Therapeutic Communication: Michelina’s Case

Introduction

After Michelina is admitted to a long-term care facility, a nurse’s primary responsibility would not only entail obtaining required information but also providing comfort and consolation. It is abundantly easy to see how the death of her spouse and estrangement from the rest of her family combined with diseases associated with old age put a strain on the patient’s mental health and well-being. Thus, the first conversation at a medical facility of her family’s choice bears great importance.

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As much as a nurse should concentrate on becoming familiar with Michelina’s medical records and preparing necessary resources, he or she should also make sure that they listen actively and are empathetic. It is preferred that the conversation takes place in a quiet setting with minimum distractions, and both the patient and a medical practitioner should be seated.

Main body

During the conversation, it is essential to assess Michelina’s mental and physical state, draw information about her motivation, and set common goals. The nature of questions asked and statements made need to reflect trust, respect, and appreciation for the patient’s narrative and point of view. Below are some examples of what a nurse could say to make conversation:

  • What do you think would make you feel better about your current situation?
  • Do you have any complaints about your health?
  • You seem to have difficulty talking about that. You have been feeling blue.
  • You have this [belonging] with you. Could you tell me more about it?

At that, a nurse should consider reflecting affection: after the woman states how she feels or what she desires, a nurse should summarize her points for the patient to recognize and accept them.

In the case description, it is stated that Michelina has a blank expression on her face, stares out of the window and possibly, refuses to make eye contact. From this information, one may assume that one of the challenges of working with the patient would be her general disengagement.

It is possible that the woman thinks that it was not her decision to be admitted to that long-term care facility. Thus, it is safe to hazard a guess that the patient would be reluctant to making conversation and even more so, setting treatment goals. A nurse would have to make a conscious effort to motivate the woman and ensure that her admission was in her best interests.

Another challenge in this situation would be dealing with transference and countertransference. For instance, depending on a nurse’s previous experiences with elderly patients, she may find the situation straining and exhausting or on the contrary, an opportunity to learn and grow. This phenomenon of evoking past feelings and manifesting them into the present would be transference. Countertransference, on the other hand, may occur if Michelina reminds a nurse of someone in her past – for example, an elderly relative of which a nurse was not very fond. In this case, hostility due to emotional entanglement may develop, and a nurse-patient relationship would have another dimension with the potential to jeopardize treatment.

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Conclusion

A nurse should be aware of developmental changes associated with old age. Nowadays medical practitioners use Erikson’s theory of stages when providing care for elderly patients. According to Erikson, the main psychological conflict that characterizes the stage that Michelina is going through is Integrity vs. Despair (Scheck, 2014). A nurse should understand that on the one hand, Michelina may be enjoying her wisdom, but on the other hand, reflecting on her life and revising past events might make her anxious. A medical practitioner should practice compassion towards Michelina and make sure that not only her physical but also emotional needs are met.

References

Scheck, S. (2014). The Stages of Psychosocial Development According to Erik H. Erikson. Munich, Germany: GRIN Verlag.

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