My patient Mrs. S.K., is an 81 year old female. She was diagnosed with Pneumonia. Mrs. S.K. had been in the unit for almost three days prior to the dialogue. She reported not being ever diagnosed with any medical condition ever before.
During the morning shift I went with my assigned nurse J to the client’s Mrs. S.K room. She was lying in her bed awake. While given her medication, Nurse J mentioned to her that I was a nursing student from York University who would be shadowing her. I took this opportunity to introduce myself and asked her if it was okay with her. She nodded with a smile
DIALOGUE: 1 Mrs. S.K was sitting in the chair and looking out through the window.
Nurse: Nice view (pointing to the window), How are you doing? (I stood right beside her near the window)
Mrs. S.K.: I am feeling much better now. Yesterday, even moving from bed to chair was very exhausting for me. I felt breathlessâ€¦â€¦ Much better now.
Nurse: Hummm, I listened attentively. When did you first notice any changes in your breathing?
Mrs. S.K.: I was in U.S at family function. While I was reading our holy book and was almost on conclusion I found really hard to even recite the hymns. My son asked me to get myself checked, I just ignored. I wanted the ceremony to end smoothly without any interruption.
Nurse: I nodded to convey I was listening
Mrs. S.K.: The journey from U.S. airport to here (Toronto) was very hard. I was coughing constantly. I felt so much tightness in my chest.
Nurse: I know how you would have felt. It is hard to go through all this. How did it feel being in such a situation?
Mrs. S.K.: I was so anxious and fearful. I did not even know whether I will be able to catch my next breath (pause). I am grateful to God, my family is really caring. They immediately brought me to the hospital.
Nurse: So, you have a really caring family.
Mrs. S.K.: Yes,â€¦â€¦now I am a great grandmother (She smiled)
Nurse: Wowâ€¦.. I smiled back. (Someone knocked at the door, it was her relatives. I introduced myself to them).Your relatives are here, I am going to leave you with them for now so that you can spend some time with them. I will check on you later on. Is that okay with you?
Mrs. S.K.: Noddedâ€¦ Yes. Nurse: See you later Mrs. S.K. (With a smile and I left the room)
Through this paper I will critically reflect on the dialogue that I had with my patient -Mrs. S.K, who was admitted to the hospital for pneumonia. In this paper, I will identify blocks to communication in the dialogue and will focus on integrating the principles of dialogue with the client-centered care (CCC) core processes.
Prior to beginning the dialogue, my only intent was to know Mrs. S.K. better and to listen to her concerns if any so that I could better meet her needs. “It hurts not to be listened to” (Nichols, 1995).While critically reflecting on the dialogue I realized that actually I was making an effort to be build trusting relationship with her by giving her my undivided attention. Clients often wait to express their needs and concerns until the nurse gives them undivided attention (Messner, 1993).
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I initiated the discussion with open-ended question. I asked Mrs. S.K., “How are you doing?” As a result, she had a liberty to choose whatever she wished to reveal. I also attempted to carry the open-ended question throughout the conversation. I wanted Mrs. S.K. to feel that I was really interested to know more about her health issues or other concerns that impact her health.
I think I went with the flow during the dialogue with Mrs. S.K. I did not interrupt in between when Mrs. S.K. talked about her concerns with breathing a day before and her visit to U.S. I followed her lead, listened attentively and patiently to her, as this is what she wanted to talk about. According to the human becoming theory, going with the flow is very crucial in order to recognize the ups and downs and the joys in the context of the client’s situation (Parse, 1998). Also, keeping the client- centered care in my mind, most of the time I spoke with my client in her mother tongue that is Punjabi. This made her more comfortable and confident to express her true feelings and concerns.
Validating was one of the blocks that were evident during the dialogue with the client. Though, I made proper eye contact with Mrs. S.K. and listened to her in a non-judgmental and caring manner, but I felt that if I would have sat at eye level with her during communication she would have felt even more comfortable. When Mrs. S.K. talked how hard her journey from U.S. airport back to Toronto due to illness, I validated her experience by saying “I know how you would have felt. It is hard to go through all this”. This is in total contrast to the CCC value of honesty. Each individual’s meaning of a particular circumstance is totally unique. Therefore no one can really know or experience the same meaning as the other (Beitel, 1998). Also, when she showed her concern about feeling breathless yesterday, I could have asked her “Tell me more about it.” This would have helped me to seek depth and clarity about her concerns.
Other then that I did not act on the need to do something to fix things my client, neither did I gave her false reassurance.
As this was my very first experience of having a reflective dialogue with the client, it was a good learning experience for me. I realized the importance of a good dialogue in assessing the needs and concerns of the client. Openness, good eye contact and genuine interest in the client go a long way in building a caring relationship build on trust.
In future dialogue, also I would focus on being truly present with the patient. I will ask open ended questions to get in depth insight about client’s concerns. This would help me to better understand a situation from client’s perspective. I will not validate client’s emotions or experience. Instead I will listen to the patient with openness.
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