Information Giving and Counselling Skills Case Study

Information Giving and Counselling Skills Case StudyINTRODUCTIONAs health masters, every day we atomic topic 18 invited to represent patients presenting different bothers and which pauperisation various dissolvers or therapies such as medical checkup give-and- make, information giving, t apieceing, counsellor, etc. I am a trained nurse in dialysis and renal pathologies management and I work in dialysis unit of our hospital. My main role is to receive patients with renal pathology and preface them to the Nephrologist, to plan and to execute prescribed treatment for those who are diagnosed with renal failure. That treatment concerns in general renal replacement therapies homogeneous hemodialysis or peritoneal dialysis. For the following work, I have chosen one of our patients because of the following reasonsHe is a patient suffering of break stage renal disease and undergoing dialysis treatment since 2 years, he passed the first year under peritoneal dialysis just now by and by developed chronic peritonitis and for this he has been transferred for hemodialysis.He is waiting for renal transplantation just now now lacks fund needed for the processBecause of peritonitis he has received pain pill drugs for a long condemnation to relieve pain exclusively he finished by developing dependency to painkillers. Still now he continues to claim for painkillers while at that place is no valuable reason.He presents signs of anxiousness and depressionIDENTIFYING THE PROBLEMIdentifying leaf nodes problematicaly is the key of the success of hash out process. Problem exploration is an important step, because it permits counselor-client initial contacts and to map out the clients problem. For this, any the process has to be well prepared. The preparation concerns the client and the environment in which counselor-at-law provide be given. Concerning my client preparation, to get his consent, I have in front every(prenominal) explained him what is couns eling and what its benefits are for people undergoing it. Concerning the environment, all counseling sessions have taken place in our service, in one of our offices that I have chosen because its calm, well illume and aerated and where distracting conditions have been eliminated. We used chairs permitting to have various positions but every time it was possible, I arranged them in manner to permit face to face interaction. This arrangement permits us to avoid distractions and to have a full opened interaction. Counseling sessions were arranged to have place before each hemodialysis session, and I tried to avoid they went over 30 minutes. This has the purpose to permit my client to begin quietly his hemodialysis session.My client MV is a young expectant presenting various problems. After a careful analysis, I found that my client has various problems which need to be resolved by him ego or through avail from other people. Here, I found that needed answer could be categorized as fo llowingProblem necessitating other facilitate than counselingTreatment of abate stage renal disease the management of that condition is accomplished primarily by medication, diet therapy and renal replacement therapy. The initiators of the treatment are Physicians (Fink et al., 2001).Problems which may find solution with counselingAddiction to painkiller drugs treatment by painkiller began while my client was treated by peritoneal dialysis. He developed chronic peritonitis with intolerable abdominal pain. For the pain he received painkiller each time he claimed it. After stopping peritoneal dialysis and starting hemodialysis, my client continues to ask painkiller although we dont see a real reason for it. We concluded that he has developed dependency to painkillers. Understanding a variety of models and theories of colony and other problems related to sum total use, describing helping strategies for reducing the negative effects of substance use, abuse, and dependency are among competencies of a counselor in habituation (U.S CSAT, 2005).Problem which may find solution in combination of medical assistance and counselingAnxiety and depression which according to my judgement are due toWaiting a long time the renal transplantation without hope to find financial assistance for the process.Thinking to be useless for the familyAnxiety and fear of the future before he felt sick, he was going to begin university studies and has been obliged to stop themBrusque stop of painkiller treatmentCucor D. et al, (2007)recognized that depression is one of common mental health problem for people with End-stage renal disease. According to them, depression is one of factors influencing morbidity and mortality rates among those people.Various medications are used to fight anxiety and depression but to be more effective, medication need to be combined with other therapies like behavioral therapies. When associated, both medical and behavioral therapy, patient benefits from be tter lessening in symptoms and a lesser risk of setback (http//helpguide.org/mental/anxiety_types_symptoms_treatment.htm).The client has developed dependency on painkillers drugs and has been obliged to stop them without any psychological assistance to help him to do gentle withdraw from drug victorious. According to my assessment and a long time passed with the client, its for that problem that my client needs to be helped foremost and its around it I have chosen to work with him as also he has wished. It may be a hard task, but this will help the client and will help me to get more experienced because we are lacking experienced