Reflective account of a nursing assessment of a new admission

INTRODUCTION

This essay is going to reflect upon the care that was provided to Patient A, a 16-year-old with a diagnosis of self-harm and psychosis. A care assessment was carried out, with the use of various questions. The Gibbs (1988) reflective model will be utilised to reflect on the care provided. Reflection is key, to identify strengths and weaknesses in practice and develop as a professional (Bulman and Schutz, 2013).

DESCRIPTION

I entered the ward to carry out a nursing assessment for a new patient named A. I asked him questions about his health and wellbeing, with the use of a health assessment guide and paper to document the information. The patient answered most of my questions; however, it was clear that he was uncomfortable with some of them at times. There were some silent moments and pauses, and the assessment lasted for one and a half hour. I thanked Patient A for his cooperation and reflected upon the nursing plan.

FEELINGS

Prior to the assessment interview I was feeling eager to begin; however, I was slightly nervous as it was my first experience of doing so. I was worried that my questions would be too pressing, or too invasive of his private life or past experiences. Although, at all times I was feeling empathetic and wanting to achieve the best care outcome for him. At the beginning of the interaction, I felt anxious and struggled to coherently ask him the questions. I had to often repeat and rephrase what I was saying. Furthermore, the environment was at times quite noisy, which interrupted the flow of conversation. However, as the assessment progressed, my confidence increased and I felt that overall it was a positive and effective experience.

EVALUATION

From a positive perspective, my ability to progress and develop my skills during the assessment process was beneficial in the care evaluation. I was able to overcome my nerves and anxiety and focus upon the needs of Patient A. It was quite difficult to do so, however, I persevered and obtained the relevant information from the patient. I initially expected it to be a smoother interaction, with a continual flow of communication. However, I realised that non-verbal cues can be just as informative, with the patient’s pauses and silence suggesting a sense of discomfort. I should have utilised emotional intelligence skills at this point to re-direct the topic of conversation. Furthermore, the environment was quite noisy and I should have considered this and moved to a quieter setting. I did, however, successfully write down the patient’s answers; although following the experience I realised that my handwriting was not clear and legible and that I often abbreviated some terms.

ANALYSIS

It is clear that I should have utilised emotional intelligence more so when caring for Patient A, as research has revealed that it is a key component of effective care (Carragher and Gormley, 2016). It results in patients being more inclined to share their concerns with the professional, for an enhanced care and an improved patient experience (Beauvais et al, 2017). However, Foster et al (2017) suggests that emotional intelligence skills increase over time, following each practical interaction with a patient. The study measured levels of emotional intelligence with the Assessing Emotions Scale, at the end of the first year, the beginning of the second year and at the end of their nursing programme. There were 111 nursing students within the study, with the authors conclusively revealing that emotional intelligence skills had increased significantly by the end of the study (Foster et al, 2017).

Furthermore, communication theory could have been considered more during the exchange with Patient A, such as Peplau’s interpersonal relations theory. The orientation phase of Peplau’s interpersonal relations theory was not adhered to when caring for Patient A, which could have enhanced the communication process and resulted in a more therapeutic relationship. Peplau’s theory reveals four stages that need to be met to achieve a common goal of successful communication and interaction with others (McCabe and Timmins, 2013). This is inclusive of the orientation phase, the identification phase, exploitation and resolution phase. The orientation phase suggests that the nurse should engage with the patient, enabling them to ask questions and receive a full explanation of the care process. If this was implemented with Patient A, he may have felt more comfortable during the experience, with a sense of trust and the beginning of a therapeutic relationship that could evolve (Montgomery et al, 2008). The identification phase refers to the stage in which the patient and nurse collaborative, whereas, the exploitation phase focuses upon treatment goals, ensuring that the patient can take advantage of the available services. Lastly, the resolution phase states that a patient’s needs are likely to be met after adhering to the prior stages, moving forward with more independence and clarity (Morrissey and Callaghan, 2011). This model could have been adhered to when caring for Patient A, to ensure more autonomy, control and thus independence and patient confidence.

The Dyadic interpersonal communication model could also have been utilised and considered when caring for Patient A. This model reveals that dynamic interactive relationship that takes place between two individuals. It is based upon a sender and recipient model, with an encoder and decoder (Solomon and Theiss, 2013). This process is influenced additionally by perception content, attitude and emotional and physical elements, suggesting that there are many outside factors that can affect the message’s delivery during communication (Antai-Otong, 2008). The environment was quite noisy at times, due to the opening and closing of doors and so the Dyadic interpersonal communication model could have been considered at this point. In addition, non-verbal cues were utilised often by the patient, which should be considered alongside verbal remarks. The model reinforces the importance of clarity and the awareness of various aspects such as the environment in which communication takes place (Grant and Goodman, 2018). The importance of clear and transparent written documentation and patient notes is reinforced within evidence (Andrews and Aubyn, 2015). It is necessary to inform other healthcare professionals, in addition to the patient, to facilitate safe, high-quality care (Burton and Ludwig, 2014). However, when caring for Patient A, the notes were not legible and abbreviated terms were utilised. This can result in a lack of continuity as other healthcare members will not be able to read and utilise the written notes (Vincent, 2011).

ACTION PLAN

From an overall perspective, the process was effective, obtaining the relevant information from Patient A. However, slight changes could be made to encourage more of a therapeutic, trusting relationship. To develop and progress, it will be important to focus upon improving levels of emotional intelligence, adhering to communication theory and considering the impact of non-verbal cues and written documentation. I will continue to gain knowledge that discuss these aspects, making notes and reflecting upon my know and skill set following practical experiences. The Dyadic interpersonal communication model and Peplau’s interpersonal relations theory will be utilised in future practice, alongside other models and theory. This will be important to ensure that practice is based upon succinct, evidence-based information. Journals will be assessed and critically appraised with the use of a model such as CASP (2017) to ensure once more, that evidence-based practice takes place. This will facilitate the provision of high-quality, safe care and effective communication with patients. To encourage professional development, it will also be important to continue to reflect upon practical experiences, with the use of the Gibbs (1988) model to do so, as it structures the process and provides insight into personal strengths and weaknesses to improve upon. I will ensure that future written notes are legible, without the use of abbreviated terms. This will enable continuity of safe care, in addition to ensuring that the patient can access and understand their notes. Lastly, I will carry out communication role play with colleagues, to help enhance my communication skills. This will include written notes and reflection of the process, to ensure that I continue to improve as a healthcare professional.

These learnings can be applied to every care scenario, as communication is key, in addition to communication between team members and others within the wider multidisciplinary team. This experience has emphasised the importance of effective communication, to facilitate safe, high-quality practice that is patient-centred. From a personal perspective, I have learnt that I am resilient, with the ability to progress and overcome feelings of anxiety and uncertainty. This is an important trait within nursing, which I will focus upon within my future practice to continue to develop my confidence and skill set.

CONCLUSION

To conclude, it is clear that effective communication, emotional intelligence and adherence to evidence-based information and theory is key to facilitate the provision of high-quality, safe care. This paper has identified personal improvements that could be made when communicating with patients, inclusive of emotional intelligence, considering non-verbal cues, written documentation and the consideration of theoretical knowledge. It has also reinforced the benefits of reflection, to identify personal strengths and weaknesses to focus upon to aid with professional development.

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