In this assignment, I need to reflect on the situation that taken place during

my clinical placement to develop and utilise my interpersonal skills in order to

maintain the therapeutic relationships with my patient. In this reflection, I am

going to use Gibbs (1988) Reflective Cycle. This model is a recognised

framework for my reflection. Gibbs (1988) consists of six stages to complete one

cycle which is able to improve my nursing practice continuously and learning

from the experience for better practice in the future. The cycle starts with a

description of the situation, next is to analysis of the feelings, third is an

evaluation of the experience, fourth stage is an analysis to make sense of the

experience, fifth stage is a conclusion of what else could I have done and final

stage is an action plan to prepare if the situation arose again (NHS, 2006). Baird

and Winter (2005, p.156) give some reasons why reflection is require in the

reflective practice. They state that a reflect is to generate the practice knowledge,

assist an ability to adapt new situations, develop self-esteem and satisfaction as

well as to value, develop and professionalizing practice. However, Siviter (2004,

p.165) explain that reflection is about gaining self-confidence, identify when to

improve, learning from own mistakes and behaviour, looking at other people

perspectives, being self-aware and improving the future by learning the past.

In my context with the patient, it is important for me to improve the

therapeutic relationship which is the nurse-patient relationship. In the therapeutic

relationship, there is the therapeutic rapport establish from a sense of trust and a

mutual understanding exists between a nurse and a patient that build in a special

0
link of the relationship (Harkreader and Hogan, 2004, p.243). (Peplau 1952, cited

in Harkreader and Hogan 2004, p.245) note that a good contact in a therapeutic

relationship builds trust as well as would raise the patient’s self-esteem which

could lead to new personal growth for the patient. Besides, (Ruesch 1961, cited

in Arnold and Boggs 2007, p.200) mention the purpose of the therapeutic

communication is to improve the patient’s ability to function. So in order to

establish a therapeutic nurse-patient interaction, a nurse must show up caring,

sincerity, empathy and trustworthiness (Kathol, 2003, p.33). Those attitudes

could be expressed by promoting the effective communication and relationships

by the implementation of interpersonal skills. Johnson (2008) define the

interpersonal skills is the total ability to communicate effectively with other

people. Chitty and Black (2007, p.218) mention that communication is the

exchange of information, thought and ideas via verbal and non-verbal which both

present simultaneously. They explain that verbal communication is consists of all

speech whereas non-verbal communication consists of gestures, postures, facial

expressions, tone and level of volume. Thus, in my reflection in this assignment

would be discussed on my development of therapeutic relationship in the

circumstance of the nurse-patient relationship using the interpersonal skills. My

reflection is about one patient whom I code her as Mrs. A, not a real name

(Appendix I) to protect the confidentiality of patient’s information (NMC, 2004).

In this paragraph I would describe on the event takes place and describe

that event during my clinical placement. I was on the female psychiatric ward

1
having a 2 weeks clinical placement for mental health care in semester 3.

Generally, there were two separated psychiatric wards which were male

psychiatric ward and female psychiatric ward but both wards were sharing the

small cafeteria in the area of psychiatric ward. The psychiatric wards were locked

up from one main entrance. In the ward, the female psychiatric patients were

encouraged to walk out from the female ward and combine with the male

psychiatric patients at the small cafeteria during their meal time. During lunch, I

noticed one lady was still sitting on her bed. She was Mrs. A, 76 years old been

diagnosed a schizophrenia. She was unable to control the muscle also called

tremor due to lack of the chemical as she was having a side effect of anti

psychotic medication which was a Parkinsonism (Sahelian, 2005). She could not

walk herself and need to be assisted if she wanted to stand or walk. So I took the

Mrs. A’s lunch meal and fed on the bed. This old lady was unable to feed on her

own. So I checked her diet and served her meal. I fed her meal until finished.

In this paragraph, I would discuss on my feelings or thinking that took

place in the event happened. Before I started to feed her, I introduced myself and

approached Mrs. A. So I tried to build a good rapport with her as I do not want

her to feel strange as I was not her family members or her relatives. My first

approached was to her was to ask whether she wanted or refused to take her

lunch. She was on soft diet as she was having a difficulty in swallowing or

dysphagia. Then I asked her permission to feed her. She looked at me and

looked like blur. In this situation, I showed up my emphatic listening as I put

2
myself in her shoes and assuming I was having a hearing problem. According to

Wold (2004, p73) the emphatic listening is about the willingness to understand

the other person not just judging the person’s fact. Then, I touched her shoulder,

kept saying, and raise my tone a bit because I was afraid if she had a hearing

trouble. At the same time, I did some body gesturers which could be interpreted

an action of eating. I paused, repeated my actions but this time I was using some

simple words in the patient dialect. Then she looked at me again and nodded her

head. Fortunately the body gesturers also helped me in the conversation with

her. In the meantime, I was thinking whether the first language was not her

mother tongue but I kept myself communicate verbally with her including using

my body gesturers and facial expression. Body gesturers and facial expressions

are referred as a non-verbal communication (Funnell et al, 2005, p.443). In my

thinking, I needed to speak louder and know more words in her language so that

she could understand and interpret of my actions towards her. I thought of the

language barrier that breaks our verbal communication. Castledine (2002, p.923)

mention that the language barrier arises when there are individuals comes from a

different social background use their own slang or phrases in the conversations.

