NUR1 222 Week 9 Strengths-Based Nursing and Professionalism PDF

NUR1 222 Strengths-Based Nursing and Professionalism Prof Maria Di Feo October 26, 203 Outline • SBNH - Essential Nurse Qualities • Reflective Practice • Strengths • Characteristics of Strengths • The Spiraling Process for Uncovering and Discovering Strengths • Approaches for Working with Streng...

NUR1 222 Strengths-Based Nursing and Professionalism Prof Maria Di Feo October 26, 203 Outline • SBNH - Essential Nurse Qualities • Reflective Practice • Strengths • Characteristics of Strengths • The Spiraling Process for Uncovering and Discovering Strengths • Approaches for Working with Strengths • Quiz 2 1. Strengths of Mindset Ø SBN: Essential Nurse Qualities (Qualities that are a good fit with SBN approach) (Gottlieb, 2013) Mindfulness: Ø Ø Ø Ø Ø Knowing what one knows and what one doesn’t know. Acknowledging mistakes, limitations, gaps in knowledge.. Appreciation for another person’s contribution. Open-mindedness Ø Ø Paying attention to what one is doing, what one is feeling. Being fully present. Humility Ø Ø Skills required to connect with patients and maintain caring relationships. Actively seek out different ideas, open to different opinions. Non-judgemental attitudes Ø Show tolerance for another person’s beliefs, values, perspective. 3 SBN: Essential Nurse Qualities 2. Strengths of Knowledge and Knowing (acquisition and use of information) Ø Curiosity Ø Leads to a deeper understanding of situation. Ø Ask open –ended questions. Ø Ø Try to discover “why” behavior is happening. Self-reflection (reflection) Ø Examine critically one’s own thoughts, emotions, and actions. 2023-10-26 4 3. Strengths of Relationships SBN: Essential Nurse Qualities Ø Respect and trust. Ø Empathy. Ø Compassion and loving kindness. Ø Emotional Intelligence Ø Ø Daniel Goleman (1995) defined emotional intelligence as a set of abilities. Ability to: Ø motivate oneself Ø persevere in the presence of frustrations Ø control impulses and delay gratification Ø regulate one’s emotions Ø manage distress Ø have empathy for others Ø to possess hope 2023-10-26 5 A neurologist and psychiatrist as well as a Holocaust survivor (1905-1997) Emotional Intelligence SBN: An Essential Nurse Quality 6 Stimulus (Space) Mother “My son does not have very much appetite, he didn’t eat any of his food that came on his tray. He asked for some ice cream, can you bring him some ice cream.” 10/26/23 Response Nurse “Sorry, but this is not a hotel.” Nurse walks away. Level of nurse’s Emotional Intelligence 7 4. Strengths of Advocacy Ø Courage Standing up for one’s beliefs. Ø Taking risks Self-efficacy Ø SBN: Essential Nurse Qualities Ø Ø Person’s belief that she can perform a behavior that will produce a desired outcome. “I can do it”. Ø Determinant of whether a person attains her desired goals. Capacity to influence 2023-10-26 8 9 Required: SBN Essential Nurse Qualities 10/26/23 •To form a Collaborative Partnership •To engage in Compassionate, Competent and Ethical Care Reflection SBN: an essential Nurse Quality “Reflection is a systematic way of thinking about our actions and responses that contributes to a transformed perspective or the reframing of a given situation or problem that determines future actions and responses.” Sherwood, G., & Horton-Deutsch, S. (2012). Reflective practice: Transforming education and improving outcomes. Sigma Theta Tau p. 17 10/26/23 10 Requires that nurses are aware of their own strengths, vulnerabilities and weaknesses. Reflection Increases Self Awareness Practicing SBN Requires Self Awareness 10/26/23 Nurses need to be aware of how their behaviours affect people. Self awareness helps nurses understand why they behave in certain ways. Self awareness is an important element in the growth and development of being a professional. 11 • Donald Schon (1983) identified two types of reflection; Types of Reflection • Reflection on action: refers to going over in your mind an event that happened; what went well, what didn’t go so well and then coming up with more effective actions for the future. • Reflection in action: refers to examining your behavior and behavior of others as the event is occurring. • Max Van Manen identified a third type of reflection • Anticipatory reflection: refers to reflection that occurs before the event takes place. It can involve planning of the event and reviewing possible scenarios. 