Communication in Clinical Care - Essay Example

Reflection in Clinical Care Introduction In my work as a clinical support worker in a mental health facility, I have encountered myriad cases that have put my skills into context and taught me valuable lessons. A particular case of a 13-year-old girl suffering from a psychotic disorder allowed me to put the clinical skills that I have gained in my coursework into practice. The service user, an only child, presented with irritable, but imbalanced mood and physical aggression. She was both paranoid (alleged that she might have been poisoned) and grandiose (convinced she was a superstar) but illuminated an incongruent mood mixed with auditory hallucinations. Her affect was inconstant, shifting from a blunted to euphoric to inappropriate, and his insight, as well as judgment, was partial. She did not have thought insertion, broadcasting, withdrawal, and no thoughts of reference. She often made comments that were grossly inappropriate and had problems engaging with peers. She had poor concentration, initial insomnia, and high energy. The manifestation of the mood disorder threw me aback leaving me in a situation of deep thought regarding the best way to handle the patient in a professional manner. I chose to draw lessons from Gibbs model of reflection, allowing me to make a quick description, analysis, and an assessment of the experience helping me to make sense of the experience at hand and examine my practice. The reflection was not enough, and I had to employ other skills gained during training to formulate an action plan. I knew that I had to apply logic to exhibit the fallacy of the hallucinations and delusions in the client, be neutral in case the service user neglected my contact and use non-verbal communication methods such as smiling, facial expressions, and tactile tactics to win the trust of the patient (Peschken & Johnson, 1997). I asked questions, made comments, and focused on what was happening. I also found it necessary to communicate acceptance to the patient, even though many people at the setting did not understand the perceptions and thoughts of the client. In this paper, I expound on the application of theories of reflection in the clinical practice to learn from experiences and to make the best decisions in stressful situations. Theory to Practice Within the clinical setting, reflection is regarded as the active process of analyzing, reviewing, and evaluating experiences, drawing from theoretical models or past learning. The purpose of applying reflective models is to inform current as well as future actions in the healthcare milieu (Reid, 1993. A professional reflective clinical officer or clinical support worker frequently reflects on experience and can ton reflect while in action, continually gaining skills and competence from experience to inform future actions. The practice of reflection has achieved general acceptance in the healthcare sector, such that paybacks of being a reflective clinical worker are well documented in myriad medical journals. The most prominent application of reflection is in the field of nursing, although medicine and pharmacy also employ reflective techniques to design ideal solutions and learn from experiences. I believe that continual reflection and critical thinking can narrow, and possibly close, the gap between theoretical models and practical application. Consequently, this will enhance the quality of care and motivate professional and personal development (Moon, 2004). Indeed, scholars and practitioners alike have suggested that reflecting on professional experiences, instead of learning from formal studies, may serve as the most essential source of improvement and professional development (Barker & Buchanan-Barker, 2004; Tsingos, Bosnic-Anticevich, & Smith, 2014). Within the taught aspects of clinical care and practice, I have learned of several reflection models including Gibbs’ reflective cycle and Kolb’s model of experiential learning. I have learned the importance of these models and the relevance of incorporating them into work based practices. Kolb’s model encourages us to be proactive in learning and developing our wealth of skills in professional and clinical practice (Kolb, 1984). Experiences enhance the achievement and development of reflective skill. Therefore, in addition to the theoretical components taught in class and the achievement of a professional development portfolio, a guided methodology of incorporating the reflective assignments and multi-sourced feedback helps in facilitating the professional development of reflective competencies (Morrissey & Callaghan, 2011). The models are aimed at developing a culture of compassionate care while ensuring competence in every respect. Assessment tools consider common competencies, ethical practice, and teamwork. Through the reflection in clinical care, we can attain and conform to the standards. Figure 1: Gibb’s reflective cycle (Morrissey & Callaghan, 2011) In the following section, I portray how I applied Gibb’s reflective cycle in the