More knowledgeable I returned to Betty, pulled a chair up beside her and in a calm and comforting manner I explained the reason she was in hospital, but Betty looked confused and asked me to speak into her right ear as she was deaf. I patiently repeated the information and she looked brighter as I mentioned her nephew’s name. Betty had a few more questions and I tried to answer them accurately and confidently as I felt she had the right to know all decisions being made in her interests. Betty smiled then confided she knows she is forgetful and could not sleep as other patients were disturbing her. I gave Betty assistance with personal hygiene needs and she thanked me for ‘just talking’. Betty felt at ease knowing everything was alright and she fell asleep in her chair.
Feelings
I was angry that staff had agreed that Betty was very confused and aggressive, without investigating and I was annoyed that the staff felt this gave them a reason to laugh and mimic a patient. I also felt very sad that no one had taken the time and effort to sit down with Betty and explain the situation. After I had helped Betty, I was happy that I had taken the time to get to know my patient and in turn seen a different side to things and was proud that I had reassured and relaxed Betty so that she could rest properly.
Evaluation
The experience I encountered was positive as it taught me to make the time to listen to patients in my care, to have patience and be sensitive when interacting with them, in particular those who are vulnerable. I did not like the approach the nursing team took to the patient, as they did not make an effort to help or support her as she was known as a ‘difficult’ patient. Stockwell (1972) wrote the infamous book “The Unpopular Patient” and she explains that studies of communication in nursing demonstrate inadequacies in nursing practice. Stockwell (1972) describes the nurse-patient interaction, insisting that such interaction is not always satisfactory, especially when dealing with a ‘difficult’ or ‘unpopular’ patient. Betty was considered an unpopular patient as she was demanding of attention due to the condition she had. I also think that the nursing team were ignorant of Betty’s difficulty in hearing and found it irritating to continue repeating themselves.
Analysis
There was no interaction between nurse and patient as Betty approached the nurses’ station, and to be mocked then dismissed must have been a terrible experience for her. Davis (2008) explains how hectic times of the day such as handover, mealtimes and ward rounds leave insufficient time to help patients who need it. However, if the nursing team had engaged in a little conversation with Betty, she might have retired feeling valued and understood, instead of upset and belittled. The NMC Code (2008) clearly states many standards of conduct which a registered nurse should be trusted to do, these including “You must treat people kindly and considerately” and “You must listen to the people in your care and respond to their concerns and preferences”. If as nurses we should comply with The Code (2008), a lot of work is required to raise the awareness of the importance of communication in the delivery of care. In 2007 the NMC introduced Essential Skills Clusters. These Essential Skills are to be delivered by all registered nurses’, one of these clusters containing Care, Compassion and Communication. The NMC introducing these clusters show the importance of interpersonal skills in nursing care, and significance of communication in the nursing profession. On this occasion, the nursing team did not show care or compassion for Betty, and certainly did not engage in therapeutic conversation.
As a student nurse I felt I had the knowledge and skills to approach the patient to appropriately calm and reassure her. Heyward and Ramsdale (2008) explain that a patient who thinks his nurse is not listening to them will lose faith in the service a nurse provides, and in the nurses’ willingness and ability to do as they have promised. They explain that sympathizing with a patient shows willingness to understand their anxieties and make the patient feel more comfortable. As I entered the room the patient stood up with a defensive posture, which I assumed was using non-verbal communication to inform me that she was suspicious and distrustful of me. This was caused by the nursing team’s disability to make the patient their first priority and to listen and respond to her concerns. Santamaria (1993) tells us that nurses must deal with the full range of human behaviour, and at the same time deliver the highest quality of care. I acknowledged that Betty was upset and gave her the opportunity to ask questions and voice her concerns, and in turn made her feel special by giving her my time. As Betty asked me to speak loudly into her right ear I wondered if her history of deafness had been accurately assessed, as she was definitely not deaf but having communication difficulties. Eradicating this problem with help of a speech and language therapist or a hearing aid would have helped Betty and the impatient staff enormously in this situation.
