NRSG139 Ax3 Vignette: Reflective Essay on Therapeutic Relationships

This essay is a reflection on the NRSG139 Ax3 TPR Vignette video, focusing on the second standard of engaging in therapeutic and professional relationships using Gibb’s reflective framework. The reflection describes an event where a practitioner engages with a patient, explaining procedures and fostering a professional relationship. It explores the feelings associated with forming clinical relationships, emphasizing patient autonomy and informed decision-making. The evaluation highlights the positive experience for both practitioner and patient, noting the effectiveness of communication and respect for patient dignity. Analysis centers on establishing trust and adapting to diverse patient characteristics. The conclusion underscores the importance of communication skills and situational awareness for improving future professionalism and patient interactions. The essay also includes an action plan to enhance communication skills and utilize tools like I-PASS for better patient hand-off.

Running head: NURSING REFLECTION
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Nursing Reflection
Student’s Name
University

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Nursing Reflection
The role of the nurse standards for practice is to provide a person-centered and evidence based
preventive, supportive and palliative elements through standards that nurses use to work with
patients. Since Australian patients come from a wide array of culture and linguistic diversity,
then there is need for nurses to be guided by these standards to achieve quality of care and
uniform standards of performance across families, groups and communities (Henderson, 2013).
The framework provides seven interrelated standards that define how the nurses use their skills
and knowledge in the care process. This essay is a reflection of the NRSG139:Ax3 TPR Vignette
video of nursing practice based on the second standard of engaging in therapeutic and
professional relationships using the Gibb’s reflective framework.
Description
The event is the application of the principle of engaging in therapeutic and professional
relationships where the practitioner is seen engaging the patient in the care process. The
practitioner enters the room, greets the patient by name and explains the activities that are to take
place within the short time that the two will be together. This is a professional relationship where
the nurse is explaining to the patient what needs to be done to keep the patient informed of the
care process (Wilkinson, Rance, & Fitzsimmons, 2017). This is a participative process that
allows the patient to understand the role of the vital signs being measured. Every measure that is
taken starts with an explanation to the patient to keep him informed of the care process.
Information sharing is important in clinical settings since it improves patient response to the
clinical decisions being made. The second standard requires the practitioner to engage the patient
in a way that differentiates between professional and personal relationships. This is seen in how
the practitioner engages in conversation with the patient by defining the professional boundary

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that exists between the two and asking questions that meet the requirements of practice. By
recognizing that patients are experts in their life experience, we see the practitioner asking follow
up questions to the patient to clearly understand the clinical response of the patient. To achieve
the desired outcome, the practitioner informs the patient that he will report the outcomes of the
process to the doctor for further informed decisions.
Feelings
Jones, Livingstone, & Hawkes (2013) suggests that the role of the practitioner is to form clinical
relationships that guide interactions with patients. In the second standard, the nurse recognizes
their role as care givers who engage with patients at a personal level. By sharing basic
information like, the tests being done and asking the patient how long they have been on the
clinical journey, the practitioner gets professional closer to the patient thus increasing the ability
of the patient to respond to the clinical processes being carried. The principle of autonomy
requires patients to make healthcare decisions on the processes that are carried out on them.
Therefore, Hill, Paley, & Forbat (2014) add that by engaging in a therapeutic and professional
relationship, the practitioner is ensuring that the patient is informed of every care process taking
place and uses doubt clearance to improve patient participation. The patient seems informed of
the clinical processes since he is seen following and responding to a few questions that the
practitioner is asking.
Evaluation
Every practitioner strives for the best experience with their patients as a way of fulfilling their
careers (Ya-YaWang, Linb, & Shao-MeiShang., 2018). Nurses enjoy this process more since
during the care process, they engage with patients at a personal level making it easy for them to
form bonds with patients. This went well in the process since both the practitioner and the patient

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seem contented with the whole care process. Despite the fact that they were meeting for the first
time, they talked like they know each which is an impact of the therapeutic and professional
relationship formed between the two. The nurse engaged the patient with high professionalism
which is seen in the end of the care process where the nurse tells the patient to reach out to him
any time he has an issue. The whole process went well and the nurse achieved the required
clinical outcomes since the patient complied with all the tests making it easy for the nurse to
achieve the clinical process (Holmqvist, Holmefur, & Ivarsson, 2012). The effectiveness of the
second standard is seen in the way the practitioner communicates with the patient by recognizing
his dignity, culture, values and rights in the care process.
Analysis
The role of the second standard is to define the way professional interact with patient and carry
themselves around. The outcome of the care process between the patient and the practitioner was
informed by establishing and sustaining relationships that respect the patient. When the nurse
entered the room, he immediately builds therapeutic and professional rapport which guides the
way the whole care process runs and the engagement that the two have. The second standard
exists to ensure that the nurse can develop apply mutual trust and respect in the professional
relationship with the patient. Since patients display different characteristics that are defined by
both demographic and the clinical challenges that they face, the practitioner is charged with the
responsibility of ensuring that a professional relationship is formed regardless of the nature of the
patient (Turkelson, Aebersold, Redman, & Tschannen, 2017). By being non-judgmental and
recognizing that each patient is unique in their own way, the practitioner approached the patient
with an open mind that led to achieving the intended clinical outcome.
Conclusion

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The second standard was applied well in the process leading to achieving the intended outcomes.
I believe the practitioner was informed of the care requirements of the registered nurse standards
for practice that informed the way the practitioner engaged with the patient (McCarthy, et al.,
2013). The practitioner engaged with the patient professionally while at the same time combining
the elements of other standards for practice. One thing that I have learned from the reflection is
that application of the standard is important in guiding the way the practitioner engages with the
patient. When engaging the patient, it is important for the practitioner to understand that patients
have different characteristics that need to be accommodated in all contexts of care. The most
important skill that the practitioner needs to apply the standard well is communication skills.
This guides the way the practitioner engages the patient and responds to the issues within
healthcare. Communication entails both verbal and non-verbal skills. Patients can verbally raise
the concerns that they have and at the same time some use non-verbal communication when
dealing with patients (Kourkouta & Papathanasiou, 2014). Understanding the non-verbal cues
that patient’s use makes it easy for the practitioner to handle different patient situations.
Research shows that communication skills are used to prevent medical errors since they improve
coordination between practitioners thus leading to increased clinical outcomes.
Action plan
As a practitioner, to improve future professionalism I need to work on communication skills that
will inform future interactions with patients. Communication skills and the education that
practitioners receive should go hand in hand to ensure that all round practitioners are developed.
It is a must for every nurse to develop their communication skills since they engage with patients
at a personal level. Nurses form the point of contact between the patient and other medical staff
as seen in the case video. The nurse is the point of contact since the data gathered from the

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interaction is relayed to other professionals for decision making. By developing situational
awareness and open communication, I will be able to improve my interaction skills with patients
and other practitioners within the field (Midleton, 2017). Further, I will focus on developing the
I-PASS (illness severity, patient summary, action list, situational awareness and synthesis)
communication tool, I will be able to improve patient hand off communication which will lead to
increased competitiveness.

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References
Henderson, K. (2013). The importance of the therapeutic relationship in improving the patient's
experience in the in‐patient setting. International Journal of Mental Health Nursing,
23(1), 23-97.
Hill, H. C., Paley, J., & Forbat, L. (2014). Observations of professional–patient relationships: A
mixed-methods study exploring whether familiarity is a condition for nurses’ provision of
psychosocial support. Palliative Medicine, 28(3).
Holmqvist, K., Holmefur, M., & Ivarsson, A.‐B. (2012). Therapeutic use of self as defined by
Swedish occupational therapists working with clients with cognitive impairments
following acquired brain injury: A Delphi study. Journal of Australian Occupational
Therapy, 60(1), 48-55.
Jones, F., Livingstone, E., & Hawkes, L. (2013). Getting the balance between encouragement
and taking over': reflections on using a new stroke self-management programme.
Psychotherapy Research International, 18(2), 91-9.
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in Nursing Practice. Journal of
the Academy of Medical Sciences of Bosnia & Herzegovinia, 26(1), 65-67.
McCarthy, D., Buckley, B., Engel, K., Forth, V., Adams, J., & Cameron, K. (2013).
Understanding patient-provider conversations: what are we talking about? Academy of
Emergency Medicine, 20(5), 441–448.
Midleton, J. (2017, November). Communication skills 1: benefits of effective communication for
patients. Nursing Times.

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Turkelson, C., Aebersold, M., Redman, R., & Tschannen, D. (2017). Improving Nursing
Communication Skills in an Intensive Care Unit Using Simulation and Nursing Crew
Resource Management Strategies: An Implementation Project. Nursing Care Quality,
32(4), 331–339.
Wilkinson, W. M., Rance, J., & Fitzsimmons, D. (2017). Understanding the importance of
therapeutic relationships in the development of self-management behaviours during
cancer rehabilitation: a qualitative research protocol. BMJ Open, 7(1).
Ya-YaWang, W. Q.-Q., Linb, F. Z.-J., & Shao-MeiShang. (2018). Interventions to improve
communication between nurses and physicians in the intensive care unit: An integrative
literature review. International Journal of Nursing Sciences, 5(1).