Nurse (student): Shawn Milner

Clients Initials: L.D.

Diagnosis:
-CVA with dysphagia
-HTN (unspecific essential)
-Vertigo
-Diverticulosis of colon
-Dementia (uncomplicated)
(G-tube placed)
Date: 3/18/2005
Age: 83
Time: 1200
Gender: F
Location Setting: The clients room was neat and clear and is the only resident of that room
although there is room for two. I had plenty of space to freely move and respond with
appropriate personal space. One icon of interaction I used for an introduction was the paintings
on her wall. Latter on in the evening beyond this conversation I talked to her about all of the
pictures of family on the wall and could asses part of her family social being. There are huge
windows to look out which are really bright, so on a different day than this conversation she had
me close the curtains before talking or doing anything else. I noticed that her door is usually shut
so by having a door she can have a sense of privacy in addition to being the only occupant of the
room. In her room she is able to fit a full dresser so she is able to have some selection in the
clothing she wears. She also has her own bathroom which may compliment her new toilet
training program. Her bed has side rail which can be removed, the top of the bed can be raised as
well as the bottom and it is a twin size mattress. She also has a television which she is captivated
by and interested in and is knowledgeable in adjusting the volume and channel. There is also a
chair in the room for visitors which is useful in maintaining eye contact level with the patient.
Nurse/Patient Dialogue

Communication Technique
Needed by Nurse

Nurse: Hey, how are you doing

Patient: Nods o.k.
Nurse: Hows your pain
Patient: O.K.
Nurse: How would you say that is on a scale
of one to ten
Patient: A two
Nurse: How is your arm coming along
Patient: I dont know
Nurse: Is it starting to get a little stronger and
more flexible

Acknowledgement

Therapeutic
(T) or NonTherapeutic
(N)
T

Assessment

Focused assessment and

clarification

Focused assessment
Focused assessment and
verification and clarification

Patient: I dont know (raises her right hand

for a handshake and squeezes as tight as she
can with a smile (as she does with other
C.N.A.s as kind of a theme of a joke)).
Nurse: Wow, you have got quite a grip, that
what you call a handshake
Patient: (Grinning Still)
Nurse: Hows your family
Patient: Good
Nurse: How are coping with your son-inlaws death
Patient: I am doing o.k. My son is a big shot
at wal-mart. All of my other daughters are
teachers (tells me more about her family
history) (then just silence and sitting for a few
minutes averting attention back to T.V.
intermittently because the commercial is over).
Nurse: What hand do you paint with

Acknowledgement and
Assessment

Offering Self, Acknowledgement

and Assessment

Offering Self, Acknowledgement

and Assessment without aversion
Silence

Assessment of why stopped

painting and potentially
exploring feelings of self coping
w/ CVA.

Patient: My right
Nurse: I can tell, you have quite a grip with
Acknowledgment
that hand
Patient: Every time I look at those paintings I
feel happy, it gets better every time I look
Nurse: When did you stop painting
Assessment to see if it was from
moving to health facility or if
from an emotional problem.
Patient: A while ago, it takes too much time, I
paint pictures in my mind
Nurse: Thats neat you must have quite an
Acknowledgement and focused
imagination. Would you paint again if you
assessment and clarification.
had time and materials
Patient: I dont know, I would like to take
that painting (on the wall) and touch it up a
little with some white
Nurse: That is one thing about art is that it is Acknowledgment.
always a work in progress
Patient: I like it
Nurse: Me too, I like your paintings also
Acknowledgment
because they make people happier when they
see them, thats really amazing, thats how you
can tell its art.
Patient: (Nodding and grinning) (commercial

N
N

is over and we watch together exchanging eye

contact every once in a while when there is
something funny).
Evaluation:
This time I learned that addressing problems rather than averting is easier and less
uncomfortable for the patient and nurse. This time I was ready and open for further exploration
however, I dont believe my client really initiated into every opening I gave her. I think I might
have closed her down from last time and she does not feel comfortable going further or just
didnt feel like it right now or because of some other reason. I think because I have had more
experience with her I was able to guide and assess by asking better questions than before. For
instance I was able to narrow down a little bit about why she stopped painting. I did not push too
far but at least I know that it may be more than her CVA that stopped her. I asked when because
I wonder if it is because of the healthcare facility that has discouraged her, but I didnt really find
out. I think this time I was more comfortable and able to accept silence even though the T.V. was
on as kind of something to do.