A STRUCTURED REFLECTION ON THE DEVELOPMENT OF A THERAPEUTIC RELATIONSHIP WITH A CLIENT In this essay, I am going to give a structured reflective account on the development of a therapeutic relationship with a client on one of my clinical placements as part of my training as a student nurse. I will be using a reflective model which explores the processes involved in developing and maintaining such relationships bearing in mind theoretical knowledge and how it applies to this clinical experience. Jasper (2003) describes reflective practice as one of the ways that professionals learn from experience in order to understand and develop their practice. As a trainee health care professional, I have learnt the importance of reflection in practice as a platform for judging one’s progress, strengths and weaknesses and also as a tool for appraising what went well during an intervention and what needs to be improved upon. Reflective practice is an important factor for nurses when building a therapeutic relationship with clients. Though this is essential in all nursing practices, it cannot be over emphasised in Mental Health nursing as this is based on quite a lot of understanding and trust between nurses and client. It is also now a respected and required learning and assessment method in many nursing programmes worldwide. The Nursing and Midwifery Council (NMC, 2008) requires nurses to keep knowledge and skills up to date throughout their working life. Considering the importance of clinical competence in the nursing profession, then it will suffice to say that reflection is an important tool in the nurse’s range of skills which aids the achievement and maintenance of clinical competence and performance (Mattews, 2004). I have chosen to use the Gibb’s, (1988) reflective cycle as a model of reflection to help me systematically analyse the experience better for the purpose of this essay and for future practice. This model is made up of six stages depicted as a cycle which supports the notion that learning is a continuous process as through reflection; we are able to continuously learn from our experiences and thereby improve our nursing practice in future. This cycle is made up of description of the event, the feelings that was experienced, an evaluation of that event, an analysis to make sense of the experience, a conclusion drawn about the experience and finally an action plan put in place in preparation of a future reoccurrence. Siviter, (2004) sees reflection as a way of gaining self confidence, identifying when to improve, the ability to learn from own mistakes and behaviour, looking at issues from the perspective of others and becoming self aware to improve the future by learning from the past. My client whose relationship I will be discussing is a seventy-two year old lady with a diagnosis of Dementia called Trisha. This is a pseudonym to protect her identity as necessitated by the code of conducts of the Nursing and Midwifery Council (NMC, 2004a). The clinical setting was a specialist care unit for older adults with Dementia, the incident involved issues around compliance with prescribed medication and the dilemma that ensued over what was an appropriate course of action to take as well as the effect it had on my relationship with Trisha. The therapeutic relationship that exists between a nurse and their client is built on a series of interactions which is developed over a period of time. Although not all interactions develop into a relationship they may still be therapeutic. This relationship is usually for the benefit of the client only and differs from social relationships as the Nursing and Midwifery Council (2004b) expects that at all times nursing staff must maintain appropriate professional boundaries in the relationships they have with patients and clients. It is time limited, goal oriented and in phases (Arnold & Boggs, 2003). Peplau (1952) describes the nurse – client relationship as the foundation of nursing...
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