DESCRIPTION OF SITUATION AND ENVIRONMENT IN WHICH INTERACTION TOOK PLACE:

Transcription

1 STUDENT NAME: Angeline Barbato DESCRIPTION OF SITUATION AND ENVIRONMENT IN WHICH INTERACTION TOOK PLACE: The conversation took place in a closed and quiet examination room located in the emergency room. The client who is involved in the conversation was in a car accident and is experiencing some abdominal pain as well as a laceration on her head. The two individuals who are involved in the conversation are the client and the nurse. Upon the nurses arrival into the room, the client is lying in bed, pinching her nose, and looking very stressed. INTERPERSONAL PROCESS RECORDING Verbal Interaction Non-Verbal Cues/Actions SN Facilitative Communication Nurse: Hi, How are you? The nurse enters the room, touches the client s shoulder and makes eye contact. The nurse did not introduce herself upon entering the room. The nurse is providing Therapeutic touch Values (V) of Both and The nurse should have introduced herself to make the relationship a little more comfortable. (T) : Hi, I ve been better. The client is startled and rolls her eyes as the nurse speaks to her. The client is feeling very stressed and anxious after what has just happened to her. Nurse: Can you tell me what happened today? The nurse s hand remained on the clients shoulder. The nurse is providing therapeutic touch. She is also asking a focused question about the accident. The nurse wants to know exactly what happened in the accident. (T) : in the accident? The client makes eye contact with the nurse and grabs her neck. The client is stressed and aggravated that she is in the hospital. Nurse: yeah The nurse nods her to show she is listening to what the client is saying. The nurse focused on the main issue right away to find out exactly what happened in the accident.

2 : uh,well I was out to dinner with my friend Kathy, and I was just on my way driving her home and um she was you know going off at the mouth she had too much to drink at dinner, she was using my phone to call everybody she knew all of a sudden tonight and she was going on and asking for it again like a few times and uh I guess I was distracted and I did not see this cab come at me and broadsided me. Nurse: did you hit the windshield? The client spoke directly to the nurse while moving her hands restlessly. She seemed very frustrated and stressed. The nurse was showing good eye contact and nodding her head to show that she was listening to the client. The nurse grabs the client s chart but is still maintaining eye contact. She has asked a focused question to have the client answer more specifically. Values (V) of Both and The client is upset and shook up from the accident. She seems to be confused and is having a difficult time remember what was going on before the accident. The nurse was asking this question to try to find an immediate solution as to what is causing the abdominal pain. (T) : I hit the steering wheel. The client grabs her head and closes her eyes. The client is still showing signs of stress and perhaps pain as she grabs her head. Nurse: you hit the steering wheel? Did you hit it with your chest too? The client is still holding her head at this time. The nurse asks a focused question to find out if the patient is having pain anywhere else. Both questions however, were closed and offered only yes or no answers. I think the nurse is trying to figure out what happened but could have been more empathetic towards the client. : not that I know of. The client then grabs her chest and looks confused. The client is still upset and confused about what happened in the accident. Nurse: no? Did the bag go off? The nurse asked a closed question. She could have said, What happened with the air bag? By asking a closed question, the nurse is not allowing the client to really explain what happened. (T) : no The client wouldn t have answered so shortly if she had been asked an open ended question. (T)

