Question

Case 1 (typed please) this scenario is for fundamentals about Culturally Competent Care, Teaching, Learning, and Therapeutic Communication

Patient’s View

You suffered a back injury 15 years ago and have required around-the-clock pain medication since then to manage the pain. Today, your back is really hurting. The only position that relieves your pain is walking around. You ring your call button and ask your nurse for a dose of oral pain medication.

Nurse’s View

Your patient with a history of chronic back pain rings the call button and asks for pain medication. You enter the room and see the patient standing up and moving around. You don’t understand why they need pain medication if they are able to walk. The patient’s pain obviously isn’t that bad if they’re able to move!

Would the following responses by the nurse encourage communication or block communication? Why?

Nurse’s Response (in bold)	Is this a communication barrier? Why? What could be said instead?
Patient says, “Sorry for you calling you. My back just really hurts.” “Now, you know you are not a bother at all, it’s my job.”
Patient says, “I’m worried about having back pain so young. I want to be able to play with my kids.” “At least you are young and will bounce back from this back just fine - all you young people do.”
Patient says, “Is it possible for you to bring my pain medicine in every 3 hours, so I don’t have to keep calling you?” “If I were you, I’d focus on getting better so you don’t have to keep taking this pain medication and risk getting addicted.”
Patient says, “I needed my pain medicine an hour ago. I tried to wait but I couldn’t. My back hurts so bad!” Patient starts sobbing. “You’re not acting very grown up for an 48-year old. You should be happy you can still walk.”

Answer 1

The patient feels apologized for calling the nurse ,so it's the duty of nurse to care for him talking positively that he is not a bother or burden to anyone

This is a good response from the nurse encouraging him to bounce back to healthy life from this pain ,having the chances to revert back are really very high at this age with determination and follow up of the patient

The nurse could have explained in the way by telling that she will come and assess him every three hours for pain and if needed will administer as per the order,so that he may not be addicted to pain killer. A nurse when puts themselves for explanation can be little unsound because there are high chance of thinking that the nurse is mocking at the patient .So a comparison with other patients of his age can really give him confidence that he can also find a way or end to the problem.

This is a communication barrier which will make the patient feel very sad ,dissatisfied, frustrate or show anger to a nurse.This makes the nurse unprofessional .It is a duty of nurse to motivate not demotivate by telling that you have pain,but still you could walk is a good sign of your energy and recovering soon.n