Assessment 3: Reflective essay
2500 words ± 10%
Weighting: 50%
Purpose:
The purpose of this reflective essay is to demonstrate your ability to apply theoretical understanding of the content contained within this subject, to your clinical practice.
Assessment:
Construct a reflective essay in which you will apply your knowledge of communication theory, communication strategies and professional communication, to the challenges associated with maintaining therapeutic relationships with individuals requiring challenging or complex conversations. Consider your professional responsibility to demonstrate clinical leadership, collaboration and advocacy in these circumstances.
Throughout your reflection, refer to a reflective model (e.g. Gibbs’ [1988] model of reflective practice) and benchmark your practice against the standards, codes and guidelines underpinning Australian nursing and midwifery practice.
Assessment criteria
You will be marked against the criteria in the marking rubric for reflective essay.
Reference: Gibbs, G. (1988). Learning by doing; A guide to teaching and learning methods. Further Education Unit, Oxford Polytechnic, Oxford UK.
Reflective Essay: Critical Thinking, Teaching, and Learning
Student’s Name
Institutional Affiliations
Reflective Essay: Critical Thinking, Teaching, and Learning
Learning by experience helps nurses to integrate theoretical knowledge into practice and be able to develop the best action plans to address different situations. Cheng et al. (2020) define experiential learning as the ability to directly recognize, accept, respect, and apply the acquired knowledge and competencies to real practice. Students who engage in experiential learning are able to relate different situations within their practice environments with theoretical knowledge and personal experiences as they continue to accumulate knowledge through a course or program. Gibbs (1988) developed a reflective learning model that can guide learners to relate theoretical knowledge with practice experiences. The model involves six stages implemented in a cyclical sequence during reflective learning. The stages include describing, feeling, evaluating, analyzing, concluding, and action planning. The purpose of this reflective essay is to use Gibbs’ reflective model to apply knowledge of communication theory, communication strategies, and professional communication to the challenges associated with maintaining therapeutic relationships with individuals requiring challenging or complex conversations.
The Application of Gibbs’ Reflective Model
Description
Mr. Elly, a 72-year-old white male has been having Parkinson’s disease for three months. He visited the clinic two weeks ago accompanied by his wife and son aged 67 and 30 years respectively. Since his diagnosis, Mr. Elly has not been able to get proper treatment for his condition. Mr. Elly’s family members are now concerned that it might be challenging to treat him in the near future considering the fact that the disease has caused severe impairments in a number of functional abilities, including the ability to communicate effectively with others. As Basirat et al. (2021) explain, Parkinson’s disease affects a person’s ability to engage in effective verbal communication with people around them. Therefore, engaging in dialogue with these patients presents great difficulties for healthcare providers who always find it difficult to build direct and meaningful therapeutic relationships. Considering his current situation, Mr. Elly has slurred and slow speech. He takes time to provide feedback when engaging in verbal communication with others. Sometimes he does not even respond to questions asked.
Mr. Elly’s wife and his son stayed around throughout the caring period. I wanted to know how Mr. Elly was feeling in order to identify the best way to approach his problem. Unfortunately, he could not describe when and how his problem started. He could not even describe his symptoms, worsening factors, and relieving factors. The most serious aspect of the experience was that Mr. Elly could not even explain the type of help he wanted from the healthcare provider, his feelings towards sickness and health, his wishes in life, his life plans, as well as beliefs, values, and perceptions regarding health care. I had to get some of this information from Mr. Elly’s relatives. They were able to explain when the sickness started, some of the symptoms displayed by Mr. Elly, the duration of his sickness, and their reason for visiting the clinic. Getting this information from Mr. Elly’s family members made it easy to start the clinical assessment and the development of a therapeutic relationship. My role in Mr. Elly’s situation at this point of care was to apply my knowledge of communication theory, communication strategies, and professional communication to address the challenges associated with maintaining a positive therapeutic relationship with Mr. Elly who has Parkinson’s disease and requires challenging or complex conversations.
Feelings
Mr. Elly’s situation elicited feelings and thoughts which impacted the experience in numerous ways. Before interacting directly with a patient with Parkinson’s disease, I never thought that their conditions could prevent them from communicating effectively with others. During my interaction with Mr. Elly and his family members, I thought that he could communicate effectively when given time to reflect upon the questions and allowed enough time to give feedback. However, after the experience, I learned that people with Parkinson’s disease have difficulties engaging in effective verbal communication with people around them. This makes it difficult to obtain relevant information from them to build a good therapeutic relationship and guide the therapeutic process (Basirat et al., 2021). I now feel that to be able to provide effective care for Elly, it is important to develop a strong therapeutic relationship with him by understanding his views regarding the types of care that he would like to receive from the healthcare provider. Since this is not possible by directly engaging the patient in verbal communication, the healthcare provider can use significant others like spouses and children to gather the information that can guide the therapeutic process.
