NURS5027 Therapeutic Relationship Assignment – UK.

Subject Code & Title : NURS5027 Therapeutic Relationship
Assessment Type : Written Assignment
Word Count : (2,500 words)
Assignment Briefs
1.1. Option 1 assignment brief
I.Assignment Detailed Guidance
The aim of this module is to equip you with a greater range of tools and knowledge with which you can deepen your understanding of your patients’/clients’ perspectives and needs (including their families too).

NURS5027 Therapeutic Relationship Assignment – UK.

NURS5027 Therapeutic Relationship Assignment

There are two options for the assignment for this module, depending on whether you have any recent (within 1 year) previous experience of clinical practice in your role in health care.

For those with recent clinical practice experience in nursing you may select either Option 1 or Option 2:

Assignment Brief (Option 1)

A reflective analysis of a specific interaction you have had with a patient/client, incorporating learning about therapeutic relationships.

For those students who are ‘direct entry’ to year 2, and have no experience of clinical practice or for those who have been on approved temporary withdrawal and therefore may have been away from clinical practice for a period of a year or more,please select option 2 for the assignment, as that option does not require you to reflect on your past experience in your role as student nurse

Questions to check understanding :
Check key terminology:
1.What is a ‘specific interaction’?
2.What is a ‘therapeutic relationship’? (Can you define it?)
3.What ‘new learning’ have you gained from the module?

Option 1: 
This assignment is devised to help you identify and apply the knowledge that you have gained from the module to a specific interaction from your own practice and to result in new learning about therapeutic relationships.

1.What ‘knowledge’ have you gained from the module?
2.How will you ‘apply’ the knowledge?What does this mean?

You are required to provide a reasoned argument, using literature which demonstrates an appropriate depth and breadth of knowledge of the topic area.

You are required to select an interaction that you have been part of with a patient. It is recommended that you choose a recent interaction from placement that you can easily recall.  The focus of the reflective
analysis needs to be on YOUR practice in the interaction and on your relationship with the patient/client. If you’re uncertain whether the interaction you decide to explore is suitable, please ask your seminar leader.
1.What interactions have you experienced that you could choose from?

Tip: Don’t select an interaction that is still very upsetting for you to think about. For example, if you have experienced a recent personal bereavement it is difficult to reflect on a situation that involved the death of a patient. Seek support from staff to discuss such situations.

You are required to write a description of the interaction in 600 words. This is the ‘story of what happened’ in the interaction.Include your own feelings and thoughts as they occurred at the time.

Give enough detail to enable the reader to picture the scene you are describing.

1.Have you written the description with enough detail that someone else can ‘picture’ this scene?
2.What is the difference between an observation and an interpretation?

Building on your reading from the literature and the learning throughout the module, you are then required to write a reflective analysis to demonstrate how the theories and concepts you have explored
can be applied to this interaction.

1.What will you reflect on? What concepts and theories can you apply to this particular interaction?
2.Why is it important to reflect on this?

In order to be able to write this you will have to think about what concepts and principles are under pinning this interaction

NURS5027 Therapeutic Relationship Assignment – UK.

NURS5027 Therapeutic Relationship Assignment

The relevant assessment criteria grid for your level (level 5 for BSc & MSci or Level 7 for MSc)will help you to do this (available in the module guide and in the marking criteria chapter of the unit 7 assessment preparation guide).
1.Have you read the assessment criteria grid?

The knowledge base you draw on for the assignment relates directly to the module content and themes. Of course you can also use your own additional reading, to further extend this knowledge base, but we would expect some concepts/theories or research from the module to inform your writing.Don’t worry, as we will be providing a range of’Assignment Tips’ throughout each unit of learning to help guide you in the assignment completion.
1.What is a ‘knowledge base’?
2.Where does the knowledge base for this assignment come from?

Reflective Writing :
You have been writing reflections, either privately or as part of the course, prior to this point and you will all be in different points of your journey in how you use reflective practice in your everyday life.

At year 1 level, you will have become familiar with cyclical models of reflection,e.g. Gibb’s, and probably mainly focused on the story of the experience, the context and your self experience. Now in year 2, we are
expecting you to ‘use a more discriminating approach and a wider and broader search within an experience’

We have the hope that this module will be another step in your journey to deepen your reflective practice to the benefit of your nursing practice. You are expected to engage with the reflective process in a deeper way than in year 1 of the course. To be much more critically questioning of both your own and others’ perspectives and also of the evidence (from real life and from literature). This will help you to unpack the
experience to reveal different layers of meaning and to critically reflect upon those.The types of layers that you may be revealing within your chosen practice interaction are likely to include psychological emotional,cultural,social and or ethical themes.The essential reading in chapter 5 of the book discusses these themes further.

