Glan Clwyd Hospital

The gynaecology department at Glan Clwyd Hospital provides a service for women who are experiencing difficulties in early pregnancy. The most common emergencies that present onto the ward are women with threatened and / or complete miscarriages, the service is available for women up to 20 weeks gestation, they are referred to the unit by either their G. P. or midwife. Due to routine ultrasound scanning the ward also experiences a number of women admitted for medical terminations because an abnormality has been detected or due to fetal demise.

This can be a highly emotional and ensitive experience for the patient, her family plus the staff that are involved. Women who are referred to the ward via their G. P. or midwife are offered an ultrasound scan to assess the viability of the pregnancy, this takes place in another department within the hospital. Part of my role as a health care support worker is to escort the patients to the scan department and provide support to them if needed. The women who attend the hospital have a wide ranging diversity of circumstances, some of these include age, social / domestic background, values, beliefs and attitudes.

I am aware of my own values, beliefs and ttitude towards pregnancy but always am conscious of displaying a non judgemental attitude towards each individuals unique circumstances. I recognise the fact that because I have certain values and beliefs does not mean the next person shares those same values and beliefs. On a regular basis I have to escort very young women to the ultrasound department who may well be on their second or even third pregnancy, many of these young women are not in a stable relationship.

I have escorted one young woman recently who had discovered she was pregnant but did not want to continue with the pregnancy. I was unaware of this fact until we were actually in the scanning room. The woman did not show any interest whatsoever in what the ultrasonagrapher was saying to her and displayed no interest in the monitor which clearly showed the pregnancy, which was viable. Her body language conveyed to me her sense of unease, the way she was unable to make eye contact with either myself or the ultrasonagrapher and what appeared to be an apparent lack of interest made me feel there was an underlying reason for this.

I am aware that body language is an important part of the communication rocess, as nurses we should be aware of it and mindful of the non verbal clues that patients portray through their body language. Dimbleby & Burton (1995) suggest that body language has several elements these include; gesture, facial expression, gaze, posture, body space and proximity, touch and dress. I tried to reassure her by speaking to her and touching her lightly on the arm. It was not until I made physical contact with her that she opened up and discussed how and why she was feeling the way she was.

She admitted the pregnancy was a mistake and that she had no intention of ontinuing with it. She then went on to apologise to the ultrasonagrapher and myself for her decision and explained to us that she was very worried about what we would think of her, especially the nurses on the ward, at this point I felt great empathy towards the woman. I tried to put her at ease by explaining to her that none of us were going to judge her, we were there to support her through her decision.

I emphasised the fact that it was not an easy decision to come to, one that only she could make and whatever she decided should be what is right for her and nobody else. My wn personal thoughts were that this woman was very brave in making the decision to terminate the pregnancy. Personally I feel it is better to terminate a pregnancy than to bring an unwanted child into the world who may not be loved and cherished as a child should be. I do understand that not everybody would share my thoughts and feelings towards this.

She may well of become an unpopular patient with some members of staff because of her decision although it would be wrong for nurses` own values and beliefs to interfere with the care being delivered. On another occasion I had to escort two women and their partners, who ad come from very different social backgrounds, to the ultrasound department, this occasion was very sensitive. The woman of the first couple had achieved ten pregnancies, six children were alive and well four of which had been fostered to various foster parents because of the woman’s social background.

She has experienced one miscarriage and had three pregnancies terminated, the third one being the day before. She had been admitted onto the ward with abdominal pain and vaginal bleeding. The woman of the second couple had achieved her first pregnancy after any years, she was experiencing difficulties with the pregnancy and was in an emotional state, the pregnancy was very precious to her and her husband. Knowing the circumstances of each couple I could not help but feel empathy for the second couple, I was aware that I should not show a judgemental attitude towards the first couple because of the obvious difference in the circumstances.

