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NURSING 1004 Communication And Professional Nursing I

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NURSING 1004 Communication And Professional Nursing I

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NURSING 1004 Communication And Professional Nursing I

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Course Code: NURSING1004
University: The University Of Adelaide

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Country: Australia

Question: 
Clinical ScenarioIn this clinical scenario you are in the role of a new graduate nurse. Stefan is a 32 year old man being admitted for day surgery. You are admitting this morning for surgery later in the day. This is the first time you have met Stefan.Stefan is in the waiting room as you meet him. You notice he is walking about the room, looking at various objects as if he is not paying any particular attention. He appears fit, has two-day beard and bags under his eyes. His hair is cut short, but not combed. Jeans and dark t-shirt look to be unironed. You also happen to notice nicotine stains on his fingers and the strong smell of stale cigarettes. A neatly dressed younger woman is also sitting in the room reading a magazine. He later introduces her as Marie; his partner.You sit down with both to take admission details. Stefan is cooperative with the interview, but you notice after a short while that Marie provides some of the medical history you need to complete the forms, such as weight loss over the past few months, and expands where Stefan provides only short answers such as more background to his recent loss of employment. He doesn’t appear relaxed. You are only a short way into the admission when gets up and walks about the room and you can see he clenching and unclenching his hands.
 
1. Discuss the communication skills you consider to be important to use in order to help Stefan through the rest of the admission interview. 2. You have formed a clinical opinion that Stefan is presenting with signs and symptoms of anxiety. Briefly explain the presenting features in the scenario that support your opinion.3. You decide to provide relaxation techniques to help reduce Stefan’s anxiety. Briefly describe how you would apply this intervention to help Stefan. 4. You have a medication order available to you for diazepam 5 to 10mg oral PRN once-only for anxiety symptoms. You make a decision to offer this medication to Stefan. Briefly describe the relevant information you need to provide to help him decide. 
Answer: 

