial to be good at listening as well as talking. With the patients, this is important to make them, and their loved ones feel secure leaving their care in your hands and this skill proves important with doctors and peer because without communicating with them, carrying out the task of patient care will be impossible. The skills of active listening and reflection promote better communication and encourage empathy building.
Working in the surgical ward entails many responsibilities for a health care professional, thinking about the holistic care, recovery of patients and minimising any complications from occurring are a few of those responsibilities that a surgical nurse always must keep in mind. According to Anthony Lee (2007), whether it is abdominal surgery, plastic surgery, or any other invasive surgical treatment, it is dangerous to assume 100% safety. He also stressed that due to the miracles that surgery gives, people might often tend to forget the risks and complications that go with it.
In the postoperative phase, patients who undergo lengthy or orthopaedic surgery are at risk of deep vein thrombosis. (NICE, 2010). Nurses must be constantly alerted to changes in patients’ conditions and the implications in terms of care (Waddell, Donner, & Wheeler, 2008). They must be able to spot anything out of the ordinary or basically anything that does not seem right. These changes need to be communicated back to the doctors clearly and concisely to ensure the patient’s well-being.
With poor interpersonal skills, barriers might occur in this communication process which might include misunderstandings and even lack of information provided to certain parties involved in this communication process. Effective communication requires a combination of good verbal and non-verbal skills (Donner & Wheeler, 2004). Therefore, as a nurse, I would have to be able to understand gestures and facial expressions of my patients, peers as well as doctors, especially during an emergency. This interaction with the patient must be kept as patient-centred as possible to improve concordance with treatment (Walker, J et al, 2007).
Rena and Upton (2009) suggest that “being patient-centred” should involve the asking and receiving of questions and information which result in patient’s understanding of the health information and the treatment proposed. I was given the courage and confidence to do things independently by being able to express opinions clearly and confidently as it was essential in my future career as a nurse. In my mentor’s view, the only way to develop confidence was to participate regularly which Bulman & Schutz (2008) confirms.
My reflection is about a patient, to whom, to maintain patient information confidentiality (NMC, 2004), I will refer to as Mrs R. It concerns an event which took place when I was working in a post-surgical ward. This was Mrs R an 84-year-old lady who had come in for Total Knee Replacement (TKR) surgery, was paranoid and kept on asking if procedure was going to be successful and how soon to recover. She was one of my mentor’s clients to whom I had been assigned to monitor and check observations to coordinate and oversee her care under supervision.
Nurses owe their patients a duty of care and are expected to offer a high standard of care based on current best practise, (NMC 2008). I would now like to discuss the feelings and thoughts I experienced at the time. Before I gave Mrs R. her cup of tea, I approached her in a friendly manner and introduced myself; I tried to establish a good rapport with her because I wanted her to feel comfortable with me even though I was not a relative or family member. When I first asked Mrs R. if I could get her a cup of tea, she looked at me and replied, “I have asked the girl for a cup of tea, I don’t know where she is.
” I answered “Well, I will see where she is and if I cannot find her, I will gladly get one for you Mrs R”. In doing this, I demonstrated emphatic listening. According to Wold (2004, p 13), emphatic listening is about the willingness to understand the other person, not just judging by appearance. At the same time, I used body language to communicate the action of drinking. I paused and repeated my actions, but this time I used some simple words which I thought Mrs R. would understand. Mrs R. looked at me and nodded her head.
As I was giving her the cup of tea, I maintained eye contact as I did not want her to feel embarrassed. Fortunately, using body language helped me to communicate with this lady. At the time I was worried that she would be unable to understand me since English is not my first language, but I was able to communicate effectively with her by verbal and non-verbal means, using appropriate gestures and facial expressions. Facial expression and body language are referred to as non-verbal communication (Funnell et al. 2005 p. 443).
I kept thinking that I needed to improve my English for her to better understand and interpret my actions. I thought of the language barrier that could break verbal communication. Castledine (2002, p. 923) mentions that language barrier arises when individuals come from different social backgrounds or use slang or colloquial phrases in conversation. Luckily, when dealing with Mrs R. the gestures and facial expressions used helped her to understand that, I was offering her assistance. The eye contact I maintained helped show my willingness to help her; it gave her reassurance and encouraged her to place her confidence in me.
This is supported by Caris-Verhallen et al (1999) who mention that direct eye contact expresses a sense of interest in the other person and provides another form of communication. In my dealings with Mrs R. , I tried to communicate in the best and appropriate way possible to make her feel comfortable; as a result, she placed her trust in me and was more co-operative. In evaluating my actions, I feel that I behaved correctly since my actions gave Mrs R. both the assistance she needed and provided her with some company. I was able to successfully develop the nurse-patient relationship.
