Developing Professional Practice using Gibb’s Reflective Cycle
Challenging communication encounter
Last semester, I attended my Complex Care Nursing placement in the Coronary Care
Unit. One of the clients was a fifty three year old woman, and a Muslim. The patient had been
admitted to the ward on 16th July, 2012 with arteriosclerosis. The patient spoke French fluently
and only understood and spoke few English words. My male colleague could have translated
what the woman was saying, but she could not agree to being attended to by male professionals.
She could not communicate effectively in English, and for us to communicate therefore; one of
her family members had to be present for translation. In case her family members were
unavailable, I had to try my best and communicate with her all by myself. Moreover, the patient
never wanted to be attended to by male nurse. My male colleague could therefore, not attend to
her. I had to take care of this patient all by myself.
I realized that when the male colleague accompanied me to attend to the woman, she
never made attempts to express herself or she refused to talk. Sometimes, the patient became
aggressive and resulted to talking to herself. While on duty one morning, I saw the patient trying
to come out of bed, and she had been given a bed rest. I walked up to her and motioned that she
should not come out of bed. She shouted in French at me. Although I did not understand what
she was saying, I guessed that she was telling me to leave her alone to do what she wanted. I
called my male colleague to tell her that if she got out of the bed, her discharge would be
delayed. Even though, she disliked the idea of being addressed to by a male nurse, she paid
attention and made efforts to get back to bed. After that, she was always obedient to what I told
her so that she would be discharged quickly. She became my friend from then and always
enquired of the day she would be discharged. She talked to me in French always thinking that I
Developing Professional Practice 2
understood. I used nasal- gastric tubes to feed her every morning, and she was almost healed by
the time I finished my placement. The encounter has impacted on me tremendously in realizing
that effective communication is principal to the health outcomes of the patient, and that language
influences effective communication. The patient shall be referred to as MBN.
Stages 2, 3, 4 and 5
Feelings
The patient had been in the ward for two weeks by the time I finished the placement. I
felt happy that the patient had learned to obey my instructions even though she never heeded to
instructions at the beginning. Considering that she only knew French, it was difficult to
communicate with her using the few English words she knew. I felt sorry the patient could not
express her feelings to other patients and people in the ward. No one understood her. Language
barrier rendered the patient vulnerable. Both the general public and the nursing profession expect
nurses to have the ability to communicate effectively with patients so as to achieve desired
patient outcome (Davis, 2004).
Evaluation
In my reflection, I realized that people who do not have a common language and are
trying to communicate faced a lot of difficulties. Cheek and Gibson (1996) argues that language
barrier is likely to lead to medical errors in health facilities by impending provider patient
communication. Being a student, I felt extraordinarily sensitive as far as patient needs are
concerned. The notion of individualized care approach based on the individual’s unique needs
was uppermost in my thoughts as I approached MBN to interact with her. After the reflection, I
now know that language expertise is principal to effective communication. According to Street
(1995) language barriers are linked to lower patient satisfaction and less health education.
Developing Professional Practice 3
Research shows that patients who converse in different languages from their doctors have a less
likelihood of receiving lifestyle counseling on exercise, diet and smoking cessation. Considering
that MBN had a heart condition, it is extremely essential that she received lifestyle counseling on
how she can manage the condition. According to DeFleur, Kearney and Plax, 1993), access to
clinical interpreters ensures health education and overcomes language barrier partially. Patients
who are able to talk to their doctors directly are more satisfied.
Analysis
After analyzing the entire situation, I released that language barrier and religious beliefs
impact considerably on the patient’s health outcomes. One impact of international migration is
that professionals in health care institutions face a wide array of patients with whom they have
no common language (Atkins and Murphy, 1994). At the same time, they are required to offer
health care of the highest quality to patients as expected by human equity and right principles.
