Barriers in Communication with Old Aged Patients
With the advancement of the science and medicine, expectancy of life has increased. The older generation is living for longer days but they are suffering from huge burden of disorders. Most of them are affected by chronic ailments and nursing professionals have to assess their conditions and develop proper care interventions. However, for achieving that nurses need to establish effective relationship with patients through therapeutic communication and understand their quality of life regarding their activities of daily living. Therefore, this assignment would discuss the barriers that nurses may face while initiating communication and will also show how nurses can overcome them effectively. It will also show how assessment of daily activities of patients is done and how it helps in setting of proper care goals with effective application of Roper, Logan and Tierney’s Activities of Living model (1980).
Case study
An aboriginal old woman named Brenga aged 70 years was admitted to the ward after she faced a fall in her garden. She was bruised on her arms and legs and was bleeding severely. She was suffering severe pain in her pelvic areas and her knee and was crying heavily.
Communication with Brenga
After admitting to the ward, I was assigned as the nurse to care for her. It was seen that she was crying with pain and was panting heavily. She was not able to speak at all and was highly anxious. She was fearful as she did not understand the severity of her fall and was not able to comprehend the initiatives that the nursing professional would take. The patient was panting so heavily that she was not able to communicate with me and I could not understand that exact issues she was facing. Her anxiety and fear towards the interventions that would be taken by the western mode of healthcare was actually the main concern of him. Her daughter in law who was a non-indigenous Australian was the main person who was accompanying her and she was quite stressed. On asking her the main issue, she was seen to be fearful of the situation as she was present in the home when her mother in law fell. She stated that her mother in law is not a believer of western culture and western healthcare system but she had gone against her will to save her from the pain.
Analysis of the communication barrier
From the entire situation, it was seen that there had been two important barriers in the communication procedure of the patient and that of the nursing professionals who attended her. One of the most important factors that had created barrier in the communication was the fear and anxiety that she had developed after the fall. The pain associated with the fall had contributed to the fear and anxiety of the patient as she was anxious that she had gone through fractures or not or whether she had to go through hip replacements like that of one of her neighbour. When such presumptions are made beforehand, it results in development of perceptions, fear and anxiety that prevent individuals from communicating effectively (O’Hagan et al. 2014). Patients become unable to communicate with nursing professionals, as they remain unaware about the specific interventions tat nurse would take and these add to their anxiety (Kourkouta et al. 2014). The second barrier that had also contributed to the ineffective communication between the patient and the nurses was his cultural perceptions. She was quite concerned that her cultural preferences would not be taken care for and she was upset that her daughter in law had taken her to hospital irrespective of her wish. For this reason, she was crying heavily, and it was getting very difficult to talk with her. Researchers are of the opinion that non-compliance and lack of will of the patient may become one of the most important barriers of the communication procedure (Bramhall 2014). This has the capability to not only harm the health of the patient but also involve the nurses in legal and ethical obligation if they try to force interventions on the patient even for their beneficence. In such situations, development of effective communication strategies are extremely important for the professionals to help the patient overcome her barriers, communicate effectively, get educated about the intervention, express their feelings and thereby receive care that would help to care for their help (Sprangers 2014).
Developing Communication Strategies
Effective steps that need to be taken for establishing effective communication
One of the most important initiatives that the nurses should take in this situation is an empathetic approach to make the patient calm. As the patient had been going through sever pain, the first priority of the nursing professional would be to care for the pain. However, in order to care for the pain, the nursing professional should communicate with the patient and ask her for informed consent. When the patient sees that the nursing professional is trying her best to maintain the dignity and autonomy of the patient, it would help her to develop trust on the professional (Finkelman 2015). This would ensure her that the professionals have genuine feelings for her. For effective communication, professionals should have active listening skills. Active listening skills mean that individuals should be fully concentrating on what is being said rather than passively hearing the message conveyed by the speaker (Bramhall 2014). Active listening skills would help the nurses to understand the concerns of the patient and develop ideas about the presumptions of the patient. Professionals need to be patient while listening so that the service users feel that the professionals are keen to know about the issues and are trying their best to help them (Davis 2014). This would automatically ensure compliance of the patient with the interventions. The patient is from a native background and may have language barrier. Therefore, professionals need to ensure that they have culturally competent communication skills so that they can communicate with them effectively to understand their feelings (Weber and Farrell 2016). Non-verbal communication skills are also important to be maintained by the professionals as if they need to maintain proper customs of eye contact, silence, touch, direct questioning, greeting and others that should align with the patient’s cultural traditions and preferences (Williams et al. 2016). This ensures the patient that she is not disrespected and devalued and this would in turn have positive effects on the communication procedure. She would successfully participate in the communication, provide effective feedback and comply with the interventions of the nurse.
