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.