Communication Between Patients and Nurse

Nurse-patient interaction script

Use the following script to guide your interaction with your patient for Assignment 3. Note that the items within [square brackets] indicate where non-verbal communication is being used.

You may also refer to Table 2.3 (p. 19) in Critical Conversations for Patient Safety (Levett-Jones, 2014) which provides verbal and nonverbal communication techniques as well as contextual examples. Try to incorporate some of these techniques, as appropriate, into your patient interview. Communication Between Patients and Nurse

The interview Nurse Sarah Percy: Good morning Mr Flores my name is Sarah and I’ll be the nurse doing your health assessment today. How are you?

[Sarah is smiling and looking at Mr Flores]

Mr Flores: Hi, Sarah, nice to meet you. I’m doing well, thank you.

Nurse Sarah Percy: That’s great! Are you ready to get started?

Mr Flores: Sure. Let’s go.

Nurse Sarah Percy: Let’s go into this office, it’s nice and quiet. Please have a seat.

[Sarah indicates the chair nearby]

Nurse Sarah Percy: Is the chair comfortable?

Mr Flores: Yes. Thank you.

Nurse Sarah Percy: I have to ask you some personal details and record them for our files. We keep them confidential. Is that ok with you?

Mr Flores: Yes. No problems.

Nurse Sarah Percy: Great. Are you ready to begin the assessment?

Mr Flores: Yes.

Nurse Sarah Percy: Good. Thank you. Let’s get started. Can you please tell me your full name and date of birth?

Mr Flores: David Flores, the 4th September 1952.

Nurse Sarah Percy: [Repeats details] And your address please?

Mr Flores: Flat 20/ 541 Pacific Highway, Morningside, New South Wales 2098

Nurse Sarah Percy: [Repeats details] Do you have a phone number?

Mr Flores: Yes, just a mobile. The number is 04788960123.

Nurse Sarah Percy: Do you have any allergies?

Mr Flores: I’m allergic to strawberries. They give me an itchy rash. No strawberry ice cream for me.

[Mr Flores laughs]

Nurse Sarah Percy: Oh dear that sounds nasty. So you have to stick to chocolate. That’s not so bad. [Sarah smiles at Mr Flores] That’s great information thank you. I see that you have come in today for a check-up because of joint pain?

Mr Flores: Yes, I am not as young as I once was. And I have to admit I’m a bit overweight and I’m having some pain in my joints. I play a lot of golf and like to stay active. So I thought I’d have a health check-up.

Nurse Sarah Percy: It is a good idea to have a check-up. Now you are getting older may be think about having a check-up once a year. But let’s see what we can help with today. I see that your observations have been taken and that your temperature is normal, at 36.7 Celsius. Your pulse is in the acceptable range, at 78 beats per minute, and your oxygen saturation in your blood is very good, at 98%. You mentioned that you are worried about your weight and this joint pain?

Mr Flores: That’s right.

Nurse Sarah Percy: Are you generally happy with your well-being otherwise?

Mr Flores: I’m a pretty happy person with a great family and lots of friends so my retirement from work is going great.

Nurse Sarah Percy: So you play golf? How many times a week?

Mr Flores: I love golf. It keeps me active now I’m retired. I play competition with my friends. We usually have a lunch and a few drinks after the game. I practice every day for about an hour – walking the course and hitting around. I play competition on Monday and Saturday. I’m quite good [Mr Flores smiles] and win a prize most weeks. Communication Between Patients and Nurse

Nurse Sarah Percy: Wow you do play a lot. [Sarah smiles] So it keeps you in contact with your friends and you have a good time together?

Mr Flores: Yes, there is always something on at the club and I take my wife along most Fridays for the Bistro and some dancing. We do that if we aren’t minding the grandchildren.

Nurse Sarah Percy: That sounds lovely. So you live with your wife?

Mr Flores: Yes, we own our own home in Morningside. We’ve been married for 40 years now, and have two children and two grandchildren. They all come to visit us once a month and stay the night. Our place is big enough to fit them all.

Nurse Sarah Percy: What a nice way to keep the family together. Do you need help around the house at all?

Mr Flores: We have a cleaner once a week and a gardener once a week. We’ll probably down size to a retirement village in the next couple of years.

Nurse Sarah Percy: Okay, so you live with your wife in a pretty large house but have help with the chores, and the family all come to visit once a month? Have I understood that right?

Mr Flores: Yes, that’s right.

Nurse Sarah Percy: Sounds like you are pretty active and social. Are you religious? Do you attend a church?

