In this essay I will use the Rolfe’s Reflective Model (Rolfe et al. 2001), which by asking three question what, so what, then what, will help me to self-reflect on my nursing practise. I will also focus on using 3Cs from the 6Cs framework launched by Department of Health in 2012 (Baillie, 2017), as they are essential in nurses work. The 3 C’s which chose to focus on are communication, care and compassion .The 6Cs are the values which empower health care professionals to deliver the highest quality care to patients, help people to stay independent, maximise their well-being, improve health, build and strengthen leadership, and provide a positive experience of care (NHS,England,2015) . I will discuss about how professional or unprofessional use of this values can positively or negatively impact on patients psychological, and physical wellbeing.
The first C that I will focus on is communication which is an essential component in nursing and in providing the patients with high standards of care (Papagiannis, 2010). The second C is compassion, and how important it is to provide high quality care based on empathy, respect and dignity (Clarke ,2014) Third C that I will focus on is care, as we need to make sure that care is right for patients, and consistent, and that we provide patient-centred care, as good care can improve health (NHS, England, 2015).
Nursing and Midwife Council ( NMC) (2018) code declares the need to respect people’s confidentiality and this is a reason for me to not use patient’s real name in my essay, I will use pseudonym or just call them as a patient or service user.
While working as an EU adaptation nurse on General Surgical Ward I met a patient with Alzheimer Dementia who was diagnosed with bowels obstruction and admitted to my ward. With the late stage patient condition change and patient started to received End of Life Care(EOL) Patient was bed bound and patient needs help with all activities of daily living such as washing, dressing, feeding, administration of medication. I was looking after this patient and provide care to him. While communicate with patient I spoke in slow and short sentences, with smile on my face and I remain calm. I was observing patient reaction because I was not sure whether patient understood what I am saying. I was repeat what I have already said.
At first, I was scare and quite nervous when I interacted with the patient. I was already aware of his condition; hence, I was in a dilemma as to how I can communicate with patient.This experience helped me realise that communication is truly an important part of nursing practice. Rimal et all (2009) state that communication is the way that people exchange information. The most commonly used is verbal communication but there is also non-verbal communication like written or electronic communication, body language, gestures, and sign language . Webb (2011) indicate that communication is an important tool use to deliver a high standard of care, which enable patient to voice out their needs, engage in the care, help to build a therapeutic relationship and to comply with their treatment. Kourkota &Papathansiou (2014) declare that good communication is vital to effective nursing and successful outcome of nursing care of patient. Communication skills and technique such active listening, questioning and appropriate use of verbal or non-verbal communication are crucial. It is important as well to being friendly, cheerful, and being an effective listener (Stein-Parbury,2013). However I realised that communicating with a patient with dementia is more difficult than I have actually expected. Dementia affects the ability to communicate (Nazarko,2015). Service user condition was definitely the barrier that hindered effective communication. Even though I spoke in clear, short and simple sentences, there were still instances when the patient did not understand what I said . McNamara (2016) point out that communication with people with dementia in 90% is nonverbal. I release how important is to spend the time with this patient, talk to him, listen him, observe him and use physical touch as a form of non-verbal communication to give service user reassurance ,comfort and breaking down barriers (Gleeson and Higgins,2009). The experience also led me to realise the importance of valuing non-verbal communication. This experience shows me that observe patient’s bodily gesture, facial expression, presence or absence eye contact can help to interpret a patient’s feelings, mood and also attitude towards the nurse and the intervention given by the nurse(Videbeck,2010). I learned how important is that nurse is able assess not only patient who can verbalise but also those with non-verbal communication signs and the nurse can truly understand patient feelings and needs.
I need to improve my communication skills with patient with dementia or learning disabillity or even with aggressive patients. I would like to take a part of training about communication skills in different situation to make sure I will be able to communicate and understand my patients and their needs.
When patient with dementia was admitted to my ward ,he was looking like he is struggling with personal hygiene. Patient had strong odour and patient did not have shave for long time. Patient was refusing any personal care . The situation was difficult for me as there was the barrier with communication because patient suffer dementia .I was trying to be empathic and do understand patient feelings ,trying to put myself in patient’s shoes and I was trying to go through with that situation with my patient. However this was the first time for me to be with patient at the end of patient life .I was not sure what should I do and what not to do. I feel lost in this situation.
Everyone who became ill, they became particularly vulnerable, most of the time they need assistance from others ,in these situation, patients want to be treated with care and compassion (Proctor et al,2013).Compassion is the ability to feel for another living being., sees the suffering in others, and it is motivation to help others and wishes to heal the emotional. physical and spiritual hurts (Johnson,2008;McConnell,2015) . Bradshaw (2011) point out that Florence Nightingale said that compassion is one of certain virtues and qualities in good nurses character . The most vulnerable moments and intimate experience nurses share with people they look after.(Daly et al,2010). However, according to Gilbert (2013) we should remember that to express compassion we need to transpire sympathy(being able to feel for others) and empathy (being able to understand others feeling).
Compassion is important however t when health care provider working in busy environment, with lack of staff , with lots of pressure from management and in stress make them be struggle to work and not to be able to provide high quality care (Nolte et al,2017) . Potter et al (2013) state when a nurse displays the more empathy with patient ,there is the higher risk of compassion fatigue ,where the emotional effort required to show compassion is exhausted. It is the emotional and psychological distress that creates because of continuing self-sacrifice coupled with long exposure to difficult situation. Compassion fatigue makes a person to reduced feeling of compassion towards suffering person (Bush, 2009; Cocker & Joss, 2016). Compassion fatigue is often linked with the study of burnout. Maslach(2001) and Stamm(2010).state that burnout is a syndrome including emotional tiredness, depersonalization and a reduced sense of individual achievement (Maslach, 2001; Stamm,2010). While compassion fatigue is fast beginning, burnout is a slowly continuing condition generally seen in a heavy organisational environment (Slatten et al, 2011).
When I spend time with my patient I was helping him with personal care, assisted with meals, hold his hand , I spend time with patient, I was reading patients favour book. The situation was new for me ,I was not sure if I show compassion in care I provide, I would like to read and learn more how to show compassion . I would like to learn how to help myself to deal with stress, trigger situation to not feel burnout and to make sure I am showing compassion .