Developing Relationship Centred Care assignment PDF

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Student Name: Student Number: Course Title: BSc Nursing (Child) Module Title: Developing Relationship Centred Care Module Code: 66-501120-AF-20190 Tutor: Sara Morris-Docker Assignment Title: Challenging Communication Assignment Deadline: 19/03/2020 Word Count: 1845 Declaration I confirm that this assessment is my own work and that I have duly acknowledged and correctly referenced the work of others. I am aware of and understand that any breaches to the Code of Academic Conduct will be investigated and sanctioned in accordance with the Academic Conduct Regulation, found on shuspace| Rules and Regulations| Conduct and Discipline

Signature: Date Submitted: 19/03/2020 -----------------------------------------------------------------------------------------------------------------------------------------------------Learning contracts If you have a learning contract recommendation for adjusted marking you will need to use blue stickers to alert the tutor to this. You must attach a blue sticker on all your assignments and exam scripts. If you submit work electronically you must type the wording of the sticker in blue on the front of your assignment where tutors can easily see it.

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Communication is a fundamental aspect of the nursing and healthcare profession, underpinned by theory applicable to practice. In Children’s Nursing, this is particularly important and closely relates to family-centred care. This assignment will focus on a challenging communication scenario from clinical practice and discuss the following: the socio-psychological science and theory behind patient and family reactions, communication science, whilst analysing the scenario and possible resolutions.

The scenario chosen focuses on a 16-year-old patient, ‘Molly’. To protect her confidentiality a pseudonym has been used in accordance with the Nursing and Midwifery guidelines (Nursing and Midwifery Council, 2018). Molly had been an inpatient on the paediatric oncology ward for a long period of time and was post bone-marrow transplant. Unfortunately her transplant had failed and she developed Graft-versus-host disease (GVHD). During her time on the ward, Molly and her family came to the tough decision that she would begin end-of-life care. This assignment, following the unfortunate death of Molly, discusses the understandably challenging behaviour from her family. Molly was surrounded by family members when she died, however for the purposes of this assignment, her parents will be focused on. Molly’s mother became extremely distressed and began to scream, cry and beg for her to come back. Whilst Molly’s father appeared to remain calm and collected, focusing on practicalities such as organisational tasks. This scenario was challenging for all staff involved emotionally, physically and in terms of communication.

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To full understand and analyse parental reactions in the chosen scenario, it is imperative to discuss psychological theory underpinning this. Psychology involves the study of human behaviour, thought processes and emotions. The study of this allows nurses to understand how people’s needs differ, ultimately gaining a better understanding of communication processes to enhance the therapeutic relationship. (Walker, Payne, Jarrett, & Ley, 2012). The death of a child is one of the most traumatic and stressful events for parents, with grief being unique for each individual affecting all aspects of their life (Aho, Tarkka, Kurki, & Kaunonen, 2006; Cowles, 1996; Jacob, 1993; Bergstraesser, Hornung, & Landolt, 2015). It is therefore essential to incorporate psychology into the process of understanding why Molly’s parents acted in this way, to know how best to support them, with evidence showing that bereavement can be associated with psychological illness (Hendrickson, 2009; Li, Laursen, Precht, Olsen, & Mortensen, 2005).

Different psychological perspectives can offer sound explanation for the way people react in certain situations. The psychodynamic approach focuses on the ‘inner-self’, suggesting that behaviour is determined by unconscious thoughts, memories and feelings (Gross & Kinnison, 2007). The psychodynamic approach could offer explanation for Molly’s mother’s distressed behaviour. Freud would suggest that this is behaviour that is not controlled by her conscious memory, and a solution to support her is through psychotherapy such as rational emotive therapy (RET) (Freud, 1914). However, this approach has been criticised for being unscientific and therefore unreliable (Scodel, 1957; Gross & Kinnison, 2007).

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In contrast, the Humanistic approach focuses on the idea of free will and suggests that people have the ability to choose how to act (Gross & Kinnison, 2007). This takes a phenomenological approach to grieving, taking into consideration the subjective experiences of the bereaved- Molly’s parents. This approach focuses on the use of personcentred care in providing support, and nurses have the ability to carry this out in their use of communication in the therapeutic conversation (Nye, 2000) (Gross, 2005). When considering Molly’s fathers reaction- the Humanistic approach could be used to explain his lack of emotion and desire for practicality. It would suggest that he is choosing to behave in this way and the therapeutic support from nurses and other health professionals in the multidisciplinary team (MDT) would be fundamental in him coming to terms with the death of Molly.

