Questions and Answers
What is the primary role of caring relationships in nursing?
What is essential for nurses to become the best communicators?
What is the outcome of competent communication in nursing practice?
What is the core of nursing, according to the described nursing practice?
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What is the primary goal of developing communication skills in nursing?
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What is the relationship between critical thinking skills and communication in nursing?
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What is the scope of competent communication in nursing practice?
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What is the term for the process of conveying information and ideas through facial expressions, body language, and tone of voice?
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What is the role of interpersonal relationships in nursing?
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Why is communication a lifelong learning process in nursing?
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Which of the following is an example of therapeutic communication technique?
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What is the relationship between critical thinking skills and perceptual biases or stereotypes in nursing?
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What is the primary goal of the assessment phase in the nursing process?
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Which of the following is a barrier to effective communication in nursing practice?
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What is the term for the communication that occurs between two or more people in a small group?
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Which of the following is an element of the communication process?
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What is the term for the process of conveying information through written or spoken words?
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Which of the following is an example of a nontherapeutic communication technique?
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What is the term for the process of interacting with patients, families, and communities to promote health outcomes?
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Which of the following is an element of professional communication in nursing practice?
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Which leadership style is most likely to empower teams in a nursing organization?
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What is the primary focus of the Magnet Recognition Program?
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What is the main goal of shared decision making in a nursing team?
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Which nursing care delivery model emphasizes collaboration between patients, families, and healthcare providers?
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What is the primary role of a nurse manager in supporting staff involvement?
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What is the primary focus of interprofessional rounding in a nursing team?
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What is the primary goal of staff communication in a nursing team?
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What is the primary focus of professional shared governance councils?
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What is the primary role of nurse executives in building a strong nursing team?
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What is the primary goal of staff education in a nursing team?
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What is the primary distinction between clinical decision making and clinical judgment?
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What is the main purpose of a model for clinical judgment?
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What is the primary goal of critical thinking in nursing?
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What is the characteristic of critical thinking?
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What separates professional nurses from technicians or assistive personnel?
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What is the relationship between critical thinking and clinical judgment?
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What is the primary focus of models for clinical judgment?
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What is the primary characteristic of critical thinking in nursing practice?
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What is the primary role of clinical judgment in nursing practice?
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What is the purpose of reflection in the evaluation of clinical judgments?
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Which of the following is an attitude of critical thinking?
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What is the primary goal of critical thinking in the clinical judgment model?
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What is the distinction between basic and complex critical thinking?
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Which of the following is a component of critical thinking in the clinical judgment model?
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What is the purpose of critical thinking synthesis in the evaluation of clinical judgments?
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Which of the following is an example of a critical thinking competency?
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What is the primary focus of commitment in the levels of critical thinking?
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Which of the following is an example of a critical thinking attitude?
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Which ethical approach prioritizes the greatest good for the greatest number?
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What is the primary role of an ethics committee in nursing?
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What is the primary focus of values clarification in ethical discourse?
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What is the primary goal of Step 3 in processing an ethical problem?
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Which ethical principle prioritizes doing no harm?
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What is the primary distinction between moral distress and ethical dilemma?
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What is the primary focus of the Code of Ethics for Nursing?
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What is the primary focus of feminist ethics in healthcare?
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What is the primary goal of bioethics in healthcare?
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What is the primary role of a nurse in resolving ethical conflicts?
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What is the primary purpose of a patient's health care record?
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What is the primary difference between an Electronic Health Record (EHR) and an Electronic Medical Record (EMR)?
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What is the primary purpose of maintaining privacy, confidentiality, and security of healthcare records?
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What is the basis for determining a patient's acuity level?
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What is the primary purpose of acuity rating systems in healthcare?
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Which organization has specific guidelines to establish eligibility for home care reimbursement?
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What is the primary focus of standards and guidelines for quality nursing documentation?
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What is the primary purpose of documenting communication with providers and unique events?
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What is the purpose of documentation in the home care setting?
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What is a critical pathway?
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What is the primary purpose of the American Recovery and Reinvestment Act (ARRA)?
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What is a variance in the context of a critical pathway?
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What is the primary focus of the Health Information Technology for Economic and Clinical Health (HITECH) Act?
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What is the primary purpose of flow sheets and progress notes in documentation?
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What is the primary goal of health care information technology (HIT)?
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What is a clinical information system (CIS)?
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What is the primary purpose of charting by exception in documentation?
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What is the primary focus of nursing informatics?
