TAFE Queensland Nursing: Communication and Care Plan Case Studies

This comprehensive nursing assignment delves into critical communication skills essential for effective patient care. The assignment covers various aspects, including non-verbal and verbal communication techniques for patients with conditions like Parkinson's disease, and strategies to address vision and hearing impairments. It explores the principles of open disclosure, providing examples of conversations and documentation using SBAR. Ethical considerations, such as patient confidentiality and advocacy, are addressed, alongside email etiquette and constructive feedback methods. The assignment includes case studies, focusing on closed and open questions, active listening, and the elements of effective communication in nursing practice. It emphasizes the importance of clear communication, patient rights, and professional conduct, offering practical examples and scenarios to illustrate key concepts.

Diploma in Nursing

a. How would you make Mrs Jackson feel comfortable, using appropriate non-verbal
communication (discuss at least three (3) points)?
Three types of non-verbal communication would be effective for a Parkinson’s patient, are:
 Direct eye contact would be helpful to understand what the patient wants to express
through eye ball movement.
 Monitoring the patient's facial expression: facial grimacing, crying of the patient indicates
some sort of discomfort feeling. Monitoring these feelings may help nurses to understand
what the patient wants to express.
 Sign language use: nurses can educate patient some necessary sign languages through
which patient can communicate with nurses easily.
b. How would you make Mrs Jackson feel comfortable, using appropriate verbal
communication (discuss at least three (3) points)?
In order to make the patient comfortable through verbal communication, nurses can use the
following communicative strategies. These are:
 Clear and slow communication is important for Parkinson's patient as they need extra
time for processing the information and response.
 Parkinson's patient cannot understand complex sentences. Thus, short and precise verbal
communication would be helpful for them.
 patient with Parkinson’s can not understand commands and information by one chance.
Thus repetition of sentences can make them easier to understand the communication.

c. Referring to the Core standards for nurses who provide support to people with
disability, outline three (3) strategies that you could use to aid communication with Mrs
Jackson giving consideration to her vision and hearing impairments.
 Getting the attention of the patient: absence mindedness is observed in a Parkinson's
patient. Thus, it is important to grab their attention to communication. Slower and clear
approaching, gentle touching in hand and arm, facing directly is the best way to get their
attention.
 Communication exchange through code language: sign language or code language is the
most effective way to communicate with a parkinson’s patient with vision and hearing
impairments.
 Have patience during communication: as Parkinson's patient needs time to understand the
messages. They can not respond on an immediate basis because of their nervous rigidity;
holding patience is an important aspect of nursing care.
d. Provide a definition of ‘open disclosure’ and discuss the principles of open disclosure
referring to the Australian Open Disclosure Framework (2013) .
Open disclosure indicates an open communication with the patient and her family members
when care provision does not go according to the nursing plan. Open disclosure ensures a
patient's right during care service distribution. If any unusual circumstances occur during the
period of care, open disclosure critically evaluates the faults discuss about the effective
communication and care services in order to provide safety and security to the patient. The main
purpose of any open disclosure is to attribute high-quality care services with the help of a patient
and family members.
e. Provide an example conversation of what you would say when communicating the
incident to the patient and son (min 100 words).

Nurse: sir/ Madam, first of all, we are really very sorry that we could not be able to protect Mrs.
Jackson from falling.
Son: its okay, but you should be careful in the future as I can not spare time for my mother. You
need to be closure around my mother. She can not express her needs properly, as you know.
Nurse: sure sir, but let me tell you, we have examined her, and she is completely fine even after
her fall. But this falling might be harmful to her if we do not come at the right time. Sir, we need
to discuss about care strategies in details.
Son: yes, I also think so. I feel you should modify your care plan regarding safety issues.
f. Identify the key/relevant health professionals/ facility teams you are required to contact
in this situation and provide a rationale.
Orthopedic:
An orthopedic recommendation is important to make an Xray in order to understand if there is
any crack or fracture in her body.
Physiotherapist:
A physiotherapist delivers some useful exercises and therapies for recovery from pain.
Psychologist:
A psychologist consultation is important in this case to understand the feelings of the patient. It
is because she is suffering from Parkinson’s disease and can not express her feelings and needs
properly.
g. Using SBAR provide an example of what you would document in the patient chart
ensuring that you use appropriate terminology. .
Situation: Mrs. Jackson has been fallen out on the floor from the bed

