Nursing 3
Therapeutic Comm. Paper
February 24, 2008
Introduction
For this therapeutic communication paper I interviewed CR. This client is a single, white twenty-four year old male who before admission to the Oasis facility was living with family. His admission date to Oasis was December 7, 2007 he was at first in the PHF unit until being admitted to the MHRC C unit. This client does not have any type of income source or occupation at the moment. The current legal status of this client is LPS. The clients presenting signs and symptoms are, gravely disabled manifested by delusional paranoid thoughts, depression, and bipolar disorder. He has no known allergies or reactions to medications. There has been a history of substance abuse with this client, such as, alcohol, ecstasy, and methamphetamines.
DSM-IV-TR
Axis I (Identifies clinical Disorders) – 296.80 Bipolar Disorder could be seen in this client by his constant change in mood. According to Frisch and Frisch, bipolar disorder is “characterized by up-and-down mood swings.” (Frisch and Frisch, 2006, p.878) , 296.24 Major Depression with Psychotic Features, this disorder related to my client in a way that he seemed to feel like things were much worse than the really are. Also he sometimes would have psychotic type episodes as described in the chart, but never during my time with him did he experience one. Depression is defined by Frisch and Frisch as “a state wherein an individual experiences a profound sadness, has become so severe that she/he has become psychotic; he/she has almost lost completely lost touch with reality.” (Frisch and Frisch, 2006, p. 262)
Axis II (Identifies Personality disorders) – None
Axis III (Identifies General Medical Conditions) – Nephrotic Syndrome – is a disease marked by proteinuria, hypoalbuminemia, hyperlipidemia, and edema often characterize nephrotic syndrome. (Lippincott, Williams and Wilkins, 2005, p. 544)
Hypertension – An elevation in diastolic or systolic BP that results from renal disease or another identifiable cause. (Lippincott, Williams and Wilkins, 2005, p. 189) Hypothyroidism – Results from hypothalamic, pituitary, or thyroid insufficiency or resistance to thyroid hormone. (Lippincott, Williams and Wilkins, 2005, p. 515)
Elevated Cholesterol.
Axis IV (Identifies psychosocial and environmental problems) – B) Problems related to social environment, this client has a hard time with his social environment because of his bipolar disorder and depression. D) Occupational problems, being in the current state this client is in, it is hard to get any jobs and have a source of income. E) Housing problems, client was living with family, but after having episodes of depression and psychosis the client was sent to Oasis for evaluation. J) Other psychosocial environment problems. J) Unknown or not available
Axis V (Identifies a global assessment of functioning) – This client when he was first sent to the Oasis facility had a GAF score of 00, because that didn’t have enough information. With further evaluation they later found he had a GAF score of 20. A score a 20 signifies that this client has some danger of hurting self or others (i.e. suicidal attempts or frequently violent), occasionally fails to maintain minimal personal hygiene, or gross impairment in communication (i.e. largely incoherent or mute). (Frisch and Frisch, 2006, p.74)
Process Recording
I began my process recording of therapeutic communication with CR in the community room. Myself and him sat in the row of chairs by the Television. The room was fairly cold and there was quite a bit of commotion going on with other clients that were also in the community room. All of this conversation took place in the community room, which made it hard to converse with the TV and people around.
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “Hi, How are you today?”
I sat in a forward position with my hands resting on my legs. I tried to keep the best eye contact with CR to ensure trust. I tried not to do any fidgeting or nervous movement so that the client wouldn’t become nervous
CR: “I’m feeling alright.”
He was sitting across from me using two chairs, with his legs over the arm rests. He would watch some TV while also talking to me.
Broad Opening
“Initiates conversation, puts the client in control of the content.” (Frisch & Frisch, 2006, p.93)
I felt that for the beginning of this interaction the verbal and nonverbal were appropriate. Nothing could be to effective at this point of the interaction, because this was the orientation phase, “where we are just getting to know one another, for establishing trust.” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “How have you been feeling this last week?”
I sat back in my chair and put my hand on my face. I put my other hand on my lap. I was trying to give a comfortable look and feel about myself so that I could be trusted.
CR: “It has been going so-so.”
He was relatively still in the same position, except he was keeping better eye contact, but his affect was kind of flat with no emotion.