clinical situation that involved the 13-year-old girl affected by the schizoaffective disorder. I depict how I employed the five constructs to assist the service user while ensuring that I upheld ethics, common competencies, and teamwork in my practice. I began by describing the situation, highlighting who was there, the reasons that warranted me to be there, and the events that were taking place. Next, I assessed my feeling and thoughts are elucidating my self-awareness by describing how my colleagues and I felt regarding the events. I also expressed my feelings regarding the outcome of the event. In my evaluation, I considered my judgments, describing the things that went well and those that did not go very well. I also exhibited the good as well as the bad things that occurred things that occurred during the experience. In the analysis stage, I broke down the events and explored each one of them in a separate manner asking myself more in-depth questions. I finally looked at possible alternative solutions that could have applied and later made an action plan that would guide me if I found myself in such a situation again. Description The patient that I was attending to was a 13-year-old young girl who had been diagnosed with a mental disorder commonly known as schizoaffective disorder. Schizoaffective disorder is a combination of schizophrenia symptoms and affective mood disorder. A patient presents symptoms such as hallucinations and delusions that are related to schizophrenia and bouts of mania or depression. The disorder is elusively understood because it is a blend of two mental health conditions. The two conditions complicate matters as they often run a unique course in the affected person. If left untreated, the disorder can make a person lead a lonely life full of trouble maintaining good relationships. Treatment is essential in managing the symptoms and enhancing the quality of life for patients with schizoaffective disorder. The service user, an only child, presented with irritable, but imbalanced mood and physical aggression. She was both paranoid (alleged that she might have been poisoned) and grandiose (convinced she was a superstar) but illuminated an incongruent mood mixed with auditory hallucinations. Her affect was inconstant, shifting from a blunted to euphoric to inappropriate, and his insight, as well as judgment, was partial. She did not have thought insertion, broadcasting, withdrawal, and no thoughts of reference. She often made comments that were grossly inappropriate and had problems engaging with peers. She had poor concentration, initial insomnia, and high energy. As I approached the psychiatric ward and made way towards the patient with schizophrenia, she turned and started fiddling around as though she wanted me to believe that she was busy. As I stood next to her, two of my colleagues had also assembled by her bed intending to assist me. However, as we began to converse, a few other support workers had gathered around as they heard the conversation going on and watched the bizarre mannerisms that had become obvious by now. The service user told me: “We drank and often smoke around here.” I thought how could that be possible… drinking alcohol in a hospital environment? However, I said nothing and kept silence. The client repeated the same statement, and this time, I started nodding my head saying, “Yes, I see what you said.” I showed recognition to the patient by commending her for combing her hair. I also offered myself saying, “I will spend some time here with you.” I started asking the service user to tell me what bothered her, but instead she screamed aloud and threw herself on the bed. Other support workers ran away, and the nurses also backed a bit, but I considered that as a response to the conversation and asked myself if that was her way of telling me what was bothering her mind. Feelings and Thoughts I was scared, and I bet my colleagues were too. It was too obvious they were, as they kept their distance as some called for hospital security, fearing that the patient would harm herself. However, I was determined to take things in a stepwise manner, and I knew that if I left the conversation hanging in that position, I would have done more harm than good. At that time, she was asking for her mother, and it clicked to me that she was probably seeking a shoulder to lean on. I answered her by disillusioning her and introducing myself to her. She answered in a small voice saying, “Really?” and I knew that she was coming to terms with the reality. I reasoned that if continued with the sessions of disabuse, the outcome and prognosis would be good. I focused on empathetic listening, showing willingness to understand what the service user was trying to say; regardless of the fact that I knew she was having a psychotic bout. Empathetic willingness is one of the characteristics of good patient-physician communication (Burnard, 1997). I was afraid that the service user would not respond or go into a trance during our session, but my body gestures must have made her feel