This is a reflective essay based on my experiences whilst on my five week surgical placement in a local hospital. The aim of this essay is to explore the use of communication and interpersonal skills in clinical practice. I have chosen this particular incident as i spent a considerable amount of time communicating verbally and non verbally with this particular patient. To protect the identity and maintain confidentiality of the patient i have chosen to discuss they shall be known as lsquo john', this is accordance with the nmc code of professional conduct 2008.

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To assist me in the process of reflection i will be using gibbs 1988 reflective model. The structure of this framework allows the reflection to be written in a clear way, which provides opportunities to look at the incident from a number of perspectives this will help to highlight areas of practice which could be changed in the future jasper, 2003. Through reflection we can get to know more about what we do and what limits our abilities and this gives the opportunity to improve the way we care ghaye and lillyman, 2001. John was a 74 year old man admitted onto the ward from the emergency department 2 days previous to me starting my first late shift of that week. My mentor and i were informed during handover that we would be looking after john on this particular shift and could we change the dressing on his right leg as he had an ulcerated leg due to suffering from a condition known as peripheral vascular disease alexander el al, 2004. As a consequence of this disease he also had his left leg amputated below the knee some years ago and mobilised using a wheelchair.

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It became clear during the handover that john had been very difficult the last couple of days. The nurse in charge went on to say that he had thrown items across his room and was constantly pressing his nurse call button and shouting all day, he had also refused to have a wash and change his pyjamas. As we left the room where the handover had taken place, my mentor said she thought that we should change john's dressing now but first we should get him washed and changed and could i assist her. We gathered all the equipment we needed from the treatment room and made our way to john's room. I knocked on his door and introduced myself as a student nurse, i then asked john for his consent for me to assist him in having a wash and change of clothing nmc, 2008. John was sat on his bed, he appeared to be quite tense, he looked up at me and shouted lsquo no, i want to see a doctor and i haven't had a cigarette for 2 days'. I explained that i was here to assist in changing the dressing on his leg and to help him to have a wash and change.

I then began to engage in conversation with him by maintaining a soft tone of voice and asking him if he would like a cup of tea after we had finished. His body language softened and he looked up and smiled, he said lsquo i would love one'. I smiled back at john, i then repeated the question of assisting him with having a wash and change, whilst maintaining a relaxed posture and eye contact with him. John gave me his consent and i proceeded to assist him in maintaining his personal hygiene with respect and dignity nmc, 2008. With john's co operation my mentor and i were then able to go on and change his dressing on his leg. Through this learning experience i encountered different feelings towards the situation. From the initial handover, the staff nurse in charge did not paint a positive picture of john.

I wondered why this particular patient was so aggressive and demanding and the staff described him as being lsquo difficult'. I felt anxious, as this was my first placement as a first year student and i did not feel experienced enough to deal with the situation. During my encounter with john it became clear why he would feel so angry and frustrated.

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I noticed he didn't have a wheelchair in his room, and it became apparent that he was a smoker. He also hadn't been given any nicotine replacement therapy to help him cope with his withdrawal symptoms. When the full extent of john's situation became clear to me, i felt immense frustration for him.

According to the nmc code of professional conduct 2008 , nurses should treat patients with respect and maintain their dignity. With john not having a wheelchair, he was confined to his bed and therefore had lost his autonomy. The situation also made me very angry, reflecting back i feel i should have been more assertive and maybe questioned why john's requests had been ignored by the staff. It was a shame that the professional staff acted the way that they did, ignoring how angry and frustrated john had become and not acting upon it. The nurse's compassion and communication skills seemed to be very much lacking, not listening to his requests and showing no feeling towards him. This breakdown in communication in the nurse ndash patient ndash relationship with john, left him feeling frustrated and not in control of his own wellbeing garnham, 2001.

At first, i could not see any good points in this situation however looking back i can see that it did have its positive side, in as much as allowing me to examine myself and to search for my short fallings in relation to the incident. The way i communicated with john had a positive outcome for both of us in that his personal hygiene needs were met, and i learnt that effective communication is essential in building a trusting bond between the patient and the nurse almond amp yardley, 2009. The bad points of this experience were that i judged john based on the information i received during handover without meeting him first.

Accepting a patient as a unique individual and without judgment is very important in the communication process. I have learnt from this experience that as nurses we should respect a patient's beliefs and values, and we should not let our own beliefs and values affect our decision making in patient care rogers, 1957. I also feel i should have been more assertive when it came to the way john was being treated by the staff. As a first year student i did not feel comfortable questioning the way a professional staff nurse carried out her nursing care. However, from this experience i will question bad practice in future, as the nmc 2008 states that i am personally accountable for my actions and omissions in my practice and i must always be able to justify my decisions. According to briggs 2006 as cited in compendium of clinical skills lsquo communication is the process of conveying information between two or people'.

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Communication is essential in building relationships with patients and gaining trust. In the nhs the majority of the complaints brought against them were for poor communication from healthcare staff pincock 2004. To highlight how important communication is in the nursing profession, the nmc identified it as being an essential skill and only if a student is competent in this skill can they then go on and register as a nurse nmc 2007b. In order to communicate with john the situation required the use of interpersonal skills, known as non verbal and verbal communication. Non verbal communication is described by lister and dogherty p62 as being information transmitted without speaking.