counselors.TRANSCRIPT OF PART OF MY COUNSELLING INTERACTION WITH MY CLIENTDuring counseling sessions, the counselor uses various techniques to interact with his client. Communication and interaction management skills are used during counseling interaction and their use depends on how the session is going. Here downstairs is a short transcript of one se ssion I had with my client.Myself you come just to present me problems which are stressing your life, could you tell me now about the intensity of each problem?Here I have used questioning skills to help my client to express himself and explore issues concerning his problems.Client As I told you in the furthest session, I have been suffering from chronic renal failure there are now more than 3 years. As you see it, I am young and I was about to begin my university studies when I felt ill. At the graduation, I was confident even though my doctor had told me that I will need long term treatment. Now when I think about my future, I rule hopeless. My studies stopped, I lost a lot of money with medical treatment, and I dont have money for renal transplantation, and for my unluckiness although he knows that I am suffering the doctor has stopped my injections of painkiller.Myself I understand you feel overburden by all those problems according to you which problem is mostly troubling yo ur life? What are your main concerns?Client actually its my continuous unrelieved pain.Myself Can you briefly speak about that pain?Here, focusing skills to bring my client to give a clear definition of the problem for which he needs our help.Client as you know it, I have started treatment with peritoneal dialysis. After 5 months of treatment I developed peritoneal infection which was causing me serious pain. Other patients who had the same problem in the past advised me to ask to my doctor to prescribe me Pethidine which relieves pain and permits to sleep.Here, active listening skills helped me to show to my client that I am attentive to what he is telling me.Myself how did you appreciate the treatment with Pethidine?Here also I used questioning skills to get full information which can help me to analyze the family relationship between my clients problems and his medical accounting.Client at the start it was wonderful to not feel pain and I was again able to close my eyes and sle ep.Myself and after?Client after, it became impossible for me to sleep without my injection and one injection a day was not sufficient for me. For this, all the day I was harassing my nurse to give up me Pethidine.Myself You told me that when you begin treatment with Pethidine everything was ok, no pain and you were able to sleep. So, how did you take it when the Nephrologist decided to stop Pethidine injection for you?Here I used summarizing skills to help my client to cover fixed on our subject pain. I asked him that question as a challenge to see if he will continue to tell me that he solace needs Pethidine injection.Client it has been a bad moment for me and up to now I dont understand him because I am still feeling pain.Myself how do you feel when you are at your home?His family members have told me that he is quite at home and claims to feel pain only when he arrives in medical facilities. I wanted to get deep information about his pain.Client Not very bad. I feel exaggerat ed pain when I come for treatment. notional UNDERPINNINGSIn this work, I have been using the client-centered approach. That approach of counseling has been conceptualized by Carl Rogers (1946). The fundamental belief turns around the idea that each soulfulness innately strives towards self actualization, in the other words to be the best that he can.Essentially the person or child centered approach extends the central conditions of empathy, no qualified positive regard and congruence to the client, facilitating, in a reflective and non directive way the clients exploration and harmonizing of his emotional and own(prenominal) issues that have been arisen from his lifes experiences.The target is, to help the client to give up the personal image which he has built around his individual experiencing (Mearns D. Thorne B, 2000 p5).This approach con slopers a client as an active agent, able to take responsibility for his own condition. Palmer reinforces this when he notes clients are encouraged to explore their most intimately held opinions and values, in order to discover for themselves, what it is that really matters to them, what it is worth living for or what would be worth dying for (Palmer, 1996p31).The respect of client is essential in this approach. According to Corey (1977) the strength of this approach come from its capacity to focus on preferences and pathways headed for personal growth. Emphasis is on freedom, responsibility and the persons ability to redesign his life through attentive choice.The counselor-client relationship is also essential to good practice of client-centered approach. To participate efficaciously in counseling, Freshwater (2003) claims that nurses necessitate to recognize the client as an equal, though as clients often view nurses as experts it can make this relationship difficult to obtain.Through this work I have been using the theories of motivational interviewing counseling, in which the main objective of the counselor is t o identify and work with the clients motivation to neuter. Motivational interviewing builds on Carl Rogers optimistic theories about peoples capabilities for exercising free choice and changing through a process of self-actualization (Alcohol answers, 21.8.2009).The therapeutic relationship counselor-client