comfortable enough to respond to some of my questions. The most interesting part was when she paused and wondered that her mother was not at the hospital. For a moment, it was as though my message to her that served as an attempt to let her know that she was in a psychotic episode worked. When she inquired if that was the truth, I was ready to let her know that it was through my facial expressions. Evaluation Several things went on well while a couple of occurrences were negative. Starting a conversation with the patient and affirming her claims, even though they were bizarre, was positive. It is clear that psychotic ideation is illusionary and delusional. People shy away from conveying to psychotic individuals that they have valid perspectives. However, I found it essential to affirm some of the statements that the patient made as we were beginning the conversation so as to gain her trust. To some extent, research has asserted the importance of affirming the thoughts of a psychotic patient. Contrarily, some clinicians trust that they should deny validations to schizophrenics about their psychotic thinking. Research states that open dialog with schizophrenics bear positive outcomes even in patients with acute or severe crises such as psychosis. In fact, open dialog stands as a valid method of assisting schizophrenics come to terms with reality that it compares to commonplace treatment (Daniel, 2011). Studies also show that if communication is to continue through and through, patients become disillusioned slowly, and eventually the psychotic symptoms dissolve (Varcarolis & Halter, 2012). This was the logic behind my continuity with the conversation and given time, it would lead to positive outcomes. On the other hand, the sudden reaction exhibited by my colleagues may have scared the patient into withdrawal disrupting the communication process. Communication with schizophrenia patients occurs at two levels, nonverbal and verbal. While I was keeping my verbal communication brief, simple, and specific, the physical distance and facial expressions maintained by my colleagues may have sent the wrong message to the service user. At times, the non-verbal communication that comes across in a psychiatric ward or a session with a service user is more important than the spoken word. I can say that my communication towards the service user depicted patient-centred communication elements. I was able to relate to the situation of the patient in a bid to show my empathy that would consequently develop trust. Trust in psychotherapy is considered essential and enhances prognosis of mental disorders, especially when comorbidity is involved. The situation allowed me to improve my non-verbal communication skills, which is essential when communicating with mentally ill patients. With young people, verbal communication may be limited, implying that better non-verbal communication can enhance therapeutic outcomes of patients. Analysis As I analysed the situation, I recalled very clearly proper non-verbal communication occurs when a practitioner stands close to a service user without crowding his or her space. Non-verbal communication through posture should also depict concern, interest, and alertness portrayed through facial expression and body posture. Maintaining eye contact also serves as an essential step that makes the clear and calm words sink into the patient’s mind without rousing any negative attitude. I could see the words sink deep as I asked the patient questions in a calm manner. As the patient began the communication, I employed effective communication skills and observed the first step in communication, which is attempting to understand the patient. I did not assume that the young girl did not have it right, and I attempted to make her feel as comfortable as possible. Without boundaries, the relationship with the service user would be bound to achieve great things. Conclusion If the situation were to repeat itself, I would ensure that communication among the practitioners would have been different. Consequently, this would have affected the communication amongst the health workers presented. I was able to maintain relatively good communication with the client. However, staff communication is also important in the provision of equitable mental health services. I will emphasize completion of tasks in a sufficient amount of time and support optimal focus on every focus. Mental health solutions require time, which also allows the relationship between patient and physicians to grow. According to Kimberly and Chapman (2009), the relationship between providers and patients and among providers usually suffers as providers rush to complete more tasks in less time. Flawed assumptions, miscommunication, poor coordination results, and decreased patient and staff satisfaction are prevalent in such settings. In addition to that, I would try to persuade my colleagues not to panic or react sharply when the patient is presenting bizarre mannerism or symptoms. A study that highlights the reaction of patients to negative