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Introduction Of Therapeutic Practitioner
Therapeutic nurse and patient relationships are considered to address the mutual learning experience, and corrective emotional experience alongside being sensitive to self and others (Allande-Cussó et al. 2022). It also includes assisting the gratification for patience, and emotional physical, and spiritual requirements by using knowledge and skill. By supporting this, Lessard?Deschênes and Goulet (2022) have mentioned the development of respectful relationships between patient and nurse, improving the overall patient outcome. This factor also includes using five significant factors namely communication, partnership, practicing patient's needs, pharmacology, and self-evaluation. While de-escalation is an effective process of solving conflicts in the professional field, Alternative dispute resolution (ADR) is considered another technique that is used in organizational settings to resolve disputes and stands for alternative dispute resolution. There is a growing interest in this technique in the healthcare setting while resolving issues among healthcare staff and patients (Sohn and Sonny Bal, 2022).
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On the other hand, I work as an apprentice nursing staff in an oncology care unit. As per the Nursing and Midwifery Council (NMC) guideline (2018), the patient name is needed to be confidential, and hence, a pseudo name will be used here to address the context of service users (Nmc.org.uk, 2023a). NJ is a 65 years old man who has colon cancer and is currently in the hospital in a palliative care setting. He has a history of uncontrolled blood sugar along with Hypertension and he lives with his wife as his daughter lives 1 hour away from his home. He is a retired army major and he enjoys watching football and social hangouts. I was in charge of taking care of him while providing end-of-life care including nutrition, medication, and maintaining his well-being.
Discussion
Communication
Effective communication is considered an essential part of nursing practice and it has a significant impact on the overall outcome in terms of improving interpersonal relationships in the working environment (Grover, 2023). While effective communication is shaped by using basic techniques such as open-ended questions alongside listening to the patient, showing empathy and assertiveness; it also enhances the outcome of nursing intervention by using quality communication (Abu Dalal et al. 2022). Besides, it also involves using speaking ability alongside active listening skills while reducing language barriers, anger as well as disparities in the same field (Grover, 2023).
Effective communication is essential for nursing staff in the healthcare setting to support the therapeutic relationship between patients and healthcare staff. Failure in maintaining effective communication with patients can lead to the development of uncertain emotions, anger, frustration as well as disputes (Jack et al. 2022). Failure in communicating with patients can occur due to different reasons such as language barrier, anger, and despair alongside incomplete training and improper communication skill of staff while listening to patients' explanations.
There are four significant ways of using communication strategies in clinical settings and these are managing positive behavior while preventing violating behavior, understanding patients from their significant perspective, maintaining a safe distance, and maintaining respectful communication (Davies, 2022). While 42.5% of nurses consist of moderate conflict levels, communication is considered one of the most effective strategies in the form of conflict resolution in clinical settings (Ahmed and Gaballah, 2023).
The use of effective communication in ADR is solely based on the management of communication between parties to dissolve conflicts while mediating the overall communication process (Bhati, 2023). As mediators must use strong communication skills, it also helps them understand the reason for disputes while connecting the parties. Communication in nursing is also an essential mechanism in terms of constructing and developing interpersonal human relationships (Metheny and SELPA, 2022) which involve nurses and patients during conflict tension and strengthening the connection between them to generate unexpected beneficial situations. Here, Delak and Širok (2022) have stated the success rate of using ADR is based on its voluntary proceedings which refers to 75% resolving capacity of conflicts in the same field.
While I was working with NJ, at first there was a communication barrier due to the language barrier. It also has the possibility of medication that can cause barriers to communication. Here, Seyhan (2019) has mentioned the role of medication while affecting communication due to dry mouth or excessive saliva while affecting the patient's ability to engage in conversation. However, NJ was not on such medication and he faced issues due to using different language. he started opening up in terms of addressing his hobbies and family during my shift which made me change my approach and ask him about his feelings while enquiring about his family life. I was focusing on the open-ended question and expected him to answer that contributed to his care process. As per the NMC code, the use of different ranges of communication skills and strategies with patients is done to support the person-centered care approach while enhancing quality and safety alongside making informed choices and shared decisions (Nmc.org.uk, 2023b). Besides, efficient communication in ADR helps in terms of preventing communication barriers in the forms of negotiations and arbitration (Hackner et al. 2022). The primary motive of ADR in communication provides different measurements that impact the effective communication styles of an individual in terms of expressing their views and opinion alongside ensuring the accuracy and correctness of communicating with the opposite person (Law, 2023). This stated my role as a mediator in terms of providing space for NJ to open up and be at ease during the care system.
Partnership
It was important for me to provide NJ with the essence of empowerment over his own HealthCare decisions in terms of adopting an approach to partnership working and his participation towards facilitating a shared decision-making process (Romariz Peixoto et al. 2022). The partnership between the health practice for the patient based on communication relies on focusing on the primary condition of the patient with the aim of promoting health and a healthy lifestyle (Pulvirenti et al. 2022). This step in the health care setting process is effective while encouraging the patient to make decisions on his health gas alongside changing the relationship between practitioner and patient. As per NMC guidelines and article 5 (2), the nurses are responsible for establishing a standard of proficiency that is considered necessary for the staff to develop relationships and manage safe and effective practice in a legal way (Nmc.org.uk, 2023c). This has been maintained by me while managing NJ's case. On the other hand, concentrating on the patient care process and maintaining patient-centredness is an effective way for the patient to feel empowered and it helps in making the clinical practice easier to provide insight into communication (Mistelis, 2023). The implementation of Arnstein's typology of citizen participation is significant in the following context as it presents the metaphorical ladder to focus on citizen agency, control, power, and participation (Varwell, 2022). I have implied this to NJ in terms of discussing his current step of care while addressing his present goals on nutrition alongside improving his emotional well-being. This made me help NJ to identify the different levels of his participation in terms of moving to the present goal of nutrition, medication, and well-being. This is similar to the ladder of the implied model with the aim of influencing legitimacy, authority, and governance of citizens while moving up the ladder to access the desired outcome (Pulvirenti et al. 2022). This approach is also effective towards continuous processes which help the involved parties to negotiate and confront the present situation for achieving a shared goal. It also reduces the chance of dispute in therapeutic practice while dealing with palliative care setting patients.
