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Discuss the Care of one patient from a participating placement area that demonstrates establishing a therapeutic relationship in the short term setting including advocacy and the use of clinical science knowledge.

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Introduction

Discuss the Care of one patient from a participating placement area that demonstrates establishing a therapeutic relationship in the short term setting including advocacy and the use of clinical science knowledge. This assignment will revolve around a single episode of care provided to Mr. A, a recently diagnosed Human Immunodeficiency Virus (HIV) positive gentleman. As part of his ongoing care, he attends a Genito-Urinary Medicine department as an outpatient every 3 months in order to ascertain the progression of his disease. As part of this assessment, he undergoes a series of blood tests, including a count of his T-helper cells (colloquially known as a "CD4 count"). At the time, Mr. A was a Clinical Stage 1 asymptomatic patient, according to the World Health Organisation (WHO) HIV staging criteria (WHO, 2005), meaning that he was not currently receiving Highly Active Antiretroviral Therapy (HAART). The assignment will cover the pathophysiology of HIV, focusing specifically on the relationship of the CD4 count to disease progression. Communication strategies relating specifically to the short-term professional and therapeutic relationships developed with Mr. A will also be discussed. In line with guidelines published by the Nursing and Midwifery Council (NMC), specific names and places have been amended to retain anonymity for all concerned, and consent has been obtained from the patient (NMC, 2008). ...read more.

Middle

A, the communication employed seemed appropriate at the time. On his arrival at the clinic, I greeted Mr. A and introduced myself, as I was waiting for him to arrive. Nolan and Ellis (2008) advocate that the therapeutic relationship begins as soon as the patient and practitioner meet: thus the adage about first impressions being everything. Smiling and offering my hand to Mr. A seemed to relax considerably: he had seemed initially quite lost and tense. This initial introduction already seemed to soften the perceptions that most have of the Genitourinary setting. In fact, Bilney and D'Ardenne (2001) found that patients visiting GU clinics can have a decidedly 'warped' view, mainly relating to confidentiality and shame issues, and can therefore be quite hostile and withdrawn: thoroughly non-productive within any healthcare setting. In this particular outpatient setting, the power balance between patient and nurse can be difficult to maintain. From the patient's perspective, the nurse holds most of the power: patients are asked to divulge deeply personal information to a complete stranger and then potentially undress and submit to an extremely intimate examination. With Mr. A, the nursing staff were possibly the only people aware of is HIV diagnosis, and because of this, could have held all of the perceived power. ...read more.

Conclusion

This was handled in an informal manner: a jovial suggestion rather than an edict. Culley (1991) suggests that such behaviour can help to empower patients: getting them to share responsibility and progress, rather than being static. Through this means, not only could Mr. A progress personally, but he could also feel better connected to the service, and by extension more comfortable. In conclusion, it appears that developing a genuine therapeutic relationship is not only vital to the success of outpatient care, but also a cornerstone of good nursing practice. Although many outpatient encounters are single episodes of care with sometimes no follow up, it is still vital the strategies such as those outlined above are employed to ensure that patients receive the best possible care. With respect to GU medicine, it is intrinsic to the nature of the work that a trusting, productive relationship is built with patients: due to the intimate nature of the exchange, trust is vital to provide an accurate and useful service to patients. I feel that in this circumstance, I displayed and employed several effective strategies to build the initial patient relationship, but with the benefit of hindsight, I think that there is still more work that I can do to develop my practice and ensure that patients feel comfortable and by extension engaged with the service that I am offering. ...read more.

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