Month: April 2021

Nurses play a big role in caring for the physiologic and mental health needs of patients no matter what setting they are in. A persons mental and physical health impact each other in different ways and it is very important for a nurse to be able to acknowledge that when caring for their patients. Last semester, I went to clinical at New England Rehab facility for my first clinical experience. Since it was our first time, we were not allowed to do much with the patients, which enabled me to have really good and long conversations with them. Although I was able to have many conversations, one of the patients that I had the pleasure of working with really stood out to me. 

            This patient was a younger woman who was in the hospital because she just recently had a stroke. When I used to think of stroke patients I would think of older adults, so it surprised me to see someone her age having a stroke in general. The right side of her body was affected, which was her dominant side. Her speech was impaired and so was the strength and ability to use her upper and lower extremities on her right side. Being young and completely healthy prior to the stroke, I was able to tell she was struggling to this new adjustment and that it was taking a toll on her mental health. Aside from the physical effects this was causing, she was also unable to have any visitors due to the pandemic, which only added to the stress of being in the hospital. I was able to have a conversation with her where she talked about how she was struggling with these adjustments especially because she realizes she’s one of the younger stroke patients on the floor. She was very down on herself, especially because she did not know how this would affect her future. The patient did not directly state that her stroke and its effects were becoming detrimental to her mental health, but I was able to tell by the way she was talking about her current situation. I would say that she did have at least some insight between the connection of her physical and mental health because she was able to verbalize her fears and struggles when it came to dealing with the effects of her stroke. However, she did not clearly state that she sees a connection, so as a nurse I could have (and I wish I had) asked her more about her specific worries regarding how she feels about her treatment process and therapy. Since she already was having negative views I could have used her talking to me that as an opportunity to turn the conversation around. I would attempted to help her into having a more positive outlook by switching her focus onto what motivates her to get better and what she feels her strengths are. Helping a patient turn their thinking around will benefit their recovery process, especially if they are focused more on the strengths they have then their weaknesses. 

            When I had been in the role of the patient, it made me feel really good when the nurse took time out of her day to sit and talk with me no matter what it was about. It made me feel as though she cared about me as a whole person and not just as a patient that needs to be fixed. That is something I want to carry with me throughout my time as a nurse. I want to make people feel comfortable and know that I want to hear what they have on their hearts. That was my goal when talking to my patient that day. She did not tell me too much information about her life outside of the hospital, but she told me enough to understand how this diagnosis could possible affect her. She explained to me how she is married and has kids that I believe are in college and out of college. Going to watch her children play sports is something that she really enjoys along with hiking with her husband. From what I gathered, she seemed concerned about her current physical health will affect what she loves to do. Although she is worried about how this will affect her role in the family, she explained that her family is also what is giving her the motivation to get better. I wish I asked more about the activities she enjoys in order for her to develop more motivation to recover and participate in therapy. She also had a cross on the table and around her neck. Religion/ spirituality was not discussed, but looking back at the situation I could have asked her more about that. I wish I had asked about the cross and the role of spirituality and religion in her life. It would have allowed me to get to know her better and have a better understanding of the way she thinks. A big question regarding the social domain that I should have asked is, “what helps you get through tough times?” That question is very important and can reveal a lot about the patient. It would have also directed her on the path of thinking positively about her recovery and diagnoses. Based on what I knew about this patient (her stories and what she has told me), I would say that there are no elements of the social domain that would need further assessment or nursing attention. I just feel that it is very important for the nurses to be there for the emotional aspects of her care. 

            Thinking about this patient and the challenges she faces I came up with three nursing diagnoses for the social, biological, and psychological domain. For the psychological domain I put situational low self-esteem as evidence by being very down on herself and frustrated with being in that situation at that age.  ADL deficit as evidence by the weakness in her face and right extremities is the diagnosis I have for the biological domain. She is now faced with many challenges regarding the basic activities a person does during the day. For the social domain I have ineffective role performance as evidence by her concerns with how this is going to affect her role as a mother and as a wife. Taking these three diagnoses into consideration, there should be interventions put in place to help meet the goals of the current, long-term, and post-discharge care. The interventions should be based upon the goals of achieving independence and identifying positive aspects of self. In order to achieve those goals, the nurse should encourage the patient to talk about factors that contribute to the low-self-esteem and ineffective role performance, so the nurse is made aware of what needs to be worked on. The nurse should collaborate with other services such as a psychologist and occupational therapist, as appropriate. A psychologist would be a more effective way to turn the patients outlook into a positive one and an occupational therapist will help promote independence. Regarding the ADL deficit, the nurse should give the patient sufficient time to perform tasks and talk to the patient about how much time they feel they need for the ADLs. Also, assist the patient in anything they need while maintaining and sense of independence. That will enable the patient to see what they are capable of doing. It is very important that through all of this, the caregivers do what they can to keep the patient motivated in order to get the results of the care that she deserves. From what I was able to see, the nurses and health care team did a good job with addressing the mental health needs especially because she is not afraid to voice her fears and concerns. I hope they continued to address those needs because the patient did give off signs that she may need encouragement here and there and to be reminded that if she puts in work, her life will change for the better. I was also unable to identify any barriers to the treatment because although she seemed down on herself, she was still ready to get better. 