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What is the primary goal of clinical decision support systems (CDSS)?
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What is the primary benefit of nursing clinical information systems (NCIS)?
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What is the primary goal of patient education?
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What is the nurse's role in teaching and learning?
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What is the process of understanding and applying newly acquired concepts?
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What is effective communication in teaching?
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What is the purpose of patient education in health promotion?
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What is the role of the nurse in patient education?
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What is teaching in patient education?
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What is the primary focus of patient education?
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What is learning in patient education?
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What are the three main domains of learning?
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What is a key factor in motivation to learn?
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In which setting do nurses have more time to identify patients' learning needs and provide comprehensive ongoing education?
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What is a key factor in readiness to learn?
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What is essential for nurses to predict the topic and level of instruction required in patient education?
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What is a key consideration for nurses in an acute care setting?
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What is a key aspect of clinical judgment in patient education?
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What is a key factor in the learning environment?
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What is essential for nurses to identify in an acute care setting?
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What is the primary focus of the assessment phase in the nursing process?
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Which of the following is a key aspect of building on existing knowledge and ability during implementation?
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Which of the following is an important consideration in instructional methods during implementation?
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What is the primary focus of teamwork and collaboration in planning and outcomes identification?
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Which of the following is a key aspect of cultural diversity in implementation?
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What is the primary purpose of using teaching tools during implementation?
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Which of the following is an important consideration in health literacy during assessment?
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What is the primary focus of incorporating teaching with nursing care during implementation?
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Which of the following is a key aspect of maintaining learning attention and participation during implementation?
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What is the main purpose of the teach-back method in evaluation?
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Study Notes
Communication and Nursing Practice
- Communication is a lifelong learning process.
- Competent communication maintains effective relationships within the entire sphere of professional practice and meets legal, ethical, and clinical standards of care.
Importance of Interpersonal Relationships
- Caring relationships are at the core of nursing.
- Being able to relate to others is important for interpersonal communication.
- Therapeutic communication occurs within a healing relationship between a nurse and patient.
Developing Communication Skills
- Nurses who develop critical thinking skills and clinical judgment make the best communicators.
- Critical thinking applied during any patient interaction helps to overcome perceptual biases or stereotypes that interfere with accurately perceiving and interpreting messages from others.
Levels of Communication
- Intrapersonal communication
- Interpersonal communication
- Small-group communication
- Public communication
- Electronic communication
Elements of the Communication Process
- Circular transactional model
- Referent
- Sender and receiver
- Message
- Channels
- Feedback
- Interpersonal values
- Environment
Forms of Communication
Verbal Communication
- Vocabulary
- Denotative and connotative meaning
- Pacing
- Intonation
- Clarity and brevity
- Timing and relevance
Nonverbal Communication
- Personal appearance
- Posture and gait
- Facial expression
- Eye contact
- Gestures
- Sounds
- Territoriality and personal space
- Metacommunication
Professional Nursing Relationships
- Nurse-patient caring relationships
- Motivational interviewing
- Nurse-family relationships
- Nurse-health care team relationships
- Lateral violence
- Nurse-community relationships
Elements of Professional Communication
- Courtesy
- Use of names
- Trustworthiness
- Autonomy and responsibility
- Assertiveness
Nursing Process
Assessment
- Through the patient’s eyes
- Environmental factors
- Physical and emotional factors
- Gender
- Developmental factors
Analysis and Nursing Diagnosis
- Planning and outcomes identification
- Outcomes
- Setting priorities
- Teamwork and collaboration
Therapeutic Communication Techniques
- Active listening
- Clarifying
- Sharing observations
- Focusing
- Sharing empathy
- Sharing hope
- Sharing humor
- Sharing feelings
- Using touch
- Using silence
- Providing information
- Paraphrasing
- Validation
- Asking relevant questions
- Summarizing
- Self-disclosure
- Confrontation
Nontherapeutic Communication Techniques
- Asking personal questions
- Giving personal opinions
- Changing the subject
- Automatic responses
- Defensive responses
- False reassurance
- Sympathy
- Arguing
- Asking for explanations
- Approval or disapproval
- Passive or aggressive responses
Building a Nursing Team
- A strong nursing team works together to achieve the best outcomes for patients, requiring team building and training, trust, communication, and a collaborative workplace.
Empowered Teams
- Empowered teams begin with the nurse executive, who demonstrates transformational leadership and servant leadership.