3 Nurse: you are holding your side : yea, it s a little painful, but The nurses tone in her voices seems more interested. She points to the clients side. The client the holds her side. The nurse is nodding her head to show she is listening to the client. The nurse is stating observations after seeing the client hold her side. Values (V) of Both and The nurse is thinking maybe she should take a closer look at the client s abdomen since she is holding it. (T) Nurse: and your head? The nurse grabs the client s pillow. She is maintaining good eye contact and nodding her head. Nurse is showing active listening techniques. The nurse is now thinking she should take a closer look at the client s head especially since she is having trouble remembering. (T) : yeah it feels ok, is it that bad? The client is looking concerned and worried on her face. The client is feeling very stressed about what could be wrong with her. Nurse: will be checking it out it may need a little help. Let me take some notes here. : hum, The nurse has a concerned look on her face. She maintained good eye contact with the client. She then changed the subject. The client touches her eye, looks away, and sighs. The nurse is showing active listening. The nurse is also reassuring the client that she is going to be helping her out. The nurse is gathering the information she needs in order to continue on with the client s assessment. (T) is annoyed. Nurse: I just want to take your vital signs. Say your BP. The client makes eye contact with the nurse. The nurse does not giving information to the client since she did not explain the blood pressure procedure to her. She is also unclear about what she s going to do. The nurse is not informing the client so she is able to understand the situation. This does not build a trusting relationship with the client. : all right, do you have any idea how long I am going to have to stay here? The client looks down and scratches her head. The nurse is gathering the blood pressure supplies up and is therefore not maintaining eye contact. The client is irritated and is preoccupied. Nurse: no I don t right now, um The nurse is not giving information. She should have said and estimated time of how long the client may be there with injuries like hers. The nurse seems uninterested with the client s questions and is more concerned on getting her work done. (T)

4 : not over night though The client raises her hand off her head. Values (V) of Both and The client is irritated that she may have to be there over night. The client is also impatient and anxious. Nurse: not sure, not sure, but I will check The nurse is looking at the blood pressure cuff as she gets it ready. The nurse is not showing active listening since she is not maintaining eye contact. The nurse again is more concerned with getting the blood pressure taken then helping the patient with her concerns. (T) : really? Nurse: yeah I will check it out The client s eyes widen. The nurse is maintaining eye contact. The nurse is showing active listening and is giving information to the client that she will check out if she has to stay. looks irritated and surprised that she might have to stay. The nurse wants to finish the information she is gathering because the client is getting restless. (T) : really? Really I don t want to be here overnight if I don t have to be, if you could get a doctor in to see me and say it is ok. The client flares her arms and has a frustrated tone. The nurse is putting on the blood pressure cuff. The nurse interrupts the client and asks a why question in between the clients statement which should never be done. is getting more irritated as the conversation continues since it is still unclear if she will have to stay the night. I could stay a few hours. I just have a really important meeting tomorrow with a client. I have a trial next week that I can t get anyone to replace me for. I ve done all the work on it so, it s just a bad time for me, you know. The client is fidgeting. The nurse is maintaining eye contact and nodding her head. She is also putting her stethoscope around her neck. The nurse is showing active listening through her eye contact and by nodding her head. She is also agreeing with the patient as she is talking about how busy she is. The client is using a defense mechanism of displacement; changing her emotions from the accident to work. The client has no interest in staying there. She is more concerned with how much she has to get done for work the following week. (T) Nurse: what do you do for work? The nurse places her arms down in front of her and folds them. She also makes eye contact. The nurse changes the subject to find out why the client is stressed about work. The nurse is interested in client s life outside of the hospital. (T) : I am a lawyer Nurse: you re a lawyer The client looks away from the nurse and puts her hands down. The nurse restates what the client says but in a monotone. The client is now informing the nurse what she does for work. (T) The nurse sounds to me like she is uninterested in the client s answers. (T)

