Formative Reflective Practice
The purpose of this Reflective Practice is to use critical thinking as a nurse and enhance personal and professional development while out in Clinical Practice. My study will provide the importance of therapeutic communication while working with Tangata Whaiora in order to maintain good nurse patient relationship. I have chosen Gibbs (1988) framework to analyze my past experience in order to promote learning and development. There are six stages of this framework 1. Description 2. Feelings 3. Evaluation 4. Analysis 5. Conclusion 6. Action plan.
Description: in my Reflection I have chosen the classroom learning scenario of client Myra (pseudo name) with symptoms of depression, anxiety, social isolation as well suicidal ideation after the death of her husband. She often concerns about she will too have heart attack like her husband, she sits quietly and listening for her heartbeat and rhythm.
On first approach, Myra looked depressed and very low. It was my first scenario to approach Tangata Whaiora, and I choose the role of assistant Mental health Nurse to observe Myra. One of my colleagues participated as head Mental health Nurse to approach service user. Because of my first experience with Tangata Whaiora, I was anxious and not much confident to start conversation (may be due to new to New Zealand Mental Health workforce), misconceptions among Mental Health professionals (Tane Rangihuna,2018).
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In last, I have tried my best to start my conversation by saying Karakia (prayers) to make Myra comfortable. Then me and my colleague start conversation with Myra by asking first thing “What brings her here today,”, the purpose is to make Myra think about herself and open up regarding her feelings. After introduction and Karakia, I have checked Myra’s BP and Pulse, and let her know about the normal findings of BP and Pulse, that helped her a lot to feel more relaxed as she was worried and continuously trying to check her pulse due her delusional feeling of Heart attack.
Feelings: there were two types of feelings in my mind. First was sense of anxiety related to first interaction with Tangata Whaiora, which I have never experienced in New Zealand before. For example: there were lots of feelings and questions in my mind to ask, but I felt so difficult to start coversation, as Myra was very depressed, hardly making any eye contact, feeling insecure. The powerful tool to start interaction is to understand difficulties, to develop rapport, to respond sensitively, let consumer lead the discussion, keep questions open ended, most important is to Listen. (A. Chaddock, 2014) Hence, I break the ice and start with normal conversation with Tangata Whaiora.
Evaluation: I have found that the way I involved with Myra and check her vital signs that helped me to gain more confidence, and sense of connectivity with her. After that Myra have answered all the questions, such as responded to complete the “Mental state Examination” “Patient Health Questionnaire for Depression” “Suicide Risk Assessment” “Geriatric Depression Scale” (Trimmer & Byrne, 2018). After a positive screen test my Colleague guided me the next step of making referral for further assessment and treatment.
Analysis: from this assessment and classroom learning of model Te Whare Tapa Wha (Durie, 1988), I have analysed that how mental health is connected with other walls of body such as your physical, spiritual and family well-being. In this case I can corelate the relation of Myra’s mental state (depression) relates to her family (husband) and physical well-being (concerned about her heartbeat and rhythm).
Moreover, nurses and practitioners can work together as interdisciplinary team to implement the Primary Health Care Strategy to treat population suffering from depression. (New Zealnd Guidelines Group, 2008, p. 19). This approach can be supported by “Stepped Care Model” by starting from less to progress towards intensive treatment (New Zealnd Guidelines Group, 2008, pp. 18-19).
Conclusion: from this case I came into conclusion that how therapeutic communication, active listening and stepped care model is important to understand Tangata Whaiora. Try to involve the whanau, let the client involve in self-care is really important. On the other, its equally important to involve your team members, self-reflect yourself, for the better outcome.
Action Plan: I will take this experience with me in terms of “power of best communication” with client and your team, on my Rotation starting from next week. Building Rapport with person seeking help without making any judgments, and without thinking of previous misconceptions between health professionals (mentioned in first paragraph).
I really feel privileged to be a part of this Reflection Practice, and I will practice this learning experience, throughout my Nursing Profession.
Chaddock, A., Thwaites, R., Bennett-Levy, J. & Freeston, M. H (2014). Understanding individual differences in response to Self-Practice and Self-Reflection (SP/ SR) during CBT training. The Cognitive Behaviour Therapist, 7, e14. doi: 10.1017/ S1754470X14000142.
Definition of Reflection in Nursing. https://www.google.com/search?client=safari&channel=mac_bm&ei=CBhiXpHAFo349QPRop-wDg&q=reflection+definition+in+nursing&oq=reflection+definition+in+nursing&gs_l=psy-ab.3..
Durie M. Whaiora: Maori Health development. Auckland: Oxford University Press; 1998.
Mulder, P. (2018). Gibbs Reflective cycle by Graham Gibbs. Retrieved from
https://www.toolshero.com/management/gibbs-reflective-cycle-graham-gibbs/
Mental Health Foundation (2020). How to support someone with a mental health problem. Retrieved from https://www.mentalhealth.org.uk/publications/supporting-someone-mental-health-problem.
New Zealand Guidelines Group. Identification of Common Mental Disorders and Management of Depression in Primary Care. An Evidence-Based Best Practice Guideline. Published by New Zealand Guidelines group; Wellington: 2008
Trimmer, W. & Byrne, L. (2018). Mental Health in Primary Care: A resource for New Zealand health professionals (2nd ed.). Wellington, New Zealand: Whitireia New Zealand.
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