Rationale For Choosing Communication And Therapeutic Engagement Nursing Essay

rule For Choosing Communication And healing(p) Engagement Nursing EssayMy ward is a Patient Intensive C ar Unit (PICU) of a forensic placeting. It has long dozen in- long-suffering roles and a staff strength of twenty three take fors both pendent and unqualified. Agency staff ar frequently engage to make up the number of staff necessary to portion out for patients on a occurrence shift. On the average there atomic number 18 amidst seven and football police squad wet-nurse staff per shift depending on the prevailing stead on the ward. It has both oversee confinements and two intensive burster areas. Admissions are mean and it is based on a set of estimation criteria. Only aggressively unwell patients are admitted. This essay will draw on my start working experience as a primary nurse of an precipitously unwell psychiatric patient to illustrate my organic evolution with regards to conference and remedial engagement. Gibbs (1988) reflective cycle will be used to reflect this experience. translationI had just started work as a newly utilise member of staff and was assigned primary nurse to a 30 year old patient of Afro-Caribbean origin who was transferred from an otherwise ward chase a relapse in his cordial state. He was at a lower military position air division 3 of the Mental Health feat (1983). This patient is named A for confidentiality purposes (NMC, 2008) had diagnosing of paranoid schizophrenia and had no insight into his mental infirmity. His carer was his mother with whom he had a luke warm kinship. He was very suspicious of staff interventions and would non engage. Routine blood tests had revealed that he had elevated createnine kinase (CK) take aims (Cretenine Kinase enzyme, high levels of which case spartan muscle damage, neuropletic malignant syndrome, myocardial infarction etc.. Following this finding, his antipsychotic medicament was withdrawn pending further blood tests. He refused to drive a blood sample taken for further tests, he believed staff would draw his blood. As his primary nurse, I made several attempts to encourage him to have the blood tests, but he would not be persuaded.He was in like manner diagnosed with type II diabetes and was dependent of insulin. He self managed his fleshly illness by carrying out blood glucose level monitoring and self administering insulin under staff supervision. Patient A fed only on pre-packed cook out chicken purchased from the supermarket and would not eat food served on the ward. I had champion(a) to one engagement with him to discuss his dietary intake and in like manner give voice a bodily and mental healthcare plan. He was not interested and made no contributions to the discussions. I gave him copies of the care plans which he declined. He verbalize you shtup keep those care plans I dont fill them and I am able to take care of myself. By the end of the second week, his mental state had deteriorated so frequently that he was very paranoid, irritable and acquiring into arguments with fellow patients and staff. He was involved in incidents both verbal and physical aggression and became increasingly problematical to manage on the ward. For his natural rubberty and that of others the squad made a decision to nurse Mr. A in supervise confinement based on rationalist -analytical approach, having carried out pretend assessment and looked at his history as well as the trust policy. As part of this risk precaution plan he was transferred to the intensive care area (ICA) and nurse under enhanced rumination by two treat staff. I requested to be allocated to nurse him in the ICA as often as the trustingness and unity policy old allow, so as to assess his mental state and attempt to build a rapport with him. Mr. A would not talk but I persisted. He noticed that I was frequently allocated to observe him and gradually opened up. I explained to him the teams decision to nurse him in the supervised co nfinement and the ICA. We talked about politics, football, harmony etc and our relationship positive and continued till he was transferred to a rehabilitation ward.FeelingsI matt-up very frustrated and inadequate and was very much under stress. It was obvious from his reaction that he had no confidence or trust in me and saw me just like any other healthcare nonrecreational. Woods (2004) highlights the complex problems and needs of patients who find themselves in forensic settings and maintain that it is a common occurrence that nearly patients can not engage in treatment while others simply refuse to do so. Arnold and Underman-Boggs (1999) maintain that any meaningful relationship begins with trust. Trusting a nurse is particularly difficult for the mentally ill, for whom the idea of having a caring relationship is incomprehensible. As his primary nurse I saw myself as the suggest ready to work with him and seek his interest at all clocks. As nurses, we are called upon to pl ay our roles as advocates, supervising and protecting clients rights and empowering them to take manoeuvre of their lives. Ironbar and Hooper (2003) stresses that therapeutic relationships can be stressful. Working closely with people who are mentally unwell and under stress can be very demanding and emotionally draining experience. Consequently, nurses need to be aware of the effect that such(prenominal) relationships can have on them. This requires insight, self awareness and ability to get away effectively with stress. My initial perception was that Mr A was a difficult patient and considered withdrawing as his primary nurse but I matte emotionally attached. I understood that I owed Mr A a duty of care (NMC, 2008) and simply withdrawing was not professional in my view. OCarrol et al (2007) contended that in our professional roles, nurses do not have the same option as we do in our psycheal life by withdrawing from difficult relationships. Rather it requires exploring the pos t which whitethorn wait on recognise ways in which the nurse is influenced by his emotions. The authors caution that nurses must learn to manage their own emotions. Furthermore, they need to bring their emotional reactions to the