Peplaus’s communication theory in development of nurse patient relationship (1952):
The first step is called the orientation phase. This is the first step of the communication model where the client’s willingness to accept treatment and trust the professional is the main criterion (Jeoung and Bak 2015). The first step itself was not being able to be completed by the professional as the patient was neither willing to take treatment and did not trust the professionals. In this situation, professionals need to exhibit empathy and compassion towards the patient thereby expressing their genuine feeling to the client. Through effective speaking and listening, the professional should make the patient feel that she understand the client problems, is therefore empathetic to her problems, and feels for her. The genuineness would be reflected in her body language that would help the patient to trust on the professional (Williams et al. 2016). The second step is the identification step where the nurse client relationship mainly forms the basis of the understanding, trust, acceptance and helping relationship (Lambert and Kogh 2014). This step also helps the patient to feel as an active participant and thereby decrease the feelings of helplessness and powerlessness. In the case also, the professional would involve Brenga in such a therapeutic relationship so that Brenga feels empowered through effective communication. The next step is the exploitation phase where the client gains a sense of independence and navigates through the healthcare system as an active participant. With effective communication established between the patient and nurse, this step would be completed successfully which will have positive outcomes on Brenga and would increase her satisfaction (Kearney et al. 2015). The last stage of this theory is the resolution theory. In this step, the needs of the client are met through effective nurse-client partnership and effective communication and leads to resolution of healthcare problems. The professionals should follow this procedure to ensure that with effective communication, the different barriers that Brenga is going through can be overcome and hence effective interventions can be applied (Matziou et al. 2014).
Roper, Logan and Tierney’s Activities of Living Model
Roper, Logan and Tierney’s Activities of Living model (1980) also known as the Human needs model that the professionals treating old people can use to ensure that patients are able to manage their everyday living activities. This would help such old patients to achieve their individual optimal status of well being or health successfully (Burke et al. 2016). This theory provides importance to 12 important areas where care is often required for old aged patients. In the nation of the United Kingdom, it is seen that this model is excessively used to assess the various ways about how the life of the patient has changed due to illness, injury as well as admission to a particular hospital. It also shows the ways of effective planning that would help in the increasing of the independence and better quality life (Meuter et al. 2015).
Assessment
One of the most important problems is seen is that she has low body weight and is quite anaemic. After being admitted to the ward, it was seen that she does not have proper idea about diet management and hence she does not take balanced diet in her meals. Her daughter in law has stated that her mother stays alone and lives on canned foods. In many of the days, she does not feel like eating and hence skips meals. Therefore, lack of proper nutrition in her diet has made her anaemic and she has shown vitamin d deficiency and calcium deficiency for which she suffers from pain in different bones of her body (Beck et al. 2016). Therefore, out of the twelve important aspects of healthy living put forward by Roper, Logan and Tierney’s Activities of Living model, the aspect where Brenga needs care is the eating and drinking habits. In order to assess her dietary condition, the nursing professionals can use an assessment tool. Subjective global assessment tool can be used by the professional in order to develop detailed idea about the nutrient up take of Brenga and thereby realise the necessary diets she lack in her meals. The professionals will be able to develop detailed idea about the nutrient intake, weight, symptoms, metabolic requirement as well as functional ability of the patient (Bolsmszo et al. 2015). It would also give the individual a detailed idea about the physical examination, SGA rating, contributing factor and many others. The assessment tool also guides the professionals to develop idea about subcutaneous fat, muscle wasting as well as fluid retention (Bibas et al. 2014). All these information will help the professionals to develop idea about Brenga’s diet and reason of her low weight and accordingly set interventions and care plans for her.
Assessing Nutritional Status of Old Aged Patients
Brenga has been admitted to the ward after she had a fall in the garden and was bleeding profusely. Previously, also she had fallen a number of times and hence the aspect of the model that needs to be considered for her is mobilisation of the patient. The Hendrich II Fall Risk Model is found to be used extensively in the adult acute care, assisted living, ambulatory, population health settings as well as long-term care for effective identification of the adults who are at a risk for fall (Williams et al. 2014). This tool also helps the professionals to understand the interventions that need to be taken as well as the ways that will help to reduce presence of any risk factor effectively. Researchers are of the opinion that this tool is effective in determination of the different risks of falls based on gender, mental and emotional status, and symptoms of dizziness as well as any categories of medication that increases the risk (Von et al. 2015). This tool will be useful for successful screening of chances of fall for Brenga and will help professionals to develop idea about the interventions that need to be taken.
First Goal: To develop a healthy body weight of Brenga and overcome her conditions of anaemia
Specific: development of a healthy body weight of Brenga so that her height and weight results in a BMI that indicates her healthy body and to increase her iron content of the body
Measurable: the goal is measurable in the sense as her body weight can be measured anytime with the help of weighing machine. Her increase of iron in blood can be understood by undertaking complete blood count test. This blood count test will help to show the amount of haemoglobin and RBC. This may indicate the increase of iron in blood (Hopkinson 2015).
Attainable: the goals are attainable as proper intake of diet, if maintained by the patient and his family members may result in the development of her body weight. Proper intake of correct nutrients would help to overcome her anaemic condition. Therefore, the goal is also attainable.
Relevant: This goal is relevant, as researchers have already said proper maintenance of diet results in maintaining not only proper body weight but also helps the body to keep safe from any non-communicable diseases like scurvy, goitre, anaemia, night-blindness and many others (Donini et al. 2015).
Timeframe: about 8 to 10 months would be required for development of her body weight.
