This assignment is a reflective account of my first experience when assisting a patient to eat lunch. For the purpose of this assignment I will refer to this patient as Mrs C to maintain confidentiality and comply with the NMC code (2008). It will discuss the importance of non-verbal communication when providing effective nursing care to the elderly.
As a framework for this reflection I am going to use the Gibbs (1988) Reflective Cycle which uses 6 stages; description, thoughts and feelings, evaluation, analysis, conclusion and action plan which will improve my nursing skills by continuously learning from both good and bad experiences, and develop my self confidence in relation to caring for others (Siviter 2008). Description This was the first day of my first placement. Lunch arrived on the ward, to be distributed to patients by nursing staff.
My mentor told me the trust operates a ‘protected mealtimes’ policy where routine nursing care stops and staff dedicate time to mealtimes, she asked me to assist a patient with lunch. The patient, Mrs C is a frail old lady, 95 years old who suffers with dementia and diabetes and has aphasia (speech loss) and dysphagia (swallowing difficulties). She was admitted to hospital with general deterioration and pneumonia. She is nursed in bed and because of her medical issues requires assistance with many of the activities of daily living as described by Roper, Logan and Tierney (2000).
In spite of the medical and communication difficulties Mrs C suffers with, I was able to help her into a comfortable sitting position and fully assist her to enjoy her meal, resulting in her eating practically all of it and recorded details on her food chart. Thoughts and Feelings I will now discuss what I was thinking and feeling during this event. I was apprehensive as I approached Mrs C. I did not know this patient and wondered what difficulties I might have. I introduced myself and explained that I had brought her some lunch.
I observed her diet sheet and checked the lunch was suitably soft and easy to swallow for a patient with dysphagia. I asked her if she would like to try some lunch and would she like me to assist her. She did not answer me verbally or with any other gestures other than to gaze at me. This made me feel very uncomfortable and slightly anxious. I attempted to put myself in her position and think how she might feel, unable to respond verbally to a complete stranger. I maintained her gaze to show her I was listening emphatically.
I leaned closer to her, aware that I was invading her personal space and asked her if I could sit her up so that she was more comfortable and able to enjoy her lunch (Williams 1999) and reduce the possibility of choking and aspiration (Holmes 2008). As once again I did not get a verbal response, I maintained her gaze and helped her into an upright position, telling her what I was doing to reassure her. To create a secure and relaxed environment I pulled up a chair to sit on next to the bed.
I started to feed Mrs C small teaspoons of food giving her my full attention and talking to her as I did so. I lightly touched her hand to give her reassurance as I was unsure whether she could hear me. She did not withdraw her hand and appeared relaxed, therefore my uneasiness began to disappear. I was mindful that as she was unable to speak, extra effort would be required from me to maintain effective communication. I therefore tried to demonstrate an open posture, keep eye contact and use body gestures and facial expressions whilst keeping my tone even and caring (Miller 2002).
When Mrs C coughed and had difficulty swallowing I initially felt a bit panicky through lack of experience, but I forced myself to think logically and encouraged her to swallow and when necessary stroked her throat lightly, making sure she was sat upright. I felt most relieved when she began to settle and was able to eat most of her meal. Evaluation I felt this first experience was very rewarding and a big learning curve for me in caring for others. I was delighted that I had been able to support Mrs C to eat nearly all of her meal which she clearly enjoyed.
The ‘protected mealtime’ policy ensured that I had time to dedicate to assist her and as she did not have the ability to feed herself, without my help she would have eaten very little or nothing at all. On the negative side, staff on the ward did not take into consideration this was my first placement with little previous nursing experience, I was inexperienced, did not know my patient and subsequently the issues I would experience when assisting her with a personal activity of daily living.
Taking note of the details on her diet sheet prepared me for what difficulties Mrs C might have when eating her meal. I was able to communicate effectively with her whilst assisting her with her meal. She made good eye contact and I was able to understand her needs. Analysis Mrs C’s illness means she depends on others for most of the 12 daily activities of Living (Roper et al, 2000) and l feel she had the best nursing care I was able to give. Dementia can impair both verbal and non verbal communication.
Her ability and willingness to communicate may be attributable to factors associated with physical, emotional, physiological or language barriers (Miller L 2002). In compliance with the NMC (2008) code of conduct I was able to identify my patient’s preferences regarding care whilst easing any stress or discomfort that she might have been feeling. I was conscious during this experience the effect my non-verbal communication could have on Mrs C’s nutritional intake and meal enjoyment (Holmes 2008).
Initially my involvement with Mrs C was task orientated as I was charged with assisting her to heat a healthy lunch which was soft and easy to swallow (Shepherd 2009) in line with the Trust’s ‘Protected Mealtime’ policy. However I felt that my non verbal communication skills played a vital role in not only the task but delivering effective therapeutic nursing care, which according to Arnold and Ryan (1999) is the linchpin between the nurse/patient relationship. Spouse, Cook and Cox (2008) also confirm I was using touch both in an instrumental way and also in a therapeutic manner.
According to Egan’s (2002) non-verbal communication model I was right to sit on a chair next to my patient, and to show a relaxed and open posture while maintaining sufficient eye contact, Baillie (2001) agrees this is good practice as it shows patients that nurses have time to deliver individual care. However, Giddens (2006) suggests that non-verbal communication can be misleading and therefore nurses need to be aware of their own personal style and any potential for misinterpretation. In order to communicate with Mrs C, I modified the usual rules of communication.
I did not speak to Mrs C in an inappropriate way or use elder talk which may have damaged her self esteem and confidence (Argle 1994). I talked to her as I would address any adult but put more emphasis on non-verbal communication which according to Caris Verhallen (1999) is the main way in which humans communicate, in order for her to receive my message, extract the meaning and give me feedback. By holding Mrs C’ gaze I was maintaining communication and encouraging engagement and interaction (Argyle 1996).
By nodding her head, maintaining eye contact and opening her mouth Mrs C showed me that she understood that I wanted to assist her with her meal and gave me permission to feed her. In order to assist Mrs C with her lunch I had to invade her personal space, I used touch to communicate and help her relax, feel safe, reassure and offer warmth and togetherness in a setting which is not natural (Spouse et al 2008) As the receiver of my message Mrs C showed me that she had received by message, understood the meaning of it and gave me good feed back by opening her mouth for each spoonful and taking hold of my hand.
When she was full she maintained eye contact with me, but kept her mouth closed and gripped my hand a little tighter (Arnold et al 1999). Conclusion This experience for me was about developing my non-verbal communication skills which play a fundamental role in delivering effective holistic nursing care to the elderly patient. I demonstrated that I have the ability to deliver patient centre care and have the skills necessary for effective communication, active listening and am able to show empathy. Through this experience I am more aware of the skills I require to support patients who are in a vulnerable position.
Action Plan As a result of this experience: 1. I will research the anatomy of the ears, eyes and speech to improve my knowledge and understanding of the medical and social reasons some older people are unable to communicate by speech. 2. I will endeavor to get to know my patients at the earliest opportunity and identify potential barriers to communication so that I am able to adapt and communicate effectively with them as individuals. 3. I will research my personal style of communication to further improve my delivery of holistic care to patients.