True Clinical Story
Maximizing Function Competency
Mr. D. was 73 years old. He had been admitted to the geriatric unit of a
hospital where I was a clinical instructor for nursing students in their
medical-surgical nursing rotation. Mr. D. had multiple medical problems and his
care was complicated by his mild dementia. The hospital environment was
unfamiliar to him and it had multiple stimuli. Mr. D. became agitated easily.
One afternoon, Mr. D. was quite agitated. An IV push medication was ordered, to be
administered through the IV lock in his forearm. The medication was supposed to
be injected slowly over 5 minutes. Administering it more rapidly would likely
cause Mr. D.ís blood pressure to drop dangerously low.
The nursing student and I prepared for the procedure. She was very
apprehensive. This procedure required that Mr. D. hold his arm still for 5
minutes. But Mr. D. was agitated and restless, waving his arms, and moving
frequently in his bed. He was not combative, but he had the potential to become
so. What should the student do in order to administer the IV push medication
Here are my instructions to the student: "This morning, we discovered
that is difficult to engage Mr. D. in a sustained conversation. He kept
wandering off topic and a few times he said something about a farm. So I suggest
that you use mental imagery of a farm. Sit down so you are not towering above
him. Position yourself so that you can reach his arm and can also look him
directly in the eyes. Speak in a quiet, calm voice. Create the mental image of a
farm and engage him in it. Once he is calmer, then hold his arm gently but
firmly while you administer the medication. Take him mentally to the farm and
continue the imagery for the full 5 minutes until you have administered the
medication. Meanwhile, keep watching for the physiological changes that would
indicate his blood pressure is plummeting. Iíll be in the room if you need
Can you imagine what happened?
An agitated Mr. D. became quiet and engaged as
the student spun out the verbal description of a farm.
Occasionally, she would
ask him a simple question about the color of a tractor or the sound of an animal
to keep him fully engaged. The student administered the medication over the 5
minutes without difficulty.
After she measured his blood pressure and we left
the room, the student was awestruck at what she had been able to do. She had
become so caught up in creating the image for Mr. D. that she had forgotten her
own fear. Her quiet voice, calm manner, eye contact at his level, and vivid
mental imagery of a scene that was important to Mr. D. had enabled her to avoid
a problem behavior and give safe, compassionate care.
Narrated by L. Felver, Ph.D., R.N.
To hear this story narrated by the author, use this audio