experiences shows illuminates on communication errors commonly made in the hospital setting. Patients who record poor satisfaction seem to attribute that to the capacity of staff enduring negative dispositions from features caused by certain situational contexts. Negative experiences seem to affect scores on most information and communication domains. On the other hand, patients who record higher satisfaction appear to delineate positive experience from negative ones, and they relate to the positive reactions of health workers (Kimberly, 2009). Action Plan My action plan will assist the clinical team makes better decisions towards supporting patients with similar situations. The plan highlights areas that the team needs to work on to improve communication between patient and practitioners and amongst practitioners. My action plan will also entail things that will assist me to react in a more appropriate manner if faced with the same situation in the future. This is because I would love to see the best for my patients. Effective communication will enable me to achieve my goals as I relate to other practitioners and patients in an ideal manner. In my current experience, I have realized that communication bears many capabilities to developing a good relationship with the patient. Many scholars affirm that communication is important in developing healthy relationships in the hospital setting. I will also improve my listening skills as good skills in listening break interaction barriers between physicians and patients. Listening without prejudgment or judgment reduces complaints and improves compliance (Ha & Longnecker, 2010; Varcarolis & Halter, 2012). I will also improve on my non-verbal communication skills and encourage my fellow practitioners to observe the same. Research shows that non-verbal communication stands for over 55% of the entire communication process. If the figure is correct, then positive gestures and body language is essential to effective communication since we have physician-patient profession relationship, conversations between parties should be goal directed, therapeutic, and aimed at assisting patients get better. Those conversations include both verbal and non-verbal intonations (Kimberly, 2009). I will advocate kinesics, which is the study of gestures and non-verbal communication such as smiling, nodding, and expressions, to improve outcomes in similar cases. In addition to that, I will encourage my colleagues to observe ideal proxemics, which come into play during such situations. Proxemics refers to the physical space that a practitioner should maintain with a client during a nursing session. In this situation, my colleagues were too far from the patient, but appropriate proximity is advised to ensure that the patient develops a feeling of belonging and inclusiveness. Summary Gibbs’ reflective cycle served as an important model in my reflection of the clinical situation. The stages of reflection in Gibbs cycle are essential to the development of robust skills and competencies required in the provision of equitable, professional care. The reflective model enables me to reflect on the importance of communication skills in developing trust and a good relationship with a client, which underlies a good prognosis. Good communication should exist amongst health workers as well as between a physician or practitioner and a patient. Empathy, non-verbal signs, and affirmation are some of the features of good communication that drives healthy relationships and spurs positive response to treatment, as well as a relatively fast prognosis. Reference List Barker, P. P. J., & Buchanan-Barker, P. (2004). The Tidal Model: A Guide for Mental Health Professionals. Routledge. Burnard, P. (1997). Effective Communication Skills for Health Professionals. Nelson Thornes. Daniel, M. (2011). Schizoaffective Disorder Simplified. Chipmunka Publishing Ltd. Ha, J. F., & Longnecker, N. (2010). Doctor-Patient Communication: A Review. The Ochsner Journal, 10(1), 38–43. Kimberly, B. (2009). Improving Communication Among Nurses, Patients, and Physicians. Retrieved April 1, 2015, from http://www.nursingcenter.com/lnc/journalarticle?Article_ID=940556 Kolb D.A. 1984. Experiential Learning: experience as the source of learning and development. New Jersey: Prentice‐Hall. Moon J.A. 2004. A handbook of reflective and experiential learning: Theory and practice. New York, NY: Routledge. Morrissey, J., & Callaghan, P. (2011). Communication Skills for Mental Health Nurses. McGraw-Hill Education (UK). Peschken, W., & Johnson, M. (1997). Therapist and Client Trust in The Therapeutic Relationship. Psychotherapy Research, 7(4), 439–447. http://doi.org/10.1080/10503309712331332133 Tsingos, C., Bosnic-Anticevich, S., & Smith, L. (2014). Reflective Practice and Its Implications for Pharmacy Education. American Journal of Pharmaceutical Education, 78(1). http://doi.org/10.5688/ajpe78118 Varcarolis, E. M., & Halter, M. J. (2012). Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence-Based Care. Elsevier Health Sciences. Read More