question archive You are a nurse in a rehabilitation center for seniors who have experienced either strokes or heart attacks
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You are a nurse in a rehabilitation center for seniors who have experienced either strokes or heart attacks. It is your job to encourage your patients to participate in various programs. What would you say to those who refuse to participate? What would you say to those that participate but do not work on "homework" outside of therapy?
To those who refuse to participate:
"First, I'd like to know why you don't want to participate? There might be information which I can provide which would open your mind to trying. The program is reliable and have been useful to other people who struggle with similar conditions as yours so we do strongly encourage you to try it. But you also have every right to making decisions for your own body and self, and I respect whatever final decision you arrive at. I only ask that we could take some time to listen to each other first."
Following the ethical principle of human dignity and consent, it's important to understand the reasoning behind the decision not to participate. There may be external/internal factors and emotions which are critically influencing the decision-making process. It would be helpful to first ask the client/patient what guided this decision—was it borne out of apprehensions, reservations, misinformation or lack thereof—which may be assuaged through empathic communication and education. Programs require effort, energy, and may be an emotionally taxing experience especially given their age and histories. This feeling of being highly vulnerable may triumph over their pre-existing ways of coping and agency/self-empowerment, which increases feelings of helplessness, leading to low help seeking behaviors and commitment. There may be certain interventions which should come first prior to implementing the program to help arouse motivation and clarify/soothe these genuine and valid feelings. Relationship building between nurse and client/patient is essential, and have been observed to lead to more successful therapeutic or treatment outcomes.
To those who were not able to comply with homework:
"It seems that you've been struggling with doing the homework for the program or are avoiding them altogether. I wanted to ask what's making it difficult for you? These homework are designed purposely for the program, and they serve as practice or exercise. Participation in the program is only one part of the healing the process, and these assignments are another. In what ways can we help you and/or you help yourself in committing to these?"
Similar to the previous question, it's important not to make assumptions about behaviors and instead inquire the potential reasons or causes from the clients/patients themselves. This form of communications is not meant as interrogations, but rather, as relationship and trust building. This consistent checking and assessment of their health status through narratives and story-telling also increases awareness, recognition, and may even facilitate insight. These behaviors may be done with full intent and conscious awareness, but they may also be done with unintentionally with poor awareness. They may also be mentally, emotionally, and physically occupied by other matters which are depriving them with the energy or drive meant for the homework tasks. Following the standards of care and ethics in nursing practice, person-centered approaches and trust are crucial elements in rehabilitation; and an open and empathic communication channel between patient and healthcare provider is one which is built steadily through genuine human encounter and interaction—getting to know patients as human beings just being human—appreciating their strengths and vulnerabilities, their successes and flaws.
Step-by-step explanation
The answer above was guided by insights from the following peer-reviewed and academic texts, which I also strongly encourage you to read as they offer valuable and richer insight on this important issue on the ethics of care and practice in nursing: