Therapeutic Communication Assignment NSG 350 Mental Health Clinical Adam Padilla Stratford University

Therapeutic Communication Assignment NSG 350 Mental Health Clinical Adam Padilla Stratford University THERAPEUTIC COMMUNICATION DATA FORM Student's Name Adam Padilla Client's Initials T.E. Date of Interaction 1/25/2019 ASSESSMENT: • Background information of client (age, sex, marital status, admission hx, etc.) from chart: T.E. A 29-year old Caucasian male was admitted to 3A on 01/17/2019 at 1230 as a TDO with the admitting complaint of Suicidal Ideation with a plan and Homicidal Ideation. Diet: Regular, No pork-derived and shell-derived products. Allergies: Benadryl, pork and shellfish products. Upon admission, patient is selectively mute and would respond by head and hand gestures only. Per report, patient called 911 this morning, stating he was suicidal with a plan to walk into traffic, but will not act on it. Patient also had HI, stating he had thoughts of harming others "on a global level". Merrifield CSB was called and issued a TDO. Per report, patient has a history of substance abuse (alcohol, Marijuana and Methamphetamines), last alcoholic intake was on 01/15/2019, last drug use was in December 2018. At approximately 1830, writer was able to briefly speak with writer, presents with pressured speech. Patient stated, "I just want to get back to my son. He's 2-years old, living with his grandma and grandpa.". Patient stated he collects disability for income. Denies HI/AVH. Admits to still feeling suicidal with no plan, contracted to safety • Psych meds: (list all psych related medications that the pt is prescribed, list the dosage, route, class, indication for use, and the top 3 side effects) o HydrOXYzine (Vistaril) capsule Q4H, PRN for anxiety Classification-Antianxiety Use: Anxiety Side Effects: dizziness, drowsiness, blurred vision o Haloperidol (Haldol) 5mg, oral Q4H, PRN Classification: Antipsychotic Use: Schizophrenia Side Effect: nausea, vomiting, diarrhea o Benztropine (Cogentin) 1 mg, oral Q4H; PRN; Classification-Antiparkinsonian Use: tremors, dsystonia/EPS Side Effects: skin rash, fast/irregular/pounding heartbeat, fever o Olanzapine (Zyprexa) 10 mg, injection (IM) Q4H, PRN Classification: Antipsychotics Use: Schizophrenia Side Effects: headache, weight gain (teenagers), speech/memory problems o QUEtiapine (SEROquel) 100 mg tablet PRN, Classification: Antipsychotic Use: Insomnia Side Effects: mood/behavior changes, constipation, dizziness o Ziprasidone (Geodon) 80 mg, oral, PRN, Classification: Antipsychotic Use: severe agitation Side Effects: unusual tiredness, dizziness, upset stomach • Medical and or psychiatric diagnosis: (If none, state “none” but do not leave any portions blank.) Check paper & on-line chart. o Axis I: Schizophrenia, schizoaffective type o Axis II: Narcissistic personality disorder, Avoidant personality disorder and Dependent personality disorder o Axis III: none o Axis IV: Housing problems, Other psychosocial or environmental problems, Problems related to social environment, Problems with primary support group o Axis V: 31-40: impairment in reality testing. • Assess yourself- describe your thoughts and feelings prior to the TC o My thoughts and feelings before the initial interaction was feeling a little nervous talking to the patient. Another aspect is how the patient responds to the type of questions I am asking. Though I was nervous, I was still very interested in learning how to interact with my patient. I also did not want to say anything that would trigger my patient’s condition. • What is happening in the environment - the milieu or clinical setting? Has it had an effect on the interaction or the client? o The milieu was quiet during this time period. There were only a few patients walking around. Some of the patients were in group therapy while some of the other patients were taking a nap. The environment of the milieu had no effect on the interaction nor did it have an effect on the patient. The peaceful environment had a positive effect on the patient. He was more open, and he talked more than he did before this interaction. DIAGNOSIS: • Nursing diagnosis: This should be the source for your eventual goal and objectives. “Ineffective coping related to disturbed though processes” (Ackley, 2017, p. 287) as evidenced by patient’s diagnosis of schizophrenia. PLANNING: • Describe a tentative goal of the TC (this is what you hope to achieve by this communication, i.e. "Help client recognize need for PRN medication) ▪ Encourage the client to find a useful coping strategy that works for his needs. • Write a minimum of two objectives to guide you to achieve the goal. An objective is often referred to as an outcome. They are something you can measure, i.e. "Patient will describe two symptoms that indicate a change in status". They always begin with an action verb. By the completion of the TC, the patient will: 1. By the completion of the therapeutic communication, the patient will find an effective coping strategy. 