Bowlby’s phase theory of grief offers a model of predicted behaviour for Molly’s parents with four main stages; Phase of numbing, Yearning and Searching, Disorganisation and Despair, Reorganisation (Bowlby, 1980). This model of grief focuses on the idea of attachment and separation anxiety. Nurse awareness of this model is useful in understanding why Molly’s mum is so distressed- she is in the phase of numbing, which can be shown by intense outbursts of extreme distress (Gross & Kinnison, 2007). However, although Bowlby’s phase theory of grief is widely used, questions have been raised regarding the generalisation of it due to the wide range of individual reactions to death (Stroebe, Stroebe, & Hansson, 1993). It is difficult to relate this model of grief to Molly’s father as he

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does not show behaviours suggested in the ‘phase of numbing’ stage. However, it has been shown that fathers tend to bottle up their feelings and are skilled in masking their emotions, often feeling that it is their duty to stay strong (Aho, Tarkka, Kurki, & Kaunonen, 2006; Pelchat, Lefebvre, & Levert, 2007).

This psychological knowledge allows nurses and other members of the MDT to tailor their care to the needs of the parents. Psychological support discussed previously could be offered when supporting parents after Molly’s death and during this challenging time. When making a support plan with parents, nurses should discuss options such as opportunities to talk to professionals and local bereavement groups that may be a source of support, giving them time to talk and share their feelings (National Institute for Health and Care Excellence, 2019). However, some families such as Molly’s show different expressions of mourning and wish for privacy at this time. Therefore, nurses can support them by offering an appropriate space for this such as closing of doors or moving them to a more private environment, recognising that there is no right or wrong way to grieve (Mullen, Reynolds, & Larson, 2015).

Good communication is paramount in the delivery of quality care to Molly’s parents, however there can be difficulty establishing open communication and mutual goals with a distressed family (Mullen, Reynolds, & Larson, 2015; (Price, McNeilly, & Surgenor, 2006). Therefore, communication strategies need to be considered in order to effectively engage with the family. Communication in children’s nursing has strong links with family centred 5

care- care that is planned around the whole family, not just the child (Shields, Pratt, & Hunter, 2006). To provide this physical, psychosocial and spiritual care nurses need excellent communication skills and knowledge of appropriate models and interventions (Beckstrand, Rawle, Callister, & Mandleco, 2010; Janzen, Cadell, & Westhues, 2004; Stevenson, Achille, & Lugasi, 2013; Meyer, Ritholz, Burnes, & Truog, 2006; Gilmer, Foster, Bell, Mulder, & Carter, 2012). Active listening in this scenario is key and involves asking questions, paraphrasing responses and acknowledging feelings to encourage dialogue from those who are grieving (Rushton, 2005; Curtis, 2004; Stone, Patton, & Heen, 2010; Stanley, 2002). Active listening was used with Molly’s mother through the use of questions such as ‘is there anything I can do for you?’. There is a temptation to say that ‘Molly is in a better place now’ however it is important to avoid statements like this as it can be perceived by parents as diminishing Molly’s value (Wender, 2012). It is particularly important to be mindful of what is said to Molly’s parents at this time of crisis as they may remember for years the pain and anger from any insensitive communication (Basu, 2013).

Non-verbal communication is another fundamental aspect of successful communication with Molly’s distressed parents (Meert, Eggly, & Pollack, 2008). Physical presence, body language and eye contact all contribute towards the acknowledgment of Molly’s parents vulnerability and offer a supportive stance (Travaline, 2002; Lipson & Dibble, 2005). Techniques such as facial expressions were used when caring for Molly’s parentscompassionate expressions can offer sincerity when offering condolences to them and is often appreciated by families (Brooten, Youngblut, & Seagrave, 2012). Eye contact was

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another important aspect in supporting the parents, showing active listening to their emotions (Meert, Eggly, & Pollack, 2008; Travaline, 2002).

SURETY is a model to help facilitate the therapeutic relationships through using non-verbal communication. 1. Sit at an angle to the family, creating a non-confrontational and comfortable seating arrangement conducive to one-to-one discussion (Stickley, 2011). 2. Uncross arms and legs, research shows that sitting with arms and legs crossed can suggest defensiveness and a lack of interest (Stickley, 2011). 3. Relax, it is important for the nurse to take a relaxed stance, leaning in slightly to demonstrate active listening. 4. Eye contact, this is a powerful communication method particularly when the family members are distressed as this can show encouragement and support (Stickley, 2011). 5. Touch, sensitive use of touch can often be useful in conveying compassion and empathy, but this must be done with caution (Burrai, Cenerelli, & Bergami, 2009). 6. Your intuition, it is imperative for nurses to trust their own intuition and so the model should be applied however they feel it is best done (Smith, 2009; Traynor, Boland, & Buus, 2010).

