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Irp Nursing

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Submitted By jennifercompton
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Jennifer Compton September 20, 2012 Number of Interaction: 1

Nursing goal: To sit down with the client and have a therapeutic conversion with her.
Setting: A Meadowview Terrace on Periwinkle on Wednesday from 11:00 am until 1:00.
Introduction: We arrived at Meadowview Terrance Wednesday morning at 10:00 am for orientation. After orientation we were assigned a patient and a chart to review and gather some history. After we reviewed their chart we were to sit down and have a therapeutic conversation with them. I had a very pleasant lady who had Alzheimer’s. She was sitting on the piano bench by herself when I approached her and ask if she minded if I sit down for a while and talked with her. She was alert and orientated times four she was dressed appropriate to the weather. She can move around with a walker but is very unsteady. She was able to tell me about more recent events in her rather than about her past. I could clearly see that she had long-term memory problems. After reviewing her chart, I went over and introduced myself and asked if it was okay if we sat down together and talk for a while.

Client | Nurse | Analysis | | Good morning. My name is Jennifer and I am a RN-student. How are you doing this morning? | I introduced myself because I thought it would make the patient more comfortable knowing who I was. I used open ended question. | My name is MS. Doing okay just sitting here. | Well that’s good. Is it okay if I sit down and talk to you for a little while before lunch? | The patient was sitting on the piano bench; she smiled and told me her name. She seemed to be relaxed. I then ask her if I could sit down and talk to her. I was offering myself to her to keep her company. | Okay that’s fine. | How was your morning? | She seemed very happy to have someone to talk to. I then asked her about her morning by using open ended question. | It was okay just ready to eat lunch and take a nap. | Okay that does sound good. Hopefully they will start severing lunch in a few minutes so you can go lay down. | .I should have restated my answer to the pt since this was giving my approval to go to sleep after lunch, maybe I should have said, “Did you sleep okay last?” | So you are nursing student? Where do you attend school? | (I smiled)Yes ma’am, I am in my second year of RN school and we go to school in South Boston. (pt is responding by nodding her head yes and smiling) | The patient is asking me questions about nursing school. We are both using nonverbal communication by smiling at each other | Oh okay well that must be nice. | Yes ma’am it is, it’s very close to home. What did you use to do? | I used an opened ended question to ask her about her occupation. | I became a teacher after the school became intergraded because I saw a need to help the children. So one day I woke up and told my husband I wanted to teach. | I am sure there was a need for teachers at that time to help the children learn and get a good education. What grade did you teach? | I was reassuring the patient about her decision to become a teacher. Reassurance in a non-therapeutic communication I should have tried to rephrased my statement so I would be using a more therapeutic communication. I then asked her another open ended question about what grade she taught. | I taught English in high school. I loved English because I thought it was important to know grammar. | I agree it is very important to know grammar many children these days don’t. So why did you decided to come and live in a nursing home? | She was smiling and having a very nice conversion so I decided since I had established a good relationship with the patient I used the exploring technique and asked her why she decided to come live in a nursing home. She smiled and answered the question with no hesitation. I am actively listening to my patient as she tells me about her career. | I didn’t decide to my daughter brought me to live here. | Oh, okay. How long have you been here? | I probably should not have asked her that question it seemed to make her more anxious. I tried switching the topic quickly. Patient was using a defense mechanism here; displacement. | I don’t know exactly? | That’s fine. Can you tell me about your daughter? | I used reassurance that it was okay that she didn’t know how long she had been here. I asked her an open ended question about her daughter to change the subject. I realized that she had some memory deficit related to dementia as evidence by short & long-term memory lost. | She lives in Creedmoor, NC and has one daughter and recently she just got remarried. Are you married? | Yes ma’am I am married. It has almost been a year and my older brother is getting married next weekend. | She then changed the subject back to me by asking if I was married I smiled and responded. It was therapeutic because I was telling her about me so the whole conversion wasn’t just me asking her a lot of questions. It was more like we were talking and getting to know each other and establishing trust. | Oh, that’s nice. Where is he getting married at? | He is getting married at Second Baptist in South Boston. | I am offering myself to the patient to build on to our nurse-patient relationship. | Okay I think I might know where that is. Who is your husband and did you get married their too? | My husband name is Jesse. No, I didn’t get married in a church. My wedding was on my papa’s family’s home place in Oak Level. He had bought it back from his sister and restored the house. He had done so much work on the house I wanted to get married there because it was beautiful and to make him happy. | We are having a nice conversation about her family and me. I am allowing her to get to know more about me and my family. | Well that was really nice of you to do that. Was he happy about you getting married their? | Thank you, he was. It was the perfect way for him to show off the house to friends and family. Where you married? | I used a close ended question. Patient seemed interested in me talking about my wedding. | Yes, I was. He passed away a few years ago. | I am sorry to hear about that. How long where you married? | I used an open ended question to find out more about her. | I don’t remember it was a long time though. (silence) | That’s okay. (silence) | I used a therapeutic technique, silence; by sitting