Mr Flores: No, we don’t go to church any more. We are Catholic and go to Mass at Christmas time but that’s all. We go mostly for the grandchildren they have live animals and do the Christmas story. [Mr Flores smiles]

Nurse Sarah Percy: Christmas is a good time of year to go to church. Apart from the joint pain you are experiencing do you have any other health concerns? Do you smoke or drink?

Mr Flores: I’m a little overweight but I don’t smoke. I do have a couple of beers after I play golf and I sneak some hot chips in as well. I look forward to that.

Nurse Sarah Percy: So how may beers would you drink a day?

Mr Flores: Probably three to four

Nurse Sarah Percy: And the hot chips?

Mr Flores: Well, I might get two serves after golf if I’m hungry

Nurse Sarah Percy: Do you eat a lot of fried food?

Mr Flores: Come to think of it, we probably fry a lot of our meals: steak, fish, and chicken.

Nurse Sarah Percy: Do you eat fruit and vegetables as well?

Mr Flores: I like mashed potato and peas. I like bananas but not much other fruit.

Nurse Sarah Percy: So you have mashed potato and peas every night because you like it?

Mr Flores: Yes. I suppose its habit now.

Nurse Sarah Percy: Okay. I’ve had a look at your Body Mass Index and for your height (180 centimetres) and weight (90 kilograms), your BMI is 27.8 which means that you are overweight. At this stage you blood pressure is within the acceptable range of 135/70; however, we should probably look at a healthier diet for you to lessen your chances of heart problems or diabetes. How does that sound to you?

Mr Flores: That sounds good.

Nurse Sarah Percy: Okay. In regards to your diet, you should try to eliminate, or lessen, the amount of fried foods. Can you grill or BBQ meat, fish and chicken? Also, you should eat some salads and different vegetables rather than mashed potato each night. Potato has a lot of carbohydrates and when you add butter and milk the calories are very high. Tomatoes and cucumber are great in a salad do you like the sound of that? Communication Between Patients and Nurse

Mr Flores: That sounds fine.

Nurse Sarah Percy: Your alcohol intake adds calories as well and the amount you are drinking is over the recommended daily intake of two standard drinks a day. That could affect your liver function over time and add to your weight. A standard drink of beer has 10 grams of alcohol for beer. A middy is 1.1 standard drinks. Do you think you could try light beer or quenching your thirst with cold water before having a beer?

Mr Flores: That sounds reasonable. I’d not thought about how thirsty I am after golf. I try cutting back to one light beer per day.

Nurse Sarah Percy: As to your snack after golf, you could try a small handful of nuts or bringing a piece of fruit from home. Maybe an apple or an orange? Would that work for you?

Mr Flores: I can certainly try. Maybe I could freeze the orange in summer, so it’s cold. Thanks for that information.

Nurse Sarah Percy: My pleasure. The Heart Foundation web site has some good and helpful suggestions and I also have a brochure for you if you would like one.

Mr Flores: Great! Can l have the brochure and the web address please?

Nurse Sarah Percy: The other thing I’m worried about is: do you wear sunscreen or a hat when you are out playing golf?

Mr Flores: I don’t wear sun screen but I probably should.

Nurse Sarah Percy: Well to protect yourself from developing skin cancer you really should and also wear a long sleeve SPF shirt and sun glasses. Have you had a skin check?

Mr Flores: I have sunglasses and I’ll get some sunscreen. The golf shop does has some hats that look good. I’ll try some on this afternoon. I have never had my skin checked though, Sarah.

Nurse Sarah Percy: We should make an appointment with the skin clinic for a skin check. Is this afternoon okay with you?

Mr Flores: Yes. I am free this afternoon.

Nurse Sarah Percy: Okay, let’s get back to that joint pain. What joints do you feel it in?

Mr Flores: in the shoulders and knees mostly. Sometimes I can’t straighten my legs and I have trouble getting into the car. Communication Between Patients and Nurse

Nurse Sarah Percy: So you experience pain in shoulders and knees and you have difficulty straightening your leg and getting into the car sometimes?

Mr Flores: That’s right.

Nurse Sarah Percy: Have you been assessed by your doctor and do you take anything for the pain?

Mr Flores: Yes. The doctor said I have some age-related arthritis. I take Panadol sometimes.

Nurse Sarah Percy: So you only take the Panadol sometimes?

Mr Flores: Yes, I don’t like taking tablets if I don’t have to.

Nurse Sarah Percy: Does anything else you have tried help with the pain?

Mr Flores: I have a hot pack I heat up in the microwave that I use every day.

Nurse Sarah Percy: So it must be quite painful if you use the heat pack daily. Is it restrictive for your movement as well?

