Nursing intervention can include (1) educating the patient, (2) maintaining extended contact with the patient or (3) arranging for at least one home visit during recuperation. A 45-year-old woman who had had surgery was being released to continue recovery at home. She lived with her adult daughter but would be supplying most of the effort for her own wound care. Intervention began with detailed education in how to care for the wound, followed by descriptions of changes that a nurse would consider to be reason for medical attention. The client was able to recite to the nurse most of the characteristics described to her.
A follow-up call to the client’s home several days after discharge included direct questions about the current condition of the wound and its healing progress. Pre-discharge education of the client resulted in her being able to report more specific details about the wound and its progress. A home visit would have been in order if there had been any doubts about the client’s ability or willingness to practice proper wound care.
2. How would you rate yourself in communicating with patients – and with families?
As is the case for many people, I dislike rating myself because communication of technical information to non-technical people can be difficult at times. I always want to include enough information without wandering off into extraneous areas that have less value for the individual or for the family. Even so, I believe I can honestly rate myself above average and even excellent in some cases.
I strive to practice therapeutic communication and “read between the lines” to ensure that what I think I’m hearing from the patient or from family members is really what they’re saying. I try to anticipate fears or concerns without causing any fears they had not thought of on their own, addressing common features of the conditions or therapies with which the patient or family will be dealing. Most of all, I strive to communicate on a level even with individuals’ knowledge and experience.
3. Can you describe a situation in which you dealt with a difficult family member?
An elderly woman on life support in ICU was in the process of gradually dwindling away and her care team had been discussing removing life support to let her pass in peace. Most of the family members were understanding but one of them was quite vocal about keeping her grandmother alive at all costs. The difficult family member asked many questions that I found necessary to defer to the lead physician, who was not present at the time. I was left to reassure the granddaughter that I and the entire treatment team would do everything possible to ensure her grandmother’s comfort and dignity, and that I would contact the lead physician to speak with her. Ultimately, it was other members of the family who calmed the granddaughter. I realized she was speaking from personal pain and unwillingness to lose her grandmother, as did other family members.
4. How do you motivate patients?
Many patients possess intrinsic motivation that some refer to as determination and others may simply label as stubbornness. Some appear to take a defeatist attitude, however. This seems to occur more with patients who are not allowed or encouraged to take active roles in their own care, however. Patient participation generally is thought to enhance patients’ motivation to do more to care for themselves and take an active role in their own health. Healthy patient participation such as that defined by Orem certainly is easier to implement with a diabetic than with a cancer patient undergoing ravaging treatment, but where it is appropriate, involving patients in their own care can greatly enhance their motivation.
5. What would you do if you were caring for an alert patient who became confused and disoriented?
The second stage of investigating the cause of acute confusion can vary depending on the patient’s age, particularly if the patient is elderly. The first course of action is to seek the immediate attention of a doctor or send the patient to the emergency room. The individual could be having a stroke. If so, s/he needs medical attention as soon as possible. There are several conditions for which the patient can be assessed, but only after stroke is ruled out.
6. What would you do if you found an elderly patient on the floor in his room? How would you document it?
Follow up depends on the situation, but first actions generally are the same. Examine the patient for possible injury sustained in the fall and ask if there’s any pain. Do some gentle range of motion if no injury is discovered to ensure that the patient can move all limbs without pain, but stop immediately if the patient experiences any pain at all. Perform neurochecks. If suspecting a break or if there’s any pain, leave the patient where s/he is and make comfortable in place with pillows, a blanket and reassurance. Notify the doctor, call 911 if pain is present and document an occurrence report.
If the fall occurs at a nursing home or similar organization, document the fall in nursing notes rather than on an incident form if there is no injury. If there is injury or if it is necessary to call 911, the incident is reported to the health department.