Introduction

Description of the Clinical Situation

Found patient crying in the middle of the shift.

Patient stated that she used to be a very strong and independent person and
because of her condition, she can no longer move by herself. She constantly needs
help and feels helpless and powerless. She said she no longer has control of her
life. She cannot move without assistance.

Patient usually in bed, cannot complete ADLs as she has diminished energy,
always in pain, has pressure ulcer in sacral area stage 3.

Patient had rectal prolapse (part of the rectum about 3inches is out), bleeding.
Patient is using wheelchair to help her walk.

Patient is seeing physical therapist.

Patient needs to have surgery done but will not be done until she is stable enough
as stated by the general surgery physician.

She lives alone, no family.

Discussion of Relevance of Clinical Situation/ Topic Both Personally and
Professionally

Need to develop Therapeutic communication for me to be really able to build

rapport with patients but also make sure that there is still professional boundary.
English is not my first language.

Need to learn how to give advice without giving false reassurance.

Need to know resources to help patient cope with her feelings of hopelessness and
powerlessness.

To be able to empower patients and/or provide empowered based interventions

Identification, Discussion and Analysis of 3 Issues of the Concept Within the Clinical
Situation

Powerlessness
Issue 1: Ineffective coping
5 -10 bullets why she is having that or why she has that

Patient is unable to complete her usual activities of daily living.

Patient is unable to perform self-care activities.

Verbalization of negative feelings and inability to function effectively with the

disease process

Patient feels overwhelm with what is going on.

Patient is always sleeping and verbalized inability to cope.

Lack of social support.

Inability to meet needs for pain management.

Inability to meet role expectations.

Issue 2: Lost of Hope/Hopelessness

Patient verbalized feelings of being helpless and hopeless of her condition.

Patient feels isolated and alone.

Patient thinks she is dying.

Patient is in bed all day, no motivation to really get up and do activities.

Lack of initiative and interest with daily life activities.

Patient is passive with her care.

Patients condition is unstable as a result limits treatment options.

Issue 3: Impact of institutionalization

Patient verbalized lack of control with what is going on with her body, as patients
condition needs to improve before surgical intervention can be done.

Patient has to follow routine hospital schedule.

Patient feels restricted with what she wants to do and what she can do while in the
hospital.

Choosing not to follow through with suggested treatment. Patient refused to be

walk with a physiotherapist as she felt too tired to walk around. Also, she is in a
lot of pain.

Patient has to adhere to taking medications.

Discussion of How My Future Practice May be influenced

Summary

Patient has a lot of physical limitations.

Patient has no control over what is going on with her life and her body.