Epstein and Hundred(2002) stated reflective practice as being a benefit for practitioner while using communication ,knowledge ,reasoning , emotions and values n the care provided to improve the service for clients and communities. In addition Duffy(2007) considers that reflective practice is an active process that uses critique to analyses the practice ,where the practitioner is challenged to self-enquire the practice experience to Improve professionally .
This reflective assignment of practice Is not Just my ability to analyses the case scenario ,glove sense to the events and draw a conclusion ,but an opportunity to predict what the practitioner need to Improve for future professional development (Epstein and Hundred,2002). Communication Communication it is a key aspect in day to day practice as a health visitor , purposely helps identifying the client needs and enable the practitioner to build in a short period of time relations .
Healthy Child Programmer (2009) highlighted the importance of different health professionals identifying health visitors for instance as one of the first point of contact for families during pregnancy and the first five years of a child life. Furthermore HCI (2009) identifies the importance of health visitors as trained and experienced health professionals that are working using a variety of skills including communication. This is in order to provide a universal reach service for parents and children with support and If necessary to access other services available when needed.
Dougherty and Leister (2008) define communication as a two way process that Involves verbal and non-verbal way to convey Information, knowledge and feelings. Scenario For the purpose of this assignment and to maintain the guidance of Nursing and Midwifery Code of Conduct (2008) with regards to confidentiality I will refer to the client in this scenario as Jenny. I met Jenny a mother of two in her twenties ,during a allow up visit with my mentor in a client home .
The purpose of the visit was to follow up Jenny’s moods and feelings as an initiative supported by the guidelines of Healthy Child Programmer (2009) with guidance for practitioner to use assessment of maternal mental health following child birth and ability of the mother to integrate and cope with family life Jenny had a past history of mild post-natal depression following birth of her first child, now two years old . An the new birth visit with her second child she had also showed signs and symptoms of feeling loss, low self- esteem and anxiety.
On the day of the evils I and my mentor found Jenny very angry, contact and seemed not interested and subsequently not eager to communicate. Analysis Gibson et al (2009) defines postnatal depression(POND) as an affective disorder occurring in women in the first year after child birth with various stages of mild depression where minimal intervention is required ,but which left untreated can lead to a stage of psychosis. Furthermore such situations will require multi therapy intervention and long term support.
As health visitors to understand if the client identifies with the condition there is a need of different forms of assessments to establish what form of help and support can be offered. Jeering and Yawn (2007) supports the need of screening for POND to improve the chances of clinical outcomes and suggests combining the screening with a system-based supplementary care to outline an accurate diagnosis and further focus on adequate treatment. The screening tool used by health visitors locally to assess signs and symptoms of POND is known as Edinburgh Postnatal Depression Scale (FEEDS).
This is considered effective with a positive predictive response identified from the use of the questionnaire(Beck and Gable,2001). However there is evidence from studies conducted by Lee et al (2000) showing that using a double-test strategy screening, combining FEEDS with General Health Questionnaire(GHZ) can improve identification of signs and symptoms of POND and in the same time potentially become more cost effective with a positive impact in reducing referrals to general practitioners or psychiatrists.
Further, Lee et al (2000) explained that FEEDS and GHZ even used together to support identification of signs and symptoms cannot stand as diagnosis of POND and further clinical evaluation is required to accurately diagnose. Myself and my mentor entered he house and observed that Jenny appeared to be very agitated and anxious explaining that she is not coping with two small children and she was blaming herself for not being a good mother .
Cooper et al (2007) explained that quite often POND is characterized by low mood, loss of interest in usually enjoyable activities with symptoms that include difficulty in sleeping, feeling of worthlessness or guilt and low energy. I observed my mentor spoke to Jenny using a soft tone of voice trying to assure her and saying that the purpose of the visit was to identify her problems and come up with positive solutions. Delivering HCI (2009) in practice is not an easy task for health visitor especially when promoting improvement in maternal mental health.
However clients have sometimes difficulty in comprehending information and therefore communication is paramount (DO, 2009). Recognizing client particular needs is very important part in the communication process as POND can have effects on the whole family including fathers hence the role of health visitors is to try to understand family dynamics using creative solutions for further counseling or treatment options (BETA, 2013).
According to Department of Health (2009) key aspects hat influence health visiting practice are outlined by the way practitioner promotes maternal mental health as lack of support for mothers can lead to POND and affect in long term the child cognitive and affective development . Furthermore Forman et al (2007) discusses important insides with reference to maternal depression as prevalent and the need of practitioners to focus more on mother-infant relationship in addition to maternal mental health assessment like FEEDS for example.
However during antenatal period can increase considerably risks of delay in child behavioral development. Furthermore explore the importance of assessment on maternal mental health during pregnancy as could be more effective long term in treatment and support outcomes for mothers and the whole family during postnatal period. Referring to our case scenario is important to outline that the aim of the conversation with Jenny was also to identify if her mental health problems and behavior could impose as a risk factor for her two children behavior and their cognitive development .
