Assign a primary nurse to patient if possible. Primary nursing provides consistency, enhances trust, and decreases the potential for fragmented care.- Provide a specific time (e.g., 10 minutes each shift) to talk with patient and family members. In many cultural groups, trust develops slowly and may be hampered by lengthy interviews.
- Provide specific, noncare-related time with patient each shift to encourage social interaction. Begin with one-on-one interaction and increase to group interaction as patient's skills indicate. Gradually increasing social interaction reduces patient's feeling of being overwhelmed and eliminates sensory input that may renew a cognitive or perceptual disturbance.
Follow the medical regimen to treat the underlying condition. The nurse is responsible for following the medical regimen and working with the physician to plan appropriate care.
Assess neurologic function and mental status every shift to monitor changes in patient's status; reorient patient as often as necessary: Reorienting patient and involving family members enhance patient's reality-testing ability and overall mental status. Scheduling a daily routine narrows patient's frame of reference, thereby decreasing the potential for increased confusion. - Call patient by name and say your name during each interaction.
- Tell patient the correct day, date, time, and place at least once per shift.
- Teach family members how to reorient patient and help them do so.
- Ask family members to bring patient familiar objects from home, such as clock, radio, and photographs.
- Post a structured schedule of daily activities in patient's room within visual range.
- Explain the schedule to family members and other caregivers to provide consistency and continuity.
- If delusions and hallucinations occur, don't focus on them; provide patient with reality-based information and reassure patient of safety to increase patient's ability to grasp reality and reduce fears associated with these disturbances.
- Help patient identify and use effective social interaction behaviors, such as increased eye contact, calling people by name, and asking questions. Teaching patient effective interpersonal communication helps in functioning more effectively in a social environment.
- Demonstrate respect for patient's privacy, personal belongings, cultural norms, and religious beliefs and practices to provide sensitive care to patients from varied cultural backgrounds.
- Give positive reinforcement for appropriate and effective interaction behaviors (verbal and nonverbal) to help patient recognize progress and enhance feelings of self-worth.
- Assist patient and family members in progressive participation in care and therapies to reduce feelings of helplessness and enhance patient's feeling of control and independence.
Initiate or participate in multidisciplinary patient-centered conferences to evaluate progress and plan discharge. In addition to patient and family members, conferences may include physical, occupational, and speech therapists; a social worker; the attending physician; and other consultants, as necessary. These conferences involve patient and family members in a cooperative effort to develop strategies for altering the care plan, as necessary.
Suggested NIC Interventions
Behavior Modification: Social Skills; Complex Relationship Building; Family Integrity Promotion; Family Therapy; Normalization Promotion; Support System Enhancement |