Nursing Case Study and Analysis

Nursing Case Study and Analysis

The interaction between Shona and the nurse displayed a mix of a few elements of effective communication and a significant share of ineffective communication on the side of the nurse, making it a challenge for the patient to express herself fully.

Specific Instances of Effective Communication within the Case Study

The first instance of effective communication is when the nurse asked the question, “Why are you here, Shona?” as an introduction to the interview. This is a leading “why” question to find out why Shona is visiting the hospital. The primary aim of a patient interview is to obtain comprehensive information, including patient history, to deliver effective patient-centred care. A methodological approach applies when obtaining information from the patient and starts with establishing the chief complaint or the reason for the clinical visit before beginning to explore the patient’s specific problems (Kuhnigk, Schreiner, Reimer, Emami, Naber & Harendza 2012). It is essential to let the patient show by themselves the reason for visiting the medical facility from the beginning of the discussion.

The second instance of effective communication is when the nurse expressed some empathy with the patient during the conversation. The statement, “It seems like you’ve been having a stressful time,” shows that the nurse understands and feels what the patient is going through. Empathy is when physicians or nurses place themselves in the patients’ situation during the interrogation and respond through vicarious understanding or personal experience. Empathy enables the patient to feel as though the nurse understands her experience and that the nurse is applying her expertise to the patient from an individual perspective. Asking a follow-up kind of question or nodding are ways of expressing empathy (Digby, Williams & Lee 2016). For instance, in the case study, the nurse asked Shana, “Can you explain that further?” after showing an understanding of her stressful situation, an excellent example of empathy.

Instances of Ineffective Communication within the Case Study

First, the nurse went straight into inquiring why the patient visited the clinic, “Why are you here, Shona?” instead of greeting her first, which is not the best way to build a rapport with the patient.  Building a good relationship from the start is vital in setting the tone of the interview, making the client feel comfortable with you. As such, it is essential to start the conversation by first greeting the patient by name if you know him or her to show your interest in the patient and that you care (Brinkert 2010). This aspect of effective communication is missing in the conversation between Shona and the nurse.

Secondly, the nurse is judgmental. A statement such as “You are probably just upset about your Mum and Dad,” is an excellent illustration that the nurse morally judged the patient. Moral judgment, according to Hill (2010), occurs not only in criminal and egregious cases but also in day-to-day situations where appraise of the social worth of the patient and the culpability becomes routine.

Thirdly, ineffective communication is explained by conclusions such as “It’s likely all of the stress that’s making you ill. I believe you should talk with a counsellor.” “Maybe you’re depressed.” An interviewing nurse or physician is required to practice active listening—a dynamic process that entails hearing, processing, and interpreting to understand both spoken and unspoken words from the patient to get the complete message. The interviewer should not jump into a conclusion or makes a premature assessment during the interview as it may distract the patient from giving full details (Andrews, Burr, & Bushy 2011). The nurse in question bombarded the patient with conclusions out of her scope of practice

Last but not list, the nurse disrespected the doctor and his medical expertise in front of the patient, which is an ethical communication practice. “Well, I have been here for years, and I know much more than these doctors,” is not appropriate for a nurse operating within the nursing professional scope of practise that requires the nurse to know what is right when giving out medical opinions. Health care members are required to work together in the nursing family and with doctors and specialists to deliver quality care (Brinkert 2010). As such, it is unethical to disregard co-workers opinions, particularly the seniors in front of the patients.

Consequences to the Nurse-Patient Relationship, As A Result Of the Ineffective Communication

Infective communication can lead to patient dissatisfaction and ultimately lose the focus in the conversation. The nurses must provide the chance for the patients to tell their stories without interjecting, failure to which the patient might get dissatisfied, and hid much information (Andrews, Burr, & Bushy 2011). In the case study, the patient even shouted to the nurse at one point because of the nurse’s insensitivity to some issues, concluding that Shona is probably depressed, while to the patient, she was grieving. “I’m not depressed! I’m grieving! Am I not allowed to grieve?” Research shows that long-term practicing nurses are more likely to be ineffective in communication as most of them might have gotten used to a similar pattern of communicating to the extent that they no longer sense that their behaviours influence professional communication skills (Brinkert 2010). As such, continuous training is essential to create awareness of the importance of effective communication nursing practices.

Poor communication between the nurse and the patient can also translate to significant mistakes such as administering the wrong medication or treatment plans, improper diagnosis of the patient’s condition, and to some extent, death of the patient because of misdiagnosis. Both the physician and the nurse play an essential role in the care delivery and support of the patient. As such, a communication breakdown translates to severe medical challenges for the patient (Asnani 2009).  For example, the nurse in question seems to disregard the expertise of the physicians, her seniors, as exemplified by the statement such as, “Well, I have been here for years, and I know much more than these doctors,” making the nurse-patient-physician interaction a challenge. Nurses interlink the patient with the physician, and a communication breakdown from either way affects the patient.

Thirdly, ineffective communication also leads to diagnostic inaccuracy. Most diagnostic decisions emanate from the history-taking element of the interview. However, the study of clinician-patient interactions shows that patients are often not given the time or opportunity to tell their history because of interaction, hence compromising diagnostic accuracy (Asnani 2009). Incomplete history/story such as in the case of Shona because of interjections results in insufficient information for decision making.

Presents three alternative statements to the ineffective communication identified above

1. Hello Miss Shona, why are you here today? Instead of “Why are you here, Shona?” Beginning a conversation with a greeting creates a welcoming environment for the patient making him or her open up and you as much as possible the information needed.
2.  Well, it seems your condition is stress-related. You are anxious, aren’t you? I will get you the doctor on shift. Please tell him about this when he is here. Nurses act as mediators between the patient and the physicians. By advising the patient on what to say to the doctor when he arrives shows some mediation skills.
3. Instead of “It’s likely all of the stress that’s making you ill. I believe you should talk with a counsellor,” the statement can be “It’s likely all of the stress is contributing to your illness.” Let the doctor assess you; then, you can probably talk with a counsellor if that is the case. It is essential for the nurse not to jump into the conclusion in areas outside her scope operation as that disregards the teamwork spirit in the healthcare teams.

References

Andrews, D. R., Burr, J., & Bushy, A. (2011). Nurses’ self-concept and perceived quality of care: A narrative analysis. Journal of nursing care quality, 26(1), 69-77.

Asnani MR. (2009). Patient-physician communication. WestIndian Med J, 58(4):357-61. PubMed

Brinkert, R. (2010). A literature review of conflict communication causes, costs, benefits, and interventions in nursing. Journal of nursing management, 18(2), 145-156.

Digby, R., Williams, A., & Lee, S. (2016). Nurse empathy and the care of people with dementia. Australian Journal of Advanced Nursing, 34(1), 52.

Hill, T. E. (2010). How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research. Philosophy, Ethics, and Humanities in Medicine, 5(1), 11.

Kuhnigk, O., Schreiner, J., Reimer, J., Emami, R., Naber, D., & Harendza, S. (2012). Cinemeducation in psychiatry: a seminar in undergraduate medical education combining a movie, lecture, and patient interview. Academic Psychiatry, 36(3), 205-210.

Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M., & Samami, E. (2016). Communication barriers perceived by nurses and patients. Global journal of health science, 8(6), 65.