The goal fifths study was to study different type of communication skills between a psychiatric clinical nurse specialist and a client with schizophrenia through assessment of their videotaped interactions. The TTY. ro types of communication used during this study were verbal and nonverbal communication, as it were suspected, the client had different responses to each type of communication. The research observed three different patients, each session lasting between 12-19 minutes. The conversations took place in an urban community mental health center during a medication monitoring session.
All three tenants were videotaped three times each for a total of nine meetings. The analysis Of the videotapes proceeded in a series Of fours steps. After each step was completed, the data revealed interesting behavioral interactions between both the client and the nurse. It was noted that when the nurse moved her body towards the participant while he or she was speaking, this conveyed a message of concern towards the patient. This would cause the patient to want to open up a little more, and continue to speak to the nurse.
The nurse at times would also display nonverbal body language that conveyed the participant to want to join in. In other instances, the nurse would sit forward with the chart in her lap, which in a sense presented body language, and smiled and nodded when the client spoke. The article also stated that at times, the nurse would use exaggerated verbal and nonverbal language to connect with them. At the end of the study, the nurse described an understanding of her need to use these type of techniques extremely useful in order to asses and intervene with the clients.
I found this information very useful for our Audience project, due to the fact that it reminded me to use both verbal and nonverbal communication. In this case, it would be therapeutic communication. This study was done four years ago, which would explain the new theory that we are learning today in class about proper communication. On our first exam, we learned how to be active listeners by being attentive to what the client is saying both verbally and nonverbally.
By doing so, we as nurses communicate acceptance and respect for the client, we do this to hopefully in return enhance the trust between the client and the nurse relationship. Chapter 8 in our psychiatric book described the acronym SOLES. This acronym resembles what this study identified a few years back, to be active listeners, we as nurses need to sit squarely facing the client, observe an open posture, lean forward toward the client, establish eye contact, and lastly we need to relax.
Overall, this was a really good article and it was just another insight to the best techniques utilized to date on how to interact with a schizophrenic patient, or with any individual with a mental disorder. Prevention and Management of Depression in Primary Care Depression is a common mental health problem that can lead to suicide. The quality of a patient’s life can be improved when persistent and severe homonyms are recognized in a timely matter.
The nurse’s communication is enhanced by increasing confidence in screening and treating patients when utilizing strategies outlined in Sheila Hardy (2013) article Prevention and management of depression in primary care. When assessing a patient, it is essential that the nurse question about any significant life events that may have resulted in depression as well as any symptoms that accompany this debilitating illness. In this article, Hardy stated life events include physical illness, bereavement, relationship or financial problems (as cited by National
Institutes for Health and Clinical Excellent (NICE) AAA). The symptoms of depression are divided into physical and psychological. Physical symptoms include change in appetite, bowel changes, decrease participation in daily life, general appearance, sexual dysfunction, sleep disturbance, dry mouth, indigestion, and general aches and pain. The psychological symptoms include depressed mood, feeling fed up, indecisive, denial, loss of interest in life, slowed speech and negative talk, and slowed thought process (Hardy, 2013).
Screening for depression and assessing suicide risk are helpful with managing depression. The nurse should screen for depression, and if diagnosed with depression the patient must be an assessed for risk of suicide. To diagnose depression the patient must have five of the following symptoms for a minimum of 2 weeks: persistent depressed mood; diminished interest or pleasure; significant weight change; sleeping too much or too little; psychosomatic agitation or retardation; fatigue or loss of energy; feelings of worthlessness; diminished ability to think or concentrate; or recurrent thoughts of death.
One of the symptoms that must be present is either persistent depressed mood, or diminished interest or pleasure. If the patient is diagnosed with depression, it is important for the nurse to ask the patient about any suicidal ideas and intent, whether they feel hopeless, and if there have been past attempts or family history of suicide. It is also vital to see if the patient has a plan and if they are capable of carrying out this plan and if whether they have any support from family and friends (Hardy, 2013).
Once depression has been diagnosed treatment is dependent on the severity of the condition. Treatments for depression should be evidence-based and approached differently based on the severity of the illness. For a patient who exhibits mild depression, it is recommended to provide an opportunity to talk about his or her problems without being offered advice along with general information about depression and its treatment. A follow up appointment with the patient is usually arranged with 2 weeks to ensure depression has not become worse.
In moderate depression the patient is offered a choice of low-intensity interventions. One intervention includes individual guided self- help it is based on the principles of cognitive behavioral therapy (CB), which involves encouraging patients to increase adaptive behaviors, such as exercise, socializing and working. Moderate to severe depression can be treated with antidepressant medication containing serotonin re-uptake inhibitors such as Florentine and Catalonian, which are first-line drugs.
