The this helps advance patients’ health both physically and

The aim of this
assignment is to critically reflect utilising the Gibbs (1988) reflective cycle
on a therapeutic encounter at placement. This aim will be reached by
understanding and critically evaluating approaches with the adult nursing field
which enable care to be person centred. Also, the 6 C’s adopted from the
Francis report will enable the aim of the assignment to be reached (Barber,
2016). The 6 C’s are competence, care, compassion and communication, courage
and commitment (Caughan and Long, 2015). The 6 C’s are of immense importance in
therapeutic communication as they help in delivering excellent care which is
person centred (Darzi, 2008). They enable the patient to be involved in their
care and this improves the care they receive and how they feel about themselves
(Roach,1997; Darzi, 2008). The 6 C’s are also important in therapeutic
communication as they enable patients to be treated with empathy, respect and
dignity. In turn, this helps advance patients’ health both physically and
mentally as they are made to feel they are part of the care they are receiving (Barber,
2016). Therapeutic communication can be defined as an interactive process
between a nurse and a patient/client with the aim of achieving specific health
associated goals (Ruesch, 1961 as cited in Sheldon and Ellington, 2011).

Furthermore, a range of verbal
and nonverbal communication skills will be demonstrated within this essay. These
included use of appropriate touch, active listening- mirroring, nodding. In
addition, the impact on relationships between patients and their carers will
also be systematically explored.

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Moving on, as per Nursing
and Midwifery Council’s Code for Nurses and Midwives NMC (2015) and Data
Protection Act’s (1998) guidelines on confidentiality, a pseudonym (Charlotte) will
be adopted in this essay. Charlotte is a young female in her late 20’s who was
admitted a few days after the start of my nursing placement in a certain ward.
She is a sportsperson whose life revolves around sports and has won several
medals around the country.  She was
admitted due to severe breathlessness. Charlotte has never suffered from
breathlessness in her life before. She was also recently diagnosed with type
one diabetes which was wrongly diagnosed as type two diabetes in the first
instance. She is managing the diabetes well by taking insulin and diabetes
tablets (metformin) as directed by her doctor. According to Steinberg and
Miller, (2010) and Holt and Kumar, 2(015) type 1 diabetes in recently diagnosed
adults is often misdiagnosed as type 2 diabetes.

This patient and the
therapeutic encounter were chosen as I was greatly involved in their care from
the time she was admitted to the time she was discharged. Also, I managed to build
a great professional relationship with this patient hence why she was chosen
for this essay.

Therapeutic approach.

The therapeutic approach
adopted for the encounter was Carl Roger’s (1950) person centred therapeutic
approach (Rogers, 1957; Overholser, 2007; Brauer, 2015). This type of therapy
focuses on how the patient is feeling and what could be done to help them. It
also recognises that some episodes in one’s life can alter their way of
thinking (Overholser, 2007). Additionally, it is a holistic approach as it
seeks to understand the patient’s life experiences, values and their current
health issues. It also recognises that to have a good therapeutic relationship
there should be acceptance/ unconditional positive regard by the nurse for the
patient, the nurse should be genuine and empathetic (Benner, 2010; Caughan and
Long, 2015). This type of therapy focuses on how the patient is feeling and
what could be done to help them (Overholser, 2007). Person centred approach is
also known as client centred approach (Arnold and Boggs, 2011).

The therapeutic encounter.

Two days after being
admitted, Charlotte was diagnosed with asthma. Asthma is a lung condition whereby
recurrent bronchial obstruction occurs leading to difficulty in breathing
(Martinez and Vercelli, 2013; Brauer, 2015). At present, there is no cure for
asthma, however, there are several available treatments which help ease the
symptoms (Liu, 2017). Symptoms of asthma include chest tightening, wheezing,
breathlessness and coughing (Brauer, 2015; Liu, 2017).

