Student’s Name: Ocean LevineDate: 03/29/2019 Client’s initials: A.Z. Age: 62 Medical Diagnosis: Cerebrovascular Client’s strengths contributing to holistic health (3 or more): 1. Because of the health changes and circumstances, that Mrs. A.Z is dealing with she is not positive concerning her health and appears to be angry. 2. The client Mrs. A.Z. wants to get well again, or at least get back to her optimal health as much as possible or to what can be expected given her condition and illness. 3. The client Mrs. A.Z. is not receptive to most of her care and is combative at times.Client’s family and/or other support systems (describe): Mrs. A.Z.’s support system are mainly her dogs, and her two brothers, one of her brothers are very ill, but he can still maintain himself. Mrs. A.Z and her brothers are very close Mrs. A.Z.’s younger brother is very helpful to her and to her brother that is ill. Mrs. A.Z. and her brother lives together in the house they grew up in; they took possession of the house after their mother died. Since her family unit is in the older adult category, they have a home health care nurse that comes to her home four times a month to helps with her medication. In addition, they have a handy man that keeps the grounds and the house in good repair. Mrs. A.Z. and her brothers are on a fixed income and they put the monies together to maintain the bills for the shared household.Client’s behaviors limiting holistic health (3 or more): 1. The client A.Z. is a heavy drinker (red wine) and smoker she had to stop when she was admitted to the hospital for her current medical condition. 2. The client A.Z is a diabetic. She was diagnosed with cerebrovascular disease about 25 years ago and her younger brother suffers from the same diagnosis as she has. 3. The client A.Z. doesn’t monitor her diabetes and her blood sugar readings has had been very high she had even refused insulin.Give a description of the physical setting and interpersonal climate where this interaction occurred. This interaction occurred in A.Z.’s. room at the hospital she was laying down in her assigned bed watching television and talking to her friend who came to visit her. We talked for about thirty minutes until a person from transport came to take Mrs. A.Z. to cat scan. I waited for Mrs. A.Z. to return form cat scan, at which time I was able to get more background information to complete my interview. Clients verbal and non-verbal behavior Student’s response to client’s verbal and nonverbal behavior Communication technique & rationale for student’s intervention Students evaluation of intervention with client:Effective or Ineffective and why?1 Looking angry and confused: “Good morning.” 1 Smiling: “Good morning, my name is Ocean Levine and I will be your student nurse today. I see that you have taken your shower and are now watching television, is it okay if I come in you room to speak with you?” Therapeutic: Acknowledgement: I talked with Mrs. A.Z and interact with the her. A.Z. was still getting dress after taking a shower and watching television. I didn’t want her to feel like I was trying to interrupt her personal space. (Berman & Synder, 2016 page 421). Effective: A.Z. didn’t feel as if I was interrupting her television time. She was happy to have company and welcomed me in her room.2 Smiling: “No I don’t mind at all, come on in.” Smiling: “Ok, how are you feeling today?” Therapeutic: Using open-ended questions: I asked A.Z. a broad question that would lead her to explore her feelings (Berman & Synder, 2016 page 420). Effective: A.Z. began to tell me how she felt and why she felt that way. 3 Mrs. A.Z. was Positioning herself into a sitting position: Ms. AZ stated “I feel much better today. This was the best day that I had since I have been here.” 3 Happy and surprised: “ I’m so glad to hear that.” So, this is the best day that you have had since you’ve been here. what has to helped you feel better way?” Therapeutic: Restating and paraphrasing: I actively listened for the client’s basic message and then I repeated those words back to her. This would have conveyed that I did listened, and I understood her message (Berman & Synder, 2016 page 420). Effective: A.Z. continued to smile as she talked and opened up to me and express even more information. 4 “Mrs. AZ, stated “I was able to exercise with walking in the halls and I went to therapy today I’m moving around much more then I was.” 4 Excited: “That’s great! I am happy to know that you are making progressing with your health. Why are you unable to walk?” Non-therapeutic: Probing: I asked for information mainly out of curiosity rather than with the intent to assist Mrs. A.Z. (Berman & Synder, 2016 page 422). Ineffective: A.Z. was quiet and began to think about the events that led her to be in the condition that she is in. Instead of probing I could have asked more about other areas that she has progressed in.5 Sadly gathering her thoughts: “I don’t know exactly what it is called, but I’m sure the doctor will tell me. I know that I came to the hospital because I was feeling weak, confused, and light headed I have COPD.” 5 Surprised: I listened silently without saying anything. I just allowed A.Z. to talk. Therapeutic: Using silence: I was quiet without interjecting or having any verbal responses to A.Z. so that she could gather any information that she wanted to talk about or to share. (Berman & Synder, 2016 page 420). Effective: A.Z. thought long and hard about all of the things that happened to her that day.6 Continued gathering her thoughts: “It all happened really fast, I was fine days before this happened, this has never happened to me before.” 