NURSING MAKING A DIFFERENCE
Title: NURSING MAKING A DIFFERENCE
(Reflection and Personal action plan)
Introduction
In this assignment the author will utilise the reflective cycle (Gibbs 1988) as a framework to review experiences from the management simulation day. In writing up this reflection, I will use both the first person and the third person in the pursuit of reflexivity (Webb 1992). The transferable skill of communication will be reviewed. The reflection will emphasise on the personal aspects of both verbal and non-verbal communication as this contributes to the quality of nursing care (Hinchiff S, Norman S, Schober J. 2003). An action plan in communication skills for the personal and professional development of the author has been presented. The authors Curriculum Vitae is presented as appendix I. Pseudonyms will be used to maintain anonymity and confidentiality in accordance with clause five of the Nursing and Midwifery Council (NMC) Code of Professional Conduct (NMC 2002).
Health professionals in carrying out their tasks constantly engage and disengage with their patients, without communication this relating will be almost impossible (Purtilo 1990; Hinchiff 2002). As far back as 1990, Purtilo realised that communication is extremely important for nurses as they are more likely to initiate interactions with patients in a health care setting (Hargie et al 1994; Holyoake 1998). It is through personal communications that people make their thoughts and wishes known to one another (Hargie et al 1994). Davies (1994) defines communication as an interaction where two or more people send and receive messages and in doing so both present themselves and interpret the other. Communication is about sharing information, through speaking (verbal) and writing (non-verbal) gestures like hand movements and even making faces (Hargie et al 1994). It will be almost impossible to care for patients without the use of verbal and non-verbal communication (Ellis et al 1995; Hinchiff 2003).
Taylor (2000) defines reflection as the re-collecting of thought and memories in a cognitive manner such as thinking in order to make appropriate changes when necessary. Reflecting is not jus about recalling events but also requires the nurse to want to make a change (Reid 1993; Holyoake 1998).
Description
Mary, the team co-ordinator handed over a patient to me (Helen) who came in with falls. Helen is a 30-year-old woman who lives alone and has no past medical history of falls. On this occasion, she missed a step and fell down the stairs at her home. Neighbours heard her cries for help and called an ambulance, which took her to the hospital and Helen needed to be admitted.
During the admission interview, I introduced myself to Helen who was fully conscious and explained the complete admission process. Although she was fully conscious, she ...
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Description
Mary, the team co-ordinator handed over a patient to me (Helen) who came in with falls. Helen is a 30-year-old woman who lives alone and has no past medical history of falls. On this occasion, she missed a step and fell down the stairs at her home. Neighbours heard her cries for help and called an ambulance, which took her to the hospital and Helen needed to be admitted.
During the admission interview, I introduced myself to Helen who was fully conscious and explained the complete admission process. Although she was fully conscious, she seemed very reluctant to talk to me. She was hardly answering any of my questions. I carried out a neurological assessment on her using the Glasgow coma scale. She scored 13, which supported her consciousness level. According to Lindsay et al (1991), the Glasgow coma scale is used to assess a patient's neurological abilities especially after a possible head injury. Helen was breathing independently and her observations were within the normal range.
I moved closer to Helen as I was sitting a bit far and I placed my hand on her hands and told her I could imagine how bad she was feeling and that if there was anything I could do to help. Helen's attitude suddenly changed towards me, she smiled and started answering my questions. She also asked me a few questions about her current job and possible brain injury, which I was unable to answer. Helen's elder sister was also present at the interview but I focused al my attention on Helen. At the end of the assessment interview, I prepared a care plan.
Feelings
In the beginning of the interview, I was nervous and sat a bit far from the patient. Helen seemed very anxious and angry. I was very anxious about the assessment going well. I was also angry at myself about not being able to answer some of Helen's questions. I regret not having involved Helen's sister in the interview interaction. It became apparent to me that there is still a lot for me to learn in order to become a good professional nurse. I noticed my lack of confidence in the beginning of the interview. I got a better response from Helen with improved confidence. I was sincerely empathetic to Helen's situation and noticed how empathy can change a patient's attitude. Helen was a Bank manager and she was worried about losing her job. I did most of the talking and feel that I should have listened more. I realise that I did not involve Helen in preparing her care plan.
Evaluation and Analysis
My anxiety and poor non-verbal communication skills (e.g. sitting position and posture) could have increased Helen's anxieties (Hargie et al 1994; Tuohy 2003). According to Alexander et al (2000) patients do feel anxious during hospital admission especially when they are not sure of their diagnosis I should have listened more to Helen. Olson et al (1991) suggests that some patients might not require an answer to their problems and need just a good listener. Furthermore, Olson et al (1991) and Bulman et al (2004) emphasised the importance of good listening skills in interpersonal communication. On the other hand, Bulman (2004) also emphasises the importance of answering patient's questions and providing good explanations in reducing anxiety. It is important to empathise with patients as this could increase their trust in the health professional (Bulman et al 2004). Helen should have been involved in the preparation of the care plan, as this would have increased its effectiveness (Alexander et al 2000).