How does reflective writing differ from year 1 level to year 2 level?

1.2. Option 1 structure overview

Option 1: Recommended Structure

Introduction :
1.brief introduction to what the assignment contains
2. include your rationale for selecting your interaction
3.state your role within the interaction (e.g. what field of nursing/setting in which the interaction took place)
4.state how you have removed potential identifying details of people included in your writing

Description of the interaction :

This is the ‘story of what happened’ in the interaction.
a. describe the interaction (give a lot of detail about a shorter interaction)
b. include your own feelings and thoughts as they occurred at the time

Example “Ted smiled as I introduced myself and I felt some relief with the thought that he might be willing to allow me to remove his dressing”.

Analysis :
1.Define and explain the importance of ‘therapeutic relationships’
2. state why this interaction/patient is important to you
3.state which concepts/themes (from the module learning) you are going to focus on and explain them (using literature)
4. use the concept/theme to analyse your interaction 
o break down the interaction into key moments and analyse these individually
o refer to specific theory from the module content

Example:
Interaction: your usual way of greeting a patient and asking them for permission to undertake observations did not go as smoothly as you expected

Concept: you identify the concept of trust as being relevant to this situation

Analysis: use the module content (such as attachment theory or Erikson’s psychosocial theory) to revisit and develop your knowledge of:

  • what this patient’s experience of trusting others might have been – how it was expressed
    through their behaviour
  • how this might have contributed to the interaction.
  • What were your pre-conceptions about how readily this person   would trust you?
  • how did this match what happened?

Conclusion :
1. summarise all the learning you have gained from this reflective analysis
2. include how it will inform your practice in the future

1.Assignment Briefs
1.3. Option 1 Recommended Structure

2.Recommended Structure of the Assignment
We recommend that you use these subheadings to structure your assignment. You may include additional subheadings within the analysis section if you wish.  
Option 1: A reflective analysis of a specific interaction you have had with a patient/client, incorporating learning about therapeutic relationships.

Recommended Structure :

Introduction : Here please provide a brief introduction to what the assignment contains, the topic you
are going to explore and the essay’s What four things must be included in the introduction?

Questions to check understanding
What four things must be included in the introduction?
1……………………………………….
2……………………………………..
3……………………………………..
4……………………………………

structure. It is helpful to state your role within the interaction (e.g. what field of nursing/setting in which the interaction took place). Briefly state how you have removed potential identifying details of people
included in your writing. You may choose to include here your rationale for selecting this particular interaction for deeper reflection.

What  additional points can you choose to include?
1…………………………………..
2………………………………….

Description of the interaction
Describe the interaction (maximum 600 words) including your own feelings and thoughts as they occurred at the time. It is best to integrate your description of your thoughts and feelings into the description of the interaction. For example “Ted smiled as I introduced myself and I felt some relief
with the thought that he might be willing to allow me to remove his dressing”.

Where should you position the description of the interaction within the assignment?

What three elements of the interaction need to be included in the description?

1.
2.
3.

Describe body language and facial expressions as well as the verbal aspects of the interaction.

It is often better to give a lot of detail about a shorter interaction than broad descriptions of longer periods of time.

Give enough detail to enable the reader to picture the scene you are describing.

For example, you might have chosen an interaction where using your usual way of greeting a patient and asking them for permission for you to undertake observations did not go as smoothly as you expected or has gone in the past. In this example, you would need to describe what you did and said as your way of greeting the patient. You also need to describe the patient’s verbal and non-verbal communication as observed by you.

The 600 words used for this description is not counted in the word count. Please do not include the description of the interaction in the appendix. It makes reading the reflection as a coherent narrative more
difficult for the marker. Instead, it should be presented after the introduction with a subheading within your assignment, in order to indicate it is your description and not counted within the word count.

Analysis :
Begin by stating why this interaction is important to you.

Identify which module topic/theme or concept you are going to explore. This will include what themes or specific aspects (from the module learning) you are going to focus on within the analysis section.

How many topics/themes/concepts do you need to discuss?

Have you decided which ones you are going to choose?

Do you have a clear explanation of these,supported by literature?

NURS5027 Therapeutic Relationship Assignment – UK.

Although some of the module themes are inter related, with only 2500 words for this essay, you should identify one or two main concepts to explore. Clearly, in order to be able to write your reflective analysis you will have to think about which concepts and principles to focus on before you start writing. Such thinking will inform what reading you do. We would expect you to use the library databases, as well as the
module reading lists and literature to demonstrate your detailed understanding of the topic.

You will provide a thorough exploration and appropriate evaluation of the main issues in relation to your specific interaction. You will show the links between the evidence from literature and the specific practice example.