5 Values (V) of Both and : yeah The client has no eye contact. The nurse is grabbing the client s chart. The client seems sad. Nurse: ok, do you have any allergies? The nurse has no eye contact. She is looking and filling out the chart instead of looking at the client. The nurse changes the subject. She is not showing active listening skills. She should look at the client while she is speaking then fill out her chart. The nurse is getting a health history done before the client is sent off to have any tests. (T) : no, God this is just awful. The client rolls her eyes and scratches her head. The client sounds frustrated and impatient. Nurse: any pain anywhere else before I listen to your pressure? The nurse is putting her stethoscope on and moves her hands over the client s legs. The nurse interrupts the client and doesn t show any interest in what she just said about it being awful. The nurse asked an open question about the client s pain. The nurse is sensing that the client is uneasy, yet she wants to finish her assessment. : no The client places her hand behind her head. seems unconcerned with what the nurse is asking her. Nurse: no, you can move all extremities? The nurse points to the client s legs and looks at her legs. The nurse restates the client s answer. She also asks a focused question from the client s feelings, to what is wrong with her. The nurse is trying to gain an idea of what is hurting or bothering the client. The client may not be telling the nurse all the pain she is experiencing. (T) : yeah Nurse: yeah The client still has her hand behind her head. The nurse speaks in a monotone voice. The nurse restates what the client has answered to her to show she is listening. The client is annoyed that the nurse is still asking her questions. The nurse is trying to see if the client is keeping pain information from her. (T) Nurse: move both legs for me, great. Can you squeeze my hands? The nurse checks the client s legs and touches her hand so she can squeeze it. The client moves her legs and squeezes the nurse s hand. The nurse is observing the client as she moves her legs. She is also observing how hard the client can squeeze her hand. The nurse is observant of the client s health.

6 : sure The client rolls her eyes and laughs sarcastically. Values (V) of Both and The client is annoyed because she feels she is completely fine. Nurse: terrific, no pain in your back? The nurse touches the client. The nurse offers a therapeutic touch. Nurse is trying to further assess what else could be giving the client pain. (T) : no The client arches her back and looks away. is uninterested about what the nurse is asking her. (T) Nurse: no, it s not difficult to breathe? The nurse restates what the client says. She also asks a focused question about the client s breathing. Nurse is now focusing on the possibility of the client having trouble breathing. (T) : nope The client rolls her eyes. The client sounds very annoyed that the nurse has asked her this. Nurse: ok, just a quick minute for a BP here. The nurse puts the blood pressure cuff, takes the client s blood pressure, and looks at the readings. The nurse is not giving information because she does not explain the procedure to the client. The nurse is more concerned with getting the blood pressure done than explaining the procedure. (T) : Is there any way I can make a few phone calls? I know that I am not allowed to use my cell phone. Nurse: hold on a second great.phone calls The client raises her hand up and scratches her ear. The nurse is still taking the client s blood pressure The client is listening for the blood pressure. She then grabs the chart, charts the blood pressure, and lowers her stethoscope. The nurse interrupts the client because she started talking. If she would have explained that she needed silence in the procedure, the client wouldn t have talked. The client seems preoccupied and not interested in her blood pressure readings. (T) The nurse is getting impatient with the client as she is trying to get a good blood pressure reading. : yeah The client rolls her eyes. The client is irritated and just wants to use the phone. Nurse: yeah, we can pull a phone over in a few minutes ok. The nurse is still charting and has no eye contact with the patient. The nurse is not showing good active listening skills. She is however providing the client with information about the phone. The nurse is trying to help comfort the patient by providing her information about the phone, but is still more concerned with her assessment. (T)

7 : Yeah that would be great, I need to find out where my car is, where it got towed, insurance company. Nurse: sure, it s a worry The client raises her hands and sighs. The nurse is still charting and looks away from the client. The nurse has no eye contact and is still charting. The nurse is not actively listening. The nurse is agreeing with the client but could show some more sympathy towards her worry. Values (V) of Both and The client is preoccupied and stressed about where her car is. The nurse is showing more concern in getting her charting done than what the client is worried about. (T) : what a mess! The client shakes her head and scratches her face. She also emphasizes the word mess. The client is really stressed at the point. Nurse: Is there anybody you can call? The nurse glances at the client then back to her chart. She does not seem to really be listening. The nurse is not showing active listening since she has no eye contact. The nurse is showing a little more empathy towards the client s worry. : right now, well I mean my friend Kathy, that s about it. The client lowers her hand and looks away. The nurse touches client and glances at her. The client is annoyed. Nurse: Can you just be quiet for a second til I take your pulse and respirations. The nurse puts her hand on the client s pulse and looks at her watch. The nurse should not have told the client she is going to be checking her respirations. She also interrupts the client. She did not provide the client with information about the procedure about her pulse and respirations. The nurse seems impatient because the client is so worried about what she needs to do that she is obstructing the nurse s job. : I have to get home and feed The client looks annoyed. is not interested about what the nurse is doing. (T) Nurse: Just a second, almost done, oh great okay The nurse smiles when the client talks and looks at her. The nurse interrupts the client again. She should have explained that she needed silence while performing the pulse and respirations. Nurse wants to complete her vitals assessment. (T) : Who s going to feed the dog? The client puts her hand on her head and sarcastically laughs. The nurse is charting her vitals. now shows worry since no one is home to take care of her dog.

