This paper presents a reflective case study of a therapeutic communication session between a nursing student and Helen, an 86-year-old woman with Alzheimer's disease residing in a care facility. Following the recent loss of her husband, Helen was experiencing depression and social withdrawal. The paper narrates the session in detail, examines the specific techniques employed — including open-ended questioning, active listening, restatement, humor, and redirecting toward positive memories — and offers a candid critique of both strengths and weaknesses. Notably, the analysis acknowledges that Helen's Alzheimer's diagnosis posed unique challenges, particularly around short-term memory retention and the inability to address underlying grief directly.
This paper demonstrates reflective practice — a core competency in nursing education. The writer moves systematically from description (what happened) to analysis (what techniques were used and why) to evaluation (what worked, what did not, and what should be done differently). This structure mirrors the Gibbs Reflective Cycle commonly used in healthcare training and gives the paper its logical progression.
The paper opens with contextual background on the patient and setting, followed by a chronological narrative of the session. A separate technique analysis section identifies and justifies each communication strategy used. The critique section weighs strengths against weaknesses with specific reference to Alzheimer's-related limitations. The paper closes with a brief reflection on professional growth. This clear four-part architecture — context, narrative, analysis, evaluation — makes it easy to follow and assess.
The communication session evaluated in this paper took place on February 24, 2009, in the early afternoon at a residential care facility for the elderly. The conversation occurred between the narrator and a patient named Helen, an 86-year-old Caucasian woman with Alzheimer's disease. Helen's family visits frequently, and she had recently lost her husband. She had been feeling depressed and was in need of someone to talk with. The following sections evaluate the conversation, the techniques employed, and the overall effectiveness of the interaction.
Upon entering the room, Helen was sitting in a wheelchair facing the window, with her hands on her lap and her gaze directed outside. She did not immediately acknowledge the narrator's presence. After walking across the room and gently touching her on the shoulder, she looked up and said, "Hello." When greeted and asked how she was feeling, she turned her wheelchair and responded, "Ok, I guess." The tone of her voice suggested this was merely a polite response, masking something deeper. She showed no emotional expression — no smile, no connection.
The conversation began with small talk about the weather. Helen responded politely but made very little eye contact and showed little sign of genuine engagement. She provided short answers and offered little spontaneity. To encourage her to open up, an open-ended question was posed: whether anything was bothering her that she would like to share. Her eyes immediately darted to the picture of her late husband on the wall. She answered, "No, not much." Reflecting her phrasing back — that "not much" sounded like something — accompanied by leaning forward, making eye contact, and reaching out to hold her hands, brought tears to her eyes and prompted her to begin talking.
Helen spontaneously described how much she missed her husband and expressed concern that she did not want her children to worry about her. She talked about good times and recalled humorous moments from when they were young. As she spoke about these happy memories, the tension in her face eased and she began to smile. Her eyes brightened as she relived the past. The narrator engaged in active listening, laughing, and responding with genuine interest, maintaining open body language throughout.
When asked how she and her husband met, Helen told the story in an animated fashion. Her eyes became distant, but a grin spread across her face as she recalled the details — it was almost as if she forgot herself momentarily and became lost in the memory. Reminiscence therapy approaches suggest that revisiting positive long-term memories can provide significant emotional relief for elderly patients, particularly those living with dementia. Continuing to pose open-ended questions prompted further storytelling. The two laughed together and shared jokes, and Helen appeared to be having a genuinely good time.
The narrator then summarized: "It sounds like you have led a very interesting and fun-filled life. You have many happy memories." Helen agreed that she had indeed enjoyed many good times, and her face was visibly brighter than at the start of the conversation. She was then reminded that when sadness arises, returning to those good memories can be a source of comfort.
At this point, Helen looked up at the picture of her late husband again and her face became somber. When asked how she was feeling in that moment, she said she was sad because the good times were over and she missed him. The narrator restated her feeling — that she was sad because she missed her husband — and she nodded in confirmation. She was gently reminded of her children and the wonderful grandchildren who came regularly to visit, and she managed a small smile.
A suggestion was offered: the next time her grandchildren visited, she might ask to go outside with them and share some of her stories, as they would likely enjoy hearing them as much as the narrator had. Helen was initially doubtful, saying she was not sure her grandchildren would want to listen to old stories because they had their own lives. She was reassured that they would love to hear the stories and that doing so would give everyone something to look forward to. Helen agreed, and her face once again relaxed.
Her gaze became distant, but this time with a smile. When asked what she was thinking about, she said she was thinking about her grandchildren and their smiles. The narrator offered to help her remember what to say — particularly the story about the dog not recognizing her husband when he returned from military service. She laughed again, this time in earnest.
Before leaving, the narrator assured Helen of availability anytime she was needed. Helen smiled pleasantly, said thank you, and called the narrator "Sweety." She returned to looking out the window, but this time with a broad smile. The narrator quietly left the room.
A number of therapeutic communication strategies were used during this interaction. The first and most challenging task was encouraging Helen to open up about her troubles. Open-ended questioning and active listening were employed to draw out a spontaneous response. In the early moments, Helen responded only with brief answers. Creative use of open-ended questions — ones that could not easily be answered with a single word — was necessary to elicit longer, more reflective responses.
Once Helen had shared her stories, restatement was used to highlight her happy memories and summarize the positive experiences she had described. The purpose of this technique was to redirect her attention from grief toward the richness of her past, encouraging a focus on the positive rather than the negative aspects of her current circumstances.
The narrator then suggested a concrete strategy: encouraging Helen to share her life stories with her grandchildren during their visits. This intervention served multiple purposes. It redirected Helen's focus toward joyful memories, gave her a purposeful "project" to work on, and created a framework for building new connections and memories with her grandchildren. The shared storytelling would also benefit the grandchildren, providing them with a meaningful family legacy to carry forward. Both Helen and her grandchildren would have something to anticipate during future visits.
Humor was used intentionally to build rapport and connection. Helen responded in kind, which lightened the mood considerably. The humor was grounded in shared laughter and mutual engagement rather than anything dismissive or patronizing. Care was taken to ensure Helen did not feel mocked. Laughter was used at appropriate moments as encouragement, signaling genuine interest in her stories and experiences.
The summation of the experience gained in this communication is that a variety of therapeutic strategies can be effectively employed to help patients open up and share. However, a tendency emerged to become absorbed in the moment and neglect follow-through on a concrete plan that specifically addresses the patient's individual needs. In future sessions, a checklist may be a useful tool to keep these critical points in focus throughout the interaction.
You’re 78% through this paper. Sign up to read the remaining 1 section.
Sign Up Now — Instant Access Already a member? Log inAlways verify citation format against your institution’s current style guide requirements.