Curriculum Integration Of Oncology Palliative Care: Nursing Standards & Therapeutic Communication

Description of Scenario: 5 W’s

Discuss About The Curriculum Integrate Oncology Palliative Care.

The given video shows an interaction between a nurse and his patient, where the nurse came to check the patient’s vital signs. Given below is the description of the scenario, outlining the 5 W’s of the event:

The given scenario involves a nurse visit to a patient, where the nurse had to check and record the vital signs of the patient. The nurse used the time while checking the vital signs to engage in communication with the patient, asking him how he feels, and how long has he been admitted to the hospital. After checking the vital signs, the nurse informed that everything seemed normal, and that he will share the report with the doctor.

The nurse exhibited strong commitment to the NMBA (Nursing and Midwifery Board of Australia) standards. The nurse showed a professional code of conduct and presentation as recommended by NMBA guidelines. Also, his interaction with the patient showed evidence of the influence of the second standard 2 of NCAS (Nursing Competency Assessment Schedule), which focuses on the engagement of therapeutic and professional relationships between the nurse and patient.

Standard 1: critical thinking and analysis, Standard 2: engaging in therapeutic and professional relationship, Standard 3: maintaining the capacity for practice, Standard 4: comprehensively conducting assessment, Standard 5: developing nursing plan, Standard 6: Providing safe, appropriate the responsive quality nursing practice and Standard 7: Evaluating outcomes to inform nursing practice.

In the video only the patient and nurse was present. No other individuals were seen on the video.

The nurse was checking and recording the vital signs of the patient, as well as assessing the patient’s health status. It could be seen that the nurse was attempting to develop a therapeutic professional relationship with the patient.

The nurse informed the patient that all the vital signs (the temperature and pulse rate were normal.

From the beginning of the video, the set up seemed to be very clinical, with the hospital bed and the hospital patient’s attire worn by the patient. The patient seemed to be stable enough to be sitting on the chair, waiting for the nursing round. The patient was also responsive and understood what was being told by the nurse. Even his sense of humor seemed to be fine, which showed that he had emotional stability and his cognition normal. This gave me a strong impression that the patient seemed to be content with the care plan, and had not serious complaints, which otherwise would have been reflected in his behavior or body language. This was in accordance to the NMBA standards of the nursing code of conduct.

Importance of Nursing Standards

The event started with the nurse introducing himself to the patient, asking him how he felt, and informing him what he wanted to do (that is check the vital signs). From the beginning of the video, the nurse’s attitude was very friendly, and showed focus on how the patient felt. He continued with the development of the therapeutic relation with the patient. He also listens to the patient carefully, and responds accordingly. At the end of the event, I felt that the nurse was able to progress the development of the therapeutic relation with the patient, which is an important aspect of care. This followed the standard 2 of the NMBA NCAS guidelines that highlights the development of therapeutic relation.

The Nurse followed the guidelines of the NMBA in the given video, following the standard code of conduct and professional practice. In the event, the nurse was able to successfully develop a therapeutic relation with the patient. The patient seemed to be comfortable enough with the nurse to share a small joke, and also was very friendly to the nurse. Overall, I would say that the nurse did a decent job in his attempt to familiarize himself with the patient, and was therefore able to gain confidence from the patient. I found most part of the event to be positive, which fostered the development of the mutually beneficial and therapeutic relation between the patient and the nurse. The ability of the nurse the engage the patient in the communication, as well as assuring the patient that is vital signs were good, was also important to gain the confidence of the patient. The nurse was also very professional, and explained his duty clearly to the patient. I could also see that the nurse maintained eye contact and the information provided was also very clear. His answers to the patient was also very honest, for example, when the patient asked about how long the nurse was engaged in this profession, which he seemed to have answered honestly. All such aspects showed congruence with the NMBA standards.

I did not find anything particularly negative about the entire incident. However, the nurse could have also provided more information regarding the discharge plan of the patient, informing him when can he expect to be discharged and showed more proactiveness in initiating conversations with the patient, while checking the vital signs, and thus prevent the moments of silence. The NMBA standard suggests that the nurse should have a proactive approach towards the development of communication with the patient.

The event showed few crucial components which fostered the development of the communication between the patient and the nurse. I believe these components were: the usage of appropriate language, use of effective communication strategies with respect to the attitude and demeanor (Gausvik et al., 2015; Nieswiadomy & Bailey, 2017). The nurse showed a positive attitude towards the patient, showing interest in how he felt. He also listened to the patient attentively, and his responses were also appropriate. This related to the Standard 2 of NCAS code, that suggests that the nurses should exhibit competency in effective communication straregies.

The communication between the patient and the nurse went quite well, as the patient seemed to be comfortable enough with the nurse.

The video did not have the involvement of any other personnel apart from their patient and the nurse. The nurse did well in engaging the patient in a therapeutic and friendly conversation.

I believe that the interaction between the nurse and the patient went excellently well. However, at certain point during the checking of the vital signs of the patient, the nurse seemed to be very focused on the activity, and the patient was seen to be trying to initiate c conversation with the nurse, by asking how the vital signs were or how long was he working as a nurse. I believe that the nurse could have been more proactive in his conversation with the patient. According to the NMBA standards, the nurse should have the ability to multitask, and engage the patient in communication.

