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Synthesis of a Simulation

Gregory Wendt

Health Sciences, Sault College

BSCN 3206 – Relational Practice

Jennifer Flood

December 5th, 2022

Synthesis of a Simulation

The scenario involved an unscheduled visit to the apartment of a single mother of two

children as a public health nurse for Healthy Babies Healthy Children. Upon arrival at her

apartment, the client was upset and explained that she had not been aware that anyone would be

coming by today. Her one-year-old was at daycare and her infant was at home with her sleeping.

Although the client was irritated, she invited me to sit down, and I asked her how she was doing.

She explained that she has been feeling very stressed and overwhelmed lately. The client was

concerned that her neighbour had called the Children’s Aid Society on her because they thought

that she was having a loud party the previous night. The mother accused her neighbour of being a

liar and said that only a few people were over. The client had previously stated that she uses

drugs and alcohol but denied that it is an issue. However, there were empty cans of beer as well

as the smell of marijuana within her apartment. The client found herself regretting a lot of her

life choices and expressed feeling stuck and hopeless in her situation.

Relational Difficulty

The key relational difficulty would be a lack of trust between myself and the client. I had

shown up unannounced to the client’s apartment and CAS had been called on her the night

before. This in combination with the client’s feelings of hopelessness in trying to balance school

and childcare has likely led to her feeling like the entire system is against her and that she cannot

fully trust me. The client had told me that she has not had a party and had stated that she is not

drinking or using drugs around the children, but there was evidence of drinking and marijuana

use within the apartment. This caused me to not completely trust the client during our

conversation. Clients can often perceive that there is a power imbalance, and this can lead to

them feeling vulnerable. Trust is an important factor in any therapeutic relationship since it
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allows nurses to work with clients to reach treatment goals. To develop trust, there must be

consistent and clear communication as well as honesty and respect from both parties (Price,

2017). It has been found that people with a lower income level such as the client are less likely to

trust social service workers. This is problematic since people within the lower-income population

are more likely to require the need of social assistance and they are unlikely to want to seek help

from organizations they deem to be untrustworthy. This distrust can lead to people refraining

from accessing help or resources that they would benefit from (Nilsson & Landstedt, 2022).

Strengths and Weaknesses

A strength that I displayed was empathy, such as when I sat down and talked to the client

about what she was going through. This allowed the client to feel comfortable enough with me to

be willing to open up and talk candidly about her feelings. Empathy is a core concept within the

development of client relationships and refers to the capacity for understanding and relating to

the feelings of others. Clients who receive empathy from healthcare workers are more likely to

develop trust in their abilities (Moudatsou et al., 2020).

The weakness that stood out to me the most was that, despite feeling empathy for them, I

was unable to relate to the client’s situation. I found it difficult to fully comprehend her situation

of being a single unemployed mother with two children. This impaired my ability to use affective

self-disclosure in the building of a therapeutic relationship. Self-disclosure can help to enhance

and strengthen a relationship with a patient by sharing a similar personal experience with them

(Steuber & Pollard, 2018). Ironically my weakness goes against my strength since self-disclosure

correlates with empathy, and nurses who used self-disclosure were also shown to have higher

levels of empathy. Self-disclosure is often associated with developing trust with a client, so this

could have negatively impacted the relational difficulty (Ibrahimoglu et al., 2021). Other
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weaknesses I identified through reflection were unconscious bias towards the client and a lack of

knowledge regarding community resources available in Sault Ste. Marie.

Healthcare Issues

Since the client is trying to complete her high school diploma and is feeling

overwhelmed, one healthcare issue is that it is hard for single mothers with low income to get a

break from childcare. The client does have a daycare for her oldest child, but she has nobody to

help her with taking care of her infant. The client’s ex-boyfriend and the father of her youngest

child do not live with them, and the father of her oldest child does not have any contact. The

client also does not have any contact with her father and does not have a good relationship with

her mother. Therefore, she does not have any family that is willing or able to watch her children.