Moving on, Charlotte was
independent and used to administer her insulin by herself. She would also check
her own blood sugar levels and kept a record of them. Nevertheless, this
suddenly changed after being diagnosed with asthma. She also became withdrawn
and isolated herself. According to Chand and Lo (2016) isolating oneself and
withdrawing from other people can cause mental health problems such as anorexia
nervosa, anxiety and depression. In other cases, depression also causes one to
isolate themselves and to withdraw from other people. In turn, both cases can
lead to low self-esteem and confidence (DeHart, Pelham and Tennen, 2006; Silverstone
and Salsali, 2013).

Therefore, healthcare
professionals started checking her blood sugar levels, but she would still
administer her insulin. She was becoming weak, thirsty and sweating only to
realise she had stopped taking her insulin. Her blood sugar levels were
checked, and they were out of range- 14.5 mmol/L. The normal range of blood
glucose levels for a person with type 1 diabetes are 4-7mmol/L before eating
and between 5 and 9 mmol/L two hours after eating (Holt and Kumar, 2015;
Steinberg and Miller, 2015). Doctors were informed, and intravenous fluids were
prescribed and administered. The diabetic team was involved and prescribed an
emergency fast acting insulin to help regulate her blood sugar levels (Holt and
Kumar, 2015). After a few hours Charlotte recovered but however, still
withdrawn. Having built a professional relationship with her, I went and
knocked on to her room asked for permission to go in and it was granted.  The reason for my visit was to check if
Charlotte was okay and if she needed anything as highlighted below;

 “You can
always talk to me or any one of the healthcare workers if you need anything or
if you have got any questions. We are always here for you”, I said whilst
holding her hand and mirroring her.

The above can be viewed
as an illustration of a reflective statement based on empathetic insight
(Ruesch, 2016). Also, reflection as a listening response, focuses on the
emotional implications of a message and helps the patient clarify important
feelings (Platt and Gaspar, 2013). Egan (2014) suggests that empathy is a significant
skill in positive relationships. Furthermore, Rogers (1975) as cited in Overholser
(2007) suggests that empathy is a cognitive skill of communication which
consists of the helper’s capability to communicate with genuineness and warmth
whilst trying to understand another person’s thoughts and inner world. Empathy
can be viewed in ‘compassion’ which is one of the 6 Cs (Nadzam ,2015). Having
known Charlotte for a few days and how she was on this day made me feel her
emotions and saw that something was not well with her. This drove me to want to
help Charlotte hence why I asked her if she was okay and if she needed someone
to talk to. Additionally, compassion can be said to be an essential part in
delivering high quality patient care (Nadzam, 2015). Although a nurse can be
competent and caring in their role, there is still a need for them to be
compassionate and be able to comfort patients if need be (Liu, 2017). For
instance, in this case, Charlotte needed empathy to help her deal with the new
diagnosis. By so doing, a person-centred approach is achieved, and high quality
of care is given (Benner, 2010).

In addition, use of touch
(holding Charlotte’s hand is claimed to be one of the most powerful ways one
can communicate nonverbally (Cuaghan and Long ,2015). Within a professional
relationship, affective touch can convey caring and reassurance (Inoue, Chapman
and Wynaden, 2016). The above is also supported by studies undertaken which
suggest that touching patients or clients was reported to be perceived
positively as an expression of caring and on the other hand negatively as
threat (Harding, North and Perkins, 2010). Moving, the use of mirroring used in
the therapeutic encounter is a body language which was used to reinforce the
message which patient (Charlotte) heard. This is supported by Sheldon and
Ellington, (2011) when they suggested that the influence of facial expressions
such as mirroring far outweighs the influence of the actual words.

 Charlotte responded to me whilst shading some
tears, “I cannot take this anymore. Why,
why me? It’s too much.”

When Charlotte responded
with the above, I sat down and touched Charlottes’ lap and gave her a few
seconds to breath and then asked her what was too much. She responded, with the
below.