10/26/23 12 REFLECTION & REFLECTIVE PRACTICE 13 Ø John Dewey, an American psychologist, philosopher and educator was among the first to write about “Reflective Practice”. Ø J. Dewey believed that we don't learn by experience; we learn by reflecting on our experience. Reflective Practice Ø Reflection, according to J. Dewey, moves the person from one experience to the next with a deeper understanding of their relationships with, and connections to, other experiences and ideas. Ø According to J. Dewey “Reflection is the thread that makes lifelong learning possible”. 10/26/23 14 Reflection is usually triggered when we find ourselves experiencing emotional discomfort, when we are faced with challenging issues, including ethical dilemmas. Reflection Practitioners and students should also engage in reflection when they experience positive and rewarding experiences. These positive experiences can also contribute to learning and growth. 10/26/23 15 Individual • Individual engages in reflection process Reflective Practice Collective (group) • A group of people (practitioners) engage in reflection process • i.e. Post - critical event, a death, a code white, a code blue… 10/26/23 16 Models (frameworks) of Reflection Provide us with a structured process to facilitate reflection and to provide guidance in the reflective process. Several models of the reflective process exist. 10/26/23 17 Gibb’s Reflective Model Description What happened? Action Plan If it arose again what would you do? Feelings/ thoughts What were you thinking and feeling? Evaluation What went well and what went not so well? Conclusion What else could you have done? Analysis 10/26/23 What sense can you make out of the situation? Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Further Education Unit, Oxford Brookes University, Oxford. 18 Description Gibb’s Reflective Model • This is context of the event .e.g. • Who was there? • Why were you there? • What was happening? Feelings/thoughts • This is self awareness .e.g. • How did you feel? • How did the others around you feel? • How did you feel about the outcome of the event? Initial Evaluation • Consider your judgments.eg. • Consider what went well, what not so well. • What was good and not so good about your experience. 10/26/23 19 Analysis Gibb’s Reflective Model • Break down the event and explore each part separately. • What sense do you make of the experience? Conclusion • What have you learnt from reflecting on this experience? Action plan • Consider what you would do differently if you encountered this situation (again). • Would you act differently or do the same? 10/26/23 20 Reflection in Nursing Practice Benefits Ø Examine critically one’s own thoughts, emotions, and actions. Ø Leads to greater self awareness; being aware of one’s own values, strengths and weaknesses. Ø Contributes to flexibility of thinking. Ø Every situation encountered becomes an opportunity to learn, develop and grow. Ø Greater satisfaction in your practice. Ø For students reflection also encourages engagement, selfdirected learning and lifelong learning. 10/26/23 21 To be a Reflective Practitioner Essential … ØTo be open-minded ØTo be curious; develop clinical imagination (Benner & al, 2010) ØTo have a sense of inquiry; exploration ØTo be open to changing your perspective on a situation based on evidence ØTo be willing to challenge assumptions (your own and others) ØTo not be defensive 10/26/23 22 Reflection has been cited as being an effective strategy in enhancing emotional intelligence competencies. 10/26/23 23 Strengths 24 • Strengths can be biological, psychological, and social. Classifications of Character Strengths Wisdom & Knowledge Courage Humanity Justice §Curiosity §Bravery §Love §Citizenship §Open- §Persistence §Kindness §Fairness §Integrity §Social §Leadership mindedness §Love of learning §Perspective (wisdom) §Vitality intelligence Temperance Transcendence §Forgiveness & mercy §Appreciation of beauty & excellence §Humility & modesty §Gratitude §Prudence §Selfregulation §Hope, future mindedness §Humor §Spirituality Adapted from Positive Psychology Movement. Peterson & Seligman,(2004) Ten Categories of Strengths (Smith, 2006) Gottlieb, L.N. (2013). Strengths-based nursing care. Springer Publisher Canada p. 110 Wisdom and spiritual strengths Emotional strengths Character strengths Creative strengths Relational and nurturing strengths Educational strengths Cognitive strengths Work related and provider strengths Use-of-resources strengths Survival skills strengths Wisdom and spiritual: Age-related and spirituality Emotional: Perseverance, insights, optimism, putting