The overall result seemed to be positive to me, as the patient seemed to be comfortable with the nurse. This can be attributed the positive and professional attitude of the nurse and his willingness to build a therapeutic relation with patient. This highlighted the adherence to both the NMBA guidelines and the standard 2 of NCAS.

Korkouta and Papathanasiou (2014) pointed out the importance of effective communication strategy for the development of therapeutic relation with the nurse. The authors suggested that a good communication between the nurse and patient is vital for successful outcomes of individualized nursing care, and to do that, the nurse should be able to understand and help the patients, show courtesy, kindness and sincerity. Doherty and Thomson (2014) also supported such views, stating that through therapeutic relation between the nurse and patient, person centered care can be further enhanced. While Klingaman et al. (2015) pointed out that therapeutic relation can improve the client satisfaction. Study by Kelly et al. (2014) also shows that the relation between the patient and healthcare professional can significantly affect the healthcare outcomes. Feo et al. (2017) also opined that an effective and caring relationship between nurse and patient can be developed through a framework that is based on the best available evidences of effective care delivery. The authors propose that the fundamentals of care framework should involve 5 relational elements, namely: trust, focus, anticipation, know and evaluation. I believe such aspects were utilized by the nurse in an appropriate manner in the given scenario. Doing so can improve adherence to the NMBA standards of nursing.

Components of Effective Communication Strategy

I believe that through effective training strategies on communication and cultural competencies can further help to improve the development of the therapeutic relation. Moreover, the training of the nurses should focus on aspects such as accountability; focus on client’s needs, clinical competence and supervision (Wiechula et al., 2016; Wittenberg et al., 2015). The development of the relationship can also be broken into 3 phases: orientation, working and termination. Training the nurses to follow these phases can also be effective in the development of effective therapeutic relation. It can also be suggested that 1) the patient should set the pace of the conversation, 2) listening to the patient properly, 3) developing a good and positive first impression, 4) ensure the patient feels comfortable to engage in the conversation, and give them a sense of control over the direction of the conversation and 5) acknowledging the expectations and through processes of the client (ohsu.edu, 2018; Stewart et al., 2017). Also, the knowledge base of the nurse should also be developed regarding the patient, the clinical condition, treatment plans and pathways in order for the nurse to better explain the treatment plan to the patient, and educate the patient on his/her condition (rnao.ca, 2018). Such recommendations can also be effective in the improvement of the working practice and help to reflect adherence of the NMBA guidelines. Given below is the action plan:

Identified Learning Need/ Opportunity	Set Goals	Planned Actions	Resources	Evaluation
Developing therapeutic relation	Developing communication. Focus on client’s needs, clinical competence and supervision. Improving skills of the nurs	Develping therapeutic relation in 3 stages: 1.     the patient should set the pace of the conversation. 2.     listening to the patient properly 3.     developing a good and positive first impression 4.     ensure the patient feels comfortable to engage in the conversation, and give them a sense of control over the direction of the conversation 5.     acknowledging the expectations and through processes of the client 6.     Discussing the care plan with patient.(ohsu.edu, 2018; Stewart et al., 2017)		Effective communication established between nurse and patient. The patient aware of his/her condition and about the care plan.

 

References:

Doherty, M., & Thompson, H. (2014). Enhancing person-centred care through the development of a therapeutic relationship. British journal of community nursing, 19(10), 502-507.

Feo, R., Rasmussen, P., Wiechula, R., Conroy, T., & Kitson, A. (2017). Developing effective and caring nurse-patient relationships. Nursing Standard (2014+), 31(28), 54.

Gausvik, C., Lautar, A., Miller, L., Pallerla, H., & Schlaudecker, J. (2015). Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of multidisciplinary healthcare, 8, 33.

Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J., & Riess, H. (2014). The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PloS one, 9(4), e94207.

Klingaman, E. A., Medoff, D. R., Park, S. G., Brown, C. H., Fang, L., Dixon, L. B., … & Kreyenbuhl, J. A. (2015). Consumer satisfaction with psychiatric services: The role of shared decision making and the therapeutic relationship. Psychiatric rehabilitation journal, 38(3), 242.

Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia socio-medica, 26(1), 65.

Nieswiadomy, R. M., & Bailey, C. (2017). Foundations of nursing research. Pearson.

ohsu.edu (2018), Developing Therapeutic Relationships. Retrieved on 18 May, 2018., from: https://www.ohsu.edu/xd/outreach/occyshn/training-education/upload/developingtheraputicrelationships_ch10.pdf

rnao.ca (2018), Establishing Therapeutic Relationships, Nursing Best Practice Guideline Shaping The Future Of Nursing., Retrieved on 18 May, 2018., from: https://rnao.ca/sites/rnao-ca/files/Establishing_Therapeutic_Relationships.pdf

Stewart, K., Doody, O., Bailey, M., & Moran, S. (2017). Improving the quality of nursing documentation in a palliative care setting: a quality improvement initiative. International journal of palliative nursing, 23(12), 577-585.

Wiechula, R., Conroy, T., Kitson, A. L., Marshall, R. J., Whitaker, N., & Rasmussen, P. (2016). Umbrella review of the evidence: what factors influence the caring relationship between a nurse and patient?. Journal of advanced nursing, 72(4), 723-734.

Wittenberg, E., Ferrell, B. R., Goldsmith, J., & Paice, J. A. (2015). A nurse communication training curriculum to integrate oncology and palliative care.