It would have helped the patient and I in this situation if I had taken the mental health class prior to meeting her. The conversations I had with her that day were the perfect example of how physical and mental health affect each other. If I had taken the class prior, I would have had more knowledge on what to say and what to talk about in order to help her and to change her mindset. She really made an impact on my life because it made me realize not to take anything for granted and that as I nurse I need to be able to help in the recovery of the patient’s mental health along with caring for their physical health. 

  In mental health nursing, it is very important for the nurse to have therapeutic communication and develop rapport with your patient. It also decreases the patient’s anxiety and opens opportunities for optimal patient care. In the simulation experience there were many good examples of how the students demonstrated therapeutic communication. Watching the video over, enabled me to have a better understanding of the role of therapeutic communication in the mental health assessment process and as in intervention. They first started off by making him feel comfortable as he walked in, sitting facing him with arms open along with the appropriate body language. Right after that they all introduced themselves, beginning to form that patient-nurse relationship. Everything they said was with a caring tone, which also makes the patient feel comfortable and safe. They were very understanding with the struggles he was explaining to them and expressed that by saying things like “I understand how this can be difficult for you.” Letting the patient feel that you understand them will make them feel more comfortable in explaining what is going on. 

            The students were asking the patient open-ended questions and gave him time to think of a response and speak his mind. Open-ended questions allow the client to explore their thoughts and feelings and in turn helps the nurse have a better understanding what’s going on. There were specific moments when the students asked things like: “can you tell me what a normal day would look like,” “what do you mean by that,” “can you explain more about that guilt you were talking about,” and “tell me more about how that makes you feel?”  When the patient would answer their open-ended questions, they would reassure him that he is not alone and he is supported. For example, he kept talking about how he feels guilty that his marriage problems are his fault and the students would reassure him that guilt is a common side effect of depression and it is not uncommon for someone who is depressed to feel that way. They also gave him suggestions on different types of therapy he can go to and ways to improve his marriage and life in general, while assessing his willingness to do so. It was also effective to ask the patient to explain to them the medications he is on in order to get a better understanding of his current knowledge and what needs to be taught. Overall, communicating therapeutically with patients will benefit the nurse and the patient. I was able to see that when watching the simulations that my classmates did. I could see progression from the first scenario to the second to the third, and as they got better at interviewing and using that type of the communication, the patient was more willing to talk and express their struggles. 

Through evidence appraisal and synthesis, we discovered more information that backed up what we are trying to prove with our PICOT. The evidence gathered in the appraisal was based off of reliable sources and ongoing studies. However, we also realized that there still needs to be more research done regarding the effects of prenatal alcohol consumption on school aged kids in order to support nursing education points when talking to pregnant women about the future consequences of drinking alcohol while pregnant. The literature appraisal and synthesis did not change our assumptions about the topic, it only made them stronger. All of the articles used in our paper has the same results about the cognitive deficits kids have to deal with due to being exposed to alcohol in the womb. Those were the results we were trying to look for because we want to stress on the importance of educating women about all possible effects alcohol consumption could have on their child instead of just telling them it is bad to drink while pregnant.  Our findings will give us a strong base of knowledge with reliable evidence when having the opportunity to talk to women about alcohol and pregnancy. It will enable us all to feel confident while talking about this matter, and make women really see how important it is to look into what the future could look like for a child before deciding to have a drink of alcohol. 

             The team members and I all came to the same conclusion about the findings because all of the articles found backed up what we assumed in the first place. We all agree that there should be more education for women regarding the future of their child when exposed to alcohol in the womb, and that there should be even more research done to make the education points stronger. Our team came to some confusion while creating the critical appraisals. Since we have 5 people in our group and there are only 4 articles, there was miscommunication between group members on how to split it up. We should have worked more as a team instead of doing the articles we separately found and not communicating about them. The one person who did not have an article did part of one of the group members while another thought she was helping with hers. That lead to there being no critical appraisal for one of the articles and it led to confusion and troubles creating the annotated bibliography. This was solved way too late since half the group did not even know this happened until there were issues with our annotated bibliography. This confusion is something our group learned from and moving forward we are going to better our communication and write the paper while we are together instead of each doing a separate part.