Principles of Care Delivery.
This reflective account will demonstrate my knowledge and understanding of the skills used by practitioners when undertaking client assessment.
The name of any patients referred to have been changed in order to maintain client confidentiality, in accordance with the Nursing and Midwifery Councils Professional Code of Conduct. (2002)
The reflective model used in this account is Gibbs (1982), a copy of which can be found in Appendix (1).
My clinical placement was at a day centre which catered for the elderly, suffering with mental health problems. During my time there, I witnessed many examples of both positive and negative communication and interaction with patients. Riley (2004) describes communication as a lifelong learning process for the nurse.
Initially, I had some concerns about how I would communicate with some of the patients, in particular, those who were suffering with Dementia and Alzheimer’s disease. I was unsure whether to “go along” with a patient’s story, despite being aware of their confusion, or whether to familiarize the patient with reality. This made me feel awkward and at times, embarrassed.
I had the pleasure of meeting Gladys a 79 year old lady who had Alzheimer’s disease. It became apparent to me over the weeks that Gladys’s behaviour varied considerably depending on which member of staff dealt with her and how they approached the situation. I also realised that although at times Gladys was extremely confused and often paranoid; there were times when she reminisced and spoke of her life in a coherent manner.
For example, it was often difficult to feed Gladys, as she was extremely suspicious of the food given; she believed that the nursing staff had put oil in her food or drinks. I observed a nurse feeding her at teatime; she approached Gladys and told her “You are having your dinner”. There was a real lack of warmth in her voice and she told Gladys, rather than asking her – thus removing her autonomy. She proceeded to feed Gladys, but did not sit down. She stood over her and impatiently spooned the food into her mouth; there was little eye contact and no verbal communication. When some food accidentally spilt on her hand, she screwed up her face in disgust and walked off to get a tissue. By the time she returned, Gladys had lost interest and refused to eat any more; she was agitated and became aggressive. This was clearly an example of poor practice. The Fundamental Caring Skills Assessment Book (2002) clearly states the standard required when assisting with feeding a client via the oral route. Part of the component elements of the skill are; greeting and gaining client consent, collecting all necessary equipment, sitting beside or in front of the client, allowing time and matching the speed of feeding to patient’s requirements and thanking the client when closing the contact.
In contrast, on a separate occasion, I witnessed another nurse feeding Gladys, prior to giving out the meals, she took the time to go over and have a chat with Gladys, she told her what was on the menu and asked her if it was ok to give her a hand. Her whole approach was different; she maintained eye contact throughout and touched her shoulder as she left. When she brought her dinner over, she asked Gladys whether she could manage to feed herself, if the food was cut up. Although Gladys said she preferred to be fed – the nurse had given her the choice.
When the nurse chatted to Gladys, I noticed that she cleverly only asked closed questions – allowing Gladys to indicate “yes” or “no” without it interrupting her dinner. The nurse was sat at a comfortable distance from Gladys as opposed to stood over her. This gave Gladys the sense that she was not in a rush. Using her interpersonal skills, the nurse encouraged Gladys to eat her dinner. Alder et al (2004) suggests that nurses can be aware of factors that interfere with the quality of their communication skills. He stresses the