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a. Create a scenario depicting an interaction between an NP and a client. Describe the setting and type of encounter.
b. Describe the client’s challenging behaviors related to the topic assigned.
c. Examine the potential impact of the client’s behavior on the client-provider relationship.
d. Analyze techniques to enhance communication with the client and address the client’s behavior.
e. Create sample documentation for the encounter.

Sample Solution

Scenario: Nurse Practitioner (NP) and Client Interaction

Setting: A community health clinic in Kisumu, Kenya.

Type of Encounter: Follow-up visit for a patient with chronic hypertension.

Client’s Challenging Behaviors:

The client, a 55-year-old man named Joseph, exhibits several challenging behaviors during the encounter:

  • Defensiveness: Joseph becomes defensive when the NP asks about his adherence to medication. He denies any missed doses, even when presented with evidence to the contrary.
  • Minimizing Symptoms: Joseph downplays the severity of his hypertension, claiming that he feels fine despite elevated blood pressure readings.
  • Lack of Motivation: Joseph expresses a lack of motivation to make lifestyle changes, such as improving his diet or exercising regularly.

Impact on Client-Provider Relationship

Joseph’s challenging behaviors can negatively impact the client-provider relationship in several ways:

  • Communication Breakdown: Defensiveness and minimization can hinder effective communication and make it difficult for the NP to provide appropriate care.
  • Decreased Trust: If Joseph feels judged or misunderstood, it can erode trust in the NP and the healthcare system.
  • Non-Adherence: Joseph’s reluctance to make lifestyle changes may lead to non-adherence to his treatment plan, which can have serious health consequences.

Techniques to Enhance Communication and Address Challenging Behavior

  • Active Listening: The NP should use active listening techniques to demonstrate empathy and understanding. This involves paying attention, reflecting back what Joseph has said, and asking clarifying questions.
  • Empathy and Validation: The NP should validate Joseph’s feelings and experiences, even if they disagree with his perspective. This can help build rapport and reduce defensiveness.
  • Motivational Interviewing: Using motivational interviewing techniques can help Joseph identify his own reasons for making lifestyle changes and increase his intrinsic motivation.  
  • Collaborative Goal Setting: Work with Joseph to set realistic and achievable goals for managing his hypertension. This can help him feel more empowered and motivated to make positive changes.

Sample Documentation

Patient Name: Joseph Ouma

Date: [Date]

Chief Complaint: Follow-up for hypertension

Assessment:

  • BP: 150/90 mmHg
  • Denies chest pain, shortness of breath, or dizziness
  • Reports difficulty adhering to medication regimen
  • Appears defensive and reluctant to discuss lifestyle changes

Plan:

  • Reinforce the importance of medication adherence and discuss strategies for improving adherence.
  • Explore barriers to lifestyle changes and develop a personalized plan to address these challenges.
  • Schedule a follow-up appointment in [timeframe] to monitor blood pressure and assess progress.

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