Background: Mrs. Jackson is a patient of Parkinson's disease with early-stage dementia. Her age
is 82 years.
Assessment: she has a vision and hearing problem. She uses spectacles with high power and
hearing aids. She has a little problem in balancing, can not understand commands by one chance.
She has a problem to understand complex sentences. Muscle rigidity is observed sometimes.
Recommendation: a special mental health care strategy needs to be taken. A special old-age care
strategy needs to be implemented. Code language would be helpful to communicate with Mrs.
Jackson. Psychologist, physiotherapist consultation is needed. Strict surveillance is important for
her safety ("SBAR Definition, How To, and SBAR PDF - MedPro Medical Waste Disposal",
2019).
h. Michael, Edith’s son will be traveling overseas for the next few weeks and will not have
telephone access. He has asked if you could email him to provide him with a progress
report on his mother. Identify at least five (5) factors relating to email etiquette you will
need to adhere to when emailing Michael.
 Complete information should be addressed through precise format with attached
file of testing reports.
 It would be better if nurses can ensure the betterment of the patient in order to
reduce his tension.
 Hence, easy and clear terms should be used to provide the information.
 The email must be written in a respectful and professional manner ("Email
Ettiquette", 2019).
 It is important to mention the present situation of Mrs. Jackson.

Case Study 2
a. What ethical principles and regulatory responsibilities do you need to consider in this
situation?
As per the nursing guidelines and ethical and legal policies nurses must keep all the medical
information of the patients confidential. It may impact directly to the reputation of the hospital.
Not only that, patients can take any legal actions against this health center. Hence, it is a request
to the administration department to arrange some training and workshops in order to educate all
the registered nurses and midwives regarding the safety and security policies in the nursing
practices. It is to be noted that, administration must take strict actions if further anomaly is
observed in this regards.
b. Provide a definition for the term ‘advocacy’ and describe how you would advocate for
the patient in this situation?
Patient advocacy is an important part of nursing duty. A patient advocate plays an advocacy role
for client’s right. They also provide guidance and sources to educate patients about relevant
incidence. Patients must be advised about the legal and ethical considerations related to the
safety and security issues. It is important to ensure patients and their family members to provide
the best care treatments in all aspects and make them educate about the care policies and safety
policies. They should be informed to take legal actions if they feel insecure. Also, strategies to
overcome the probable barriers must be mentioned at the time of advocacy (Olin, 2012).

c. You are asked by your supervisor to provide feedback to the colleague who has posted
this information on social media. Describe at least four strategies you could use to
deliver a constructive outcome when providing this feedback.
 A constructive feedback must be problem-focused not the individual
focused.
 Addressing the problem must be done in a clear, specific and precise
format.
 It is important to mention the legal and ethical consideration related to the
matter of information disclose.
 At the end, some positive note or advice must be provided. Probable
solutions can be discussed at the end of the feedback in order to overcome
this situation("7 ways to give valuable and constructive feedback to staff -
SEEK Hiring Advice", 2019).
d. Provide an example of the feedback you could provide to your colleague, using
appropriate language and a respectful manner. (min 75 words)
Being a registered nurse one should not post any confidential medical data or patient’s
information in the social media. Hence, being a colleague, it is important to inform her fault
immediately. Must be forced to delete this post as soon as possible before administration take
any serious actions. She must be advised about the rules and ethics in the nursing professions.
She must be informed that it is her duty to protect all the medical information of the patients. It is
important to warn her by mentioning the consequences and after effects so that she can not make
this mistake again in the near future.

Case Study 3
a. What are closed ended questions and in what situations would you use closed
questions with David? (provide at least two (2) examples of a closed question)
Close ended questions can be defined as the questions where nurses provide options. Some times
patients need to answer simply by expressing ‘yes’ or ‘no’. Patience and politeness are two most
important factors. Polite gesture may reduce his aggression towards others.
Question 1: do you feel any chest pain right now Mr. David?
Question 2. Do you feel claustrophobic or suffocating in this room?
b. What are open questions and in what situations would you use open questions with
David? (provide at least two (2) examples of an open question)
Open questions encourage the patients to speak their mind. Open questions provide facilities to
answer in more depth. Open question can be considered as the next level of questions when
patient accustomed with the situation and feel free to talk. Polite gesture is the most helpful
probe in order to get an answer from any verbally aggressive patient.
Question 1. If you feel any problems or issues regarding your treatment procedure you can tell us
openly Mr. David.

