NURSE-PATIENT INTERACTION
STUDENT-NURSE STUDENT-NURS E
PATI ENT
THOUGHTS AND
ANALYSIS ANALYSIS
F EEL I NGS NGS OF THE STUD STUDENTENTNURSE
ORIENTATION PHASE April 14, 2010 (This is my first time to see my patient as she was called by the nursing aide for our first session)
Good Morning po! (smiles)
Sus, anlaki naman ng katawan ng babaeng ito! Parang amasona! Kayangkaya akong patulugin nito. nito. (No reaction from the patient) I felt happy to meet my patient for the first time.
(While walking from the front door of the ward to the area where we shall have the interaction, I and the patient were were both in silence)
Silence
Dito tayo umupo ate. Diyan ka at dito ako.
No response but sits.
I keenly observed my patient. Many questions formed in my mind like why is she not wearing wearing slippers, etc. etc.
First impression with the patient normally occurs at the initial meeting. This may be positive or negative. The good/bad impression will be validated as the interaction progresses. Showing joy in meeting the patient for for the first time time leaves leaves a long and lasting impression to her. It is also a gesture of wanting to be a friend to the patient which which is an initial step step in getting her trust.
Not asking questions right away is giving myself and my patient time to compose ourselves before starting the main orientation phase of our our NPI. It is also a good time to keenly observe the behaviour of of the patient patient especially if the patient has the tendency to do harm. Ushering the patient to sit is a form of courtesy and a gesture of caring. If the patient feels that you care for her, it will be easier
to gain her trust. Likewise, allowing the patient to sit before you sit is a gesture of showing importance. Showing her where to sit and where I sit is to maintain the proper distance which is neither too close nor too distant. Magandang umaga po ulit! Ang kulit ko ano?
Ako po si ALFRED V. CORPUZ (pointing to my ID). Isa po akong student-nurse na kasama sa health team na mangangalaga sa yo.
“Magandang umaga po naman”
(Nods and smiles with arms folded in front, chest level)
I felt relieved that finally my patient started to talk.
I thought and felt that the patient’s folded hands is not a sign of hostility.
I emphasized the word makulit because I wanted to elicit response from my patient since she never responded to my previous queries.
Nurses should take note of and respond to the variety of non verbal behaviors displayed by the patient particularly voice inflections, body movements, gestures, facial expressions, postures and physical energy levels. ((Schwartz & Shockley, 1956) Introducing myself to the patient is the first step of establishing rapport.
Ikaw po? Ano naman ang pangalan mo para iyon ang itatawag ko sa iyo.
Ako si Mary Joy Ramos kuya, pero tawagin mo na lang akong MJ para mas maikli.
Taga saan ka naman MJ?
Taga Brgy Aggay, Bantay, Ilocos Sur ako kuya.
Asking the patient’s name is eliciting information for the patient’s profile. Generally, one’s name is the sweetest word one can hear (except perhaps if your name is Tiburcia, Cordapia and the like hehehehe). I felt surprised and happy that my patient is my own kababayan.
Asking the patient’s address is eliciting information for the patient’s profile. This also aims at establishing
connections and knowing if the patient and the student nurse have something in common like cultural and language commonalities. Hala! Agkailian ta gayam MJ! Taga San Juan, Ilocos Sur nak met.
Talaga kuya! Agkalugaran ta a ngarud.
I felt that as early on, I have already gained some form of trust and rapport with my patient.
MJ, siak ti agbalin nga Nasayaat a ngarud Manong Alfred. student nurse mo (looking straight to my eyes) manipud tatta, April 14, 2010 agingga inton April 24, 2010. Bale umay ka alaen dita ward yo ti 8:30 AM sa umay kan to met la isubli ti mga 10:30 AM.
Finding connection between the nurse student and the patient is the first step in gaining trust and cooperation.
This is establishing contract with the patient. Whenever the nurse-student tries to put her relation with the patient into the kind of time scale we use, and whenever she defines the patient’s actions and relations with others in terms of our conventional ideas of time, he/she might be helping the autistic patient. (Schwartz & Shockley, 1956). (Although my patient is not autistic, I feel important to always orient her with time as some patients in Pavilion 35 have some form of disorientation). Mentioning the time of the day when appropriate, dating occurences by the day of the week and the month of the year, all may help to orient the patient. (Schwartz & Shockley, 1956)
MJ ading ko, mabalin kadi nga ikkan nak ti sangkabassit nga background mo?
Deep sighs.
I felt excited to know more about MJ.