8 Nurse: No neighbors to help you out? The nurse raises her eye brows and continues charting. The nurse is not showing active listening. She should make eye contact with the patient. She also asks a closed statement. Values (V) of Both and The nurse is trying to give the client ideas to help her not be so worried. (T) : I guess, but it s late they are already in bed. The client looks back at the nurse and sighs. The client is very stressed. Nurse: We ll check if you are going to stay. Hum, can I ask you a few more questions? The nurse takes the thermometer out and continues to look at it. She has no eye contact with the client. The nurse is not showing active listening. The nurse is trying to get back on track to her assessment rather than listening to the client express her feelings about her stress. (T) : Sure scratches her ear. The client agrees to listen to the nurse s questions. (T) Nurse: All right, have you ever had a tetanus shot in the last few years? The nurse has good eye contact and nods her head. She is getting the thermometer ready as she speaks. The nurse is showing good active listening skills through her eye contact and by nodding her head. The nurse is gathering some more information for the client s health history. (T) : yeah, four or five years ago I think. is trying to remember her health information. (T) Nurse: oh good, ok, take your temp great, just a second almost done. Ok, very good The nurse takes the client s temperature. She is looking back and forth between the client and the thermometer. The nurse should have done the temperature first, followed by the pulse and respirations, then the blood pressure last. That way the assessment was not effected in any way. She does not provide the client with information. The nurse is trying to get the last part of the client s vital assessment done. (T) : Look I know it s not your fault, I really can t afford to be here right now. The client starts to cry, looks away from the nurse, and closes her eyes. The nurse is getting the chart out. The client is now very stressed, worried, and upset. Nurse: I know, it would be upsetting to me too. The nurse touches the client s shoulder. The nurse is offering a therapeutic touch. She however should not compare the situation to herself. The nurse sees that the client is upset and tries to comfort her.

9 : it s ok, I m sorry The client sighs and touches her eye. Values (V) of Both and The client tries to calm herself down. Nurse: Ok, a little bit about your medical history can you tell me? Have you been in the hospital before? The nurse touches the client s bed and makes eye contact. The nurse changes the subject inappropriately. The nurse does not express concern towards the client s previous worry. : Healthy, never been in the hospital The client looks away and laughs sarcastically. The client is annoyed again that the nurse is asking her questions about her health. Nurse: Do you have a primary care physician? The nurse is still touching the bed and is making good eye contact with the client. The nurse is showing active listening towards the client. The nurse is focusing again on finishing the client s health history. (T) : Yeah Nurse: You do, When was the last time you saw them? The nurse shows good eye contact and nods her head. The nurse is continuing active listening from the client s previous statement. The nurse is trying to get a more detailed idea of when the client saw her physician. (T) : Oh, I think more than a year ago. I d have to check back. The client is looking up and away from the nurse. She grabs her head. The nurse nods her head. The nurse is showing active listening by nodding her head. The client is having trouble remembering when she saw her physician last. (T) Nurse: Ok, Do you keep up with your GYN? The nurse starts with good eye contact then looks away from the client. She should maintain eye contact to achieve active listening. The nurse is making sure the client is healthy. (T) : oh yeah The client has an irate tone in her voice. doesn t understand what this has to do with the accident. (T) Nurse: Breast exams? The nurse should have asked a full question such as, Have you kept up with your breast exams as well? The nurse is trying to finish getting all of the information she needs. (T) : yeah, what does that have to do with this right now, really come on? The client brings her hand down angrily and rolls her eyes. is confused as to what the point to all of these questions is. (T)