Although McCabe (2004, p-44) would describe this as task centred communication I feel that the situation involved both good patient and task centred communication. I treated Mrs R. with empathy because she was unable to perform certain tasks herself due to her mobility problem just after surgery. It was my duty to make sure she was comfortable and felt supported and reassured. My involvement in the nurse-patient relationship was not restricted to task centred communication but included a patient centred approach to provide warmth and empathy toward the patient.
There are many effective ways to maximise communication with people, for example, by trying to gain the person’s attention before speaking – this makes one more visible and helps to prevent the person from feeling intimidated or under any kind of pressure, I feel that the interaction with Mrs R. had been beneficial to me in that it helped me to learn how to adapt my communication skills both verbally and non-verbally. I used body language to its full effect since the language barrier made verbal communication with Mrs R difficult.
I used simple sentences that Mrs R. could easily understand to encourage her participation. Wold (2004, p. 76) mention that gestures are a specific type of non-verbal communication intended to express ideas; they are useful for people who have limited verbal communication skills. To analyse the situation, I aim to evaluate the important communication skills that enabled me to provide the best level of nursing care for Mrs R. My dealings with Mrs R. involved interpersonal communication between two people (Funnell et al 2005, p-438).
I realised that non-verbal communication did help me considerably in providing Mrs R. with appropriate nursing care even though she could only understand a few of the words I was speaking. I did notice that one of the problems that occurred with this style of communication was the language barrier but despite this I continued by using appropriate communication techniques to aid the conversation. Although it was quite difficult at first, the use of nonverbal communication skills helped encourage her to speak and allowed her to understand me.
The situation showed me that Mrs R. was able to respond when I asked her the question without me having to wait for an answer she was unable to give. Funnell et al (2005, p 438) point out that communication occurs when a person responds to the message received and assigns a meaning to it. Mrs R. had indicated his agreement by nodding her head. Delaune and Ladner (2002, P-191) explain that this channel is one of the key components of communication techniques and processes, being used as a medium to send out messages. In addition, Mrs R.
also gave me feedback by showing that she was able to understand the messages being conveyed by my body language, facial expression and eye contact. The channels of communication I used can therefore be classed as both visual and auditory. Delaune and Ladner (2002 p. 191) state that feedback occurs when the sender receives information after the receiver reacts to the message, however Chitty and Black (2007, p. 218) define feedback as a response to a message. In this situation, I was the sender who conveyed the message to Mrs R. and Mrs R.
was the receiver who agreed to talk about her Total Knee Replacement, and allowed me to assist her. Reflecting on this event allowed me to explore how communication skills play a key role in nurse and patient relationship in the delivery of patient-focussed care. Whilst I was trying to assist Mrs R. when she was attempting to walk, I realised that she needed time to adapt to the changes in his activities of daily living. I was also considering ways of successful and effective communication to ensure a good nursing outcome. I concluded that it was vital to establish a rapport with Mrs R.
to encourage her to participate in the exchange both verbally and non-verbally. Walsh (2005, p. 31) also points out that stereotyping and making assumptions about patients, by making judgements on first impressions and a lack of awareness of communication skills are the main barriers to good communication. I must not judge patients by making assumptions on my first impression but should go out of my way to make the patient feel valued as an individual. I should respect each patient’s fundamental values, beliefs, culture, and individual means of communication (Heath, 300, p. 27).
I should be able to know how to establish a rapport with each patient. Cellini (1998, p. 49) suggests many ways in which this can be achieved, including making oneself visible to the patient, anticipating patients’ needs, being reliable, listening effectively; all these factors will give me guidelines to improve my communication skills. Another important factor to include in my action plan is the need to consider any disabilities patients may have such as poor hearing, visual impairment or mental disability. This could help give the patient some control and allow them to make the best use of body language.
Once I know that a patient has some form of disability, I will be able to prepare a course of action in advance, deciding on the most appropriate and effective means of communication. Heath (2000, p. 28) mentions that communicating with patients who are impaired requires skills and consideration. Nazarko (2004, p. 9) suggests that one should not repeat oneself if the patient is unable to understand but rather try to rephrase what one is saying in terms they can understand, for example try speaking a little more slowly when communicating with disabled people or patients who have a hearing problem.
In summary, my action plan will show how to establish a good rapport with the patient, by recognising what affects the patients’ ability to communicate well and how to avoid barriers to effective communication in the future. In conclusion, I have discussed the importance of reflection in nursing practice and why I choose Gibbs’ (1988) reflective cycle as the framework.
I have discussed each stage of the cycle, outlining my ability to develop therapeutic relationship by using interpersonal skills in my dealings with my patient and I have applied the situation to theory; as, Boud Keogh & Walker (2013) explain that reflection in the context of learning is a general term for intellectual and effective activities whereby leaners engage to explore their experiences to lead to a better understanding. In future with this reflection and knowledge, I will approach the therapeutic relationship much more carefully than I have up to now.