Luckily, those particular body gesturers could make her understand that I was

going to feed her lunch. During the feeding I maintained the eye contact as I do

not want her to feel shy. This is because; my eye contact could show up my

interest to help her in feeding. This is supported by Caris-Verhallen et al (1999)

which mentioned that the direct of eye contact could express a sense of interest

in the person to the other person involves in that communication. In the

3
meantime I communicated with my best with her do that she felt comfortable. As

a result, she gave a good cooperation and enjoyed the meal until finished.

In my evaluating, I feel I make the right decision to accompany and assist

Mrs. A in feeding. Furthermore, I could develop my nurse-patient relationship.

Although McCabe (2004, p.44) would describe it as a task-centred

communication as one of the element caused the lack communication among

nurses, but I think my nurse-patient relationship communication both involved a

good patient-centred communication and task-centred communication. In my

personal opinion, I attended to Mrs. A as a patient to show my empathy because

she was unable to feed herself. It was also as my duty to feed her so that I could

make sure the patient get the best care in the ward. So my involvement in this

nurse-patient relationship does not only restrict to the task-centred

communication because (Burnard 1990, and Stein-Parbury 1993, cited in

McCabe 2002, p.44) define attending as a patient-centred process as wells as to

fulfil the basic conditions as a nurse to provide the genuineness, warmth and

empathy towards the patient. I was able to improve my non-verbal

communication skills in my conversation with her during the feeding. As she was

having a hearing problem and could not communicate in the first language

properly, so the non-verbal communication plays a role. Caris-Verhallen et al

(1999, p.809) state that the non-verbal communication becomes important when

communicating with the elderly people who develop a hearing problem. Hollman

et al (2005, p31) suggests some effective ways to maximize the communication

4
with hearing impairment people such as always gains the person’s attention

before speaking, visible yourself to prevent them feel frighten and try to use

some sensitive touch. I feel this is a good experience to me because I learn to

develop my non-verbal communication. I used most of the body gesturers

because of the language barrier was being a gap in my conversation with Mrs. A.

She could speak very limited in the first language so I tried to speak in her

dialect. Furthermore, Wold (2004, p.76) mention that gesturers are one specific

type of non-verbal communication intended to express ideas and are useful for

people who cannot use much words. However I also used my facial expressions

to advise her to finish the meal. It might be not so delicious because she

withdraws the meal after few scopes but I smiled and assured Mrs. A that it was

good for her health to finish her meal. In addition, the facial expressions are most

expressive which are not limited to certain cultural and age barriers (Wold, 2004,

p.76). Therefore my facial expression worked out to encourage her to finish the

meal. Although I could not explain detail to her about the important nutrition diet

that she should take, but I could advocate her to finish the meal served because

the meal was prepared according to her condition.

In order to analysis of the event, I could evaluate that, my communication

skills are very important to provide the best nursing care to Mrs. A. My

communication with Mrs. A was the interpersonal communication. This is

because the interpersonal communication is a communication which involved of

two persons (Funnell et al 2005, p.438). I realized that my nonverbal

5
communication did help me a lot in my duty to provide the nursing care to Mrs. A.

Even though she could understand few simple words when I was asking her but I

noticed that one of the problems occurs within the communication was the

language barrier. As the patient was not using the official language and the

second language, I tried to speak in her language. I still could manage the

communication in our conversation. However, it was quite difficult to promote the

effective verbal communication with the patient. Besides, White (2005, p.112)

recommend that a nurse should learn a few words or phrases in the predominant

second language to put a patient at ease for better understanding. Although it

was quite difficult but using the nonverbal simultaneously with the verbal

communication did encourage her to speak on her best to make me understand

her words. In the event showed that, there was a response from Mrs. A. when I

was asking her questions. Funnel et al (2005, p.438) point out that a

communication would occur when a person responds to a message received and

assigns meaning to it. She nodded her head to assign that she agreed with me.

Delaune and Ladner (2002, p.191) explain that the channel is one of the

component of the communication process which act as a medium during the

message is sent out. In addition, Mrs. A also gave me a feedback that she

understood my message by transmitting the message via her body gesturers and

eye behaviour. Thus I could consider that the communication channels used in

my conversation were visual and auditory. Delaune and Ladner (2002, p.191)

state a feedback is that the sender receives the information after the receiver

react to the message. However, Chitty and Black (2007, p.218) define feedback

6
is a response to a message. In my situation, I was a sender who conveyed the

message receiving the information from Mrs. A, the receiver who agreed to take

lunch and allow me to feed. Consequently, I could analyse that my

communication with Mrs. A involved of five component of communication process

which are sender, message, channel, receiver and feedback (Delaune and

Ladner, 2002, p.191).