is a reciprocal partnership. The counselors role in motivational interviewing is directive, with a goal of eliciting self-motivational statements and behavioral change from the client in addition to creating discrepancy to enhance motivation for positive change (Miler and Rollnick, 1991).As healthcare providers, we are often asked to act as change agent for our patients, students, and colleagues. When we play that role we try to help people make necessary behavior changes by instructing them in the whys and hows of making them. We may have been trained to believe that if we simply teach our patients what they need to do to change and do it effectively enough they will change (E llen R. Glovsky, and Gary R., 2007).In our daily work, tendency is to think that our clients need only medical assistance, but when we try to analyze the situation, we may find that we are wrongful. any clients needs are not answered by medicines or other medical and nursing interventions. Most of the time, we ignore the socio-psychological aspect of the problem. This is remarkable with chronic renal diseases like end stage renal failure, diabetic nephropathy, cancer, etc.Sensky (1993), in his work, showed how renal failure impacts on persons life. The impact doesnt only concern the physical condition but the whole person. With renal failure, various alterations come in the life the patient has to learn new skills and strategies which can help him to cope with his condition. The patient has to attempt to hold to his chronic illness and the necessity to deal with dependence on dialysis machine or other elses kidney to continue to live.In their works, (Levenson, 1991 Kimmel, 1993, a nd Finkelstein, 2002) recognize that anxiety and depression are the most common psychological problems in dialyzed patients. The same idea can be found in the work of Chilcot and his colleagues. They found 20% to 30% of End stage renal disease patients with signs of depression at various levels (Chilcot, Al., 2008).The other problem found in patients undergoing long term dialysis is a possible addiction on pharmaceutical drugs like painkillers (Manjula, Bennett, Chertow, 2003).Addiction is defined as a state characterized by impaired controlover the use of chemical substance and/or behavior. This top off the addict to seeking and abuse of drugs, a need to continue to take drugs to which both(prenominal) one has become habituated following a repetitive utilization because it produces some special effects like euphoria and other types of mental status alteration. Clinical manifestations occurbeside physical, psychosocial and apparitional dimensions (College of Physicians and Surge ons of Saskatchewan, 2008). accustom substances are like alcohol, stimulant substances like cocaine, heroine, marijuana, and medicines like tranquilizers and painkillers.Others may habitually mix prescribed drugs with alcohol to numb the mind from staying on disappointments or personal conflicts. Many people persist in taking medications to feel better physical or psychologically even when no ailments are present and some insist that they cant function without them. Statistics indicate that, the number of visits in emergency room for prescription and illegal drugs overdoses are the same and that individual abusing medical drug like codeine can be just as given up as the one who abuses of illegal drug like cocaine. While prescribe medicines is absolutely legal, ethical and moral laws prohibits the use of medicines for purposes other than the original aim. devoted people need therapists specialized in chemical dependence counseling and who can help them to recover from the addiction by reviewing past medical history and patterns of substances abuse. Most of the time counselors discover that long term abuse has produced undesirable psychological and physical effects. The case presented above concern a patient prone to Pethidine, a painkiller of opioids pharmacological family. Addiction to opiates like morphine can occur after chronic pain suffer is given dosages to control cunning discomfort, and continues its use long after pain has collapsed (ChristiaNet, 2009).Many people with long-lasting pain receive treatment by opioids. But, there are evidence throwbacks and side effects that may follow this treatment. Developing tolerance to drugs is one major risk, sometimes at short time. The second major risk is the development of addiction. Addicted people to painkillers becomeso fixated on getting more of them that the obsession prevail over the medical target of relieving pain (Media Planet, 2009).COUNSELING IN ADDICTIONThe focus of individual drug counseling is on the symptoms of substances addiction. It also relates areas of weakened function and the structure and content of the clients ongoing rehabilitation program. The first target of counseling in addiction is to support the addict to achieve and maintain abstinence from addictive substances or behavior. The second target is to aidthe addict to recover from damages which have caused by addiction in his life (Delinda E. Georges W., 1999).The addicts counselor works firstly by helping the client to be aware of the reality of a problem and the connected unjustified thinking. In the next steps, client is stimulated to achieve and uphold abstinence from accustom substance or behavior. This can help to develop needed psychosocial abilitiesand spiritual growth to remain in recovery process (Delinda E. Georges W.).ADDICT INDIVIDUALIZE COUNSELING PROCESSCounseling as a helping process consists of 3 main phases. Each phase has its distinct aims although the same