In doing this assignment, the need to improve my interpersonal communication skills both verbal and non-verbal was identified. Good communication skills are paramount to the delivery of good quality nursing care today (Pied 2000; Bulman et al 2004). This critical incident reflection and action plan will improve my interpersonal communication skills. Hinchiff (2003) suggests that critical incident analysis could be used to further develop all aspects of nursing care including communication. Furthermore, Schuster (2000) also stated that good communication skills are the key to the therapeutic relationship. Writing this reflection has made me aware about the need to improve my theoretical knowledge of patient health assessment.
References
Alexander MF, Fawcett JN, Runciman PJ.(2000) Nursing Practice: Hospital and Home. The Adult. 2nd ed.Edingburgh: Churchill Livingstone.
Bulman C, Schuts S (2004) Reflective Practice in Nursing. 3rd ed. London:Blackwell.
Davies P (1994) Non-verbal Communication with patients.
British Journal of Nursing 3(5):220-222.
Ellis RB, Gates RJ, Kenworthy N, editors. (1995) Interpersonal Communication in Nursing. London: Churchill Livingstone.
Gibbs G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. London: Further Education Unit.
Hargie O, Saunders C, Dickenson D. (1994) Social Skills in Interpersonal Communication. 3rd ed. London: Routledge.
Hinchiff S, Norman S, Schober J. (2003) Nursing Practice and Healthcare: A Foundation Text. 4th ed. London: Edward Arnold.
Holyoake D.(1998) Observing nurse-patient interaction.
Nursing Standard 12(29):35-38.
Lindsay KW, Bone I, Callander R.(1991) Neurology and Neurosurgery. London: Churchill Livingstone.
Nursing and Midwifery Council (2002) Code of Professional Conduct. London: NMC
Olson JK, Iwasiw CL, Gerrard BA. (1991) Criterion-related validity of the active listening component of the behavioural test of interpersonal skills. Canadian Journal of Nursing Research 23 (2): 49-59.
Purtilo R. (1990) Health Professional and Patient interaction. 4th ed.
London: WB Saunders.
Reid B.(1993) Exploring a response to the Concept of reflective practice in order to improve its facilities. Nurse Education Today 13, 305-309.
Taylor JB.(2000) Reflective Practice. A Guide for Nurses and Midwives. Buckingham: Open University Press.
Tuohy D.(2003) Student nurse-older patient communication.
Nurse Education Today 23(1): 19-26.
Webb C. (1992) The use of the first person in academic writing: objectivity, language and gate keeping. Journal of Advanced Nursing 17: 747-752.
Bibliography
Hagston R, Simpson MP. (2000) Foundation of Nursing Practice: Making the Difference 2nd ed. Hampshire: Palgrove.
Roper N, Tierney A, Logan W. (1990) The Elements of Nursing. 3rd ed. Edinburgh: Churchill Livingstone.
Wilkinson S, Roberts A, Aldridge J.(1998) Nurse-patient communication in palliative care: An evaluation of a communication skills programme.
Palliative Medicine 12,13-22.
Appendix I (Curriculum Vitae)
My Name
Career aim:
As a final year student nurse I gained both community and ward experience. I would very much like to undertake my first post as a qualified nurse in Primary Care.
Skills and Achievements:
* Gained an in depth understanding into community nursing during my final year placement especially wound dressing and ulcers.
* My years training and my work and health care assistant enhanced my ability to work within a multidisciplinary team.
* During my placements in general medical, accident and emergency, surgical and orthopaedic wards, I carried out numerous admissions. The admission process has improved my assessment, planning, implementing and evaluating nursing care; I followed the patients from admission to discharge.
Professional Education
2001-2005 Kingston University School of Nursing and Midwifery. Diploma of Higher Education in Nursing Studies. Registered Nurse Part 12 of the NMC Professional Register
(Sep 2003-Feb 2004 stepped down from my studies due to personal reasons)
998-2000 Southwark College Diploma in Child Care NNEB
Major Placements
2001 Mayday University Hospital: Kenly medical ward; admission and discharge process.
2002 Mayday University Hospital: Ashburton 2 general orthopaedic.
2003 Mayday University Hospital: Norwood 2 medical and surgical ward (assessing patients, nursing documentation).
2003 Mayday University Hospital: Fairfield II (nursing the elderly; observed and assisted with orthopaedic nursing).
2004 St Georges Hospital: Accident and Emergency (Resuscitation, wound dressing, ECG, blood glucose monitoring.
2004 London Borough of Wandsworth community Nursing (communication skills, leg ulcers, diabetic care, general holistic nursing) .
General Education
981-1986 Holy Rosary Secondary School science class, Freetown Sierra Leone
996 Southwark College: return to learning
Relevant Experience
998 To present Age Concern home care helping the elderly with personal care, assisting with medication and maintaining their safety.
2000-2001 Nursery Nurse for Select Education Agency
2002 To present Health Care Assistant St Georges Hospital. Assisting patients with personal care, maintaining activities of living and carrying out vital sign observations.
Sep 2003-Feb 2004 Health Care Assistant St Georges Hospital
Achievements and Positions of Responsibility
2000-2001 Nursery Nurse responsible for nursery children in my classes.
Additional Information
Member of the Royal College of Nursing
Referees
K010096