To try and support Molly’s parents, the nurse could acknowledge and offer the parents time to spend with Molly, respecting their values and wishes such as helping bathe, dress and do last offices for her (Mullen, Reynolds, & Larson, 2015). This has been highlighted as a key thing for parents who have lost a child, as research shows that it is imperative for parents to have enough time with their deceased child and to not feel rushed (Meert, Briller, Schim,

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Thurston, & Kabel, 2009). Doing this gives parents a sense of control over the situation, highlighting that grief is not about forgetting that member of the family but reintegrating them back into the family in a different, more spiritual way (Foster & Gilmer, 2008).

Resolving challenging communication scenarios can involve multiple methods of communication and psychological support depending on the issues raised. In this scenario, it was imperative for psychological considerations to be taken into account due to the nature of the situation, the use of non-verbal communication and person centred care was paramount in resolving this challenging situation with Molly’s parents and nurses were able to support parents in enjoying their last moments with their daughter through these mechanisms.

In conclusion, it is evident that understanding psychological aspects of nursing is fundamental in any challenging scenario. The humanist and psychodynamic are just two of many schools of thought in terms of psychology, Molly’s parents behaviour were understood deeper by gaining knowledge of these perspectives. Along with psychological science, the knowledge of different communication techniques used to de-escalate challenging situations has been useful not only for reflection on this scenario but for future practice as a children’s nurse. It is inevitable that nurses will come across challenging communication with patients, family members and other staff. Therefore with the knowledge of different methods, such as SURETY and the importance of active listening, this can alleviate anxieties around dealing 8

with such events. Molly’s parents were successfully supported by nursing staff to come to terms with their situation and this was done through the use of some of the methods discussed. In reflection of the scenario, the SURETY model could also have been used to deescalate these emotions, whilst providing that all important therapeutic relationship.

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References Aho, A., Tarkka, M., Kurki, P., & Kaunonen, M. (2006). Fathers' grief after the death of a child. Issues in Mental Health Nursing, 27, 647-663. Basu, R. (2013). End-of-life care in pediatrics: ethics, controversies, and optimizing the quality of death. Paediatric Clinicians North America, 60(3), 725-739. Beckstrand, R., Rawle, N., Callister, L., & Mandleco, B. (2010). Paediatric nurses' perceptions of obstacles and supportive behaviours in end-of-life care. Journal of Critical Care, 19(6), 543-552. Bergstraesser, E., Hornung, R., & Landolt, M. (2015). Dyadic Coping of Parents After the Death of a Child. Death Studies, 39, 128-138. Bowlby, J. (1980). Attachment and Loss. London: Hogarth Press. Brooten, D., Youngblut, J., & Seagrave, L. (2012). Parent;s perceptions of health care providers actions around child ICU death: what helped, what did not. Journal of Hospital Palliative Care, 30(1), 40-49. Burrai, F., Cenerelli, D., & Bergami, B. (2009). International therapeutic touch: energy-based nursing practice. Nursing Perspectives, 9(1), 21-28. Cowles, K. (1996). Cultural perspectives of grief: an expanded consept analysis. Journal of Advanced Nursing, 23, 287-294. Curtis, J. (2004). Communicating about end-of-life care with patients and families in the intensive care unit. Critical Care Clinicians, 20(3), 263-280. Foster, T., & Gilmer, M. (2008). Continuing bonds: a human response within paediatric palliative care. International Journal of Palliative Nursing, 14(2), 85-91. Freud, S. (1914). Remembering, Repeating and Working through. The Standard Edition of Complete Psychological Works of Sigmund Freud. London: Hogarth Press. Gilmer, M., Foster, T., Bell, C., Mulder, J., & Carter, B. (2012). Parental perceptions of care for children at end of life. Journal of Hospital Palliative Care, 30(1), 53-58. Gross, R. (2005). Psychology: The Science of Mind and Behaviour. London: Hodder Arnold. Gross, R., & Kinnison, N. (2007). Psychology for Nurses and Allied Health Professionals: Applying Theory to Practice. Kent: Hodder Arnold. Hendrickson, K. (2009). Morbidity, mortality, and parental grief: a review of the literature on the relationship between death of a child and the subsequent health of parents. Palliative and Supportive Care, 7, 109-119. Jacob, S. (1993). An analysis of the concept of grief. Journal of Advanced Nursing, 18, 17871794. Janzen, L., Cadell, S., & Westhues, A. (2004). From death notification through the funeral: bereaved parents' experiences and their advice to professionals. Omega, 48(2), 149164. Kubler-Ross, E. (1969). On Death and Dying. London: Tavistock/Routledge. Li, J., Laursen, T., Precht, D., Olsen, J., & Mortensen, P. (2005). Hospitalisation for mental illness among parents after the death of a child. The New England Journal of Medicine, 352, 1190-1196. Lipson, J., & Dibble, S. (2005). Culture and Clinical Care. San Francisco: UCSF Nursing Press. Meert, K., Briller, S., Schim, S., Thurston, C., & Kabel, A. (2009). Examining the needs of of bereaved parents in the pediatric intensive care unit: a qualitative study. Death Studies, 33(8), 712-740. 10

