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Final Blog Post

My first clinical experience as a CNA is what made me fall in love with the profession of nursing. At that time, I comforted an older adult with dementia. She had aphasia, and I listened and nodded as she babbled to me, letting her know I was listening while  empathizing with her. The change I was able to make that day for this woman was profound, and the idea there was a career where I could do that was incredible. Therefore, I was very excited to get to go back into that clinical setting this year. Being with people is what drew me to nursing in the first place! I was also really excited to take this class. Communication is so important, but I know I am not always good at it. Anxiety can get the best of me, and sometimes I overthink on what the right thing to say is. That definitely happened in clinical this semester. There were times when I struggled to connect with a patient or could not find the “ perfect” words I was pressuring myself to come up with. In clinicals, I was often amazed at the ease of which some HCP joked with patients or carried on natural conversation. I feel really really confident in my ability for empathetic and deep conversation, but the natural and light-hearted talk is more difficult. In general, communication at East Hospital did not come as easily as it had in previous clinical scenarios. In the past, I have worked for long-term dementia care units or been employed to care for children and young adults with mental and physical disability. As I grew up with a brother with Down syndrome, I excel at communication with adults with mental disabilities and patients with dementia. However, I was surprised that I had a harder time communicating with the more alert patients. This class really helped me to navigate those struggles. In both the clinical setting and with my own peers, I have become so much better at therapeutic listening skills. Also, this class made me realize how often I used to say “I’m sorry” when that was often not a helpful statement. I also recognized certain terms I used that may upset patients, such as saying elderly instead of older adults or using the term “shot” when talking to a child. I recognize now some of my inherent biases and need to be aware of those when practicing. I also feel more confident in my ability to care for and advocate for various patient groups. I definitely still have a lot of work to do. My communication could be much smoother, and I have come to realize that the pressure I put on myself for “perfect” communication is actually a barrier to my communication! I especially want to grow in my ability to connect and have natural conversation with patients. I think that will come with more experience as I feel more comfortable in patient-care settings. Regardless, I am very excited to get back into clinical practice as soon as possible to keep practicing those communication skills. In the meantime, I have been really cognizant of trying to be an empathetic listener and use therapeutic communication techniques in my daily conversations. Those skills have actually been very helpful in keeping good communication and peace within my own family during these crazy times! Thanks for all you have taught me this semester. I really enjoyed this class.

The Good Doctor

This blog was actually such a perfect assignment. I have been getting into the Good Doctor lately, a tv drama that follows a young doctor with autism named Sean. Sean is incredibly brilliant, virtually unbiased and incredibly resilient. However, he struggles with social awkwardness, sensory overload problems, and difficulty with communication.

The Good Doctor 2017.png

I decided to pick a specific scene in the second episode. Sean walks in while the team is assessing a scan of the patient’s thoracic cavity. The team starts making guesses about possible diagnosis based on looking at the scan. Already, this is kind of unrealistic. I don’t think a doctor would start guessing diseases in the presence of a patient. I guess on one hand, it is good for the patient to be informed on the doctor’s thinking. We talk about how providing inform

ation can be an important part of therapeutic communication. However, we should only be providing relevant information; glancing at a scan and starting to guess diagnosis’ in front of the patient does not help the patient. Instead it can cause fear, anxiety, and even confusion. After thinking for a second, Sean decides (just based on the scan) that the patient has malignant lymphoma. Scared, the patient asks “that’s cancer- does that mean it’s killing me”. Sean immediately chirps back “yes”, leaving all the team and the patient in shock, and one of the other residents then tried to comfThe Good Doctor IDont Understand GIF - TheGoodDoctor IDontUnderstand Confused GIFsort the patient and reassure her she was not dying.

Several communication issues are at hand here as well. First of all, Sean does not practice empathy with the patient. Sean is also not practicing active listening. His autism prevents him from being able to read the non-verbal cues of the patient and talk to her in a way that is therapeutic and in the best interest of the patient. At the same time, falsely reassuring the patient she was okay was not exactly helpful either. Ideal therapeutic communication would have been perhaps to speculate cancer and explain that to her, wait for test result, and finally give the diagnosis sis to the patient while explaining all her options and listening to her feelings about the situation.  

Despite these communication barriers Sean has, Sean’s unique communication offers him some advantages over other doctors. Sean does not give false reassurance. He does not lie to patients. He does not harbor secrets. Sean does not argue, get defensive, or cross patient relationship boundaries. 

