STUDENT: Karla Larin GROUP: CA15 INSTRUCTOR: Joyce Wise DATE: 7/27/13 PATIENT (Initials): AG SITUATION: Ms. A was standing in the roof patio during a “fresh air” break on a bench. When my clinical coach approached her asking if it was ok to sit and chat with her once the break was completed. She agreed to talk in her room as we sat on her bed. GOAL: To have Ms. A engage in a therapeutic relationship. I’m hoping to have open dialogue on her experiences on a lock down ward. SUMMARY: 1. Was the goal reached? Explain if the goal was met or not met and include rationale for your explanation. The goal was partially met. I had interacted with the patient briefly on a number of occasions in the dining room through small talk prior to our talk. The patient was more apprehensive to keep the conversation going and withdrew due to fatigue. 2. Which phases of a relationship were demonstrated? The orientation phase was completed. Ms. A abruptly ended the conversation during the working phase of therapeutic communication. The subject matter became very close and personal on subject matter to which she presented in the emergency unit. 3. Stressors: Ms. A seemed to be very guarded during the conversation when details of her marriage were discussed.
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STUDENT NURSE’S VERBATIM COMMUNICATION (AND NONVERBAL BEHAVIOR) CLIENT’S VERBATIM COMMUNICATION (AND NONVERBAL BEHAVIOR) STUDENT NURSE’S THOUGHTS AND FEELINGS ANALYSIS Might not be a good time to talk. I wonder if she remembers that we asked to sit and have a talk. She is really not interested in talking and I might not be able to complete the assignment. -I just spoke with my Doctor (Sitting on bed, legs crossed with hands on lap, not making eye contact) -Oh, um to talk about what? What questions do you have? (Sitting on bed, legs crossed with hands on lap, not making eye contact, glancing at a cartoon strip newspaper clipping )
-We we chat a little? (Standing at doorway, facing client, soft tone)
Confusion and if it was related to the illness. Identifying myself in the front end would have caused less confusion. Seems like she is guarded and wants to know the topic to be discussed prior to agreeing to talk.
-Oh no, I’m not a Doctor, I’m a student, a nursing student from WGU and I’m here doing clinical rotation with Tracey,RN and I just wanted to chit chat, if that’s ok with you? (Standing closer to patient, facing client, soft tone) -Well, I’d like to know how your experiences have been like at the hospital. I don’t have a check list of questions. (Standing closer to patient, facing client, soft tone) Thanks! so how has your stay been? (Sitting on patient’s bed, facing client, talking in a soft tone) -Ok, let me clear a seat (Made space on her bed removing the newspaper and returned to previous) Wow, she is even clearing a seat. She was so hesitant previously I didn’t think we would be able to have a conversation. She is aware of how the program works. I didn’t know she has other admissions. Should have looked for that in her chart
She is guarded initially until she feels there is no real confrontation.
Allowing her to tell me her story without providing her knowledge that I knew about how her admission occurred.
Oh ok, how is it different from previous times? (Sitting on patient’s bed, facing client, nodding of head with legs crossed) Has something changed? (Sitting on patient’s bed, facing client, legs crossed, caring expression)
Well, it has been ok; This is my 3rd time here. It’s different from the previous two. (Sitting on bed, legs crossed with hands on lap, making eye contact, mostly looking at my appearance) I am more accepting of treatment and I know that the other times I didn’t want help. (Sitting on bed, soft tone while nodding head in acceptance) Yes, God is helping me and if he didn’t think I could handle it he wouldn’t give it to me. I need to stay on my medication. (sighs, eye contact and starts to look...