in silence for a minute giving her time to think for a minute. Then I gave her reassurance that it was okay that she didn’t remember. | | Would you like to walk over and see the finches? | I asked her a close ended question. I also changed the subject because she seemed a little depressed when I asked her about her marriage. | We have finches in here? (puzzled) | Yes ma’am we do. They are right over there. (pointing to the other side of the room) Would you like to see them? | Patient mood was lifted back up when I asked her about going over to see the finches. I was giving the patient some information on where the finches were located. It was a sign of her dementia that she has a hard time with short-term dementia due to her dementia. However it was not therapeutic to change the subject. | Why yes I would. I love animals. (pt gets up with her walker to go over to see the finches) | Okay. (I get up smiling and lead the way to the empty couch in front of the bird cage). | Offering myself to the patient. | Aren’t they beautiful? | Yes they are. Which one is your favorite? | The patient seemed to enjoy looking at the birds so I decided to talk about something in the present time by using an open ended question about the finches. | I like the colored one that has the purple neck and different color back. | That one is my favorite too. He is just so colorful. What kind of activities do you like to do? | As I agreed on the patient about the finches. I told the opportunity to explore what other activities the patient liked to do. | Well I used to love to go outside and garden, but I can’t really do that anymore. What do you do for fun? | Well I love to ride horses; I have a horse name Scout. I also like to hunt and have many hunting dogs that I take care of daily. | She smiled as she answered the question, but then frowned a little about not being able to garden, and then she changed the topic back to me, so I answered. | I bet riding horses are fun. How many animals do you have all together? | I have 20 dogs, 1 horse, 1 cat and 1 house dog. | Offering information about myself to the patient, to continue to build on our relationship that we have established. It is clear that the patient is more interested in my life rather than in her own life. | Wow! That’s a lot of animals to feed. | Yes ma’am it is thankful with the dogs they aren’t all mine they are my husband’s family so we divide the cost in fourths. So that helps out a lot. Did you ever have any pets? | I am trying to change the conversation back to her by answering her question and asking her a close ended question. | I have had a few dogs. But I mostly just loved the nature. (Silence watching the finches). | I do to. (Silence) | We both smiled. I used the therapeutic technique, silence and we just sat watching the bird for a few minutes. | | They are interesting to sit and watch isn’t they? | I then tried keeping the conversation in the present by saying how the finches were interesting creatures since she seemed to really enjoy watching them. | They are. I wonder how they hold on to that stuff in the back of the cage? | I am not sure. I will have to try and find out for you. | I answered the question honestly by telling her that I did not know the answer and I need to find out. I never did find the answer out that day so I never gave her a answer. I should have really tried to get an answer back to her before I left. | Okay that sounds good. I wonder when lunch is going to be severed. I am getting pretty hungry. | It looks like they are starting to step everything up now. Would you like to start walking over there to eat? | I used therapeutic technique, redirecting, by telling her that they were getting ready for lunch. I helped her walk over to wash her hands. | Yes I would but first I need to go and wash my hands. | Okay I will walk with you if that’s okay? | Offering myself to her. | Sure that will be fine. (Pt gets up with walker and starts walking to the sink to wash her hands) | (I smile and get up and follow her over to the sink). | Using the therapeutic technique silence. | Can you put some soap in my hands? | Yes ma’am I sure can. (Picked up the soap and put some in her hands). (Smiling) | Using therapeutic technique by offering my assistance when the pt asked for my help. | Thank you. (Smiled). | You’re welcome. (Smiled). | I used therapeutic technique, silence. | Well let’s go sit down and eat some lunch. Are you going to eat lunch too? | No ma’am I am going to just assist you with your lunch if you need my help. | I used therapeutic technique by giving her information about why U was here and to help her if she needed my help. | Oh okay then. Thank you. (pt continues to walk over to the dining room table to her regular seat). | (I continue to walk behind her, pt isn’t stead on her feet). | Offering my assistance if she needs it. Risk factor for falls related to patients mental status as evidence by unsteady walking and pass falls. | (pt sits down in her seat). Pull you up a seat. | Okay I will. Thank you. | Smiled and proceeded to pull up a chair so I could help assist her with anything she needed. | Can you open up my straws and put it in my tea please? | Yes ma’am I can. (opened patients straw and place it in her tea). | Using therapeutic technique, offering myself to her when she asks for assistance. | Thank you. | You are welcome. | Smiled | (silence waiting for her food). | Here comes your food. | She appears to be very calm, relaxed and comfortable around me. | Yes it is. It smells good. | Yes it does. Do you need any help opening anything up? | Exploring if she needs any assistance with eating. | Yes, can you please open up my ketchup pack? | Yes ma’am. (opened up her ketchup pack). | Offering my assistance to her. | | Do you need anything else? | Close ended question to see if I could help her with anything else before leaving for the day. | No, I think that is it. | Okay. Well it is time for me to go. It was nice talking to you. I hope you enjoy your meal. | Reflecting on my conversation with her and letting her know I was departing for the day. | Okay. I enjoyed talking to you too. Thank you for helping me get set up for lunch. | You’re welcome. You have a great day and enjoy your nap. | Summarizing our conversation for earlier to let her know I was listing to her. | Okay I will. Bye Jennifer. (smiling and waving). | (smiling and waving bye to the pt) | She smiled at me and said okay I smiled back at her and as I walked away we waved bye to each other. |

