Observed Therapeutic Communication and Reflection Report - Nursing

This report provides a comprehensive analysis of a therapeutic communication scenario observed in a video, employing the Gibbs reflective cycle to evaluate the interaction between a doctor, a nurse, and a patient diagnosed with breast cancer. The report details the observed communication, including the doctor's delivery of the diagnosis and the nurse's subsequent care plan discussion, highlighting both positive aspects such as eye contact and explicit communication, and negative aspects such as the one-way nature of the conversation and lack of feedback. Applying the Gibbs cycle, the report delves into the feelings experienced, evaluates the strengths and weaknesses of the communication, analyzes the situation in relation to nursing professional standards, and concludes with an action plan that emphasizes the importance of active listening and obtaining feedback to improve patient outcomes. The report references relevant literature to support its analysis and recommendations, focusing on the application of Standard 2 (therapeutic relationships) and Standard 3 (capability for practice) of professional practice to enhance communication effectiveness.

Running Head: THERAPEUTIC COMMUNICATION
OBSERVED THERAPEUTIC COMMUNICATION & REFLECTION

THERAPEUTIC COMMUNICATION
Introduction
In the current scope of reflective analysis, the therapeutic communication was observed
and analysed using Gibbs reflective cycle. There are six stages of the cycle to evaluate the
nurses’ therapeutic communications against the professional standards of NMBA professional
guidelines.
Reflection Analysis
Gibbs Cycle Stage 1: Description
During the video, I watched Bronwyn, John, and Taylah waiting for the test results of
further investigation of Bronwyn's breast lump. The doctor provides the diagnosis that the
pathological tests of mammogram and biopsy confirmed breast cancer. The GP calls Bronwyn
for giving her test results and she is found to be anxious regarding the results. The GP honestly
tells her regarding her condition. The doctor tells Bronwyn regarding the metastasis of breast
cancer has spread to other regions beyond the breast. The GP asks her for any recent changes she
has noticed in her body or any specific condition. To which she responds that she has a back pain
that does not seem to go away. The GP then asks if the back pain had been discrete or continuous
in nature. To which she responds that her back pain had been continuous to some extent.
The nurse attempts to provide advice and care which Bronwyn needs to adopt for her
ongoing cancer treatment. The nurse also suggests her to meet oncologists for her further
treatment. The nurse asks her and her family members to share any questions if they had
regarding the disease. The nurse said that she would keep in touch in the treatment process and
asked her to call regarding any questions or queries she had.
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THERAPEUTIC COMMUNICATION
Gibbs Cycle Stage 2: Feelings
I felt bad about communication in the entire video. The doctor's and nurse's communication was
direct and lacked empathy. Both the GP and the nurse tried to put forward their point of view and
did not show any feelings for the patient. I was disgusted at the way the GP and nurse introduced
the patient to her current condition. The facts and way of treatment were presented to the patient
in a rather direct manner, which hurt my feeling. I felt the patient could have been told regarding
her situation in a much gradual and planned manner.
Gibbs Cycle Stage 3: Evaluation
Evaluating the video, it can be said that there were some good and some bad aspects. It
had challenged my assumption to think whether the GP and the nurse will be able to indulge in
positive therapeutic communication. From my observation and research, I discovered that there
were present several positive aspects of communication.
The positive aspects of the video are eye contact (evidence) that the GP and nurse
maintained throughout the discussion with the patient. Direct eye contact helps communicate in a
positive manner non-verbally (Halcomb, Stephens, Bryce, Foley & Ashley, 2016). Example,
when the GP told the patient about her condition, he maintained steady eye contact. The nurse,
while providing a care plan and guidance to the patient also was maintaining steady eye contact
with the patient.
A good aspect of this video was the therapeutic communication process used was explicit
communication technique (Riley, 2015). As for example, the GP when explaining regarding the
spread and extent of the disease used explicit communication by clearly stating that the patient
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THERAPEUTIC COMMUNICATION
was diagnosed with breast cancer. It is also noteworthy that the GP stated the facts without
hesitation. The nurse while providing a care plan for the patient explicitly expressed what the
patient needs to do and what could be the obvious expectation and outcome from the disease.
She clearly stated the patient that she could call for help any time for any question she wants to
ask.
One positive aspect of therapeutic communication process noted was assertive verbal
and non-verbal communication process was noted (Davis Boykins, 2014). As for example both
the GP and the nurse had communicated in a positive verbal manner. They also had an assertive
non-verbal communication.
A negative aspect of therapeutic communication is that the communication was one-way
and did not much depend upon the feedback process. As for example, the nurse did not obtain
feedback in the communication process. The entire process of communication was rather one-
way. The GP though took time in explaining the details to the patient, the communication was
