NRSG 139 - Integrating Practice

Running head: Integrating Practice
NURSING 139- Integrating Practice
Name of the Student
Name of the University
Author Note

1Integrating Practice
The video titled “NRSG139 Ax3 TPRVignette” revolves around a nurse visit in the
hospital setup, where the nurse performs routine check on the patient (youtube.com, 2018).
Described below is a reflective analysis of the video, based on the GIBBS reflective cycle
and the Nursing Competency Assessment Schedule (NCAS) standards to reach to a
conclusion and action plan based on the video (cdnm.edu.au, 2018). The analysis will be
segregated according to each part of the Gibbs reflective cycle, that is: Description, Feelings,
Evaluation, Analysis, Conclusion and Action Plan (kcl.ac.uk, 2018).
The NCAS outlines 7 interrelated standards in Registered Nursing Practice which is
implemented by the NMBA (Nursing and Midwifery Board of Australia). These standards
include: 1) Thinks critically and analysis nursing practice, 2) Engages in therapeutic and
professional relation, 3) Maintains capacity for practice, 4) Comprehensively conducts
assessments, 5) Develops a plan for Nursing Practice, 6) Provides safe, appropriate and
responsive quality nursing practice, 7) Evaluates outcomes to inform nursing practice. In the
given scenario, the nurse showed a strong emphasis in the standard 2 (Engaging in
therapeutic and professional relationship with the client) (cdnm.edu.au, 2018).
Figure 1: Registered Nurse Standards, source: (cdnm.edu.au, 2018)

2Integrating Practice
The Gibbs reflective cycle consists of 6 stages in a cyclic process, consisting of:
Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan. The event will be
analysed utilizing this plan (kcl.ac.uk, 2018).
Figure 2: Gibbs Cycle: Learning By Doing; source (kcl.ac.uk, 2018)
Description of the Event:
What happened: The video showed a regular nursing visit, where the nurse was performing
routine checkups, and was engaged in developing a therapeutic and professional relationship
with the client (Standard 2 of NCAS). The nurse checked the vital status of the patient, while
engaging him in communication (asking him how he was feeling) and also gave confidence
to the patient, informing that his vital signs were about normal and his health was improving,
which he will also share with the doctor.
Where the event occurred: The event occurred in a hospital ward
Who was there: The event involved a patient and a registered nurse

3Integrating Practice
What the people were doing: The Registered nurse was performing routine assessment of
the patient’s vital signs, and was engaged in conversation with the patient, thus trying to
develop a therapeutic and professional relation (in accordance to NCAS standard 2).
What was the result: At the end of the video, the patient seemed to be comfortable
communicating with the nurse and expressed that he was looking forward for the next visit
from the nurse.
My Feelings on the incident:
Watching the video, gave me the impression that the patient was in the hospital on the
road to recovery, and possible expecting to be discharged soon. The patient informed the
nurse, that he was feeling much better than before, although not at a hundred percent, but
hoped to be there soon. He showed faith in the care provided to him, and didn’t seem to have
any qualms about it. The patient was coherent and articulate and responded to the nurse’s
questions. The nurse also showed conviction to develop a therapeutic relation with the client,
trying to understand how he felt, and tried to make the patient feel comfortable. However, it
also felt that the nurse lacked adequate skills for multitasking, as he became too engaged in
checking the vital signs, and the patient had to ask how the status of his vital signs seemed.
Otherwise, the patient was very courteous and professional with the patient, and answered his
queries in the best of his knowledge. The nurse also had a very friendly nature, and showed
concern towards the well being of the patient. I believe that the nurse was able to develop a
professional and therapeutic relation with the patient (Standard 2 of NCAS), as the patient
showed comfort to communicate with the nurse, and expressed that he looked forward for the
next visit.
Evaluation of the scenario:

4Integrating Practice
It was evident from the video, that the nurse was attempting to develop a Therapeutic
relation with the patient (according to Standard 2 of NCAS), and exhibited a professional,
courteous and friendly and honest approach through the visit, asking the patient how he felt,
and keeping the patient updated on the findings of the routine check. The nurse showed
confidence in what he was doing, and in my opinion, he gain the trust of the patient, which
was a proof of the development of the therapeutic and professional relation. However, the
nurse did not seem to be very familiar with the care plan of the patient, and was not able to
properly inform the patient regarding how long his treatment might continue and what the
progress of the overall treatment was. However, he did inform that the vital signs showed
positive results, and he seemed to be better. I believe the nurse could have been a little more
encouraging as educative for the patient, instead of placing that responsibility on the
shoulders of the doctors. Overall, I feel the nurse was successful in developing a good
therapeutic relation with the patient.
Analysis of the event:
Several important aspects (such as usage of appropriate language, effective
communication strategies, having the right attitude and body language) have been implicated
by many authors as the strategies for effective communication (O'hagan et al., 2014; Blais et
al., 2015). These aspects help to foster a therapeutic relation with the patient. In the video, the
nurse was able to show a professional approach (introducing himself, and his tasks), was
courteous to the patient (talking with the patient with courtesy) and showed care for the
wellbeing of the patient (asking him how he felt), as well as informing that his vital signs
showed signs of improvement, thus encouraging the customer. This shows that the nurse
showed commitment towards the development of a therapeutic relation with the patient, and
thus helped the patient feel comfortable talking to him. This was an important aspect of care

