Nursing Essay: Importance Of Therapeutic Communication For Health

Question

Task: Scenario
Tobias (Toby as he prefers to be called) is a fit and healthy 26year old male, admitted to hospital this afternoon with a fractured ankle, confirmed on Xray and requires surgery in the morning. Elevation of his leg to assist in the reduction of swelling and administration of pain medication has been ordered as part of his overnight nursing care. This is documented in the patient records and in the care plan. He is to remain on bed rest, with no toilet privileges overnight, to immobilise the ankle and reduce further swelling.

In your introductions to ‘Toby’ at the start of your shift, you find him standing beside his bed, looking in his beside cupboard, while weight bearing on the affected limb. As you introduce yourself, he turns to respond, his voice slightly raised and facial expression of surprise. Toby states, “I know nurse, I am not supposed to be standing up, but I need my iphone to email my soccer coach to explain why I am not at training today, as he will be upset with me for not playing”. You explain to Toby why he must immediately return to his bed and not place any weight on his ankle, potentially causing further damage to his ankle injury. As he attempts to walk back to bed unassisted, partially hopping, he grimaces with the pain and moans out loud. You then state, “Toby, you must not do this again before your surgery tomorrow. You risk causing more damage to your fracture and then you may not play soccer for a very long time.” Toby looks at you, with fixed eye contact and a stern frown, then states in a very loud voice, “That is a terrible thing to say to an athlete! Are you trying to scare me even more? Just go away nurse and leave me alone.”

Brief Nursing Essay Description
In the provided scenario you are required to discuss the ineffective communication that is evident between the nurse and the patient. You will also discuss and apply the communication skills, strategies and approaches that should have taken place to best support therapeutic communication between the nurse and patient. You will also discuss the inclusion of cultural awareness and selfawareness in relation to the scenario. Finally, you will describe your understanding of literacy skills for healthcare applied to this scenario.

Rationale for assessment task
This assignment has been designed for you to demonstrate your knowledge of therapeutic, interpersonal and professional communication skills utilising evidencebased practice and professional standards of nursing. Strategies that promote resilience, self-care and cultural safety for interpersonal communications, will also be addressed.

Graduate Attributes
• Effective communicators and collaborators who actively and respectfully lead, listen, reflect, discuss and negotiate in order to work productively with a range of individuals and groups, including professional teams.
• Critical, creative, thinkers who can integrate and apply knowledge and relevant skills, including research and digital literacy skills, to analyse and evaluate ideas, concepts, theories and problems, and offer insights, innovative approaches and solutions.

Answer

Introduction
As examined in the present context of nursing essay, an appropriate communication skill is excessively essential for every individual, especially for the nurses or the therapists, who help to increase positive attitude among patients by communicating with them properly within the healthcare organisations.However, lack of communication skills or inadequate utilisation of facial expressions or gestures mayaffect the quality of conversation between a nurse and a patient, which may lead to an unwanted or detrimental experience for the patients.Considering the context, therapeutic training is provided to the nurses, as well as therapists in order to develop their communication skills (Abdolrahimi et al., 2017). Therapeutic communication is another essential communication skill for the nurses as it helps the healthcare service providers in health care organisations in providing psychological support and care by communicating with them. The following essay will discuss the importance of communication skills, strategies and strategies to best apply therapeutic communication based on the provided scenario.

Discussion
In this illustrated scenario, a deficiency in communication between the nurse and the patient is seen in a situation where the patient, Tobias (Toby) came with a broken ankle and required surgery the next morning. However, Toby was found standing beside his bed and looking for his phone. When the nurse told him not to stand on his own, Toby started to communicate with a raised voice, and then, when he again tried to walk, his immense ankle pain started to occur.However, in this situation, the nurse loudly told that this kind of activity might increase the damage, but Toby did not like the way the nurse talked to him, and he started to browbeat the nurse that the nurse should have increased his courage rather downsizing it. Here, in this scenario, a lack of appropriate therapeutic communication is to be seen. The nurse was supposed to provide some basic patient care while Toby was standing or trying to move. Therapeutic communication skills play an effective role for both patients and their family members in order to come out from both mental and physical trauma and ensure the best patient outcomes. Furthermore, therapeutic communication helps nurses or therapists to build a trustworthy relationship with the patients and enables care providers to effectively collaborate towards the physical and psychological wellness of the service users. As per the statement of Chichirez & Purc?rea (2018), therapeutic communication skill includes different skills, strategies and approaches, among which some are confronting, asking open-ended questions, encouraging desired behaviours, encouraging and motivating, excessive concentration on patients, providing the required information, reflection and many other skills and strategies.