“Another diagnosis within eight months. I have just stopped taking my
insulin because I can’t take it anymore. I’m sure if I die everything will end
and I will rest without all this.”

Being diagnosed with a long-term
illness can be life changing and distressing and this can be viewed in the
above (Leininger, 2008). Thus, it is important for nurses and healthcare
professionals to be competent enough to able to recognise if a patient is
distressed and offer help and support to them. This is supported by the NMC
(2015) when they state that all nurses should build therapeutic relationships
with patients through effective and safe communication such as active listening
and use of touch (Bach and Grant, 2015).

To help a patient deal
with a new diagnosis, it is of immense importance for ta nurse and other
healthcare professionals to be knowledgeable about the illness for them to
offer hope (Doherty and Thompson, 2014). Furthermore, the healthcare
professionals should also be aware of the help and support the patient can
receive (Smith, 2007; Sheldon and Ellington, 2011).

Moreover, the use of
silence as seen when Charlotte was given is a powerful listening response
especially when used deliberately and judiciously (Caughan and Long, 2012).
Intentional pauses enable the patient to think and enable the nurse to process
what they would have been told by the patient (Bush, 2001; Burgoon, Guerrero
and Floyd, 2010).

It can be suggested that
for one to open-up as Charlotte did to me, there must be an established trust
and respectful relationship between a patient and a nurse or any other healthcare
worker (Honey, 2009).

“I can only imagine how you are feeling and what you are going through.
However, I believe there are other ways we can go about dealing with the new
diagnosis instead of stopping to take your insulin. You know it’s crucial for
you to take it, otherwise there will be more problems. There are also some
asthma treatments available to help you live a normal life.”

The above is an example
of a response with the use of communication skills and providing information
which is accurate, clear and meaningful to the patient (NMC Standards as cited
in Bach and Grant, 2015). By doing so a patient is empowered to be involved in
the treatment and care planning process of the condition/diagnosis with the use
of a person-centred approach (Baughan and Smith, 2009).

After a lengthy
conversation with Charlotte, she lightened up and felt much better and agreed
to start taking her insulin as prescribed and to consider how she would
positively cope with living with asthma. She felt cared for and appreciated my
efforts to bring out the best in her situation. This reinforced my knowledge on
the importance of how caring is a base of relationships. This is supported by Sully
and Dallas (2010) when they suggest that the core of a nurse and patient
relationship is care, and it should be the lead in defining action and
communication. Additionally, it can be suggested that from the above, “caring
is nursing, and nursing is caring” (Leininger, 2008: p83). Benner (2010)
supports the above by describing caring practice as the helping role, effective
management of rapidly changing situations and administering and monitoring
therapeutic interventions and regimens.

Reflection on therapeutic encounter.

The therapeutic encounter
went well as it led to a positive outcome for Charlotte- thus, restarting to
administer her insulin and this made the diabetes to be well managed and under
control. It also made her think positively about the new diagnosis (asthma) and
how to manage it. Furthermore, Charlotte agreed to be referred to the mental
health team for psychotherapy. Also, the therapeutic encounter strengthened the
professional relationship I had with Charlotte.

The encounter also
enabled me to have the capacity to be with a patient on a one to one note and
to perceive accurately her feelings, experiences and meaning. It also enabled
me to offer some hope to the patient. Thus, expecting in their future despite
the asthma diagnosis alongside living with diabetes. Additionally, the
encounter enabled me to be compassionate to those in my care by recognising
their need for comfort. I managed to do the above do to having an empathetic
understanding of the patient’s needs.

To achieve the above some
of the skills used were, active listening through nodding and eye contact,
silence, paraphrasing and use of touch. Eye contact was used in this encounter
as it bears a positive message- sign of interest in what is being said (Harding
et al., 2010). However, there are some cultural differences to this. Nodding
the head was also used as it helps to highlight interest and concentration.
Also, use of touch offers comfort and care (Inoue et al., 2016).