Broad Opening
“Initiates conversation, puts the client in control of the content.” (Frisch & Frisch, 2006, p.93)
I wasn’t able to get to another question without using another broad opening question and I was still in the orientation phase “where we are just getting to know one another, for establishing trust.” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “So, some days you are feeling good, where as others are not so good?”
I was still in sitting back in my chair in an upright position. I was giving my full attention and trying not to look at the TV.
CR: “Yeah some days I feel better, where as others I feel really bad and depressed.”
He did put his feet on the floor at this point and was more focused. I felt I had got his attention.
Reflection
“Presents themes that have emerged through a series of interactions.” (Frisch & Frisch, 2006, p.93)
I felt at this point with the verbal and nonverbal communication being used that I was starting to get to a point where I could use some effective communication. It seemed that it was getting into the working phase, “implementing nursing interventions to achieve outcomes” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “Why is it you feel that way? Stress?”
I brought my self my forward in my seat. I folded my hands on the lap. I tried to keep my eyes focused on the client and my mind focused on the conversation.
CR: “Yeah I feel that way sometimes because of stress and just how things are.”
He was still sitting more forward with hands at sides, while holding the remote in his left hand. His mood seemed a little better as he watched something on TV.
Focusing
“Directs conversation back to an area of importance explores a topic in depth.” (Frisch & Frisch, 2006, p.100)
I felt that I was getting somewhere with verbal and nonverbal communication. I felt that I was getting to a point where I could help him out with some of my input and ideas to help with his stress. This was when I felt the working phase has started “implementing nursing interventions to achieve outcomes” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “What do you usually do to relax and elevate your stress?”
I sat forward in my seat and gave my full attention. My hands were on the arm rests and my eyes focused on the client. I had tried not to make any fidgeting or nervous movements.
CR: “I either watch TV, meditate in my room, or read the bible.”
He was back into sitting across to chairs. He affect was slightly flat again. It was at this time I noticed that he had a New Testament bible in his hand.
Focusing
“Directs conversation back to an area of importance explores a topic in depth.” (Frisch & Frisch, 2006, p.100)
The verbal and nonverbal I was using here was to get an idea of how the client deals with his stress and what types of things he uses to distract himself from it. I felt I was getting somewhere in the working phase nursing interventions to achieve outcomes” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “That’s good, it helps to sometimes relax take deep breaths and read the Bible it has a lot of guidance and help in there. Have you also tried to listen to music or play an instrument for stress relief?”
I sat forward at this time and used a lot of hand gestures to help with getting my idea across. I did start to tap my foot a little, but stopped after I caught myself.
CR: “Yeah, I like listening to some classical music, I was actually going to college to get a Music theory degree. I like to play the piano.”
He put his feet back down on the ground. His hands were at their sides. His affect seemed a little more positive.
Suggesting
“Presents new ideas, assists client to consider alternative options.” (Frisch & Frisch,
My communication I used here I felt was working great. I was able to get something out of the client and then give him some of my insight. I also was able to give him some other ideas on how to relieve his stress. This was all still being done in the working phase. “implementing nursing interventions to achieve outcomes” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “Really, How long did you play the piano?”
I sat in an upright position with my arms resting on the armrests. I made sure to use good I contact.
CR: “I played the piano for three years, I didn’t get to good at it.”
The client was in a curled up position in the chair. Appearing relaxed, calm, and interested in the conversation.
Suggesting
“Presents new ideas, assists client to consider alternative options.” (Frisch & Frisch, 2006, p.93)
Here I was again just going into a suggestive type of verbal communication with the client. I felt if I could give him some more ideas on things to help with the stress he was feeling the better. I was still in the working phase of my conversation. “implementing nursing interventions to achieve outcomes” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “That’s good it’s always good to have something to do to distract you from stress and negative thought, Do you have any other things that help you with stress?
I was sitting forward using hand gestures to show interest and further my idea. I keep good eye contact with the client at this time, so that he knew I was also interested in his answer.
CR: Well I did Tae Kwon Doe for ten years. It always seemed to help me relax.
He was sitting up in his seat at this time. I think since I was showing interest in him, he know showing more interest into the conversation.