skills may be used in those 3 phases. Those three main phases areExploration, assessment and mean phaseIn this phase, the main objectives are to apprehend the client as a whole person, to plan counselors interventions, and to arrange an agreement between counselor and client. refilling counseling and goal achievement phaseCounselors objectives in this phase are the initiation and implementation of his treatment plan in collaboration with his client.Termination and evaluation phaseIn the closing phase, objectives are to conclude treatment process and deliberate its outcome with the client, and to arrange agreement on up approach actions.renewal and elapse preventionIn addiction counseling, the objectives of the all process are to rehabilitate the client from the addicted substance or behavior and to prevent the relapse.RehabilitationRehabilitation may be defined as the process consisting in recovering the capacities that have been reduced due to injuries or illness. The recovery is sustained only when there is no relapse or return back to addicted substance or behavior. Here, the goal of counseling is to lead the client to a full reintegration into his conjunction as dynamic and valued person. Each time its possible, detoxification comes first, and after can be started the laying of the basis of rehabilitation process. Abstinence from addicted substance or behavior is not enough in itself. The addict has to see the profits of staying abstinent otherwise he can relapse at short or long term (United Nations International Drug Control Program, 2003).Individual addiction counseling doesnt only focus on stopping or reducing addicted substance or behavior. It will also address the other related domains of impaired functioning and those are such as social relations, illicit activities, practice session status, etc. When additional helps are needed, the counselor is advised to refer the client (U.S National institute of Health, 2009).RelapseAbove, I have mentioned that counseling process ha s to help client to maintain abstinence after the recovery period, otherwise the client can relapse and return back in addiction.What is a relapse?thither is a relapse when, a client in recovering period or in post recovery, returns to the addicted substance/behavior or becomes addicted to a new substance.Prevention of relapse in counseling processPreventing relapse is a very important element of recovery. When the client becomes able to fix some constancy in abstinence, he could begin to develop skills to put off future relapse to addicted substance/behavior. To prevent relapse, the addict has to be taught how to identify in advance, when he is headed near a relapse and to modify course of events. Through counseling process, by education, the addict can identify indicators of coming up relapse. Those indicators are like negatives changes in clients behavior, feelings and attitudes. Once the client became conscious of the environment of relapse process, his next mission is to build up the skills to intervene and change any occurring negative behavior or feelings (Delinda E. Georges E.)SELF-EVALUATIONI am not a schoolmaster or trained counselor. I am only a student in nursing studies who is trying to apply learnt counseling skills. I have chosen to work with my client about his addiction. I know its a very complicated subject for a beginner in counseling, more experience is needed. Difficult to handle that subject has stimulated and encouraged me to do move on reading and researches concerning addiction what is it, its causes, its management by a combination of counseling and other ways of help like pharmacotherapy. During my counseling process, in my clients needs assessment I was more influenced by medical side of my clients problems. The social situation of the patient has not been full analyzed and I think that this can a bit weaken the problem exploring process. The second difficult is to know borderline between intervention domains of a professional c ounselor and a health professional who applies counseling skills to help a client. We may think that its easy but in practice its very complicated. You ask yourself Does the clients problem need a professional counselor or a skilled health professional can help?This can lead us to be fluctuating in our practice. I suggest here to insist on this point during elaboration of Professional practice and counseling skills module. My strength now reside in fact that I can now lead counseling process without apprehension, methodically and without asking about the beginning or next stages. To help my client, I didnt consider medical data as enough to conclude that my client is addict. I have spoken with my client but it was necessary to know what his family thinks about him. For this, I had backchat with some members of his family about my clients problems and needs. From the family I received information reinforcing the medical diagnosis of addiction. I consider this as a positive point, be cause we have to check the all environment of client to get real and full information which can help us during counseling process. Not long time after the beginning of my counseling sessions, my client begins to withdraw progressively from his constant obsession to receive Pethidine injection and stop to advise other patients to ask that drug. He was suffering from end stage renal disease a chronic condition so we had many counseling sessions to prevent relapse. We didnt continue to work together he died before the termination of our counseling process but all this process has been helpful for him and full of experience for me.