Reflection Essay | Professional Nursing Standard

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Introduction:
Adhering to the professional nursing standard is an important responsibility for all
nursing staffs today. This is paramount to provide safe and clinically competent care.
Professional nursing standards is a framework that introduces all new registered nurses to
expected standard of care and desirable action required to effectively complete caring
responsibilities. All student nurses are aware about key nursing competencies and professional
nursing standards during their nursing training program (Poorchangizi et al., 2017). For nurses,
the process of developing professional competency starts from nursing schools and continues by
taking part in academic training and clinical placement. This experience exposes them to real
practice scenario where they get to apply nursing theories and professional standards to practice
(SHARGHI et al., 2015). All nursing students must reflect on their practice so that they can
develop their professional competencies in a positive way (Karimi et al., 2017). The purpose of
this essay is to provide a reflection on personal professional placement experience as a student
nurse and the link that the experience with one of the Australian Registered Nurse Standard. The
details of the practice experience have been attached in appendix and a reflection on the impact
of nursing activities on the patient will be done.
Relation of placement experience with the Australian Registered Nurse Standards
On review of the pervious placement experience, it can be said that situation gave the
opportunity to implement therapeutic communication skills during a patient encounter. As the
patient was depressed and anxious about her current health state, entering into communication in
a general way was difficult. Hence, therapeutic communication techniques were applied to
ensure that that the care is delivered in accordance with the professional nursing standards. The

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process of establishing mutual trust and therapeutic relationship with patient is related to the
standard 2 of the NMBA registered nurse standards for practice. This standard is about engaging
in therapeutic and professional relationship with patient. The standard 2.2 of the nursing standard
states that nurse must communicate effectively and respect patient dignity, culture, values,
beliefs and rights (Nursing and Midwifery Board of Australia, 2017). Therapeutic
communication is a fundamental part of the nursing process. It is a process involving use of
specific strategies to support patient to express their feelings and concerns (Sherko, Sotiri &
Lika, 2013). Through the NMBA standard 2, all nursing students are given the guidance
regarding the way to establish therapeutic relationship with patient. As poor nurse patient
encountered lead to poor nursing care quality, depression, anxiety and low self-esteem in patient,
it is an important responsibility of nursing educators to promote deep understanding of the
therapeutic communication among nursing students (Abdolrahimi et al., 2014). Therapeutic
communication is favoured as it helps in doing accurate nursing work and ensuring satisfaction
of patients with care (Kourkouta & Papathanasiou, 2014).
During the clinical placement, the main task at hand was completing vital signs assessment
and attending to hygiene needs of patient. However, depression and anxiety of patient created a
barrier in the nursing task as the patient was not responding well and effective communication
technique was needed to deal with such patients. The review of research literature shows patient
anxiety and depression as two common factors that act as a barrier in the nurse-patient
communication process. A study investigating about the communication barriers perceived by
nurse and patient revealed that patient anxiety and physical discomfort was some of the barriers
in the communication process apart from other barriers like hectic environment of the ward and
heavy workload (Norouzinia et al., 2016). The primary cause of anxiety in any hospitalized

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patient includes the effect of disease and dependence on others for care. The tension, uncertainty
and fear in the mind lead to anxiety in patients (Alexandri et al., 2017). In such situation,
communication skills of nurse play an important role in clarifying doubts of patient and
increasing their motivation level (Norouzinia et al., 2016). Lang (2012) argues that as lot is at
stake because of a patient’satisfaction with a facility, good communications skills of care
providers are strictly monitored as it affects their reimbursement and bonuses. Thus, in current
health care system, nurses need to be competent in use of therapeutic communication technique
to improve patient outcome and achieve better professional gains too. During the personal
practice placement experience, the patient also suffered from anxiety because of above reasons.
There was a need to apply therapeutic communication skills to overcome the barriers in
providing care to the patient. Hence, for this reason, the professional practice experience relates
to the NMBA standard 2 of the professional nursing standards.
Reflection on own practice and impact on patient
The clinical practice experience of caring for an anxious hospitalized patient with fear about
her disease was a very enriching experience for me. This activity boosted my confidence level a
lot because I could utilize my theoretical knowledge related to therapeutic care and effective
communication technique in a correct manner. Although initially I was nervous as I found the
patient to be totally unresponsive and not responding to treatment, however my values of
perseverance and the dedication supported me to overcome this initial barrier to care. For
example, while communicating with patient, I demonstrated the right courtesy by greeting the
patient, displaying kindness and allowing patient her own space to express her thoughts and
feelings. I recalled the rapport building skills learnt in class and acted accordingly. This process
helped me to understand that the patient was not comfortable and I need to allow her enough

