Background
During my night shift in emergency ward, I received the handover of an 82-year-old female aboriginal patient named Rachel. She was suffering from acute appendicitis and was experiencing excruciating pain. However, she showed sheer resistance to receive the treatment from a female aboriginal health care worker. Her resistance to receive treatment from a female aboriginal worker was delaying the intervention process. Her annoyance due to the delay in arrangement of female aboriginal health worker was reflected through her body language and communication style. I immediately decided to seek the help of the supervising senior RN. Being a nurse, I was obliged to obey the advice of my supervising nurse. I told the supervising RN that an aboriginal patient was showing resistance to receive treatment from an aboriginal female HCP. However, I failed to communicate that arranging a female aboriginal HCP in such a short span was not possible (Betancourt, Green, Carrillo & Firempong, 2016). The RN told me to wait for the arrival of aboriginal health care worker and to respect the patient’s autonomy. I had the moral and ethical obligation to respect the patient’s autonomy to make the decisions regarding her treatment plan. However, I knew that arranging a female aboriginal health care worker in such a short span of time was almost impossible (Gibson et al., 2015). The patient was screaming in pain. I could not see the patient in so much pain and started preparing to give the first aid to the patient myself. As soon as I started giving first aid to the patient, the patient got annoyed and started shouting. When the supervising RN saw this incident, she felt angry and told me to meet her outside. When I came outside she disclosed her discontent for not taking her advice seriously and blamed me for the patient’s annoyance.
I felt annoyed and helpless for not being able to help a patient who was experiencing excruciating pain. I had never seen a patient who was experiencing excruciating pain, but still showed resistance to receive treatment from a female aboriginal HCP. I felt sorry for the patient as she was in so much pain. I knew that she required immediate analgesics to relieve her pain, however; her resistance had become a major barrier in her care plan. As per NMBA Standard 3.2, a nurse must establish a therapeutic relation of trust and confidence with the patient (Nursingmidwiferyboard.gov.au, 2018). I tried to remain calm and establish positive communication with the patient. However, her reluctance due to cultural differences as aboriginals feel more comfortable to receive care from female aboriginal HCPs became a barrier in her treatment process. I realized that aboriginal female patients have certain cultural beliefs that include receiving treatment from female aboriginal community members. Moreover, I failed to communicate about the unavailability of the female HCP to my supervising RN. When she got angry for not acting according to her advice, I felt more regretful and sorry for my actions (Ghiyasvandian, Zakerimoghadam & Peyravi, 2015).
The Incident
I think that I made a wrong decision by ignoring the patient’s autonomy. Also, my lack of professional communication skills was the chief cause of this whole misunderstanding. I have realized that a nurse needs to think critically and make rational decisions (Kelaher, 2014). However, my inabilities to build a professional communication lead to this misunderstanding between me and my supervisor. I realized the importance of establishing a positive communication relationship with the health care workers of the team. Had I communicated the whole scenario to my supervising nurse, she could have helped me to solve this issue in a more efficient manner. By communicating the incident to my supervisors, I can not only gain their trust and confidence, but also they can become by guide and help me to manage the clinical scenarios in a more convenient way (Douglas et al., 2014). The supervising RNs are definitely more experienced and more skilled to deal with such scenarios on a daily basis. I should have shown better communication skills while describing the case scenario of Rachel to my supervising nurse.
After the incident the supervising RN was able to convince the patient to receive care from a female non-aboriginal health care worker. I felt embarrassed and ashamed. However, I realized that I need to improve my professional communication skills and learn from my seniors to prevent such incidents in future.
As it was the first time that I had seen a patient experiencing excruciating pain and still showing reluctance. I was quiet shocked at first, however; when the supervising RN handled the whole situation by exhibiting excellent communication skills and was able to manage the patient as well as her family members, I felt embarrassed due to my incompetence. I realized that how an incomplete communication can deteriorate the patient’s as well as the teammate’s trust in me. The supervising nurse, physician and I were supposed to work as a team for the well-being of the patient. However, my inadequate communication skills led to extreme communication gap, mistrust, loss of confidence and misunderstanding between the RN and me. I learned that I need to improve my professional communication skills just like the supervising nurse (Freeman et al., 2014). Also, I should learn about the cultural beliefs of female aboriginal patients to prevent such incidents in future. By improving the gaps in my communication, I will become more confident in handling such scenarios in my future clinical nursing practice.
