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.
"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."
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.
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.
Narrated by L. Felver, Ph.D., R.N.
To hear this story narrated by the author, use this audio