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Reflection: Therapeutic Relationship

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Describe about the Report for Reflection of Therapeutic Relationship.



Reflection 1:-

This particular incident is that situation that reflected how I managed to have a healing and a therapeutic relationship with Patient A, a patient who was unable to speak after a stroke she has suffered five years ago. I was in the psychiatric ward having a 3 weeks clinical placement for mental care in my 4th semester. In the ward patients were encouraged to walk out of the ward towards a small cafeteria during meal time. During lunch time I noticed that Patient A, who is a77 years old diagnosed with Schizophrenia is sitting on her bed and not heading towards the cafeteria. She was having tremors and was unable to control her muscles in her legs. These tremors are usually caused as a side effect of the anti psychotic drug she was being given. Due to her mental state she was unable to understand this and was getting agitated. At first I introduced myself and approached her to build a rapport with her. I asked her whether she wanted to take her lunch or not. Due to these tremors she was unable to walk unassisted and was unable to feed herself. I checked the chart for her diet and got her lunch from the cafeteria. Through her chart I got to know that she was on a soft diet as she has difficulty in swallowing. After that I took her permission to feed her but she only looked towards me in a blur. In empathy I imagined myself in her place and assumed that due to her age she may have an issue with hearing. I touched her shoulder and raised my tone and at the same time made gestures to feed her. She understood my actions and nodded her head. Luckily the non verbal communication in the form of gestures and facial expressions helped me to convey my message to her. I maintained eye contact with her while feeding her as to show that I am interested in feeding her. She cooperated well and enjoyed her meal. In my evaluation I made the right decision in approaching Mrs A and feeding her. I had used my interpersonal skills to establish a rapport of mutual understanding and sense of trust. When sense of trust exists between a nurse and a patient it builds a relationship that raises the patient self esteem. This helps the patient to communicate well with the carer and in this case it was in the forms of facial expressions and actions. It is important for a nurse to be trustworthy, caring, and to show empathy. As our communication was non verbal it included postures, gestures, and facial expressions. I attended Mrs A to show my empathy towards her as she was unable to walk and feed herself. As it was my duty to care for her. Therefore a nurse’s involvement should not be limited to task centered communication but it should be good patient centered communication.


Reflection 2:-

I had a 3 week surgical posting and I was assigned to care for patients who had a number of diseases. One of them was a 70 year old male who had diabetes mellitus, end stage renal disease, gall bladder gangrene, gout, hyperlipidemia and hypertension. I had observed that he seemed to be lonely and did not mingle with other patients. No family members visited him. During interacting with him I came to know that he thinks that he is a burden on his family due to his numerous medical conditions. He had expressed his desire to die instead of living with so many diseases. He also told me that no one showed concern, care and love for him. During our conversation he mentioned numerous times that he wanted to die. I had listened to him patiently but at the same time was also noting clues of suicidal tendency. I informed the nurse in charge that Mr B has shared his depressive desire and mood with me. I started spending more time with him and explained to him that dying will not be solution to his problems. The staff started paying more attention on him and counseled him. I used the distraction strategy with him and took him around to interact with others. I had felt highly uncomfortable when he had disclosed his desire to die therefore I sympathized with him. His feelings of committing suicide were quite evident through his words therefore I had decided not to ignore them. He had a fear of physical dependence which can only be addressed by communicating with him through compassion. I was very cautious, careful and patient with him. In situations like these the carer or nurse has to be cautious, patient and careful with the patient. We cannot vent our anger, or shout at the patient after hearing to their wish to die over and over again. I was able to win Mr B’s trust only then he has confided in me, his negative feelings. I started with building a good rapport with the patient which helped me in offering him the right resources to his way to getting better. In his case keeping him in contact with other people was important as it would ensure a safe environment for him to get better. Through this experience I was able to learn basic counseling skills by actively listening to the patient and empathizing with him. With a few words of empathy and encouragement an elderly patient was turned from a depressive person to a calm and pleasing person. Through communicating with me and ward staff he was usually in a calm and cheerful mood. On the day when Mr B was getting discharged he thanked me and the staff for our care and encouragement.


Reflection 3:-

it is an example when I was involved in care of a 14 year old girl which I feel is an example of an outstanding good practice. In clinical site interaction I got the chance to observe the public health nurse who was working with a 14 year old who was physically abused. Firstly I was highly impressed with the way that the nurse talked to the girl. When we examined and talked to the girl she told us that had fallen and had a “black eye”. She was unable to see from that eye. I noticed that she has various scratches and bruises on her face and arms. She was hesitant and withdrawn to talk about the incident. I noticed now the nurse was reassuring in her tone when she interacted with the girl. She was very gentle when she examined the girl and asked very politely whether she had any issues at home. To that the girl blatantly replied “No” but the nurse did not push the girl for a different reply. I noticed how the nurse was non-threatening and attentive towards the girl. The nurse then shared her observations with me when the girl left. She took time in helping me to notice and observe many things that I had missed.  I learned how the nurse had used her interviewing and observation skills along with her experience to know the true picture even when she was being told otherwise by the girl. She drew conclusions only when she had carefully analysed the situation and the data that was presented in front of her. She did not reached to conclusions and knew that she had to form a short term plan as she still did not have enough information. Her interpersonal skills and collaborating with me helped me to learn and experience something that I would definitely want to learn. In my course I had learned that therapeutic communication is all about active listening, respecting the client and being a non-threatening listener. Through this incident I was able to experience a therapeutic communication between a nurse and client. I had learned how caring is about seeing beyond what the patient is telling you as it is about reading clues that are there in front of you. It is about making the patient trust you by listening to them patiently even when you know that it would take time for the patient to open up to you. In situation like this the patient may take time to trust the nurse to tell the truth but the nurse has to be patient to let them take their time in order to form a trusting relationship.  The simplest technique to communicate empathy is through reflection and as a nurse you can do it in many ways. We need to understand that patient have their own concerns and should interpret the clues that the patient presents in front of us. As nurses we have to aware that communication of pain will not always be verbal but it can be in the form of expressions and gestures.


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