patient, albeit in a modified form. I empathised with Mr A and it force me closer to him, revealing to me the depth of hi mental illness. I worryed I could doe something here and now to help alleviate the state f confusion, anxiety and helplessness in which he found himself. Barker (2003) reports of how in recent times empathy has been shown to enable nurses to investigate and understand the experience of persons experiencing a state of chaos as a consequence of psychiatric order. I felt uncomfortable when Mr A had to be physically restrained (PSTS techniques) and nursed in supervisory confinement, I felt that this procedure was not excusable because the privacy, dignity and measure of this client had been compromised. As nurses we are to demonstrate respect for patients by promoting their privacy and dignity (NMC, 2008) (Essence of Care, 2003). On the other hand, I purview that his safety and that f others was paramount and this could be achieved only by nurse him separately from the rest. The NMC (2008 para 84) Code of sea captain Conduct clearly states that when facing a professional dilemma, the first consideration must be the safety of patients. The collaborative team decision to nurse him in the supervised confinement area made me feel valued as a team member. I was actively involved in the decision reservation demonstrate and carried out risk assessments. I felt that I was insensitive with my sustained persistence to get him to talk. I should have understood that his moments of relieve were necessary to help him calm down ( ray of light, 2008). I in addition felt unsupported and struggled to cope with the management and care of Mr A. I was unable to price of admission clinical supervision because my supervisor wa s away on holiday.EvaluationAlthough it seemed difficult at the beginning, but by the time Mr A was out of the ICA we had developed a good working relationship. I did not show my discomposure at his reluctance to engage when he was sapiently unwell and stayed positive. loving with him while nursing him in the ICA offered me the opportunity to explain to him the teams decision to place him under enhanced observation. Actively listening to him and discussing with him his thoughts and feelings have helped lessen his distress. It alike enabled me to give a comprehensive feedback to the team regarding his mental state.We met in one to one engagements and discussed his concerns and needs. A good and well ventilated environment was eer made for our meetings. Following assessments, we discussed his care plans, participation in group activities, crisis management and other forms of therapies. He felt very much in charge, highlight his most pressing needs. Whenever we met, there as a dem onstration of vulgar respect and desire for working together in a partnership. in concert we identified and prioritised his goals for recovery based on his strengths and what he believes is achievable. Faulkner (1998) asserts that goals must be clearly defined so that both the professional and the patient are going in the same direction in terms of what they wish to achieve by a certain time. During or interactions clear boundaries were set and clarified for Mr A what were acceptable behaviours. Boundaries were set as to what he was allowed to do without supervision, how he engaged with others and appropriate ways of addressing issues he felt discontent or uncomfortable with. The plan of care was therefore service-user centred and recovery orientated approach. The recovery model has been incorporated into the principles of care delivery in the trust (SLAM, 2007). It aims to help service-users to give notice beyond mere survival and existence, encouraging them to move forrader a nd carry out activities and develop relationships that give their lives meanings. Wood (2004) indicated that nursing forensic patients is not easy and requires complex treatment plans that focus essentially on reducing risk of harm to others.As part of his recovery, he was encouraged to self manage his diabetes under supervision. Giving his understanding of his physical illness information was provided to enable him to make informed decisions about his lifestyle. Mr A consented to giving regular blood samples. His CK level fell to normal levels and was restarted on anti psychotic medication. However, it took time for Mr A to adequately understand the situation that he was in and the effect of his illness on his lifestyles. It must also be stated that it was not always possible to meet with Mr A as planned. Scheduled meetings had to be cancelled due to being engaged with very pressing ward issues.AnalysisThe use of therapeutic communications in nursing, particularly empathy, is what enables therapeutic change and should not be underestimated (Norman and Ryrie, 2004). Egan (2002) argues that empathy is not just the ability to enter into and understand the world of another person but also be able to communicate this understanding to him/her. The relevance of empathetic relationships to the goals of health services are suggested by the increase in focus on patient centred care and the growth of consumerism. The client-centred focus is illustrated by the NHS patient charter which emphasises that clinicians need to collaborate with users of the health services in the prioritising of clinical needs and the setting of treatment goals (Barker, 2003). Nurses should be aware that patients who are paranoid and suspicious of staff interventions as was the case of Mr A, might not readily accept support from staff. This implies that working with such patients can be very challenging and difficult. It therefore calls for the nurse to remain impatient, calm and focused. The need to build therapeutic relationship with the patient is paramount in gaining trust and respect (Rigby and Alexander, 2008). Caring, empathy and good communication skills are needed to help patients with their illness. Therefore the use of effective interpersonal skill s facilitates the development of a positive nurse-patient relationship. McCabe (2004) argues that the use of effective interpersonal skills, a staple component of nursing, must be patient centred.Nursing Mr A