In the given scenario, different types of skills, strategies and approaches to therapeutic communication would be best for the nurse and the patient. In order to implement an effective therapeutic communication technique, nurses and therapists should follow some steps that are, firstly, nurses should understand the patients’ indications to identify whether they are anxious, sad, confused or angry. Secondly, the nurses should select a technique or approach, which will assist in carrying out a positive discussion based on the patient's present circumstances. Thirdly, nurses should maintain their words with proper body language, for instance, avoiding facial expressions, screaming, impatience, etc (Brownie, Scott & Rossiter, 2016). As per the scenario, the nurse did not follow such steps before communicating with Toby, which later turned into an inadequate conversation between them. Before judging Toby’s actions, the nurse should have asked him some open-ended questions to recognise Toby’s perceptions and thoughts, as well as his attitude, thinking abilities and awareness. This would help the nurse in reducing Toby’s anxiety, and at the same time developing his safety.

Apart from this, caring is another skill or approach that defines the feeling of a nurse and demonstrates kindness and concern for the patients. Besides offering physical care or medication, a patient should be provided psychological or mental support by the nurses. Caring for a patient in healthcare can be accomplished in several ways, in which the "5C’s” approach is most effective, which includes commitment, compassion, competence, conscience and confidence. These variables are excessively essential in health care organisations as these factors excessively help in developing a quality relationship between the nurses and the patients, and improve the skills of therapeutic communication (Veloza-Gómez et al., 2017). The main component which seems missing in the scenario is “compassion”. If the nurse showed Toby a little compassion by smiling, greeting him by his name, fulfilling his requirements and answering Toby’s questions, then an effective and quality therapeutic communication could have been made between them. Healthcare literacy can be considered as an ability to collect, process and comprehend the initial services and healthcare-related information that is required to construct effective healthcare commitments (Mullan et al., 2017).Inappropriate healthcare literacy might negatively impact patients and the overall healthcare services. This kind of literacy is mostly seen among those individuals who belong to a lower income level society and have less education. In this context, “Gibbs Reflective Cycle" considers being an effective model that consists of six different stages. Each step helps individuals to learn from their past experiences (Pinheiro, 2021). In the first description stage, users asked several questions including, when and what happened and by this, nurses may gain experience about the situation. Then, in the next phase, what thoughts an individual has during the situation and how it has impacted the person. These are the two most effective stages that play essential roles while addressing the requirements of those individuals who have a deficiency in healthcare literacy.

Conclusion
In conclusion, the provision of an effective nursing communication skill is one of the highly required skills within a healthcare organisation that improves the positive outcomes of the patients. When inappropriate communication takes place between a patient and a nurse, it not only generates a misunderstanding scenario but also increases a detrimental patient experience among the patients. The overall essay has deliberated the core communication skills, strategies and approaches that should have been taken by the patient before talking to Toby in the given scenario. However, due to a lack of healthcare literacy, Toby did not understand the consequences of his health situation, on the other hand, due to a lack of therapeutic communication skills, the nurse did not take the required steps to help Toby or to motivate him in such a situation. In that case, the nurse should have maintained an effective therapeutic communication skill, as well as cared for the patient to address all such situations and Toby's such behaviour.

References
Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electronic physician, 9(8), 4968. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614280/
Brownie, S., Scott, R., & Rossiter, R. (2016). Therapeutic communication and relationships in chronic and complex care. Nursing Standard, 31(6), 54. https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1087&context=eastafrica_fhs_sonam
Chichirez, C. M., & Purc?rea, V. L. (2018). Interpersonal communication in healthcare. Journal of medicine and life, 11(2), 119. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101690/
Mullan, J., Burns, P., Weston, K., McLennan, P., Rich, W., Crowther, S., & Osborne, R. H. (2017). Health literacy amongst health professional university students: a study using the Health Literacy Questionnaire. Nursing essayEducation Sciences, 7(2), 54. https://www.mdpi.com/2227-7102/7/2/54/htm
Pinheiro, P. (2021). Conceptualizations of Health Literacy: Past Developments, Current Trends, and Possible Ways Forward Toward Social Practice. HLRP: Health Literacy Research and Practice, 5(2), e91-e95. https://journals.healio.com/doi/pdf/10.3928/24748307-20210316-01 Veloza-Gómez, M., Muñoz de Rodríguez, L., Guevara-Armenta, C., & Mesa-Rodríguez, S. (2017). The importance of spiritual care in nursing practice. Journal of Holistic Nursing, 35(2), 118-131. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4332997/