Types of Communication

• Communication involves exchanging messages between two or more people with a specific goal

Aggressive Communication

• This type of communication is verbally and sometimes physically abusive.
• It involves the use of "YOU" statements and can be verbally abusive, controlling, and interruptive.

Assertive Communication

• It is honest and clear communication that respects the rights of others.
• It uses "I" statements.

Passive Communication

• Individuals using this style avoid conflict, often saying nothing or simply agreeing with others.
• They tend to avoid conflict, feel anxious, and hesitate to stand up for themselves.

Passive-Aggressive Communication

• This communication style appears calm on the surface, but the individual expresses anger in subtle, indirect, and secretive ways.
• They tend to act out anger indirectly and feel powerless, resentful, and sarcastic.

Communication Barriers

• These can include language differences,
• cultural diversities,
• medication effects,
• speech or hearing impairments,
• distress,
• developmental or cognitive disorders,
• effects of recreational drugs, and
• environmental factors.

Non-Therapeutic Communication

• This involves not listening to the client, dismissing what the client has to say, attempting to reassure or give advice, and challenging or disagreeing with the client's statements.

Therapeutic Communication

• Characteristics of this communication style is active listening
• Asking opening questions, restating the client's message to ensure understanding, and reflecting on the client's message to reveal feelings or summarize.

Intrapersonal Communication

• This is self-talk, communication within an individual.

Crucial Conversations

• These are conversations that are important but can be difficult.
• They may involve disagreeing with peers, providing criticism, or asking for something.

Possible Reasons for Crucial Conversations

• Broken rules, witnessing a mistake, lack of support, disrespect, incompetence, poor teamwork, and micromanagement.

Emotional Communication

• The sender's feelings and emotional state affect how the message is accepted and received.

Energetic Communication

• How the person projects themselves.

Learning

• It is the process by which a person acquires or increases knowledge or changes behavior in a measurable way as a result of their educational experience.
• Educating someone repeatedly does not guarantee that they will learn, actual learning requires the information to be internalized and utilized.

Cognitive Domain of Learning

• The thinking domain involves seeking information and being able to comprehend it
• The six stages are knowledge (recalling prior knowledge) and comprehension (understanding and interpreting information)
• Other stages include application (using information), synthesis (creating a new whole), and evaluation (deciding on the best ideas).

Affective Domain

• This domain involves the client's feelings regarding values, attitudes, and beliefs.
• Education can affect the client's feelings and emotions

Psycho-motor Domain

• The doing domain involves the physical or mental activities required to learn skills, which are the hands-on skills needed to teach patients.
• The five stages are imitation, manipulation, complex adaption, and origination.

Client Education

• It is an ongoing, goal-driven interactive process to provide clients with new information and is a fundamental element of nursing practice.
• Nurses aim to effect changes in the client's knowledge, attitudes, behaviors, and skills to improve their health, maintenance, and improvement.

Pre-Teaching Assessment Process

• Involves parameters for assessing readiness to learn, ability to learn, and learning strengths BEFORE beginning client teaching.
• It helps analyze the focus of the client education, what the client needs to know, believe, or be able to do, and preparation for receiving care or new diagnosis.
• It involves planning and implementing interventions by thinking about the client's main problem or question, what they need to know or do, and why it is important

Evaluation

• This step involves determining whether the plan needs to be revised.
• It is important to provide helpful feedback to the learner to aid in improvement during and after the education session, so clients understand.

Promoting Compliance

• Ensure that instructions are understandable and support patient goals.
• Include the patient and family as partners in the process, and utilize interactive teaching.

Relevance

• A key component is to ensure the client understands why they should be learning the information provided

Motivation

• This is the clients ability to engage in a learning process by deciding when, where, and how they will learn

Age Impacts on Learning in Older Adults

• Consider these factors when teaching older adults
• Plan short teaching sessions
• Accommodate for sensory defects
• Relate new information to familiar activities or information
• Allow extra time

Client Literacy Level

• Most clients have a sixth-grade reading level or lower

Teach Back

• This involves asking a client to repeat or demonstrate education information to confirm that they received the information accurately and correctly.

