Marcus Engle was freshman in college when he got into a car accident that changed his life forever. With decreased physical ability and inability to see, Marcus had to find a way to adapt to theses modifications to this life. Most importantly, this life changing experience helped to analyze all effective and ineffective forms of communication he experienced while he was in the hospital. In his book “I’m Here” he talks about it is important establishing an effective therapeutic relationship between healthcare provider and the patient because it will help them work together towards a common goal, patient’s ealth goals.
Unlike social relationship, this relationship is dynamic, client focused, and client’s goal oriented to enhance patient outcome. Social relationship is an interpersonal relationship, which is not allowed in health care, because it’s intimate, and mutual (deliberates about both sets of goals, needs & feelings). Social relationship can be seen between Marcus and his parent or Markus and his friends. The boundaries are less defined and both individuals benefit from the relationship.
The boundaries that are set in a therapeutic relationship to focus on the patient and the healthcare provider hould not disclose any personal information. Nurse Barb was able to build a therapeutic relationship with Marcus by built connection through respect, empathy, confidentiality, trust, and being genuine. In chapter three, Barb initiates nurse-patient relationship by introducing herself to Marcus, which is also known as orientation phase in Peplau’s theory on how nurse- patient relationship is initiated.
In this phase, Barb and Marcus are strangers to one another, and they must develop partnership to address the health problems Marcus is facing. Barb uses this stranger role to make small talk to get to know Marcus and providing a climate that promotes trust by showing interest in his life (Engle, 25). She does this through telling Marcus that he has the best team possible caring for him, which helps Marcus feel that he is “under the care of competent and quality individuals” (Engle, 28).
By the end of the day, Barb moves to working phase where she and the Marcus share ideas and expectation for this relationship to devolve a nursing care plan. It is at this moment the boundaries are set between patient and nurse, for this to be a therapeutic relationship Barb must focus on the patient and the she should not disclose any ersonal information that make her feel uncomfortable. Only information Barb disclosed to Marcus was how long she has been a nurse and that she has a son around the same age as Marcus. This helps to build a connection between Barb and Marcus.
As a nurse, Barb, understands that Marcus is a teenage, like her son, and she tries to empathize with him. Any time Marcus needs something he calls for Barb because she always helps him without making him feel like he is a burden on her; she identifies his problem and resolves it, which is also known as resolution phase in Peplau’s theory. A really good example of this is when Marcus has an accident (soils himself) and Barb cleans him up without making it into a big deal (Engel, 33). At the end of each task, Barb always lets him know that she is done and asks if he needs anything else.
Every task is like a short- term relationship between patient and healthcare provider, which must have initiation and termination phase for it to be therapeutic. Barb makes Marcus feel as though he is a big part of this healing process, which add to a relationship being therapeutic. At the end of his stay at the hospital, the health are providers’ (such as Barb) and patients’ (Marcus) relationship comes to an end because that is the evolution that must be taken by all nurse-patient relationship, this is known as the termination phase.
Because nurse-patient relationship is a professional, it ends when the patient meets their health goal or helps patient set a new goal. Building therapeutic relationship is critical because it helps the patient leave with a feeling of being incorporated in their health care process, but also satisfied with the cared they have received. Two healthcare workers stood out o me because they were practicing helpful techniques. Dr. Dennis Fuller, speech pathologist used therapeutic technique with Marcus.
When Marcus spoke his first word, he knew that he was slurring and not speaking as clearly as he used to before the accident. Marcus at this moment felt defeated and states “it’s awful” (Engel, 68). Dr. Fuller responded by saying “you can’t expect miracles on the first day” (Engel, 68). Which gave Marcus hope that he will one day be able to speak mo did today. Dr. Fuller wanted to give Marcus realistic goals, helping him take one step at a time. Another helpfully technique as practiced in this book was when Dr. Beehner came to unwire Marcus’ jaw.
During their whole interaction, the doctor directed all question to Marcus and talked to him, making him feel like he is a vital part of this healing process. Dr. Beehner created this feeling in Marcus through the use of pronouns like we, us, and our (Engel, 114-17). Giving the patient that you as a health care provider want the same thing they do is very important. These two techniques help Marcuse positively respond to the treatment because he felt like he was part of the team. However, there were some techniques used by some of he health care providers that I did not think were helpful.
One example is in chapter eleven, when the doctor comes into the examination room and doesn’t introduce himself or acknowledge Marcus. As a patient, Marcus felt like he was an inanimate object because he “starched out this hand towards” doctor “but he doesn’t take it” (Engel, 48). He felt like he was being passed around from one health care provider to the next without knowing who was coming into the room and who was leaving. First impression always is favored my people and it is important form healthcare individuals to leave the best mpression possible on their patients.
The way one can do this is by introducing themselves to the patient when they first come into the room, even if they are in there for few minutes (Engel, clearly than he 45). Another example of a nontherapeutic communication was when the physical therapist, Jamie, came to Marcus’ room and told him she would be come back later, but she never did (Engel, 110-13). This is not a helpful technique because as a healthcare worker are supposed to establish a trust between them and the patient but Jamie did the opposite. These two examples should elp health care workers be more aware of their verbal and nonverbal communication with patients.
The two most critical learning points for me was when Marcus started that as healthcare providers we should always ask if the patients has any question at the any meeting because, patient might not understand all medical terminology used every day in health care (Engel, 54-7). Another key learning point for me from this book was when the doctors asked Marcus about his feeling about a treatment he was receiving, even though they might know how the treatment is making Marcus feel, they still give im a chance to have an input (Engel, 120-23).
These two techniques stood out to me because they actively involve the patient, not only making sure the patient understanding all the information health care provider shares with them, but also listening to what they have to say. The way I would integrate this into my nursing practice is by always making sure I ask the patient if they have any question and always giving them a change to have an input. By reading this book, I have learned that the use of therapeutic communication is important to make sure patient health goal has been accomplished.