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Reflection on practice, “Just being there”. A retrospective evaluation of the nurse's role in unplanned counselling interaction using Egan’s Model.

Reflection on practice, “Just being there”. A retrospective evaluation of the nurse's role in unplanned counselling interaction using Egan’s Model.

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An essay for the 2012 Undergraduate Awards Competition by Sharon McDaid. Originally submitted for BSc Honours in General Nursing at Letterkenny Institute of Technology, with lecturer Kevin O Brien in the category of Nursing & Midwifery
An essay for the 2012 Undergraduate Awards Competition by Sharon McDaid. Originally submitted for BSc Honours in General Nursing at Letterkenny Institute of Technology, with lecturer Kevin O Brien in the category of Nursing & Midwifery

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Published by: Undergraduate Awards on Aug 31, 2012
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05/13/2014

 
Reflection on practice, “Just being there”. A retrospective evaluation of the nurse's role inunplanned counselling interaction using Egan’s Model.Reflective practice has become a keystone of modern nursing practice. Nurses are expected todeliver holistic care and perform varied roles within their practice and are often viewed as“experts”. However, within the therapeutic relationship it must be acknowledged that the patient is the expert when it comes to their own needs. They must retain control over their situation at all times and we as nurses are there solely facilitate their journey. Nurses are privileged to intimate details about those they care for and the utmost respect must be shown. This can be demonstrated by using varied verbal and non verbal communicationwithin a safe, private environment. Nurses subconsciously use non verbal communication toassess patient needs on a daily basis, whether physical or psychosocial. Analysis of thisinteraction and surrounding literature has identified several themes.Positives identified from this interaction include the finding that limited self disclosure can bean effective tool in developing rapport and demonstration of the core conditions. Also, theconcept of “just being there” and allowing the patient to tell their story are highly valuedroles that we cannot underestimate within our patients’ journey’s. These steps alongside personality, probative questioning and the use of leverage are vital tools we must employ tofacilitate the best possible outcome.Barriers that emerged were the time constraints placed upon the delivery of nursing care andthe subconscious power struggle between nurses and patients. This may manifest as the “sick role” and the stigma surrounding illness. These must not be underestimated as both havedirect inferences on the outcome for all parties involved. However, the most devastatingfinding from this interaction lies in the use of the professional role to hide behind and
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reluctance by “professionals “to admit that they do not have all the answers. This also lendssupport to the development of clinical nurse specialist roles within multidisciplinary team.The following reflects upon an interaction between a student nurse and patient who was facedwith a life altering, potentially life threatening diagnosis namely breast cancer. Samples fromthe dialogue have been included solely to lend support my assertions. Pseudonyms have beenused to protect the privacy of those involved.
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As nurses we are often in contact with patients during traumatic and devastating incidentsrelating to their health (Gilbert and Leahy 2007). Therefore we must be able to demonstrate acounselling role in order to help patients and their families cope with their diagnosis (YingChen and Hui Chen 2011). Van Vliet et al (2011) reinforce these requirements as they statethat healthcare professionals have a duty to assist their patients to develop new perspectivesrelated to their diagnosis. Egan (1998) model and The Person Centred Approach (Rogers1976) was utilised in this interaction and will be referred to in this text. Egan (1998) providesa model which may be useful to nurses who engage in the counselling process and it can beused to identify which stage of the counselling process the patient is at. However in order togauge which stage the client is at we must first engage into a counselling relationship.The Person Centred Approach (Rogers 1976) outlines that the counsellor must demonstratethe necessary core conditions for the relationship to develop. These conditions arecongruence, unconditional positive regard and empathy. When a patient presents in anincongruent state the counsellor promotes the actualising tendency by demonstrating theseconditions (Sanders et al 2009). The actualising tendency exists within us all and it is driven by the need to grow, develop and realise our actual potential. This insinuates that the patientknows best what the problem is and is best placed to solve these problems (Joseph 2003).The counsellor is there to facilitate the patients journey through t he crisis in order to restore astate of congruency (Stang and Mittlemark 2010).Upon reflection on practice I was reminded of a counselling interaction that took place whileon placement in a Day Services Unit. My duties on the day ward were the immediate postoperative care of my allocated patients and their preparation for discharge. After lunch Ireturned to the ward and given a very brief handover by the staff nurse in charge. In factdetails were limited to their patient names and procedures. Mrs Doherty was one of these
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