Tuesday, 8 October 2013

Interpersonal Communication in Nursing:Sample Reflection Paper

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Reflection is turning experience into learning (Boud, 1985). This is more applicable in the health service provision and care for it forms the core of a healing and therapeutic process. Reflection in nursing practice enhances effective care and therapeutic process (Parker, 2006).In line with this thought I shall reflect on an experience and discuss the communication skills used or should have been used during the encounter. In this context two of the five caring processes which are knowing and enabling/informing will be applied (Swanson, 1993). Communication forms the core part of our day to day life and is an integral part of human survival and growth.
Communication is important in nursing practice for it is said to weave together practice to ensure that care is continuous, consistent and congruous within and across practice settings(Johns, 2004). Communication is one of the essential factors to maintain a good quality of life because it allows humans to interact and provide comfort (Ashurst, 2010). The nature of the nursing profession makes it indivisible with communication for an effective nurse practitioner must get involved in daily communication. In this context I will adopt the five stages of reflective cycle as given by Gibbs(Jasper, 2003)
I had just reported to duty at the hospital and since I was the shift leader I commenced the routine ward rounds. I was the shift leader and we were together with the other shift team. Suddenly, we heard an unusual noise from one of the wards on the adjacent block. This was unusual because wards are known to be somewhat quiet and serene because the occupants are sick and unable to shout.
We headed straight to the ward in question and on arrival witnessed a horrifying scenario. Two patients were lying on the floor, one unconscious and the other with a deep cut on the forehead and was profusely bleeding.
Certainly, there was no patient with a psychiatric case and the scene witnessed must have been caused by something. There were some relatives who had come to see their patients and some patients were shouting hysterically. Obviously, the relatives were in the wards at a wrong time for visiting time was far gone. There were many obvious lapses in this incident and the most conspicuous one was lack of proper communication and direction from those in charge for this would have brought sanity to the wards
We tried to calm them down in order to ascertain the cause of the commotion but our pleas fell on deaf ears. Some became abusive and even threatened violence. When I found out that our efforts were not yielding fruit and we were actually unable to communicate, I called for assistance from the security who threw the relatives out. The ward was in a total mess hence we embarked on resettling the patient. We called in the doctors who attended to the unconscious patient who later stabilized after six hours.
When dust had settled the hospital administration had to get to the bottom of the matter by ascertaining the cause of that ugly incident and immediate investigations were launched. The immediate outcome was that since it was Christmas season and the festivities were on, the  patients’ relatives smuggled alcohol to the ward to celebrate with the their kin!. The matter was reported to the hospital administration and all those patients involved as a disciplinary measure.

