The video titled “NRSG139 Ax3 TPRVignette” revolves around a nurse visit in the hospital setup, where the nurse performs routine check on the patient (youtube.com, 2018). Described below is a reflective analysis of the video, based on the GIBBS reflective cycle and the Nursing Competency Assessment Schedule (NCAS) standards to reach to a conclusion and action plan based on the video (cdnm.edu.au, 2018). The analysis will be segregated according to each part of the Gibbs reflective cycle, that is: Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan (kcl.ac.uk, 2018).
The NCAS outlines 7 interrelated standards in Registered Nursing Practice which is implemented by the NMBA (Nursing and Midwifery Board of Australia). These standards include: 1) Thinks critically and analysis nursing practice, 2) Engages in therapeutic and professional relation, 3) Maintains capacity for practice, 4) Comprehensively conducts assessments, 5) Develops a plan for Nursing Practice, 6) Provides safe, appropriate and responsive quality nursing practice, 7) Evaluates outcomes to inform nursing practice. In the given scenario, the nurse showed a strong emphasis in the standard 2 (Engaging in therapeutic and professional relationship with the client) (cdnm.edu.au, 2018).
The Gibbs reflective cycle consists of 6 stages in a cyclic process, consisting of: Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan. The event will be analysed utilizing this plan management (kcl.ac.uk, 2018).
What happened: The video showed a regular nursing visit, where the nurse was performing routine checkups, and was engaged in developing a therapeutic and professional relationship with the client (Standard 2 of NCAS). The nurse checked the vital status of the patient, while engaging him in communication (asking him how he was feeling) and also gave confidence to the patient, informing that his vital signs were about normal and his health was improving, which he will also share with the doctor.
Where the event occurred: The event occurred in a hospital ward
Who was there: The event involved a patient and a registered nurse
What the people were doing: The Registered nurse was performing routine assessment of the patient’s vital signs, and was engaged in conversation with the patient, thus trying to develop a therapeutic and professional relation (in accordance to NCAS standard 2).
What was the result: At the end of the video, the patient seemed to be comfortable communicating with the nurse and expressed that he was looking forward for the next visit from the nurse.
Watching the video, gave me the impression that the patient was in the hospital on the road to recovery, and possible expecting to be discharged soon. The patient informed the nurse, that he was feeling much better than before, although not at a hundred percent, but hoped to be there soon. He showed faith in the care provided to him, and didn’t seem to have any qualms about it. The patient was coherent and articulate and responded to the nurse’s questions. The nurse also showed conviction to develop a therapeutic relation with the client, trying to understand how he felt, and tried to make the patient feel comfortable. However, it also felt that the nurse lacked adequate skills for multitasking, as he became too engaged in checking the vital signs, and the patient had to ask how the status of his vital signs seemed. Otherwise, the patient was very courteous and professional with the patient, and answered his queries in the best of his knowledge. The nurse also had a very friendly nature, and showed concern towards the well being of the patient. I believe that the nurse was able to develop a professional and therapeutic relation with the patient (Standard 2 of NCAS), as the patient showed comfort to communicate with the nurse, and expressed that he looked forward for the next visit.
It was evident from the video, that the nurse was attempting to develop a Therapeutic relation with the patient (according to Standard 2 of NCAS), and exhibited a professional, courteous and friendly and honest approach through the visit, asking the patient how he felt, and keeping the patient updated on the findings of the routine check. The nurse showed confidence in what he was doing, and in my opinion, he gain the trust of the patient, which was a proof of the development of the therapeutic and professional relation. However, the nurse did not seem to be very familiar with the care plan of the patient, and was not able to properly inform the patient regarding how long his treatment might continue and what the progress of the overall treatment was. However, he did inform that the vital signs showed positive results, and he seemed to be better. I believe the nurse could have been a little more encouraging as educative for the patient, instead of placing that responsibility on the shoulders of the doctors. Overall, I feel the nurse was successful in developing a good therapeutic relation with the patient management.
Several important aspects (such as usage of appropriate language, effective communication strategies, having the right attitude and body language) have been implicated by many authors as the strategies for effective communication (O'hagan et al., 2014; Blais et al., 2015). These aspects help to foster a therapeutic relation with the patient. In the video, the nurse was able to show a professional approach (introducing himself, and his tasks), was courteous to the patient (talking with the patient with courtesy) and showed care for the wellbeing of the patient (asking him how he felt), as well as informing that his vital signs showed signs of improvement, thus encouraging the customer. This shows that the nurse showed commitment towards the development of a therapeutic relation with the patient, and thus helped the patient feel comfortable talking to him. This was an important aspect of care given to the patients, due to which is incorporated in the nursing standard under NMBA (Standard 2) (Pinto et al., 2017; cdnm.edu.au, 2018).
