Nursing Fundamentals: Chapters 6-15

Fundamentals of Nursing Chapters 6-15 Overview:

• Chapter 6: Caring (page 108)
• Chapter 7: Concepts of Nursing (page 109)
• Chapter 8: Teaching (page 132)
• Chapter 9: Problem Solving Process (page 174)
• Chapter 10: Nursing Process (page 228)
• Chapter 11: Procedures Basic to Nursing Care (page 295)
• Chapter 12: Asepsis (page 322)
• Chapter 13: Safety, Security and Emergency (page 361)
• Chapter 14: Complementary and Alternative Therapies (page 395)
• Chapter 15: Medication Administration (page 414)

Chapter 6: Caring (page 108)

• Caring is unique to the nursing profession, and is the heart of a nurse's ability to work therapeutically and respectfully with people.
• Caring signifies that people, events, projects, and things matter
• Caring is a phenomenon influencing how people think, feel, and behave.

Caring Practices Models

• Benner offers a holistic understanding of nursing practice and caring through expert nurse's stories and sees caring as creating possibility.
• Leininger (1991) describes care as unifying and the essence that distinguishes nurses.
• Leininger's Transcultural Caring stresses the importance of understanding cultural caring behaviors, recognizing that caring is personal
• Leininger's Transcultural Caring is central to distinguishing nursing from other health disciplines.

Cultural Aspect of Care

• Nurse Caring Behaviors includes knowing a patient's cultural values and caring practices.
• Patient-Centered Care Implications involves beliefs, attitudes, end-of-life practices, family/cultural group identification, and body care practices.
• Watson's Transpersonal Caring is central to nursing and maintains ethical/philosophical profession roots.
• Healing is communicated through the nurse's consciousness.

Swanson's Theory of Caring

• Defines caring as a nurturing way of relating to an individual
• The five caring processes are knowing, being with, enabling, and maintaining belief.

6 C's of Caring:

• Care
• Compassion
• Competence
• Communication
• Courage
• Commitment
• Caring in nursing involves caring for self and others and is a fundamental human behavior.
• Caring in nursing practice involves presence, touch/comfort, listening, knowing the patient, spiritual aspects, symptom relief, and family considerations.

Challenge of Caring:

• The challenge of caring comprises caring for oneself which includes the importance of the nurse's self-care and caring for oneself.

Chapter 7: Communicating (page 109)

• Communication involves reciprocal influence through information, ideas, and feeling exchange.
• Communication facilitates personal growth and the attainment of health-related goals.
• Communication is crucial to the nurse-patient relationship.
• One with expertise in communication expresses it through caring (Ryan, 2005; Wartson 1985 page 133)

Levels of Communication:

• Intrapersonal Communication: self-talk to build self-awareness.
• Interpersonal Communication: one-on-one exchange for problem-solving and expressing feelings.
• Small Group Communication: goal-oriented, organized, concise and complete (3 or more)
• Public Communication: engagement with an audience
• Electronic Communication uses technology to connect with patients and healthcare teams.

Modes or Forms of Communication

• Verbal Communications (VDPCT)
• Non-verbal Communication
• Verbal Communication includes speaking/writing, vocabulary, (layman versus jargon, special words for children, abbreviations), and connotative/denotative meaning.
• Denotation is a word's literal meaning.
• Connotation is influenced by thoughts and feelings.
• Pacing involves appropriate conversation speed; nurses need clear enunciation.
• Intonation uses voice tone to convey concern/enthusiasm

Clarity and Brevity

• Clarity focuses on clear and easy to comprehend messages
• Brevity focuses on using few words
• Brevity, or conciseness, means using few words; effective communication is simple, brief, and direct, reducing confusion.

Timing and Relevance

• Relevance involves pertinent messages for the situation/audience.
• Timing includes delivering messages at the right moment.
• Non-verbal Communication involves five senses, including gesture, face, body position, tone, eye contact.

Aspects of Nonverbal Communication:

• Personal Appearance
• Posture and Gait
• Facial Expression
• Eye Contact
• Gesture
• Sounds
• Territoriality and Personal Space
• Metacommunication is a broad term for factors influencing communication.
• an awareness of influencing factors enhances understanding

Zone of Personal Space and Touch

• Intimate Zone (0-18 inches): For bathing and carrying a baby.
• Personal Zone (18 inches to 4 ft): bedside client care plus teaching.
• Social Zone (4-12 ft): for making rounds
• Public Zone (over 12 ft): speaking in the community

Zones of Touch:

• Social Zone (permission not needed): includes hands, arms, shoulders, and back.
• Consent Zone (permission needed): includes mouth, wrist, and feet.
• Vulnerable Zone: the front of the body area.
• Intimate Zone: genitalia and rectum

Communication Characteristics:

• Simplicity
• Clarity
• Timing and Relevance
• Adaptability
• Credibility

Elements of Communication Process

• Referent: motivates communication.
• Sender and receiver: the person who delivers a message.
• Message: communication content.
• Channel: auditory, visual, or tactile message delivery.
• Feedback: the receiver's response.
• Interpersonal variables: factors influencing communication.
• Environment: setting for interaction.