Mr Flores: I can’t run after the grand children as fast as I used to anymore.

Nurse Sarah Percy: If you address your diet and happen to lose a few kilos and get back to a healthy weight it might ease the pain for you. Also you could try some cream for joint pain. You can get some from the local pharmacy. Also, some stretching and warm-up exercises before you play golf

might help. Have you thought of yoga? I believe it is good for golfers. I have a web site that has some good information I can give to you if you like. Communication Between Patients and Nurse

Mr Flores: That would be great. I’ll try those things, Sarah.

Nurse Sarah Percy: Okay, Mr Flores, sounds like you will be on the right track soon. Let’s go over what we have discussed today. In terms of your alcohol intake: currently it is over the current recommendations of two standard drinks per day. You’re going to try drinking water after golf and having one light beer only. This will also help address your BMI as it is in the overweight range. You’re also going to try not to fry your food and add in some salads and more fruit to your diet. Protecting your skin is important and we have discussed using sun screen, a hat, sunglasses and sun- protective clothing. Finally your joint pain; we have discussed the possibility of yoga, warm-up exercises and applying some joint cream from the pharmacy. That sounds like quite a lot, to do doesn’t it?

Mr Flores: I’m sure I can get started today, Sarah.

Nurse Sarah Percy: Terrific Mr Flores. I’d like to see you in two weeks to check how it’s all going. Is that ok for you?

Mr Flores: No worries. I’ll be here then!

Nurse Sarah Percy: Excellent. Here is the information I promised you. [Sarah hands him the leaflets]. I’ll see you in two weeks, okay. Thanks for your time, Mr Flores. Bye for now.

Mr Flores: Bye, Sarah, thanks for your help.

Assessment 3: Health Assessment

Professional Communication in Nursing 2019: History for Nurse and Patient Interaction – Health Assessment

Scenario 3

Patient 3: History for Nurse and Patient Interaction – Health Assessment

Student (Community – Registered Nurse): Use professional nursing communication with the patient to conduct a 10 minute health assessment video interview taking into account the following:

• Introduction – nurse and patient • Situation – reasons for assessment, allergies, and relevant personal details • Background – health history, general health and psychosocial status • Assessment – observations, nutrition/diet, exercise, lifestyle, health beliefs and

values, and cultural/spiritual/religious practices • Recommendation – confirm health assessment information and implications for

well-being, recommend changes to manage and improve health and suggest timeframes for any plans

Assessor (Patient – Chester Abioye): You are cooperative, alert and orientated. You are willing to provide all requested information. You like to ask general questions of the nurse related to the health assessment and like to know your observations and if they are within normal limits. You are open to discuss ways to improve your health through possible changes to your diet, exercise, daily habits, and lifestyle choices.

STUDENT (General Practitioner’s Office – REGISTERED NURSE) Scenario 3: Patient- Chester Abioye Chester has come to see a Registered Nurse at his General Practitioner’s Office for a health assessment. Chester is not very active and feels stress and lonely living Australia without his family. He has suffered from depression in the past and wants to improve his health through regular exercise, eating well and by making positive changes to his lifestyle. Communication Between Patients and Nurse

Chester Abioye: Male, height 187 cm; weight 73kg (BMI = 20.9). BP 118/ 70, HR 86, RR 22, temperature 37.0 C, SaO2 99% on room air.

Assessment 3: Health Assessment

Professional Communication in Nursing 2019: History for Nurse and Patient Interaction – Health Assessment

ASSESSOR (PATIENT )

Scenario 3 Patient 3- Chester Abioye Biodata

• Chester is a 19 year old man (DOB-14th January 2000) and lives at 97 Leafy Avenue, Broadfields, 2173 in a share house with 4 other people.

• Chester has a girlfriend that lives in Melbourne who is planning to move to Broadfields later in the year to be closer to him.

• Chester regularly smokes about a packet (30 cigarettes per day).

• Chester often drinks up to 6 to 10 standard drinks (beer and spirits) when he catches up with two of his friends once a month.

• Chester was born in Zambia and came to Australia to commence a law degree but only did 1 year of the degree because he did not enjoy the course. He is now working at Aldi in the storeroom. He often volunteers to work overtime to save money to send back to his family.

• Chester mostly stays at home watching television. He rarely exercises because he finds it boring. He does enjoy emailing and talking to his girlfriend and family on the computer when he can.

• Chester says he is no good in the kitchen. He mainly eats rice, bread and meat. Sometimes he buys vegetables to include in a meal.

• Chester doesn’t like wearing a hat or using sun block when he does go outside.

• Chester does not follow any religion.