Second Goal: to develop her mobility and to provide her with steady gait
Specific: specific interventions would be taken so that Brenga can walk steadily without support and there is reduction in the chances of her fall.
Measurable: with the help of specific assessment tool for fall prevention, the risks of her fall can be measured such as the Hendrich II Fall Risk Model. Moreover, also with the help of other assessment tool like 10 item gait assessment tool, her condition of her gait can be also understood (Costa et al. 2014).
Attainable: with proper interventions by the healthcare professionals, the goal would be easily attainable.
Relevant: effective development of her mobility would not only reduce the chances of her fall but would also help her to maintain independency and thereby a better quality life.
Timeframe: about 8 to 10 months would be required to develop her mobility.
In order to ensure her to take a balanced meal, the professional should initiate a patient contract with Brenga. This patient contract should include rewarding as well as reinforcing progressive goal attainment. Researchers are of the opinion that patient contracts help in rendering unique chance for the patient helping them to learn as well as to analyse the behaviour in the relationship with that of the environment (Abizande et al. 2015). It also helps the individuals to choose behavioural strategies that help in facilitating learning. Brenga should be also helped with setting up of long term as well as short term goals. Researchers are of the opinion that improvement in the nutritional status take up a lot of time and hence the patient may lose interest in the whole procedure. Therefore, professionals should also set up with short-term goals. The patient may be also advised to take water as water helps in elimination of the by-products of different breakdown of nutrients and prevent ketosis (Hopkinson 2015). The patient should be educated about adequate nutritional intake, as this would help the patient to comply with the nutritional diet chart developed for her and maintain the nutrient quantity in her diet. Along with this, the patient should be also educated about the ways by which she can self monitor herself as self monitoring has the biggest capability to maintain proper lifestyle interventions and habits that would help her to maintain healthy body weight (Donini et al. 2015). In addition, a dietician should be appointed to her who would help her to make a proper diet chart and ensure she understand the importance of marinating a diet and development of proper body weight. Proper nutritional intake would help het to overcome her anaemic condition.
Brenga is at high risk of fall as her motor skills have become impaired and she had already fallen a number of times before in her house as well. Therefore, the healthcare professionals should clean out her bruises and help in developing a fall prevention plan that would help her family members of her carer to assess her risk for fall and modify her environment to reduce her chance of fall (Milos et al. 2014). While she is staying at the hospital or other care centres, a wristband would be secured around her wrist. This would help the professionals to be careful with her during handling her and caring for her activities of daily lives. This wrist band would help them to identify that she had fall risks and special care in handling would be taken to protect her from any fall accidents. The patient should be transferred to a room near the station of the nurse so that better observation and quick response can be assured to her in her treatment procedures (Inouye et al. 2014). Both at the healthcare canter as well as the house, items of her use should be kept closer to her to reduce the risk of fall hazards. Moreover, heavy furniture should be only kept in the house and light furniture should be removed as light furniture may make the patient tumble. Moreover, care should be taken so that the position of the bed is kept adjacent to the flood level reducing the chances of fall. Bed rails, bathroom bars and similar other supporting bars should be fixed in places that will help to reduce her chances of fall (Matarese et al. 2015) . Use of non-skid shoes, slippers and soles, wearing of not-so-loose clothes and brightening the environment with proper light decreases fall hazards and these would also be helpful for Brenga. Moreover, care should be taken to appoint a physiotherapist who would provide her with therapy session and help her to develop with her gait and motor skills (Vlayen et al. 2015). The nurses should take the patient on mini walk assisting her to walk independently so that she does not lose the confidence of her capability. All these would help Brenga to not only develop her mobility but would also reduce the risk of fall.
From the entire experience, I have understood that effective communication has a huge capability to not only handle a person successfully but also establish therapeutic relationship with her. With my effective communication skills like proper language efficiency, compassion , empathy, my body language and my genuine feelings helped to ensure that the patient trust me. I communicated with her in a way that made her feel respected. I protected her autonomy and dignity by communication in a culturally competent manner that made her feel that I respect their culture and traditions. All these ensured Brenga to comply with the interventions that was proposed to her. After I was able to ensure that she trusted on me, I conducted important assessments and this helped me to recognise the important areas that needed attention and care in Brenga. I first developed two smart goals so that I can properly develop the intervention plan that would help her to overcome two important health risk factors. Not only that, by using SMART gaols, I could specify my objective in such a way that it gave me the cope to develop evidence-based interventions for Brenga. I had mainly developed long-term goals so that Brenga could lead better quality life even after she is discharged to home.
Conclusion
From the entire discussion, it was clear that effective communication plays an important role in developing therapeutic relationship. Empathy and compassion during communication have the capability to reduce anxiety and fear in patients can in turn develop trust and reliance in the nurse-patient relationship. Effective listening skills, culturally competent communication both in verbal and in non-verbal mode and similar other features helped to develop therapeutic relationship with him. After establishment of effective bonding with the patients, assessment tools were used to identify the main healthcare needs and then evidence based intervention plan was based. The plans were implemented and helped in developing the quality of life of Brenga and helped her to develop trust in western education.
References:
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