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Reflective practice is a key part of nursing, which enables the nurses to reflect upon own practice, experiences and regular performance in clinical context, based on which, appropriate steps could be undertaken for improving clinical practice and skills (Li et al., 2020). In order to reflect own practice, I have followed the Gibb’s reflective cycle, which helped me to analyze and reflect about my clinical experience and understanding about person-centred care (PCC) regarding Tula’s case in the following 6 steps (Cherkis and Rosciano, 2018).
Tula Folau is a 38 years old woman, who is admitted to the hospital, after experiencing persistent dry cough, paroxysmal expiratory wheeze and acute dyspnoea during her 12 hour factory shift. The past medical history about Tula indicates hypertension, PCOS and obesity, considering her high BMI, i.e. 44.5. Tula Folau has been cared by the unit nurse Clorinda in the respiratory ward. The nurse took her vital signs, administered medications and helped the patient to reposition, for improving her breathing. However, considering the concept of person-centred care principle, it is noted that nurses should prioritize patient’s consideration, preferences and opinion in their care practices (Taylor, Lynn & Bartlett, 2018).
In addition, communication and building positive therapeutic relationship with the patient is the central perspective of person-centred care, which has not followed by the nurse Clorinda. In the clinical scenario, I have identified that Clorinda has talked about the patient’s weight with her colleague, behind the patient, without having her consent, which can be significantly distressing for the patient. As a consequence, Tula became reluctant to seek assistance from nurse Clorinda. On contrary, I have identified empathic behaviour from Nurse Kate, who communicated positively with the patient to gain her trust. Further, I revealed from the scenario that nurse Clorinda shouted upon the patient for getting out the bed, which further made the patient agitated and worsen her condition.
Through the clinical scenario, I felt distressed and sad about the patient’s condition. As I have learnt about the person-centred care in the last few weeks, I was unable to connect my learning with the scenario, I have observed that nurse Clorinda have not followed the principles of PCC, as she has shown unethical and aggressive behaviour towards the patient. I know that being transferred in the hospital environment, a patient needs support to get empowered and engaged in the care procedures; and a positive therapeutic communication could influence the patient to adhere onto the care procedure, which is important for the overall wellbeing of the patient.
However, the patient Tula has not received such warmth and positive attitude from her caring nurse. Thus, it is unfortunate for the patient and I feel the nurse should not have such a negative attitude like nurse Clorinda. On contrary, my understanding changed upon observing the approach by Nurse Kate, who greeted the patient in a positive manner and attempted to make the patient calm through positive communication (Brummel‐Smith et al., 2016).. I also felt good, observing that positive attitude and communicate enabled nurse Kate to calm and settle down, which would have positive impact upon her health and wellbeing.
Evaluating my clinical experience with Tula’s case, I understood the importance of person-centred care and positive therapeutic communication in clinical nursing. Initially, the concept of therapeutic alliance was not clear to me. The patient Tula’s case helped me to understand it in the clinical scenario and its purpose. I have learned that a positive therapeutic alliance can promote beneficial change in the patient and absence of it could have significant negative impact upon the patient, which was also evident in the literature by (Groves, 2016). For instance, in case of Tula, I evaluated the behaviour and care approach of both the nurses, attending the patient and understood that the behaviour and attitude of nurse Clorinda caused deterioration in the health and wellbeing of the patient.
Negative attitude and disrespect towards the patient caused her reluctant to seek assistance from the nurse, which worsened her condition further. It is evident in the scenario, her SPO2 reduced from 96% to 90%, RR increased from 28 to 33 bpm. On the other hand, reflecting upon Nurse Kate’s behaviour, my learning shaped and I understood about the approach that I should have, while attending a patient in clinical setting. For instance, Eklund et al., (2019) claimed that PCC focuses more on needs of the person, rather than needs of the service. In the scenario, Nurse Kate prioritized the patient’s needs and asked her about her feeling, making eye contact with the patient, which is the way to gain trust. On contrary, nurse Clorinda prioritized service needs; she fulfilled all her responsibilities towards the patient, but failed to develop trust in the patient, while reduced patient’s self-esteem too.
Evaluating my observations, I need to analyze my learning from the experience with Tula’s case study. The entire scenario shaped my understanding, perspective and skills regarding integrating PCC principles and approaches in clinical context. Initial understanding about the role and implication of PCC in the clinical context was difficult for me to understand, which was later became clear with the help from my mentor. In addition, behavioural attributes of Nurse Kate further shaped my view towards person-centred care. Nurse Kate’s behaviour towards the patient worked as an evidence in support of the positive impact of PCC in patient’s wellbeing, which I would use in my future clinical practice.
Initially, I was unaware about the key behavioural attributes a nurse should possess for developing positive therapeutic relationship. I have identified one key point from the scenario that is to show respect towards the patient, which nurse Kate showed by dropping down at her eye level and asking her about feeling, instead of having all information. Behrens et al., (2019) highlighted some key attributes a nurse should possess for positive therapeutic communication, including “eye contact, showing respect through body language, asking open-ended question, listening skill, low pitch of voice, empathic communication, touch, calling the patient by her last name”, which were lacking in case of nurse Clorinda.
It shaped my clinical skill significantly, besides my positive communication skill. On the other hand, I have also analyzed the scenario to identify negative aspects of therapeutic communication, which I should avoid to gain trust in the patient, by analyzing nurse Clorinda’s behaviour towards the patient. It was supported by Menendez and Ring (2018) who stated about the unethical behaviour of nurses, highlighting talking about patient with others without her consent.
In conclusion, I can interpret that this was a positive learning experience for me. I was able to gain new knowledge and fill existing knowledge gaps. In addition, identifying own strengths and weaknesses, this learning promoted my self-awareness too.
From the above reflection on my experience from Tula’s case, I have identified that I need to focus more on developing a strong verbal and non-verbal communication skill, which is central for implementing PCC in clinical practice. Thus, I have planned to undergo a training session on therapeutic communication online. In addition, I would also undergo brainstorming sessions for improving my decisiveness, important for prioritizing patient’s needs and preferences.
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