Nursing Therapeutics II: Lecture 2 - Therapeutic Communication and Homeostasis (University of Doha for Science & Technology)

Nursing Therapeutics II: Lecture 2 Therapeutic Communication and Homeostasis. Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Outline Therapeutic Communication Homeostasis Potter (Chapter 18 Pages 271- Potter (Chapter 31 P...

Nursing Therapeutics II: Lecture 2 Therapeutic Communication and Homeostasis. Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Outline Therapeutic Communication Homeostasis Potter (Chapter 18 Pages 271- Potter (Chapter 31 Pages 286). Pages 527-555). 1-Communication skills 1-Dynamic Equilibrium 2-Levels of communication 2-Vital signs: 3-Basic Elements -Body Temperature 3- Forms of communication -Pulse 4-Therapeutic Communication -Respiration Techniques and challenges -Blood Pressure  Therapeutic Communication www.udst.edu.qa Learning Objectives: Therapeutic Communication Describe aspects of critical thinking that are important to the communication process. Describe the basic elements of the communication process. Discuss the role of communication in relational practice and therapeutic communication techniques Discuss nursing care measures for patients with special communication needs. 4 Communication and Nursing Practice A lifelong learning process for nurses. An essential attribute of professional nursing practice. Builds relationships with patients, families, and interprofessional team members. 6  Communication and Interpersonal Relationships Communication is the means by which to establish helping and healing relationships. Relational practice: is “guided by conscious participation with clients using a number of relational skills including listening, questioning, empathy, mutuality, reciprocity, and self-observation, reflection, and a sensitivity to emotional contexts” Relational communication – Initiative – Authenticity – Mutuality and being in a mutual relationship – Questioning beyond the surface 7 Developing Communication Skills Developing communication skills requires: – An understanding of the communication process. – Commitment to an evolving capacity to be in relation to others. – In-depth reflection about personal communication experiences. 8  Developing Communication Skills Reflexivity: being Perception: based Perceptual biases: Contextual aware of your own on information human tendencies knowledge: is the patterns of acquired through that interfere with building block to communication the five senses of accurately providing context- and response to sight, hearing, perceiving and based and communication, taste, touch, and interpreting relevant care. as well as the smell. messages from responses you are other people. evoking in others. Communication and the nursing process: Integration of communication skills throughout the nursing process facilitates collaboration with patients and members of the interprofessional team. 9  Levels of Communication Intrapersonal Occurs within an individual (self-talk or inner thought) Interpersonal One-to-one interaction between two people Transpersonal Interaction within a person’s spiritual domain Small-group Interactions with a small number of people Public Interaction with an audience 10  Basic Elements of the Communication Process Referent Motivates one to communicate with another Sender and receiver One who encodes and one who decodes the message Message Content of the communication Channels Means of conveying and receiving messages Feedback Message the receiver returns Interpersonal variable Factors that influence communication Environment The setting for sender–receiver interactions 11  Forms of Communication Forms Verbal Non-verbal Symbolic Metacommunication 12  Forms of Communication: Verbal Communication Vocabulary: Intonation: Tone of Timing and relevance: Communication voice dramatically Even though a message is is unsuccessful if affects the meaning of clear, poor timing can senders and a message. limit its effectiveness. receivers cannot decode each Pacing: Messages are Clarity and brevity: other's words and conveyed more Effective communication phrases. successfully when sent is simple, brief, and direct. at an appropriate Fewer words result in less Denotative and confusion. speed or pace. connotative meaning: A single word can have several meanings. 