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-Discuss specific communication strategies and approaches relative to clients with mental illnesses.

-Identify communication strategies to de-escalate a volatile situation.

-An analysis of effective communication used by the nurse

-An analysis of ineffective communication used by the nurse

-The consequence of ineffective communication.

-Suggestions of alternative statements.

-Suggestions for ways to build the nurse-patient relationship.

 

James is a 24-year-old college student who has been admitted to the psychiatric unit. Over the past few months, James’ behaviour has become increasingly erratic, with him missing classes, missing appointments and meetings, and avoiding friends and family. James’ mother reports that last week she got a phone message from him stating that he has shut down his email account because the government is monitoring it. Last night James was found unconscious in his apartment by one of his friends. It was discovered that James attempted suicide through an overdose of sleeping pills. James has been diagnosed with paranoid schizophrenia with suicidal ideations. 

The following is the conversation between James and the nurse:

Nurse:  Hi James. I am the nurse who will be working with you today. How are you feeling?

James: Ok, I guess. I still don’t understand why they won’t let me leave.

Nurse:  I can’t answer that for you. You will need to discuss that with your psychiatrist. 

James: *Looks past the nurse, nodes his head to indicate ‘No’ and then says “Shhh!”*

Nurse:  James, can you tell me what just happened?

James: I…I…I don’t know. There was someone in the corner of the room, but now they are gone.

Nurse:  Now, James, you know that no one is here. You need to stop talking like that or you will scare people.

James: I guess. I just don’t know what is real and what isn’t. I just want all this to stop! 

Nurse:  Is that why you tried to kill yourself?

James: Yeah. I just want all this to go away. I’m damaged!

Nurse:  Don’t say that! And you shouldn’t think about killing yourself either. You have so much to live for.

James: Maybe. But I don’t even know if I’m going to be allowed to leave the hospital. You know they committed me, right?

Nurse:  It sounds like you are feeling a little concerned about when you will be going home. 

James: Kinda, it’s mostly that I don’t really even understand what being committed means.

Nurse:  Would you like me to ask the psychiatrist to come in and explain what has happened and what the plan is for the future?

James: I think that would be a good idea. I’m feeling so lost with all this.

Nurse:  You don’t need to worry. Everything will be ok. We are all looking after you here.

James: I can hear the nurses whispering about me at night. I know you all think I’m crazy! I know you are putting drugs in my food.

Nurse:  That is a ridiculous accusation! 

James: It’s true! I heard them last night!

Nurse:  James, if you keep talking like this and accusing the staff, we aren’t going to be able to work together anymore. Now, do you promise to behave?

James: Fine.

Nurse:  Good. 

James: I’m a little tired now. Would it be ok to have some quiet time to myself?

Nurse:  Absolutely. I will be back in a few hours with your medication. If you need anything before then just ring the bell and I’ll come.

SCIENCE
HEALTH SCIENCE
NURSING
LPN 3002

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