Asking the patient to tell something about her is better than just asking individual questions because aside from observing her voice, you can observe the manner she talks, her facial expressions, her gestures,
and the like. Likewise, many of the mental status examinations can be assessed by merely listening to the story of the patient. Some of these are: speech, mood and affect, sensorium, etc. which will later be validated through the MSE proper. (I attentively listen to what MJ would share)
(She clasped her fingers together and laid on her lap perhaps to make her comfortable and to temporarily stop the trembling of her hands). Kas tay nakunakon kuya Alfred, siak ni Mary Joy Ramos. Taga Barangay Aggay, Bantay, Ilocos Sur nak kuya. Naiyanakak idi Mayo 03, 1980. Agtawen nak ti 29 kuya. Maysanak nga Pilipino. Nayyanak nak diay Villasis Panagsinan ngem dimmakkel nak diay Barangay Aggay, Bantay. Awan asawak kuya ken awan anak ko.
I showed great Listening is the foundation of all interest to MJ’s story therapeutic communication. as evidenced by my (Ruesch,1962 as stated by Lara, looking straight to 1987) her eyes while Showing interest to what the narrating and using nods and words like patient is sharing is like saying: “I am here, willing to listen to okay and “wen la”. you” which in itself is a therapeutic technique.
Nakunam MJ nga naiyanak ka diay Villasis, Pangasinan ngem dimmakkel ka diay Bantay, Ilocos Sur. Mabalin kadi ading nga maammuak no apay nga kas diay?
Impaampon nak gamin ni inang ko ken ti gayyem na nga taga Bantay kuya Alfred. (stops talking).
I felt a bit sorry and Restating and clarifying the emphatic for MJ. I words of the patient ensures that think I have “bulls you really get what the patient eyed” one aspect in meant. her life that needs to I purposely did not question yet be clarified more in the patient about her adoption my succeeding interactions with her. because I felt it is too early talk about that at the first meeting.
Thank you ading ti takek mo nga nangibingay ti kabibiag mo kanyak.
Wen kuya Alfred.
I felt happy that I was able to achieve my goal in eliciting my patient’s profile.
Thanking the patient gives her the impression that she has done you a favor. Most mentally ill patients have low self esteem. Thanking them so often gives them the sense that
sick as they are, yet they still have something to contribute. Ulitek lang ading no naalak met la nga nalaing dagiti inpormasyon nga inted mo kanyak.
(smiling) Pudno amin nga imbagam kuya Alfred.
Naibagam nga Mary Joy Ramos ti nagan mo, naiyanak ka idi May 3,1980, 29 ti tawen mo, maysa ka nga Pilipino, awanan asawa ken anak, naiyanak diay Villasis, Pangasinan ngem dimmakkel diay Aggay, Bantay, Ilocos Sur, ken aglugar diay Aggay. Agyaman nak manen MJ. Ituloy tan to manen ton bigat wen? Same time and place met laeng.
One thing that I was very happy about is that MJ always calls me Kuya Alfred. My patient is very respectful.
Wen Kuya Alfred.
Narrating what the patient has told me is a form of validation, confirmation and summarizing what has transpired.
Completing this task is a form of accomplishment on my part because aside from the information I gathered, I was able to establish rapport and develop trust with my patient. WORKING PHASE APRIL 15, 2010
Facilitators: ALFRED AND MOISES “Mga kuya at ate, mag-eexercise tayo ngayon. Okay lang po ba yun?”
A therapeutic relationship must be based on respect as well as trust. Respect means acknowledging the value of the client, accepting and valuing her individuality and recognizing her rights and needs. The student nurse demonstrates respect for the client by listening to her viewpoint, respecting her
preferences, giving her choices and treating her with dignity. (Schwartz & Shockley, 1956) This helps in enhancing the self esteem of patient which in turn will help him verbalize and express her feelings more. “Kung ganun po ay tara na at mag-exercise tayo……
“Sige.” (smiles) When a client entrusts herself to a student nurse, she demonstrates confidence that she will be accepted, respected and helped. (Schwartz & Shockley, 1956)
Before the group singing activity on April 15, 2010:
Group activity is considered an effective way of modifying maladaptive behaviours. In group activity, client learns to communicate with others, to become aware of how they appear to others, and to improve their communication skills. (Schwartz & Shockley, 1956)
Before explaining the mechanics of the activity, student-nurse introduced it by asking each patient about his/her favourite song.
Eye contact can communicate level of interest about or involvement with a current interaction. (Schwartz & Shockley, 1956)
(shifted body position to face the nurse, established eye contact)
Kuya Alfred, music and art therapy ba ang gagawin natin?
I was surprised that my patient knows about music and art therapy.
