Pee review article

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Introduction
Critically ill patients as in the case of those mentally challenged require special handling using modern facilities, technological support to help them express themselves when regulating and monitoring the physiological functions of their bodies. Unconscious patients such as the mentally challenged patients are usually unable to communicate verbally and therefore are not able to express themselves. Such patients in critical condition are not able to express their desire feelings as well as their needs to the nurses and even to others. In such situation, they cannot even respond to the verbal communication by anybody in the hospital. The nurse’s first encounter with mentally challenged patients is a non-verbal platform which is the first and best category of the art of caring for them. This form of communication is crucial since it encourages interaction with the patient and avoids the notion of taking them as being passive subjects.
The unconscious and mentally challenged patients after a long period of contact with the nurses would eventually get used to them and may start nonverbal communication with them. As the days progress with such contact, the patients can express good image of themselves through various movement of the body parts expressed through gestures and several other nonverbal cues. Facial expression is the main nonverbal communication whereby such patients can express smile on their faces upon see or hearing anything being spoken of by their nurses who they are used to.

Such patient is still able to hear and see well the communications going on in their environment and may then learn them day by day just as the children do. In most cases such patients can express themselves in emotional expressions like laughter, frowning and smiling. Most unconscious patients express their knowledge especially to the nurses and the people they interact with most of the time by smiling. This way they express their love for them even through gestures and other non-verbal cues. The way the mentally challenged patients express themselves is in most cases dependent on the relationship with the audience and also the objective he or she desires.
The every-day social interaction and self-presentation act as part of the strategic game of behaviors. In the strategic game, the players who in this case are the mentally challenged patient and the nurses, in action will tend to manipulate and decode information which reveals their actual characters so that the information they convey specific information to each other and which may not even be understood by the public but themselves alone. In this case, the players will only act within a set series of rules which are aimed at enhancing their perception to the dialogue partner(s) which regulating and manipulating the strategic games of self-expression. It is notable that however much such patients may have the problem of communicating verbally, they hear and sometimes understand bits of information and even respond emotionally by either being violent or/and through other emotional expressions. In fact, mentally challenged and unconscious patients do understand the communication the nurses, and other healthcare providers are expressing before them but the challenge may seem exaggerated and at times virtual. That is why the unconscious patients feel low self-esteem in such situation since they are not confident or their expression before even the people they are familiar.
Through the use of gestures and facial expression, the patient with the unconscious mind or mentally challenged and those with communication problems can communicate themselves especially about how they feel. The mentally challenged patients can recognize their doctors due to their daily interaction with them. They don’t only know them by their faces but also through their name as they hear it mentioned the daily basis. It is also common to note that both those patients who cannot communicate and the one with the mental challenge do know their identity either by name or other calling pointing them. Although such patients may have the difficulty of expressing themselves about other people, they can recognize the people of their family.
According to Goffman’s analysis of face work, the healthcare providers and such patients can develop their identities and recognition of each other through interpretation of their facial expression. In so doing can communicate effectively through getting used to the specific expression for a particular thought, idea, and emotion as the days elapse. The maintenance of face to face interaction with the nurses or other medical health care providers with both unconscious and language challenged patients in the long-run becomes a ritual hence mastering expression of oneself become easy. When such interaction is established, communication in nonverbal ways becomes more and more clear. The facial work has therefore been very crucial in the expression of self and others and also in managing communications with the patients in general. The nurse and other healthcare provider become known to the unconscious patient not only through facial interaction but also through the day-to-day attires they wear during working hours, and that also becomes their identity to the patients. Gestures have been of crucial importance for communication with patients with language challenges. Language signs, in this case, have always been crucial in expressing oneself among the patients and the healthcare providers. Counting of fingers, for example, is used when dispensing of medication dose for such patients and also during diagnosis period (Shattell et al., 726).
The mentally challenged patients also tend to recognize the healthcare providers through the commands they in most cases give them and notice their superiority above them. The patient gets to learn of the vertical communications going on between them and their nurses. Through the instructions healthcare professionals provide to such patients, communication of the identity of who they are and their positions or rather occupation is also conveyed. The patients like these can learn of the agendas given to them, and associated punishment may be associated if they do not comply so that communication is passed effectively and a defined interaction is developed between the patient and the nurse. Positive compliance to the instructions and agendas by the patient, mentally challenged or unconscious, is communicated by the healthcare provider or professional through applauding or reward which in the long-run will learn it is meaning by the conditional reflex method. The patient will learn to associate the reward with compliance with agenda since they do understand it and also negative consequences for non-compliance (Unhjem et al., 27).
The patients with language challenge may be communicated to by treating them well or attending them in a way that shows them that they care. This practice of valuing their needs will help boost their dignity and self-esteem. In so doing, they learn to appreciate the value and the position played by the nurses and other healthcare professionals towards their well-being. Both gestures, facial work and management and demonstrations approaches are used in communication with such patients. The nurses would also communicate with them by applying a smiley face to portray to them how lovable they are within the hospital setting (Jessica, Hemberg, and Lipponen-Sofie, 87). In so doing the patient develop faith, confidence, and trust in the nurses due to such a close relationship and interaction with them. Through touch, the nurses can express their most intimate contact with the mentally challenged patients and even other patients whereby they can show forth their identity through such messages as tenderness, emotional support, personal attention and also encouragement. Such touch especially when the patient is in bed include holding hand as a comforting touch for that patient with emotional losses. Maintaining eye contact between the patients and nurses is essential is ensuring that the patient understands the message conveyed by the nurse. The nurse, on the other hand, would be able to read and understand the feelings of the patient and also act as a way of expressing love, respect for the dignity and also the willingness to listen and cooperate to alleviate the situation the patient is experiencing (Jessica, Hemberg, and Lipponen-Sofie, 87).
Conclusion
Non-verbal communication though difficult for the healthcare professionals is essential in building a good relationship with the patient which in turn facilitate medication. The training of the healthcare providers should also include discipline in non-verbal communication skills. The nurse-self disclosure is also crucial in building a good relationship with the patients. It helps build the faith, trust, and confidence of the patients towards the services offered to them by nurses.
Work cited
Jessica, Hemberg, and Lipponen Sofie. “The caring encounter between patient and nurse within a mental health and psychiatric care context–as described by nurses working in an emergency polyclinic.”
Unhjem, Jeanette Varpen, Solfrid Vatne, and Marit Helene Hem. “Transforming nurse‐patient relationships–A qualitative study of nurse self‐disclosure in mental health care.” Journal of clinical nursing (2017).
Shattell, Mona. “Nurse–patient interaction: a review of the literature.” Journal of Clinical Nursing 13.6 (2014): 714-722.