in supervised confinement and subsequently in the ICA was in accordance to SLAM (2008) Engagement and Formal Observation Policy. Despite the frequent occurrence of this nursing intervention in mental health settings, for the social unit of the UK there are no national standards or guidelines for practice of observation. The current situation in England and Wales is that policies are developed and implemented at a local level using SNMAC (1999) practice guidance for observation of patients at risk as a templat e (Harrison et al, 2006). Nursing patients in supervised confinement, though a common practice in the PICU raises a number of ethical, professional and intelligent issues about the role of the nurse, whether he/she is a custodian or therapist and a friend is debateable. Alland et al (2003) noted that patients view enhanced observation as uncomfortable at best, custodial and dehumanising at worst. Mr A felt that his pride and dignity had been taken away from him he was at risk and therefore an immediate and effective risk management plan had to be implemented. This was necessary to ensure his safety and that of others even though he evince unhappiness with this intervention. By engaging him and encouraging him to share his thoughts and feelings his anger appeared to have lessened as he joined in the discussions of politics, music, football etc. Thurgood (2004) empathised that showing your human side to clients is very important. Engaging meaningfully with patients and component th em talk about their feelings is the first step to alleviating some of their distress. The NMC (2008) Code of Professional Conduct clearly points to the rights of patients in relation to autonomy. There appeared to have been a reach to Mr As rights. The difficulty we faced as a team was finding the balance between allowing some privacy and dignity versus uphold his safety and security. Consequently, a dilemma arose for me as his primary nurse in relation to his rights, obligations and duties. In fact Article 5(1) e of the Human Rights Act (1998) specifies the right of the state to lawfully detain the person of unsound mind. deep down the UK, that framework is provides by the Mental Health Act 1983 (DOH, 1998). One may argue then that there is no fundamental incompatibility between the Mental Health Act and the Human Rights Act.There were times that schedule meetings with Mr A had to be cancelled because of urgent administrative duties. It meant that he baffled the opportunity to m eet up with me to discuss his concerns and needs. The concept of Patient protected Time (PPT) in inpatient units is therefore valid. It allows patients to meet with a healthcare provider on one to one for a specified time when the ward is closed to administrative duties to discuss care plans, social activities, therapies and others. such(prenominal) interaction according to Song and Soobratty (2007) promotes feelings of self confidence, esteem and recovery. It can also aid the patient therapeutic progress as it can help with social interaction and building relationships. However, nurses complain they already have potful to do without an added pressure of PPT to contend with. Nurses frequently complaining of being too busy to develop therapeutic rapport with patents (Mental Health Act counsel 2008). Yawar (2008) reported that only 16% of patients time was pass in what can loosely be termed as therapeutic interaction. The remaining of the 84% was spent aimlessly either pacing p an d down the ward or doing nothing. Nurses recognise their responsibilities to engage with patients and welcome the opportunity to do this without other demands (Edward, 2008). The plane section of Health (2002) called for improvements to ensure adequate clinical support inputs to inpatient wards and to tap the time spent by staff therapeutically engaged with patients. Therapeutic engagement, therefore involves spending quality time with patients with the aim to empower them to actively participate in their care.ConclusionCommunication is without doubt the medium through with(predicate) which the nurse-patient relationship takes place. The skills of active listening and reflection promote better communication and encourage empathy building. My first role as a primary nurse as a good learning experience. My conduct throughout the whole experience earned me a favourable feedback from my team leader. Caring for acutely mentally unwell patients requires of the nurse sensitivity, convey ing warmth and empathy. Engaging meaningfully and actively listening to patients under enhanced observation makes them perceive the practice as valuing rather than punishing, therapeutic rather then custodial. Feeling safe and secured provides a platform which can assist patients to begin to resolve some of the difficulties they may be facing in their lives. It is imperative that nurses involve patients in all aspects of their care, empowering and making decisions in partnership with the team. By developing collaborative relationship with patients, nurses can provide prompt and focused interventions which can restrict illness damage, assist in the process of symptoms management and help the process of recovery.Action planMy aim is to be proactive in the hereafter by promptly seeking support from senior colleagues and requesting for clinical supervision. I aim t develop the skill of emotional resilience and light to be able to deliver care that will promote patient welfare and aid recovery. The preceptorship experience has been a breath of fresh air. A time to look back and take stock of the transition from pupil nurse to an accountable practitioner. Listening and sharing in the experiences of fellow nurses was a good learning experience. The preceptors were fantastic master clinicians who were receptive to our contributions as they explored our experiences at the beginning of each teaching session. This experience has undoubtedly enhanced my exact thinking as a nurse and prepared me to move forward in my development and practice as a caring and able nurse. I see myself as being in the right trade which offers many opportunities for development and to improve upon my knowledge and skills.