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time before proceeding with my assigned work. Research evidence strongly encourages nurse to
take adequate time while communicating with the patient as each patient need their own pace to
disclose their problem to nurse (Kourkouta & Papathanasiou, 2014). Although the patient
assigned to me disclosed her problem after 30 minutes of time, I feel that taking adequate time
may be difficult in real practice because of barriers like workload, busy schedule and
overcrowding. Maame Kissiwaa Amoah, Anokye, Boakye and Gyamfi (2018) reported about the
same issue of workload as barrier in establishing therapeutic communication process. Thus, I
think that I may face challenges in this area in my future practice and I may require the support
of clinical leaders when faced with such situation in future.
Once I was able to built rapport with the patient, I tried to explore the patient thoughts and
attitude to treatment process by using questioning skills and listening attentively to the answers.
According to Price (2017), understanding patient’s concern is most important to understand how
patient could benefit from the treatment. Consistent with this evidence, I could interpret the
patient’s concerns and views about treatment. I used questions like ‘What are your expectations
of treatment?’ and ‘How do you feel now?’. The significance of this open ended question was
that it supported me to elicit more information from patient. I also tried to provide leads to
patient, which was necessary to increase patient’s interest in expressing her problems (Sherko,
Sotiri & Lika, 2013). Active listening involved the appropriate use of verbal and non-verbal
communication techniques and this skill allows the nurse to accurately assess situation and
patient problem (Kourkouta & Papathanasiou, 2014). The above form of questioning and
attentive listening made me aware that patient was worried about her breathing difficulty. She
was having the perception that she need to be under medical supervision for a long time.
However, with good questioning and verbal exchange, I could provide patient more clarity on

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treatment. I shared treatment results with her and discussion on positive outcomes made her feel
more optimistic too. Thus, I was successful in providing clarity on treatment to patient and
addressed her anxiety symptoms too.
During my clinical placement, the correct use of my communication skills was the main
highlight of the nursing activity as this helped to complete the assigned task smoothly. I was
sensitive to patient needs and chose to respect patient and be sensitive throughout the interaction.
Instead of focussing on completing the task at hand, I respected patient’s autonomy by asking for
permission before starting the vital signs observation and giving patient adequate time when she
did not responded to my initial greetings and purpose of my visit. This behaviour strongly relates
with the NMBA standard 2.5 which states that registered nurse must advocate on behalf of
people that respects their autonomy (NMBA, 2017). Therefore, by taking the decision to allow
patient adequate time before starting the assigned task, I was successful in engaging in
therapeutic relationship with patient. Advocating for patient autonomy facilitate patient centred
care (Flickinger et al., 2016). Evidence also suggests that a communication style that values
patient autonomy is associated with high satisfaction with care (Oliveira et al., 2012). Reflecting
on the impact of promoting patient autonomy during my clinical encounter with patient, I can say
that I could feel that the patient was satisfied with my nursing care. This is because I noticed that
by the end of the interaction, the patient was relaxed and she was not reluctant in asking
anything. She gave me smile at the end too which was a positive non-verbal gesture from her
side. This was a remarkable achievement for me at that moment because I could recall how the
patient was totally unresponsive when I first came in front of her and how her expressions
changed significantly within the one hour of my nursing activity.

