Nursing Reflection Essay on Barriers in Nurse-Patient Interactions

This nursing reflection essay examines the challenges encountered in a nurse-patient therapeutic relationship, focusing on a hypothetical case involving a patient with depression and schizophrenia from an Aboriginal background. The essay utilizes Gibbs' reflective cycle to analyze the experience, ...Read More

Running head: NURSING REFLECTION
NURSING REFLECTION
Name of the Student:
Name of the University:
Author note:

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Introduction:
The Australian Nursing Standards Assessment Tool (ANSAT) tool was developed to
evaluate the nursing practice in genuine situations and work place situation. This tool is also
used to outline the national and registered nursing standards, which can be implemented
within the nursing practice. The Australian Nursing Standards Assessment Tool (ANSAT)
tool was developed in the year 2016 (Sweet et al., 2018). Different data and information were
gathered from the registered nurse, health care providers, educators, stakeholders, nursing
students and academics that was used for the formulation of ANSAT tool. The NMBA
nursing standard 2 of the ANSAT tool, highlights that, every registered nurse must be
included in the therapeutic and professional association with the patient to deliver better care
and support to the patient (Nursingmidwiferyboard.gov.au, 2019).
The essay will therefore focus on the barriers and challenges observed during the
association between the registered nurse and the patient in order to maintain a healthy
professional and therapeutic relationship based on the standard 2 of NMBA. Gibb’s reflective
cycle is used in the essay that will identify the analysis and evaluation procedure of nursing
and collect relevant information based on the learning of nursing engagement with the patient
(Smith & Roberts, 2015).
Description:
In the initial stage of Gibb’s cycle, the description revolving around the complete
incident was explained. During the tutorial classes, I was hypothetically assigned a case
scenario of the patient X (pseudonym), who was suffering from depression and was also
exhibiting the symptoms of schizophrenia. The patient belonged to the Aboriginal population
and could barely understand English. Hence, it was very difficult for me, as a nurse, to
communicate with him practically and understand his concern or what was bothering him and

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affecting his mental health (Dauwan et al., 2015). After studying the case scenario, it was
identified that the major cause of his depression was his bad financial condition and poverty.
The patient was 40 years old and after his wife’s death he had nobody to take care of his
health and his children’s well-being. He also had Type 2 diabetes mellitus that was affecting
his health condition very badly.
Feeling:
Initially I was confused that if the patient could understand English and would be
supportive during his treatment procedure because the patient belonged to indigenous group
and could barely understand English and follow the instruction. Since, the patient was
suffering from depression it was very likely that he would forgot to take his medicines that
will be useful for evaluating his health condition and improvement. In order to identify the
risk factor it was very crucial that a healthy and friendly therapeutic relationship should
establish between the patient and me according to the standard 2 of ANSAT tool but the
language barrier was again a major concern (Reljic et al., 2017).
Standard 2 of ANSAT tool assist the nurses in effectively building a healthy
therapeutic relationship with the patient that will motivate the nurse to establish a quality
rapport and identify the risk factors leading to the bad heath condition of the patient
(Ossenberg, Dalton & Henderson 2016). Though the patient could barely understand English,
I was still very confident and positive that I can build a therapeutic relationship with the
patient in future when I will independently hand the patient and make the patient comfortable
during the entire treatment process. However, I also realised during my tutorial classes that it
was not easy for me to overcome the challenges and barriers, as language barrier is the major
challenge in maintaining a healthy therapeutic relationship with the patient. The major barrier

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and challenge identified during the treatment process was language barrier, as the patient
belonged to a different cultural background.
Evaluation:
I was instructed on different ways of evaluating the health condition of the patient. I
have identified my strength and weakness of handling the patient and application of clinical
knowledge. The strength identified by me during the classes was that I can successfully apply
my clinical knowledge while treating the patient and could understand exactly what is
required for helping and motivating the patient in effectively involving in the treatment. With
the help of language translator I could communicate my concerns to the patient and through
some sign activities I could interact with him and build a therapeutic relationship with the
patient (Meuter et al., 2015). I could identify the triggering factors that resulted in his bad
mental health condition, based on which I established a care plan for treating the health
condition of the patient. The major weakness of this incident was that I could not handle the
patient alone and always required the language translator to communicate the concern to the
patient, which was major hurdle for the engagement procedure with the patient.
Analysis:
From the tutorial classes, I analysed that I had to develop my skills on understanding
the concern of every patient based on their evaluation of vital signs and identify what could
be the possible health issue. I also had to work on my engagement skills with the patient as I
took a lot of time to develop a therapeutic relationship with the patient (Mason, 2018). I also
analysed that language barrier was a major problem in building a healthy and therapeutic
relationship with the patient as it will be very crucial for me during my summer placement,
where I have to actually deal with the patient. I had tried to acquire the basics of his language
so that he could feel comfortable with me and build trust on me.

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Conclusion:
From the complete discussion, it was analysed that preserving a healthy therapeutic
association with the patient is considered as the major factor in providing best and effective
care. As the patient was suffering from depression it was very important for the nurse to build
a quality rapport that would help the patient from slowly recovering from depression and also
controlling the blood sugar level. The barriers identified during the complete procedure was
language barrier, cultural difference, and physical awkwardness during the engagement
procedure, which required detail handling and care.
Action Plan:
From the complete incident, I evaluated that it was necessary for me to work on my
communicating skills prior my placement starts because if the cultural background of the
patient is different it would be difficult for me to help the patient and treat his health
condition in order to maintain a healthy therapeutic association with the patient. I will make
sure that I use diverse forms of non-verbal and verbal communication proficiency that will
assist me to gain confidence of the patient (Totton, 2018).

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References
Dauwan, M., Begemann, M. J., Heringa, S. M., & Sommer, I. E. (2015). Exercise improves
clinical symptoms, quality of life, global functioning, and depression in
schizophrenia: a systematic review and meta-analysis. Schizophrenia bulletin, 42(3),
588-599.
Mason, B. (2018). Relational risk-taking and the therapeutic relationship. In The Space
Between (pp. 157-170). Routledge.
Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015).
Overcoming language barriers in healthcare: a protocol for investigating safe and
effective communication when patients or clinicians use a second language. BMC
health services research, 15(1), 371.
Nursingmidwiferyboard.gov.au. (2019). Nursing and Midwifery Board of Australia -
Professional standards. Retrieved from
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/
Professional-standards.aspx
Ossenberg, C., Dalton, M., & Henderson, A. (2016). Validation of the Australian nursing
standards assessment tool (ANSAT): a pilot study. Nurse education today, 36, 23-30.
Reljić, N., Lorber, M., Vrbnjak, D., Sharvin, B., & Strauss, M. (2017). Assessment of clinical
nursing competencies: Literature review. Teaching and Learning in Nursing, 49.
Smith, J., & Roberts, R. (2015). Reflective practice. Vital Signs for Nurses: An Introduction
to Clinical Observations, 222-230.
Sweet, L., Bazargan, M., McKellar, L., Gray, J., & Henderson, A. (2018). Validation of the
Australian Midwifery Standards Assessment Tool (AMSAT): A tool to assess
midwifery competence. Women and Birth, 31(1), 59-68.

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Totton, N. (2018). Power in the therapeutic relationship. In The Political Self (pp. 29-42).
Routledge.