 

Blog Post 3: Communication at Clinicals

So far, I have had very few communication challenges. I have only had two patients. My first patient was not fully alert and oriented, so I had to adjust my communication to that. It was a little odd for me at first. When I worked on my memory-care and dementia floor at the nursing home, we didn’t attempt to reorient a lot of the patients. We were taught to “enter their reality” and speak to them therapeutically in that way. At the hospital, I had to remind myself to orient my patient. When she did not correctly answer the date, I gently reminded her it was the end of January, and the next Holiday approaching was Valentine’s day. This easily led into a conversation about Valentines and her husband who passed. Other than the lack of orientation, my first patient was very kind and easy to communicate with. She was about to be dismissed, so there was little for me to communicate to her regarding her care

My second patient was also quite fine. However, for the sake of the assignment, I will say out of the two patients and clinical experiences, my largest communication challenge occurred with him. My patient was very tired after having been kept up the entire night getting admitted to the E.D and then into the hospital and going through initial hospital entry protocols. Several times I went into his room to find him sleeping. This was a barrier to me being able to do some of my vitals, Health assessment and rounds. I contribute to this challenge because if I wake him constantly, I jeopardize both his health and temperament. However, I made it a point to wake him gently for necessary vital signs, and I let him sleep in other situations where I could just peek into the room to check on him.

I am excited to continue to communicate with patients. I know more “difficult” patients will likely be in my future, and I am glad to know techniques now to appropriately address any communication issues I may come across.

Blog Post 2: An Afternoon at the RPAC

I am no stranger to people watching. Ever since I was a little kid, I have loved to go sit somewhere and observe those around me. Some of my favorite places to ease-drop and observe are at coffee shops, long lines, parties, before and after class when everyone is settling in, etc. The world really has some interesting people in it!  Therefore, it was exciting that one of our assignments was to go observe. However, I never had observed people before with the purpose being to examine communication, so this was a new experience for me.

A buzzing place on campus is the RPAC; on Saturday afternoon, I casually walked around the gym area, doing some light exercises to blend in.

After absorbing what was happening around me, I started to search for verbal communication patterns. Verbal communication is pretty easy to recognize, and I did not see much out of the ordinary. Some forms of verbal communication I observed are people casually chatting with each-other. Some people watching TV or listening to phones while working out. In this case, communication served as a distraction for them from the pain or boredom of working out. This made me think that perhaps in a hospital setting patients might want to chat or watch t.v. as a form of distraction from pain. There were also written instruction around the gym intended to keep people safe and let guests know how to appropriately use equipment. Finally, there were written announcements posted all throughout the RPAC letting students know about upcoming events, opportunities, etc.

However, the real deal at the gym is non-verbal communication. I knew from class that non-verbal communication can consists of posture, appearance, facial expression, tone, eye-contact, gestures, and more. To start, posture helped me figure out quickly how tired a person was. All around me were guests hunched over, hands on knees, breathing heavy, collapsing back after a tough set, etc. In the case of the gym, posture was less indicative of mood like boredom vs. excitement but more indicative of physical exhaustion. Next, appearance at the gym is super interesting. The first thing I noticed was that the gym is a place where some social rules can disappear. For example, it is acceptable for a professional  to come workout and wear sweatpants and a t-shirt. A grown man might wear short shorts. A girl may walk around in just a sports bra and leggings. On the other hand, some students were in there with fully matching workout outfits and full hair and makeup. I wondered what these appearances might be trying to tell me. Was the girl with the full makeup rushing from somewhere and didn’t have time to take it off? Was she using makeup because she loved it and it made her feel good while working out? Was she using makeup because she is insecure to be working out without it? Facial expression also gave a lot away about people. I saw many grimaces and scowls, but in the context of the gym, I don’t think these people were angry. They were in pain! I also saw many smiles- gotta love those post-workout endorphins! Tone was harder for me to pick up on. I didn’t hear too many people talking. I did notice though a few guys yelling at each-other in an encouraging manner. I also noticed some of the signs in the RPAC were bolded or capitalized; this helped emphasize the importance of the message. As for eye-contact, it occurred to me that many guests avoided eye contact. Perhaps going to the gym is a private activity for some people? It is funny that I have been told before that the gym is a great place to meet new people, yet I did not see anyone at the RPAC engaging socially with someone they didn’t come with originally. Finally, gestures were important in the gym as well. There were random people just using hands as normal when talking. There was a trainer motioning to a guy how to lift weights, and  all of the workout equipment had pictures showing how the equipment was supposed to be used and which muscles it would work. As a beginner when it comes to lifting, that is super helpful!