I was angry with the patients and their relatives for such irresponsible act, but also remembered that the patients were ignorant of the consequences of their actions. Apparently the patients were left alone with their relatives for far too long and this must have greatly contributed to the said incident. It is a risk to have the patients all alone without any caregiver around to attend to their needs. These developments demonstrated total breakdown of communication and coordination of the healthcare services. The hospital administration had done little in communicating their protocol to both the patients and relatives.
 What happened in the ward was a portrayal of lack of information on the part of the client on what is expected of him or her while in hospital admission. A clear outline is given on patient-centered approaches to communication with patients and families in order to realize best results (Planetree, 2008). There are various practical tools that are supposed to guide both staff in all cadres, patients and families in order to maintain both best practices and obtain optimum results in healthcare provision.
In this given case the patients and relatives would have been given sufficient information upon admission and also be committed to sign some agreement to the code of conduct whilst in admission. There shouldn’t have been any assumption regarding the conduct of the patients and relatives hence proper guidance would have been communicated. Effective communication with the patients and families forms a cornerstone for providing quality healthcare (Planetree, 2008, p.78). This means that effective partnership is important between the caregiver, patients and families for effective and efficient healthcare delivery.
I felt that there were serious omissions both on the part of hospital management for lack of proper communication between patients and relatives on protocol to be followed whilst in admission.
There a number of lessons I learned from the experience which include establishment of a communicative relationship between the patient, the hospital administration and families right from the onset to know how to handle any emerging situations during admission. The patient has a right to any information that will help him/her get along well with the caregivers while at the hospital. It is imperative to inform the patient about his/her obligations and the expectation of the care giver while in admission.
There should be a well-documented patient/client and the hospital and health care givers relationship which is brought to the attention of the client before admission.
Also there was apparent security lapse for the relatives to the patients were left in the wards for unnecessarily long time. This means that no one cared so much about the state of the patients for that long hence a leeway for the incident. There must be proper security and surveillance checks to ensure that the patients are safe in the wards.
The hospital’s policy on visiting relatives should be availed to and boundaries for interaction to be clearly marked and observed. All forms of communication both verbal and non-verbal should be observed in order to ascertain the level and extent of intervention.
 Last but not least as a caregiver I should be more sensitive and try to approach issues at an early stage before they get out of hand. This also important for it is only when practitioners can communicate consistently that communication is effective (Johns 2004, p.204).
After the discharge of all the patients in the ward, I was left wondering whether there was anything I would have done as a caregiver that would have led to different results for this would have at least made me contented with my services. Definitely there’s something I would have done that would have enabled the hospital administration to make a different decision concerning the misbehaved patients and relatives. There was a great burden in my heart because the patients were discharged without having both their problems addressed.
Apparently the hospital management did not supply the patients and families with adequate information upon admission. On the other hand, as a caregiver, I would have interrogated the patients after they had calmed down in order to understand the background of the incident and try to assist in recovery and rehabilitation from alcoholism. Some patients had ailments that would be more severe if they would take alcohol, while others were under some type of medication that could not be mixed with any alcohol content.
In my opinion there was a rushed decision by the management in discharging the patients again failing to give them proper information to help them avoid such actions in future.
 As a caregiver I would have endeavoured to understand the background of the patients and their relatives in order to help them overcome such tendencies and take their health seriously. I would have also advised the hospital management to interrogate the patients and their families in order to give them necessary support.
It is at the hospital that a patient gets all-round health care services, and it is rather odd to have an ill-informed patient like the case above getting punished for lack of proper information which is to be given by the health provider.
As a health care giver I should have used the client-centered approach for it forms the cornerstone of collaborative association between the nurse and client in the quest to resolve healthcare problems (Arnold, 2003). By discharging all the patients without helping them solve their health problems, the management demonstrated an uncaring attitude and lack of sensitivity to their health needs. This is quite a contrast of what should be expected of a health care provider.
The event was an eye opener and it made me endeavour to be a good communicator in future and be a strong leader who can handle organizational policies without a hitch. I also learnt that I would initiate and implement a health education program in the hospital.
In this scenario there a clear demonstration that there’s total lack of communication or proper communication between a caregiver and the client or patient. It is much easier to manage a well-informed patient than the one who is not informed of both patient rights and obligation whilst in treatment. Good communication helps to build a therapeutic relationship which is central to nursing(Collins, 2009). It is further emphasized that effective communication is a tool that would allow the nurse to reassure a patient, empower the patient, motivate the patient, put a patient at ease, and convey understanding of the patient’s concerns(Webb, 2011)

Nurses play an important role in communicating with patients because they are always in close contact.
It is apparent that a nurse can play a key role in improving healthcare services by improving the relationship by communication (Wright, 2012). Having effective communication skills is therefore an imperative. Through the above experience I have learned that developing my skills in leading and confronting patient-related challenges through effective communication is a must. I must endeavour to acquire new communication skills and employ them effectively for best results in my practice. I would practice the key communication skills in order to be able to control the complex tasks that require high level negotiation(Bach, 2009)
We learn through experience and it is through reflection on such incidents like the above that we are able to develop better skills for effective performance. Effective communication is an imperative in the health practice for research has shown that ineffective communication among healthcare professionals is one of the leading causes of medical errors and patient harm(Leonard, 2004)
 As observed earlier, through reflection we discover different learning needs and this helps us become better practitioners. Unless given proper attention, communication aspect would either build or destroy a career(Pierre, 2012)

Ashurst, A. T., S. (2010). Communication, communication, communication. Nursing and Residential Care, 12(3), 140-142.
Bach, S. a. G., Alec. (2009). Communication and interpersonal skills for nurses. Exeter: Learning Matters.
Boud, D., Keogh, R, Walker D. (1985). Reflection: Turning experience into learning. London: Kogan Page
Collins, S. (2009). Good communication helps to build a therapeutic relationship. Retrieved from http://www.nursingtimes.net/nusring-practice/clinical-specialisms/educators doi:5003004
Jasper, M. (2003). Beginning reflective practice: Foundations in nursing and healtcare. Cheltenham: Nelson Thornes.
Johns, C. (2004). Becoming a reflective practitioner (2nd ed.). Oxford: Blackwell Publishing.
Leonard, M., Graham, S.,Bonacum D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care, 13, 85-90.
Parker, M. (2006). Aesthetic ways in day-to-day nursing. London: Sage Publications.

Pierre, A.-J. (2012). Transitions in nursing: Up-level your career, your income, your life.  Retrieved from http://transitionsinnursing.com/9-ways-to-boost-your-confidence-as-a-nurse/
Planetree. (2008). Practical approaches for building a patient-centered culture. Patient-Centered Care Improvement Guide. Retrieved from www.planetree.org, www.pickerinstitute.org
Swanson, K. (1993). Nursing as informed caring for the well-being of others. Journal of nursing scholarship, 25(4), 352-357.
Webb, L. (2011). Introduction to communication skills for nursing practice. Oxford: Oxford University Press.


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