1. Nurses train for many years primarily to ensure patient safety and to improve the quality of healthcare services to patients. However, patient safety and positive transformation of healthcare cannot take place when nurses do not possess excellent communication skills (Iris et al., 2016). Also, the nursing profession requires nurses to give special attention to patients under their care given that in most situations, the patients could be going through the worst days of their lives. This brings the need for patience, attention to details, resilience and excellent communication skills. In this clinical scenario, it is important for the graduate nurse to effectively use communication skills to help Stefan through the remainder of the admission interview. Other than Stefan, a nurse speaks to different people of varying cultural, social and educational backgrounds and as such communication with patients and their families need to be conducted in a caring, effective and professional way.
Clare & Dare (2014) assert that it is important for the nurse to speak slowly to avoid cases of some words being mistaken to mean others. While speaking slowly, it is important to ensure that what is being said is clear to ensure there is proper understanding by the patient and his or her family members. The voice might be raised dramatically if need be but the nurse should try and avoid shouting because shouting makes it hard for patients to comprehend what is being said. Also, the nurse needs to consider the type of audience, in this case a 32 year old male patient. Based on preliminary assessment of the patient’s understanding, it is important to avoid using complicated words. For example, the nurse needs to refer to drugs as medicine because most people associate drugs with illicit substances.
Communication is a two way process that is believed to take place only when the recipient understands what the sender intends to pass across (Webb, 2011).  This brings the need to be able to stop talking and to listen to Stefan’s contribution and reaction towards the admission for surgery. In this regard, it is important to be ethical and active in listening and to reflect on what the patient is saying to make sure that information is flowing. Apart from using words, the nurse might choose to communicate through body language in the hands, posture and on the face. In using body language, the nurse needs to be conscious of whether what the body is saying is consistent with the message to avoid sending conflicting messages to Stefan and his partner.
2. Spielberger & Marvin (2015) explain that apprehensive behavior creates psychological and an emotional state of anxiety that in most cases activates stress response in the body. Based on the chemical uniqueness of the body, the intensity, duration and frequency of anxiety symptoms vary from one person to another. Anxiety before a surgery is a common emotional response experienced by patients prior to a surgical procedure. Temporary emotional discomfort is experienced by many patients even in cases where the risk of death is very low. Pre-surgery anxiety is made worse by the process of making patients ready for the procedure days or hours leading up to the event. Anxiety before a surgery can lead to increased risk of infection and more pain and this brings the need for nurses to recognize common signs and symptoms of anxiety particularly if a patient fails to reveal that he or she is nervous.
Some of the signs and symptoms of anxiety evident in Stefan’s case are restlessness and inability to settle characterized by walking about in the room without paying any particular attention to the objects in the room. From the other actions by Stefan, for example, getting up during the interview and clenching and unclenching his fists it is evident that he feels like going crazy (Paulman, 2011). Besides, Marie confirms that her partner has lost weight in the recent past and thinks he is going to die during or after the surgery. Other signs and symptoms evident in the clinical scenario involving Stefan are sleep problems, being jumpy and the urge to smoke is to have a feel of relaxation created by nicotine.
In order to ensure that the surgical procedure is successful, nurses need to identify and manage patient anxiety before and after the surgery. Usually before a surgery, patients receive numerous instructions and remembering the instructions could be a daunting task to most patients. Without proper understanding of the nurses’ expectations, anxiety can be heightened and this could adversely impact on the outcome of the procedure. Therefore, it is important for nurses to be capable of effectively conveying instructions and the reasons for instructions with the patients and their families and to offer reminders when necessary (Riley, 2015). Effective use of communication skills by nurses in their discussions of why some instructions are important improves the success rate of the surgery. For example, when a nurse gives instructions to Stefan not to eat, it is important to go further in explaining why it is important so that it is not ignored by Stefan or Marie.
3. Exercises that relax muscles and those involving deep breathing are some of the most common ways that help people to relax and combat the signs and symptoms of anxiety (Elkin, 2013). Also, they may help ease symptoms of depression.  Some of the examples of activities that people do to relax are exercise, listening to music, watching television among others. Relaxation exercises are specifically significant in combating physical symptoms of anxiety. Physical exercises are more effective if practiced because through practice the muscles become more relaxed and the breaths become deeper.
In Stefan’s case, in days leading up to the surgery he could be advised to exercise more regularly because exercise lowers the body’s stress hormones and helps in releasing chemicals that act as natural pain relievers and improve his overall mood. Also, exercise increases the quality of sleep which is otherwise affected by anxiety. Regular exercise brings the feeling of competence and confidence in the body and this enhances mental well-being which comes in handy during the recovery process (Huddleston, 2013). In the hours leading to the surgery, Stefan could be advised to try chewing a stick of gum as an easy and fast way of relieving stress. The process of chewing a gum brings a greater sense of well-being and reduces anxiety because chewing gum enhances the process of blood flow to the brain and causes brain waves that bring a feeling of relaxation.
Marie needs to be encouraged to be with Stefan during the pre and post-surgery periods. This is because social support from friends and families help in reducing anxiety by giving Stefan a sense of belonging and self-worth which is important in helping him during the tough times characterized by loss of a job and deteriorating health. Other than being around friends and family, Stefan needs to practice mindfulness characterized by activities that anchors him to the present. It can help combat the effects of negative thinking which induce anxiety.  Stefan could increase mindfulness through meditation, yoga and cognitive therapy as a way of boosting self-esteem which lessens the symptoms of depression and anxiety (Suinn, 2013).  Additionally, Stefan’s anxiety could be reduced through cuddling with Marie, listening to soothing music, deep breathing and spending time with a pet days or hours before the surgery. These relaxation techniques and healthy eating habits aid in boosting immune functions, maintaining the overall health and enhancing productivity.
4. Becker (2016) explains that diazepam is a controlled oral tablet that is used to treat anxiety, agitation and as an add-on treatment for some types of seizures and skeletal muscle spasms. Also, it may be used as part of a combination therapy. The drug increases the activity of gamma acid that sends signals within the nervous system. In bodies with less GABA (gamma aminobutyric acid) the drug works by increasing the GABA levels in the body and this reduces anxiety, seizures and possible muscle spasms.
After deciding to administer this drug to Stefan, as a nurse I will provide information on how the drug works. Also, I will inform him of common side effects of the drug which include slow brain activity, thinking and interference with proper judgment (Stan et al., 2011). Also, the use of the drug will bring the possibility of quitting smoking for it to work effectively and to avoid cases of heightened levels of slowed brain activity. Also, it is important for Stefan to know that when the drug is administered, he should not operate machinery, drive or perform other tasks that require alertness. This is because diazepam leads to dizziness, fatigue, muscle weakness, inability to control muscle movement and tremor. As a nurse I will inform Stefan of some of the life threatening symptoms of the drug that include increase in the frequency and severity of seizures, memory loss, blurred vision, slurred speech and feelings of the room spinning. Stefan needs to be aware of some of the unexpected reactions as a result of using diazepam such as extreme excitement, hallucinations, sleeping problems and agitation.
Informing a patient about the side effects of a drug needs to be done in a positive manner for ease of understanding by the patient. Also, it is an aspect of informed consent that requires that patients and their families must be made to understand the potential benefits and risks of different forms of treatment. As a nurse, I must ensure that the possible benefits and the underlying risks are explained in a language that is easy to understand.  Explanation by a nurse and proper understanding by the patient strengthens the patient-nurse relationship and this enhances the well-being and safety of the patient.  When the relationship between the nurse and the patient is taken serious, it brings about a shared authority of making decisions and responsibility for the possible outcomes (Xu, 2008).
References:
Becker, R. (2016). Fundamental Aspects of Palliative Care Nursing, An Evidence-Based Handbook for Student Nurse (2nd Ed.). New Bedford: Andrews UK Limited.
Claire, B., Janet, D. (2014). Communication Skills for Nurses. New Jersey: John Wiley & Sons.
Elkin, A. (2013). Stress Management For Dummies. New Jersey: John Wiley & Sons.
Huddleston, P. (2013). Prepare for Surgery, Heal Faster: A Guide of Mind-Body Techniques. Broomfield: Angel River Press.
Iris G., Jean. S. (2016). Communication in Nursing and Healthcare: A Guide for Compassionate Practice. Newcastle: SAGE.
Marvin Z., Charles. D. (2015). Emotions and Anxiety (PLE: Emotion): New Concepts, Methods, and Applications. Milton Park: Psychology Press.
Paulman, P. M. (2011). Signs and Symptoms in Family Medicine: A Literature-Based Approach. Amsterdam: Elsevier Health Sciences.
Riley, J. B. (2015). Communication in Nursing. Amsterdam: Elsevier Health Sciences.
Stan K. Bardal, J. E. (2011). Applied Pharmacology. Amsterdam: Elsevier Health Sciences.
Suinn, R. M. (2013). Anxiety Management Training: A Behavior Therapy. Berlin: Springer Science & Business Media.
Webb, L. (2011). Nursing: Communication Skills in Practice. Oxford: OUP Oxford.
Xu, F. (2008). Informing Patients About Drug Effects Using Positive Suggestion. Journal of Managed Care Pharmacy, 395–396.

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