Jenny acknowledge that when she is at home on her own she finds it hard to deal with feeding the baby and as well to find time for her two year old daughter. Despite being difficult to address such an issue it is important to find solution as a practitioner to overcome communication barriers and identify the support tolls required to deliver the service. Department of Health (2012) outlines communication as one of the 6 Co’s in developing the culture of compassionate care and building successful client- practitioner relationships to have positive outcomes in the care offered.
Moreover focusing on overcoming barriers in communication process can become difficult for the health visitor to deliver the public health message but using different forms of communication can empower the clients and aka them feel valued (Department of Health, 2012). Eye Contact Exploring relationship with clients through communication is a major aspect in providing successful health visiting service and using different forms of communication like verbal and non-verbal can encourage clients to share their experience and discuss their health needs (Corcoran,2007).
Nonverbal communication or sometimes called body language including bodily contact, physical appearance, facial expression, eye contact, play a major role in the way practitioner communicates and convey or gain message from the clients (Andersen, 2007). In reference to the case scenario I found eye contact quite significant in promoting good communication with Jenny . Furthermore it is critical when talking to someone in distress like Jenny to give full attention and maintain eye contact as my mentor did and make Jenny to start feeling calmer, positive and more responsive (Freshwater, 2003).
As health visitors it is important to acknowledge that in practice nonverbal communication like eye contact plays a major role in understanding our intentions . Moreover (Knapp and Hall ,2007) explains that when the listener maintain ye contact with the speaker this shows that they are listening and acknowledge understanding on what the speaker is saying. It is difficult to define the normal eye contact and what entails is from person to person, but together with a positive face expression can support practitioner to introduce a conversation during visits.
However messages gained through eye contact can be misleading in interpretation and can lead to confusion in the process of communication (Freshwater, 2003). It was important to observe during our conversation with Jenny how eye contact was related as well with attachment behavior between mother and child . As a matter of fact if this aspect is hindered due to maternal depression become evident that attachment relationships will be compromised. In Jenny’s case it was important to observe her behavior towards her children and the eye contact made while the visit was ongoing (Gotten & Declare, 1997).
By avoiding eye contact with a baby for example due to mother’s ability to respond promptly can be affected (Weatherperson, 2000). At first Jenny avoided eye contact with both myself and my mentor maybe due to the fact she felt surrounded by professionals when she was already in a distress and anxious DOD and I felt that she was not able to predict the aim of the visit. However my mentor draw Jenny’s attention to strengths already present in her relation with her children and this facilitate changes in Jenny’s eye contact interactions with myself and my mentor (Davidson and Begley, 2012).
To get Jenny’s attention through non- verbal communication like eye-contact was quite difficult as she was looking away and I had the feeling that she was intimidated by my presence ,even though my mentor requested from her in advance consent for me to attend the visit . However Williams et al (2009) suggest that mothers with postnatal depression can communicate defensively in their interaction with others . Furthermore Poole et al(2006) explains that the health visitor can be seen as the practitioner who come to judge mothers ability to use appropriate parenting skills .
As this was the first time for me to meet Jenny I recognized importance of eye contact as a natural process in expressing nonverbal communication. However when Jenny expressed anger and distress maybe my reaction did not convey positivism and this did not support good listening skills (DO, 2011) . Non-verbal communication expressed through eye-contact and positive face expression will contribute to client understanding in the beginning of an important partnership.
Moreover Pancakes and Vine(2012) suggests that practitioner-mother relationship increase naturally extinction level(positive hormone)and this reaction reduces stress considerably. Through positive nonverbal communication like eye contact the practitioner supports attenuation of distress and difficulty in expressing feelings for the client. This is what Porgies (2011) resumed as smart avgas work. However when I discuss with my mentor Jenny’s visit experience he said that my eye contact levels were appropriate and acceptable but due to Jenny’s POND and subject of the conversation, these reactions were unavoidable.
As a result in the future I will be aware that different individuals react differently to this form of nonverbal communication like eye contact and for my future practice it is very important to understand how communication methods are understood in different ways by different people (Knapp,2007) . Active Listening The main responsibility of the practitioner as a listener is to encourage and enable the client to talk about their feelings, believes and attitudes . Moreover health visitor need to have the capability of active listening in a client-practitioner led conversation.
Jack et al (2002) defines active listening as the most important form of listening also known as empathetic listening. It further describes the positive relationship created when the listener is genuinely interested in what the speaker is saying but is also actively making sure they understand it so they can respond back to it. With active listening, the listener responds by restating their understanding of the message to the speaker. In this case scenario my mentor allowed Jenny to speak rely show assertiveness and focus attention using words such as “k” to demonstrate that she was listening .
The main goal of my mentor when used active listening during Jenny’s visit was to help Jenny express her concerns and understand her needs (DO,2011). Overseeing Jenny’s feelings, anger and emotion was a challenge in Jenny’s moods and improvement in her understanding was seen as she accepted therapeutic options offered as support for her situation (Smith &Horne, 2012). As listening is an active process it involves observing the nonverbal forms of communication used looking for the message not simply hearing the words being poke (Brown, 2011).