troubles in perspective, finding purpose and meaning in life, having hope, faith, love of life Ten Categories of Strengths (Smith, 2006) Character: Integrity, honesty, discipline, courage, perseverance Creative: Ability to appreciate art, ability to express oneself in writing, voice Relational and nurturing : Ability to form meaningful relationships with others; ability to communicate; capacity to nurture, show compassion, cooperation, tolerance, empathy, forgiveness, love, and kindness Educational: Academic degrees, educational attainment, informal education Cognitive : Problem solving, decision making, ability to think and reason Work-related and provider: Secure employment, provide for one’s family, generate wealth Use-of-resources: Make use of social network, access to community services Survival skills : Ability to avoid pain, provide for basic physiological and safety needs Biological Strengths What in our bodies that is working well? • Breathing, walking, voiding, hearing, seeing, swallowing, moving, talking, growing, heart beating…. Patient who experiences a stroke • What is working at a biological level? Concept Associated with Strengths • Resiliency • Ability to adapt effectively in the face of threats to development. • Ability to withstand, rebound, and recover • To be resilient you need to possess strengths. Resiliency and Strengths • By dealing with challenges, illness, trauma, tragedy, people discover their strengths; they develop new skills, competencies and understandings and in turn they become more resilient. • When people have a large reserve of strengths, they are better equipped to adapt to threats/challenges and overcome adversity. The Spiraling Process for Uncovering and Discovering Strengths Strategies to use when working with patients and families 33 ISON Nursing Process Diagram The Nursing Process used at the ISON uses the Clinical Reasoning Cycle (CRC) to facilitate the cognitive process of clinical decision making guided by Evidence – based Nursing Practice (EBNP). We use a StrengthsBased Nursing (SBN) approach in our practice with individuals, families and communities. This process is documented and orally transmitted using language adapted for interprofessional communication (IC) ISoN Nursing Process 4 IC 3 H SBN Cultivating curiosity ep 7-St 2 EBP 1 Evaluate outcomes Clinical Reasoning Cycle Process information Searching the evidence Evaluating practice change CRC Consider the patient situation References 1. Levett-Jones et al, (2010). Clinical reasoning cycle. Pearson 2. Melnyk, BM., Fineout-Overholt, E., Stillwell, SB., Williamson, KM. EvidenceBased Practice: Step by Step: The Seven Steps of Evidence-Based Practice, The American Journal of Nursing. 110(1), 51-53. 3. Gottlieb, L., & Gottlieb, B. (2012). Strengths-based nursing care: health and healing for person and family. NY. Springer Publishing Company. 4. Indicates language used by the OIIQ. Cette publicité n'est pas une publicité de l'Ordre des infirmières et infirmiers du Québec et elle n'engage que son auteur. 34 Nursing Process Using a SBN Approach to Guide Practice Copyrighted Material: ISoN McGill University (2018) Strengths Based Nursing in Clinical Teaching Online Course 2023-10-26 § A nursing model to guide nursing practice § Helps us uncover and discover a person’s strengths The Spiraling Process § Embedded in the ISoN Nursing Process § Approach to practice § Each of the four phases consists of a major activity that defines the roles that each partner (nurse, patient/family) assumes Major focus is on exploring the person’s concerns and getting to know the person and family. Phase 1: Exploring and Getting to Know § Assessing for weaknesses and deficits that may put the person at risk for illness or prevent healing § Focusing on uncovering strengths that help the patient cope/manage health problem/s and recover and heal. § Nurse creates conditions for a collaborative partnership: explains their role, asks the person about their expectations. § Begins to establish trust, which is the essential prerequisite for the collaborative partnership. Phase 1: Exploring and Getting to Know § Exploring importance of health problem/s with the person/family. § Exploring the person’s beliefs related to the health problem. Beliefs are at the heart of how a person reacts and responds to various situations. § Examples of statements and open - ended questions that can be used. Tell me how you are coping with… What have you tried so far? What is working? What would you like me