My patient is Mrs. Tardios, female aged 87 years old. She was recently diagnosed with hypernatremia (a condition that results from low sodium levels and some form of body weakness. She has been in the unit for about three days now, prior to this dialogue. When she came, she reported that she has not been diagnosed with any form of medical condition in the past. While conducting my morning shifts, I report to my assigned client Mrs Tardios and realize that she has been lying awake on her bed. While bonding with her, I take this opportunity to conduct an introduction of myself to her and asked whether it was okay for us to have a dialogue and she nodded with a smile to mean it was okay by her.
Dialogue-Mrs Tardios is sited by her bed side, next to the window having a view through the window.
Nurse: (pointing at the nice view coming from the window), Nice view Mrs Tardios. How is your morning? (as I stand beside her bed side that is close to the window).
Mrs. Tardios: I am feeling much better today as compared to yesterday where I was challenged moving from my bed to the chair because of the feeling of exhaustion and body weakness. However, I get scared because this room is a bit enormous, I would prefer to get to a different room filled with people.
Nurse: (As I listen attentively), Hmmmm, when did the feelings of exhaustion first occur?
Mrs. Tardios: I was attending a family function in the U.S and while I was going through my bible, I found it hard to even lift my hands and continue perusing through the scriptures. I became weaker and my son suggested that I should go and get checked. I assumed the weakness as I wanted to ensure that the ceremony ends in my presence.
Nurse: I nod to show I am attentive
Mrs Tadios: travelling from the function back home was a bit hard as I became weaker. My knees could not hold me anymore. I became fearful and anxious and was immediately brought to hospital.
Nurse: so I can say you have a caring family:
Mrs Tardios: (Smiling). Yes, I am privileged to have seen my great grandchildren.
Nurse: (smile Back).can I talk to one of them about your condition?, (A knock at the door is head, one of her relatively enters the room and so I have to live). Your people are here now, I will check on you later, okay?
Mrs Tardios: so long nurse.
Critical reflection
Throughout this paper, I will provide a critical reflection on the dialogue I developed with Mrs. Tardios, a patient admitted at the hospital for hypernatremia. In my paper I will also developed identification to the building blocks of patient-nurse conversations while at the same time maintaining focus on integrating dialogue principles in the client-centered care fundamental procedures.
Before I began my dialogues, I had an intention of knowing Mrs.Tardios better and at the same time listen to any concerns that she may have during her treatment. Borrowing from Spee, Chua and Nose (2001), building a relationship based on trust is essential in getting patients to voice out their needs and concerns. I began the discussion with an open ended question by asking the patient how she is doing. As a consequence, she became liberated to decide on whether she should reveal her well-being or not. However I tried to maintain using open ended questions throughout the dialogue. This was to make the patient feel that my intention was to know about her and her health concerns and other major issues that affected her health
I am confident I maintained the flow of the dialogue as I did not prompt any interruptions. From Mesner;’s article which is line with the theory of becoming human, I was critical to maintain the flow of the discussion which was very crucial to decide what challenges she face. While centering the client in mind most of the time I managed to make her comfortable to express her true concerns. To validate major blocks that should be present in dialogues, I maintained proper eye contact with the patients and maintained a state of not being judgmental. As she explained how her journey was tough from the U.S, I did not validate her experience to show that I understood how it felt but instead I kept on listening. This is not in full similarity to the valued honesty in client centered therapy Registered Nurses’ Association of Ontario, 2015).
However, I feel that when she complained about feeling weak, she I should have ask her to provide in depth clarity on the exact feelings of weakness. Since it was my very first experience of developing a reflective dialogue, I can say the experience was educating and provided good learning. I got to understand the significance of developing dialogues in every assessment especially in nursing concerns for the purpose of openness. In future, if I have to develop similar dialogues, I will heavily focus on being present genuinely with patients. I further understood the vitality of developing open ended questions for getting in depth about client’s concerns, which should enable me understanding patient’s concerns from their perspective. I will ensure no validation of client’s emotions and experience occurs but instead listens and be open with the patient (Beitel 1998).