Therefore active listening can be used with success in situations where client is in distress or present signs of stress and anxiety and the practitioner need to prove efficiency in support emotions. Moreover Brown (2010) refer to this type of intervention as ‘Psycho-education’ where the health visitor support mothers with signs and symptoms POND using active listening to acknowledge their emotional reactions as normal for the postnatal period . Even seen as simple intervention active listening can have a determinant effect on the mother.
The practitioner can use the model of five system approach that allow recantation to connect five areas like :emotion, behavior ,physical symptoms and the influence of environment(Williams et al,2009). As this model suggested active listening in Jenny’s situation was more effective and allow her to feel understood although initially she reacted with anger and distress . 1 felt my mentor gave Jenny the opportunity to feel valued and this boosted her confidence in recognizing that she needs help and support .
Through active listening I believe Jenny felt empowered to understand her health needs even though initially she refused to accept that she need support . Support like listening visits or therapeutic listening which are mainly client-led discussions where the health visitor become the active listener providing opportunity for the client to express emotions and concerns are in particular helpful for mothers having signs and symptoms of mild POND (Bach and Grand,2009). Active listening enables practitioners to demonstrate their ability of counseling and build up a relationship with the client .
Furthermore it encourages the clients to revel personal information and issues that could be detrimental in consultation process (Bach and Grand some situation the practitioner needs to take in inconsideration client personal beliefs, culture ,religion and provide adequate environment so the client can have a feeling of safety and trust was not the case in Jenny’s situation because the visit was in her own house but still my mentor tried to maintain her privacy and throughout the listening process my mentor did not attempt to ask questions that could have made Jenny feel maybe embarrassed.
Andersen(2007)suggests that it is important to develop such levels of listening skills and every practitioner need to seek continuous training to be able to overcome barriers that could cause negative reactions between client and practitioner . Furthermore (Andersen,2007)explains that this type of negative reactions can infringe relationships. Such issues when occurring in practice identify the lack of skills and knowledge for the professional.
I found this visit extremely important for my development as a professional, even though I have previous nursing experience where I used active listening as a form of communication this time was different, I had the opportunity to observe my mentor how she was able to take control of the situation and carefully brought Jenny from an angry and distressed state to a calm and coherent person, more engaged and with interest in he conversation. This experience highlighted by Jenny’s case has made me more reflect on every experience for future development.
I believe eye contact and active listening which appear to be simple forms of communication, are of great value when working in a variety of community settings and dealing with different types of clients. Leadership Every encounter with client for the health visitor has a purpose and a goal set and essential skills are required from the practitioner to achieve them . The forms of communication discussed above are part of the skills necessary to make from practitioner an effective leader.
It was very obvious that my mentor succeed in transforming a difficult situation leading the case to a different level of solution and finalizing with a good outcome of support for Jenny. Yuk (2009) defined leadership as the ability of individuals to influence behaviors for their followers while Cummings et al (2008) identifies leadership as the process where an individual can influence others to accept change in order to pursue a goal . N this case scenario my mentor practice leadership was a key aspect to enable skills like active listening and eye contact to be used in order to achieve positive outcomes. As demonstrated previously communication with clients can be difficult in certain situations but I believe as leaders in this role and with ability to work independently I can use communication skills as an attribute to succeed in managing an outcome in similar situation by offering support through empathy, active listening and eye contact .
As a student health visitor I have the advantage that I benefit from knowledge gained from two sources : practice and studies from the new agenda of practice and through this I have the opportunity to reflect on various experiences like this one and underpin hero to practice to gain leadership skills for the future(DO,2007; 10TH). Taking responsibility as a leader it is an important aspect that enable practitioner to delegate tasks and promote a goal for further achievements . To transform this aspect as a leader I should ensure that team members are using reflective practice to discuss communication issues experienced in practice.
Further training programmer in communication skills like verbal and non-verbal should be easy accessible to team members and periodical reviews from the management will be beneficial to avoid unnecessary errors in practice. In recent years health visiting service has gone through a series of transformations and it was identified that leadership is necessary using practical elements like coaching, reflecting ,mentoring and stimulating awareness focusing more in tackling issues experienced in practice environment (Curtis et al,2010) .
Looking at the future practice and embracing more on the principles of health visiting (search for health needs ,influence policies affecting health stimulate awareness of health needs and facilitate health enhancing activities ) I believe leadership stands as an important vision for the role. As leaders e should empower other team members to use communication strategies in work environment in order to practice effectively. To emphasis more on the idea Captions (1994) suggests that to be able to achieve leadership hard work and effort is necessary as no individual is born as leader.
Conclusion This reflective assignment was focused in analyzing aspects related to different support to deliver a safe and professional service to clients . It highlighted how important is to consider communication like eye contact and active listening when dealing with clients with signs and symptoms of postnatal depression and Rutherford it was examined how these forms of communication can have a positive therapeutic impact to relieve symptoms if this types of communication are used effectively .