What concept have you chosen to apply?
What elements of the interaction is this concept being applied to?  
What is the purpose of using this concept to analyse this patient interaction? What is the desired outcome?

For example, “Howe (2009) describes how a person with an insecure avoidant attachment style may be self-reliant when their attachment system is activated. When Joe shrugged off my attempt to help him stand, he was favouring self-reliance and this may be indicative of an insecure avoidant style of attachment.

NURS5027 Therapeutic Relationship Assignment – UK.

What evidence do you need to search for?

The example above demonstrates how the detail in the description is necessary to support the application of theory to practice.There needed to be a description of how the student attempted to help him stand and of ‘Joe shrugging’ to be able to make the links between what happened in the interaction and what the literature was saying about self reliance and attachment theory.

You will attempt to demonstrate critical insight into what the patient’s behaviour was communicating, increased self-awareness in your own practice and the relevance to the therapeutic relationship.

For example, you might have chosen an interaction where using your usual way of greeting a patient and asking them for permission for you to undertake observations did not go as smoothly as you expected or has gone in the past. You might identify the concept of trust as being relevant to this situation and use the module content (such as attachment theory or Erikson’s psychosocial theory or a trauma-informed perspective).Through your reading and analysis of the literature you could begin to consider how these concepts might have expressed themselves during the specific interaction described. Using this evidence from the literature and from the specific interaction you might consider what this patient’s experience of trusting others might have been, how it was expressed through their behaviour (even if you didn’t notice it at the time) and how this might have contributed to the interaction. What had your pre-conceptions been about how readily this person would trust you and how did this match what happened?For
example you might develop an argument proposing that this person is slower to trust than many of your patients. You might have hypotheses, based on theories and research from the module, about what had
contributed to this person’s lack of trust.

NURS5027 Therapeutic Relationship Assignment – UK.

In this example:
1.What concept has been chosen as the focus?
2.What patient issue is being used to analyse the concept?
3.What is the purpose of using this concept to analyse this patient issue? (What is the desired outcome?)

Reflect on how this change in your own interpretation of an individual’s behaviour in terms of them trusting you, may influence you to develop a therapeutic relationship in light of the new learning you have achieved.You can consider this from the point of view of what you would do differently if in that same situation again or how you might adapt your practice in the future for other patients.

Conclusion :
In a good piece of work you will have been drawing conclusions following each piece of analysis. For example, in the example above, conclusions would have been made about how attachment theory or Erikson’s theory impact a person’s ability to trust within relationships and how this might affect the therapeutic relationship with you as a student nurse.You might also have drawn a conclusion that you had not taken enough time to begin the relationship and build trust instead of expecting it as a given.In this final conclusion section of the assignment the aim is to summarise all the learning you have gained from your analysis of the literature and your reflective analysis on your future practice as a nurse (so summarise all the mini conclusions you have been making throughout). Include how it will inform your practice in the future so that you are clearly demonstrating the final stage of reflection and making the process useful; learning from experience (of academic learning and from analysing the specific interaction) in order to inform your future nursing practice.

What is the ‘aim’ of this section?
What is the ‘final stage of reflection’?

Tip: watch out for assumptions thinly disguised as conclusions. A conclusion has reasoning and evidence that precedes it; where as assumptions are presented with no evidence to support them.

NURS5027 Therapeutic Relationship Assignment – UK.

NURS5027 Therapeutic Relationship Assignment

Formative Submission Guidance
We strongly advise you to use the formative submission opportunity. Even if you are not able to submit a piece of writing, at least submit a plan and if choosing option 1 try to submit the 600 word description for your interaction. Ideally, your formative submission should include:

Option 1:
1.The 600 word description of the chosen interaction.
2. A plan or short piece of writing about how you intend to focus your analysis. (Max 500 words).

We recommend that you refer to the option 1 structure guidance. Refer to the guidance about the description section to inform your formative 600 word description of the chosen interaction.

Use the guidance about the analysis section to plan and write your formative draft demonstrating how you intend to focus your analysis.

Unit 1 – Assessment tips & preparation
Throughout Unit 1, we have included some tips relating to the topics discussed that might be helpful as you prepare for your assessment. These tips are listed below:

Assessment Tips :
1.Considering both sides of an argument is a requirement of level 5 academic study. It is often referred to as ‘critical analysis’ and involves considering the advantages and dis advantages; pros and cons; strengths and weaknesses; opportunities and challenges of an issue, concept or experience, for example, enabling you to produce a balanced discussion/argument.

2.All aspects of ‘Emotional Intelligence’ are relevant to your assessment.

3.The ability to demonstrate self-awareness is a key aspect of your written assessment task.

