NURS 6910 Week 11 reflection example

Reassurance Before She Finished: A Gibbs Reflection on Listening in Serious Illness Conversations

Student Name

College of Nursing, Walden University

NURS 6910: Introduction to Palliative Care: Principles of Hospice and Palliative Care

Instructor Name

Month Day, Year

Reassurance Before She Finished: A Gibbs Reflection on Listening in Serious Illness Conversations

Description

Early in this course I wrote a scripted conversation in which a nurse tells a composite patient that her cancer has grown despite treatment. Before revising it for submission, I read my first draft aloud and marked every place the patient spoke. I found three places where my nurse offered reassurance before the patient had finished her sentence. In the clearest one, the patient began, "I'm scared that when it gets bad, nobody will be there to..." and my nurse cut in with, "Don't worry, we'll make sure you're comfortable." I had written both lines myself, with no time pressure and no real patient in front of me, and I still did not let her finish. This reflection moves through the six stages of the reflective cycle (Gibbs, 1988), from what happened and how I felt through to what I will do differently, to ask why.

Feelings

Reading the draft, I felt embarrassed first, because I had just read about this exact mistake. Under the embarrassment was something more useful to notice: when I imagined the patient's fear, I felt an urgent need to make it stop. I could picture a real patient saying those words on a real unit, and my instinct was to reach for her hand and fix it. Silence after a frightened sentence feels, to me, like standing by while someone suffers. Writing the reassurance felt like doing something. I also recognized a wish to be seen as helpful, to have the right answer ready, that has followed me through years of acute care nursing.

Evaluation

Something good was in the line. It was kind, and it named comfort, which was a real goal for this patient. But weighing what it achieved against what it closed off, the cost was higher. The patient was about to name a specific fear, that no one would be there, and my reassurance answered a different fear, pain, that she had not raised. She would have been left with her real worry unspoken and a promise that did not address it. The other two places in the draft followed the same pattern: my nurse soothed a feeling before learning what it was about.

Analysis

The readings this term gave me language for what I did. Maguire and Pitceathly (2002) describe blocking behaviors, the ways clinicians discourage patients from disclosing their concerns, and premature reassurance is one of the most common. They explain that reassurance offered before the concern is fully explored is usually ineffective, because it is aimed at a guess. That describes my draft exactly.

Back et al. (2005) describe an ask-tell-ask approach to difficult conversations: ask what the patient understands or is worried about, tell in small pieces, then ask again what she has taken in. They also describe responding to emotion with statements such as naming or exploring before offering information or solutions. My reassurance skipped the asking entirely. It also skipped the second ask, the check on what she had taken in, because the conversation moved straight to the next topic after my nurse's promise, as if the matter were settled. If my nurse had said, "Nobody will be there to...?" and waited, the patient would have finished her sentence, and the answer would have been about her fear rather than mine.

The deeper cause is older than this course. In acute care, my job was often to fix things quickly: bring pain down, calm an anxious patient before a procedure, solve the problem in front of me. That habit served patients well in those settings. In serious illness conversations, it works against me, because many concerns cannot be fixed, and the patient needs first to be heard. My urge to reassure is a fixing reflex applied to a situation where fixing is not what is needed.

I also noticed that the reflex appeared when the emotion was strongest. At the calmer points in the draft, my nurse asked good questions. It was the frightened sentences that triggered the interruption, which suggests the reflex is about managing my own discomfort as much as the patient's.

Seeing this changed how I read the course's communication frameworks. I had treated SPIKES and the NURSE statements as scripts to follow in order. Reading my own draft, I understood them as tools for slowing down at exactly the moments when I most want to speed up. The frameworks are not difficult to learn; what is difficult is using them when my own anxiety is highest, and that is a skill that only practice with feedback will build.

Conclusion

Three things changed in my revised script and, I hope, in my practice. First, questions now come before information: my nurse asks what the patient understands and what worries her before offering anything. Second, silence is held after hard news, written into the script as a stage direction so that I cannot skip it. Third, emotion is named before facts or plans are offered. In the revised version, when the patient says she is scared, my nurse responds, "That sounds frightening. Tell me more about what scares you," and the patient's real fear, being alone, is the one that gets answered.

Action Plan

Written scripts are easier than real conversations, so I need a way to practice where the stakes are real but manageable. For the next three months, in my current role, I will choose one conversation a week with a patient or family facing a difficult situation, and afterward write down whether I let the person finish the sentence where their emotion was strongest. I will ask a colleague I trust to observe one family meeting a month and tell me whether I interrupted. I will also practice one sentence, "Tell me more," until it comes to me before reassurance does.

I expect the reflex to persist, because it was built over years. The goal is not to stop wanting to help, a wish that brought me into nursing in the first place, but to help in the right order: listen until the concern is clear, and then respond to that concern rather than the one I imagined.

References

Back, A. L., Arnold, R. M., Baile, W. F., Tulsky, J. A., & Fryer-Edwards, K. (2005). Approaching difficult communication tasks in oncology. CA: A Cancer Journal for Clinicians, 55(3), 164-177. https://doi.org/10.3322/canjclin.55.3.164

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further Education Unit, Oxford Polytechnic.

Maguire, P., & Pitceathly, C. (2002). Key communication skills and how to acquire them. BMJ, 325(7366), 697-700. https://doi.org/10.1136/bmj.325.7366.697