10 Nurse: It s part of our role to check it all The nurse has eye contact with the client and nods her head. She however sounds defensive. The nurse should have explained to the client in the beginning how important the health history is. Values (V) of Both and The nurse is getting irritated that the client keeps questioning what she is doing. (T) Nurse: out, ok we want to make sure you are ok from head to foot right now. The client looks away and rolls her eyes. She is irritated. The nurse would not have to be explaining her reasoning now if she would have explained the procedure in the beginning. The client doesn t appreciate the client questioning her reasoning behind taking her health history. : It s ridiculous, I mean I m fine. Just, I banged my head The client waves her hands around. The client is unconcerned with what is wrong with her. Nurse: Yes you did. Can we talk about dinner a little bit? : Sure The nurse is nodding her head and is holding on to the bed. The client makes eye contact with the nurse. The nurse is showing active listening by nodding her head. The nurse is going back now to what happened before the client s accident. (T) The client is still aggravated for having to answer these questions. Nurse: What d you have? The nurse could have stated what did you have for dinner to remain clear. The nurse is trying to see if the client remembers what she ate before the accident. (T) : For dinner? What s that have to do with anything? Nurse: Well just kinda, you know have to do some stitching and all the rest and we need to know. The client is confused as to why the nurse is asking about dinner. She laughs and shrugs her shoulders. The nurse is looking at the client s chart. The nurse could have told the client that she asked what she was having for dinner because she wanted to see how well her memory was after the accident. Instead she just says because of the stitching so is unclear. The client doesn t understand now what she ate has to do with anything. The nurse is trying to be patient with the client to give her an answer. (T) : I had a Caesar salad and some rolls and a steak and a glass of wine. The client closes her eyes and looks away. She then touches her eye and brings her hand down. The client is trying to remember what she ate before the accident occurred. (T)

11 Nurse: One glass of wine? The nurse repeats this to seek clarification on the client s alcohol intake. She asks a closed ended question. She should have said, How many glasses of wine did you have? Values (V) of Both and The nurse is trying to search for any clues that the client was driving under the influence. (T) : Yeah. Nurse: Yeah did um, and you said your friend was drinking? The nurse is nodding her head. The nurse is showing active listening by nodding her head. The nurse is trying to still figure out who was drinking and how much was drank before the accident. (T) : Oh yeah, she finished the bottle, yeah you should really check on her I can t really believe it. It was really her fault. The client laughs and sounds annoyed with her friend. The nurse is maintaining eye contact and nodding her head. The client sounds very annoyed with her friend and is regretting agreeing to be her designated driver. (T) Nurse: But, you only had one glass? The nurse is maintaining eye contact. The client is actively listening but should not be insinuating that the client is lying. The nurse doubts the client s word about only drinking one glass of wine. (T) : Yeah Nurse: Yeah : Yeah, Is there any way I can t check and see if Kathy is ok? The nurse nods her head. The client makes eye contact with the nurse. She lifts her head up to show she is concerned. The nurse is restating what the client has said. The nurse is still trying to figure out what the client was drinking before the accident. (T) She believes that the alcohol intake by the client could have something to do with the accident. (B) The client feels concerned now about how her friend Kathy is doing. Nurse: Kathy came in with you? : I think so Nurse: In the ambulance? The nurse maintains eye contact and is holding on to the bed. has a confused expression on her face. The nurse maintains eye contact. Nurse shows active listening. Continues to show active listening. The nurse is trying to help client figure out where her friend is. (T) The client is confused and doesn t seem to remember where her friend Kathy is. (T) Nurse is trying to help client remember more details. (T)

12 : No, I think she took a cab, I can t I m not really sure. lifts her hands up restlessly. Values (V) of Both and The client is feeling frustrated because she can t remember everything correctly. Nurse: Not remembering? The client is holding her head. Nurse could have stated the question as, Are you not remembering well? Nurse believes that client is having trouble remembering because of her head injury. (B) : No is still feeling confused. Nurse: Did you? Nurse interrupts client s train of thought. Nurse is wondering if the client is experiencing a concussion or head trauma. (T) : I don t think she was in the ambulance; yeah she wasn t in the ambulance, unless she was in the front. The client is looking back and forth from the client to the wall. She has a confused expression on her face. is irritated that she is unable to remember exactly what happened. (T) Nurse: You seem a little confused about what went on. : I m not sure cause they whisked me away so fast I didn t really see where she went. Maybe she was in the front. She might be in the waiting room right now The client waves her hands around restlessly. She touches her nose and lifts her head. She makes eye contact with the nurse. The nurse is not allowing the client to communicate and speaks over what she is saying. is drawing the conclusion that the client can t remember due to her head injury. (T) The client is worried and wanting to see her friend Kathy. Nurse: Can we go back to how much you had to drink? The nurse makes eye contact with the client. The nurse uses non-therapeutic communication by changing the subject back to how much wine she had to drink. The nurse is now wondering if the client s alcohol intake has anything to do with her inability to remember. (T) : Yeah, The client has an angry expression on her face. The client sounds very annoyed with the nurse at this point.

13 Nurse: Yeah Nurse is maintaining eye contact. The nurse is irritating the client by asking her about the wine again. She should have offered to check on the status of her friend Kathy then maybe go ask how often she drinks. Values (V) of Both and The nurse is less worried with the client s injuries and more worried about her alcohol intake. (T) : A glass of red wine. The client has a defensive look on her face. The client is angry and offended that the nurse suggested she has an alcohol problem. Nurse: And do you drink frequently at home? The nurse nods her head and has eye contact with the client. The nurse asks a closed question. She should have asked, How often do you drink? The nurse feels like the client drinks more often than she is telling her she does. : With dinner. The client lifts her hand. feels defensive towards the nurse now. Nurse: With Dinner The nurse looks down away from the client. The nurse restates what the client says for clarification. Nurse is trying to figure out if the client is telling the truth or not. (T) : Usually yeah Nurse: One, two? The client looks away from the nurse and lays her head back down. Nurse maintains eye contact with client. Nurse is leading the client s answer by giving her these options. She should have said, How many drinks do you have with your dinner? The client feels uninterested because the nurse doesn t believe what she is saying. (T) Nurse is still more focused on the client s drinking than her injuries. (T) : One or two. The client touches her eye. is confused why the nurse keeps bringing up the same questions continuously. Nurse: One or two glass of wine? The nurse restates what the client says for clarification. Also uses repetition. The nurse thinks the wine is still the source of the problem. (T) : huh huh oh forgot about that. The client grimaces in pain because she touches the cut on her head. now remembers that her head is hurting her.

14 Values (V) of Both and Nurse: Yeah, we ll check that out Nurse has eye contact and nods her head. Nurse is actively listening. Nurse shows very little concern or empathy for the client s head. : Yeah The client smiles at the nurse. feels like bringing up her head injury will change the subject by the nurse. Nurse: One or two glasses of wine. : Wine, do you really think I am going to have to stay here for awhile? The client looks and the nurse and has a concerned look on her face. She tries to change the subject again. The client nods her head. Nurse uses repetition again to clarify how much the client drinks. The nurse is actively listening. The client avoids continuing the conversation about the wine. The nurse shows little interest for client s pain and goes right back to the wine. (T) is worried that she is going to have to stay in the hospital for a while. Nurse: We have to find out what s going on in your belly. The client looks at the client s stomach and then touches her stomach. The nurse is stating facts that there might be something wrong with the client s stomach. She should have said they have to still look at her stomach to make sure there is nothing complicating her injuries, so she ll be there a while longer. The nurse finally turns her worry from the client s wine intake to her abdominal injuries. (T) : It s not that bad really, I mean can a doctor just come in and check me? Nurse: I ll check with him. then touches her stomach. She moves her hand around and shakes her head. The nurse nods her head and maintains eye contact. The nurse is actively listening. She is also reassuring the client that she will speak to her physician. The client tries to blow off her injuries and feels they aren t that bad. The nurse is frustrated that the client won t answer her questions fully. : Alright feels relieved that the nurse is going to check with her doctor. Nurse: It s probably that we ll keep you for some observation time The nurse is looking at the client. The client is looking away and seems stressed. Nurse feels that the client s injuries will have to be observed over night.

