Description of the Client
The client is a 76-year-old woman. She was born in Canada and moved to the United States at the age of 6 with her parents who came there to work and stayed for life. She is a widow. Her husband, who was five years her senior, died five years ago. She has three children who are married and have their own families. The client is White. She is Catholic and used to go to church every week. The woman worked as an accountant for over 50 years before she retired. Now she and her senior daughter volunteer in the community center on charity fairs. At present, the client lives with her senior daughter who is 50 years old, and her family in a house located in a peaceful community. She has a separate room with her entrance door that leads to the garden. Growing flowers has been her hobby for many years, and she dedicates all her time to this activity. She sells flowers to the local flower shop and thus makes some money. Her other hobby was reading, but she cannot read much because of eyesight problems. She visits a reading club for older adults at the community center on Sundays where volunteers come to read aloud.
The other two daughters live in the neighborhood. The client has seven grandchildren who visit her on weekends. They make an impression of a friendly and caring family. Her only relative apart from her daughters is her cousin. She lives in Canada and comes to the United States once in two or three years. The client had not had any particular health problems when she was young. She prefers healthy food and used to do yoga. At the age of 63, she was diagnosed with hypertension. She takes supportive therapy, and this condition does not substantially influence her quality of life. However, her daughter noticed some disturbing symptoms recently and the doctor diagnosed the early signs of dementia. The woman sometimes forgets the recent events, feels confused, or loses orientation. Most of the time she is active and looks healthy, but her relatives are worried that she can hurt herself or feel worse when everyone is at work. The woman regrets she did not visit her native country because she was always busy with work and family. Her dream is to stay healthy and in sound mind to see her granddaughters on their wedding days. She realizes that her disease is not curable and hopes not to become a burden to her family.
Type of Practice Setting
My practice setting was Adult Day Health Care Center. It was the first time I practiced in an institution of that type. Its primary goal is to serve frail elderly patients with certain disabilities, such as physical, cognitive, or emotional. Adult day health care center helps to preserve or improve the functional status of its clients. Also, it allows them to stay in their families and communities which helps to avoid being placed in nursing homes.
Number of Contacts with Client
I had ten contacts with the client. These were face-to-face contacts on a daily basis for two weeks. After two weeks, I was told that the woman went on vacation with her family and they were going to travel to Canada to visit her homeland.
Presenting Problem
The client was referred to the center by her daughter. After the first symptoms of dementia are revealed, the family tries not to leave the woman alone. Although her condition is not very serious at present, she sometimes feels confused or disoriented. All her children work full time and cannot stay with her during the day. They feel disturbed about her condition and the possible development of the disease, so they decided that staying at an Adult Day Health Care Center on weekdays could be a good solution. The client is a communicative and easy-going person, so she feels good in the company of equals.
Nature of Dissatisfaction
Despite my theoretical knowledge, I have experienced certain practice skill limitations while working at the Adult Day Health Care Center. During previous practices, I worked in a hospital unit, and my duties were different. At the day health care center, the duties of a nurse are more related to observation and general care than treatment. Of course, we control the patient concerning the administered medicine and provide help in case of necessity, but it differs from the common practice at hospitals. Moreover, I felt stuck because of my emotional condition. The clients of these centers are usually older adults with chronic or incurable diseases. Thus, the thoughts that I cannot really help to cure and my only duty is to provide care and reduce suffering were disturbing me at first.
I was too emotional, and it made me feel dissatisfied as a professional. For example, the first time the client told me about her husband and the history of their family I could not help crying which was not professional. On the whole, I was observing discrepancies between my professional duties and personal feelings. I felt stuck because of countertransference between the client and me. I became attached to this client more than to the others. She resembled my primary school teacher who was a very kind and smart woman. I suppose it could be noticed in my actions or non-verbal behavior because I was more attentive to her than to other clients. I guess the old woman was happy with my attention and dedication, but I realize that excessive attachment to one client leaves me less time for the others and is unacceptable.
Also, I experienced a lack of communicative skills. I suppose that for nurses occupied in such centers, communicative skills are as essential as the ability to provide care and treatment. I have more experience in patient care related to treatment and following prescriptions, but I do not have enough skill of long-term communication with patients in general and elderly patients in particular. I also felt stuck when the clients wanted to talk about their health condition because not all of them are aware of the seriousness of their condition. Thus, I had to find suitable words to comfort them because most of them are hypertensive and should avoid worries.
On the whole, I consider practice at Adult Day Health Care Center a useful experience. It revealed my experience gaps and skill limitations that help to define further directions of professional development. I have realized that continuous education and self-improvement are the necessary components of professional growth because the nursing practice is diverse and demands many skills.