Technology usage in the gym consisted of people talking and texting on phones, videos and media used to lead someone’s workout, using t.v. and music for distraction, scales, etc. I actually used a blood pressure machine while I was there too! That was super cool to me because it let me know what my current BP and HR was and also had written on the machine what numbers were “good” and when to seek medical assistance. This could be lifesaving in the gym if someone happened to workout to hard or was curious about their health and ended up discovering medical problems.

All in all, this was a fun project. I enjoyed seeing how people communicate around me, and the next time I find myself people watching, I plan to take note of their communication patterns as well!

Blog Post 1: About Me

Hi Prof. Newtz. My Name is Ashley Boldt, and I am very excited to be in this course. Here is a little more about myself.

I was born and raised in the suburbs of Chicago with my older sister, an older brother with Down syndrome, and my parents. I was not originally a Buckeye nor was anyone in my family. My parents and sister attended The University of Illinois at Champaign/Urbana and my house bled Orange and Blue. When I applied schools my senior year of Highschool, neither OSU nor U of I made the list. In 2017, I started college at the University of North Carolina at Chapel Hill as a Chemistry Major on the Pre-Med Track. As a Freshman I got super involved on campus in a public health organization, a research job, and two social justice groups called “Rethink Psychiatric Illness” and “Embody Carolina”. It was these social justice and public health groups as well as a bad experience with multi-variable Calculus that made me decide Chemistry and Lab research was not my end plan. Instead, I discovered an interest in public health and considered majoring in Nutrition or Public Health Management, but I still was not quite sure. I also was not sure if I wanted to stay pre-med or consider other career paths. That following summer, I decided I needed some time for self-discovery, and I opted to take the Fall semester off from school. During that semester, I got my CNA license, and that is when everything changed for me. I remember my first day of clinicals as a CNA being so powerful for me. I described it in my insert below from my nursing school application.

 “On my first day, I met Elsie , a woman living with Dementia and Aphasia, who also hated showering. It was after a tough shower that I found myself alone when she began to sob. Surprisingly though, I felt calm. She was scared, confused, and alone, so I squeezed her hand and said what I would want to hear if I were frightened, “You are safe and okay”. I repeated the phrase as I combed her hair until she started to babble at me. She seemed to be explaining why she was upset, and it reminded of me of when my brother babbled as a kid. I listened intently to her and nodded, softly offering validation, even if I could not understand. When I finished braiding, she beamed in the mirror and seized me into an embrace; my heart was so full. After that, I knew it was not a career in healthcare that I craved; it was a career in caregiving and connection. She often did not remember me, but each day we “chatted”, sang, or hummed together. It amazed me how much we could connect despite barriers and how our connection allowed her to feel safe as I cared for her.”

After that first day of Clinical, I new that patient care and interaction was what I needed. I had never considered nursing before that class, but after observing all the nurses around me, I started to investigate. It turned out nursing had everything I needed for my ideal career path! Nursing provided me the ability to participate in public health and policy work, patient interaction and advocacy, research opportunities, a possibility for higher education, the ability to specialize or not, and the opportunity help people achieve the 8 pillars of health and wellness.

Getting to Ohio after that just seemed right at the time. I wanted to be closer to home. I missed living next to a city. I had cousins and friends in Columbus, and OSU had a great nursing program that fit my family’s budget. Now, I am here. I wear Scarlet and Red, and I hate both Michigan and Duke.  Go Tarheels! Go Bucks!

Two topics that greatly interested me were psychiatric illness and mental health throughout campus as well as women’s health, especially considering hormones and eating disorders. I am involved in the Honors Program, semester of service “rethinking addiction” and intern at The Ohio Citizens Advocates for Recovery Center in Columbus. Throughout my career, I hope to help break down barriers to mental health and substance abuse treatment for those in lower income neighborhoods and underdeveloped countries. I also hope to improve and advocate for Evidence Based Practice in what I consider to be the highly unregulated field of psychiatry and psychology. 

Apart from nursing, I love to sing. On campus, I am a member of The Ohio State Women’s Glee Club as well as Scarlet and Grace notes, Ohio’s First Female Acapella Group. I love making music and traveling with these women. I also am in Delta Zeta Sorority and love to dance on the sorority’s dance team each year. 

I am so excited for this course. I love talking to people and firmly believe communication is core to any sort of professional or personal relationship. I look forward to learning this semester and improving these skills. 

Also, here is a fun little video of my Acapella Group at our Fall Cabaret!