It is worth noting that patients using interpreters get better health outcomes (Stephenson,
1993). Studies indicate that religious beliefs and language barrier should not be ignored in
conventional healthcare services (Jay, 1995). This is due to the fact that they produce substantial
long term costs if ignored. A nurse in a Coronary Care Unit has a role of communicating
effectively with patients. Therefore, it is noteworthy that a common language exists between the
patient and health care provider. I am now aware that a common language between nurses and
patients plays a truly vital role in communication. This in turn, is reflected in positive patient’s
health outcome (Johns and Graham, 1996).
Literature review
All incidents are critical and the action taken can lead to ineffective or effective outcomes
(Haddock and Bassett, 1997). As a student nurse, I had to consider the patient’s character,
Developing Professional Practice 4
limitations, strengths, qualities, values and beliefs so as to be able to offer quality care. It
involves knowing all surrounding factors that can hinder quality care (Beattie, Check and
Gibson, 1996). It is extremely critical that health care systems should train and recruit additional
bilingual providers so as to satisfy patient needs. Health care professionals should be taught
languages spoken by the surrounding nations so that effective care is given to the neighbors who
at times visit the health facilities (Schon, 1983). Miscommunication results from the language
barrier and it results to grave catastrophes. Because of the communication I had with MBN even
though impaired, it did marvelous in helping him get bed rest and take her drugs, therefore,
recover quickly (Gibbs, 1988).
Culturally appropriate communication is necessary in health care setups (Kolb, 1984).
Nurses providing health care should focus on culturally safe care, transcultural nursing and heath
care systems that are culturally competent. In ensuring health care systems that are culturally
competent, it is indispensable to offer health care settings that are culturally specific. Interpreters
come in handy in such situations as well as culturally diverse staff. Patients and staff need to be
educated using the language and culture of the community. This ensures counseling and diet
advice given relates to the needs of the community. The instructional and signage literature used
should be done using the client’s language (Gibbs, 1988).
When counseling patients; consider the dietary, religious, and health practices and beliefs
in order to offer beneficial advice. For instance, planned treatment or care may be at a time when
some religious practices of festivals are happening. The patient may not concentrate on the
advice being given as they are preoccupied with the festivals. Food consumed varies depending
on religious restrictions. When giving dietary advice, alternative foods should be mentioned so
as to ensure the patient gets the necessary nutrition.
Developing Professional Practice 5
Cross-cultural communication consumes a fabulous deal of effort and time. There is the
possibility that a patient is mentally translating what is being said and forming responses before
answering (Palmer, Burns and Bulman, 1994). Therefore, family members can be involved in
the conversations and more time given to clients before they answer.
Action plan
Cooperation amongst health care providers
My plan of action is to work always together with other health care professionals, and as
part of them so as to ensure positive patient health care results. In addition, I will have an interest
in learning more about communication and language. Being familiar with other languages is
tremendously valuable as one can assist in a situation where there is communication barrier.
Even if, not attending to a patient, talking to patients using their language lifts their spirits,
especially when from different nationalities.
Professional training schools
I will influence health care decision makers so that they start teaching other languages in
professional training schools. Moreover, I will arrange short courses for practicing health care
professionals where they can teach other the basic words in other languages, as well as facial
expressions and sign language (Schon, 1983). This is because facial expressions and sign
language imply different things depending on one’s culture. A sign may mean different things
depending on the culture. This can be accomplished through dissemination and research
publications on a regular basis during health managers’ meetings.
Interpreters
In cases where there is a language barrier, interpreters can help improve the quality of
health care provided. It is crucial to inform clients that interpreters are available at no cost. Some
Developing Professional Practice 6
clients have the notion that they be charged if they seek the assistance on an interpreter. In
addition, clients may not know that they can use the services of an interpreter or may not know
the process of requesting for one. Ghaye and Lillyman (2000) assert that there are many factors
to consider before deciding to seek an interpreter. Some clients are sensitive about confidentiality
and their English proficiency level. Clients should therefore, be asked whether they require the
services of an interpreter. In instances where the client is unable to answer straightforward
questions since they do not understand what is being asked, an interpreter should be sought.
