In this essay paper, I would give a reflection on the issue that emerged during the period of my clinical practice to build and apply the interpersonal skills that I possess so as to develop and maintain my therapeutic relationships with the patient am offering the nursing care services. In this individual reflection, I would reflect on the issue using the Gibbs (1998) reflective cycle and critically analyze the issue applying the Gibbs Model. Moreover, I shall come up with recommendations for addressing the problem in case it emerges again in the due future and state the appropriate ways of implementing the plan of action (Husebo, O'Regan, & Nestel, 2015). The Gibbs model comprises of six steps to make up the cycle which is clear and precise with high capability of improving on my health profession and clinical practice for the better learning from the daily encounters while on attachment. The Gibbs cycle begins with a brief description of the issue at stake and proceeds to the critical analysis of the personal feelings. Further, it aids in the evaluation of the encountered experience and offers the basis for critical analysis of the experience to make sense out of it. Lastly, the model involves drawing a conclusion on what I did, and the recommendations I would make for dealing with the same issue in case it arose again.
According to Baird and Winter (2005, p. 156), the Gibbs Model of reflection becomes significant in the clinical practice since it enables the nursing students to acquire the necessary practice knowledge, adapts to different environments of placement, build on the self-esteem and satisfaction as they value and develop on their nursing professionalism. On the contrary, Sivitier in his publication of 2005, argues that the reflection gets focused on assisting us students to gain the self-confidence, establish when we should improve and aid us in learning out of our mistakes and the behavior (Kumar, 2016). Furthermore, Sivitier stated that the reflection would make nursing students value their patients’ perspectives, have self-awareness and acquire the vital experience in handling the future.
At my disposal, am supposed to develop and maintain better therapeutic relationships with my patient which involves the patient-nurse relationship. In the patient-nurse relationship, therapeutic bondage gets established out of the sense of trust and the mutual understanding which exists between the patient and the nurse on duty. The good contact relationship between the nurse and patient helps to develop trustworthily and boosts the self-esteem of the patient resulting in the contemporary personal growth (Johns, 2017). Also, the therapeutic communication becomes essential in the improvement of the patient’s abilities in conducting the physical activities. It gets necessary for the nurse on duty to show total care, sincere, empathy, and trust to the patient to build a healthy therapeutic relationship. The nurse’s attitudes would only get expressed to the patient through the effective communication means and excellent interpersonal skills.
Communication will include both the verbal which comprise of speech and the non-verbal communication that involves the use of sign language, change of postures, the body movement and facial expressions, change of intonation and the volume level (Weller, Boyd, & Cumin, 2014). Thus, in this essay, I would give a discussion on the nurse-patient relationship applying the interpersonal skills. The reflection would revolve around the patient whom I shall not mention her real name so as to protect the confidentiality of her information as per the Nursing and Midwifery Council requirement. I shall call my patient as Mrs. Y.
During my clinical placement, I was assigned to serve on the female ward to offer the necessary mental health care services in my third semester. At the health facility where I got clinical placement, there existed two psychiatric wards which were partitioned and separated to serve the male and females who had mental problems (Arnold & Boggs, 2015). The two precincts shared a small cafeteria within the wards’ premises. Usually, the wards got always locked from a single and the main entrance. As a matter of interaction between patients, the female patients were advised and got encouragement to move out of their rooms mix freely with male patients at the cafeteria section during the meal time hours.
At lunchtime, I spotted one of the female patients seated still on her ward bed. She was known as Mrs. Y, aged 78 years old, early on got diagnosed with the schizophrenia condition. She failed to control the tremor as a result of the side effect of the anti-psychotic medication for the Parkinson Disease (Riley, 2015). Due to the muscle problem, Mrs. Y could not walk so I had to take lunch meal to her and consume while on the bed. Unfortunately, she failed to manage to feed herself. As a student nurse, I assessed her diet and got some meal for her. I took up the role of feeding her until she cleared all the food.
