A critical incident report
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A Critical Incident Report. Report Summary and Rationale. The aim of this report is look at a critical incident that occurred in practice and relate this to the theory and knowledge regarding communication and interpersonal skills, that is to say, what skills were and were not used at the time of the incident. Carl Roger's necessary conditions for effective counseling, Heron's six category intervention and methods of non-verbal communication will all be examined. The incident that was chosen was so for the reasons that the situation made the student aware of inadequacies on her own part and those of the staff on the ward, which made her reflect upon the situation and how this could be learned from, so as not to make the same mistake again. Due to confidentiality, the patient concerned in this incident will be referred to under the pseudonym of "Mrs. Khan". The incident took place on an adult rehabilitation ward. Introduction. Communication is essential for effective nursing practice (Kacperek, 1997; Rowe, 1999). Communication occurs all of the time between people, not just verbally, but non-verbally too, by way of gestures, facial expressions, tone of voice and so on. Clear, effective and thoughtful communication is vital for health care professionals, who work with and care for other people (Burnard, 1992). Fielding (1995) argues that communication is the transmission of messages from one person to another. These messages contain information and the senders of these messages intend particular meanings to reach the receiver of the message, who will then attach a meaning to the message. The intended meaning may differ from the meaning attached to the message by the receiver.
Kalisch (1971, cited by Betts, 2002, in Kenworthy et al, 2002) describes empathy as: "the ability to sense the client's world as if it were your own, but without losing the as if quality". Empathy involves understanding the patient's world whilst staying in touch with your own world. Empathy is frequently perceived as the most significant element of the helping relationship (Betts, 2002, cited in Kenworthy et al, 2002). The terms genuineness and congruence are used interchangeably and used to describe the helper always being real in the helping relationship (Betts, 2002, cited in Kenworthy et al, 2002). Genuineness is important to the patient. When nurse's offer support it must be genuine, nurses cannot pretend to be interested, supportive and sympathetic (Burnard, 1992). The third condition vital for effective counseling according to Rogers (1967, cited by Betts, 2002, in Kenworthy et al, 2002) was unconditional positive regard. This can be defined as accepting and caring for the patient without any conditions in place, that is to say accepting the patient for what they are, as a whole, no matter what (Betts, 2002 in Kenworthy et al, 2002). As the student could not communicate verbally with Mrs. Khan, the student attempted to use non-verbal communication (that is to say touch) to convey empathy, genuineness and unconditional positive regard. The student also attempted to use other methods of non-verbal communication in order to implement these vital components to her relationship with Mrs. Khan. During the times that the student sat with Mrs. Khan, the student attempted to show she was listening to Mrs. Khan, even though the student did not understand Mrs.
especially for nurses (Rawlinson, 1990, cited in Rowe, 1999). Reflective practice and self-assessment, which is the aim of this report, is one way of becoming self-aware, with the ultimate aim of learning from the reflection and improving communication skills. Heron's six category intervention and Berne's transactional analysis are both effective ways of increasing self-awareness (Rowe, 1999). Conclusion. The UKCC Code of Professional Conduct states that the nurse should "...act at all times in such a manner as to safeguard and promote the interests of individual patients and clients" (UKCC, 1992). The nurses on the ward did not show their awareness of this clause whilst caring for Mrs. Khan. The nurses used their power over Mrs. Khan and placed in a position that caused her to feel hurt and vulnerable, therefore their approach did not promote the best interests of Mrs. Khan. They opted for the parent-child ego state of Berne's transactional analysis and the authoritative approach of Heron's six category intervention (Rowe, 1999). At the time of the incident student felt very inadequate. She felt that she was not a good advocate for Mrs. Khan, nor did she fulfill the clause of the UKCC's Code of Professional Conduct and act in her best interests (UKCC, 1992). The hardest part for the student was not being able to communicate verbally with Mrs. Khan. However, upon examining the literature regarding communication and interpersonal skills, she felt that she did help Mrs. Khan, if only in a small way. The invaluable use of non-verbal communication has now become clearer to the student. The student believes she has become more self-aware regarding her own non-verbal communication and hopes that in the future she will use her communication skills to become a better advocate for the patient in her care.
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