Gibbs Reflective cycle: Therapeutic communication

Gibbs Reflective cycle: Therapeutic communication

Effective communication is vital in any healthcare setting. It enables nurses to collaboratively work together with patients and other healthcare providers to improve health outcomes. More so, it enhances the selection of evidence-based practices that best fit the patient`s situation. In pre-operative care, for example, nurses acts as the patient advocate by continuously communicating with the patient in a bid to apply different interventions that will help the patient arrive in the operation room ready for surgery. When there is a communication breakdown, however, effective care might be compromised. In this regard, this paper uses the Gibbs reflective cycle to explore an incidence where a student nurse (me) had a communication breakdown with a patient (Joy) during pre-operative care. The reflective cycle will be used to evaluate and analyze the situation as a way of learning from the mistakes from the incidence and further come up with an action plan on how to handle similar occurrences in the future.

1. a) Description

During my student placement, I was stationed at pre-operative care, where I helped patients with different procedures and interventions in preparation for surgery. One of the patients, Joy, however, had a unique response as I attempted to prepare her for surgery. As Joy was getting prepared for surgery, I took the initiative to explain to her the standard preoperative practice that requires her to shower with a skin antiseptic to prevent surgical site infections.  I further explained to her that she needed the Thrombo-Embolic-Deterrent (TED) to prevent deep vein thrombosis that could arise from blood clots.  Finally, I informed her of the need to remove nail polish and told her that I was willing to offer a helping hand.

Unfortunately, Joy offered the most unexpected response. She neither seemed interested in what I said nor my attempt to provide a helping hand. In a bid to get a better answer, I applied the therapeutic communication concept to ask an open-ended question in a softer tone. With the hope of making a friendly gesture, I asked her how she would feel with extra hands to help her with the TED stockings and removing the nail polish. The attempt was all in vain as the answer I got did not give any hope: she responded that if she had needed anyone`s help, she would have asked someone to do the tasks. More so, she stated that she could manage on her own, and she wasn`t just any other useless person.

1. b) Feelings

Joy`s answer made me feel unappreciated and discouraged. At first, her show of lack of interest made me feel guilty. I started questioning the approach I had used to approach her before, resulting in the application of therapeutic communication. After the attempt to ask the open ended-question, however, I felt that she should have at least acted friendly after all the efforts I had put. More so, the response created a tension that made me feel unease when talking to her.

1. c) Evaluation

According to the Standards of professional nursing by the New Zealand Nurses Organization, patient autonomy needs to be highly protected in the provision of care. Similarly, the code of conduct by the nursing council of New Zealand calls for the respect of patient`s privacy and integration of patient`s choices in the provision of care. Reflecting on my interaction with Joy, however, I concentrated too much on the pre-operative care process to the point that I forgot that she also had a say on the process. Although I approached her in a friendly manner and gave her all the information that she needed, I should have allowed her to stick to her decision of completing the tasks personally.

A reflection on my expectations and feelings on that incidence led me to the realization that I was significantly affected by my cultural background. Having previously practiced in the Philippines, I was used to healthcare settings where medical practitioners have the upper hand in decision making. Healthcare practitioners in the Philippines often give instructions while the patients follow them keenly. Besides, Philippines healthcare practitioners also major on the use of non-verbal communication where patients nod to show that they agree with what the doctor is saying. In New Zealand, however, autonomy is highly practiced, and patients are more involved in their health. Besides, a verbal form of communication is adopted where patients continuously give their opinions on the process.  In this regard, one ought to consider a patient as a partner during care provision as a way of ensuring to respect their autonomy and opinions.  Therefore found Joy`s reaction to be unique as it did not fit my expectations as constructed by my cultural background.

In my interactions with Joy, I had tried to maintain effective communication in the best way possible. I maintained active listening and employed therapeutic communication as a way of letting her feel comfortable about the process. Besides, I also gave non-verbal affirmations by nodding and showing facial expressions that matched with the conversation. I, however, failed to offer her sufficient anonymity hence I felt offended when she didn`t respond as per my expectations.

1. d) Analysis

Cultural bias can have a significant effect on communication. While nurses are expected to act professionally, they are equally humans and are often confronted by their understanding of the world around them. In this regard, the Nursing Council of New Zealand calls upon nurses to improve cultural awareness as a means of promoting cultural safety and reducing communication barriers. When I was interacting with Joy, I was not aware of the cultural differences between my home country and New Zealand. I, therefore, felt offended when the patient gave a reaction that did not fit my expectations.

Besides, it is also common for nurses to receive unkind comments from patients. Being emotionally present is, however, necessary in such situations.  Adopting a patient-centered approach is therefore essential in ensuring that both the patient and the nurse are satisfied with the process. Despite the unmet expectations, for example, I adopted the 3P principles (Participation, protection, and partnership) recommended by the Nursing Council of New Zealand to ensure that Joy was well prepared for the surgery. As a nurse, I had to understand that she is my responsibility and hence had to forget what I felt about the situation and instead focus on the patient.

1. e) Conclusion

Interaction with Joy played a significant role in helping me overcome my cultural bias. It made me understand that there is always a need to explore and consider the patient`s perspective. As a nurse, I am professionally obliged to adjust my nursing care approach based on the context and professionalism demands as opposed to personal feelings.

Secondly, I learned the importance of individualizing care to meet patient needs. Patients come from diverse cultural backgrounds and hence have different approaches to healthcare. When the patient is involved in the decision-making process; however, their confidence is significantly boosted. More so, the involvement of the patient in the care process helps the nurse to understand the patients better and hence adopt the best evidence based-practice that best fits them. In the case of joy, for example, I expected her to accept my offer without first negotiating with her.

Finally, I understood that effective communication is not just about using the appropriate communication skills but also about understanding the other person. Although I approached joy with kindness, I failed to understand her facial expressions when she appeared disinterested in my offer for a helping hand. Would I have observed this non-verbal cue, I would have realized that she was willing to follow the procedure but on her terms.

Action plan

I will continue to treat all the patients with respect, kindness, and compassion, just like I would like to be treated. In my future interactions with patients, however, I will always ensure that the patient is involved in the care process. I will engage the patients in decisions that I feel might affect their perceptions towards healthcare and offer guidance without feeling offended when patients respond negatively. I will also solve my communication dilemmas by ensuring to consider the patient`s perspective whenever any miscommunication occurs.