Her friends are into partying and using drugs, so they do not provide a healthy environment for

her children to be around. This does not leave the client with any cost-effective options for

childcare. Babysitters can be expensive, especially for somebody like the client who is

unemployed and on a fixed income. Being able to locate affordable childcare is going to be

critical to her success as a student and later when she is seeking employment. It is difficult to

have flexibility when dealing with only formal childcare and single mothers often require

informal caregivers as a backup if plans change (Brady, 2016). This is where having social

support could help the client both with childcare and moral support. Social support for single

mothers helps to increase self-esteem in both them and their parenting abilities while decreasing

depression (Hartwig, 2016). The client has also been experiencing a lot of difficulty in her life

and is feeling stressed and overwhelmed because of her responsibilities. The risk for poor mental

in single mothers is double that of single fathers or married couples (McGhee, 2019). The client

stated that she only uses drugs and alcohol casually and does not believe it is a problem.
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However, children who grow up around parents who are using alcohol and drugs are more likely

to experience a lower level of well-being (Kuppens, 2020). If the client wishes to seek

counseling or therapy for her anxiety and stress or if she is experiencing a drug addiction there

are resources within the community to help, although the client may be afraid to use them due to

her distrust in the system and fear of having her children taken away by CAS (Nilsson &

Landstedt, 2022).

Therapeutic Relationships

One intervention that I could do to improve my therapeutic relationship with the client is

to acknowledge my own biases and feelings towards her which could be impacting our

interaction, as recommended by the College of Nurses of Ontario (CNO, 2016). When talking

with the client I found myself being swayed by internal biases that I have towards her because of

her drug and alcohol use. Unconscious bias is difficult to overcome since it is natural for humans

to categorize and judge people, places, and situations based on past experiences, media, and

upbringing. Unconscious bias is different from prejudice, which is where somebody consciously

believes that a group of people is inferior. Unfortunately, unconscious bias can negatively impact

the relationships between health practitioners and clients and can lead to a lack of trust in the

healthcare system (Narayan, 2019). Nurses must first recognize these implicit biases by paying

close attention to their feelings and whether they are feeling uncomfortable or anxious when

providing care to certain groups of patients. If experiencing these feelings, it is useful to reflect

on why you are feeling that way and whether it is affecting the quality of care you provide. One

strategy I can use to overcome bias is using habit replacement to recognize the negative effects,

make a commitment to change, and a conscious effort to consistently practice unbiased thinking.

Another strategy is the use of mindfulness to let go of all my distracting thoughts and focus only
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on the present conversation with the client. This is a way to notice any biases as they come up

and prevent acting on them (Narayan, 2019).

Another intervention that could help with this interaction is for me to have a greater

knowledge of the system so that I can find resources and services that can help the client. This

was a suggestion by the Registered Nurses Association of Ontario to improve the therapeutic

relationship (RNAO, 2006). I had struggled to think of any local community resources which the

client could benefit from and for which she was eligible. I lack an awareness of what is available

to aid single mothers in the low-income bracket within the city of Sault Ste. Marie. Many nurses

outside of the public health field are not familiar with all the local community resources

available and do not know about how to incorporate them into the care of the client (Suzuki,

2020). One way that I could expand my comprehension would be by performing a community

assessment of what programs and groups exist along with any barriers that would prevent my

client from participating. Realistically this would be performed by an assessment team since a

single public health nurse would not perform this task alone. However, if I was working as part

of an agency this is something we could do to correct this gap in my knowledge (Vollman,

2022).

Conclusion

I was able to create the beginning of a therapeutic relationship with the client, despite a

difficult start to our meeting. Now that I have taken the time to reflect upon it, I have seen that

there were several areas I could have improved upon in relating with the client. In the future, I

will attempt to incorporate what I have learned to strengthen the therapeutic relationship.
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