Question 2. Tell me more about your medical history? Does any of your family members have
suffered from cardiac diseases?
c. Discuss the term ‘Active Listening’ and provide at least one (1) example of how this
could be used in this situation. (min 100 words)
Active listening is an essential part in nursing care procedures. It is used in counseling, training
and advocating the patients and their family members. Active listening indicates full of
concentration and understanding the problems what patient is trying to describe. Nurses can add
therapeutic value through this procedure. With the help of the active listening process, nurses can
build an effective relationship with David in order to make him comfortable in the hospital.
Behavioral and eye expression is an important factor to express the attention towards the patient.
Example: direct eye contact and showing interest towards the patient can be helpful in this
scenario("Active Listening | SkillsYouNeed", 2019).
d. Identify what constitutes effective communication in nursing? (List at least six (6)
points and provide an example of each).

 Effective communication is a core skill that helps nurses and midwives to avoid the
conflicts and enhance the functional relationship with patients and other health
professionals. For example, clear and concise communication related to the nursing plan
with the patients and their family members may enhance the effectivity of the care
services.
 Effective communication may help to increase the quality of nursing services and
indirectly the reputation of the hospitals. For example, the patient may feel safe and
comfortable under nursing care. This can enhance the reputation of the hospital.
 An open-ended question is a type of verbal communication in which patient can reply in
detail, for example, if open-ended questions are asked to a patient with the cardiac
disease he can answer it in details by correlating his family members. It will be helpful to
understand the medical history of the patient.
 Close-ended questions are another type of verbal communication in which patient only
answer by expressing yes or no. For example, an Alzheimer's patient feels more
comfortable to answer in expressing yes or no.
 Active listening is a part of non-verbal communication which includes signs and body
expressions to make patient empowered. For example, a blind patient is more
comfortable, talking much about his life.
 Written or digital communication is another most important aspect in this regard. For
example, with the help of written communication, nurses can collect medical data for
future purposes ("Communication skills", 2019).
e. Describe de-escalation and provide an example of a de-escalation strategy. (min 75
words)

De-escalation is a nursing technique to reduce aggressiveness or anger of a patient. It is the
toughest part of any nursing job. Nurses need to be aware and conscious in every second. For
handling any aggressive patient experienced and trained nurses is required. Nurses should handle
stress effectively and efficiently. De-escalation is a technique in which nurses make themselves
calm and polite.
A polite and caring gesture needs to be maintained.
Excessive aggressiveness of the patient needs to administer sleeping injections by consulting
with the doctors.
f. Explain the benefits of a debriefing process and explain why it would be useful
following this situation.
A debriefing process allows nurses to facilitate teamwork and develop communication in a crisis
period. This process also provides an environment to get related to the patient emotionally. It
allows confronting the true fact about the patient so that nurses can predict the extent of care
processes. The main purpose of debriefing is to discuss what went well and what did not well
well regarding any nursing care strategies. It would be useful in David's situation also as it can
provide the overall health status (mental and physical) of David to the doctors and higher
authorities in order to plan a proper care strategy.

g. Your supervisor provides you with some feedback on how you handled this situation,
identify at least three (3) strategies you could use to effectively receive feedback.
 Making some reflective statements would be helpful during an interview with
David.
 Controlling the situation without becoming demanding or authoritative is
important.
 Judgemental attitudes should not be shown to the aggressive patient("How to
Handle Difficult Patients", 2019).
PART B
1. With reference to the following resource: NSW Health (2014) Communication and
behaviour support for nurses- Practice Package retrieved on 3/11/2016 from:
http://www.adhc.nsw.gov.au/__data/assets/file/0007/301777/Communication-
Behaviour-Support-for-Nurses-Practice-Package.pdf
Communication and behaviour support for nurses- practice package was implemented for what
reason?
The nursing care communication depicts the interaction between nursing staffs and
patients as well as their families. Reasons are as follows: