Interaction With Patient With Disruptive Mood Dysregulation Disorder - Paper Example

What are your objectives for this interaction?

Determine how the patient has been coping up since he became diagnosed with Disruptive Mood Dysregulation Disorder, Depression, and Suicidal ideation;

Determine triggers that exacerbate his disruptive mood and reasoning for suicide ideation;

Formulate specific, measurable, action-oriented, realistic, and timely goals that can assist the patient to lead a normal life with his problem.

What will you teach this patient?

After assessing patients situation, I will be in a good position to make adjustments, improvements, or recommendations regarding any short term and long-term goals. Using these goals, the patient can learn how to live positively and comfortably with the diagnosed problems.

Clients Appearance: The patient is 6 years old and approximately 4 feet tall, seems to be within his weight range. He just woke up and is still dressed in his pajamas, they are blue with pictures of cars all over them, hes wearing a dark blue t-shirt with white socks and is holding his light blue blanket. You can tell he is still in the process of waking up but seemed to be more talkative than the other children in the room. He had already been told to be quiet and sit down till the other children have woken up within the first 10 minutes. He sat on the sofa and had a short conversation with the other children. He talked about his roommate and how he was still sleeping. He then mentioned that he was hungry and couldnt remember what he had ordered for breakfast the day before. The patient has blonde short hair and a small bruise on his right cheek. While he was talking to the other children, he told them he was superman, and lifted up his shirt, I was able to see that he had bruises on his torso. However, I was unable to observe the area for long since the program specialist told him to put his shirt down and sit quietly until it was time for him to go and get dressed for breakfast.

Description of the Setting: My first interaction with E.E. was in the morning when he approached me and asked me what my name was and what I was doing there. I told him I was in school to be a nurse and that I would be spending the day with them. When it was time for breakfast we all moved to a different room, it was like a classroom setting with 4 big windows. There was a TV mounted on the wall. The walls were very colorful. There were individual desks for each child, approximately 15 desks in total. The teachers desk was located at the front of the room. EE sat next to the table I was sitting at and would lean over as he was eating his breakfast and ask questions like Do you like fruitloops? or What did you eat for breakfast? He had a hard time just sitting in his chair and eating. He got up quite a few times and would talk to the other children while they were eating their breakfast. When breakfast was almost done, they had to pick out what they wanted for lunch and each child had an individual menu. EE asked me if I could help him pick out his lunch. He did have difficulty reading the menu.

Introductory/Orientation Phase

Student Nurse Client Analysis

Verbal:

Hi there, my name is Anglena and I am a student nurse from UTA. Would you mind taking a small break from playing just to talk to me for 15 minutes?

Yes, thats perfectly fine.

Nonverbal:

The client was sitting on the ground coloring. I sat down alongside the client so that I would not seem so authoritative. I sat with my legs crisscrossed, and arms uncrossed in my lap. I also sat upright, sitting towards the client and maintaining eye contact as I spoke to him.

Verbal:

Hi Anglena. My name is E***. Do you want to talk right now? I just want to play a little longer. Im going to play for ten more minutes then I can go talk. Is that okay?

Nonverbal:

The client sat crisscrossed with his eyes on the coloring book on the floor. He only made eye contact once throughout the conversation. The clients posture was slouched. Specific Technique Used: Offering self

Rationale: Making oneself available on an unconditional basis increases clients feelings of self worth (Boyd, 2017).

Any blocks and/or examples of better wording or behavior: I would not have changed the wording of my response as well as my behavior. The client agreed to talk after he finished his activity.

Students Thoughts: I was surprised that the client did not give me his full attention or his eye contact, as he was so eager before to talk to me and find out information about me. It makes me wonder if he only likes to learn information about others but not share things about him.

Students Feelings:

At this time even though I am older than the client, I still feel very nervous about this conversation. I just wanted him to know that it was ok and he could talk to me and that I was in no way judging him. Im afraid that I may not ask the right questions or I may accidentally say something that will upset the client. I am relieved that the client easily agreed to have an interview with me and I hope that it will go smoothly.

Working Phase

Nurse Interaction:

Verbal and Nonverbal

Verbal in quotes Client Interaction: Verbal and Nonverbal

Verbal in quotes Analysis of Exchange #1

(name of specific technique used, rationale, effectiveness, blocks, examples of better wording or behavior, identify thoughts/feelings)

Verbal:

How are you feeling today? Did you have anything that you wanted to talk about during our time together?

Nonverbal:

The client was still coloring and I also started coloring along with him. We both were side by side and were sharing the coloring pencils. He kept offering me the colors after he used them and I accepted them and used the colors he handed to me. He then did stop coloring and went to get his monster truck and I sat in an upright position with my hands on my lap and he played with his toy.