13 Forms of Communication: Nonverbal Communication Personal Personal appearan space ce Posture and Sounds gait Facial Gestures expression s Eye contact 14 Zones of Personal Space and Touch Zones of Touch Zones of Personal Space  Other Forms of Communication Symbolic communication Metacommunication The verbal and nonverbal A broad term that refers to all symbolism used by others factors that influence how a message is perceived by to convey meaning. other people. Usually unconscious messages. 16  Quick Quiz! Quiz What are facial expression, posture and gait, personal space, and eye contact all part of? A. Interpersonal communication B. Verbal communication C. Intrapersonal communication D. Nonverbal communication 17  Professional Nursing Relationships Nurse–patient helping relationships – Narrative interactions – Collaborative communication Nurse–family relationships Interprofessional collaborative practice relationships Nurse–community relationships 18 The Helping Relationship Preinteraction phase Orientation phase Working phase Review Box 18-4 Termination phase 19 Elements of Professional Communication Courtesy Use of names Trustworthiness Autonomy and responsibility – Autonomy is the ability to be self-directed and independent in accomplishing goals and advocating for other people. Assertiveness – Assertive communication allows individuals to act in their own best interests without infringing on or denying the rights of other people 20  Quick Quiz! Quiz Why do nurses need to communicate in a professional manner with both patients and colleagues? A. To show how much nursing has developed B. To evoke trustworthiness and competence C. To show others that nurses are smart D. To avoid jeopardizing their jobs 21 Nursing Process: Assessment Verbal interviewing and history taking Visual and intuitive observation of nonverbal behaviour Written medical records, diagnostic tests, and literature review Documenting of visual, tactile, olfactory, and auditory data gathered during physical examination Communication during assessment Psychophysiological context Psychophysiological context Relational context Situational context Environmental context Read box 18-5 Cultural context Physical and emotional factors Developmental factors Sociocultural factors Gender 22  Diagnosis Intrapersonal analysis of assessment findings Validation of health care needs and priorities via verbal discussion with patient Handwritten or electronic documentation of nursing diagnosis Impaired verbal communication 23  Planning Interpersonal or small-group planning sessions with health care team. Goals and outcomes Interpersonal collaboration with patient and family to determine implementation methods Written or verbal referral to health team members Setting of priorities Written documentation of expected outcomes Continuity of care 24  Implementation Delegation and verbal discussion with health care team. Verbal, visual, auditory, and tactile health teaching activities. Contact with other health resources and the interprofessional team. Written documentation of patient’s progress in medical record. Targeted, effective public and population health messages. Provision of support via therapeutic communication techniques 25  Therapeutic Communication Techniques – Active listening – Clarifying – Sharing observations – Focusing – Sharing empathy – Paraphrasing – Sharing hope – Asking relevant – Sharing humour questions – Sharing feelings – Summarizing – Using touch – Self-disclosure – Using silence – Confrontation – Providing information 26  Nontherapeutic Communication Techniques – Asking personal – Asking for explanations questions – Approval or disapproval – Giving personal opinions – Defensive responses – Changing the subject – Passive or aggressive – Automatic responses responses – False reassurance – Arguing – Sympathy 27  Adapting Communication Techniques for Patients with Special Needs Patients who cannot speak clearly Patients who are cognitively impaired Patients who are hearing impaired Patients who are visually impaired Patients who are unresponsive Patients who do not speak English Group activity Read box 18-8 28  Evaluation Acquisition of verbal and nonverbal feedback Comparison of actual and expected outcomes Identification of factors affecting outcomes Modification and update of care plan Verbal or written explanation, or both, of revisions of care plan to patient Receiving and responding to feedback about one’s own nursing care 29  The Communication Analysis Evaluate the effectiveness of communication. – Determine what strategies or interventions were effective and what changes in the patient’s situation were the result. – Modify care plan if expected outcomes are not met or progress is not satisfactory. 