Suggesting
“Presents new ideas, assists client to consider alternative options.” (Frisch & Frisch, 2006, p.93)
I felt that I was getting somewhere with my conversation. Because he was showing more interest in his verbal language and non verbal language. I really felt I was getting somewhere in the working phase of our conversation. “implementing nursing interventions to achieve outcomes” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “Wow, yeah that’s very helpful in clearing your mind and get some exercise, which is also good.
I was kind of slouched in my seat. I felt I might have an appearance of non interest.
CR: “Yeah”
The client was kind of losing interest, his eye contact was more focused on the TV. He went back to sitting in two chairs and was more focused in the direction of the TV.
Silence
“Provides time for nurse and client to gather thoughts, to reflect.” (Frisch & Frisch, 2006, p.93)
This time I felt that the conversation needed some silence just so thoughts to be gathered. I didn’t want to make the client feel like he was taking a survey. I still felt like we were in the working phase. “implementing nursing interventions to achieve outcomes” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “So, Do you feel like the medications that have been giving you are working?”
I sat a little more up right in my seat. My attention and eye contact were on the client. My hands were at my sides.
CR: “Yeah, I have felt they are working, like I can tell when they are wearing off. They also make me nauseated sometimes.”
He was still setting between the two chairs. His eye contact was still more on the TV, than me.
Broad Opening
“Initiates conversation, puts the client in control of the content.” (Frisch & Frisch, 2006, p.93)
At this point of my conversation I felt at a loss of things to talk about. I didn’t want to force the client into something he didn’t want to talk about yet. So I ended up having to bring something else up with a broad opening. Although I still felt as if I was in a working phase. “implementing nursing interventions to achieve outcomes” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “Yeah sometimes the side effects of medications can cause nausea. Have you been taking your medications daily? And is the nausea going away?
I was fidgeting with my hands a little. I was setting upright in my seat and keeping I contact with him.
CR: “Yeah I have been taking my medications daily. The nausea seems to be going away, I feel good today because my mom is supposed to visit.”
The client had a look of happiness on his face. He was keeping better eye contact on me and not he TV. His posture was slightly slouched.
Informing
“Provides facts or recommendations?” (Frisch & Frisch, 2006, p.93)
I felt that some of my non verbal communication might be making the client nervous and causing blocks in communication. The conversation is still in its working phase. “implementing nursing interventions to achieve outcomes” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “Well it’s nice to have some family come it can bring a calming feeling, especially games and stuff. What kind of things do you do with your mom when she visits?
I kept good eye contact and kept my hands at my sides to have a non threatening appearance. My posture was very at tentative.
CR: “Yeah, when my family visits it helps. I usually play some scrabble with my mom when she comes. Although I don’t know how well I can play.
His posture was kind of slouched. He was looking back and forth between the TV and me. Seemed to kind of have a negative look.
Suggesting
“Presents new ideas, assists client to consider alternative options.” (Frisch & Frisch, 2006, p.93)
I again was just trying to suggest some other ideas to the client to help with any stress of depressing feeling. So I was hoping to have him think of things to do when his mom comes to visit. I was definitely still in the working phase. “implementing nursing interventions to achieve outcomes” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “Why do you feel that you won’t be able to play very well?”
I looked at the client with interest and kept eye contact as I asked this question. Also made sure to keep hands at my sides.
CR: “Well just with how I have been feeling kind of stressed lately and feeling a little down.
Clients affect looked a little depressed. His posture went slouched again. His attention seemed once again more on the TV.
Focusing
“Directs conversation back to an area of importance; explores a topic in depth.” (Frisch & Frisch, 2006, p.93)
I was trying to get him to focus on the things that are stressing him so that he can find ways to relieve the stress. We were still in the working phase of our conversation. “implementing nursing interventions to achieve outcomes” (Frisch & Frisch, 2006, p.100)
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “Well you can try your best and see if you can use playing scrabble as a distraction and just focus on something else.”
I was sitting forward with my eyes focused on the client. I wanted the client to feel comfortable and that I cared.
CR: “Yeah well I’m going to go meditate in my room for a bit.”
Client at this point stood up, handed the controller to me and went to his room.