Verbal:

Im kind of tired. Im having a good day so far though because youre here. I like you. I just colored some pictures today. Did you see them? I used red. Red is my favorite color. I really like it because it reminds me of blood. Do you see a lot of blood? I also really like clowns. A lot of people think that clowns are scary but I dont think theyre scary. Theyre really cool.

Nonverbal: When the client was coloring, he was just facing down and concentrated on the coloring, very little eye contact. But when he went to get his monster truck he was making eye contact and had a smirk on his face as he was talking about blood.

Specific Technique Used:

Acceptance and use of open-ended statements

Rationale:

Used when helping patient explore feelings or gain insight (Boyd, 2017).

Any blocks and examples of better wording or behavior:

I probably should have asked the client one question at a time. That way the client would be able to focus on just one main topic and work on answering it.

Students Thoughts:

The client seemed to be easily distracted. The client displayed a flight of ideas, as his answer sort of jumped from topic to topic. I thought it was very odd how the patient stated that his favorite color was red because it reminded him of blood. I also wondered if the patient had been exposed to large amounts of blood to have such a fascination with it.

Students Feelings:

I did feel slightly uncomfortable once that client admitted why he liked blood, but decided to maintain a professional composure. I was glad that the client was helping to maintain the conversation as opposed to just sitting there quietly. I felt a little less nervous, and a little more relaxed because of this.

Nurse Interaction: Verbal and Nonverbal

Verbal in quotes Client Interaction: Verbal and Nonverbal

Verbal in quotes Analysis of Exchange #2

(name of specific technique used, rationale, effectiveness, blocks, examples of better wording or behavior, identify thoughts/feelings)

Verbal:

Yes, I did see your pictures. You colored them very well. Do you usually see a lot of blood?

Nonverbal: I nodded as I told him that I did see his pictures and crossed my legs. I maintained eye contact with him. Verbal:

I see them a lot in movies. You know the super scary movies that show people dying. Those have a lot of blood. Sometimes I see blood when the workers here take it from some of the kids. Its so cool!

Nonverbal: Client was making full eye contact as he was speaking to me. His voice seemed to get a little deep when he was talking about Specific Technique Used:

Exploring

Rationale: Delving further into a subject, idea, experience, or relationship is especially helpful with clients who tend to remain on a superficial level of communication. However, if client chooses not to disclose further information, the nurse should refrain from pushing or probing in an area that obviously creates discomfort. (Boyd, 2017).

Any blocks and examples of better wording or behavior:

I dont think I needed any modification when it came to my verbal interaction but my non-verbal could have been more warming. I didnt notice that I crossed my legs.

Students Thoughts: I was a little disturbed about when he was talking about how he liked scary movies and watching people die. I just couldnt imagine what was really going on through his head at this age to have these thoughts and feelings. He has been through so much at the age of 6 and his thoughts were a little chilling and grown up like.

Students Feelings: I didnt feel like he was a danger or had any sort of feeling of harming himself or anyone in that moment but it was sad to see he was only 6. He should be having happy thoughts and he must have gone through some traumatic experiences to think that way.

Nurse Interaction:

Verbal and Nonverbal

Verbal in quotes Client Interaction: Verbal and Nonverbal

Verbal in quotes Analysis of Exchange #3

Verbal:

I see. I noticed a bruise on your stomach earlier, and I see that you have one on your cheek as well. How did you get those bruises?

Nonverbal: Continued to make good eye contact with the client. My legs were still crossed. My facial expression shifted slighted to become more serious as the information that the client disclosed Verbal:

Well I got this bruise because me and one of the other kids got into a fight. He thought that I took one of his coloring pictures when I didnt so he hit me.

I dont really want to tell you what happened, but since I like you Ill tell you. I told the other nurses that its because I fought with some ninjas and they hit me and thats why the bruise is here, but thats not what happened. Sometimes when Im bad and I dont do what daddy says to do he hits me. But its okay, Im okay, its my fault. If I did better my daddy wouldnt have to hit me.

Nonverbal: I immediately became ecstatic and alert. Therefore, I shifted my gaze momentarily, although I smiled to ease the tension. I had to show him that he was right regarding the fact that he claimed that he liked me. Specific Technique Used:

Requesting for clarification on any unclear issues

Rationale: assists the patient to evaluate his way of thinking and decision-making. In addition, it helps to optimize mutual understanding between the patient and the student nurse.

Any blocks and examples of better wording or behavior:

Not any at this time (all was quiet since the other patients began departing)

Students Thoughts:

Firstly, I thought of what he had been going through. I was almost tempted to ask him whether he thinks that his daddy hates him or not. Secondly, I had to clarify what is that he liked in me but not in other student nurses.

Students Feelings:

I had mixed feelings. Firstly, I was shocked why the daddy could hit...