When a person asks for advice, opinion or judgment, a decision often has already been made; the person is actually seeking a validation for an idea. (Schwartz & Shockley, 1956) Offering information makes facts available whenever client needs or asks for them. This builds trust and reduces client’s anxiety
and frustration that may hinder comfort. (Schwartz & Shockley, 1956) Student-nurse could have used giving information by stating the difference between group singing and music therapy,” MJ, ang group singing ay group activity lamang na walang malalim na pinagdadaanang proseso at mithiin. Samantalang ang music and art therapy naman ay may eksaktong gamit, at mga layunin para makamit ang nais na mithiin. Itorin ay may pinagdadaanang akmang proseso.”
“Iba yun Mary Joy, group singing lang muna tayo. Saka na natin gagawin ang music and art therapy.
Or the student-nurse could have asked MJ “Ano po ba para sa inyo and pagkakaiba ng group singing at music therapy?” When it was her turn to share a song, MJ presented her singing talent by rendering the group with a tagalong song. After her presentation, MJ was given isang bagsak from the group.
MJ offered the group a big smile after the isang bagsak.
I was really happy to When behavioural action is see MJ singing. I followed by a good or rewarding wanted to give MJ event, it is encouraged and will another bagsak for occur often; when followed by a her presentation. dislike or aversive or no response, it will occur less often. (Lara, 1986) Client seemed happy with her presentation and the recognition she received from the group.
After everyone has shared his/her song, all sang the “We Are the World” and after the group singing,: MJ, saan mo gustong A therapeutic relationship must
umupo?
be based on respect as well as trust. Respect means acknowledging the value of the client, accepting and valuing her individuality and recognizing her rights and needs. The student nurse demonstrates respect for the client by listening to her viewpoint, respecting her preferences, giving her choices and treating her with dignity.
During the NPI proper after all the preliminary activities: What will my client say this time???
“Maimbag nga bigat mo ulit MJ. Ania ti kayat mo nga pagsaritaan ta tatta?
Creating a climate of trust begins with the offering of self, the reaching out of one person to another. (Lara,1986) Broad openings make explicit that client has the lead in the interaction. It also assists the client to take the initiative in introducing topics, focusing on feelings and identifying and thinking through problems. (Lara,1986) Asking open ended questions provides the individual with a relaxed framework within which to respond. Broad, open ended comments allow the person to decide the direction of the interaction. Questioning may focus on the analysis of a recent situation that has left the individual with ambivalent or negative feelings. (Lara, 1986)
Pagsaritaan kuman kuya? Ang gusto kong pag-usapan ay tungkol sa kapatawaran ng mga
Why did my patient choose this topic? Why does he need to ask forgiveness from
taong nagawan ko ng masama kuya. “Ituloy mo lang MJ.”
the people he has done wrong? Verbalization also provides a method of releasing tension and anxiety other than acting out these feelings. Through talking with a skilled practitioner, the ill person is enabled to identify problem areas, face them realistically, envisage alternatives and test new patterns of behaviour. The communication process gives the patient needed emotional support and assists her to develop the interpersonal competencies inherent in problem solving. Showing sincere interest in what the patient is saying will generally tell him that he is cared about as a human being. Showing this interest is one way the student nurse can help the patient to talk freely. (Schwartz & Shockley, 1956)
“MJ, ania kadi ti rason ta kayat mo ti dumawat ti pammakawan?
Exploration helps the client identify, face and resolve own feelings. It encourages exploration of the subject in depth. It helps keep the communication flowing and the client talking. Encourages the ill person to verbalize serves many purposes. The ability to verbalize in and of itself may be helpful to an ill person. Further, it is partially through sharing of self in verbalization process that individuals get to know each other. (Schwartz & Shockley,
1956) “Parurusahan kasi nila ako, kuya Alfred.”
In bipolar disorder just like Schizophrenia, clients often have difficulty establishing trusting relationship with other people. There may be mistrust which may be related to an inability to trust themselves or their perceptions. The condition may be manifested by the client’s feeling that everyone is against her or that powerful agencies are planning to inflict pain. (Schwartz & Shockley, 1956)
“Nila?”
Questioning is a direct way of speaking with clients. Questioning is useful when the student nurse is seeking specific information. Ni inang ko nga natayen ket ni Mang Marcial nga akinkukua kadaydiay nagibittakak ti bote ti beer ken ni Loreta Viloria nga pinagsawawak diay Bantay kuya.
“Ania met ti makairason iti idadawat mo ti pammakawan?”
The patient indeed had history of violent behaviour in the past.
