Contexts of Nursing and Primary Health Care
Contexts of Nursing and Primary Health Care
It is essential for nurses to learn how to interact with patients and their family members despite the circumstances of their encounter. Family nursing practitioners need good communication skills to interact with patients and enhance a relaxing association. This association between patients and nurses depends on their ability to communicate well on regarding their context. In most cases, family healthcare nurses and care givers who work in Alzheimer’s disease (AD) care organizations face the problem of whether to be untruthful or honest with family members about their loved one’s condition (NHS, 2012).
In the video “Come Walk with Me”, there are different scenarios showing positive and negative communication elements. The video is about John who is an elderly Australian man with symptoms of Alzheimer’s syndrome and Anne who works as a community nurse. The interaction also involves John’s youngest daughter, Kerrie, the eldest sister Jenny, a senior Paramedic by the name Phil who is with his junior compatriot Steve. The interaction happens in John’s residence in the confines of a peripheral neighborhood. John is showing signs of Alzheimer’s disease. His wife passed away after succumbing to cancer. John remains an aggressively after his previous successful stints as a business man. However, his memory has failing, and his daughter Kerrie has been caring for him at his residence. His other daughter, Jenny is busy controlling her business. Thus, she is unable to contribute to the healthcare of her father. During Kerrie’s holiday, Jenny takes the role of providing care for her father. When Anne, the healthcare nurse who checks John on a monthly basis comes to see him, he finds him in a distraught condition. There is a scalp laceration in John’s head that suggests the possibility that he had a fall. Anne informs Jenny and Kerry and paramedics for John to receive urgent medical care (Debellis et al., 2009)
Communication can become a problem for a dementia patient. The way dementia patients synthesize what one is communicating and their capacity to communicate with people properly varies from one person to another and according to various contexts. Therefore, there must be some communication tips that one has to follow when communicating with a dementia patient. These tips give communication a flow and makes it easy (Kennard, 2006).
In the video “Come Walk with Me”, the first positive element of communication that is evident is identifying oneself to the dementia patient before the communication starts. Introduction helps the dementia patient familiarize himself or herself about the person. Dementia decreases the ability to remember details about people. The patients have difficulties in expressing their emotions and thoughts as well as understanding other people. Therefore, initiating an effective communication with a dementia patient first requires one to introduce himself or herself to the patient. Anne does this when she makes her regular monthly visits to John. At first, John has confusion and thinks that perhaps it may be a salesperson looking for potential customers. He quikly informs Anne that she is not marketing products but rather she has come to pay him a visit. She tells him her name, and this makes John familiarize with her. Anne’s introduction to John is a positive element of communication in this video. The introduction puts reduces any issues of confusion and disorientation in John. It brings him at ease with Anne. In addition, Anne’s introduction is brief, clear and precise. Therefore, a clear and precise introduction attracts the attention of the patient. Also, Anne identifies her patient by his name. When she is knocking on the door waiting for John to open, she calls him by his name. This is an essential tip for communication with dementia patients (Debellis et al., 2009).
Secondly, another positive element of communication evident in this video is maintaining of an appropriate body language. The tone of the voice and facial expressions are necessary factors when communicating with dementia patients. The body language should not make the dementia patient feel a sense of fear. This can trigger a negative reaction from the patient. There should be a balancing of a unique speech that does not equate the patient to a child. One should not shout, or show frustration when they do not understand your statements. A person should use words that the patient can comprehend and give one instruction at a go. One should not push the dementia patient to offer a response to an interrogation that worries or gives them stress. Use of structured questions that require yes or no answer is more appropriate than comprehensive question (Debellis et al., 2009).
In this video, Anne uses appropriate body language. Moreover, her voice is audible, and she uses words that John can understand. She asks one question at one time. During the conversation, Anne maintains eye contact with him. She takes a seat next to John. She nods her head when John is speaking to show her attention to him. Sometimes she touches John’s hand to show care and attention to him (Debellis et al., 2009).
