A True Clinical Story

Maximizing Function Competency

Mrs. C., aged in her 80's, lived in a nursing home where I was a clinical instructor for beginning nursing students. She was not mobile, did not talk, and I had not yet had the opportunity to become acquainted with her. One day, Mrs. C.'s indwelling catheter was scheduled to be changed. I volunteered one of my students to do the job. We reviewed the procedure, which the student had practiced in the skills lab but had never done with a patient. We gathered the equipment and walked into the room. As we were introducing ourselves to Mrs. C. (who did not speak to us) and explaining what we were going to do, two of the nursing home staff marched into the room. Surrounded by four persons, Mrs. C. tensed her muscles and shrank back into her pillow. "We'll help hold her down," said one of them. "She scratches." I looked at Mrs. C. She looked trapped and wary. "Thank you," I said. "That will not be necessary."

After the two staff persons had left, we drew the curtains around the bed. I bent down so that I was near to Mrs. C. and I spoke to her in a quiet voice. I began to describe the fall weather outside. 

Drawing of two wild geese flying "Hello, Mrs. C.," I said. "Itís fall and the air outside is crisp and cool. This morning I heard the far-off honking of geese flying overhead. The maple leaves are golden yellow in the fall sunlight."  Drawing of a maple tree with golden leaves

Her facial muscles relaxed and her eyes looked deeply into mine. Gently, I reached out, took her hands in mine, and held them very lightly as I created for her the image of the fall day. At some point, I nodded to the student to begin the procedure. 

The catheter change went smoothly. I continued bringing the fall day with a golden sun and chrysanthemums into the room.  Drawing of a golden sun

When the procedure was completed and we left the room, Mrs. C's facial muscles were still relaxed and she appeared calm. My quiet approach, engagement with her, and the imagery of the fall day not only had prevented the problem behavior of scratching but had also made the procedure a time of relaxation for Mrs. C.

To hear this story narrated by the author, use this audio link. Drawing of fall leaves

Narrated by L. Felver, Ph.D., R.N.

Maximizing Function Competency Learning Activities

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contactus@olderadultfocus.org Copyright Linda Felver and Catherine Van Son, 2006, 2011