one-way and there was an absence of much interaction between them.
Gibbs Cycle Stage 4: Analysis
In the profession of nursing, there are 7 professional standards that registered nurses need
to apply for their practice. The second Standard of professional nursing states that nurses need to
engage in professional and therapeutic relationships with their patient. According to this
standard, an RN needs to communicate effectively and in a respectful manner to the patient's
dignity, beliefs, culture and rights (NMBA, 2016). The video shows evidence that the nurse is
able to communicate effectively, however getting feedback is also a part of this effective
communication. The nurse did not quite adequately obtain feedback from the patient regarding
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THERAPEUTIC COMMUNICATION
the guidelines that she had provided to her. There was no depiction where it could be understood
that the nurse was advocating on the patient's behalf for patient-centered support and care.
Evaluating literature, I could understand that using silence was a critical aspect of
therapeutic communication as highlighted by Arnold and Boggs (2019). Deliberate silence can
provide both the nurse as well as the patient the opportunity to think the process that comes next
in the conversation. It allows time and space to the patient, however, in this video no such
instance was observed. Nurses always need to provide patients the time to break their silence.
Wloszczak-Szubzda and Jarosz (2012) noted that accepting is often necessary for
acknowledging. While accepting is not the same thing as agreement, simply making eye contact
and make the patient feel that their nurses are listening to them seriously, is likely to be receptive
care. Applying this framework could have enabled the patient, in this case, open up her fears and
apprehensions that she faced from the sudden news of her cancer. The nurse was more imposing
and was not ready to hear much from the patient or provide her the opportunity to speak up.
Kourkouta and Papathanasiou (2014) stated that effective therapeutic communication
starts with seeking clarification. Similar to listening in an active manner, asking the patient for
clarification is important. It allows resolving ambiguousness and ensures that they understand
whatever is being communicated to her. It allows the nurses to understand whatever they said to
help patients were processed by them in a thorough manner. Applying this guideline could have
provided a better outcome for this case, but the nurse seemed to be in a bit hurry and not seek
clarification from the patient.
Gibbs Cycle Stage 5: Conclusion
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THERAPEUTIC COMMUNICATION
In nursing, communication is extremely important as it directly impacts patient health
outcomes. In such type of communication, 25% is verbal whereas 75% in non-verbal
communication. Often what nurse’s say verbally contradicts what they say non-verbally? Indirect
aspects of communication along with lack of education, lack of learning have the capability to
influence communication capability with individuals. In the nursing profession, it is expected
nurses, as well as doctors, interact in an empathetic manner, sympathetic manner and moreover
in an effective and efficient manner. It can be said that a lack of learning and lack of experience
primarily contributed to the nurse interacting in a manner that led to ineffective communication.
Gibbs Cycle Stage 6: Action Plan
The 2 Standards of Professional Practice includes Standard 2, which states to engage in
therapeutic and professional relationships and Standard 3 Maintains the capability for practice
needs to be applied in this scenario for a better outcome (NMBA, 2016). With the application of
Standard 2, the nurse will be able to communicate in an effective manner, whereas applying
Standard 3, the nurse will develop knowledge and skills to be able to practice in a better manner.
Standard 3 of practice also requires that nurses actively engage in their professional and are
accountable for their decisions.
The 2 communication strategies that need to be applied in the current scenario includes
active listening and obtaining feedback. Active listening is a useful element of therapeutic
communication and so is getting feedback. This will entail that the nurse appropriately
understands what the patient has understood regarding the care plan and is able to respond
accordingly.
Conclusion
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THERAPEUTIC COMMUNICATION
To conclude, it can be said that post reviewing the therapeutic communication, it has
been noted that Standard 2 and 3 of professional practice and listening and feedback as
communication strategies could have been applied in this case.
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THERAPEUTIC COMMUNICATION
Reference
Arnold, E. C., & Boggs, K. U. (2019). Interpersonal Relationships E-Book: Professional
Communication Skills for Nurses. Missouri: Saunders. 8th Edition. Retrieved from
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erapeutic%20communication%20nursing&f=false
Davis Boykins, A. (2014). Core communication competencies in patient-centered care. ABNF
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socio-medica, 26(1), 65. doi: 10.5455/msm.2014.26.65-67. Retrieved from
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NMBA. [June 1, 2016]. Registered nurse standards for practice. Retrieved from
<https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards/registered-nurse-standards-for-practice.aspx>
Riley, J. B. (2015). Communication in nursing. Missouri: Elsevier Health Sciences. 8th Edition.
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