Diagnosis of family members with terminal illnesses such as Parkinson’s disease causes psychological impacts on family members and home-based caregivers. According to Thieken and van Munster (2021), Parkinson’s disease deprives the patient of autonomy which causes a high level of dependency on relatives. The researchers found a strong correlation between the stress levels of family members and the levels of dependency caused by patients with Parkinson’s disease. I think Mr. Elly’s family members were psychologically disturbed by his health situation. They might have been worried about the kind of life that their kin will lead in the near future should the disease continue to take a toll on his health. I think Mr. Elly’s wife was worried the most about her husband’s health and the fact that he was slowly losing the ability to communicate effectively and express himself to others. Up to this time, I believe that Mr. Elly’s family members have learned that they play a crucial role in enhancing communication between their kin and the healthcare provider to enable him to obtain care that will improve his quality of life.
Evaluation
Some of the things went well while others did not in my experience with Mr. Elly and his family members. One good thing about the experience is that I was able to apply critical thinking skills and analyze Mr. Elly’s condition before identifying the best way to approach his situation. Standard 1 of the Australian registered nurse standards requires nurses to think critically, analyze nursing practice situations, and apply the best available evidence to make decisions and provide patient-centered care to patients and their families (Nursing & Midwifery Board Ahpra, 2022). I applied this standard in Mr. Elly’s situation to collect relevant data and identify the needs that would guide me to develop an effective therapeutic plan for him. I applied evidence-based research to engage in a therapeutic assessment that would contribute to improvement in Mr. Elly’s health. Liyew et al. (2021) identify patient assessment as one of the key stages of the nursing process. The reason is that it enables the healthcare provider to collect baseline data that guides the care process and acts as the basis for evaluating the impacts of nursing actions on a patient’s health.
The other thing that went well is the ability of the nurse to engage on effective communication with Mr. Elly and his family and the attempt to make a positive therapeutic relationship to guide the care process. Standard 2 of the Australian registered nurse standards requires nurses to engage in therapeutic and professional relationships with their patients. When doing so, registered nurses should approach their patients with respect and mutual trust to be able to unleash relevant information with them (Nursing & Midwifery Board Ahpra, 2022). During my interaction with Mr. Elly, I engaged in therapeutic and professional communication with Mr. Elly and his family by applying effective communication skills, communication theory, and communication strategies appropriate for the patient’s situation. A study by Kwame and Petrucka (2021) revealed that effective communication between patients and their healthcare providers is key to building a positive therapeutic relationship which is highly essential in directing clinical practice. It is one of the facilitators of ensuring optimal health outcomes for patients.
Although it was a great challenge to maintain a therapeutic relationship with Mr. Elly, the communication strategies applied in the scenario facilitated the care process and built a foundation for providing care for him, especially when asking his relatives questions. Although it was difficult to engage in verbal communication directly with Mr. Elly due to the speech challenges caused by his condition, the use of verbal communication enhanced communication between the healthcare provider and Mr. Elly’s family members, enabling the acquisition of information to start off the treatment process. As Pu et al. (2021) explain, in Parkinson’s disease patients with speech and voice problems, healthcare providers can work with relatives to gather data to direct treatment, especially in patients whose speech and voice cannot be improved using speech therapy techniques. Communication theory is the pillar on which strategies of communication rest (Ruler 2018; Bright & Reeves. 2020). By using communication theory in Mr. Elly’s scenario, I was able to analyze key events in the scenario and ask questions that facilitated the uncovering of the information required to start treatment for Mr. Elly. Mr. Elly’s relatives understood the effects of communicating effectively when building therapeutic relationships with patients requiring challenging conversations.
Healthcare providers should use things that did not go well during the care process to improve and create better experiences for their patients in the future. One thing that did not go well in Mr. Elly’s scenario is the inability to gather sufficient data regarding the type of help that he wanted from the healthcare provider, his feelings towards sickness and health, his wishes in life, his life plans, as well as beliefs, values, and perceptions regarding health care. Since the nurse had to use ethical frameworks and principles are required by the standards of care for Australian registered nurses, Mr. Elly is the only person with the autonomy to provide this information (Nursing & Midwifery Board Ahpra, 2022). As required by standard 6 of the same standards, registered nurses should safe, responsive, and quality care to all patients based on their respective situations. Guided by these standards, I did not rely on the opinions of family members regarding the best approach of care to provide to Mr. Elly. Rather, I applied clinical expertise to identify what was safe and ethical for him based on his health condition.
Analysis
Analyzing why things went well and why others did not during a clinical experience is a crucial element of learning as described by the Gribbs’ model. The reason is that analysis helps the learner to identify factors that enhanced learning and those that prevented effective learning. This information can be used to improve the effectiveness of a learning experience (Gribbs, 1988). I think my interaction with Mr. Elly’s family went well because I was able to apply my knowledge of communication theory, communication strategies, and professional communication with the patient and his family members (Fite et al., 2019; Vitale et al., 2021). Essentially, I approached every person with respect, used simple language, respected the family’s culture, protected the patient’s autonomy, and analyzes the events surrounding Mr. Elly’s condition. Additionally, I applied clinical practice standards and codes that govern the practice of nurses in Australia by striving to develop a positive therapeutic relationship despite the challenging situations (Gardner et al., 2021). An important sense that I can make of the situation is that involving family members in the care of a patient with a terminal illness can facilitate the development of a meaningful therapeutic relationship.