Effective strategies are a vital component of Registered Nursing Practice which helps in the development of effective therapeutic relation between the nurse and the client (Riley, 2015; Bramhall, 2014). Effective communication also helps to maintain the professional standards of nursing practice, outlined under the NMBA guidelines. Studies have shown that effective communication helps to improve the outcomes of care, and nurse should be able to develop an understanding of the patients, and their feelings and should be able to exhibit honesty, sincerity, kindness and courtesy towards the patient (Korkouta & Papathanasiou, 2014). Also, an effective therapeutic relation can also help in the development of a patient cantered care (Doherty & Thomson, 2014). Therapeutic relation can also be useful strategy to improve the patient’s satisfaction towards the care provided to them. Additionally, some authors also proposed that using a framework that fosters trust, focus, anticipation, evaluation and knowledge, it is possible to develop an effective strategy for developing therapeutic relation (Feo et al., 2017). The nurse was able to exhibit many of these attributes, which helped to develop an effective relation between the patients.
Engaging in therapeutic and professional relation
1. Effective communication; 2. Understanding the needs of the client, 3. Developing clinical competence and knowledge; 4. Implement a patient/client cantered care
Steps that can be utilized to develop an effective therapeutic relation: 1) Allowing the patient to decide the speed of the conversation; 2) paying attention to the views and opinions of the client; 3) focusing on the development of a good first impression; 4) focusing on the comfort level of the patient to engage in the communication, and allowing the patient to control the direction of the conversation; 5) understanding the expectation and views of the patient; 6) updating the patient on the care plan and progress; 7) involving the patient in the discharge plan
(Stewart et al., 2017; ohsu.edu, 2018; Osborn et al., 2014)
The Patients shos ease and comfort to interact with the nurse, and share his views, feeling, opinions and expectations.
Blais, K., Hayes, J. S., Kozier, B., & Erb, G. L. (2015). Professional nursing practice: Concepts and perspectives (p. 530). NJ: Prentice Hall.
Bramhall, E. (2014). Effective communication skills in nursing practice. Nursing Standard (2014+), 29(14), 53.
cdnm.edu.au (2018), NCAS RN Standards, retrieved on 22 May, 2018, from: https://www.cdnm.edu.au/assets/ncas_rn-standards_v6.2_25-09-2016.pdf
Doherty, M., & Thompson, H. (2014). Enhancing person-centred care through the development of a therapeutic relationship. British journal of community nursing, 19(10), 502-507.
Feo, R., Rasmussen, P., Wiechula, R., Conroy, T., & Kitson, A. (2017). Developing effective and caring nurse-patient relationships. Nursing Standard (2014+), 31(28), 54.
kcl.ac.uk (2018), Using Gibbs’ Reflective Cycle, retrieved on 22 May, 2018, from: https://www.kcl.ac.uk/campuslife/services/disability/onlineresources/StudyGuides/USING-GIBBS-REFLECTIVE-CYCLE-IN-COURSEWORK-DEC-2016-P-LIA.pdf
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia socio-medica, 26(1), 65.
O'hagan, S., Manias, E., Elder, C., Pill, J., Woodward?Kron, R., McNamara, T., ... & McColl, G. (2014). What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients. Journal of advanced nursing, 70(6), 1344-1355.
ohsu.edu (2018), Developing Therapeutic Relationships. Retrieved on 18 May, 2018., from: https://www.ohsu.edu/xd/outreach/occyshn/training-education/upload/developingtheraputicrelationships_ch10.pdf
Osborn, R., Moulds, D., Squires, D., Doty, M. M., & Anderson, C. (2014). International survey of older adults finds shortcomings in access, coordination, and patient-centered care. Health Affairs, 33(12), 2247-2255.
Pinto, S., Caldeira, S., Martins, J. C., & Rodgers, B. (2017). Evolutionary analysis of the concept of Comfort. Holistic nursing practice, 31(4), 243-252.
Riley, J. B. (2015). Communication in nursing. Elsevier Health Sciences.
Stewart, K., Doody, O., Bailey, M., & Moran, S. (2017). Improving the quality of nursing documentation in a palliative care setting: a quality improvement initiative. International journal of palliative nursing, 23(12), 577-585.
youtube.com (2018), NRSG139 Ax3 TPRVignette, retrieved on 22 May, 2018, from: https://www.youtube.com/watch?v=550mSnqtqRA&feature=youtu.be
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