 

 

 

Main learning.

It is of foremost
importance for healthcare professionals to be competent in offering therapeutic
support to patients. There is also need for them to be able to offer comfort
and compassion when needed, Department of Health’s (2012) 6C’s. Also, person-centred
therapeutic approach requires greater self-awareness therefore, it is crucial
for nurses and other healthcare professionals to be aware of their behaviours
and responses and recognise unintentional effects these may have on the
communication process. Correspondingly, person centred approach requires
self-regulation therefore, it is crucial that when healthcare professionals
reflect in and on action as lack of self- regulation can prompt inappropriate
responses to patients (Baughan and Smith, 2009). According to Golman (1998) as
cited in Sully and Dallas (2010) for one to be self- aware, self-regulating and
to be able to recognise the needs of those in their care, they need to develop their
emotional intelligence. Emotional intelligence could be defined as the ability
for one to be familiar with their own feelings and emotions and those of other
people (Golman, 1998 in Sully and Dallas, 2010).

Caring for patients who
have given up on their treatment or who refuse to comply with their treatment
are challenges which nurses should be aware of and know how to tackle them (Baughan
and Smith, 2009). Additionally, a therapeutic relationship is central to the
delivery of care and using communication skills (verbal and nonverbal) the main
conditions of client centred relationships are offered (Rogers, 1957). For
instance, these are empathy, understanding, genuineness, respect and openness
(Rogers, 1957). 

Moving on, on one hand, there
is a relationship between this therapeutic encounter and previous therapeutic
encounters as the patients needed comfort in their battles with health. Being
sensitive to my choice of words to the patients enabled me to offer comfort
empathetically and to prevent provoking distress. However, although there is a
relationship between the encounters, each therapeutic conversation is different
as patients are different (Caughan and Long, 2015).

On the other hand, some
therapeutic encounters were slightly different from this one at hand. This was
due to cultural differences. For instance, some of the patients there was
little or no use of eye contact as this could be viewed as disrespectful in
their culture (Leonard and Plotnikoff, 2010). Also, there was no use of touch
between me and the patient and this could be viewed in a negative light in
their culture (Sutton, 2013). Therefore, such encounters enabled me to realise
the importance for healthcare professionals to be intercultural communicators
(Sutton, 2013). Thus, being able to embrace differences in cultures, languages,
perceptions and non-verbal behaviours (Samovar, Porter and McDaniel, 2010).

As a result of my
reflection, I will continue learning about communication skills and to avoid
the use of medical jargon when having conversations with patients. I will also
continue to learn about my own communication style. According to Smith (2007),
one’s communication style can influence their patient’s behaviour and
compliance with treatment. Milton (2009), supports the above by claiming that
it is important for healthcare professionals to identify their own communication
style as they differ from person to person. However, healthcare professionals
should also be able to modify their communication styles so as for them to be
compatible with patient needs (Smith, 2007; Milton, 2009). Furthermore, I will
be an advocate for continuity of care. Continuity of care is important as
studies have highlighted that patients’ perception of positive and best quality
health care communication is greater when the same people provide their care
than when it is different individuals (Honey, 2009; DeVoe, Wallace and Pandhi,
2016). Thus, the same healthcare professionals would get to know the patients
and build a patient- nurse relationship (Clark, 2010; DeVoe et al., 2016).

Conclusively, it can be
claimed that for one to be empathetic and compassionate, they must be
self-aware. Self-awareness is a significant tool for improving nurse-patient
interaction (McCabe and Timmins, 2013). Bach and Grant (2015) support the above
by suggesting that being self-aware is essential for a successful
implementation of a therapeutic relationship. Although nurses are expected to
be caring despite the type of environment they are in, it is important for the
NHS to provide a stress-free environment for nurses in the hospitals. This can
be done by increasing healthcare funding and employing more staff so that staff
are not over stretched as this will negatively impact patient care (Clark, 2010).