There are some elements that one should avoid when communicating with dementia patients. Dementia patients can develop a negative feeling to a conversation in case it does not go the way they want. Dementia syndrome is not about understanding but rather showing care, love, inclusion, and concern for the patients. Therefore, one can ask the patient to clarify statements they may not understand. It is not appropriate to criticize or correct a statement made by the dementia patient. In addition, people should avoid starting an argument in the presence of a dementia patient. Also, they should avoid talking to the patient like a young child and talking about him with other people when he or she is present (Australian Department of Health and Ageing, 2006).
The first element of negative communication in this video is criticizing and correcting John’s decision not to go with the hospital. Anne disagrees with John on his decision of not going the hospital. However, when Anne realizes that John does not like to go to the hospital, she changes tune to be in agreement with him. She takes this action that makes him feel comfortable and happy. Then, Anne makes the wrong communication move by calling emergency ambulance services in John’s presence. John’s facial impressions reveal that he is not happy by Anne’s call (Debellis et al., 2009).
Another episode in the video where negative communicating happens when Kerry asks John about how he is fairing. John responds that Jenny is a good girl and that she is about to buy a house for him in Sidney. He also adds that Kerry should not report that to her mother. This statement is wrong because John’s wife died a long time ago of cancer. Therefore, Kerry is quick to correct her father that their mother is not there and that Jenny could be cheating on buying a house for him in Sidney. This is a negative element in communicating with a dementia patient.
The second negative communication evident is starting with an argument in the patient’s presence. When Jenny comes to check on his father, she finds her sister, Anne and two paramedics. She takes Kerry to the side to inquire about them. She does not agree that her father should be taken to the hospital. She starts to argue with Anne and Kerry in the presence of her father and the paramedics. It is not advisable to argue in the presence of a dementia patient.
Another episode of a negative element of communication in the video is communicating with John as a child. It is not appropriate to talk with a dementia patient since if he or she is a child. The patient may feel his treatment is like that of a child. The conversation should be simple, precise and clear and also mature. This element happens when Kerry is talking to her father about how he is feeling. Kerry kneels down during the conversation, an aspect related to child communication (Debellis et al., 2009).
There are different ethical issues facing family and community nurses who interact with patients and relatives with dementia. These ethical issues may come up from a personal context. In addition, long term associations can influence ethical issues (Hughes et al., 2002).
The ethical issue is evident in this video interaction is compulsion and coercion of John. Anne is in a situation where she has to call paramedics to attend John who is not keen to be hospitalized. This brings a misunderstanding between them. She lies to John that it is ok not to go to the hospital and still makes a call for emergency ambulance services. Anne has an obligation to perform her duty to provide nursing care to John. Therefore, she takes the role of calling for medical ambulance and informing Jenny and Kerry on the need for providing emergency medical care for their father. They are not happy, and this gives her feeling of guilt. Her nursing duty and responsibilities put her in this ethical issue. She feels guilty about her decision because she has a good relationship with John’s family. She knows that she has taken the decision for the best interests of John (Alzheimer’s Society, 2013).
In conclusion, it is crucial for a family nursing practitioner to consider various contexts and how to use different communications skills when giving healthcare. Furthermore, communication is crucial to daily life. It is one of the foundations of nursing professional practice. The way nurses communicate to patients and their family members is distinctive and impacts the quality of the interactions.
Alzheimer’s Society. (2013, May 15). Top tips for nurses: Communication. Retrieved from Alzheimers.org.uk http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1211&pageNumber=2
Australian Department of Health and Ageing. (2006). Dementia: The caring experience, a guide for families and carers of people with dementia. Sidney: Commonwealth of Australia.
Debellis S. L. (2009). Come into my situation- associating with a dementia patient: A learning material for nursing health care undergraduate students on person-centred care. Retrieved from nursing.flinders.edu.au:
Hughes, J. C., Hope, T., Reader, S., & Rice, D. (2002). Ethics and dementia: The opinions of casual carers. Journal of the Royal Society of Medicine 95(5), 242-246.
Kennard, C. (2006, May 15th). Talking to people with dementia. Retrieved from About.com: http://alzheimers.about.com/od/frustration/a/talking_dementi.htm
National Health Services. (2012, June 13th). Communicating with people with dementia. Retrieved from www.nhs.uk