Conclusion: I really enjoyed my patient at Meadowview today, getting to talk to her and learning things about her and her life. She was a very pleasant lady to spend the afternoon with. I enjoyed that we both enjoyed talking about nature and my wedding. She also really enjoyed sitting on the couch watching the finches in the bird cage. She did have a mental health diagnose of dementia. I could tell that she could recall some long-term memory but not her short-term memory. She seemed depressed about being their when I asked about her daughter so I quickly changed the subject because I could tell the subject was making her depressed. After I changed the topic she forgot all about it and was happy again. I think overall we both enjoyed talking to each other. She is in the despair stage of Erikson. I don’t think she liked that fact that her daughter put her in the nursing home because her anxiety level rose when I asked about that. She really could not remember many memories from her past, like how long her and her husband had been married due to the dementia. I also thought overall, I used a lot of therapeutic communication techniques. I did catch myself using a couple of non-therapeutic communication techniques throughout the conversion, but I also think I learned from this experience and will be able to have a more therapeutic conversion with another client. I am looking forward to going back to Meadowview in the next couple of week and stopping by to visit her and say hello and to make sure she is still doing well.

IPR CHECKLIST

Review this IPR checklist to make sure it includes all of the required components and attach the checklist to your IPR when you submit the IPR.

CONTENT A. Your name, date IPR done, # of interaction in a series 5 pts B. Nursing goal 5 pts C. Introduction/setting/mini-mental status 5 pts D. 5-15 minute dialogue (about 5 front pages) 25 pts E. Nonverbal behavior in ( ) 5 pts F. Conclusion 10 pts

IPR PROCESS (must be within the body of the IPR as it occurs, not at the end)

A. Communication techniques (therapeutic/non-therapeutic) 5 pts B. Your feelings, hunches, reactions 5 pts C. Themes and directions 5 pts D. Your accomplishments and mistake 5 pts E. Patient’s anxiety level (changes during IPR) 5 pts F. Nursing Diagnoses (seen throughout IPR) 5 pts

IPR PROCESS (must be within the body of the IPR as it occurs, not at the end)

A. Defense Mechanisms 5 pts
B. Growth and Development and residual behaviors 5 pts
C. Signs and Symptoms reflecting Mental Health diagnoses 5 pts ________________ Total Score = 100

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Health Economic Tools and Concept

...2013 Amy Shoales Economic Tools and Concept The United States is presently confronting a nursing shortage which is likely to get worse in the future. The shortage is compelled by amount of reasons linked to the employment and maintenance of nurses. Less young females going into nursing schools as professional prospects in other areas have stretched. Countless eligible candidates are denied admission due to a scarcity of nursing instructors at schools. The student will present economic tools and concepts pertaining to health care issues (nursing shortage); the student will use marginal analysis and supply and demand curve to assess the issue of nursing shortage as it relates to health care. These tools are designed to explore and evaluate the nursing shortage. Registered nurses are the major set of health care specialists in America and Worldwide. It is important to understand the effects that a nursing shortage has on the economy and the health care system. Supply and Demand Supply and demand curves are vital when considering the number of registered nurses available to provide services to patients in need of care. A good service is said to be scarce when more is desired than can be satisfied with available resources which means demand exceeds supply. Quantity and quality of care demanded are greater than quantity of nurses supplied (Lane & Grohmann 1995). Nursing is a professional fields in which the nurse provides services (good) to the patient. These services...

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