Accountability (Your Ownership)

• It involves taking ownership of decisions and actions and being responsible and answerable for the consequences.

Chain of Command (Lowest to Highest)

• The levels are patient care tech, staff nurse, charge nurse, nurse supervisor, team manager, nurse manager, department manager, and hospital supervisor, chief nursing officer, and hospital CEO/president.

Collaborative Healthcare

• It involves a client-centered approach where members of different healthcare professions work together toward a common goal of improving or restoring a client's health

SBAR (Do Not Use When Talking to a Patient)

• This is a standardized communication tool for uniform information delivery during transfer of care
• S: Situation - describe what is currently happening to the client.
• B: Background - provide pertinent clinical background.
• A: Assessment - give a brief evaluation of the situation.
• R: Recommendation - give suggestions for care.

Delegation: Five Rights of Delegation

• The five rights are right task, right circumstance, right person, right directions to communication, write supervision and evaluation.

What UAP Cannot Delegate

• They cannot delegate any element of the nursing process, physical assessment, discharge planning, health education, triage, interpretation of patient data, care of invasive lines, or medication administration.

What to Delegate

• Activities of daily living (bathing, grooming, feeding, linen changes), ambulation, transfer, position changes, and weighing can be delegated

Triage

• This is like prioritization but with a distinct difference.
• Prioritization involves ranking nursing actions by importance.
• Triage prioritizes based on a quick initial assessment followed by how long a client can safely wait for screening and treatment.

Other Priorities, Safety, and Risk Reduction

• Prioritize the situation or factor that poses the highest risk.
• Physical well-being has the highest priority and nurses reduce risk.

Least Restrictive

• Use the least restrictive and invasive method to resolve a problem while maintaining client safety.

Stable Versus Unstable

• Unstable means an acute change in condition while stable means the condition changes little over time.

Triage Categories: Red (Immediate)

• Life-threatening injuries with a high chance of survival with immediate treatment include open chest wounds, airway obstruction, and shock.

Triage Categories: Yellow (Delayed)

• Serious but not immediately life-threatening injuries, treatment can wait
• Examples are open fractures and large soft tissue injuries without airway involvement.

Triage Categories: Green (Minimal)

• Minor injuries where treatment can be delayed for hours or days
• This includes minor lacerations, sprains, strains, abrasions, and minor burns.

Triage Categories: Expectant (Black)

• Injuries are so severe that survival is unlikely despite care
• Comfort should be the main focus.
• Conditions include no pulse after CPR, massive head trauma, and 90% body burns.

Nursing Process

• A systemic method that helps nurses and clients make clinical judgments.

Nursing Process: Assessment

• Assess objective and subjective data pertaining to the client
• Elicit client values, preferences, and needs related to their healthcare knowledge.

Objective Data

• Observable and measurable data that is seen, heard, felt, or smelled by an observer, and signs.

Subjective Data

• Information the client reports.

Sources of Data

• Primary: The client themselves.
• Secondary: Family.

Nursing Process: Analysis & Diagnosis

• The RN analyzes the assessment data to determine actual or potential problems.
• Four steps to data analysis include recognizing significant data, comparing data to standards, recognizing patterns or clusters, identifying strengths and potential complications, and reaching conclusions.

Nursing Process: Outcomes and Identification

• The RN identifies expected outcomes for a plan individualized to the healthcare consumer
• Collaborate with patient to define expected outcomes and consider culture values and ethical considerations

SMART Goals

• Specific, Measurable, Attainable, Realistic, and Timely.