to know about… ? How would others describe you? What have you done so far to deal with this problem? What would you like to see happen? Phase 1: Exploring and Getting to Know Addition examples of statements and open -ended questions that can be used What would you like to see happen? What is happening in your life that you think is affecting this concern? What do you think you need to help you accomplish this? How are your symptoms affecting your life? What is your biggest fear with regards to …..? Tell me about what has happened that brings you here. What are you most worried about? How long has this been an issue or concern? What else is currently happening in your life that you think is affecting this concern? How are these symptoms affecting your life? 39 Phase 1: Exploring and Getting to Know Ø Nurse’s Role • Guides exploration • Listens • Clarifies • Understands person’s perspective Ø Person’s Role • Provides information • Clarifies Ø Nurse’s Expertise • Health and illness situations • Treatment regimes • Patterns of responding Ø Person’s Expertise • Their situation • Their meaning • Past coping strategies • Their own strengths and weaknesses Approaches for Getting to Know your Patients Phase 1: Exploring and Getting to Know Approach #1 Approach #2 Approach #3 Approach #4 Approach #5 Approach #6 Approach #7 Approach #8 Continuously look for strengths Get in touch with your first impressions Sensing, recognizing and noticing strengths Becoming attuned to the person Ask People directly about their strengths Complete a genogram and ecomap Offer commendation Ask about strengths that were developed through meeting past challenges Approach #1 Nurses need to continuously look for patient’s strengths Ø Nurse needs to have a strengths-based “mindset”, they need to be listening for, observing for, and be attuned to patient's qualities/capacities that could be considered strengths. Ø Sample Clinical Inquiry questions include (nurse’s ask themselves): • What does the person have going for them? • What’s working? What’s not? • How does the person use their strengths and resources to deal with challenging situation and to promote their own health & healing? Approach #2 Nurses need to get in touch with their own first impressions ØEven before the nurse meets the patient, they may begin to form an impression of the patient, based on reports, notes, knowledge of a disease process or diagnosis, etc ØNurses need to get in touch with their thoughts and feelings, and ask themselves: • What are my thoughts about this person/family? • How do I feel about them? • How do they make me feel? • What do I like about them? • What don’t I like? Why? • What feelings, fears, and insecurities does this person and his behaviour trigger in me? Once you’re aware of your biases and prejudices, and their sources, you’re better able to suspend judgement, have an open mind and be attuned to the person. Approach # 3 Sensing, recognizing and noticing strengths ØAs the patient/family express their concerns and explain their story, the nurse listens and makes note of their strengths/capacities/qualities, as well as how they’ve coped with past challenges, transitions and tragedies. ØSome of the things the nurse should consider when exploring patient strengths include: • Are they aware of their strengths and resources? • Are they open to information? Do they seek out info and ask questions? • How do they cope, manage stress, solve problems and make decisions? • Do they persevere or give up? • Do they maintain hope? • Do they have adequate social support, supportive relationships and financial resources? Approach # 3 (cont.) Sensing, recognizing and noticing strengths ØAnother way of considering the patient’s strengths is in terms of the three forces that govern human development: • Regulation and self-regulation – How are they responding emotionally and physiologically to their circumstances/situations? • Attachment and relationships – How do they seek out, develop and maintain relationships with other people? • Coping – Do they have strategies and strengths (or potential strengths) to overcome this illness or present health challenge? Approach # 4 Becoming attuned to the person • The nurse has to listen for and discover strengths that are within each unique individual/family. • Requires some effort and commitment from the nurse. • Observe, notice and sense a patient’s patterns of responding, search for clues and evidence of strengths. Approach # 5 Ask people directly about their strengths