NMIH303: Therapeutic Use of Self - Reflective Writing Portfolio Assessment Answers

August 11, 2017
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Solution Code: 1BEB

Question: Reflective Portfolio

This assignment is related to “Reflective writing portfolio” and experts atMy Assignment Services AUsuccessfully delivered HD quality work within the given deadline.

You are required to write three “diary” entries for three different healthcare experiences that you have had. These can be experiences from workplace experience, employment in a healthcare setting, experience as a patient or client of a health service or a healthcare experience of a family member or friend in which you were involved. The experience should have an element that you would like to think or learn more about through reflection and research; perhaps to help you to arrive at a new understanding. The quality of these diary entries will be assessed.

The diary entries do not count in the 2500 word count.

You can write diary entries using the first person “I”. You are required to de-identify people and places (using pseudonyms where necessary) to maintain confidentiality of participants and facilities.

All diary entries will be treated as private and confidential documents.

For each diary entry, you are required to complete a Level 1, Level 2 and Level 3 analysis (see Borton’s analysis framework available on NMIH303 Moodle site (Rolfe, Freshwater & Jasper 2002)). Please do not use any other reflection model.

Please note that within Level 2, you are asked the question of what other knowledge you can bring to the situation. Within this step, and under scientific knowledge, you are required to conduct a literature search to identify and analyse literature that will help you develop a new understanding of the situation you are reflecting upon. This section requires you to demonstrate effective literature searching skills and the ability to consolidate, analyse and critique evidence. Therefore, as many references as you need to comprehensively reflect on the experience is required within this section.

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Solution:Therapeutic use of self

Introduction

Communication plays a very pivotal role for maintaining a good life quality as it enables humans to effectively interact with one another. Communication can either be verbal or non verbal. While making use of verbal communication there is a plethora of factors that determine the words that we choose. For instance the age, the gender, the place and the race of the individual, while non verbal communication constitutes the body language of the individual, the expressions and active listening. Communication becomes of utmost importance in the health care services. A great of information is imparted and understood simply through communication (Varcarolis, Halter and Varcarolis, 2010). However it is imperative to understand the needs, requirements and the feelings of the patient as well. Hence therapeutic communication plays a very pivotal role in evidence based practice. Effectively being able to communicate with individuals helps in establishing a rapport with the other person. In the professional nursing practice, establishing a therapeutic relationship amongst the nurse and the patient helps in building relationships that are positive in nature. Such relationships are governed by respect and empathy for the patient. It also enhances the confidence of the nurses as they require support and help to overcome their anxiety while dealing with patients. This hence allows the nurses to provide the best care for their patients. As a nursing student I have the opportunity to enhance my learning via a reflection of situations that I have come across that include nursing care. I shall be presenting three scenarios that reflect of an experience where I have experienced obstacles while providing care to the patients. The Borton reflection model will be utilized in structuring my reflection and help me to understand the places where I need to improve upon my skills. As per the provision of the NMC code it is imperative that the patient’s confidentiality is respected all the identities of the patients who will be citied in this reflection shall be kept anonymous (Weaver, 2010).

Diary Entry: 1

LEVEL 1

Mr. Brown is a patient who is 75 years of age and is suffering from dementia. The case was at first being handled by a senior care giver however she had to go on leave for certain reasons and his care was instilled in my hands. The reason, why the senior nurse gave me the care of Mr. Brown was because I needed to have an opportunity to enhance my communication skills. While interacting with Mr. Brown, I tried my level best to be calm and speak very clearly. I made sure that I used words that were simple enough for him to grasp. However I was not very certain whether the patient clearly understood what I was trying to convey to him.