30  Summary Communication Professional nursing relationships Relational practice Nurse–patient helping relationships Developing communication skills Professional communication Levels of communication Nursing process Elements of the communication process Therapeutic communication Verbal communication techniques Nonverbal communication Nontherapeutic communication Zones of personal space techniques Zones of touch Patients with special communication needs  https://create.kahoot.it/details/7fde8dc5-25da-423c-87bd- 473573a55211 Homeostasis www.udst.edu.qa  Learning Objectives: Homeostasis Explain the principles and mechanisms of thermoregulation. Describe nursing measures that promote heat loss and heat conservation. Accurately assess temperature via multiple routes: tympanic, oral, temporal, rectal, and axillary. Accurately assess pulse, respirations, oxygen saturation, and blood pressure. Explain the physiology of normal regulation of blood pressure, pulse, oxygen saturation, and respirations. Describe factors that cause variations in body temperature, pulse, oxygen saturation, respirations, and blood pressure. Explain variations in technique used to assess an infant's, a child's, and an adult's vital signs. Accurately record and report vital sign measurements. 34  Homeostasis The process by which a stable internal environment is maintained despite changes in the external environment. This is the condition of optimal functioning for the humans and includes many variables, such as body temperature and fluid balance, being kept within certain pre-set limits (homeostatic range). Homeostasis and Negative/Positive Feedback https://www.youtube.com/watch?v=Iz0Q9nTZCw4&t=77s 35  Dynamic equilibrium Homeostasis is also called dynamic equilibrium: Conditions do fluctuate, but within an acceptable range – Heart Rate – Blood Pressure – Temperature – Respiratory Rate – Glucose – Electrolyte – pH – Hunger – Hormones 37  Vital Signs and Homeostasis The human body constantly struggles to maintain a stable state of being or homeostasis, which is central to life. Vital signs are measurements of the body's most basic functions and are an extremely useful tool to monitor homeostasis and measure physiological normal functions within the body. Vital sign measurements are a crucial aspect of physiotherapy assessment, screening for potential red flags and to guide treatment. Vital signs are indicators of a persons health condition and normal measurements provide assurance of proper circulatory, respiratory, neural, and endocrinal functions 38  Vital Signs The most frequent measurements are body temperature, pulse, blood pressure, respiratory rate, and oxygen saturation Pain has been referred to as the “fifth vital sign,” which alludes to the importance of its assessment Many factors such as pain, environmental temperature, physical state, activities, or illness can cause vital signs to change. 39  Guidelines for Measuring Vital Signs Equipment Knowledge of patient’s range of usual values for vital signs Knowledge of patient’s history and current status Environmental factors Systematic approach Approach with the patient Frequency of assessment Assessment for medications Analysis and verification of results Communication of results Teaching 40 Vital Signs Activity 1. Body Temperature 2. Pulse 3. Respiration 4. Blood Pressure 41  1. Body Temperature: Definition Difference between the amount of heat produced by body processes and the amount lost to the external environment. Body’s core temperature must be kept constant Ranges of normal temperature values and physiological consequences of abnormal body temperature. 42 1. Body Temperature: Acceptable Temperature Range 36C to 38C Average oral or tympanic: 37C Average rectal: 37.5C Average axillary: 36.5C 43  1. Body Temperature: Physiology and Regulation Physiology Heat loss o Thermoregulation: hypothalamus o Radiation o Sense and control o Conduction Neural and vascular control o Convection Heat production o Evaporation o Basal metabolic rate (BMR) o Diaphoresis o Shivering Skin in temperature regulation o Non-shivering thermogenesis Behavioural control o The degree of temperature extreme o The person's ability to sense feeling comfortable or uncomfortable. o Thought processes or emotions. o The person's mobility or ability to remove or add clothes. 