Suggesting
“Presents new ideas, assists client to consider alternative options.” (Frisch & Frisch, 2006, p.93)
I tried to give him some more suggestions on what he can do just to relax. I was glad that he did go to his room to meditate so he could relieve some stress. I wasn’t really able to terminate the conversation because we never really got to that point. “implementing nursing interventions to achieve outcomes” (Frisch & Frisch, 2006, p.100)
At this point the client came back out of his room and sat down next to me and we began another short conversation. The TV was still on and there was still lots of commotion and noise in the room.
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “So where you able to get your afternoon medications?”
I kept some eye contact with the client. But I was still fidgeting with my hands and I could tell it was making him a little apprehensive.
CR: “Yeah, I was able to get my afternoon meds.”
The client was distracted by other things in the room and the TV. I didn’t feel that he was to into the conversation just by his body posture and affect.
Broad Opening
“Initiates conversation, puts the client in control of the content.” (Frisch & Frisch, 2006, p.93)
After the client came back out the community area I felt I had to start with a broad opening, because I didn’t feel comfortable asking about what he did in his room. So I almost was having to move out of the working phase and back into the orientation phase.
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “It’s ok take your time, collect your thoughts.”
I sat forward so that I was in the same posture as the client. I tried to keep eye contact with the client.
CR: “I sometimes……feel like my mom wants me here”
The client was staring at the floor with a slouched posture. He also had a flat affect and seemed to get a little depressed
Silence & Listening
“Provides time for the nurse and client to gather thoughts, to reflect. Also Permits the client to be heard, conveys interest in what the client is saying.” (Frisch & Frisch, 2006, p.93)
I felt that the client was about get into something at this point, and I was trying my best to listen to what he might say. I didn’t want to rush the client into anything. I felt I was back into a working phase.
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “What do you mean? Please explain.”
I looked at the client with interest. I sat forward more and really wanted the client to know I was listening.
CR: “I feel like my parents, my mom specifically, wants me to be here.”
The client was still staring at the floor at this point. His mood seemed depressed and his posture very slouched over.
Clarification
“Puts client’s ideas into a simple statement; makes the client’s ideas explicit.” (Frisch & Frisch, 2006, p.93)
I really felt that my verbal and non verbal communication techniques were getting somewhere. I felt the client was really about to get into something. I was still in a working phase with the client.
Student Nurse
Verbal/Nonverbal
Client
Verbal/Nonverbal
Communication Technique Used
Analysis & Eval of Verbal/Nonverbal Communication & Eval of Therapeutic Effectiveness of Interaction
Me: “Well it must be hard to feel like you aren’t accepted. Is this what makes you depressed and stressed at times?
My eye contact was kept well with the client. I kept my posture straight up. I had my hands in front of me and tried not to do any fidgeting.
CR: “Yeah, I just have been feeling stress and depression, I think I’m going to meditate in my room some more.”
The client then once again stood up and walked over to his room.
Reflection
“Presents themes that have emerged through a series of interactions.” (Frisch & Frisch, 2006, p.93)
This was the point where our conversations and interactions stopped. The client spent the remainder of my time in his room. I really felt I never was able to get out of the working phase and terminate the conversation.
Summery
My communication with this client went alright, but could have went better at times. I felt it was hard to get any real good communication with the client because I didn’t have enough time to get a trusting relationship with him. This was because I only met him that day and that just isn’t enough to get someone to release personal information about themselves to you. On top of this, I felt that I should have taken the conversations and interactions to a more secluded private place so the client would feel more comfortable. I was able to use some of the techniques mentioned in the book, which did help in the ways to communicate with the client and keep the focus on them rather them focusing on me. I know there are some improvements I can make with my therapeutic communication. The first one I feel that would help with communicating with these clients, would be to take the time to really establish a trusting relationship with them. This of course is really hard to accomplish though with me only there for six hours for two days of the week. The next improvement I could make would be not to fidget with my hands, so the client won’t feel nervous because of my own nervousness. The last improvement I feel I need to make would be realize that this process takes time and practice. It’s not a process somebody can pick up and naturally do perfect the first time, it takes doing it many times and being able to always leave room for improvement. Overall, I feel I gained a lot from this experience, even though I know I could have done things better if I had more time. The things that I did gain I feel I can now apply to the other areas of nursing and they will help me with my future patients.
Credit:ivythesis.typepad.com
0 comments:
Post a Comment