LEVEL 2

Initially while interacting with the patient I was very nervous and a bit hesitant as well. Since I was aware that he was diagnosed with dementia I was in a fix as to how I could communicate with him in a way that he could understand me. This experience provided me with the insight that communication plays a very important role in being a nurse. If one is a master at all the routine tasks and the various nursing interventions that are needed it will be all be noting if the nurse does not have the ability to establish a therapeutic relationship with his/her patient and this is all based on effective communication between the two. Good communication is the pillar of nursing (Marquis and Huston, 2006). Communication helps in establishing a relationship that is therapeutic in nature with the patient. It is imperative for a nurse to be able to communicate in an effective manner with the patients as it is helps to provide the patient with reassurance, educate the patients , be a source of motivation for the patient, put them to ease and at the same time comprehend the concerns of the patient. I have realized that establishing effective communication with a patient, who is suffering from dementia, is a task that is much more difficult that what I had anticipated. The case of Mr. Brown communication acted as a major obstacle. I made use of short and clear sentences, however there were various instances where he did not comprehend what I was trying to convey to him or simply he did not hear what I had to say. As a nurse I realize that one measure that I can come up with deal with such instances is to build a good rapport with the patients as it helps in building up the confidence of the patient with the nurse. If this confidence is not present in the patient it will be very difficult to make the patient to adhere to the advice that the nurse is providing to him. It is extremely important for the nurse to understand what the patient is trying to convey. This can be done by simply observing the patient for any verbal and non verbal cures (Sheldon, Barrett and Ellington, 2006).

LEVEL 3

This experience has helped me immensely to understand how important communication be it verbal communication or non verbal communication is for a therapeutic relationship to exist between a patient and a nurse (Jasper, Rosser and Mooney, 2013). I need to work on my communication skills since I will be interacting with patients from various walks of life. I need to have the ability to establish a good rapport with all the patients and this can only be possible through communication. As a nurse it is imperative that I work on my skills so that I can empower other patients and understand their concerns.

Diary entry: 2

LEVEL 1

The patient Mrs. S is an 85 year old female. She was admitted to the nursing home with a chief complaint of shortness of breath and an altered mental status. While assessing Mrs. S, her mental status was found to be stable. Mrs. S seemed to be a very stubborn individual and appeared to be very demanding as she wanted things to be done her way. The nurses who were attending her were very flustered and irritated with her behavior. They did not wish to communicate with her unless and until there was an absolute need to do so. This scenario was one of the most suitable experiences for me to understand and deal with a difficult patient and nurse relationship. My personal opinion is, that irrespective of the patient’s behavior or no matter how demanding the patient may seem, the nurses should not avoid having any form of communication with the patient.

LEVEL 2

The above mentioned scenario left me feeling very sad for the Mrs. S as none of the nurses wanted to communicate with her. This was due to her demanding behavior. However I feel that it is imperative to understand why the patient is behaving in a particular manner, it could simply be that the environment of the hospital was causing Mrs. S to be stressed and thus behave in a certain manner. Effective communication is an integral part of a nurse and patient relationship. In order to help the patient, the nurse should be able to identify and at the same time be aware of the barriers such as physical and social those are prevalent within the patient. Physical barriers could be in the form of sensory impairment while social barriers could be differences in cultural values, beliefs and the economic status of the individual. There are instances where as nurses we come across patients who are rude and tend to speak badly to the nurses. This can cause the nurses to have conflicting values that could impact the communication that exists between the patient and the nurse. Hence working on these communication skills is essential to overcome the barriers that can prevent to establish a therapeutic relationship amongst the patient and nurse. As per research (Freshwater, 2002) it has been found that the environmental condition along with the mental illness of the patient could give rise to aggression in the patient. Thus it is essential to work on communication skills so that healthy healing of the patient can be achieved. Listening to the patient actively, for their needs and requirements can help the nurses to develop a better understanding of the patients and give them the care that they need. It is recommended to sit in a proper manner so that the patient can take an active interest in the conversation. Sit in front of the patient while maintaining and open position, keep eye contact and relax while talking (Nursing Times, 2015).

LEVEL 3

There are numerous barriers that can hinder a therapeutic communication between the patient and the nurse. As per my findings, it is important that I asses my first and have complete information about my patient’s culture, background and economic status before treating them. Conducting a comprehensive assessment will help me in understanding the needs of the patient (Ellis, Gates and Kenworthy, 2003). This will also provide the insight and help that is needed to overcome these barriers that are preventing me from helping the patient. Further, I will ensure that I look out for all the non verbal cues that include the patient’s tone of voice, facial expression and body language so that I can make certain if he or she is troubled.