I approached my client and introduced myself before offering her meal. I tried as much as possible to develop a healthy therapeutic relationship with her since I did not want her to perceive me as a stranger given that I did not belong to either her family or relative. At first, I approached her politely asked her why she wanted to take lunch or not. My patient gets prescribed for just soft diet as she had some difficulties in the swallowing or simply the dysphagia condition (Crystal & Crystal, 2016). I proceeded and sought permission from her so that I can feed her. At that very first moment, she just looked at me and kept quiet. In such a situation, I had to show up efficient and empathic listening skills as I fitted myself on her shoes assuming that I had a problem with hearing. Following Wold (2004, p73), empathic listening got viewed as that willingness to have a better understanding of another person without judging the person based on facts. I gently touched the patient’s shoulder, continued talking and raising my tone a little bit since I had some fears that she had difficulty in hearing. I made some gestures at the same time I was speaking to her, the gestures would get interpreted as the eating action. I had to pause, pardoned my actions using simpler and local dialect words for my client. Fortunately, she looked instantly at me and shook her head in acceptance. The body gestures which I used assisted me a lot in the conversation.
Meanwhile, I had some worries on whether she understood the first language, did not know her real mother tongue since did not talk at all. I tirelessly continued using the body gestures and the facial expressions. Personally, I thought that I should speak a bit louder and learn more about her language such that she would easily understand and make a good interpretation of the gestures I made. In the process of engaging my client, I felt that language barrier hindered effective verbal communication (Little, et al., 2015). But, luckily the patient seemed to understand the sign language and knew that I would feed her. At the time of feeding, I maintained eye contact so that my client would not shy off while eating. The eye contact would make my patient feel that am so much willing and interested in assisting her to take her lunch meal. I made her feel comfortable and enjoy the meal until was all finished.
Based on the Gibbs evaluation, I felt that I made an informed decision of taking up the duty of feeding my patient. Also, I developed the therapeutic relationship between my patient and I. though the communication would be termed as task-centred since only a single element hindered the effective communication amongst the nurses, in my case I felt that nurse-patient relationship developed with communication which included both the effective patient-centred sharing and the task-centred communication (Lavelle, Dimic, Wildgrube, McCabe, & Priebe, 2015). Personally, I had attended Mrs. Y as my patient with empathy since she would not manage feed herself and it turned upon me as my duty to feed her for her to receive better nursing care while in the ward. In this clinical practice, I had not been tied to only a single type of communication as task-centred but had an opportunity for building the therapeutic relationship based on the patient-centred process offering the genuineness, the warmth and the appropriate empathy towards my client. I managed to improve my personal skills for non-verbal communication throughout my conversations while feeding the patient.
The non-verbal communication played a greater part in communicating with my patient since she had a hearing problem and would not understand the first language (Stevenson, 2014). Based on this case scenario, the non-verbal communication becomes significant in handling and caring for the elderly patients with hearing problems. Such communication gets utilized in the capturing of the attention of the patients with hearing impairment before they get to speak to me or any other nurse. Through, the non-verbal communication, my patient got to see me physically and drove out any fears she head, and I had an opportunity to learn and develop on the non-verbal communication skills. In accordance to Wold (2004, p.76) the use of gestures enabled me to deal with the language barrier that existed between my patient and me, body gestures forms one of the types of the non-verbal communication with a way of expressing ideas and gets significant for patients who would not speak any word. During the feeding of my patient, I made use of the facial expressions to encourage her to finish the meal (Sarvestani, et al., 2016). The meal might have seemed not delicious to her since she would always withdraw after a short duration but I encouraged her to finish. I gave a smile on her and gave her assurance that the meal would improve her health and give her energy. Besides, the facial expressions were effective means of non-verbal communication as they got not curtailed to any particular culture or age bracket.
In analyzing the issue, I had to make an evaluation that my non-verbal communication skills were significant to provide better and quality nursing care for my patient. Non-Verbal communication enabled I to break the language between by patient and I, given that she would not speak the official language and I knew a few words of her second language (Kumar, 2016). It seemed quite hard to have interpersonal communication based on the verbal communication since I would not speak her second language fluently. Though in some publications, such as that of White (2005, p.112), a nursing student is advised to learn some words or common phrases in the second language that would make the patient at ease of understanding better the care offered.