Practicing needs
The practice requirement for patient safety in the health care setting explains the own competence of staff in order to ensure the timely referral for continuing the treatment (Konkin et al. 2022). This is important for NJ as he was on palliative care support and was ordered by the doctor in terms of fulfilling his current health goal of nutrition and medication. The use of intentional rounding is considered a significant tool that is effective for approaching patients to assess their pain levels, continence, pressure areas as well as hydration (Oji et al. 2022). In the case of the identified patient, he was feeling nauseous and had hypertension in the past 2 days which was mentioned on his daily doctoral note. However, his diet was not addressed and dietary change was not recorded on the whiteboard. While I had to be a mediator in terms of communicating with his charge nurse, I had to have an open talk with him which highlighted his small argument with the nurse. The use of intentional rounding in case of medical occasions refers to the use of open communication techniques in items of identifying issues and solving the issue (Parker et al. 2022). In this context, Harris et al. (2019) have managed to state the use of intentional rounding while contributing to the delivery of patient care and affecting the way of delivering care in a positive manner. I have played the role of arbitrator here in terms of proceedings towards the solving of disputes between NJ and respective nurses while making binding decisions as well. By supporting this, Knutsson et al. (2022) have mentioned its effectiveness to identify the practice needs of patients without creating any more disputes, improving communication between the care providers and the patients as well as meeting the health goals. This is applied for NJ to help him to identify his need, present health goals, and participate to make decisions while communicating with respective persons to achieve a positive outcome.
Pharmacology
Apart from that, pharmacology is considered an interdisciplinary field that helps in exploring different aspects of drug discovery development and preclinical drug safety (Mechler et al. 2022). In the case of a palliative care setting, the use of palliative drugs helps to provide specialised care to the patient with serious but the aim of managing their disease symptom while associating themselves in order to cope with their illness (Mawatari et al. 2022). While addressing the following case study, NJ explained physical discomfort in the form of abdominal pain. While he was on a special diet in terms of treating his cancer, it also includes the use of palliative drugs to reduce his discomfort while treating his palliative care system. While I communicated with the patient, he expressed that his pain is moderate and as per the WHO setting, analgesic drugs are used on the basis of reducing the impact of pain among patients (Anekar and Cascella, 2021). This type of drug in palliative care helps the patient to control the pain in certain situations while relieving their discomfort (Lohma et al. 2022). While NJ's pain was identified as nociceptive due to the presence of ruptured tissue, analgesic drugs including codeine and fentanyl are used in order to provide him with necessary relief from the pain. As per the opinion of the British National Formulary (Bnf.nice.org.uk, 2023) alongside under the supervision of registered nursing staff, I have played the role of mediator in terms of informing NJ of the cause of his pain and necessary changes on his diet such as the inclusion of liquid diet the reduction of solid food and fibre food in terms of providing him in regards to his abdominal pain. While it was followed in the given case study, I have also made a clear communication to inform him of his medicinal changes alongside the overall dietary requirements in terms of maintaining his daily requirements. By supporting this, Alteren et al. (2021) have mentioned the nursing responsibility to administer medication while ensuring the correct doors and administration at the right time to reduce the risk of administrative error while taking informed consent from the patient. This factor is considered a significant step that may eliminate the chance of further miscommunication between the patient and care providers.
Self-evaluation
While reflecting on own performance in terms of managing the professional practice and the behavior aspect of nursing staff the primary aim of providing service always includes the providence of good health and positive care outcomes (Nmc.org.uk, 2023). This includes maintaining the effective practice of caregiving alongside the promotion of professionalism developing relationships between patient and staff while prioritising care goals for the patient. I was able to advocate on NJ's behalf in terms of addressing his requirement of dietary needs and medications while he was invalid care. It also provides me with an opportunity to play the role of mediator and negotiate in case of minimising disputes between the patient and related staff while enhancing my skill of awareness to impact his well-being.
Conclusion
In terms of concluding the given essay, it can be stated that the case study which has been discussed here is capable of highlighting several aspects of the care setting. As the service user, NJ has his thinking and requirements alongside voice to communicate with care providers. However, being in a palliative care setting and away from his daughter have made him upset in the hospital setting which has impacted the initial journey of office care provision. While I was working as an apprentice nurse, I was capable of recognising his requirements for medication in terms of approaching him regarding his health and well-being. While the patient was aware of his medical condition the use of effective communication has provided him a sense of security alongside growing mutual trust and respect in terms of sharing his thoughts on the clinical process, his issues while receiving care settings, and his needs. This has improved my role as mediated and negotiated in order to solve the possibility of disputes between the care receivers and caregivers. This also provides me with an opportunity to use my knowledge of several approaches in terms of associating the patient to improve the therapeutic practice alongside identifying his further needs. In addition, I was able to use my knowledge of pharmacology in terms of helping the patient and providing him with a sense of comfort while he is achieving pen relief. Throughout the application of the NICE-NMC code of practice, I have realized the importance of therapeutic relationships which has helped me to achieve the partnership with NJ while enhancing his experience as a patient and my experience as a therapeutic practitioner.
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