Conclusions
Mr. Elly’s scenario provided numerous insights that have both clinical and learning implications. From the experience, I learned that patients with Parkinson’s disease are among those patients that should be approached with care, especially during communication due to speech and communication difficulties that they face (Basirat et al., 2021). Additionally, I learned that communication theory, communication strategies, and professional communication can enhance the development of positive therapeutic relationships with patients with challenging conversations. Nurses are required to adhere to the nursing standards and ethical codes of nursing practice when working with patients and their families. From my experience with Mr. Elly, I have learned that maintaining compliance with these standards when working with patients experiencing difficult conversations can help to build positive therapeutic relationships (Nursing & Midwifery Board Ahpra, 2022). However, I have learned that creating more time for patients with Parkinson’s disease and their families can help to gather sufficient data for building meaningful therapeutic relationships.
Action Plan
Nurses have the professional responsibility to demonstrate clinical leadership, collaboration, and advocacy in circumstances where there is a need to maintain therapeutic relationships with individuals requiring challenging or complex conversations. If I had to do the same thing again, I would collaborate with other healthcare providers in the facility to help the patient to receive speedy care. Hartley et al. (2020) support the effectiveness of therapeutic alliances enhancing the development of positive therapeutic relationships with patients and improving outcomes. I will enroll in nursing certification programs to develop the required skills that I need to effectively maintain meaningful therapeutic relationships with patients who require complex conversations like those with Parkinson’s disease.
Conclusion
Experiential learning gives nurses an opportunity to apply theoretical knowledge to clinical practice thereby enhancing knowledge development. This reflective essay has used Gibbs’ reflective model to apply knowledge of communication theory, communication strategies, and professional communication to the challenges associated with maintaining therapeutic relationships with individuals requiring challenging or complex conversations. To improve their expertise in this area, nurses should form therapeutic relationships and advance their education to improve in their areas of weakness.
References
Basirat, A., Moreau, C, & Knutsen, D. (2021). Parkinson’s disease impacts feedback production during verbal communication. International Journal of Language & Communication Disorders, 56(4), 826-840. doi: 10.1111/1460-6984.12630.
Bright, F. A. S. & Reeves, R. (2020). Creating therapeutic relationships through communication: a qualitative meta-synthesis from the perspectives of people with communication impairment after stroke. Disability and Rehabilitation, doi: 10.1080/09638288.2020.1849419
Cheng, Y. C., Huang, L. C., Yang, C. H., & Chang, H. C. (2020). Experiential learning program to strengthen self-reflection and critical thinking in freshmen nursing students during COVID-19: A quasi-experimental study. International Journal of Environmental Research and Public Health, 17(15), 5442. https://doi.org/10.3390/ijerph17155442
Fite, R. O., Assefa, M., Demissie, A., & Belachew, T. (2019). Predictors of therapeutic communication between nurses and hospitalized patients. Heliyon, 5(10), e02665. https://doi.org/10.1016/j.heliyon.2019.e02665
Gardner, A., Helms, C., Gardner, G., Coyer, F., & Gosby, H. (2021). Development of nurse practitioner metaspecialty clinical practice standards: A national sequential mixed methods study. Journal of Advanced Nursing, 77(3), 1453–1464. https://doi.org/10.1111/jan.14690
Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further Education Unit, Oxford Polytechnic, Oxford UK.
Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2020). Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102, 103490. https://doi.org/10.1016/j.ijnurstu.2019.103490
Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nursing, 20(1), 158. https://doi.org/10.1186/s12912-021-00684-2
Liyew, B., Tilahun, A. D., & Kassew, T. (2021). Practices and barriers towards physical assessment among nurses working in intensive care units: Multicenter cross-sectional study. BioMed Research International, 2021, 5524676. https://doi.org/10.1155/2021/5524676
Nursing & Midwifery Board Ahpra. (NMBA). (2022). Registered nurse standards for practice. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx
Pu, T., Huang, M., Kong, X., Wang, M., Chen, X., Feng, X., Wei, C., Weng, X., & Xu, F. (2021). Lee Silverman Voice Treatment to improve speech in parkinson’s disease: a systemic review and meta-analysis. Parkinson’s Disease, 2021, 3366870. https://doi.org/10.1155/2021/3366870
Ruler, B. (2018) Communication theory: An Underrated pillar on which strategic communication rests. International Journal of Strategic Communication, 12, 4, 367-381, doi: 10.1080/1553118X.2018.1452240
Thieken, F., & van Munster, M. (2021). Deriving implications for care delivery in Parkinson’s disease by co-diagnosing caregivers as invisible patients. Brain Sciences, 11(12), 1629. https://doi.org/10.3390/brainsci11121629
Vitale, E., Giammarinaro, M. P., Lupo, R., Archetta, V., Fortunato, R. S., Caldararo, C., & Germini, F. (2021). The quality of patient-nurse communication perceived before and during the COVID-19 pandemic: an Italian pilot study. Acta Bio-medica: Atenei Parmensis, 92(S2), e2021035. https://doi.org/10.23750/abm.v92iS2.11300