The use of medications can be enhanced with psychological treatments involving CAT, interpersonal therapy that assist patient with solving problems causing their depression, or behavioral activation for patients whose relationship with a regular partner contributes to depression (Hardy, 2013). During my clinical rotation at a psychiatric hospital was able to spend time with depressed and suicidal patients. I chose this article because there were times I found it difficult to know exactly what to assess for and what to ask the patient.
This article has provided strategies to screen depression and questions to ask when assessing the risk for suicide that I can use, not only psychiatric patients, but other patients I will encounter in the future. Teaching Therapeutic Communication VIA Camera Cues and Clues: The Video Inter-Active (VIA) Method Mary Ann Kluge and Linda Click assert in their article that good therapeutic communication skills are more effectively taught tit the Video Inter-Active (VIA) method than with the traditional role-playing method.
Using this method, they hypothesized that “students’ therapeutic communications skills would improve with increased self-awareness” due to the fact that “traditional role-playing activities did not include having students see themselves as their patients would see them. ” (Kluge & Click, 2006) They used mixed methods for their study, including a quantitative approach to determine relationship and comparison between communication variables using experimental and control groups; and a qualitative approach to capture he participants’ experiences with the VIA method (Kluge & Click, 2006).
Although the VIA method was proven by the writers’ study of being an effective method in teaching therapeutic communication, there may have been a variable that was not accounted for in the design of the study, which may have influenced the results of the study. The study concluded by demonstrating that the VIA method is an effective tool in improving the students’ self-awareness, as evidenced in the qualitative results; the students reflected that with the VIA method, they were able to assess their immunization techniques because they were able visualize first-hand the mistakes they committed and therefore improve their skills.
However, the study mentioned in the end of the article that the experimental group had a significant advantage over the control group in the sense that being videotaped may have brought on additional feelings of nervousness, which may have negatively affected the performance of the control group during the final VIA evaluation exercise in which both groups participated in to have their quantitative results compared. The experimental group had 5 prior VIA exercise during which they may have become accustomed to being videotaped for evaluation (Kluge & Click, 2006).
This limitation should have been addressed before the study began so as to improve the accuracy of the results. The writers’ study presented in the article was well defined, designed, and performed, producing results that outlined the need to improve the teaching of therapeutic communication to health care workers. Although the variable of the videotaping segment of the evaluation may have affected results, the overall findings of the study demonstrated that the VIA method is n effective method of teaching therapeutic communication.
The article did identify the limitation and also suggested improvements for the study as well as suggestions for further research on the topic. The writers’ withdrew from several relevant and credible nursing journal sources for the development of their hypothesis and theory, and for the design of their study. Audio Visual Scenarios Scenario #1 Patient: Patient is a 23 year old female. Lives with parents at home and two siblings. Patient complains that she hears voices that tell her to kill her whole family and then herself.
She has been diagnosed with paranoid Schizophrenia on an out-patient basis by her primary doctor. Patient was given psychiatric medication, but states that it does not help, therefore stopped taking them. Patient was brought in by her mother, she stated being afraid that Maria would follow through with her suicidal thoughts. Setting: Nurse Jackie approaches the patient while enjoying the outdoor break area of the psychiatric hospital. Goal: This is the first time that Maria has been hospitalized, so the goal is to gather information as to when the patients’ hallucinations started and figure out the rabble cause.
Also, find out what the patients plan is and if she has the means to carry out her suicidal/homicide ideation. Scenario #2 Patient information: The patient is a 29 year old female who has lost her husband and two children in a car accident that occurred 1 year ago. The patient was the driver and the only survivor. She has experienced depression and has taken antidepressants. She feels angry that no one understands her, which has led her to isolate herself from family and friends. Her hospitalizing has preceded her recent suicide attempt.
After two weeks at the mental hospital, he patient is getting ready to be discharged. Setting: Nurse is discussing discharge with the patient in the day room at a mental hospital Goal: Assess the patient’s ability to discuss the car accident and the loss of her family as well as coping strategies that can prevent future suicide attempts. Scenario #3 Patient Elizabeth is a 54 year old female widow, whose husband died a year ago in a car crash. The patient was diagnosed with cancer two months ago, but after unsuccessful chemotherapy, the cancer has metastasis’s to her kidneys.