Exploration helps the client identify, face and resolve own feelings. It encourages exploration of the subject in depth. It helps keep the communication flowing and the client talking. Ni inang kuya ket natay ta naatake gapu kadagiti problema nga naited ko kanya na kuya. Nagibittakak ti bote diay tienda ni Mang Marcial ta nagself defense nak laeng kuya. Pinagsasawak met ni Loreta Viloria ta pabpabasulen nak nga nagtakaw kuya.
The individual who feels overwhelmed by his own aggressive feelings may disown and project them onto others. Her attempt to relieve her anxiety is ineffective because now, seeing her disowned aggression in others, she may fear interaction with them.
Disowned and disassociated aspects of one’s personality can return as hallucinations that reveal intimate knowledge of the individual. This knowledge is used in the service of derogation and devaluation of the self. “Ang ibig nyo po bang sabihin ay madami kayong nagawan ng kasalanan?”
Restatement indicates that the student nurse is listening to the client and trying to enter and understand the clients frame of reference. The identification with the client is called empathy and is therapeutic because it makes clients feel understood and encouraged to continue sharing inner thoughts and feelings with their understanding listener.
Isa isahin natin MJ wen? Imbagam nga sika ti gapu ti pannakatay ni inang mo. Ielaborate mo man MJ?
Su ngarud kuya. Naatake ni Inang ta nagapa kami idi saan nga mangted ti kuarta nga igatang ko ti mary juana. Sinungbasungbatak agingga nga natalimudaw sa bimmagsak ti semento. Naitupa ti ulo na ket nagpadara agingga nga natay.
Ielaborate mo man no apay met nga nagibettak ka ti bote diay ayan da Mang Marcial?
Self defense lang met kuya ta kayat dak nga patayen dagiti sabali nga grupo.
Kumusta met ti napasamak kadakayo ken ni Loreta Viloria?
Isu ti makaigapu ti pannakaipan ko ditoy kuya. Pinagsasawak ta pabpabasulen nak ket din nga nagtakaw ti alahas nan. Saan nak met nga agtatakaw kuya. Kuya tulungan nak nga makaawiden. Nalaing nakon kuya. Tawagam ni Auntie Connie diay
I felt sad about what happened to MJ’s mother.
This will allow the patient to ventilate her feelings thereby making her fell lighter than before.
social welfare diay Bantay ta umay nak alaenen kuya. Silence
Silence
I really don’t know what to say here. So I just used silence to encourage the patient to talk more about what she is feeling.
“Iba naman kayo sa amin. Sirasira kami, kayo hindi. Pero ako magaling na. Kaya lalabas na ako.”
Silence gives patients an opportunity to collect and organize their thoughts and thereby increase their awareness of their problems.
Patients with bipolar disorders are convinced of the reality of their beliefs even though they are contradicted by logical thought and perceptions of others.
MJ, mukhang hindi kita matutulungan sa binabalak mo. Estudyante nak laeng ken sika ket pasyente. Dadtoy ka Mental Hospital tapno agpalaing ading.
Making clear expectations in relationships helps decrease anxiety and prevents misunderstandings. Clear expectations also create an atmosphere that feels safe because expectations that are clear can more easily be met. And feeling safe in the hospital environment may enable the patient to adapt in more healthful and effective ways.
Maibagak to laengen ken ni Maam Connie nga umay daka bisitaen ditoy ta isunton ti agdesisyon maipanggep ti problemam ading.
Sige ngarud Kuya Alfred.
Thank you MJ ha. Ituloy tanto manen ti agsarsarita kadagiti sumarsaruno pay nga aldaw.
Sige ngarud Kuya Alfred.
I felt sad about the MJ but I have to be honest with her in terms of her asking for favour.
I still have a long conversation with MJ but I am not going to share all of them because of space constraints.
TERMINATION PHASE APRIL 22, 2010
Kas imbagak kenka idi Maawatak Kuya Alfred. Thank umuna nga aldaw ta you met kenka a. nga nagsarsarita, daytoyen ti maudi nga aldaw ko ditoy MJ. Thank you very much ti tiwalam kanyak ading ko. Adu ti nasursurok ken ka ket sapay ta ado met ti nasursurum kanyak.
I felt sad that my 2 weeks of interaction with my patient has to end.
For the last time, I held her hands and told her to be good inside the hospital so that eventually she will get better because there is a bright life waiting for her outside.
Termination phase is the ending phase of the NPI. To feel sad is a normal thing for both the student nurse and the patient. But we should not limit our feelings with just the one side of the coin. We should also happy to let go of our relationship to give our patient our patient a chance to grow and develop as an independent person.
