WOUND care and Therapeutic communication

Therapeutic Communication- Case Scenarios

For the cases presented below, come up with therapeutic responses that you as the nurse would provide in each of these situations. Please use the ‘Therapeutic Communication Techniques’ handout as a guide.

Case #1 – A 62 year old female patient was admitted 2 days ago with a diagnosis of breast cancer. She was informed by her doctor yesterday that a course of radiation and chemotherapy was her best option. She became very upset and frightened about the proposed treatment and stated that she wasn’t sure if she would go through with it. The nurse approaches her to discuss how she is feeling today.

Nurse:

“How are you doing today, Miss Smith. I was wondering how you were feeling about undergoing radiation and chemotherapy?”

Patient: “I don’t know. I’m not as scared as I was when I got here, but I have a lot of questions about it.”

Nurse:

Case #2 – A tearful elderly patient is sitting in bed holding a picture of her recently deceased husband. A tray of uneaten food is on the bedside table next to her.

Think of a few ideas of what the nurse could say to start a therapeutic conversation with this patient.

Nurse:

Patient: “Oh, don’t bother with me. I don’t have much time left in this world and I don’t have much to live for anyway.”

Nurse:

Case #3 – A daughter of an elderly patient presents to the room to visit her mother. The nurse who just came on shift responds to the patient’s call light going off and enters the room to see the patient’s daughter present at the bedside.

Daughter: “No one has been caring for my mother properly since she’s been here! She is sitting in urine in the bed, her food tray arrived and no one has fed her, and she is having a lot of pain. Someone needs to do something or I am taking my mother out of this place immediately!”

Nurse:

Case #4 – A 35 year old patient admitted for an infected wound from IV heroin abuse is admitted to your unit. You are the nurse assigned to his care for the shift.

Patient: “I am dying in here and having drug cravings like crazy. No medication is working for me. I need to get out of this place now or else I am going to go insane!”

Nurse:

Case #5 – A 52 year old male patient admitted for chronic back pain is very frustrated about the physician wanting to wean him off his pain medications. You enter the room as the patient’s nurse because you hear him yelling down the hallway for help.

Patient: “The doctor needs to reconsider giving me my pain medications. I am so sick and tired of living with this pain, and I need my pain medications to survive. I am clearly addicted to my meds and the doctor doesn’t understand that taking me off my meds is going to ruin me. Why is he doing this to me? I can’t live like this.”

Nurse:

Wound Care Class Activity

Mr. Peters had abdominal surgery. He was discharged with medications and instructions to change the wet to dry dressing in the wound three times a day. The RN gave the dismissal instructions in a hurry because the hospital needed the bed for a new patient. When the RN asked Mr. and Mrs. Peters “Do you know what to do when you get home?” They both nodded yes. Mr. and Mrs. Peters spoke limited English.

After a few days Mrs. Peters contacted the nurse advice line to ask how many days she had to wait before she should replace the white dressing in the wound. With further questioning, the nurse realized Mrs. Peters was taking the gauze out of the wound, then rinsing it in the sink, and putting it back in the wound. The patient was readmitted for an infection and needed an additional follow-up surgery due to the infection complications.

1. What steps could the nursing team take to improve patient education for wound care for this patient & his wife?

2. What body language might indicate a patient or family member may not fully understand compliance with their medical care

3. What changes can be made to prevent this from happening again

4. What potential wound complications would you want to include in the patient teaching? What are the signs and symptoms that the patient should look for, which could indicate complications?