Case Study:  Therapeutic Communication

Case Study:  Therapeutic Communication and suchMr. Yazzie is an 87 year old Native American male admitted to ER for low blood pressure and dizziness. Wife passed away five years ago; children live in different states and visits infrequently. This patient is unable to care for himself independently due to cognitive decline and urinary incontinence. Currently he lives in a nursing home. Mr. Yazzie speaks some English. Additionally; with advancing age is easily agitated and resistant to nursing care. He refuses to take his medications, spitting them back out, gripping the bedside rail when the nurse tries to turn him, and yelling out for his wife to save him. The nurse responds by telling him “okay I understand” but then leaves the room to attend to other patients. The nurse caring for Mr. Yazzie for the first time soon learns that talking slowly and softly is the most effective way of focusing the client’s attention and prompting him to follow basic instructions such as turning side to side. The nurse feels uneasy about speaking to Mr. Yazzie as if he were a child in some ways. On the second day of caring for him, the nurse notes that Mr. Yazzie is more agitated and needs frequent reorientation regarding where he is. The nurse needs the assistance of another person to hold Mr. Yazzie’s arm steady while assessing his blood pressure since Mr. Yazzie keeps pulling his arm away yelling “no”.  The nurse does not know how to respond. The nurse ignores Mr. Yazzie’s behavior, redirects his attention to what is on television and tells him everything will be okay. When saying good-bye to Mr. Yazzie’s at the end of the second day, the nurse is frustrated that Mr. Yazzie does not seem to recognize the nurse nor remember that the nurse has been caring for him for the past two days. The nurse is saddened to see him so confused and feels emotionally exhausted after two day of responding to his frequent changes in behavior. At 2pm Mr. Yazzie had a seizure and falls out of his bed. He is send to radiology for CT of head. The PCT suggests that when Mr. Yazzie comes back he should be restrained for his own safety. But the nurse is hesitant to restrain the patient. She calls the nursing home and speaks to the nurse who takes care of the patient on regular basis. The nurse reports that Mr. Yazzie does get confused at times but is normally a quiet man. He responds well to soothing tone of voice. In fact at times he is very helpful to the nurse in assisting with his own care. He is on seizure precautions but had no recent seizures or falls in the nursing home. Questions: Discuss some of the non-therapeutic communication techniques you observed in this case scenario    Discuss the importance of nonverbal communication when communicating with a person who is confused and agitated.       The nurse caring for Mr. Yazzie overhears another nurse state, “Well of course he is confused. He is an 87 year old.” How should Mr. Yazzie’s nurse have responded?  Was patient centered provided to Mr. Yazzie?    Describe the following strategies for caring for a confused clientTherapeutic TouchSilenceNurses’ presence    Consider Mr. Yazzie’s ethnicity. How can the nurse incorporate culture and ethnicity in the care of this patient?   What should the nurse do if there are language barriers?     Discuss if restraining this patient is appropriate?   Should fall precautions be implemented? What are some of the fall precautions?     Seizures precautions should have been implemented? What went wrong in this scenario?    Which QSEN values are violated in this scenario?     Is exercise recommended for Mr. Yazzie? What kind of exercise?    What are the benefits of exercise?  Health Science Science Nursing NURSING NR222