Inside My Personal Clinical Experience
My clinical experience allowed me to apply my clinical skills to a real-world setting and an event that stuck out to me was my first time communicating with a resident who has dementia. This resident, whom I will call Resident X, put my communication skills to the test by challenging my ability to build a therapeutic nurse-client relationship.
During clinical, I decided to have a conversation with Resident X in hopes of establishing a nurse-client relationship. I was drawn to Resident X because she was the only visible minority on her floor, and I felt like I could bring her a sense of comfort being a visible minority as well. In the middle of our conversation, one of the personal support workers (PSW) said, “Hi sweetie, we need to take you to get your nails cut” and reached for Resident X’s hand. Resident X became upset, stating, “I don’t need your help, leave me alone!” and tried to scratch the PSW. I was confused as to why Resident X was so against having her nails trimmed. Her response surprised me as she was so soft-spoken with me beforehand. The PSW decided to give up, even though she was aware Resident X had a fungus growing under her nails that needed to be treated. As an attempt to encourage Resident X, I offered to help her with her nails, she then said, “I can do things on my own!”. At this point, I was unsure of what else I could do to encourage Resident X. The only thing I could think of was to calm her down so she wouldn’t escalate any further. I had only been in the facility once before and did not feel experienced enough to deal with this situation. I was apprehensive of what Resident X’s response would be if I tried to calm her down and curious as to why the PSW did not try other alternatives to get Resident X to trim her nails, considering how jeopardizing the fungus is to her health. I felt like Resident X was coping with a loss of autonomy and was being defensive to preserve her independence. I decided to use her past to cheer her up as I knew she used to be a dedicated churchgoer from skimming through her chart earlier that day. When I brought up the topic of the church she exclaimed “Halleluiah! God has brought us together again” and seemed to put all her troubling emotions behind her.
From this scenario, it was clear that the PSW did not effectively communicate with Resident X, causing her to lash out. The PSW displayed unhealthy practices by grabbing the resident’s arm and not treating Resident X like an adult by using terms of endearment to address her. Although it can be difficult, people with dementia are capable of communicating successfully. All things considered; the key issue is a lack of person-centered communication causes dementia patients to display troubling behavior. Communicating effectively requires care providers to treat their residents with dignity which can build the nurse-client relationship. Williams et. al suggests that healthcare providers should try to find common ground with their clients by analyzing the situation and trying to figure out the meaning behind their behavior. Communication requires flexibility as healthcare providers must try to meet a resident’s needs in a way they will accept (Williams et. al, 2018, p. 1021). When working with dementia patients, person-centered care recognizes the client as a person. Person-centered communication validates an individual’s feelings and provides support to encourage goal accomplishment. It allows the health care provider to gather information from the client and find alternative ways to meet their needs. The PSW did not apply patient-centered communication as she was more focused on completing the task and she did not validate the behavior of Resident X. A person-centered approach would have allowed her to focus on the origin of the behavior instead of the outcome which could have bridged individual differences of Resident X and the PSW.
In the future, I will continue to incorporate a person’s history when giving personalized care. I will also continue to treat a patient as more than just their illness and recognize the person behind the disease first before anything else. Incorporating Resident X’s past in communication effectively calmed her down and redirected her energy to something more positive. I also aim to be more confident when dealing with difficult situations regardless of my experience level and will not assume that staff members will always be mindful of a resident’s needs. If I could redo the situation, I would be more confident and diligent with Resident X so I would be able to find creative ways to encourage her to get her nails trimmed. Being confident in my clinical skills despite my lack of clinical experience will allow me to assertively use a variety of approaches to meet the needs of residents and avoid triggering aggressive behavior.
This experience made me realize that patient-centered care requires patience and strong interpretation skills. My past clinical experience with dementia patients was theoretical as I only knew as much information as my textbooks provided, however, being put in the situation made me think on my feet. This experience highlighted the need for me to improve my communication skills. When faced with a similar situation I will review my GPA guidelines to use a gentle and persuasive approach, respond respectfully and validate the patient’s feelings. GPA will help me support the residents’ emotions and empathize with their circumstances. I will also try to collaborate with the patients by encouraging choice and accommodating a person’s disabilities to enable task completion. For example, if the patient wants to be more autonomous, I can accompany them with their tasks and only assist when necessary. Ultimately, I am grateful for all the humbling encounters that came with my clinical experience.
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