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J.H was admitted to Unit 9 with a diagnosis of alcohol dependence causing induced mood disorder with depressive features. The diagnostic criteria outlined by the DSM-IV for substance dependence states that three or more of the following impairments must be seen in the patient, a tolerance for the specific substance, withdrawal symptoms if the substance stops being taken, persistent desire or unsuccessful efforts to cut back or control substance use, reduction or even cessation of important social, occupational, or recreational activities, and substance use in spite of knowledge of having a substance abuse problem (Austin & Boyd, 2008). The etiology behind substance abuse is still being researched but the evidence suggests that there are both psychological and biological aspects to addictive personalities. It is also evident that substance abuse and dependence can lead to problems in all parts of the biopsychosocial well being.
The interaction took place on unit 9 of the QEH hospital on September 24th at approximately 1530 hrs. The client and the student nurse had discussions in the pantry area of the unit as well as in the common area the conversation of focus took place in the common area.
Preceding Critical Events
The student nurse had met the client once before and had already started the orientation phases of the nurse-client relationship. The client was cleaning the pantry area of the unit while making himself a cup of coffee. This is when the student nurse approached the client and began a conversation which led to the discussion of focus.
Phase of the Nurse-Client Relationship
During the conversation of focus the student nurse and the client were in the working phase of the nurse-client relationship. They were in this phase because the client was beginning to outline areas of his illness that needed to be worked on in order to recover. Client and Nursing Partnership Goals
Client Health Goals
Short Term 1.) Client wants to get into an addiction center outside of PEI. The client has already tried the addiction center at Mt. Herberts and feels that the program does not work for him. This goal was identified by asking the client about the various treatments he has used in the past few years and he mentioned his application to a treatment center in Ontario. 2.) Client also wanted to go on a three hour pass that evening in order to complete some errands at his home. This goal was established after I asked the client what his plans were for the rest of the day. Long Term 1.) Client wants to gain control over his alcohol dependence by attending more AA meetings and getting the proper psychiatric treatment including medications and group work. 2.) Client wants to better his relationship with his two daughters but feels that he first needs to get control of his illness. 3.) Client wants to finalize his divorce, at the current time he is legally separated in order to complete the divorce the client must speak to his lawyer and finish some paperwork. Nursing Partnership Goals Short Term 1.) Establish a nurse-client relationship by defining boundaries, assuring confidentiality, and explaining the purpose of the relationship. 2.) Provide client with information regarding treatment center in Ontario. 3.) Gain enough trust with the client so that he feels comfortable to discuss his illness and his history with the student nurse.
What I Observed
Client was in the pantry area of the unit cleaning while making a cup of coffee. He seemed a little anxious and somewhat rushed (it was later observed that this is simply a part of the client personality.) When I entered the room J immediately greeted me saying “Hello Greg, I’m just making myself a cup of coffee. I like to try and do my part to keep the place clean” his tone, volume, and rhythm were all within normal limits and he seemed to be in a pleasant mood. The client then said “Oh, I don’t clean up that often the other people here are pretty good at cleaning up after themselves I just like to keep busy.” After the patient finished making his cup of coffee he moved to a couch in the common area. His mood was still pleasant and he was very talkative. After J was finished he said something that really caught my attention “I know I have a problem but I only binge drink, it’s not like I drink all the time.” Pause “Well I shouldn’t say that because it is bad enough to just binge drink and I need to get better ” At this point the patient started to ask questions about me such as where I was from, what I thought of the nursing school, and a few other things. The client was now very relaxed in the couch with his feet up on the coffee table drinking his coffee.
What I Thought and Felt
When the client greeted me so quickly and in such a pleasant tone I felt that the nurse-client relationship was developing very well and that it was time to start the working phase of the relationship. By the way the client talked about his co-patients and the staff I could tell that he was quite comfortable on the unit. I felt that this would be a good time to start a conversation. I thought that now would be a good opportunity to ask J about what brought him to the unit and to explore his diagnosis. I felt a little nervous thinking of what to say I feared that I may be asking something to private this early in the relationship
I was surprised at how easily J opened up about his history and I was slowly starting to feel more comfortable with asking questions about his illness. Again I felt that J was being very honest with me and I could sense that he trusted me as a nurse.