NR 509 WEEK 4 ASSIGNMENT – GRADED A+

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NR 509 WEEK 4 ASSIGNMENT – GRADED A+ Adolescent client who is reluctant to answer questions Create a scenario depicting an interaction between an NP and a client. Describe the setting and ... type of encounter. Brandon is a 16-year-old adolescent male client coming into the ER for suicidal ideation and cutting. After being triaged, he is placed in a room and accompanied by his mother. The nurse practitioner enters the room shortly after, and asks “how can I help you today”? The client ignores the provider and continues to scroll through his phone. The provider asks if it is ok that his mother explains what is going on. The patient states, “I don't care”. As his mother starts to explain that he made a comment to a peer at school, and that comment consisted of a specic plan he has decided to use to commit suicide. He explained that he has been cutting the sides of his thighs, where his mother could not see. The peer reported this conversation to the school counselor, and he was sent to the ER fir clearance. Brandon then stands up and explodes in anger, “I told you not to refer to me as Brandon any longer! My name is Brea not Brandon”. His mother quickly apologizes and asks the client if he would like to finish telling the provider what happened. Brea states that “this is why I cut myself, because she never cared about me”. Brea then goes on to tell the provider he is confused, and everyone at school make fun of him. He feels isolated and scared. The provider asks when these feelings started, and he completely shuts down and refuses to answer any questions the provider is asking. The provider tries to steer the encounter back to doing a physical assessment and tries talking directly to the client and building a rapport. The provider asks if the client’s mother could leave the room for a few minutes, to let the client, talk freely with the provider. The client explains that he is unwilling to participate because he has been to “multiple programs, and psychiatrists, and nothing works”. He goes on to explain that he does not want any medications because medications “make him zombielike”. He prefers to do drugs (anything that is offered), drink alcohol, and engage in risky sexual behavior, because “he hopes he dies anyway”. Describe the client’s challenging behaviors related to the topic assigned. The clients challenging behaviors include communicating challenging feelings or actions. The client is expressing anger, manipulation, and resistant behaviors. Rather than expressing his thoughts and feelings, he is looking at his phone, ignoring the provider, and blaming his mother for his negative behavior. Examine the potential impact of the client’s behavior on the client-provider relationship. The challenging behavior could potentially impact the client-provider relationship by causing the NP to feel frustrated and unable to provide the best care for the client. These behaviors impact aspects of empathy, understanding, and emotional approach to the patient ((Molina-Mula & Gallo-Estrada, 2020) Analyze techniques to enhance communication with the client and address the client’s behavior. Two techniques to enhance communication are: • The act of listening to the client and building a rapport is frequently regarded as being essential to all facets of social and health care services. Understanding the client's circumstances and way of life depends on the professional's ability to hear the client's experiences and react accordingly. Additionally, clients tend to want to be heard during consultations more than anything else ((Weiste et al., 2020. • Compassion-focused therapy (CFT) can provide an evolutionary-based perspective of interpersonal issues. By offering a variety of people who are normally afraid of, obstructed by, or resistive to compassion with unique and practical ways to receive compassion, it involves the client in their own care, as well as in the planning, development, and evaluation of services (Lucre & Clapton, 2021). Create sample documentation for the encounter. The Situation-Background-Assessment-Recommendation (SBAR) tool will be used to document the client’s information and giving report to the psychiatrist on duty in the ER. A simple, specific framework like SBAR is helpful for framing any interaction, especially those that are urgent and call for a physician to act right away. To build cooperation and promote a culture of patient safety, it enables a simple and focused way to establish expectations for what will be shared and how it will be shared, between team members. S- Situation Hi Dr. Patel, this is Elizabeth calling from the ER. I have a client here named Brandon R., and he was brought to the ER by his mother for clearance to go back to school. He made suicidal statements to one of his friends, and admits to cutting his bilateral, outer thighs. He is transgendered and prefers to be called Brea. He is reluctant to answer most of my questions but does admit to suicidal ideation. B- Background • He has no known medical or psychiatric history • No current medications, but does admit to drug use, drinking alcohol, and engaging in sexual behaviors. He denies using alcohol or drugs today. • No known allergies • His vital signs are B/P 115/82, P-102, R-22, and T-97.7 • I ordered a urine toxicity and bloodwork for a alcohol level, but he refused both. A-Assessment • Unable to do an assessment because client is uncooperative, and not willing to answer my questions. • He is AAAOx4, dressed normally, and does not seem to be under the influence of any foreign substance. He has a short attention span and is unwilling to make eye contact. • Unable to do an assessment because client is uncooperative, and reluctant to answer my questions, even when his mother was absent. He did show me his outer thighs where he had been cutting, the wounds are superficial and seem to be in the healing stage. R-Recommendations • My recommendation for the client's ongoing care is weekly visits until the client feels more at ease discussing his problems. • Once the client is ready to share, behavioral assessments must be performed to deduct the best diagnosis. This way the client can be started on medication in addition to cognitive therapy. • His mother seems to cause him anxiety and stress because he is abusive to her. I would recommend that she not be present when talking to the client. References Bickley, L. S. (2020). Bates' Guide To Physical Examination and History Taking (13th ed.). Wolters Kluwer Health. https://ambassadored.vitalsource.com/books/9781975109943 DeAngelis, T. (2019). Better relationships with patients lead to better outcomes. Monitor on Psychology. Retrieved November 15, 2022, from https://www.apa.org/monitor/2019/11/ce- corner-relationships Lucre, K., & Clapton, N. (2021). The Compassionate Kitbag: A creative and integrative approach to compassion-focused therapy. Psychology and psychotherapy, 94 Suppl 2, 497–516. https://doi.org/10.1111/papt.12291 Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health, 17(3), 835. https://doi.org/10.3390/ijerph17030835 Weiste, E., Käpykangas, S., Uusitalo, L.-L., & Stevanovic, M. (2020). Being heard, exerting influence, or knowing how to play the game? expectations of client involvement among social and health care professionals and clients. International Journal of Environmental Research and Public Health, 17(16), 5653. https://doi.org/10.3390/ijerph17165653 [Show More]

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