Meert, K., Eggly, S., & Pollack, M. (2008). National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Parents' perspectives on physician-parent communication near the time of a child's death on the pediatric intensive care unit. Pediatric Critical Care Medicine, 9(1), 2-7. Meyer, E., Ritholz, M., Burnes, J., & Truog, R. (2006). Improving the quality of life care in the paediatric intensive care unit: parents' priorities and recommendations. Pediatrics, 117(3), 649-657. Mullen, J., Reynolds, M., & Larson, J. (2015, December). Caring for Pediatric Patients' Families at the Child's End of Life. Critical Care Nurse, 35(6), 46-55. National Institute for Health and Care Excellence. (2019, July). End of life care for infants, children and young people with life-limiting conditions: planning and management. Retrieved February 2020, from NICE: https://www.nice.org.uk/guidance/NG61/chapter/Recommendations#emotionaland-psychological-support-and-interventions Nursing and Midwifery Council. (2018, October). The Code. Retrieved February 2020, from Nursing and Midwifery Council: https://www.nmc.org.uk/standards/code/read-thecode-online/#third Nye, R. (2000). Three Psychologies: Perspectives from Freud, Skinner and Rogers. Belmont CA: Wadsworth/Thompson Learning. Pelchat, D., Lefebvre, H., & Levert, M. (2007). Gender differences and similarities in the experience of parenting a child with a health problem: current state of knowledge. Journal of Child Health Care, 11(2), 112-131. Price, J., McNeilly, P., & Surgenor, M. (2006). Breaking bad news to parents: the children's nurse role. International Journal of Palliative Nursing, 12(3), 115-120. Rushton, C. (2005). A framework for integrated pediatric palliative care: being with dying. Journal of Pediatric Nursing, 20(5), 311-325. Scodel, A. (1957). Heterosexual somatic preference and fantasy dependence. Journal of Consulting Psychology, 21, 371-374. Shields, L., Pratt, J., & Hunter, J. (2006). 'Family-centered care: a review of qualitative studies'. Journal of Clinical Nursing, 15, 1317-23. Smith, A. (2009). Exploring the legitimacy of intuition as a form of nursing knowledge. Nursing Standard, 23(40), 35-40. Stanley, K. (2002). The healing power of presence: respite from the fear of abandonment. Oncology Nursing Forum, 29(6), 935-940. Stevenson, M., Achille, M., & Lugasi, T. (2013). Pediatric palliative care in Canada and the United States: a qualitative metasummary of the needs of patients and families. Journal of Palliative Medicine, 117(3), 649-657. Stickley, T. (2011). From SOLER to SURETY for effective non-verbal communicaton. Nurse Education in Practice, 11, 395-398. Stone, D., Patton, B., & Heen, S. (2010). Difficult conversations: How to Discuss What Matters. New York: Penguin Group. Stroebe, M., Stroebe, W., & Hansson, R. (1993). Contemporary themes and controversies in bereavement research. In M. Stroebe, W. Stroebe, & R. Hansson, Handbook of Bereavement Theory, Research and Intervention. New York: Cambridge University Press. Travaline, J. (2002). Communication in the ICU: an essential component of patient care. Journal of Critical Illness, 17(11), 451-456. 11

Traynor, M., Boland, M., & Buus, N. (2010). Autonomy, evidence and intuiton: nurses and decision-making. Journal of Advanced Nursing, 66(7), 1584-1591. Walker, J., Payne, S., Jarrett, N., & Ley, T. (2012). Psychology for Nurses and the Caring Professions. London: McGraw-Hill Education. Wender, E. (2012). The Committee on Psychological As...