Question

When the oldest son comes to visit at change of shift, the patient becomes visibly agitated and begins calling out loudly,

“Take this brace off me! “I have never had pain like this before!” The oldest son becomes angry and upset and approaches the nurse and states, “You need to go out and call the doctor right now, I cannot watch my mother be in pain. I don’t understand how you people can watch a patient suffer and do nothing about it!” When the oncoming nurse explains that she needs to complete report and briefly perform an assessment before she can call the primary care provider, he states angrily, “I can’t understand why you can’t just go out and call the doctor, you must not know what you are

doing!”

The nurse has all family members leave the room to complete the initial nursing assessment. Josephine begins to apologize profusely for how she was treated by her son and appears embarrassed. Her vital signs are T: 98.4 F/36.9 C P: 72 R:18 BP: 128/68. Her pupils are 3 mm/equal and reactive. Her pain is currently higher than it has been earlier and rates as a 7/10. After this assessment is completed, the nurse communicates to both the family and the patient the plan of care and contacts the primary care provider to address the need for more pain control.

1.What is the expected response of the patient and family that indicates nursing interventions were effective?

(Management of Care)

2. What response by the patient would indicate that a change in the plan of care and nursing interventions are needed?

(Management of Care)

3. What principles of therapeutic communication can be utilized to develop trust and encourage dialogue between the nurse, patient, and family? (Psychosocial Integrity)

4. How can you support and encourage active partnership with the family while you plan, implement, and evaluate patient care?

5. What is the patient and family likely experiencing/feeling right now in this situation?

(Psychosocial Integrity/Basic Care and Comfort)

6. What can I do to engage myself with this patient’s experience, and show that he/she matters to me as a person? (Psychosocial Integrity/Basic Care and Comfort)

7. What was learned from this case study that you will incorporate into your practice? (Management of Care)
   

Answer 1

1. The expected response of the patient and the family that indicates nursing interventions were effective are a smiling and thanking patient as well as family members.

2. The patient becomes visibly agitated and called out loudly to take the brace off her when her son came to visit her, which would indicate that a change in the plan of care and nursing interventions are needed. She also shouts that she has never had pain like this before.

3. The principles of therapeutic communication to be utilized to develop trust and encourage dialogue between the nurse, patient, and family are:

a. Client-focused responses.

b. Direct and honest responses.

c. Responses based on active listening.

d. Responses indicative of client acceptance.

e. Responses based on client cues.

4. Active partnership with the family can be supported and encouraged while planning, implementing, and evaluating patient care by asking the opinion of the family and listening to their opinion.

5. The patient and family are likely experiencing/feeling right now in this situation in despair due to the patient's unbearable pain. They will lose their psychological integrity.

6. To engage me with this patient’s experience, and show that she matters to me more than anything else as a person I can express my words of regret and apology. Above all, I should change the plan of care and introduce new satisfactory pain-control measures as well.

7. From this case study, I learned that plan of care should be changed based on patient observation and response. I will certainly incorporate this into my practice.