15 : I really don t need that right now in my life The client tenses her hand up and laughs sarcastically. Values (V) of Both and The client is restless and wanting to leave the hospital. Nurse: What s going on in your life? You ve said that a couple of times. : My job basically, it just a lot of pressure and a lot of stress The nurse makes eye contact with the client, yet sounds uninterested. The client rolls her eyes and pauses. She then makes eye contact with the nurse. The nurse is stating an observation that the client has brought up her stressful life before. She also asks an open ended question about the client s stress. The nurse feels that the client s stress at home is what is making her restless. The client is stressed about her job. Nurse: What do you do for stress? : What do I do for stress? The nurse looks away from the client. The client grabs her head. The nurse asks a focused question to see what the client does to help with her stress levels. The nurse is trying to figure out if the client is able to manage her stress. (T) The client doesn t really want to discuss this topic either. (T) Nurse: You know like exercise or anything? : No The client sighs. The nurse asks a focused question on how the client handles her stress. The nurse wants to see if anything helps the client s stress levels. (T) The client doesn t really want to get into her problems and is irritated by the nurse s prying. She just wants to get out of the hospital. (T) Nurse: No Nurse is still looking at the client. The nurse restates what the client says. The nurse wonders if the client does anything to help her stress. (T) : No, I mean I have a massage once a month, but it doesn t seem to do much.. Anyway, what does that have to do with anything really? The client is looking away and shrugs her shoulders. She then laughs sarcastically out of frustration. The nurse is nodding and listening to her. The nurse is actively listening. The client wishes she was not in the hospital right now. (T) Nurse: I m just checking to see you know people deal with stress in different ways. The nurse has no eye contact when speaking. She shakes her head. The nurse gives a good explanation to the client about why she asks her about how she deals with her stress. The nurse is trying not to be frustrated with the client asking her why she is asking her about her stress.

16 : Yeah. The client closes her eyes and grabs her head. Values (V) of Both and The nurse is frustrated with all the questions she is being asked yet again. Nurse: It s always good to know if they have a healthy outlet that s why The nurse is looking at the client. The nurse explains why she is asking these questions to the client very well. The nurse is wondering if the client s stress and alcohol intake is related. Maybe the client drinks out of stress. (T) : That s true, can we just get the doctor in here moving this along so I can either know what I am doing. The client s eyes are close. She is also waving her hands around. The nurse nods her head. The nurse is actively listening to the client as she speaks. The client is annoyed that it is taking this long for her to see the doctor. Nurse: Alright, that s where I m gonna go, I m gonna go out and check with the doctor. See if we are going to hold you for the night The nurse grabs the client s shoulder. The nurse is providing the client with information about what she s going to do to reassure the client that she is going to do what the client asked. The nurse believes if she goes to find the doctor and the client s friend that she will calm down and cooperate more. (B) : That would be great. The client looks up at the nurse. The client sounds relieved that she is going to get some answers finally. Nurse: And I ll check on your friend and I ll be back. The nurse grabs the client s shoulder again. She also is maintaining good eye contact. The nurse is showing the client that she cares and is listening. The nurse is happy to leave so that way the doctor can come in and examine the client. This will hopefully ease her anxiety. (T) : Ok The client sighs. The client is hoping she can get answers to her questions soon, hopefully from the doctor. (T) Nurse: Alright The nurse nods and walks away from the patient. Nurse thinks client sounds relieved already that she is going to find her doctor. (T) : Thank you. looks back away from nurse. She feels relieved that she is finally getting what she wants.

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