Although I had been informed that the patient could be aggressive, I managed the situation by relating to her position and understanding her point of view. Leadbetter and Patterson (1995) explain the prevention and management of aggression should be dealt with by showing empathy and respect for the patient’s individuality and being genuine, utilizing an open and honest manner. Finally, integrity, and being aware of ones own competence to handle the situation. Egan (1990) considers non-verbal communication to prevent violent situations such as considering body posture, nodding to show interest and making eye contact, but not as though to threaten the patient in any way. Fortunately, empathy and respect for Betty helped her to trust and confide in me.
The reason for analyzing this particular section of the scenario was to answer the question, “Why did the nurse not feel efficiently equipped to approach the patient herself, instead leaving the potentially aggressive situation with an unsupervised student?” In the NMC Code (2008), advice for a registered nurse is to recognize and work within the limits of your competence, but also to have the skills and knowledge for safe and effective practice. I believe communication skills within the nursing team must be rigorously developed and maintained as one professional alone cannot meet a patients requirements. We need to work collaboratively to provide maximum care delivery.
Betty felt more relaxed, valued and safe, after we identified and resolved her concerns. Older people generally have more barriers to communicating effectively. These barriers are worth investigating, as the acquisition of a little understanding and basic skills is a simple and rewarding exercise. (Myerscough, 1992) The barriers Betty faced, was the time the nurses had to spend with her, and the fact that she was deaf. Myerscough (1992) explains that this is overcome by speaking loudly and clearly, using clear lip movements to assist lip reading. Through actively listening to the patient and encouraging conversation we managed to focus on the problem that was causing unease. I do believe that Betty was discriminated against because of her conditions and illness, as she was not given the time and energy that was given to other patients. The Human Right’s Act (1998) Article 14 explains that every person should be treated equally without any discrimination on any ground. This section of the act was broken when the staff failed to treat Betty as they would the other patients. Betty was confused and upset that she had not been given time to adapt to her surroundings, and was in fear due to the separation from her main caregiver. Most patients do suffer a degree of anxiety and apprehension and admission to hospital is in particular a disturbing experience for anyone. (Lloyd and Bor, 1996) They offer explanations for these anxieties, such as being in an unfamiliar environment and separation from family and friends. Loss of personal space is a factor mentioned, as is loss of independence and privacy. One that closely relates to the scenario is uncertainty of diagnosis and management. Betty was uncertain of her diagnosis and felt that she was being forced to stay at the hospital against her will. By providing her with the information she required, she could understand a purpose for her admission and the decisions being made.
Conclusion
The reason for Betty’s upset, and the nursing team’s reluctance to help her, all stem from the same thing. As we have discovered communication and ones ability to reflect on practice have enormous effect on the capability to provide the highest possible quality of care. Additionally time and commitment to our patients is priceless as it can never be taken away from them. We also need to realize that ones own values have effects on interaction with our patients, so appreciating that our client has different values and beliefs to ourselves help us gain insight into the reasons they think and behave as they do. Some consider interacting with others as hard work, but we as nurses need to understand that communication is the gateway to successfully helping our patients and improving our skills.
Action Plan
On reflection I saw first-hand how easily communication can break down, if not between nurse and patient, then within the multi-disciplinary team. I will take the experience with me throughout my nursing education, remembering the importance of effective communication, and also the ability to look back at an experience and break it down to discover what really happened. Taylor (2000) defines how reflection on action occurs perfectly. He explains that only when details of events are recalled and analyzed, unpicked and reconstructed considering all aspects of a situation, can one gain fresh insights and amend actions. He quotes “Critical thinking is essential for safe practice”. (Taylor, 2000 p.64) This should be an ongoing and extensive process for all nurses in practice. I will be more aware of my interaction with others and will constantly reflect on my experiences to see the whole package of care delivery.
References
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