Dairy entry: 3

LEVEL 1

A patient, let’s call her Ms. Sunshine, was admitted to the ED because of a severe headache and CHF. On asking her to rate her pain on a scale of 10 she said she was at number 7. Her base of the lungs was emitting crackling sound as well. As the student nurse I informed the nurse in charge to provide the patient with medicine for pain management. However she seemed to be very busy to give the patient the medicine. The patient hesitated to ask for the medication as she felt that she was being very demanding, since the nurse was busy with other things. Ms Sunshine did eventually ask for medicine but the nurse came to give to her after 40 minutes. As I sat observing this scenario I wished that I could have done something to help the patient. There are barriers that prevent nurses from providing their patients with the care that they deserve. In this particular scenario, perhaps that nurse on call, was very stressed and over burdened with work. Hence she could not pay attention to the patient. I feel that if a nurse communicates effectively with her patients, it helps in creating positive outcomes.

LEVEL 2

As a nurse it is important to be responsive and assertive towards the patient. To be assertive it is important to have confidence, knowledge that is competent and the ability to initiate a conversation with the patient. Research showed that making use of e- learning packages can help in reducing the stress in a patient and at the same time enhancing the confidence of the nurses while dealing with difficult patients. Non verbal communication is an essential component of communication. Earlier I did not pay much attention to this as I did not face a scenario where the patient did not ask for the things that he or she needed. This taught me to understand the patients facial expressions, the level of eye contact, the lack of eye contact and the body language play a very pivotal role in deciphering the patients feelings towards the care that they are being offered. As a nurse it is important to understand the non verbal cues of the patient as well so as to have a complete understanding of what they are trying to communicate (Brunero, Lamont and Coates, 2010). A competent nurse is an individual who has the ability to understand both the verbal and non verbal cues of the patient. As this helps the nurse to understand the patient’s needs and requirements and provide the best care possible to make them comfortable.

LEVEL 3

There are various barriers that exist while providing health care services to patients. Communication should become an integral part of nursing. How I communicate with my patients and present myself to them is essential for their well being and healing. I feel that as a student nurse I need to practice and pay more attention on communicating in an effective manner with my patients in order to build a therapeutic relationship (Brooker, 2010). As communication plays an intrinsic role in promoting healing. Through this experience I also learned how to utilize communication techniques as the situation demanded. For instance, making observations, asking questions, proving encouragement, being silent and exploring so that I could get as much as information that was possible about the patient. Also it taught me not to ask the patient too many questions that made him or her feel uncomfortable or interrupt the patient while they were communicating.

Conclusion

It is very important to reflect on all the experiences that have been mentioned in the course of this reflection, to understand the importance of learning. It helps in identifying the strengths and weakness that an individual has in their skills. Communication is one of the most pivotal tools that help in establishing a therapeutic relationship amongst the nurses and the patients. A nurse needs to be able to communicate in an effective manner with the patients so that he/she can deliver the best nursing care possible to the patients (Boggs and Arnold, 1989). It is important to be a good listener, hear the patients out for all their needs and requirements. As a nurse it is not needed to impose one’s own feelings and ideas on the patient. As a nurse I need to develop my skills so that I can establish relationships that are meaningful with my patients and at the same time keep all confidential information pertaining to the patients to myself. Patients find it easier to discuss various details about their health concerns with those nurses who they feel are approachable, those who have a good sense of humor, appear friendly and can relate to their problems. While dealing with patients from different cultures and ethnic backgrounds I can make certain that communication does not hinder their progress. Thus by making use of pictures and drawings we can communicate with one another and not let lack of communication effect the relationship between the nurse and the patient. As a nurse I can also provide help to my patients in dealing with their health concerns while they are at the hospital (Arnold and Boggs, 2011). Most patients find it difficult to understand the medical language that doctors make use of while explaining the treatment options to patients thus it is imperative that as a nurse I bridge this gap and help the patients in understanding the medical terms that are commonly used. Critical thinking forms an intrinsic part of nursing and this can be achieved by ensuring that I practice everything that I learn while I am studying. Therapeutic nursing has several aspects that cannot be mastered at once hence I want to push myself to strive to seek ways so that I can enhance my relationships with the patients along with their families in the future.

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