Nursing IPR

DESCRIPTION OF SITUATION AND ENVIRONMENT IN WHICH INTERACTION TOOK PLACE : The patient (MM) was lying in her bed in a normal supine position when I (SF) walked into the room. MM appeared to be asleep, but as I (SF) walked into the room she opened her eyes and seemed open to conversation, so I introduced myself. MM didn’t look to be having any pain or discomfort and was receptive to my conversation and care. The room was quiet and peaceful when I walked in with no family members in attendance.

VERBAL INTERACTION

NON-VERBAL CUES/ACTIONS

SN FACILITATIVE COMMUNICATION TECHNIQUES, BLOCKS TO COMMUNICATION, PREFERRED RESPONSES AND/OR ALTERNATE RESPONSES DEFENSE/COPING MECHANISMS EXHIBITED BY CLIENT

PERCEIVED THOUGHTS (T), FEELINGS (F), BELIEFS (B) & VALUES(V) OF BOTH CLIENT AND STUDENT NURSE

(WRITE OUT AND LABEL)

SF: “Hello, Mrs. Mrs. M , my name is S F . I am a nursing student from Kent State University and I am going to be taking care of you this morning.”

MM: “Hello.”

SF: “Tell me how you are feeling this morning”?

I smiled and kept eye contact while speaking.

She readjusted her position so she was sitting up.

She smiled when speaking.

I moved closer to the patient and pulled the room chair closer to the bed and sat down so I was at eye level with her – Offering self.

Giving information.

Open-ended question.

I was nervous because I wasn’t sure if MM was going to be receptive to having a conversation with me (F).

I think she felt a little at a disadvantage with me standing over her while she was confined to lying in bed so she readjusted her position (T).

I pulled the chair next to the bed because I felt that it would make her more comfortable and open to conversing with me. I felt that it was a way of showing respect (V). I had to stop myself from saying are you feeling better which would have been a closed-ended statement (T).

MM: “I am feeling better. I am tired because I didn’t sleep much last night”.

SF: “Have you had trouble sleeping before?”

MM: “Yes, I don’t often sleep through the night anymore. I usually sleep a little and then wake up, and am not able to go back to sleep. Then I am tired throughout the day”.

SF: “That must be very frustrating to you.”

MM: “It is very frustrating. I am usually very active and being tired during the day limits me and makes me feel old”.

SF: “Mmhm”.

MM: “It’s frustrating for my husband too. He always tells me “go back to bed” like it’s my fault that I’m awake in the middle of the night. I tell him that I can’t help it, I just can’t fall back asleep”.

MM spoke directly to me keeping eye contact. She shrugged while talking about how she didn’t get much sleep.

I made direct eye contact and kept my facial expression and posture attentive to encourage elaboration.

MM had a resigned look on her face and seemed a little bit agitated.

I touched MM’s shoulder to convey sympathy- therapeutic touch.

MM, again, seemed agitated and had a frustrated look on her face.

Silence/Active listening.

MM had a frown on her face and shifted in bed, seeming uncomfortable.

Focused question.

Although it’s a focused question it’s also a closed-ended question. A preferred response might have been “You’ve had trouble sleeping?”, which is an example of paraphrasing. Paraphrasing the question might have encouraged more elaboration.

MM was coping with the lifestyle change of not being able to control her sleeping schedule by chalking it up to being a normal untreatable symptom of getting older.

Reflecting feelings, focused question, encouraging elaboration.

Instead of saying “Mmhm” I could have said something like “Go on” to convey that I am listening and to encourage MM to continue.

It seemed to me that MM was unhappy about not getting much sleep, which is understandable, but that she was also used to having trouble sleeping (B).

It felt very awkward for me to keep direct eye contact; it’s something I’m not used to doing (F).

It seemed that MM was very frustrated with her sleeping schedule and was resigned to having to deal with it for the foreseeable future (B).

I felt awkward touching the patient and unsure of how MM would respond (F).

MM was feeling very discouraged with her situation (F).

Honestly, I wasn’t sure how to respond in a way that would make her feel better (F).I almost said “I understand how you feel”, but realized that that was a stereotyped response.

MM is distressed with her sleeping problem and because it is affecting her husband as well (B). She might also be a little resentful because he doesn’t seem to be very sympathetic to her situation (T).

SF: “Not being able to sleep through the night is very distressing to you because it makes you tired throughout the day and limits your everyday activities, and because it upsets your husband?”

I spoke directly to MM keeping eye contact.

Summarizing.

I wanted to let her know that I was listening to her and cared about what she was saying even though having problems sleeping is a common in many people; I wanted to let her know that I care about her distress and would genuinely like to help her (V).

MM: “Yes, I just wish there was something I could do to make it easier fall asleep and stay asleep”.

SF: “Maybe there is something we could do to help. Would it be okay if I let your nurse know how you’re feeling about your sleeping situation, and see if she or the doctor might have any suggestions to help out?”

MM: “Yes, I think that would be okay”.

SF: “Okay, I will make sure to let your nurse know. I am going to go and do some more checking on your chart now and will be back to check your vitals shortly.”

After saying this MM sighed.

I kept direct eye contact and smiled as I was speaking to MM.

MM seemed a little more relaxed and had a smile on her face.

I again kept direct eye contact and kept a smile on my face.

MM wasn’t really exhibiting a defense mechanism; she just seemed resigned to not being able to sleep. You could say that she was rationalizing the problem of not being able to sleep by reasoning that it was an unavoidable aspect of getting older.

Focused question.

Instead of saying “maybe there is something we could do to help” it might have been better to say “why don’t we see if there is anything we can do to help” because my original response might be a little falsely reassuring.

Offering of self, giving information.

MM was feeling hopeless about her situation and resigned to dealing with it (F).

I wanted to make sure that I got permission before saying something to her nurse or doctor because I value her right to privacy (V).

MM seemed to be feeling better about her situation and more relaxed. (B).

I wanted to reassure her that I would make sure I said something to her nurse (V). Also, I wanted her to be aware that I would need to check her vitals soon so she knows ahead of time and is ok with that (V).

1. Why did you select this interaction? I selected this interaction because I felt that it was a pretty good therapeutic conversation. Also, this was one of the first times that I was able to have time to have a decent therapeutic conversation without having to deal with family members being present, physical therapy interruptions ect., and phone conversations. I felt that MM was very receptive to my conversation and my care and seemed more relaxed after our conversation.

2. What did you learn about IPR from this interaction? I learned that therapeutic communication is genuinely helpful to the patient, but that it is difficult to practice. Paying attention to someone’s non-verbal cues helps you to read between the lines and understand what is really being said. Also using open ended questions/statements and silence can really help with having a productive conversation instead of yes and no repetition. I do feel that using silence might be a little awkward and is something I will have to get used to, but I do see the benefits of this technique. I’ve also realized the importance of using the communication technique of offering of self. If you don’t offer something in return the patient won’t connect with you and won’t trust you. If your patient doesn’t trust you, you have no relationship to build on. I was much more aware of myself and how I am speaking during this conversation. It seemed awkward to keep direct eye contact continually and to make sure I had a smile on my face. I feel that I had a decent conversation and that it was helpful to MM, but I do realize that there are areas in which I can improve to make my verbal and nonverbal communication more congruent and consistent.

3. What kind of interaction was this? Overall, this interaction consisted of nonverbal and verbal therapeutic communication.