The interaction takes place between a novel nurse and a patient, to whom we will call Maria.
The nurse is in the internal medicine service of the hospital reinforcing the shift in that morning, with what the information she knows about Maria is limited to that provided by the nurse of the previous shift.
Maria is a 77-year-old woman living in her hometown with two women of similar age in a community of floors adapted for the elderly, although she is autonomous for activities of daily living.
He has two children, a married man who lives in the same city and a younger daughter who has lived in Paris for years.
No grandchildren.
She came to the Emergency Department the day before the interaction we will analyze took place, due to acute abdominal pain and was admitted for study.
The nurse did not know the information Maria had received so far about her process, but she knew she had been accompanied by her son and daughter-in-law with whom she was at the time she met her.
She had had an opaque enema and a gynecological test that had caused vaginal bleeding.
After the tests the patient was nervous, frightened and uncomfortable.
The nurse checked that the bleeding had stopped and indicated that she would return to assess it later and confirm that she was well, she also stressed that in the event of any discomfort she did not doubt whether she needed analgesia to administer.
Although not required by Maria, the nurse returned a second time.
Although the bleeding had stopped Maria, she remained uneasy, so the nurse stressed that she would be waiting for her during the morning to feel safer.
Then the child challenged her mother because she considered that she did not meet her indications, after which the child and the daughter-in-law abandoned the room.
Maria expressed her feeling of lack of affection and loneliness to the nurse and she tried to understand her and make her feel accompanied.
Somehow this is the description of the case.
Then we will delve into the object of study combining detailed description with critical look.
In the first interaction, the nurse shows her interest valuing the physical state and showing herself available, but does not indicate to Maria or her family her name, function and time, which is recommended for the first contact to generate trust and security from the moment.
The second interaction occurs at noon.
Maria was sitting and was still accompanied by her relatives, who kept a conversation outside.
The nurse approached her and squatted herself in front of her so that the eyes of both were at the same time.13 The nurse consciously cares for her posture to demonstrate an open face attitude, with a smile she showed her deep contact.
However, the nurse began to talk to Maria about her condition, finding her relatives present, which can create interruptions, as in fact happened.
At first, the nurse asked open questions in order to make it easier for Maria to express herself, 2 who explained not feeling pain but anguish because of the unpleasantness resulting from the tests and because of the bleeding, she did not feel bleeding again.
The latter is one way of expressing the dilemma that involves feelings and lack of understanding that may be intensified by the disease and hospitalization.2
At a given moment, his son lost his nerves because, as he said, he had often told him that he should not go alone to the bathroom but accompanied by a nurse if the bleeding began, he cried with his wife and Mary.
Having remained alone, the nurse sat on the edge of the bed, showing an open posture to listening, standing at the same height and looking forward to Maria.
During the interaction, the nurse takes care of her nonverbal communication and her attitude with the objective of establishing a positive bond with her and also performing a continuous feedback to all that Maria was expressing with the purpose of making her feel heard and understood.13
A change in Maria's facial expression was observed, it seemed more relieved without her relatives present.
Rescuing the indication previously made by this, the nurse asked him "What is the lack of feeling well?".
He formulated an open question to allow him to guide his response from the physical, psychic, social or spiritual sphere, without feeling directed at his response.
He answered with a half smile, "Girl" and took the hand with which the nurse touched her and squeezed her, letting us see that it was an important message.
The nurse using a clarification asked "How often is it missing?"
In this way, it allows the patient to analyze the feelings he referred to and express them as he felt them.2 Maria replied by placing the roommate as an example, better than under her family view.
What patient referred to the lack of affection she felt, so we understand that it is her priority, but it might happen that not even she knows the meaning of an explicit way to explore her affection, as Parse explains.
What kind of affection do you think is missing?", respecting the time you needed to understand the meaning and express it.9 On the other hand, the nurse did not know Maria's family circumstances either, she did not know if that lack of affection.
This aspect should have been deepened to understand and detect interferences in communication between the subjects and be able to propose interventions aimed at improving family relationships.15 In fact, giving and receiving affection is a reciprocally complex relationship where it is not always expressed affection16
"My dear fellow," said he, "that he had never been well carried with his walnut."
The nurse asked him about the conflictive focus with open questions: "What is this situation due to?
What do you suppose?", trying to know her perception.13 Maria assured that she had become accustomed to circumstances and now she recognized herself more comfortable with the presence of her child.
He began talking about his situation in the residence where he lived with two other elderly women, which seemed to please him in the way he expressed himself.
The nurse then asked her for a pleasant moment for her.
Maria smiled and began talking about her daughter; she was happy while she was doing it; however, the nurse was waiting to reflect facial expressions in line with the messages transmitted and received as an active indicator, at the same time.
The nurse was aware that the lack of affection was a priority for Maria and that she had changed the theme, probably because it was complicated for her to approach, she decided to return by asking "Whom are you kids?"
Then he asked him whether he had thought of how to make up for this lack of affection.
He answered yes, he considered that the solution was to go and live with his daughter to Paris, but he did not like leaving his city to a country with an unknown language.
The nurse hastened to ask him if he had not thought of going to groups of people of his age such as the associations of retired people, but it would have been more correct to ask if he had thought of some other way of feeling.
Then, the nurse could have taken advantage of asking him if he knew the existence of reading groups or informing him about other activities that are still carried out in his area for which he might have been interested, even if he had some incentive.
As Maria expressed the activities she enjoyed, the nurse realized that she really did it and so she made her know.
At that moment Mary again pressed her hand firmly and thanked her, feeling that this conversation had helped her a lot, comforted her, and that for a moment she had come to think that she was talking about it.
The nurse said she was pleased that it was like this.
Before leaving Mary, he asked for a hug and two kissors, and told him that he would be illusion to see him again.
