Week 4 Discussion

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Chamberlain University College of Nursing *

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509

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Communications

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Feb 20, 2024

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docx

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Uploaded by SargentGoldfinchMaster678

An adolescent client who is reluctant to answer questions. a. Create a scenario depicting an interaction between an NP and a client. Describe the setting and type of encounter. The encounter is an initial assessment session between a Nurse Practitioner (NP) specializing in adolescent mental health and a 15-year-old client named Alex. Alex has been referred to the NP by a school counselor due to concerns about declining academic performance and changes in behavior. NP: (smiling warmly) Hello, Alex. It is nice to meet you. Please make yourself comfortable. Alex: (nervously) Hi. NP: I understand that coming here might feel awkward or uncomfortable, which is okay. This is a safe space for you to express yourself. We can take things at your pace. Alex: (nodding) Thanks. NP: I would like to get to know you better. What are some things you enjoy doing in your free time? Alex: (shrugging) I do not know. I am hanging out with friends, I guess. NP: That sounds great. Friends are important. What activities do you usually do together? Alex: (hesitant) Uh, just stuff. You know, like watching movies or playing games. NP: (nodding) Cool. It is important to have those connections. Are there any specific things you have noticed that made you feel different lately or challenges you are facing? Alex: (looking away) Not really. NP: (gently) It is okay if you are not ready to share that. We can take our time. I am here to support you. How about we explore some of your strengths? What do you think are some things you excel at? Alex: (pausing) I do not know, maybe art? NP: (enthusiastically) That is fantastic! Art is a wonderful way to express emotions. What kind of art do you enjoy creating? The NP continues the conversation in a non-threatening manner, gradually building rapport and creating a comfortable atmosphere for Alex to open up. The goal is to establish trust and encourage communication, even if it takes time for the adolescent client to share their concerns. b. Describe the client’s challenging behaviors related to the topic assigned. The challenging behavior exhibited by the adolescent client, Alex, is the reluctance to answer questions and a general hesitancy to engage in open communication. Alex's initial responses are brief, vague, and guarded, indicating a reluctance to share personal information or emotions. This behavior may be indicative of underlying discomfort, anxiety, or a lack of trust in the therapeutic process (Srinath et al., 2019). Limited Verbal Expression: Alex responds with minimal words, such as "hi," "hanging out with friends," and "I do not know." This limited verbal expression suggests a reluctance to elaborate or provide detailed information. Avoidance of Eye Contact : Alex avoids direct eye contact, looking away when responding to questions. This behavior may signify discomfort or unease with the interaction, possibly due to feelings of vulnerability. Physical Discomfort : Alex

may display signs of discomfort, such as fidgeting, crossing arms, or appearing tense. These non- verbal cues indicate that the client may be experiencing emotional distress or apprehension. Deflection of Questions : When asked about challenges or changes in behavior, Alex deflects by responding with "not really" and avoiding any specific details. This behavior suggests a reluctance to discuss potential issues or concerns. Limited Self-disclosure : Alex does not readily share personal interests or strengths, responding with uncertainty and hesitation. This limited self-disclosure may indicate a guarded attitude and a reluctance to be open about personal aspects of their life. To help with challenging behaviors, you can use therapeutic techniques to make Alex feel safe and comfortable. Ask questions, listen actively, and show empathy to encourage Alex to open up about their experiences and feelings. It is important to go at Alex's pace and build a strong relationship over time to ensure they feel comfortable with the therapeutic process. (Wilkes & Anderson, 2020) . c. Examine the potential impact of the client’s behavior on the client-provider relationship. The client's behavior, characterized by reluctance to answer questions and limited engagement, can impact the client-provider relationship. Understanding these potential impacts is crucial for the healthcare provider to tailor their approach and interventions effectively: Trust and Rapport Building: The client's guarded responses may hinder the establishment of trust and rapport. Trust is foundational for effective therapeutic relationships, and if the client feels uncomfortable or hesitant to open up, it may impede the development of a strong alliance. Communication and Understanding : Limited verbal expression and avoidance of questions may lead to a lack of communication and understanding. You may struggle to gather essential information, hindering your ability to assess the client's needs and challenges comprehensively. Client Engagement in Treatment : Reluctance to engage in open communication may result in decreased participation in the therapeutic process. If the client feels disconnected or disengaged, it can impede their willingness to collaborate actively on treatment goals and interventions. Exploration of Underlying Issues: The client's avoidance of discussing challenges or changes in behavior may hinder the exploration of underlying issues. Without a deeper understanding of the client's concerns, you may struggle to address root causes and develop an effective treatment plan. Client Satisfaction and Comfort : The client's discomfort and guarded demeanor may contribute to a less satisfactory therapeutic experience. If the client feels uncomfortable or understood, it may impact their overall satisfaction with you and the treatment process. Therapeutic Alliance : The formation of a therapeutic alliance, characterized by mutual trust, respect, and collaboration, may be compromised. The provider-client relationship is a key factor in achieving positive treatment outcomes, and the client's reluctance may hinder the development of a strong alliance (Bickley et al., 2020). To create a safe and supportive environment, you must employ empathetic communication, active listening, and patience. Validating and exploring clients' concerns can help them express themselves at their own pace and increase their comfort level in the therapeutic relationship. d. Analyze techniques to enhance communication and address the client’s behavior.