Magnet Recognition Program Standards
- The Magnet Recognition Program standards for building a nursing team include:
- Shared decision making
- Leadership
- Safety
- Quality
- Well-being
- Professional development
Nursing Care Delivery Models
- Nursing care delivery models include:
- Patient- and family-centered care
- Case management
Decision Making
- Decision making in a nursing team involves:
- Shared governance
- Responsibility
- Autonomy
- Authority
- Accountability
- Staff involvement
Nursing Manager's Role
- The nursing manager supports staff involvement through:
- Establishing nursing practice through problem-solving committees or professional shared governance councils
- Interprofessional collaboration among nurses and healthcare providers
- Interprofessional rounding
- Staff communication
- Staff education
Clinical Judgment in Nursing Practice
- Nurses must make accurate and appropriate clinical decisions or judgments.
- Clinical judgment is the observed outcome of critical thinking and decision making.
- Clinical decision making separates professional nurses from technicians or other assistive personnel.
Models for Clinical Judgment
- A model helps to explain the many variables involved in making decisions and clinical judgments about patients.
- Critical thinking in nursing is complex and a model explains the variables.
Critical Thinking
- Critical thinking is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process.
- The aim of critical thinking is to focus on important issues in any clinical situation and make decisions that produce desired patient outcomes.
Critical Thinking Competencies
- General critical thinking competencies include scientific method, problem solving, and decision making.
- Specific critical thinking competencies include diagnostic reasoning and clinical decision making.
Levels of Critical Thinking
- There are three levels of critical thinking: basic, complex, and commitment.
Components of Critical Thinking in the Clinical Judgment Model
- The components of critical thinking in the clinical judgment model include competence, knowledge base, experience, and environment.
Critical Thinking Attitudes
- Critical thinking attitudes include confidence, perseverance, thinking independently, fairness, responsibility and accountability, risk taking, discipline, and humility and self-awareness.
Evaluation of Clinical Judgments
- Evaluation of clinical judgments involves reflection, meeting with colleagues, concept mapping, and critical thinking synthesis.
Ethics and Values in Nursing
- Morals: Fundamentally held principles that guide behavior and decision-making
- Value: Deeply held belief about the worth of an idea, attitude, custom, or object that affects choices and behaviors
- Bioethics: Ethics related to healthcare and biological sciences
- Autonomy: Respect for an individual's right to make decisions about their own life
- Beneficence: Doing good and promoting the well-being of others
- Nonmaleficence: Avoiding harm or injury to others
- Justice: Fairness and equal distribution of benefits and risks
- Fidelity: Loyalty and faithfulness to others
Professional Nursing Code of Ethics
- Code of ethics: Set of guiding principles that all members of a profession accept
-
Code of Ethics for Nursing: Key principles include:
- Advocacy
- Responsibility
- Accountability
- Confidentiality
Values Clarification
- Values clarification: Distinguishing among value, fact, and opinion to resolve ethical conflicts
- Importance of values clarification: Understanding one's own, patients', and coworkers' values to facilitate ethical discourse
Approaches to Ethics
- Deontology: Focus on duties, obligations, and rules
- Utilitarianism: Focus on maximizing overall happiness and well-being
- Casuistry: Focus on case-by-case analysis
- Feminist ethics: Focus on gender and power dynamics
- Ethics of care: Focus on empathy, compassion, and relationships
Nursing Point of View
-
Types of ethical problems:
- Ethical dilemma
- Moral distress
- Ethics committees: Organized groups that provide guidance and support for ethical decision-making
-
Processing an ethical problem:
- Step 1: Ask if it's an ethical problem
- Step 2: Gather relevant information
- Step 3: Identify ethical elements and examine values
- Step 4: Name the problem
- Step 5: Identify possible courses of action
- Step 6: ... ( incomplete information)
Documentation
- Documentation is a key communication strategy in healthcare that produces a written account of patient data, clinical interventions, and patient responses.
- It is available to all members of the healthcare team and allows others to track a patient's clinical course.
Purposes of the Health Care Record
- Facilitates interprofessional communication among healthcare providers.
- Provides a legal record of care.
- Provides justification for financial billing and reimbursement of care.
- Supports quality and performance improvement.
- Serves as a resource for education and research.
Interprofessional Communication within the Medical Record
- Legal documentation.
- Reimbursement, including diagnosis-related groups.
- Auditing and monitoring.
- Education.
- Research.
- Shift to electronic documentation using Electronic Health Record Systems (EHRS) and Health Information Technology for Economic and Clinical Health Act (HITECH).
- Electronic Health Record (EHR) is an individual's lifetime computerized record.
- Electronic Medical Record (EMR) is the record for an individual health care visit.
Maintaining Privacy, Confidentiality, and Security
- Protected Health Information (PHI) must be maintained with privacy, confidentiality, and security mechanisms.
- Firewall and password protection are examples of security measures.
- Handling and disposing of information must follow procedures, including policies for the use of fax machines.
Standards and Guidelines for Quality Nursing Documentation
- Guidelines for quality documentation include being factual, accurate, appropriate use of abbreviations, current, organized, and complete.
- Standards for quality documentation must be followed.
Methods of Documentation
- Documentation methods include flow sheets, progress notes, and charting by exception.
- Patient assessment data must be documented accurately.
Common Record-Keeping Forms within the Electronic Health Record
- Admission nursing history form.
- Patient care summary.
- Care plans.
- Discharge summary forms.
Documenting Communication with Providers and Unique Events
- Telephone calls and verbal orders must be documented.
- Incidence or occurrence reports must be documented.
Acuity Rating Systems
- Acuity rating systems are used to determine hours of care and number of staff required for a group of patients.
- Patient's acuity level is based on the type and number of nursing interventions required over a 24-hour period.
Documentation in Long-Term Health Care Settings
- Governed by individual state regulations, The Joint Commission (TJC), and Centers for Medicare and Medicaid Services (CMS).
Documentation in Home Health Care Settings
- Medicare has specific guidelines for establishing eligibility for home care reimbursement.
- Documentation is quality control and justification for reimbursement from Medicare, Medicaid, or private insurance companies.
- Nurses use OASIS and Omaha system data sets to document clinical assessments and care provided in home care settings.
Case Management and Use of Critical Pathways
- Case management model incorporates an interprofessional approach to delivery and documentation of patient care.
- Critical pathways are interprofessional care plans that identify patient problems, key interventions, and expected outcomes within an established time frame.
- Variances are unexpected outcomes, unmet goals, and interventions not specified within a critical pathway.
Informatics and Information Management in Health Care
- Health care information technology (HIT) enhances quality and efficiency of care.
- Health care information system (HIS) includes clinical information systems and administrative information systems.
- Clinical information system (CIS) is an example, including computerized provider order entry (CPOE).
- Nursing clinical information systems (NCIS) have two designs: nursing model and critical pathway, with advantages including better information access, better documentation quality, and reduced errors of omission.
- Clinical decision support systems (CDSS) aid and support clinical decision making.
Patient Education
- The primary goal of patient education is to help individuals, families, or communities achieve optimal levels of health through maintenance and promotion of health and illness prevention, restoration of health, and coping with impaired functions.
Teaching and Learning
- Teaching involves imparting knowledge through a series of directed activities.
- Learning is the process of understanding and applying newly acquired concepts.
- Nurses are legally responsible for providing education to all patients.
Domains of Learning
- There are three domains of learning: cognitive, affective, and psychomotor.
Basic Learning Principles
- Motivation to learn is a key factor, and nurses can use theories to enhance motivation and learning.
- Cultural factors, active participation, and readiness to learn are also essential.
- Ability to learn depends on developmental capability, physical capability, and learning environment.
Clinical Judgment in Patient Education
- Nurses should use their knowledge of a patient's health condition to predict the topic and level of instruction required.
- In clinical settings, nurses have more time to identify patients' learning needs and provide comprehensive ongoing education.
Nursing Process
Assessment
- Assessment involves identifying learning needs, motivation to learn, readiness and ability to learn, environmental factors, resources for learning, and health literacy.
Analysis and Planning
- Analysis involves identifying nursing diagnoses, and planning involves setting outcomes, priorities, and organizing teaching material through teamwork and collaboration.
Implementation
- Implementation involves maintaining learning attention and participation, building on existing knowledge and ability, and using various teaching approaches such as telling, participating, entrusting, and reinforcing.
- Nurses can use instructional methods like verbal one-on-one discussion, group instruction, preparatory instruction, demonstrations, analogies, and simulation.
- Other considerations include cultural diversity, using teaching tools, and special needs of children and older adults.
Evaluation
- Evaluation involves assessing patient outcomes, using teach-back methods, and identifying areas for improvement.
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Description
This quiz covers the fundamentals of communication in nursing practice, including effective relationships and legal, ethical, and clinical considerations.