Interpreters are used for various reasons (Gibbs, 1988). Among these are accountability,
confidentiality, impartiality, accuracy, integrity, ethical and accreditation reasons.
Interpreters should have the ability to converse with patients using even sign and body
language so that they understand what critically ill patients are communicating. Interpreters can
be the staff, on the telephone or on call.
Government policies
Effective government policies ensure that patients are provided with the best health care
services irrespective on their linguistically and culturally varying backgrounds. It is worth noting
that the marginalized and vulnerable groups in the society face a lot of health problems. Health
disparities have roots in social structural inequalities, such as discrimination and racism. Implicit
or overt discrimination is against human rights principles. Government approaches should be put
in place to ensure that linguistically and culturally different backgrounds, access quality health
care (Fitzgerald, 1994).
Intercultural communication:
So as, to curb the cultural challenges in health care provision, practitioners require a wide
range of cultural competence skills. Cultural differences exist in both verbal and nonverbal
Developing Professional Practice 7
communication. I will put measures in place to ensure health care professionals have the key
skills necessary to ensure effective communication. These include patience/ lack of hurriedness
when speaking to the patient, showing respect and social introduction. To ensure the providers
gain these skills, manuals will be given to them so that they go through them, and practice during
medical rounds. In addition, more detached or personalized interaction modes will be used,
choose indirect versus direct approaches, and touch, proxemics and silence therapeutic use.
Health care providers have to be particularly keen when selecting the communication model to
use for particular patients. For instance, indirect communication is more preferable for Hispanic
and Native American patients, as opposed to instruction and direct questioning.
The indirect approach could have worked extraordinarily well for MBN. I had the
responsibility of interacting with the patient as an equal as opposed to an authority. The patient
becomes more open when the conversation is based on a personal and equal level. When
speaking with the patient, immediate or direct responses should not be expected. In addition, ties
can be established through common locations, friends and relatives. This was the case with MBN
when a family member used to translate for me. Indirect referencing should be used when
advising the patient. For example, saying “a person who has arteriosclerosis might have the
following risks.” This creates awareness in the patient without having them pity themselves too
much, as would have been the case when using direct referencing. Health care institutions should
ensure that their workers have the skill to avoid confrontation and incorporate humor when
discussing serious matter with the patient. This aims at providing balanced communication. I will
ensure that workers can correct their colleagues or teach them the skills necessary to provide
quality health care, without receiving negative responses and attitudes.
Cultural assessments
Developing Professional Practice 8
A cultural assessment refers to a systematic and focused appraisal of practices, values and
beliefs aimed at determining the substance and context of client needs. Consequently, the best
health interventions are evaluated and adapted. Cultural assessment is necessary during
evaluation, intervention and problem identification. Irrespective of the fact that cultural
assessments do not tackle all cultural aspects, they are effective with elements related to problem
identification, the most effective intervention and evaluation (participatory). The views that the
family and client have regarding the optimal treatment choices are reviewed during evaluation.
It is necessary for hospital managements to ensure that their workers conduct cultural
assessments before selecting the intervention to be used. During the placement, I ensured that I
interacted with MBN adequately so as to identify all the cultural aspects that may affect her
treatment. This should be the case with student nurses and professional workers. Hospital
managements can do appraisals regularly to ensure the cultural needs of all their patients are
catered. Health providers require the skills to develop and select the most effective interventions
at every level of treatment. Interventions can be culturally neutral, innovative, sensitive or
transformative interventions. Providers will be equipped to all the knowledge so that they can
make effective decisions when dealing with patients.
In a nutshell, it is extremely significant that health care institutions focus on providing
care to clients in a culturally competent system. Hospital managements should initiate programs
that retain and recruit staff members who are keen about the community’s cultural diversity.
Health care settings that are culturally specific ensure satisfied health care needs. In cases of a
language barrier, the services of bilingual providers or interpreters can be sought for patients
having limited English proficiency. Cultural competence programs will form part of professional
training.
Developing Professional Practice 9
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