Crisis Paper

During my clinical rotation at NE, CW was my only patient and I was taking care of him during my six weeks period. CW is a nonverbal communicator. He communicates through changes in his facial expression and vocal tones, shakes his head back and forth, smiles, and cries when he is unhappy. He is also quadriplegic with major sensory and motor deficits, and he is entirely dependent on the wheelchair for all his means of mobility. For his nutrition, he depends entirely on G-tube and J-tube. During my first day in the clinical, I was supposed to just watch the nurse and her aid taking care of him. I arrived to the hospital around 6:30 AM and fifteen minutes later I was in the patient room standing by his bed side. When I saw CW for the first time he was in a hospital gown sleeping in his bed, connected to the ventilation machine and oxygen monitor, side rails was up. At around 6:45 AM , a nurse with a CNA wake him up, took him off the ventilation machine, and put him on O2. The nurse aid chose from his closet the clothes for the day and started giving him a bed bath. After she was done, the nurse packed his wounds, gave him his daily meds and transferred him to the wheelchair. Watching CW during the first day going by many things was racing in my head: did he like to be woken up that early? Did he like the clothes that the nurse aid chose for him? Was he in pain when the nurse was packing his wound? Gesell has said about development and maturation that “The child‘s development is directed from within, by the action of the genes” (Gesell & Ilg, 1943, p.41)1. Such definition can be applied directly to CW who has 17 years old, but behaves more like a new born. Taking care of such patient with so many health complications is very challenging and needs a holistic care that encompass body, mind and spirit, and an approach that it is culturally sensitive. When I started taking care of CW I was wondering, If he was speaking another language I would have find a way to communicate with him either by using body language or even calling for an interpreter. CW doesn’t even make eye contact or explicit body language that will help you to guess his needs. The only approach I could take during my first week is to observe him for I can understand little bit his world. I was able during my second week to understand some of his body and non-verbal language. For instance, while I was with him in a classroom I found that he can chose between two things by gazing toward the one he wants. I also noticed that whenever he is on pain he will always turn his eyes to the opposite direction where I am standing and focus his vision on one object. These little details helped me create a care plan that works for him, for instance I would never change his dressing unless I gave him pain meds at least half hour before. I thought at the beginning that he is not aware at all of his surroundings, but I found out later on that is not true at all. For instance, during the class therapy where a music switch has been placed for his convenience to allow him and others like him to cheer friends or to say hello to a new arrival that he was actively participating. In addition, I was told that during the swimming therapy that occurs once every 3 months, he is a lot more active and he even smiles. And when the therapist takes him out of the pool, he cries and protests. All these demonstrate that despite of his appearances he likes to socialize with others and there are things he enjoys and others he doesn’t. Unfortunately, this is not what we would have expected from a 17 year old boy. He was supposed to be playing football maybe, or with friends watching a movie, or at least in a mall choosing his own cloth. Culturally, CW is in the exact opposite side of a healthy boy. At this age, he was supposed to be dreaming to become maybe a doctor, or a law officer, or even an astronaut. He was supposed to be in school while working part time. CW is far away to be close to

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