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Communication in the Nurse-Client Relationship
Hospitalization can occur frequently in older adults and can result in changes to their regular routine to following hospital protocol meals being given at set times, scheduled medications, or perhaps being put on precautions they were previously not on. This change in routine can cause clients to feel less in control of their lifestyle, thus it is pertinent to have clients participate in their own plan of care and continue to communicate with the client to ensure they are as comfortable as possible. This paper will examine the importance of communication in the context of a personal situation experienced in the clinical setting.
This paper focuses on a situation I encountered involving a patient under my care during clinical placement. The female client was admitted to the hospital for a right hip fracture and underwent surgery for a right hip dynamic hip screw (DHS). She had a Foley catheter instituted but had not passed gas or had a bowel movement since her procedure two days prior. She had a previous medical history of hypothyroidism. The client instructed that she would like to use the bedpan. I attempted to put the bedpan under her, keeping caution over her right hip. Since she was a slightly larger adult, I had difficulty putting the bedpan beneath her as she could not lift her unaffected side nor roll her on her side. The primary nurse came in the room to check on the client and I asked her if she could assist me in getting the bedpan beneath the client. The bedpan was not effective as the client could not get the bedpan to fully cover her bottom, thus the nurse decided to put an incontinent brief on her. The nurse told the client that she could not wait all day for her to have a bowel movement and that the brief would be more convenient so she could change her later. The client was visibly distraught but did not say anything to the nurse during the intervention, only groaning when the nurse turned her. The nurse reassured the client that she can go in the incontinent brief and she will just change her after. Once I spoke to the client, she told me with tears in her eyes that she had never worn an incontinent brief prior to this situation. I explained that this was only temporary and perhaps we could try the bedpan once her mobility improves.
I felt powerless and intimidated as I got the impression that I could not intervene with what the nurse had decided. I did not want to make a scene with the nurse had I confronted her about the bedpan. In hindsight, I should have told the nurse that we should attempt to use the bedpan once more to maintain the clients dignity or at least explain to the client in a more compassionate way why the incontinent brief was used. I also felt dejected as this was the patient that was under my care and I did not provide her with adequate care. I was disappointed in myself when the client told me how she felt with tears in her eyes, as I felt I had played a small role in her distress. The primary nurse may have felt frustrated that the bedpan was not covering the clients underside or perhaps she was overwhelmed by her other clients and she felt that implementing the incontinent brief would make her workload easier. The client, on the other hand, may have felt feelings of shame and embarrassment, as she had never worn an incontinent brief before.
The key issue in this scenario is the lack of communication between the nurse, client and myself, leading to the loss of dignity in the client. It is important to deliver effective communication to clients to maintain their dignity, autonomy and to form therapeutic relationships.
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