4.Person-centred care; Family-centred care and Trust, Respect, Empathy &Empowerment are all useful concepts to help you explore the interaction between you and your client for your assignment.

5.Unit 2 Assignment activity: analysing an interaction.
In this chapter we want you to bring together your learning from Unit 1 and Unit 2, and use it to analyse an interaction. This activity relates specifically to the Option 1 assignment.How ever the learning from will be useful if you decide to do option 2.

In the following activity you are given a Description of an Interaction to read. This is similar to one you might write if you were reflecting on an interaction you had experienced in practice. Each is between a student nurse and the clients they are caring for.Choose the one that relates to your field of practice.

5.1: Adult Nursing and MSci Dual registration Students
5.2: Mental Health Nursing and Children’s Nursing Students

5.Unit 2 Assignment activity: analysing an interaction.
5.1. Activity for Adult and MSci nursing students

Read the description below carefully
Description of the interaction
During a night shift on the Renal Unit, my practice supervisor and I were caring for Peter (55 years old). It was my first placement as a student nurse.

NURS5027 Therapeutic Relationship Assignment – UK.

He had been admitted overnight for emergency haemodialysis due to life threatening pulmonary oedema.Peter has long-standing hypertension-induced kidney disease. He has been having haemodialysis three times a week for four years.  Peter has a good understanding of the restricted diet and fluid intake that is required to successfully manage his kidney disease, however, over the past 6 months he has often chosen to eat and drink freely,resulting in repeated emergency admissions with problems such as pulmonary oedema and cardiac arrhythmias. Throughout his illness Peter has continued to manage the complex day to day running of his very successful haulage business. He is married to Kate (52) and they have a son Tom (17).

The dialysis treatment was completed at 07.00. The staff nurse tidied away all the equipment and asked me to carry out a post-dialysis set of observations on Peter while she went back to the treatment room. I carried out Peter’s observations of TPR & BP while he rested in bed. I chatted with Peter while I was doing this, but he was very quiet throughout. As I was recording the observations on his chart, I noticed that Peter was looking out of the window and crying softly. He looked very sad and there were tears falling down his face (which he was brushing away with his pyjama sleeve). I felt worried about Peter but also very unsure about what to do. I didn’t want to intrude on his privacy. Peter turned to me and said “any
chance of a cup of tea love?”.  The nurse then came back into the room, didn’t seem to notice that Peter was crying, and said that I could make him a 100 ml cup of tea. I did that and when I brought it to Peter, he apologised to me for him being “a silly old fool, crying in front of a young student nurse like that – I’m just a bit tired. I’ll be fine”. I said ‘not at all, no need to apologise’.

NURS5027 Therapeutic Relationship Assignment – UK.

I didn’t want to leave Peter alone and distressed so I asked him if I could sit with him.Peter started talking to me very quietly as he sipped his tea. He asked me how old I was and said“you are not much older than my son Tom!” He went on to say that Tom has always done really well at college, and been ‘no trouble at all growing up’. He explained that he was now really worried about him because he spent most of his time away from home, and stays overnight with his friends drinking. He feared that if he carries on, he won’t get the grades he needs for university. I said that it must be really worrying and asked him why he thought Tom had changed. Peter went quiet for a while, looking more sad and pensive. Then he said
“Things aren’t good between me and Kate – we argue – she thinks that I should ‘get a grip’.”He described how she doesn’t come with him to the hospital anymore. After a silence he said flatly, “Trouble is, what ever I do, this kidney disease isn’t going to go away, is it?”. I didn’t know what to say so I decided the best thing to do was to sit quietly. The nurse in charge then called me into handover and I said goodbye to Peter.

Making sense of this interaction
1. Think about the therapeutic relationship between the student and Peter. What evidence is there that suggests it was therapeutic? What could the student reflect on in relation to this?Identify ideas/ theories from unit 1 which could help you to make sense of what happened in this interaction.

NURS5027 Therapeutic Relationship Assignment – UK.

NURS5027 Therapeutic Relationship Assignment

2.Consider the difficulties facing Peter and his family.

1.Write down all the possible difficulties you have identified

3.Your aim is to make sense of the difficulties they are experiencing. To do this firstly consider the possible reasons for the difficulties you have identified. You can use any of the theories/ideas you are familiar with as ‘tools to think with’ to help you: This could be from Unit 2 learning (family structure and the function of subsystems, Erikson’s ideas about the tasks we face at different ages), or from Unit 1 or from other knowledge you have for example, about relationships, families, mental health or the impact of chronic illness. Remember that behaviour always has a meaning and usually expresses feelings.Imagine you are caring for the family – what does your professional knowledge and judgement tell you, that might explain the behaviour and feelings being expressed by individuals in the family.

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