6 Feeling empathetic: “I’m so sorry to hear you had to experience this, I know that this must be difficult for you. Is there anything that I could do to help you feel better?” Therapeutic: Offering self: I offered my help to A.Z. with my presence and interest without making any demands or of any attaching conditions (Berman & Synder, 2016 page 421). Effective: A.Z. stated that she was ok, and that me visiting her was making her feel better. 7 Looking at me she is feeling happy: “I feel better having someone here to talk to me. I am fine, I just have to take things one day at a time and take my medication.” 7 Happy: “That’s Awesome! I am so glad to hear that. Having a positive mind frame will help with progressing towards healing. Your progress may not happen as quickly as you would want it to, but it will happen. Therapeutic: Giving information: I provided simple information the client may or may not had requested (Berman & Synder, 2016 page 420). Effective: A.Z nodded her head, which led me to believe that she agreed with me or was receptive to the information that I had shared with her.8 Shaking her head in a yes motion: “You are right.” Its up to me on how well I do with getting better and staying on my meds.” 8 Placed my hand on her leg: “You are absolutely right about that.” Therapeutic: Using Touch: By touching A.Z. I provided her different forms to reinforce my caring, feelings, and concern. (Berman & Synder, 2016 page 420). Effective: A.Z smiled and told me that I seem like I will be a great nurse.9 Smiling: “You seem like you are going to be a great nurse.” 9 Smiling: “Thank you, that was so nice for you to say. What are your plans for the rest of the day? Non-therapeutic: Changing topics and subjects: I directed the communication that was in my areas of interest, instead of the client’s concerns. (Berman & Synder, 2016 page 422). Ineffective: A.Z began to think about the things she would do, which caused her facial expression to change. I could have asked her what was it that I did to make her feel that way instead of changing the subject.10. Starting to think: “You’re welcome. “I know lunch is coming around soon.” 10 “Oh, okay. Do you know if they have any activities that you could join or get involved with? Do you have family coming to visit you today?” Therapeutic: Providing general leads: I used questions that would lead A.Z to facilitate continued verbalization. (Berman & Synder, 2016 page 420). Effective: A.Z. began to tell me about activities and some of her relatives which was very limited.11 “I believe that they do have activities here for seniors.” It probably would be nice for me to join some, I’ve been very angry lately.” 11 “I think that that would be a great idea. You may end up having fun, would you like to try it?” Non-therapeutic: Unwanted reassurance: I used a comfort statement to help reassure the client (Berman & Synder, 2016 page 422). Ineffective: A.Z did not agree with my assurance. Her definition of fun could have been different from mines. I could have encouraged A.Z. to join activities without saying to her it may be fun.12 “I don’t know about that.” I enjoy relaxing and staying to myself. 12 “Is your brother coming to see you today?” Therapeutic: Seeking clarification: I used this type of communication to get a broad overall answer to confirm what she had just stated (Berman & Synder, 2016 page 421). Effective: A.Z smiled and began to tell me more about her brother.13 “Yes, he is coming in to bring me clothes to wear that I like while I am here.” I have only been here since Saturday.” 13 “Is your brother supportive to the situation that you are facing with your health?” Therapeutic: Providing general leads: I used questions to encourage A.Z. to facilitate continued verbalization (Berman & Synder, 2016 page 420). Effective: A.Z began to explain more to me about how her brother helps to support her.14 “He’s very supportive.” We all lives together. We help each other financially to pay the bills and we all helps to assist around the house.” 14 Smiling: “I am glad to hear that you have some type of support. So, he helps assist your younger brother too?” Therapeutic: Seeking clarification: I used this type of communication to get overall answer to confirm what was just stated (Berman & Synder, 2016 page 421). Effective: A.Z begin to explain in detail more about her brother.15 “Yes he does”. My brother is older, and he is a diabetic. My brother and I both take care of him together.” 