5Integrating Practice
given to the patients, due to which is incorporated in the nursing standard under NMBA
(Standard 2) (Pinto et al., 2017; cdnm.edu.au, 2018).
Conclusion on the Event:
Effective strategies are a vital component of Registered Nursing Practice which helps
in the development of effective therapeutic relation between the nurse and the client (Riley,
2015; Bramhall, 2014). Effective communication also helps to maintain the professional
standards of nursing practice, outlined under the NMBA guidelines. Studies have shown that
effective communication helps to improve the outcomes of care, and nurse should be able to
develop an understanding of the patients, and their feelings and should be able to exhibit
honesty, sincerity, kindness and courtesy towards the patient (Korkouta & Papathanasiou,
2014). Also, an effective therapeutic relation can also help in the development of a patient
cantered care (Doherty & Thomson, 2014). Therapeutic relation can also be useful strategy to
improve the patient’s satisfaction towards the care provided to them. Additionally, some
authors also proposed that using a framework that fosters trust, focus, anticipation, evaluation
and knowledge, it is possible to develop an effective strategy for developing therapeutic
relation (Feo et al., 2017). The nurse was able to exhibit many of these attributes, which
helped to develop an effective relation between the patients.

6Integrating Practice
Action Plan:
Learning Opportunity Objective Actions Resources Evaluation
Engaging in therapeutic
and professional relation
1. Effective
communication;
2.
Understanding
the needs of
the client, 3.
Developing
clinical
competence
and knowledge;
4. Implement a
patient/client
cantered care
Steps that can be
utilized to develop
an effective
therapeutic relation:
1) Allowing the
patient to decide
the speed of the
conversation; 2)
paying attention to
the views and
opinions of the
client; 3) focusing on
the development of
a good first
impression; 4)
focusing on the
comfort level of the
patient to engage in
the communication,
and allowing the
patient to control
the direction of the
conversation; 5)
understanding the
expectation and
views of the patient;
6) updating the
patient on the care
plan and progress;
7) involving the
patient in the
discharge plan
(Stewart et al., 2017;
ohsu.edu, 2018;
Osborn et al., 2014)
The Patients
shos ease
and comfort
to interact
with the
nurse, and
share his
views,
feeling,
opinions and
expectations
.

7Integrating Practice
References:
Blais, K., Hayes, J. S., Kozier, B., & Erb, G. L. (2015). Professional nursing practice:
Concepts and perspectives (p. 530). NJ: Prentice Hall.
Bramhall, E. (2014). Effective communication skills in nursing practice. Nursing Standard
(2014+), 29(14), 53.
cdnm.edu.au (2018), NCAS RN Standards, retrieved on 22 May, 2018, from:
http://www.cdnm.edu.au/assets/ncas_rn-standards_v6.2_25-09-2016.pdf
Doherty, M., & Thompson, H. (2014). Enhancing person-centred care through the
development of a therapeutic relationship. British journal of community
nursing, 19(10), 502-507.
Feo, R., Rasmussen, P., Wiechula, R., Conroy, T., & Kitson, A. (2017). Developing effective
and caring nurse-patient relationships. Nursing Standard (2014+), 31(28), 54.
kcl.ac.uk (2018), Using Gibbs’ Reflective Cycle, retrieved on 22 May, 2018, from:
https://www.kcl.ac.uk/campuslife/services/disability/onlineresources/StudyGuides/
USING-GIBBS-REFLECTIVE-CYCLE-IN-COURSEWORK-DEC-2016-P-LIA.pdf
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia
socio-medica, 26(1), 65.
O'hagan, S., Manias, E., Elder, C., Pill, J., Woodward‐Kron, R., McNamara, T., ... & McColl,
G. (2014). What counts as effective communication in nursing? Evidence from nurse
educators' and clinicians' feedback on nurse interactions with simulated
patients. Journal of advanced nursing, 70(6), 1344-1355.

8Integrating Practice
ohsu.edu (2018), Developing Therapeutic Relationships. Retrieved on 18 May, 2018., from:
http://www.ohsu.edu/xd/outreach/occyshn/training-education/upload/
developingtheraputicrelationships_ch10.pdf
Osborn, R., Moulds, D., Squires, D., Doty, M. M., & Anderson, C. (2014). International
survey of older adults finds shortcomings in access, coordination, and patient-centered
care. Health Affairs, 33(12), 2247-2255.
Pinto, S., Caldeira, S., Martins, J. C., & Rodgers, B. (2017). Evolutionary analysis of the
concept of Comfort. Holistic nursing practice, 31(4), 243-252.
Riley, J. B. (2015). Communication in nursing. Elsevier Health Sciences.
Stewart, K., Doody, O., Bailey, M., & Moran, S. (2017). Improving the quality of nursing
documentation in a palliative care setting: a quality improvement
initiative. International journal of palliative nursing, 23(12), 577-585.
youtube.com (2018), NRSG139 Ax3 TPRVignette, retrieved on 22 May, 2018, from:
https://www.youtube.com/watch?v=550mSnqtqRA&feature=youtu.be