Elements of Professional Communication

• Courtesy
• Names
• Trustworthiness
• Autonomy and Responsibility
• Assertiveness
• AIDET is a technique (Struder group) for healthworkers to provide timely and accurate information and focus on excellent patient service,

AIDET means:

• Acknowledge (the patient).
• Introduce (yourself).
• Duration (of procedures).
• Explain (what to expect).
• Thank You (for their time).

Guidelines for Active and Effective Listening:

• Face the client
• Have an open posture
• Lean towards the client
• Establish intermittent eye contact
• Relax
• Touch is one of nurses most potent forms of communication

Key areas of communication include special consideration of:

• Older adults with communication needs barriers
• Infants
• Toddlers
• School age children
• Adolescents, and clients with special needs that have physical challenges, cognitive impairment, or are unresponsive, aggressive, hearing and visually impaired, or speak another language.

Therapeutic Communication Techniques

• Therapeutic communication techniques encourage expression and respect feelings and ideas.
• These include methods such as Using silence, clarifying, focusing, Sharing empathy, Sharing Hope, Sharing Humor, and using touch

Non-Therapeutic Communication Techniques

• Non-therapeutic communication techniques include asking personal questions, giving personal opinions, changing the subject, false reassurance, passive or aggressive responses, or arguing that can harm professional relationships.

Phases in Helping Relationship:

• Pre-interaction
• Orientation
• Working
• Termination
• The characteristics of an effective nurse-patient relationship are important (page 163).

Communication through the nursing process uses ADPIE:

• Assessment (physical and emotional factors).
• Nursing Diagnosis
• Planning
• Implementation
• Evaluation

Chapter 7: Teaching

• Patient Education is a critical nursing intervention
• "If you give a man a fish, you feed him for a day, but if you teach a man how to fish you feed him a lifetime."

Standards of Patient Education spells the acronym PATIENT:

• P: patient teaching is within the scope of nursing practice
• A: all health care providers assess patient learning
• T: healthcare professional collaboration
• I: patient-centered education
• E: documentation of patient education interventions/responses
• P: patient education is a goal.
• Patient education is an essential component of patient-centered and safe care.
• Education in preventive health reduces expenses and improves health of the patient.

C omprehensive patient education includes:

• Maintenance and promotion of health
• Illness prevention (Prenatal, health education, and providing information)
• Health restoration
• Coping with impaired functions (page 177)

Principles of Learning

• Learning includes activities that produces learning.
• Learning is a dynamic interaction between teacher and learner.
• Learning is imparting knowledge through series of directed activities
• Learning is purposeful acquisition of knowledge, attitudes, behaviors, throughout the experience.
• Learning is understanding and applying newly acquired concepts.

Roles of Nurses in teaching and Learning

• Nurses have ethical responsibilities to teach their patients
• SPEAK UP mnemonic helps patients to be more involved in their treatment

SPEAK UP Mnemonic:

• S: speak up if you have questions or concerns.
• P: pay attention to the care you get.
• E: educate yourself about your illness.
• A: ask a trusted family member or friend to be your advocate.
• K: know which medicines you take and why.
• U: use checked-out hospitals/clinics/surgery centers.
• P: participate in decisions about your treatment.

Theories of Learning

• Behaviorism
• Cognitivism
• Humanism

Factors Facilitating Learning:

• Motivation
• Readiness
• Active Involvement
• Feedback
• Simple to Complex
• Timing
• Environment.
• Learning and Teaching Activities (page 181)

Learning Domains:

• Cognitive (understanding)
• Affective (attitude)
• Psychomotor (motor skills)

Teaching Methods

• Teaching Methods are based on the Patient Developmental Capacity:
• Infant
• Toddler
• Preschooler
• School-Aged
• Adolescent
• Young/Middle Adult
• Older Adult

Nursing Process in Patient Education using ADPIE:

• Assessment
• Diagnosis
• Planning (Goals/outcomes, setting priorities, teamwork/collaboration, building on knowledge).
• Implementation: use different teaching methods (approaches, telling, participating, entrusting, reinforcing).

Teaching Tool for Instructions (WPCNGCPP):

• One-on-one discussion
• Group instruction
• Preparatory Instruction
• Demonstration
• Analogies
• Role play
• Stimulation

Chapter 8: ADPIE

• Contemporary Nursing uses effective thinkers and decision makers to analyze medical/nursing/environment data and translate analyses into life-saving interventions

Critical Thinking:

• It is an ability to logically think with openness to reasoning and questioning Critical Thinking and Clinical Judgment includes interpretation, analysis, inference, evaluation, explanation, and self-regulation.

Qualities of a Critical Thinker:

• Trust-seeking
• Open-mindedness
• Analyticity
• Systemicity
• Self-confidence
• Inquisitiveness
• Maturity

Levels of Critical Thinking:

• Basic
• Complex
• Commitment

Critical Thinking Competencies:

• General Critical Thinking
• Specific Critical Thinking
• Nursing Process as Competency
• Critical Thinking Method for Clinical Decision Making (pages 211-213).
• Developing Critical Thinking (page 218) through journaling, meeting with colleagues, concept mapping, and managing stress.

Chapter 10: Nursing Process

• Uses ADPIE (Assessment, Diagnosis, Planning, Implementation, and Evaluation).