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Conclusion:
To summarize, the essay gave a reflection on professional practice experience of utilizing
therapeutic communication skills during patient encounter. The act of rapport building,
displaying respect, promoting effective communication process and advocating for patient
autonomy was in accordance with the NMBA professional standard 2. Based on critical
reflection on the placement experience and the utilization of the professional values and
standards during care, it was found that therapeutic communication process helped in addressing
anxiety, clarifying patient’s doubts about treatment, building trust with patient and allowing
patient to lead the conversation. The final consequence of this action was that the patient was
relaxed, had positive views about recovery and responded well to treatment. As the essay
revealed that allowing adequate time to patient during communication might be difficult due to
heavy workload in actual setting, it is recommended that clinical leaders pay attention to this
issue so that quality nursing care is delivered.

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References:
Alexandri, A., Georgiadi, E., Mattheou, P., & Polikandrioti, M. (2017). Factors associated with
anxiety and depression in hospitalized patients with first episode of acute myocardial
infarction. Archives of medical sciences. Atherosclerotic diseases, 2, e90.
Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic
communication in nursing students: A Walker & Avant concept analysis. Electronic
physician, 9(8), 4968.DOI: http://dx.doi.org/10.19082/4968
Flickinger, T. E., Saha, S., Roter, D., Korthuis, P. T., Sharp, V., Cohn, J., ... & Beach, M. C.
(2016). Respecting patients is associated with more patient-centered communication
behaviors in clinical encounters. Patient education and counseling, 99(2), 250-255.
doi: 10.1016/j.pec.2015.08.020
Karimi, S., Haghani, F., Yamani, N., & Najafi Kalyani, M. (2017). A qualitative inquiry into
nursing students’ experience of facilitating reflection in clinical setting. The Scientific
World Journal, 2017.doi: 10.1155/2017/6293878
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Lang, E. V. (2012). A better patient experience through better communication. Journal of
radiology nursing, 31(4), 114-119. doi:10.1016/j.jradnu.2012.08.001.
Maame Kissiwaa Amoah, V., Anokye, R., Boakye, D. S., & Gyamfi, N. (2018). Perceived
barriers to effective therapeutic communication among nurses and patients at Kumasi

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South Hospital. Cogent Medicine, 5(1), 1459341.
https://www.tandfonline.com/doi/full/10.1080/2331205X.2018.1459341
Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M., & Samami, E. (2016). Communication
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Nursing and Midwifery Board of Australia (NMBA) (2017). Registered nurse standards for
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Oliveira, V. C., Refshauge, K. M., Ferreira, M. L., Pinto, R. Z., Beckenkamp, P. R., Negrao
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Appendix:
1. Outline of previous placement experience:
During my professional placement as a student nurse at a hospital, I was given the duty to
complete vital signs observations and attend to the daily care needs of 55 year old patient. The
patient was suffering from asthma and was admitted to the hospital following extreme breathing
difficulty. She also had a history of dementia, diabetes and hypertension. On first observation
with the patient, I found the patient to very disturbed and restless. As per my knowledge gained
regarding the therapeutic communication process, I started to complete my assigned duty by first
greeting the patient and informing her regarding the task I needed to do. The patient did not
responded well and her face was directed towards the floor. I was a bit nervous at this time as I
was not sure how to proceed with vital signs observations. I tried to acknowledge patient’s
concern and feelings by asking ‘It seems like you are not okay? Do you need something or Shall
I proceed? The patient nodded then and allowed me to complete vital signs process. During the
process, I tried to cheer the patient by telling her why vital signs are necessary. I inquired about
her expectations of treatment. I also gave her updates about her improvement in symptoms,
shared her medical repors and that she could be discharged soon. I suddenly found the patient to
trust me. I used this to know more about her tension and gave positive answers to her concerns.
Based on patient’s response and affect, I used appropriate non-verbal gestures to make her
comfortable and by the end of my assigned task, found the patient to be much more relaxed. By

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interacting as per patient’s response and by giving her adequate time to express, I was able to
improve the mood of the client. By the end, she smiled at me and I finally left after taking her
permission.