2. By the completion of the therapeutic communication, the patient will seek to remain free of destructive behavior toward self or others. IMPLEMENTATION: • Verbatim interaction using the following format (complete chart on next page): EVALUATION: • Strengths and weaknesses of the interaction: o One of the strengths for this interaction was forming a trusting relationship with the patient in the very beginning of the therapeutic communication. Another strength is understanding the patient’s perspective. o One weakness that stood out to me, is understanding more about his disease. Though I looked in the chart, I still would have like to read about it more before meeting him. Another weakness is I wish I had more time understanding the patient’s disease process. • Outcomes of the session (based on your objectives): o Both of my objectives were accomplished during this therapeutic communication. He has found that journaling, and minor exercising have been effective coping strategies. During this interaction, the patient was safe during my clinical shift • How could you improve for the next therapeutic communication assignment? o Some of the areas I can improve is understanding more about the patient’s disease. Another area is speaking slowly. This would ensure the patient is understanding as much as possible about what is happening. Another area is making sure to use appropriate language that the patient is able to understand. An example is using medical terms the patient may not understand. I need to break the information down into a useful and practical way. THERAPEUTIC COMMUNICATION/PROCESS RECORDING CHART Student nurse’s communication including what the student said or did. (Write in quotes and do not paraphrase.) Include a clear description of student’s non- verbal behaviors. (Write this in paratheseis.) Client Communication What the client said or did. (Write in quotes and do not paraphrase.) Include a clear description of client’s non-verbal behaviors. (Write this in paratheseis.) Student nurse's thoughts and feelings about client's verbal and non-verbal communication. What do you think of the interaction & how do you feel? Techniques and Analysis Identify the technique; then identify if it is Therapeutic (TC) or Non- therapeutic (NTC). Discuss why you used each technique. If non- therapeutic, what could you have said? Why? ◆ “Hi, my name is Adam and I am from Stratford University and everything we discuss will remain confidential (made eye contact with my patient)” ◆ How are you doing today” ◆ May I sit here talk with you for a few moments (pointed at the chair next to his chair)” ◆ How do you feel about being here? ◆ “Can you tell me more about what you are looking forward to when you leave this facility” (clarifying) ◆ Hello Adam, I am T.E.” and yes, thank you (patient made eye contact with me) ◆ Patient stated, “I am doing a little better because of groups and treatment team” ◆ Patient stated “of course you can sit here. I would really like that” (patient was already sitting). ◆ Patient stated, “He knew he needed help to deal with his hallucination s and to help with his destructive This interaction was really insightful. The patient seemed really excited to talk with me. He was reserved at first but slowly started speaking. It was really amazing to see how he opened up. I really enjoyed talking to my patient and learning more about his thoughts and understanding more about his needs. He explained that he definitely wanted to change for the better. The main reason for this was his son. He did go off in a tangent, but I redirected him back to the original conversation we were having. I can definitely see that T.E. has definitely come a long way since being on the psychiatric unit. I believe that I have helped him even if is just for a moment. ◆ I used the principle of listening which is a non-therapeutic technique. This principle allowed me to gain insight from my patient. I attentively listened to my patient while he talked. It was interesting to see how this type of therapeutic communication enhanced the overall conversation. The patient was really excited that someone was actually listening to him. Though I was intently listening, I still could have reworded some of the questions better. ◆ Another principle of therapeutic communication I used is clarification. This is a therapeutic technique. An example of this is when I asked the patient, “Can you tell me more about what you are looking forward to when you leave this facility. I ◆ “So, you get to go home tomorrow, you must be really excited” (smiling) ◆ “Tell me more about you feeling anxious” (looking at the patient). ◆ Have you discussed your concerns with your treatment team”? (openly asked) ◆ “Tell me more about what coping strategies have helped you. ◆ “I really appreciated talking to you today, I wish you all the best” (eye contact) behavior. (happily smiling) ◆ Patient stated, “I am hopeful that I get to see my son, who is two years old”. (smiling) ◆ Patient stated, “I am excited but anxious all at the same time. ◆ Patient stated, “I am a little frightened that I may not have the social support needed and the resources to help continue with treatment”. (nervous) ◆ Patient stated, “He has asked them about if there is a specific plan in place. The treatment team assured him that a plan is in place”. (patient felt somewhat relieved) ◆ Patient used clarification to ask the patient what you are most excited about. It helped me understand some his excitement to get better and get discharged from this facility. ◆ Another technique I used was suggesting. This is a therapeutic technique. This was apparent when I asked my patient, “Have you discussed your concerns with your treatment team” I used this type of therapeutic communication to allow the patient to have at least in option to talk to the treatment team next time he sees them. This is very important to allow the patient to ask relevant questions to his treatment and support systems.