Similarly, in this individual reflection, I learned how interpersonal communication played a vital role while I handled my patient in the process of delivering safe and quality care. My patient took some time in adapting to the situation of I feeding her. I concentrated much in my inner feelings and thoughts while feeding her, such that I would get the best way of improving on my non-verbal communication skills and render it useful (Ebrahim, Robinson, Crooks, Harenwall, & Forsyth, 2016). Luckily, I managed to communicate with her easily, and she enjoyed the meal up to the last bite. I realized that it was important to create a strong rapport so that I would encourage her to learn on the use of both verbal and non-verbal communication. Furthermore, the ability of effective communication would enable her to share easily with the other nurses.
My action plan for any future clinical placement involving the similar issue of feeding a patient would require me to prepare adequately to properly care such a patient with hearing impairment or unable to use the official language (Persson, Kvist, & Ekelin, 2015). Since the key priority of healthcare is to offer the safe and quality nursing care for her client, therefore, I would take my time in understanding my patient well and strategize on how to render the best care to him/her. From experience, I came to realize that effective communication whether verbal or non-verbal would enable a health care provider to understand the patient and know about the health status in the process of nursing the client. Besides, good listening skills and maintaining eye contact plays a significant role in making the patient feel that her problems get taken into much consideration, and there is the feeling of empathy (Howatson-Jones, 2016). This would cause the patient feel free and fight any fears she might be having and openly narrate to you what she wants or how she feels.
In conclusion, I would proudly mention that the Gibbs Reflective Cycle forms the better part of my reflective framework. Through the model, I managed to develop and build on the therapeutic relationships with my patient using the interpersonal skills. The reflective cycle offers critical stages which enable a health care provider to understand and apply each step in the nursing care for the patients. The Gibbs model allows us as the health practitioners to briefly and precisely describe a health issue, undertake an analysis and effectively evaluate the previous experience.
Arnold, E. C., & Boggs, K. U. (2015). Interpersonal relationships: Professional communication skills for nurses. Elsevier Health Sciences.
Crystal, B. S. N., & Crystal, E. (2016). Improving Nurse-Patient Verbal and Non-Verbal Communication Skills: ICU Patients with Neurological Communication Impairments.
Ebrahim, S., Robinson, S., Crooks, S., Harenwall, S., & Forsyth, A. (2016). Evaluation of awareness level knowledge and understanding framework personality disorder training with mental health staff: impact on attitudes and clinical practice. The Journal of Mental Health Training, Education and Practice, 11(3), 133-143.
Ekelin, M., Kvist, L. J., & Persson, E. K. (2016). Midwifery competence: Content in midwifery students? daily written reflections on clinical practice. Midwifery, 32, 7-13.
Howatson-Jones, L. (2016). Reflective practice in nursing. Learning Matters.
Husebø, S. E., O'Regan, S., & Nestel, D. (2015). Reflective practice and its role in simulation. Clinical Simulation in Nursing, 11(8), 368-375.
Johns, C. (2017). Becoming a reflective practitioner. John Wiley & Sons.
Kumar, K. (2016). Reflection and its uses in Problem Solving and Personal Development.
Kumar, K. (2016). Reflection and its uses in Problem Solving and Personal Development.
Lavelle, M., Dimic, S., Wildgrube, C., McCabe, R., & Priebe, S. (2015). Non?verbal communication in meetings of psychiatrists and patients with schizophrenia. Acta Psychiatrica Scandinavica, 131(3), 197-205.
Little, P., White, P., Kelly, J., Everitt, H., Gashi, S., Bikker, A., & Mercer, S. (2015). Verbal and non-verbal behaviour and patient perception of communication in primary care: an observational study. Br J Gen Pract, 65(635), e357-e365.
Persson, E. K., Kvist, L. J., & Ekelin, M. (2015). Analysis of midwifery students' written reflections to evaluate progression in learning during clinical practice at birthing units. Nurse education in practice, 15(2), 134-140.
Riley, J. B. (2015). Communication in nursing. Elsevier Health Sciences.
Sarvestani, R. S., Moattari, M., Nasrabadi, A. N., Momennasab, M., Yektatalab, S., & Jafari, A. (2016). Empowering nurses through action research for developing a new nursing handover program in a pediatric ward in Iran. Action Research, 1476750316636667.
Stevenson, F. (2014). Achieving visibility? Use of non?verbal communication in interactions between patients and pharmacists who do not share a common language. Sociology of health & illness, 36(5), 756-771.
Weller, J., Boyd, M., & Cumin, D. (2014). Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgraduate medical journal, 90(1061), 149-154.
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