15 “That’s great how you and your brothers support one another. Does anyone else in the family have any type of conditions that they are facing?” Therapeutic: Focusing: I was able to help AZ. expand on and develop the topic of importance. (Berman & Synder, 2016 page 421). Effective: A.Z. answered the questions and provided me with more information about herself that I didn’t know. Summary The analysis and the overall tone of the conversation was truly a worthwhile experience for me. A.Z. was very receptive and opened to my presence. She didn’t mind engaging in conversation with me concerning her life, family or sharing personal information. This was my first clinical day and my first encounter with the client Mrs. A.Z. Even though we didn’t know one another until then, I felt as if she was comfortable and relexed with me. Even when it was time for the two of us to separate from one another, she was curious about when I would return; I told her I was a nursing student and that we would return next week.A.Z. seemed like a very nice, but scared woman. During our interview she seemed receptive about her health now that she knows why it’s important to take her medication. She informed me on how her brothers are both diabetics. During A.Z’s speech evaluation that I had accompanied her on, I learned that A.Z was diagnosed with cerebrovascular. Her brother has also suffered from this condition. Being culturally aware of certain things helped me to understand that A.Z. is more susceptible to some of the conditions she is battling with due to her race which is nonmodifiable. However, some of the choices that she has made prior to her admission, like smoking, and not taking her medication is modifiable she has to change a few habits to her lifestyle.During my one on one time and interview with A.Z., I felt confident within myself about how I was interacting with her. I think I have good social skills: and getting along with others regardless of their race or gender, has never been an issue for me. I also have a few years of medical experience from working as a surgical tech. Having that interaction experience helped me to not feel scared or nervous about my first interactions with A.Z. When A.Z. stated I would be a great nurse it made me feel really hopeful. It made me feel like I was making a difference in someone’s life, even if it was just from a small conversation or even spending time with Mrs. A.Z. talking with her. I know that there are many areas that I must grow in as a Student Nurse as I move through the different levels of nursing school, but I willing to learn. Being able to understand the basics is the first foundation, this foundation will help me to grow.Overall my therapeutic communication with A.Z was really good. However, as I reflected on our conversations, there were things that I noticed that I could have expressed differently. There were remarks that I made that I could have done a bit better. Those remarks were barriers during our one on one interview. As the conversation continued, due to the client’s verbal and nonverbal responses, I could distinguish the areas of communication that I was unsuccessful in instantly because of how A.Z. would respond. I will use this clinical experience as a learning tool and experience to help me with enhancing my therapeutic communication skills during my upcoming clinical days. This one to one communication experience was great. From this I will learn what not to do while communicating and interacting with my clients.Another area that I was unsuccessful in was teaching my client. There were moments where I could have given A.Z. information about her health that could have helped her, but at times she was very angry and, her anger made teaching difficult. I had interactions with this client for two before she was discharged. On the second day I was able to chime in on morning report. During the report A.Z. had a glucose reading that required coverage which she refused. I failed to bring it up during one of our communication sessions with A.Z. However, when we changed settings and I participated in his speech evaluation, the therapist asked A.Z how her blood sugar levels have been. A.Z mentioned to her that they were good and that they would be better if she took her medication on a regular basics. Without offending A.Z., in the politest way that I could, I let the therapist know that during report that morning, A.Z.’s reading was high and that she also refused the medication. The therapist began to explain to her the importance of her cooperation with her health and how vital it is for her blood glucose to be in an acceptable range. I feel as a Student Nurse, that is something that I should have informed A.Z. on as well and this should have been part of my teaching.
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