44 1. Body Temperature: Factors Affecting Body Temperature Age Exercise – Hormone level Circadian rhythm Stress Environment Temperature alterations – Fever (pyrexia) Pyrogens Febrile versus afebrile Fever of unknown origin – Hyperthermia Malignant hyperthermia Heatstroke Heat exhaustion – Hypothermia 45 Frostbite  1. Body Temperature: Assessment – Sites Rectal, skin, oral, axillary, tympanic membrane, temporal artery – Thermometers Electronic – Tympanic, oral, rectal, temporal artery Chemical strip (single-use or reusable) Glass Box 30-4 46 Advantages and Disadvantages of Select Temperature Measurement Sites 1. Body Temperature: Implementation Health promotion Acute care o Fever o Antipyretics o Heatstroke o Hypothermia Restorative and continuing care Evaluation 47 1. Body Temperature Summary 48  2. Pulse: Physiology and Regulation The pulse is the bounding of arterial blood flow that is palpable at various points on the body. It is an indicator of circulatory status. Electrical impulses from the sinoatrial node stimulate cardiac contraction. 49  2. Pulse: Assessment Radial pulse Apical pulse: Use of a stethoscope Character of the pulse Rate: bradycardia, tachycardia, normal, absent Rhythm: regular or irregular Strength: bounding, weak (thready), full, normal Equality: Pulse Deficit 50 2. Pulse: Assessment 51 2. Pulse: Factors affecting Pulse rate Exercise Temperature Emotions Pain Medications Hemorrhage Postural changes Pulmonary conditions 52 Quick Quiz! The nurse notices that an 18-year-old male patient has an irregular pulse. What would be the nurse’s best course of action? A. Read the history and physical examination findings of the patient. B. Assess the apical pulse rate for one full minute. C. Auscultate for the strength and depth of the pulse. D. Ask the patient whether he feels any palpitations. 53 2. Pulse Summary 54  3. Respiration: Definition Three components of respiration: Ventilation The movement of gases in and out of the lungs Diffusion The movement of oxygen and carbon dioxide between the alveoli and the red blood cells Perfusion The distribution of red blood cells to and from the pulmonary capillaries 55 3. Respiration: Physiology and Regulation Physiological control Carbon dioxide (low pH) Oxygen Hypoxemia Mechanics of breathing Inspiration Expiration Tidal volume 56  3. Respiration: Assessment Respiratory rate: apnea, tachy, brady Ventilatory depth: normal, hypo, hyper Ventilatory rhythm: regular, irregular Arterial oxygen saturation 57 3. Respiration: Factors Affecting respiration Exercise Acute Pain Anxiety Smoking Body Position Medications Neurological Injury Hemoglobin Function 58 3. Respiration Summary 59  4. Blood Pressure: Definition Force exerted on walls of an artery Standard unit for measuring: millimetres of mercury (mm Hg) – Recorded as systolic reading over diastolic reading Systemic (arterial) BP: a good indicator of cardiovascular health 60 4. Blood Pressure: Physiology Cardiac output Peripheral resistance Blood volume Viscosity Elasticity 61 4. Blood Pressure: Factors Influencing Blood Pressure Age Stress Ethnicity Gender Daily variation Medications Activity Weight Smoking 62 4. Blood Pressure: Assessment Measurement – Equipment – Auscultation Canadian Hypertension Education Program (CHEP) encourages the use of automated devices – Assessment in children – Ultrasonic stethoscope – Palpation – Lower extremity BP – Automatic BP devices – Self-measurement 63  4. Blood Pressure: Assessment Ensuring correct size cuff and accurate technique Guidelines for proper blood pressure cuff size. Bladder length should cover 80 to 100% of arm circumference Bladder width should be close to 40% of arm circumference. 64  Quick Quiz! When assessing the BP of a school-age child, using a normal-sized adult cuff will affect the reading and produce a/an ______ value. A. Accurate B. Indistinct C. Falsely low D. Falsely high 65 4. Blood Pressure: Assessment, Common mistakes in BP assessment 66  4. Blood Pressure: Acceptable Range Normal Blood Pressure Ranges Average: 120/80 mm Age Systolic (mm Hg) Diastolic (mm Hg Hg) Pulse pressure: 30 to 50 mm Hg Infant 65–115 42–80 7-year-old 87–117 48–64 Adult Less than 135 Less than 85 67 4. Blood Pressure: Hypertension and Hypotension  Hypertension  Hypotension BP greater than 140/90 Systolic pressure less mm Hg than 90 mm Hg More common than Dilation of arteries hypotension Loss of blood volume Thickening of walls Decrease of blood flow Loss of elasticity to vital organs Family history Orthostatic or postural Risk factors 68 4. Blood Pressure Summary 69  Summary Vital signs Heat production and loss Body temperature Factors affecting temperature Assessment sites and thermometer types Assessment sites Pulse Factors affecting pulse Respiration Respiratory rate, depth, rhythm Factors affecting BP Blood pressure Assessment of BP 70