Importance of Professional Communication Skills
This incident has prompted me to gain professional communication skills. Also, I have decided to learn about the cultural differences in relation to female aboriginal patients in more details. As a nurse, I need to become a patient’s advocate (Hall, 2016). I have to build therapeutic relation of trust with the patient. I also need to respect the patient’s autonomy (Levett-Jones, Reid-Searl & Bourgeois, 2018). I order to attain best patient outcome, I should develop my communication skills by learning the skills from my supervisors and seniors.
Conclusion
This incident has helped me to understand that I need to improve my communication skills. I have realized that an incomplete communication regarding any incident is equivalent to non-professionalism. Describing the half incident not only leads to confusion and doubt, but it also leads to misunderstanding between colleagues and loss of trust. Professional communication involves describing the incident in a short, precise and clear manner so that the ambiguity of the communication is removed (Panaretto, Wenitong, Button & Ring, 2014). According to Standard 1.2 of NMBA, a nurse is ought to utilize effective communication skills with the patient as well as other health care professionals to inform regarding the treatment and diagnosis (Nursingmidwiferyboard.gov.au, 2018).
Mistakes can become important milestones of professional learning. I have decided to learn from my mistakes and improve my professional practice. I will try to remain calm and confident in clinical scenarios. Instead to becoming afraid by the clinical situations, I will try to think in a more rational and critical manner. This will help me in making decisions based on my thinking, instead of making decisions based solely on feelings of fear or anxiety. Moreover, as per Standard 2.2 of NMBA, a nurse ought to communicate about important health issues and diagnosis to the health care team in a timely manner (Nursingmidwiferyboard.gov.au, 2018).
In future, I need to improve my professional communication skills. I will be more careful to describe the complete scenario to my supervisors. An incomplete communication can increase mistrust between the members of a health care team. I should work in a co-ordinated manner to act as a team player. An inefficient communication can lead to mistrust and loss of confidence (Purnell, 2014). I will build my communication skills by listening to my seniors when they communicate with their colleagues and seniors in a clinical setup. Also, I will try to learn about cultural differences and similarities in aboriginal and indigenous patients. I will respect the patient’s autonomy and at the same time try to build a therapeutic relation of trust with the patient (Delany & Molloy, 2009). I have realized that aboriginal females prefer to seek care from aboriginal health care workers. I will try to foresee such clinical scenarios in future. In future, I will initially try to convince such patients or else make the patient clear regarding the availability of aboriginal female HCP before admitting the patient in a polite and professional manner. This will help the patient to decide beforehand and will also decrease the confusion if an aboriginal HCP cannot be available.
References
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.
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Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S., & Francis, T. (2014). Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Australian and New Zealand journal of public health, 38(4), 355-361.
Ghiyasvandian, S., Zakerimoghadam, M., & Peyravi, H. (2015). Nurse as a facilitator to professional communication: a qualitative study. Global journal of health science, 7(2), 294.
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Kelaher, M. A. (2014). Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities. Education, 55(56), 8-3.
Levett-Jones, T., Reid-Searl, K., & Bourgeois, S. (2018). The clinical placement: An essential guide for nursing students. Elsevier Health Sciences.
Nursingmidwiferyboard.gov.au. (2018). Nursing and Midwifery Board of Australia – Professional standards. [online] Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed 14 Aug. 2018].
Panaretto, K. S., Wenitong, M., Button, S., & Ring, I. T. (2014). Aboriginal community controlled health services: leading the way in primary care. The Medical Journal of Australia, 200(11), 649-652.
Purnell, L. D. (2014). Guide to culturally competent health care. FA Davis.
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