Reflection on the Role of Communication and Encounters in Nursing
“Importance of communication in nursing” essay critically reflects on an encounter with parents of a neonate and makes an accent on the importance of building effective communication relationships with patients. Bulman and Schutz believe that reflection is crucial for effective and person-centred professional practice.
Reflection can be defined in different ways. One of the descriptions stands that it is a process of making sense of situations that occurred in the past. Reflection can also be defined as a process of transformation in result of people change their actions. In healthcare reflection if done appropriately and correctly, can significantly improve skills of health care providers. For the purpose of this essay, I will use The Gibbs’ Reflective Cycle. According to Gibbs reflective cycle is beneficial to help people to learn from situations they experienced, especially when it did not go well. The process of reflection was seen as a cycle incorporates six different elements where the outcome of a previous reflection informs future actions. This process enables the reflectors to think and evaluate actions through every step of their reflection.
Description
The incident I will be reflecting on occurred on a neonatal unit not long after my registration as a qualified nurse. In order that I could use this situation for my reflection the patient will be named as “baby A”. This is in order to maintain privacy and confidentiality in line with the NMC Code of Professional Conduct, “as a registered nurse, midwife or health visitor, you must protect confidential information”, and to “Treat information about patients and clients as confidential and use it only for the purpose for which it was given.”
Baby A was born via emergency cesarian section at 30 weeks after his mum developed preeclampsia. He was born a fair condition, but developed respiratory distress syndrome, therefore required CPAP support. When I was looking after baby A he was still on CPAP and was getting parenteral feeding via a long line. For a couple of hours doctors were trying to put a long line into a baby’s big vein to start parenteral feeding. When they finished the baby was distressed and it was obvious, he was very tired. Not long after that, the baby's parents came to visit him. They were very anxious and distressed about his condition. Although baby’s condition was stable, when parents asked me if they can do a kangaroo care, I didn’t feel comfortable to take out a baby from the incubator I answered “Maybe not today, it is better to let him rest.”
This caused more stress in the parents, because they thought the baby detreated from the day before, when they were allowed to hold him for a couple of hours. I took me and a senior nurse some time to calm them down and ensure that the baby is stable.
Feelings
As I was a novice nurse, I was feeling quite stressed out at the beginning of my shift when I was allocated to look after a high dependency baby, although I was working with a senior nurse. I didn’t want to say that, as I was feeling it is not professional. I didn't want to be judged by other nurses, as not being competent, however I was only working on a neonate unit for a few months. When the doctors were trying to insert a long line into the baby’s arm, I was trying to comfort him, as he looked very distressed. I was very sorry for him and when it was possible I was using containment holding, which helped the baby feel safe and comforted. After the insertion of a long line by the doctor, I was happy it was successful and the baby can rest. However, when parents came and after my advice which caused stress in them, I was feeling very anxious and upset. Instantly I also felt I was not acting in a professional manner.
Evaluation
When looking at the above situation I can see good and bad elements. The incident helped me to understand the importance one of my roles as a nurse working in a neonatal unit which is promoting family centered care.
The significance of the attachment between a child and their parents is acknowledged in the National Service Framework for Children, Young People and Maternity Services and recommends neonatal nurses, as primary care providers, to understand how to advertise parental care in order to create an attachment in NICU and promote family cantered care. I feel that I didn’t fulfil this duty completely. However, on the other side I was very aware how important is sleeping and rest time for neonates.
I should also be more courage and follow the NMC code requirements that says that ‘nurse should ask for help from a suitably qualified and experienced professional to carry out any action or procedure that is beyond the limits of your competence’. Although, I was not feeling comfortable enough to take out of the incubator a baby on a CPAP and with a long line and TPN infusion, I should have asked for help one of the senior nurses working with me.
Analysis
According to Flacking et al. a close physical contact with a newborn baby after birth, is crucial for emotional bond to be formed into a secure attachment relationship between parents and their child. Attachment theory says that a secure attachment comes from the child’s believe of hisher mother’s (or other attachment figure’s) physical availability. According to Bowlby, the earliest bond that is formed between a child and primary attachment figure has a key impact on child’s life. Bowlby believed that attachment also helps to keep the infant close to the mother, therefore improves the child's chances of survival.
The significance of the attachment between a child and their parents is also acknowledged in the National Service Framework for Children, Young People and Maternity Services which suggests neonatal nurses, as primary care providers, should understand how to advertise parental care in order to create an attachment in NICU and promote family cantered care. Kangaroo care is suggested by the WHO as one of the most effective way to maintain correct body temperature, regular breathing, improving blood saturation, preventing infections and better weight gain in preterm infants. Also, Cho et al. confirms that skin to skin care can be used to promote emotional bonding and support between mothers and their babies, and to stabilize the physiological functions of premature babies. Despite this, Meeks et al. emphasize the importance of sleeping and resting, indicating that overstimulation is causing a stress hormone releasing, which is not good for brain development in neonates. Additionally, growth hormone is releasing during quiet sleep phase.
I believe that the incident may occurred because lack of my confident and courage. The Department of health introduced in 2012 6 C’s - the values all health professionals should follow in order to deliver high quality care. One of that values is courage, which I believe that nurses should have in order to confront fear of difficulties.
I also feel that I did not fully fulfil in another field which is communication. NMC Code obligate nurses to communicate clearly. I should explain baby’s parent more in details what procedures were carried out on their baby, so they understand better their baby’s condition. I feel I wasn’t in depth enough when I was updating the parents. Some studies show that attentive communication gives the parents a relief in their hard situation, while lack of good communication with health care practitioners cause stress and lead to feeling abandonment and loneliness. Effective communication and keeping parents well informed, including involving them in care and decision making affecting their child are crucial in promoting family centered care which may decrease stress and insecurity of parents. Also, communication between health care professionals is very important. Effective communication among staff encourages effective teamwork and promotes continuity and clarity within the patient care team. Good communication encourages collaboration, fosters teamwork, and helps prevent errors.
Conclusion
From this experience I am now more aware of the importance of communication in nursing, especially in the field I work in, which is a neonatal intensive care unit.
By mentioning communication, I mean both communication between health care professionals but also between nurses or other practitioners and service users and their families. Communication between nurses is not only sharing information, but also when necessary questioning, raising concerns and asking for help. All those actions also require courage - a value which enable getting rid of nerves in order to develop into a professional and competent nurse.
I am now also aware how stressful and hard is having a child who requires high dependency or intensive care treatment, therefore informing then and encourage to participate in care and decision making is crucial. However, in order to enable them to be their children care participants the effective communication is necessary. Collaboration between medical staff and family members to manage the infant’s care is a foundation of family cantered care.