In a nutshell, for my reflection of this event explores about on how the

communication skills play a role on the nurse-patient relationship in order to

deliver the nursing care towards the patient especially the adult. She needed

quite sometime to adapt the ability changes in her daily activities living where I

was trying to help her in feeding. I was concerning my feeling and thoughts

during the feeding so that I could improve more skills in my communication. I

successfully communicated with her effectively as she enjoyed finishing the

meal. So it is vital to build rapport with her to encourage her ability to speak up

verbally and non-verbal. Moreover, this ability could help her to communicate

effectively with other staff nurses. Later, she would not be neglected because of

her age or her disability to understand the information given about her treatment.

(Hyland and Donaldson 1989, cited in Harrison and Hart 2006 p.22) mention that

communication express what the patients think and feel. In order to communicate

with adult, it is important to assess her common communication language and

her ability to interact in the other languages. As I used some words in her dialect,

I essentially encouraged the patient to speak out verbally and communicate non-

7
verbal so that the message could be understood and do not break the nurse-

patient communication. In my opinion, I evaluated that it does not a matter

whether it was a patient-centred communication or task-centred communication

because both communication mentioned by McCabe (2004) actually does

involves communication to the patients. So it was not a problem to argue which

type of communication involves in my conversation with my patient. After

analysed the situation, I could conclude that I was be able to know the skills for

effective communication with the patient such as approach the patient, asking

questions, be an active listening, show my empathy and support the patient

emotions (Walsh, 2005, p.34). Actually helping the adult was a good practice in

delivering the nursing care among adults.

My action plan for the clinical practice in the future, if there were patients

that I need to help in feeding or other nursing procedure, I would prepare myself

better to handle with the patients who would have some difficulty in

communication. This is because, as one of the health care worker, I want the

best care for my patients. So in related to deliver the best care to my patients, I

need to understand them very well. I have to communicate effectively as this is

important to know what they need most during warded under my supervision as a

nurse. According to my experience, I knew that communication was the

fundamental part to develop a good relationship. Wood (2006, p.13) express that

a communication is the key foundation of relationship. Therefore a good

communication is essential to get know the patient’s individual health status

8
(Walsh, 2005, p.30). Active listening could distinguish the existence of barrier

communication when interactions with the patients. This is because, active

listening means listening without making judgement to listen the patients’

opinions or complaints which give me chances to be in the patients’ perspective

(Arnold, 2007, p.201). On the other hand, it also crucial to avoid the barriers

occurs in the communication with the patients. I could detect the language

barriers by interviewing the patients about their health or asking them if they

needed any help in their daily activities living. However, I would remind myself

for not interfere my communication with barriers such as using the open-ended

questions, not attending to non-verbal cues, being criticising and judging, and

interrupting (Funnell et al, 2005, p.453). Walsh (2005, p.31) too summary that

making stereotyping and making assumptions about patients, perceptions and

first impression of patients, lack awareness of communication skills are the main

barriers to communications. I must not judge the patients by making my first

impression and assumption about the patients but I have to make patients feel

devalued as an individual. I should be capable to respect their fundamental

values, beliefs, culture, and individual means of communication (Heath, 2000,

p.27). I would be able to know on how to build rapport with the patients. There

are eleven ways suggest by Crellin (1998, p.49) which are becomes visible,

anticipate needs, be reliable, listening, stay in control, self-disclosure, care for

each patient as an individual, use humour when appropriate, educate the patient,

give the patient some control, and use gestures to show some supports. This

ways could help and give me some guidelines to improve my communication

9
skills with the patients. Another important thing to add on my action plan list is to

know which the disabilities of the patients have such as hearing disability, visual

impairment and mental disability. Once I could know the disability that a patient

has, I could well-prepared my method of communication effectively as Heath

(2000, p28) mention that communicating with people who was having some

hearing impairment, sight impairment and mental health needs required the

particular skills and considerations. Nazarko (2004, p.9) suggest that do not

repeat if the person could not understand but try to rephrase and speak a little

more slowly when communicating with the hearing difficulties people. Hearing

problem commonly occurs among adults because of ageing process (Schofield,

2002, p.21). To summarize for my action plan, I would start a communication with

a good rapport to know what affects the patients’ ability to communicate well and

to avoid barriers in effective communication in future.

In conclusion of my reflective assignment, I mention the model that I

chose, Gibbs (1988) Reflective Cycle as my framework of my reflective. I state

the reasons why I am choosing the model as well as some discussion on the

important of doing reflection in nursing practice. I am able to discuss every stage

in the Gibbs (1988) Reflective Cycle about my ability to develop my therapeutic

relationship by using my interpersonal skills with one patient for this reflection.

10
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APPENDIX I

The consent form is attached in the hard copy.

15