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Reflective Account of Complex Communication with Patient

Info: 3222 words (13 pages) Nursing Essay
Published: 11th Feb 2020

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Case study chosen:

A 36-year-old gentleman has been admitted to an acute Surgical ward with abdominal pain. He has been experiencing this for several months, but because he is trying to keep his position as a waiter in a local independent coffee shop, he has ignored this. He speaks some English, but mainly Urdu, and has a young family here in the UK. He has just returned from theatre having had an appendectomy and right hemicolectomy. He has a stoma in situ.

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Katkhouda and Kaiser (2005). Appendicitis is located on the appendix between two endoloops and operation is known as an appendectomy or appendicectomy. Right hemicolectomy is a process of removing the colectomy in one side of the colon is called hemicolectomy. Appendix operation is one of the most common in the UK. This mostly occurs if there is something that is blocking the entrance of the appendix. In the UK around 40, 000 people are admitted to hospital with appendicitis each year (Fadok 2005). As this patient has suffered from abdominal pain, there is a higher risk of infections. Macaluso & McNamara (2012). The study found that acute abdominal pain is difficult to deal, and it is life-threatening conditions that require intervention to limit morbidity and mortality. 

The role of the nurse is to monitor the patient over the 24 hours to ensure that care is delivered within a multi-disciplinary team to shared vital information between various of (MDTs) involving the patient’s care. Multidisciplinary team and clinical disciplines come together to make the decision regarding patient treatment and care plan, allow to share relevant information from each other professional, therefore it has a positive result on the patient care plan.

(NICE Guidelines, (2017). Good communication is vital as working as an MDTs in order to deliver the optimally care and to ensure the process is performed professionally with minimal delays and repetition. This allows the patient to feel more open and discuss any issues they are struggling, experiencing with the nurse they would feel that nurse is taken time to bond in order to build the trust and communication. However, it is also important to promoting independence to the patient, for example, encoding them to complete the little task in order to do exercise to keep them going with daily task, as the patient can become too attached and become too reliant on the nurse.

Main Body

For this patient applying the communication and psychological theories, in order to support, as this patient is going through emotional distress, anxiety, depression, fear, and resentment. As a nurse supporting the patient and family throughout the psychological l distress. Empowering patient through support and education enable them to have some feeling of control. As a nurse showing empathy, understanding, and reassurance helps to provide positive psychological treatment to the patient. The is nurse taking on the counseling role as this patient is suffering from abdominal pain, the patients limited understanding is causing him to feel worried, angry, fearful and it is difficult to provide an explanation due to fact that English is not his first language. As a nurse creating a mood that make the patient feel comfortable and clam provides the patient with piece of mind, as well as considering the individual’s needs, this will help patients to have a better attitude toward their recovery. It is particularly important to work together with the multidisciplinary team as support from other health care professionals will help the patient receive the best patient-Centred care (Henderson 2017). England (2016). As a nurse showing compassion in practice to help this patient, identifying the future support that might be helpful. For this gentleman, some complication can arise after the appendectomy, wound infection, bleeding, redness and swelling (Burch 2008). By using good hygiene and cleanliness will help to reduce the risk of serious infection (Boyles & Hunt 2016).

Egan (1975) developed SLOER theory non- verbal communication can help the effectiveness of communication between patient and nurse. For this case study using nonverbal communication method can make a patient feel comfortable and help the nurse to have a better understanding. By using nonverbal communication, such as appropriate eye contact, the clear impression which makes a patient feel that nurse has been interested and listening to their needs. This SOLER theory has used five stages in order to explain how these stages can help an individual while using nonverbal communication, firstly sit squarely this shows that nurse is getting involved with a patient as willing to help and actively listening. Open posture such as legs and arms are not crossed while taking to the patient and this made the patient felt less intimidated. Lean forward to a patient it shows that nurse has been listening to what patient is experiencing and therefore important because it has shown him care, and interest, which made him feel comfortable and was more open. Use of good eye contact while communicating this show that more listening to their concern, however, due to this patient culture belief may be sing disrespect, changing eye contact so he doesn’t feel threatened or intimidated. Relaxing backs the final stage of SOLER theory while communicating with the patient, not putting any pressure, tension and not rushing and having time to listen to their concern responsively. This will allow the patient to speak and as a nurse providing the most effective care (Stickley2011). This Eden SOLER theory uses to ensure the patient concern, strategies to patient have received the best patient Centred care. One of the strengths about Eden SOLER theory is that it helps nurse with communicating effectively with a variety of different patient using serval form of nonverbal communication. For the patient, this theory could provide the best, secure and comfortable setting. It also allows the patient to share their concerns with a nurse and health care professional. (Pullen 2014). As a nurse building trust with patients in order to enhance communication in nursing practice. Using gestures and short simple sentences and active listening to patient needs can drastically help with communication. It is important to understand patient from a different culture in order to use a trained medical interpreter. As a nurse bringing down language barriers by using nonverbal communication, such as writing, using plain English and body language in order to understand patient experience. For this patient using plain English, for example, “pain” or “hurt” rather than saying discomfort which makes easy to understand and does not leave them worried. (Silverman et al. 2013). found that the involvement of the family can help the patient with their therapeutic support and emotional reassurance. This patient may be experiencing loneliness, worried about being away from family and emotional distress. Therefore, it is an effective way to create a positive environment for both the patient and his family.