The patient has been given a prognosis of 6 months of life. The patient was confident that the chemotherapy was going to work, since it did not the patient decided not to continue therapy. This caused her daughter to be upset at her mother for stopping the chemo. Setting: The patient has elected to leave her home and settle into a hospice facility. This is her second day at the hospice, and the night shift nurse reported that the patient was unable to sleep at night. Goal: The nurse wants to assess the patient’s stage in the grieving process.
The nurse wants to develop trust and help the patient identify and express her feelings. VA Project: Critique of Performance In our first scenario which consisted of the Schizophrenia patient, we had both therapeutic and nontransparent communication. A few examples of good therapeutic techniques in that scenario where exploring, seeking clarification and validation, presenting reality, and voicing doubt. Nontransparent techniques were avoided but at one point the nurse did accidental asked why, and we know that as psychiatric nurses, we should never ask a psychiatric patient why.
I do not believed we had any blocked communication in this scenario, both the patient and the nurse were able to deed off of each other which made the communication fluent. Other techniques that could have enhanced the dialogue would have been not having the table in between the patient and the nurse because it acted as a barrier. We could have instead been seated in chairs facing each other to provide a more comfortable and open communication setting. The article about the schizophrenia patient helped recognize how a nurse should respond and physically sit in order to get a positive response from the chichi patient.
In this role the student nurse, being Jackie learned that sometimes it s difficult to interview a patient that needs redirection back into the relevant topic. Our second scenario consisted of a depressed patient who recently had a suicide attempt. Effective therapeutic techniques used in this scenario were using silence, accepting, giving broad openings, exploring, focusing, and verbalizing the applied. In this scenario there was no blockage of communication between the nurse and patient. The goal Of this scenario was accomplished by the nurse and student, which was to discuss the patients’ plans after discharge.
The article influenced the scenario because it offered information as to how to assess and communicate with someone with depression. The nurse learned that it is essential to remain UN-judgmental with a suicide patient. It is important to become more self-aware in order to prevent bias interpretations. Our third and final scenario was about the hospice patient. In this scene we were able to utilize the therapeutic techniques as well, we used silence, accepting, offering self, giving broad openings, and exploring.
This scenario was very difficult due to the fact that hospice is a hard subject not only for the patient and their family, but also for the nurse. It was very hard not being able to give the patient reassurance about their family)DSL well-being when she passes. A communication technique that could have enhanced additional dialogue would have been therapeutic tough. It could have made the patient feel comforted as well as strengthened the trust between the nurse and patient. The article helped identify positive and negative techniques for communication to present an VA project.
It stated that using the video method was an affecting way of critiquing and reflecting on therapeutic communication techniques. The nurse, Maria, learned that it is difficult to main objective to the plan of care without getting emotionally attached to the patient. VA Project Self Reflect This VA project was difficult to imitate due to the fact that we had to establish a schedule that would accommodate each member. As a group, we all have a set schedule when it comes to work, school, studying, and family.
Maria in the beginning was the person who established communication between the other two members of the group. Jackie and Elizabeth had not met or worked together on a project before, because they had yet been in a class together. Maria and Elizabeth happen to know each other from clinical in our endearments course. Once, we all exchanged phone numbers, we were able to arrange a meeting that fit in to our scheduled. On our first meeting, we discussed what the topics of each of our scenarios would be.
There was no set leader in our group when working on the project. We had a democratic approach being that we were able to share and exchange ideas about the direction of our project. The biggest problem we had was agreeing on a date and time to meet that would accommodate all Of us. We were able to fix the issue and establish dates that worked the best and give us enough time to work on the project. Each member had good and bad qualities that affected the progress of our project. Jackie was gracious enough to provide her home as the place to meet.
In her role as the nurse, she was good at feeding off the patient and being able to continue the conversation by asking questions that would explore the issue. As the patient, Jackie was nervous and forgot her script. This prolonged the completion of the video, but she was able to overcome that and improvise dialogue. As for Elizabeth, her best role was being the patient. As a group we all felt she got into character and was able to recall err dialogue. This allowed us to complete the scenario in one take. The downfall of Elizabeth was that she had a hard time meeting up with us, which put a set-back in production.
Finally, Maria was really good a coordinating and accommodating everyone?s schedule. She took the role of initiation by establishing communication between Jackie and Elizabeth. She was the coordinator of the group. As the patient, Maria was able to portray a believable schizophrenia patient. As the nurse, she was able to elaborate as much as she could by asking the right questions. The negative of Maria would eve to be that at times she could be the dominator of the conversation, but was able to overcome that and allow the group to participate as well.