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Poor Nursing Practice: Therapeutic Communication and Professional Boundaries Assessment 2 Answer

ASSESSMENT 2: VIDEO STIMULUS

Intent: To enable students to identify poor nursing practice, specifically with regards to therapeutic communication and professional boundaries and to link this to patient safety.

Word count: 1000 words

Format: 4 short answers with reference list

Task: Students will watch a short video which shows an interaction between a student RN and patient and will:

  1. Identify FOUR (4) errors with regards to therapeutic communication and/or professional boundaries and discuss the significance of the error.
  2. For each error identify and discuss the correct actions the student RN should have taken.

Answer

ASSESSMENT 3

Identify the error:

Four errors can be identified from the given case study, with regards to therapeutic communication and professional boundaries, those are:

  • Unprofessional way of communication where the nurse has been interacting in casual manner with the care user and discussing about her personal life with the patient. 
  • Inappropriate hygiene practices while conducting patient check-ups. Professional boundaries are violated when she argues about her clean hands and hair but not following patients request as well as violating professional responsibilities
  • Further the registered nurse had not enquired about the health conditions of the patient while conducting regular check-ups 
  • The registered nurse also had ignored when the patient tried to share her feelings of distress about the last week health conditions by stating it as a normal affair that a large number of women go through. 

2. Significance:

Error 1: The first error that has been identified, demonstrates that the registered nurse violated professional, therapeutic relationship and a non-professional relationship between nurse and care user was built. Nurse also has discussed her personal issues which shows excessive self-disclosure which is not expected in a professional relationship. Professional relationship or therapeutic communication is maintained in health and social acre settings to ensure effectiveness and safety of patient (Nursing and Midwifery Board of Australia, 2010). Over involvement may lead to boundary crossings and boundary violations. 

In the first identified error, the registered nurse has shown more interest in discussing her own personal things rather than maintaining a therapeutic relationship in professional manner of communication with the patient. This way of communication may make the patient feel uncomfortable and non-dependable on the registered nurse which may again restrict her or him from sharing health issue. Non-disclosure of health issues due to ineffective communication may result in inaccurate care service (A Nurses guide to Professional Boundaries, 2018). The registered nurse also has forgotten patient’s name, which may have detrimental impact on the patient trust in the care provider. Through professional relationship, nurse promotes mutual trust, respect and acceptance as these elements are critical to improved care service and better health outcomes (Nursing and Midwifery Board of Australia, 2016). 

Error 2: The second error that has been identified, shows that the registered nurse has not been maintaining hygiene practices while conducting patient check-ups. Even after requested by the patient to maintain hygiene practices, she has explained how her hair and hands are clean. Unhygienic attitude of the registered nurse also may have negative impact on the patient’s health care expectation from the professionals as well as the health care setting. Significance of hygienic practices are extremely high in the health and social care settings with regards to safety and health of the care user. Hand hygiene is the most essential tool to prevent the spread of infections and maintain an improved patient health outcome. Disinfecting or washing hands before and after patient contact happens to be the most essential solution to prevent the spread of bacteria (Dalton, L., Campbell, S. and Bull, R., 2018). Therefore, maintenance of hygiene has very important role in maintaining health and preventing care users of any possible infections.  Additionally the patient’s needs should be met accurately by the registered nurse, which has been avoided by the professional by explaining or arguing about her cleanliness (Nursing and Midwifery Board of Australia, 2007). 

Error 3: Third error in the case, which the registered nurse has committed is ignorance about health conditions of the patient. The patient had not enquired about how the health of the patient is and she did not even have provide accurate blood pressure measurement and stated that it is an estimation as this does not matter. These unprofessional behaviour and inaccurate health check-up measurement have very ill effect on the patient as patient will not have trust on the registered nurse. 

The care user will find the registered nurse an incompetent care provider, which may further increase her concern of ill health, especially when she has been experiencing extreme pain. Additionally rough estimation and lack of accurate measurements may also have ill effects of medications and treatment on patient’s health, as health physician makes are plan and prescribe medications based on the health reports and records. Therefore, updating health reports has very important role to play in maintaining as well as improving health conditions of the patient. 

Error 4: The registered nurse also had ignored when the patient tried to share her feelings of distress about the last week health conditions by stating it as a normal affair that a large number of women go through. This is a very irresponsible and unethical behaviour towards a patient who has been experiencing tremendous pain and has been admitted in emergency with PV bleeding. In this context, therapeutic relationship has been violated by the registered nurse. In a therapeutic relationship the nurse should be sensitive to a person’s situation and engages with them using knowledge and skills in kindness, compassion and respect (Halcomb, et al., 2017). Person’s rights and dignity are recognised and respected in regards to therapeutic relationship. Professional boundaries and establishing effective therapeutic relationship ensures person’s rights and dignity are recognised and respected (Isobel, S. and Delgado, C., 2018).

Identify and discuss the correct actions:

Error 1: To avoid first error, the student registered nurse should have maintained very professional way of communication by addressing patient’s name properly. Additionally the student registered nurse should have avoided discussing personal issues with the patient which could result in boundary crossings and boundary violations and mutual trust, respect and acceptance are violated as well (Australian Nursing and Midwifery Council , 2016). 

Error 2: To avoid this error, the student registered nurse should have followed hand hygienic practice before she comes in contact with the patient, which is essential to prevent infection. Additionally, the patient had requested the student registered nurse to follow hand hygiene before carrying out her roles. The student registered nurse should not have argued about her clean hair and hands but should have followed her request rather than arguing. 

Error 3: The student registered nurse should have not stated that she has taken estimated blood pressure as these do not mater at all but rather should have noted the accurate measurements and recorded the same. The student has not shown any interest on the health aspects of the patient as she demonstrates her ignorant attitude rather she should have developed a communication that promotes trust and respect. 

Error 4: To avoid an un-empathetic and disrespectful approach towards the feelings and distress of the patient, the student registered nurse should have listened to the feelings that the care user had to share about her pain. The student also had avoided comments such as the health issues that the patient is experiencing is very common and a large number of women go through this so this is not a big issue. Instead, she should have tried to maintain an empathetic environment and provide support to the patient.

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