ØSome patients may be able to answer directly, others might need clarification or rephrasing, such as: • What do you think you do well? • What do you think is working (in your body, relationships, other aspects of your life)? • What resources are available to you and your family? • What do friends or others tell you about what you do well? • What makes your family unique or special? • Tell me about a time you felt proud of yourself/your family? Approach # 6 Using a genogram and an ecomap to uncover and discover family strengths Tools for conducting nursing assessments to help the nurse to gain insights into a patient’s family life and family resources. • A genogram is a visual representation of the members in a family and the nature and patterns of their relationship. • An ecomap is a tool that depicts a person’s social network, including friendships, extended family, neighbours, work, health care system, religious or community affiliations, etc § Type of line indicates nature and quality of the relationship. Approach #6 Genogram https://www.genopro.com/genogram/symbols/ https://www.genopro.com/genogram/templates/ Approach #6: Ecomap https://www.researchgate.net/figure/Aneco-map-of-a-60-year-old-male-patientwith-type-2-diabetes_fig1_282651055 Approach #7 Offering commendation § Commendation is when you provide specific, positive feedback regarding a behavior or strength/quality/capacity. § As important as the commendation, is observing for, and listening to the person’s response to commendation. For example: § What does their body language indicate? Do they acknowledge the praise, or feel uncomfortable, avert your gaze, or fidget? § What is their verbal response? Do they minimize or dismiss the feedback or graciously thank the nurse? § What is the fit between the person’s body language and their verbal response? § Commending patients can give you insight into how a person feels about himself, his abilities and his strengths. Approach #8 Asking about strengths that were developed through meeting past challenges § Nurse can ask a patient directly about how they successfully responded to and overcame past challenges. Strengths can be transferred from one situation to another. § Useful questions might include: § Tell me about another difficult situation you dealt with in the past? § What helped you get through the situation? § Part of the nurse’s assessment includes noting if the patient developed and grew as a result of past challenges. Were they transformed? Did they remain unchanged, regress or struggle to meet the challenges? These insights can help inform your approach to the situation. Phase 2: Zeroing in ØPoint in the assessment when the nurse must step back in order to gain perspective. Work with the patient to identify specific, workable goals and then prioritize them (involves negotiation). § Clarify with the person what they would like to see happen. § Decide together which goals are most important and most achievable, exploring different avenues. § Create the conditions to help the person manage their health problem. ØMust consider the person’s readiness to learn. ØIdentify strengths that person may be lacking to reach one’s goals. Use time with the nurse as an opportunity to develop those strengths. Phase 2: Zeroing in Nurse’s Role vHelps identify goals vHelps prioritize goals Person’s Role vIdentifies goals vPrioritizes goals Phase 3: Working out Involves putting the plan into action (the plan developed in the “Zeroing In” phase) ØInvolves making time with patients to take stock of where things are, what progress has been made, what has been learned, and what is sill left to do. Phase 4: Reviewing ØSample questions: • How did the plan we agreed on work out? • Did issues improve? Deteriorate? Stay the same? • Did you discover new capabilities or talents that you weren’t aware you had? • What new skills have you developed? References • Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educa&ng nurses: A call for radical transforma&on. San Francisco: Jossey-Bass. • Dewey, J. (1933). How we think: A restatement of the rela&on of reflec&ve thinking to the educa&ve process. Boston: D.C. Heath and Co. • Go\lieb, L.N. (2013). Strengths-based nursing care. Springer Publisher Canada • Schön, D. A. (1983). The reflec&ve prac&&oner: How professionals think in ac&on. New York: Basic Books. • Van Manen, M. (1991). Reflecbvity and the pedagogical moment: the normabvity of pedagogical thinking and acbng 1. J. Curriculum Studies, 23(6), 507-536. 10/26/23 57