In contemporary nursing practice, nurses need to integrate scientific knowledge and nursing theories prior to providing optimal health care. Nursing theories guide nurses to treat clients in a supportive and dignified manner through client centred approaches. However, it is challenge for nurses to practice client centred care in daily realities due to heavy workloads. In order to assist nurses to decrease the gap between ideal and real practice, Registered Nurses Association of Ontario (RNAO) develops Best Practice Guideline of Client-centred-care (Neligan, Grinspun, JonasSimpson, McConnell, Peter, Pilkington, et al., 2002). This guideline offers values and beliefs as foundation of client-centred care, and the core processes of client-centred care can facilitate provision of optimal nursing care. These four core processes of client-centred care include identifying concerns, making decisions, caring and service, and evaluating outcomes. According to RNAO (2006), ongoing dialogue with clients and self-reflection are essential for nurses to develop their nursing skills and knowledge on client-centred care. As a nursing student, I reflected on written transcripts of interactions between patients and me, so that I could gain insights into client-centred care for further improvement. Therefore, the purpose of this paper is to discuss importance of the core processes of client-centred care in nursing practice through identifying and critiquing blocks to conversation. Based on the guideline of RNAO (2006), respect, human dignity, clients are experts for their own lives, responsiveness and universal access will be elaborated in each core process of client-centre care as reflecting on three dialogues with patients.
The purpose of identifying clients’ needs and concerns is to obtain particular knowledge about clients’ lives with illness; furthermore, truly listening and using open-ended questions can facilitate this process (Stickley & Freshwater, 2006). Through reviewing and critically reflecting on my three dialogues with patients, I have heightened my awareness of seeking patients’ needs and concerns as initiating the first nurse-patient encounter. In dialogue 1, blocks and closed-ended questions became obstacles for me to identify the patient’s concerns and needs. For example, when the patient stated he “slept on and off”, I did not seek for the depth and clarity of his answer. Instead, I switched the topic to my pain assessment through applying closed-ended question. According to Stickley & Freshwater, therapeutic listening is to identify the potential information that clients would express to nurses by noticing the tone of voice or the facial expression (2006). In the situation of dialogue 1, I should recognize that the patient would convey his sleep problem through performing therapeutic listening.
However, I developed my communication skills via applying open-ended...