Nursing Process: Planning/Generate Solutions

• The RN develops a plan with prescribed strategies to achieve expected measurable outcomes.
• The plan addresses how the patient will meet the goal and what support is needed, involving the patient actively

Nursing Process: Implementation

• Perform the nursing actions identified in planning.
• Nurse partners with patient to efficiently implement the plan in a safe, effective, timely, patient-centered, and equitable manner.
• Collaboration with interprofessional team

Nursing Process: Evaluation

• Here the the RN evaluates progress toward attainment of outcomes and goals

Priority Setting Framework

• This is an essential skill for all nurses, as intervening on the highest risk problems first decreases adverse client outcomes.
• Defined as the delivery of nursing care based on the urgency of importance of a client needs.

The ABCDE Method

• An algorithm for establishing priorities for individual or groups of clients in any clinical crisis.
• A: Airway, B: Breathing, C: Circulation (e.g., O2 sat), D: Disability, E: Exposure.

The CURE Hierarchy

• Nurses use this to prioritize client care with managing multiple needs.
• C: Critical (emergencies), U: Urgent (situations where harm or discomfort could occur), R: Routine (routine tasks associated with client care), E: Extras (tasks that promote comfort but are not essential).

Palliative Care vs Hospice Care

• Palliative Care occurs throughout the course of an illness and in any setting, allowing for curative therapies.
• Hospice care occurs during the last six months of life and can be in the home, inpatient hospice units, or long-term care settings, and the patient decides to forgo life-sustaining therapy.

Palliative Care Goal

• Improved quality of life through aggressive symptom management.

Needs of Dying Patients: Spiritual Needs

• Meaning and purpose, forgiveness, love and relatedness, and hope.

Needs of Dying Patients: Psychological Needs

• Control over fear of the unknown, pain, separation, leaving loved ones, loss of dignity or control, and unfinished business.
• All clients need dignity is regarded as an everyday necessity for well-being.

Needs of a Dying Patient: Physical

• Hygiene, movement, pain control, nutritional needs, elimination, and respiratory care.

Performing Post-Mortem Care: Physical Care

• Washing the body, accounting for the client's possessions, removing invasive devices (unless an autopsy is scheduled), and placing identification tags.

Performing Post-Mortem Care: Documentation

• Record date and time of death, name of anyone notified, location of belongings, where the body is moved, funeral home name, death certificate issuance, and review of organ donation arrangements.

Telling Patient About Terminal Diagnosis

• The healthcare provider is responsible for initial information such as diagnosis, progression, and what it means for the patient.

How Individual Individuals Process Grief

• Grief is feelings or reactions to a loss in one's life
• Grief is individual and endurance is not necessarily related to death as grief can be experienced from any loss or personal experience.

Code Status (DNR)

• Do not resuscitate.

Code Status (DNI)

• Do not intubate but perform CPR.

Code Status (DNR-FI)

• No CPR but full intervention.

Code Status (DNR-LI)

• No CPR but limited intervention.

Types of Grief: Normal Grief

• This is also known as uncomplicated grief and is caused by the loss of someone very close to death or the ending of a relationship.

Types of Grief: Anticipatory (Anticipating/Waiting)

• Grief experienced before the expected loss of someone or something.

Types of Grief: Disenfranchised

• Grief related to a relationship that does not coincide with what is considered by society to be a recognized or justified loss.

Denial

• The client refuses to believe the truth to lessen the pain.

Anger

• Experiencing is severe emotional distress and is often asking why, suggesting it's not fair.

Bargaining

• Usually involves bargaining with a higher power by making a promise to do something in exchange for a different, better outcome.

Depression

• Reality sitting in the loss of the loved one our thing is deeply felt

Acceptance

• The client still feels the pain of the loss but realizes they will be alright

Grief Reactions and Signs of Grief Processing

• Shock, anxiety, denial, depression, anger, sadness, guilt, numbness, relief (if expected).

Responsibility

• Being obliged to perform work duties or tasks using sound professional judgement and for one's actions.