Strategies for therapeutic communication Essay -cystic fibrosis
You are the home care nurse assigned to develop a home care strategy for a 2 year old diagnosed with cystic fibrosis and his family following discharge from most recent hospitalization.
determine community resources to optimize health and decrease hospitalizations.
identify members of interprofessional care team that will contribute to his care.
describe evidence-based therapeutic communication strategies. see uploaded documents for more info.
In the given scenario, Alex is the two-year-old patient who has been diagnosed with Cystic Fibrosis (CF). He has struggled with respiratory infections which required hospitalization, decreased growth rate, and decreased weight. Because of his age, he is dependent for all of his care needs. He is cared for at home by his parents. Strategies for therapeutic communication Essay -cystic fibrosis. His parents, Michael and Kim, have exhibited knowledge deficit regarding his disease process and infection control techniques. An individualized plan of care must be established to address all of the entire family’s needs and must be accessible to all care providers as well as to the patient and his family. In order to develop and implement a written plan of care, all of members involved in Alex’s care will have to share information and communicate effectively to ensure that Alex receives the highest quality of care. Effective communication and information sharing will also allow Alex’s parents to be aware of the continuity of care, (Quigley, 2014). Strategies for therapeutic communication Essay -cystic fibrosis.
CF is a debilitating, genetic disease that affects the mucous glands of the lungs, pancreas, and other organs. Primarily, the cilia in the lungs are not able to work as effectively, when compared to non-diseased lungs. Because of the disease process, mucous and bacteria cannot be cleared efficiently which also causes increased inflammation in the lungs, (Thompson, 2008). Due to the complexities of CF, the ideal place for treatment would be at specialist center with an interdisciplinary team (IDT) providing care to meet the needs of Alex and his parents. It will be important for the home care nurse to help Michael and Kim gain access the nearest CF center.
According to the Cystic Fibrosis Foundation (www.cff.org), the IDT will focus on Alex and his parents as the center of the team. As Alex ages, more responsibility for his care will shift from his parents to himself. In addition to Alex and his parents, the team will be comprised of many members across many disciplines. Strategies for therapeutic communication Essay -cystic fibrosis. The CF nurse will most likely serve as the point of contact. The CF nurse should be able to provide education and answer questions or address concerns. The CF nurse should also be able to help Alex and his family to access other members of the IDT as needed. The CF nurse will be able to communicate the treatment plan and assist the patient/ caregiver with communicating with other team members. The CF nurse will also teach the family regarding infection control techniques that will help prevent rehospitalizations. The CF medical doctor is specialty trained to work with patients suffering from CF. This doctor will have the special knowledge required to determine a medical treatment plan specifically for Alex. The Respiratory Therapist (RT) is another vital part of the team. The RT provides tests that measure lung function, teaches techniques that help clear mucous and bacteria from lungs, and administers nebulizer or inhaled medications. The RT will also help the family learn to care for the nebulizer machines and other respiratory equipment needed.
The Registered Dietitian (RD) is trained to determine Alex’s over all nutritional needs. The RD will make recommendations that will help him to build up to and maintain an ideal body weight. It is difficult for children with CF to absorb vital nutrients because they have difficulty digesting and absorbing fat. Sometimes, CF children will require alternative nutrition, such as through a feeding tube. The dietitian will make these recommendations and help explain to Alex’s parents what this will mean.
Other members of the IDT may include a Social Worker, Psychologist, Physical Therapist and Pharmacist. A Social Worker is especially beneficial because they help with difficult decisions and offer direct support with insurance, schools and specialist referrals. The Psychologist has experience in helping to recognize and treat emotional issues, such as anxiety or depression, or other behavioral issues. The psychologist also helps with learning disabilities and social interactions with family, friends, and others. Strategies for therapeutic communication Essay -cystic fibrosis The psychologist will be an asset to Michael and Kim as Alex ages. A Physical Therapists (PT) may be needed to help with daily exercise routines to strengthen muscles and promote energy. The PT can also provide therapies that help improve coughing, again helping to clear mucous and bacteria from the lungs. The CF Pharmacist is another member of the team and can help teach about medications and their benefits, as well as possible side effects and drug interactions.
Other members of the care team may be optional, such as a CF Research Coordinator, a Genetic Counselor, a Child Life Specialist, or a Chaplain. The CF Research Coordinator will work to answer questions and determine if any clinical trials might be beneficial for Alex. A Genetic Counselor will help Michael and Kim understand how conditions such as CF are inherited and the likelihood of CF occurring in future children. The Child Life Specialist will help Alex, Michael, and Kim learn to cope with CF and all of the specialized tests and treatments required to treat CF. The Child Life Specialist may be especially beneficial in helping Alex understand about his illnesses and deal with his anxieties and fears regarding tests and treatments as he ages. Finally, many CF centers also provide Chaplain services which may help guide the family with spiritual issues.