Once we reached the ultrasound department I became aware of the fact that the first couple were talking openly to each other about their circumstances, this was in earshot of the other couple. I could see that hey were becoming affected by what they were hearing. I made the decision to approach the appropriate staff within the department and requested that the second couple be seen first. I briefly explained the circumstances for my request remembering the importance of maintaining patient confidentiality. (Nursing & Midwifery Council 2002).

The couple were seen first and did receive the news that the pregnancy had failed, they were both extremely upset. I respected the fact that they needed to be alone in private for a while to come to terms with the sad news they had just received. When they felt ready I escorted them back to the ward where I informed the emergency nurse of the outcome and handed the scan report to her. The couple were shown to a private room where the doctor had a chat with them and was able to answer any questions they may of had.

I am often asked questions from patients on the walk back to the ward, the most asked question is “What happens now”. I am constantly aware of the limitations of my role, if I am able to answer the question then I do but I always stress to the patients that the trained nurse and the doctor are the eople with the knowledge to explain things to them in greater detail than I can. If I do not know the answer to their question I am honest and admit it to them but reassure them that they will have the opportunity to ask any questions they may well have once on the ward.

I sometimes do find these situations difficult due to the fact that I have a close family member who is having to spend a large amount of money on receiving IVF treatment for infertility to no avail as of yet. The affect that not being able to conceive naturally and having to invest money into treatment is emotionally upsetting for them. Introduction This reflective account discusses the sensitive nature of coping with situations that can be highly emotive for patients and their families. It discusses situations where I have had to be non judgemental as well as empathetic in different circumstances.

Empathy is described as being the most fundamental sense which involves understanding the experience, behaviours and feelings of others as they experience them. (Duxbury, J. ) As nurses it is important that we are aware of our own feelings, values and beliefs and how our own behaviour is portrayed to others. Becoming self aware enables us to look at our personality, we may discover strengths or weaknesses we were not aware of. We could use these discoveries to develop our own self esteem which may reflect on our relationships and the ability to communicate more effectively both personally and professionally.

Parbury (1993:p23) states that “self awareness builds a sense of self, this moves nurses towards a health self concept both as persons and nurses”. Developing a deeper understanding of oneself makes it possible to distinguish between our own thoughts and feelings and those of the patient. Sundeen et al (1998) suggest that a firm understanding and acceptance of our own self will allow nurses to acknowledge a patients difference and individuality. To link the theory of self awareness to practice I have reflected on a number of occasions where I have had to respect the patient as an individual with differing thoughts and feelings to myself.

I am always conscious of not displaying a judgemental attitude in what can be upsetting circumstances. I acknowledge the fact though that as nurses we cannot be expected to behave in a robotic way with our emotions but through self awareness they can be managed appropriately. Conclusion Although the two couples discussed came from very different social backgrounds with differing circumstances the need to treat each person as an individual is imperative.

Patients have the right to be treated with respect and dignity at all times regardless of their decisions and choices. However I do personally feel that the two woman who had achieved unwanted pregnancies, especially the woman who had achieved numerous pregnancies should be given some form of education in the use of contraception to prevent any more unwanted pregnancies. Ewles & Simnett (1992) suggest that the aim of education is to give nformation and ensure knowledge and understanding to enable well informed decisions to be made.

Education may change their attitude towards contraception and teach them how to prevent any further unwanted pregnancies. They would then be able to make their own decision about whether to achieve a pregnancy or not. This choice would prevent them from having to go through the upset and trauma of terminating any future unwanted pregnancies. I did empathise with the first patient I discussed, she made the decision that it was not the right time for her to have a child, she had made a istake and was having to go through the trauma of terminating the pregnancy.

In this situation it is vital that the woman concerned should not be made to feel that she is being judged by other people. The wrong attitude could lead to feelings of guilt on the patients conscience which may have lasting physiological effects for many months if not years. My experience of this situation has taught me the importance of self awareness and how each individual should be treated with respect and dignity at all times. We should treat individuals as we ourselves would expect to be treated if we were a patient.

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