As a Registered Nurse pursuing my Masters and currently placed in the Accident and Emergency department, am obliged to establish a therapeutic relationship with my clients. Therefore, I always try to facilitate our communication with patients so as to offer quality and holistic care based on their needs. Accordingly, I will reflect on an experience at the clinical placement to develop my interpersonal skills and knowledge on the subject. It is about concerns by a parent on her treatment protocol and management of pain. I will use the Gibbs (1988) reflective model to assess the experience to enable me improve my nursing practice.
Description of the Situation
On this particular day, I was scheduled for a night shift. At around midnight, an elderly woman entered the treatment room tearfully accompanied by her husband. She was supposed to get a morphine injection according to the medical doctor in charge. The lady had lung cancer that had metastasized to the lungs and was causing severe pain for the last one year. Palliative care involved taking oral morphine for the last ten months. This particular night, she was in too much pain that brought her to hospital. She was concerned that she was becoming dependent on morphine and it was like she is abusing it yet the doctor had prescribed the same drug. She was concerned about the fact that the drug would make her sleepy and depressed and could not do much in the house. I listened patiently and explained to her that it was normal for patients to raise concerns over such drugs. Although the drug is usually abused by young people, I explained to her that using it regularly was medically helpful. The couple then suggested the use of heat packs to relieve pain, especially during the day time, while keeping morphine for extreme emergencies. I wrote down their worries and suggestion and assured them that I would present them to the cancer pain clinic where I would book an appointment for her. We had a lengthy talk with the couple as they confided in me about their children, who were all living in other states or countries, and other family members. I was able to convince her to receive the dosage as we waited for a better solution from the specialist the following day.
Feelings
The client talked to me in sobs as she felt frustrated. At first, I was confused as I have weak emotions and often experiences difficulties while dealing with a patient older than me who is in distress. However, I was able to compose myself and listened to her empathetically. When I listened to the concerns of the client, I felt that it was more of a confrontation. Initially, I felt that the patient was discrediting the treatment offered to her. I remember rumbling to myself words of disappointment because I was angry at her. However, she continued expressing her concerns while crying, and for a moment, I was touched. I discovered that I was acting unprofessionally and decided to be calm to develop a therapeutic relationship. I became more attentive to her concerns and decided not to dismiss her suggestions. I felt the pain that she and her husband were going through because the drug was making her drowsy even during the day. I understood why she felt that the drug was becoming too much for her. I felt embarrassed for judging the couple before getting the full information. From then, I always listen to and consider suggestions by patients as they may help me to serve them better
Evaluation of the Experience
This encounter helped me to reflect upon some important issues in nursing regarding care of patients with chronic condition. My initial reaction was uncalled for as nurses should not dismiss any concerns raised by patients without a valid reason (Robb, 2004). According to Wiener (2009), nurses should develop a therapeutic relationship that incorporates receptivity, empathy, tolerance, and mutual communication. Therefore, I ought to have encouraged the elderly lady, from the beginning, to inform me about her worries so that we could find a solution. Also, the fact that I appeared confused and not composed for seeing the elderly patient crying is not ideal for my profession. Taylor (2010) indicates that nurses should have confidence in their abilities and trust that they would deliver quality care to the patient to reduce their distress.
After some few minutes, however, I was able to develop the much needed composure and empathy to create a relationship that led to mutual trust. One of the core aspects of a therapeutic relationship is open communication (Bennett, 2005). I encouraged the patient to open up about her concerns as I wrote them down as communication does not only involve talking and listening but also mutual participation (McSherry, 2007). Jones (2009) indicates that nurses should also develop non-verbal cues such as facial expressions and nodding to make the patient feel understood, which I exactly did. Straneva (2000) also mentions holistic care as a part of a therapeutic relationship. It is for this reason that our talk extended to her family and other non-medical issues as I tried to assess her psychological and social aspects of her illness. Another critical aspect in developing a therapeutic relationship is the environment (Schuster, 2000). For this reason, the treatment room is structured in a way that it gives an ambience environment for patients and the nurse. It has comfortable seats for both, proper ventilation, and is cleaned frequently to avoid any contamination.
Conclusion
This experience gave me a chance to reflect on the importance of educating patients about their medication. Evidently, she had not been informed adequately about the effects of morphine. Also, I discovered the need to explore more treatment options that have fewer side effects. Additionally, I came to know that developing mutual trust between the care provider and the patient is critical in offering palliative care (Jones, 2009). In my opinion, I was able to have a therapeutic relationship with this patient as we waited for the next day so that she would be seen by a cancer specialist.
Action Plan
This episode draws us to various approaches for pain management, especially in chronic illnesses. Morphine is a narcotic drug used for relieving, but is known for side effects such as nausea, drowsiness, respiratory depression, and addictive (Lipman, 2015). Therefore, according to Lipman (2015), it is administered as the last resort for patients with chronic illnesses. The idea of using heat packs for such patients is also welcome. According to Lane and Latham (2009), heat therapy improves blood flow and circulation to a particular part of the body relaxes muscles and help in healing of damaged tissue. Given that this kind of therapy is not associated with reduced activity as morphine, as the patient suggested, it can be used in instances that are not severe. In the management of chronic pain, other options such as cold therapy for swollen or bruised areas may also be explored (Lane & Latham, 2009). However, these options should be discussed with a cancer pain specialist and approved before being administered. Protocol demands that any change of medication for a chronic patient be appropriated by a doctor.
References
Bennett, C. (2005). Becoming a Reflective Practitioner.Nursing Standard, 19(38), pp.36-36.
Jones, L. (2009). The Healing Relationship. Nursing Standard, 24(3), 64-64. http://dx.doi.org/10.7748/ns2009.09.24.3.64...
Lane, E. & Latham, T. (2009). Managing Pain Using Heat and Cold Therapy. Acute Pain, 11 (3-4), 155. http://dx.doi.org/10.1016/j.acpain.2009.10.026Lipman, A. (2015). Morphine and Metastasis. Journal of Pain & Palliative Care Pharmacotherapy, 29(2), 194-195. http://dx.doi.org/10.3109/15360288.2015.103McSherry, W. (2006). Making sense of spirituality in nursing and health care practice. 1st ed. London: J. Kingsley.
Robb, M. (2004). Communication, relationships and care. 1st ed. London: Routledge.
Straneva, J. (2000). Therapeutic Touch Coming of Age. Holistic Nursing Practice, 14 (3), 1-13. http://dx.doi.org/10.1097/00004650-200004000-00004Taylor, B. (2010). Reflective practice for healthcare professionals. 1st ed. Berkshire, England: Open University Press.
Wiener, J. (2009). The therapeutic relationship. 1st ed. College Station: Texas A & M University Press.
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