Discuss problem-based scenarios involving communicating with patients and clients who have special needs.

Discuss problem-based scenarios involving communicating with patients and clients who have special needs.

Words limit: at least 200 words in each question.
References: at least two journal articles in each question.
Marking Criteria:
Demonstrate outstanding evidence of research.
Outstanding critical use of a range or high quality resources
Outstanding demonstration of critical analysis and innovative thinking


Activity 1

You walk into a care facility for older persons to commence your shift. Once in the lounge area you notice May in the corner. May is 79 years of age and has had a severe stroke that has left her with a profound right sided weakness; she is also dysphasic. May is quite but obviously distressed. On closer observation you notice that she is restrained in the chair by bed sheets and a bed table. As you walk towards her you notice that she has been incontinent of urine and is crying and tugging at she sheets with her left hand.

1. How will you support May in communicating the cause of her distress to you?
2. What communication strategies will you employ to relieve her discomfort?



Activity 2

Whilst working in the community you meet Olga. She has always seen herself as a sexually attractive woman who pleased her partner. She liked how her body performed and this view supported her self esteem. Then, in her early 30 s she developed multiple sclerosis. This caused her to feel fatigued and in turn reduced her interest in sex. Most difficult for her was the problem of urinary incontinence during coitus. Her other problems, nystagmus, tremor and loss of muscular coordination, diminished her self-image as an attractive woman. During your visit and the course of your conversation she starts to weep and comments tha:

 I and ashamed of what I have become, I don t want to see what I ve become& . My husband no longer desires me and who can blame him when I wet myself. It s disgusting, I m disgusting.......

1. How would you feel if you were presented with this situation?
2. How would manage these feelings?
3. How would you communicate positively with Olga in your attempt to care in a responsible and accountable way?
4. Give rationales for your actions.



Activity 3

You are on clinical placement on a medical ward. You have been assigned to undertake a nursing assessment of Mr. Jankowski. He arrives on the ward with his wife who is carrying a large shopping bag containing two large books. Mr. Jankowski appears very distracted and his wife is weeping. You sit them down and begin to take a nursing history. Mr. Jankowski has very limited English and becomes increasingly agitated; he exclaims  no good, no good and raises his arms in frustration. He then takes his wife s handbag and pulls out a letter which he gives to you stating  read, read . The letter which is from the Department of Immigration Multicultural and Indigenous Affairs (DIMMIA) states that Mrs. Jankowski must return to Poland within 30 days.  No hospital& you help states Mr. Jankowski. He turns to his wife and speaks to her in Polish. She lifts the two books out of the shopping bag and you see that she is giving Mr. Jankowski two Polish-English language dictionaries. Mr. Jankowski opens one of the dictionaries in an attempt to communicate with you.

1. How would you feel in this situation?
2. What communication techniques would you employ to facilitate effective and positive communication in this situation?
3. Give rationales for the strategies that you choose.



Activity 4

Frank is a 55 year old man who has bowel cancer that has spread to his liver. He is married with two daughters aged 24 and 21. They no longer live at home with him and his wife Jean. Janet, their eldest daughter, is expecting a baby in three month s time. You walk into the ward and notice that Frank is fatigued, anxious and complaining of back pain. You go over too his bed to see if you can make him comfortable. During this process he mutters  I m not getting any better . This quiet statement is followed by:  How long do you think I have got nurse?

1. How will you respond?
2. Give rationales for your communication strategy.



Activity 5

Breaking bad news.

You are a registered nurse working on an acute surgical ward where Mrs. Arnold, a 48 year old lady, has been admitted for removal of a lump from her left breast. Her surgeon called to see her prior to her going to operating theatre and has advised her that he will return later that evening to inform her about the pathology results.

The surgeon returns at 6pm and tells you that Mrs. Arnold has breast cancer. He asks you to tell her that he will be back in an hour to discuss her situation and requests that you be available during the consultation.

1. What would you tell her?
2. How would you prepare for the surgeon s visit?

At 7pm you accompany the surgeon to talk with Mrs. Arnold. You are aware that the surgeon is about to tell her that the lump is malignant. On hearing the news Mrs. Arnold becomes very distressed and begins to scream and cry.

3. How would you manage this situation?

The surgeon goes on to tell Mrs. Arnold that he will consult with his colleagues about her treatment options and that he will return tomorrow to discuss things further. The surgeon then leaves. You remain with Mrs. Arnold.

4. Describe what you would do.

A short time later Mrs. Arnold s husband arrives and seeing his wife so distressed guesses the news; he says to you  It s cancer isn t it?

5. Describe how you explain to Mr. Arnold what has happened.

Mr. Arnold says,  What can be done?

6. How would you answer this question?

You get called away by the other registered nurse on duty to review another patient. Mr. Arnold remains with his wife. It is no w10 pm. And you are about to go off duty. Before you do you return to see Mrs Arnold who is now alone as her husband has gone home to look after their two teenage children. Mrs Arnold is weeping quietly.

7. How would you conclude your interaction with her before you go ff duty?