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. 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.

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.

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.