With so many professionals as a part of the IDT, it is important that communication is open. All IDT members will need to make observations and thoroughly document their findings and recommendations. All IDT members will need to participate in care plan development. There will be times when members of the IDT will not agree, or choices for treatments will be conflicting. It is important that team members commit to joint problem solving for conflict resolution. Good communication will directly impact Alex’s health Strategies for therapeutic communication Essay -cystic fibrosis.
With this large of a team, it is easy to understand how the family may feel left out of the communication process (Quigley, 2014). When communicating with any pediatric patient, the challenge is usually in the lack of a developed vocabulary. Using forms of play is highly recommended and has been used as communication tools with children for a very long time (O’Reilly, 2016). When possible, Alex should be allowed to touch equipment and push buttons, to feel comfortable with using the equipment, such as a nebulizer machine. At two years old, Alex likely has a short attention span and will need a lot of interactive communication to maintain his attention (O’Reilly, 2016). When teaching Alex to cough, for example, a game could be made to see who could cough the loudest or make the weirdest noises. When working with a nebulizer machine and tubing, Alex could be allowed to play with the equipment or taught to self-apply the mask, then be praised for being “big enough” to do it alone, as positive reinforcement is also a valuable communication tool with any child.
When Michael and Kim, as Alex’s primary care-givers, have an adequate understanding of Alex’s care, the result will be a decrease in hospitalizations (Trehearne, 2014). For this reason, inclusion of Michael and Kim is mandatory. They will need education regarding every aspect of Alex’s care as well as emotional support. It is crucial to openly answer any questions that they have, guide them to resources such as the CF center and other members of the IDT, support groups, and information available on the web. Active listening and deliberate silence on the part of the nurse may lead to sharing of observations, feelings, and hope Strategies for therapeutic communication Essay -cystic fibrosis. Using touch, when appropriate may let Michael and Kim know that they are not alone and that the nurse recognizes their vulnerabilities. Providing Michael and Kim will relevant information will help them make more informed decisions and may even decrease their anxiety. Occasionally it will be necessary to confront Michael and Kim so that they become aware of attitudes and beliefs that are not realistic, but only after a rapport has been well-established.
The more that Michael and Kim are involved, the safer Alex’s care will become, (McDonald, 2010), thus making therapeutic communication absolutely necessary. All information should be recorded in Alex’s medical record and this record should be available to Michael and Kim. When the team works efficiently together, Alex benefits the most.
Quigley, L., Lacombe-Duncan, A., Adams, S., Hepburn, C.M., Cohen, E. (2014). A qualitative analysis of information sharing for children with medical complexity within and across healthcare organizations. BMS Health Services Research, 14(283). https://doi.org/10.1186/1472-6963-14-283
McDonald, C., McCallin, A. (2010). Interprofessional collaboration in palliative nursing: What is the patient-family role? International Journal of Palliative Nursing, 16(6), 285-288. Retrieved from: http://search.ebscohost.com.libauth.purdueglobal.edu/login.aspx?direct=true&db=rzh&AN=105049999&site=eds-live Strategies for therapeutic communication Essay -cystic fibrosis
Trehearne, B., Fishman, P., Lin, E.H.B. (2014). Role of the nurse in chronic illness management: Making the medical home more effective. Nursing Economic$, 32(4), 178-184. Retrieved from: http://search.ebscohost.com.libauth.purdueglobal.edu/login.aspx?direct=true&db=rzh&AN=107873910&site=eds-live
Thomson, A.H., Harris, A. (2008). Cystic Fibrosis (vol. Updated and rev. 4th ed.). Oxford: OUP Oxford. Retrieved from: http://search.ebscohost.com.libauth.purdueglobal.edu/login.aspx?direct=true&db=nlebk&AN=604157&site=eds-live
O’Reilly, L., Dolan, P. (2016). The voice of the child in social work assessments: Age-appropriate communication with children. British Journal of Social Work, 46(5), 1191-1207. https://doi.org/10.1093/bjsw/bcv040
Cystic Fibrosis Foundation. (2019). What Is Cystic Fibrosis. About Cystic Fibrosis. Retrieved from: https://www.cff.org/What-is-CF/About-Cystic-Fibrosis/ Strategies for therapeutic communication Essay -cystic fibrosis