Enhancing communication with a reluctant client involves employing techniques to foster trust, comfort, and openness. Addressing the client's behavior requires a sensitive, patient approach (Wilkes & Anderson, 2020) . Here are some methods that you, as a Nurse Practitioner (NP), can use: Active Listening: Demonstrate active listening by maintaining eye contact, nodding, and providing verbal affirmations. Reflect on the client's statements to show understanding and encourage them to share more. Empathetic Responses : Use empathetic responses to validate the client's feelings and experiences. Express understanding and acknowledgment of their challenges, creating a non-judgmental space. Open-Ended Questions : Ask open-ended questions to encourage the client to share more detailed information. Instead of yes/no questions, prompt them to elaborate on their thoughts and feelings. Normalization: Normalize the client's feelings and behaviors to reduce stigma and assure them that their experiences are valid. This can help create an environment where the client feels more accepted and understood. Psychoeducation : Provide information about the therapeutic process, the purpose of the assessment, and the potential benefits of open communication. This can help demystify the process and alleviate concerns. Strengths-Based Approach : Highlight the client's strengths and positive attributes. By focusing on their abilities and positive aspects, the healthcare provider can build the client's self- esteem and encourage a more open dialogue. Cultural Sensitivity : Be culturally sensitive and aware of the client's background. Understanding cultural nuances and preferences can create a more inclusive and respectful communication style. Use of Non-Verbal Cues : Pay attention to the client's non-verbal cues and respond accordingly. If the client appears uncomfortable or distressed, acknowledge those feelings and adapt the communication approach as needed. Collaborative Goal Setting : Involve clients in setting treatment goals and objectives. Collaborative goal setting fosters a sense of autonomy and investment in the therapeutic process, motivating the client to participate actively. Building Gradual Disclosure : Respect the client's pace and comfort level. Allow for gradual disclosure instead of pressuring them to share everything at once. This approach helps build trust over time. Therapeutic Relationship Building : Emphasize the importance of the therapeutic relationship. Reassure the client that you support them and work collaboratively towards their well-being (Bennett et al., n.d.). e. Create sample documentation for the encounter. Subjective: The session began with a warm greeting. Alex, a 15-year-old client referred by the school counselor, presented with concerns related to academic decline and changes in behavior. The client appeared hesitant and reluctant to engage in open communication initially. Objective: Alex displayed limited verbal expression, responding with brief and vague answers. Non-verbal cues included avoidance of eye contact, fidgeting, and signs of physical discomfort. The therapeutic environment was designed to be comfortable and inviting.

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The NP employed active listening, open-ended questions, and empathetic responses to encourage communication. The client gradually disclosed an interest in art as a potential strength. Assessment: The client's behavior indicated a reluctance to share personal information, possibly due to discomfort or unease. Initial assessment suggests building trust and rapport to address underlying academic performance and behavior concerns. Plan: Schedule follow-up sessions to continue building rapport and addressing concerns. Utilize communication-enhancing techniques such as active listening and open-ended questions. Explore underlying issues contributing to academic decline and behavioral changes. Introduce psychoeducation to enhance the client's understanding of the counseling process. References Bennett, E. D., Le, K., Lindahl, K., Wharton, S., & Mak, T. W. (n.d.). Five Out of the Box Techniques for Encouraging Teenagers to Engage in Counseling. American Counseling Association, 3 , 1–17. Retrieved from https://www.counseling.org/docs/default-source/vistas/encouraging- teenagers.pdf Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2020). Bates' Guide To Physical Examination and History Taking (13th ed.). Wolters Kluwer Health. Retrieved from https://ambassadored.vitalsource.com/books/9781975109943 Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical Practice Guidelines for Assessment of Children and Adolescents. Indian Journal of Psychiatry, 61 (Supp 2), 158–175. Retrieved from https://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18 Wilkes, M. S., & Anderson, M. (2020). A primary care approach to adolescent health care. The Western Journal of Medicine, 172 (3), 177–182. Retrieved from https://doi.org/10.1136/ewjm.172.3.177

Week 4 Discussion

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