A Reflection Feedback: Introduce Yourself
This is introduce yourself essay about yourself, a reflection of the feedback, from the 360 interpersonal skills assessment tool. This has been completed within practice to help develop a therapeutic relationship with service users. The 360 tool will be signed by my mentor, to show that consent and confidentiality has been obtained. The Royal College of Nursing clarifies the importance of obtaining consent from all service users, as it makes sure the service user is happy to participate in what you propose to do, nurses should never assume consent. The Code of Conduct also, says nurses owe a duty of confidentiality to all service users receiving care. The effective use of a recognised reflective model, will be used to identify and discuss development needs in relation to interpersonal and communication skills and personal effectiveness. The feedback will be used to create an action plan to address further improvements.
According to Smith & Field one of the most essential skills a nurse can have is the ability to communication. Strachan states that communication is crucial for accurate decision-making. Communication is the process of listening, hearing, allowing for and accommodating silences, as well as responding to non-verbal communication. It is important that nurses communicate effectively with patients as this provides successful patient-centred care. The patient’s outcome is greatly influenced by the quality of the communication, a mutual understanding is a necessarily for good care to be given and received. There are several barriers to effective communication. The use of over-complicated, unfamiliar terms; lack of attention, interest to the nurse; lack of privacy and background noise are also potential barriers. Time, or lack of it. Creates a significant barrier to communication for nurses.
Communication is vital as one of the NMC competencies stipules: ‘All nurses must build partnerships and therapeutic relationships through safe, effective and non-verbal communication. They must take account of individual differences, capabilities and needs.’ A therapeutic relationship is built on the needs and health outcomes of the patient, protecting them from harm and assisting them towards recovery or a peaceful death. The base of a good therapeutic relationship is trust. The therapeutic relationships between nurses and patients has been linked to improvements in patient satisfaction, adhering to treatments, quality of life, lower levels of depression and decreased healthcare costs.
Reflection is the process of understanding events, or situations that have occurred, through deep thinking. Reflection is crucial for nurses as it helps to improve the quality of care together with professional development, one’s own approach, personality and personal contribution to how a situation arose and how it was handled. Reflection doesn’t always look at how to correct practice but also enables individuals to celebrate good practice. Reflection models are used to help guide individuals to described, analysis and evaluation the situation, to make better sense of where there went wrong, and how there can improve next time. The Gibb’s model will be the model used to reflect on the 360 tool. The Gibb’s model has been chosen as it’s a model I have used before, and it’s also easy to understand and apply to practice. However, John argues that Gibb’s model offers basic questions to help structure reflection but a broader more critically reflexive approach is needed. As the word count is only 2,000 words, I am going to reflect on two aspects of the 360 tool in detail.
The first aspect I am going to reflect on is, ‘Introducing themselves to you’. I received three good and one excellent on the feedback. I rated myself as a good because I recognised that I was not as good at introducing myself to other members of staff as I was to patients. Before introducing myself to patients I felt nervous and anxious as to how the patients were going to react, as some of the patients presented in an agitated manner. This became a barrier between patient and myself. I felt that I did not always get the chance to introduce myself, sometimes my mentor would start the conversion and introduce me before I got chance. However, as my confidence grew I got around this by introducing myself to the patient and asking them for permission to be present in observing there meeting before my mentor.
After reading around Kate Granger’s, Hello my name is campaign prior to practice. I understood the importance of introducing myself politely and confidently as it shows respect for the patient and is the first step in building a therapeutic relationship with patients. This helps the patient feel more relaxed and safe while receiving care. Introducing myself to the patient starts the communication process. Student nurse are supernumerary while in practice which means we are not accounted for in the workforce numbers, we are present to observe, learn and progress. Been supernumerary, has given me the opportunity to sit with patients, engage in communication with them, and develop my communication skills and also gain knowledge around patients and their history, as well as gaining more confidence.
Introducing myself to others was successful as it helped make me more approachable and put the patient at ease, which made the patient more willing to communicate and voice their concerns. Some patients reported that there were more willing to communicate with student nurses as their felt there were a burden on staff nurses due to how busy the ward was. Wright likewise confirms student nurses have more time to communicate with patients than staff nurses. Through introducing myself to patients I have learnt that it is the basic to building a therapeutic relationship, showing care and compassion to the patient. Showing compassion helps the patient open up and build trust with the nurse. Building trust and therapeutic relationships helps to improve patient recovery. However, The Francis Inquiry, outlines how a hospital trust which was meant to care for patients, let patients and their families down by following a target driven approach rather than focusing on patient’s needs. Patient’s basic needs as such water and food lacked, leaving patients drinking from vases. Around 400-1,200 patients died due to basic needs not been met. Following the recommendations of the report, Professor Jane Cummings launched, Compassion in Practice, built on the values of the 6C’s (Care, Compassion, Communication, Competence, Courage, Commitment). During my time out in practice I tried to keep the six C’s in mind, offering assistance to patient to help keep them as independent as possible to improve their health outcomes, giving the highest quality of care I could, and working with the individual to provide them with a positive experience of care.
My action plan moving forward is to continue to introduce myself to every patient whether it be a new patient or a patient I have already met. I need to be more conscious of introducing myself to doctors and healthcare assistants. I am going to ask my mentor to give me regular feedback on this. The 360 feedback from my next placement will evidence that I have continued to work at introducing myself to both patients and staff members.
The second aspects of the 360 tool I am going to reflect on is, ‘Providing patients/ service users with information they need about their care’. For this aspect I received mixed feedback three good and one excellent. I have found that I struggled with this aspect, so I rated myself as an ok. I felt that having minimal knowledge of the patient and their history was difficult to know the best way to care for them. Before going out on placement I read up around the field I was entering, to give me more knowledge. The feedback giving shows that I still have a lot more to learn. I found it difficult at first to ask qualified nurses for information around patients care as I did not want to seem inexperienced. Once my confidence grew I soon realised that the qualified nurses were willing to help and improve my knowledge around patients. Graham O’Brien carried out a study which found that student nurses do struggle with feeling inadequate and the complexities of care packages when supporting and caring for patients.
While providing patients/service users with information they need about their care, I found it useful to use my active listening skills. Active listening helped me to understand what the patient was asking. I paraphrased the question back to the patient to ensure that I interrupted it correctly. Active listening helps to show understanding and empathy to the patient. I had to be mindful of non-verbal ques such as nodding. Lang states that active listening helps to build trust and establishes rapport, shows concern for the patient, and with using open questions helps gain more detailed answers. I also used skills which I learnt in university such as SOLER (Sit squarely, Open posture, Lean towards the other, Eye contact, Relax) and SURETY (Sit at angle to client, Uncrossed legs and arms, Relax, Eye contact, Your intuition). SOLER and SURETY are both effective ways of communicating in a non-verbal manner. The SURETY model encourages nurses to think about the therapeutic space, while building a relationship with the patient. I also needed be to self-aware of my own verbal and non-verbal communication as it can impact on the therapeutic relationship between patient and myself, McCabe also reports this. I had to be respectful of the patient when feeding back any information about their care, keeping the patients privacy and confidentiality in mind.
From the feedback I feel like I need to gain a lot more knowledge and understanding around patients, so that I am more prepared when patients ask me questions around their care. The NHS Constitution states that the patient should be at the heart of everything the NHS does. It should support individuals to promote and manage their own health. The NHS services should coordinate around and tailor to the needs, and preferences of patients, their families and their carers. My action plan moving forward is to be more pro-active and read up around the patients, their history, their care packages and engage in updating patients case notes. Also asking my mentor for assistance in building confidence around providing patients/ service users with information they need about their care. By doing this it will help me give the patients better holistic care and support around their needs. I can use tools such as SWOT (Strengths, Weakness, Opportunities and threats) and learning contracts, which I can use to show I am working within my limitations, and to identify any weaknesses to address and act upon.
In conclusion, the 360 tool has been beneficial in gaining information from patients and my mentor around my interpersonal skills which will be useful to help me improve as I continue my studies. The reflective model has helped me to assess and evaluate my time in practice, creating an action plan to enhance my further development. As I continue my studies, I will continue to reflect on my progress as I feel it is an essential part of improving my skills throughout my nursing training, and as a qualified Mental Health nurse.
