Therapeutic Communication question

nurseprnRN, BSN, RN · May 6, 2015

This appears on the top of the Nursing Student Assistance Forum but probably also ought to appear at the top of this one too. It doesn't, though, so I'll give you a pass this time:).

"This is the place for nursing students to consult the membership to share knowledge, ideas, and experience, and to explore ways to maximize success in nursing school. Feel free to seek assistance with difficult content, care plans, interviews, papers, study questions, dosage calculations, and other academic challenges you are facing. This is NOT the forum to ask someone to do your homework for you. When asking for assistance with an assignment, please show what you have done first."

Don't be afraid to ask, though. If you have scrolled through the other forums here, you'll see there is a LOT of assistance given to students. We want to help, we do. We just don't want to be copy-and-pasted into somebody's assignment, and far too many students come here with a first post who have that entitled expectation.

From what you said, though, you aren't among them. So, let's all start over. Tell us what you know/think already, and we'll be happy to chime in.

VivaLaVespaGirl, BSN, MSN · May 6, 2015

Hi ChristtineD.

One bit of advice that will help you not only in this forum, but in your career going forward, is to always present your own ideas along with your questions. "Hey, I have this question. Here is what I think but I would really like your input" will go a long way on the forums as well as when you are working with your professors, clinical instructors, nurses, etc. It helps to show that you have put thought into the question and utilized your resources before asking. Good luck to you!

Tenebrae, BSN, RN · May 6, 2015

Wow, I'm really surprised by the snappy comments. I'm not looking for someone to do my homework.

Regretfully we get alot of people who are wanting help with home work. It has us all more than a touch jaded.

I have my own ideas and just wanted some input since I've never dealt with anything like this.

Great. Why dont you post what you are thinking? and we can help you fine tune it

pumpkinspice · May 7, 2015

Hi Everyone,

Thank you for your explanations, I completely understand now. I definitively have good intentions and look forward to being a part of this site:) I'd like to explain my reasoning in the posted scenario.

Quick recap:

A patient underwent a radical mastectomy 2 days ago. She was given health teaching regarding exercises needed to prevent lymphedema. When the RPN enters the patient's room, she yells at the RPN stating "I don't want to do those exercisesâ€¦can't you see this is really hard for meâ€.

What is the best therapeutic response the nurse could use? What are the priority assessments in order from most to least importance?

I think the best therapeutic response is to ask how the patient feels about her surgery. This is an open-ended question that allows her to give a lot of information and explain her anger and reluctance to do her exercises. Its an opportunity to health teach the importance of the exercise and build a trusting relationship. In turn, it will also reduce her stress which will not only improve her cooperation in performing exercises, but reduced stress can help her healing process.

Regarding the priorities, I need to follow ABCD- airway and breathing a fine. I'm sure circulation is fine also. So I need to focus on the disability. I think I need to address the pain first. She can't do excerises if she's in pain and relieving it will improve her cooperation. Second, I think the exercises are important to avoid/reduce lymphedema and further complications. Lastly, communication is essential for said reasons.

Hope I'm on the right track:)

pumpkinspice · May 7, 2015

Very good advice, will be helpful when I start clinical next week. Thank you:)

allnurses Guide · May 8, 2015

Good start: "Everything about this is hard, what is hardest for you?",

"You don't have to do anything you don't want to, did the instructions make sense about why we think these exercises are important?" this lets her have control while emphasizing what needs to be done.

Disability; I personally had the tendons in my axilla tighten up during surgery and physically could not do some of the exercises until after some physical therapy. Is she unwilling, or unable to them? bang on correct with addressing the pain.

Keep up the good work (and welcome back)

nurseprnRN, BSN, RN · May 8, 2015

People can't, and won't, do much until they have the internal strength to do it. Hers is all wrapped up in a life-threatening diagnosis and a huge body change with implications far beyond the immediate postoperative recovery phase. Put yourself in her position. What are you afraid of now? Remember that anger almost always comes from fear.

Also, consider how much control she has over this situation- it probably feels like, "Not much." Sometimes when people feel like that, all they can do us say "NO!" it's the only control they have. Think about dealing c that in your interactions--find some things she can control, even little ones, like wash up first or breakfast first. Every little bit helps.

pumpkinspice · May 8, 2015

Hi,

Thank you so much for your input:) I didn't consider giving her more control..These are all great points that I will apply in my clinical practice and will be very compassionate and empathetic. Understanding and support can go a long way...

BertG77 · May 8, 2015

Another thing that is useful in this situation is to assess their 'readiness to learn' which in this case is very low. If your intervention is to teach the patient their current state makes this intervention impossible so implementing therapeutic communication is key. You can say something that simply indicates to the patient that you recognize how they're feeling, such as, 'I can only imagine what this must feel like for you, do you feel like telling me about it?' Which can shift the dynamic and allow communication to flow. Many people here have commented on assessing or focusing on the patient's pain, which I don't disagree with, I just feel that this advice should specify that the patient is in emotional/psychological pain as well as the physical. I know that my instructors would get on me if I answered this question solely from the standpoint of assessing their physical state and focusing on a remedy for that only, such as pain meds.

nurseprnRN, BSN, RN · May 8, 2015

Hi,
Thank you so much for your input:) I didn't consider giving her more control..These are all great points that I will apply in my clinical practice and will be very compassionate and empathetic. Understanding and support can go a long way...

See, this is what happens when students tell us where they're at first, so then we can supplement.

It also points out something very important-- while it's easiest for new students to focus on what they see in the bed and what they think of first, the most obvious things (pain, mobility, airway, circulation...), as your education proceeds you should be progressing to adding thinking at higher levels. Your next level will be looking at things like coping (NANDA-I Domain 9), Roles (Domain 7), Self-perception (Domain 6) and others.

When you have the book, you can thumb through it and get a much fuller sense of nursing.