Julia’s Site

During the fall semester of my junior year, I participated in clinical for my Adult Health class at a rehab center. There I came across so many patients with tons of different backgrounds and stories. One patient in particular that I had made me think of the complex connections between physical and mental health. The connection between physical and mental health is something not a lot of people often think about but is important to advocate.
While I was in the rehab center, I had an older patient who was there for a COPD exacerbation and had a few falls. Along with their COPD, this patient also suffered from moderate depression and was showing early signs of dementia. Because of the early signs of dementia, this patient was often confused and did not have a lot of insight into their physical and mental health problems. Though the patient was often confused, there were times when they were alert and oriented. The times the patient is alert and oriented were good opportunities to give this patient a little more insight into her physical and mental problems.
Some interventions could be used to help the patient gain some insight into their disease processes. Assessing the patient’s current knowledge level is very important to tailor their education to them to lead to the most effectiveness. Giving the patient written handouts with pictures and visual diagrams can also be a good intervention for this patient. Since this patient is often confused, having the handout can help remind them of what is going on in times of confusion.
With a combination of talking to the patient and reading their chart, I learned a lot about their social history. Though I am not sure what they had as an occupation, I learned that this patient has been a widow for about 10 years. With their partner, they had two children and two

dogs. This patient still has family members who are alive, yet none of them visit the patient. This lack of social support has exacerbated their depression and they expressed how lonely they often feel. They often try isolating themselves by staying in bed all day and only leaving their room for the required therapies they need to attend. The nurses at the rehab center often try to engage the patient in activities and encourage them to sit out in the hall outside their room for more social interaction. The patient tries to participate as much as they can, but their “social battery” seems to run out quickly. An intervention for the social domain that could be tried is to talk to the patient about activities and hobbies they like doing, and ones they don’t like doing. Figuring out what the patient likes to do will make the patient more likely to participate in the activity, and maybe even enjoy it.
One nursing diagnosis for this patient pertaining to the biologic domain is an ADL deficit. A goal for this patient could be for them to be able to perform their ADLs within the parameters of their disorders. The nurse should first assess the patient for which ADLs they can perform independently, dependently, and their motivation to perform the tasks. After assessing the patient, the nurse should provide a safe environment and allow sufficient time for the patient to perform their tasks. Educating the patient on the importance of ADLs is important too. There are many positive aspects to completing ADLs including improving mental health. Completing ADLs independently can help the patient feel more accomplished and better about themselves.
For the phycological domain, this patient has a nursing diagnosis of knowledge deficiency. A goal for this patient could be for them to demonstrate that the knowledge they learned about their disorders has been retained. Assessing the patient’s current knowledge level

can help give the nurse a baseline for the patient and give a better understanding of what needs to be worked on. After assessing the patient, teaching them about their disorders in their learning style is important to help them understand the information easiest. Using a teach-back method is also very helpful to gauge how much information the patient has retained.
Within the patient’s social domain, this patient has a risk for loneliness due to her lack of familial support. A goal for this patient could be for the patient to not feel a sense of loneliness through different learned coping mechanisms. A good intervention for this patient is to use therapeutic communication and touch with them and let them talk about how they feel. Promoting socialization with other patients in the hospital or participating in support groups could also help this patient’s sense of loneliness. Being present and actively listening to this patient is important to make them feel heard and cared about.
During my time at the rehab facility, I enjoyed interacting with all the patients I had and especially the patient I wrote about in this reflection. Their situation is a good example of how your physical and mental health really is connected. Even though the connection can seem complex, it is still important to understand the care of your patients. Teaching patients about the connection can also help them have a better quality of life.