Peplau’s theory discussed a therapeutic approach to build the relationship between the patient and nurse. The common goals are achieved by following the steps to meet the patient need as well as to become more knowledgeable about the situation. (Peplau, 1997). As a nursing profession, it is important to have compassion, concern, advocacy in order to provide the patient with care and support. This theory is beneficial for the developing therapeutic approaches, as it helps the nurse to understand the individual needs of the patients. Referring to the case study, this theory would improve nurse’s knowledge of abdominal pain on the patient, by considering patient’s needs, for example including looking at the physical, psychological, cognitive, emotional, spiritual and as well as social care of the patient in order to provide the best care. This theory explains important situations that nurse must identify to help patient using the therapeutic relationship approaches.

(Peplau 1991). theory of interpersonal relationship focuses on the nurse-client relationship, and the therapeutic process in order to communicate and understand the patient’s problems and psychological difficulties. The interpersonal relations concepts allow a nurse to observe their own behavior while interacting with the patient. As this patient is from the different background using his Peplau’s interpersonal theory and focusing on the four stages mentioned in theory helped to give a clear understanding between the relationship between the nurse and client. The four stages consist of the orientation phase, which is the stage in which the patient starts to receive treatment and trust is developed between the nurse and patient, identifying phase explains interaction provide the basis for understanding, trust, and acceptance as the patient become open to interact and able to ask a question. Exploitation phase, when the patient makes full use of the service that nurse provide, and last stage is resolution phases when all the need has been met and they are able to become independent and they no longer need to be taken care of. Nursing as a profession it is important to develop a good personal relationship, with kindness, compassion, and care. As a nurse it is an important part of communication, listening in order to achieve verbal and nonverbal message by the patient. From this case study, this theory would improve the nurse’s knowledge of effective communication skills in nursing practice.

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Person-Centred in practice focus in various way to help patient engagement, this framework, which aims to achieve concepts of person-Centredness as it related to practice. A person-Centred approach to nursing understands the person needs, wants desires and goals Person-Centered practice explores in the concepts within own setting in order to improve on delivering the care to the patient. The framework helps the nurse to understand the important aspect of a person- Centred care in their practice and meet the outcome of care processes, for example, engagement, shared decision making, working with the patient’s beliefs and values, providing holistic care and having a sympathetic presence (McCance (2011).

The 1970 Roger’s concepts to the theoretical basis of nursing were one of the most useful works of Roger’s which explain that all the human beings are viewed as an integral part of the universe. This theory suggests the human being are dynamic and the environment has the energy field, nursing action which is direct toward patterning and maintaining these energy fields. Roger’s concepts propose that emphasis should be given on understanding the patient view of point. The concepts of mutual interaction explain that patterning can be done by suggesting the variety of alternative, education, empowering, encouraging and this is also depending on the individual patient. This theory suggests that pattering activities which help patient with therapeutic touch, meditation, humor, and imaginary (Dorothy 2009). Through applying this Roger’s theory, this will help to explore the importance of patient behavior changes and working together as a multi-disciplinary team will be benefit both the healthcare professional and the patient. Relating back to this case study which can help the patient with their recovery quicker by using this pattern appraisal along with the patient in order to motivate and encourage the patient to make a change to their behavior. Roger’s theory has the purpose of nursing in order to promote well-being and health when dealing with a patient in nursing practice. (Date protection Act 1998). patient information confidentiality, as teamwork making sure that all the information is up to date to provide possible care and treatments. The legal duty to maintain patient confidentiality, sharing relevant information with the organisation with paper or by access to a computer system.

Belbin’s (1981) management team model focus on the team role and the categories into three groups, action-oriented, people oriented and thought oriented. In team identify their strengths to help achieve a better result and be more effective. When as an individual share their team roles knowledge within a team (Fisher et al 1998). This theory suggests that working effectively is most important in the team in order to help each other to complete the task. Applying this theory in order to support the patient by working as a team in order to provide quick recovery and health well-being. Luke (2009). The study found that motivational interviewing has helped and encourage patient to consider health behavior change. MI is a counseling approach aims to promote individual goals and values in order to provided information and advice to patients. This motivational interview has been used in nursing in various conditions and it has been found to have benefits on a patient with psychological distress and low in mood.

Conclusion and recommendation for practice

In the conclusion for future development as nurse communication and psychological theories is very beneficial to both health care professional as well as the patient. Psychological theories will be useful when understanding the behavior of the patient. For this case study monitoring of this gentleman closely over the 24 hours a day in order to deliver the best care. Due to English has not been the first language it is important to use various communication tools in order to communicate and uses of body language can help to create better interaction and to achieve better understanding. Eden SOLER theory nonverbal communication (Stickley2011).

As a nurse provided the care and support by using communication and psychological theories, which are beneficial for both patient and health care professional. For this case study various of health care professional work tighter to delivery to best care to this patient. For the future development, this case study will improve my effective communication skills in practice, known for caring for the patient who has a difficult and needs more support to the recovery. It is important to support patient with emotional, physical, social, physiological and spiritual. Therefore, working as a multidisciplinary team, using psychological theories, and other health care professional, good teamwork, as this will develop my skills for nursing. (Dorothy 2009). Using Rogers theory to focuses on the patient to motivate and encourage to make a change to their behavior and help to promote health well-being. This case study was also from different background culture; therefore, this will allow me to improve on my future development to understand of different culture and able to explore person-centers in nursing practice.

 Reference list:

  • Bladder and Bowel Community. (2018). The Role of a stoma Nurse. Retrieved from https://www.bladderandbowel.org/bowel/stoma/role-stoma-nurse/
  • Data Protection Act (1998). Confidentiality. Retrieved from https://www.legislation.gov.uk/ukpga/1998/29/pdfs/ukpga_19980029_en.pdf
  •  Dorothy, D. (2009). A way of knowing, being, valuing and living with compassion energy: a unitary science and Nursing as caring perspective. (Report) The journal of Rogerian Nursing Science. (8) 40.
  • England, N. (2016). Compassion in practice- evidence the impact. NHS England: Serrant, Laura. Retrieved from  https://www.england.nhs.uk/wp-content/uploads/2016/05/cip-yr-3.pdf
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  •   Fisher, S., Hunter, T., Macrossan, W. (1998).The structure of Belbin’s roles. Journal of Occupational and organizational Psychology, 71, 283-288. Retrieved from doi.org/10.1111/j.2044-8325.1998.tb00677.x
  • Henderson, A., Jenny, J. (2017). Developing and maintaining compassionate care in nursing. Nursing standard Royal College of Nursing (Great Britain). 32 (4)60-69. DOI: 10.7748/ns. 2017.e10895
  • Katkhouda, N., & Kaiser, A. (2005).Appendectomy. Operative Techniques in General Surgery. 7(1) 8-14.  doi.org/10.1053/j.optechgensurg.2004.12.004
  •  Luke, M. (2009). Motivational Interviewing in Health care: Helping Patient change Behaviour. Child and adolescent mental health,14(1),55-56. DOI: 10.1111/j.1475-3588.2008.00516_9.x
  • Macaluso, C. & McNamara, R. (2012). Evolution and management of acute abdominal pain in the emergency department. International journal of General Medicine. 5. 789-797. doi: 10.2147/IJGM.S25936 
  • McCance, T., McCormack, B., Dewing, J. (2011) An exploration of person-Centredness in practice JIN: online journal of issues in Nursing, 16 (2), Manuscript 1.  doi.org/10.3912/OJIN.Vol16No02Man01
  •  NICE (2017). Appendix A: Review protocol Multidisciplinary team meeting (MDT’s) https://www.nice.org.uk/guidance/ng94/documents/draft-guideline-29
  • Peplau, H E. (1997). Peplau’s theory of Interpersonal relations. Nursing Science Quarterly, 10 (4), 162- 167.  doi:10.1177/089431849701000407
  • Peplau, H. (1991). Interpersonal Relations in Nursing, A conceptual Frame of Reference for Psychodynamic Nursing. USA: Library of congress cataloging.
  •  Pullen, R. (2014). Communicating with patient from different cultures. Nursing Made incredibly Easy.12 (6) 6-8. doi: 10.1097/01.NME.0000454772.77545.13
  • Silverman, J., Kurtz, S., & Draper, J. (2013). Skills for Communicating with patients (3rd ed.) Cultural and social diversity UK: ltd. Croydon.
  •  Stickley, T. (2011). From SOLER to SURETY for effective non-verbal communication. Nurse Education in practice. 11 (6), 395-398. doi.org/10.1016/j.nepr.2011.03.021
  • Walsh, k., McAllister, M., Morgan, A., Thornhill, J. (2004).Motivating change: Using motivational interviewing in practice development.  Practice Development in Health Care, 3 (2), 92-100. doi.org/10.1002/pdh.134


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