Relational Practice Midterm Outline

Week 1 Introduction to Professional Relationships and Relational Practice What is communication? Answer - Communication connects people and ideas. Occurs through, words, nonverbal behaviors and actions. What is the diff...

Week 1 Introduction to Professional Relationships and Relational Practice What is communication? Answer - Communication connects people and ideas. Occurs through, words, nonverbal behaviors and actions. What is the difference between a therapeutic vs. a social relationship? Answer - Social Relationship 1) Personal or intimate relationship 2) Identification of needs may not occur. 3) Personal goals may not be discussed. 4) It is not necessarily time oriented. Ii ) Therapeutic Relationship 5) Goal oriented 6) Personal but not intimate 7) Needs and goals are identified. 8) Specialized professional skills are used to employ nursing interventions. 9) Time oriented, gauged by the time that care is provided, or care is transferred. What actions support the nurse to engage in relational practice? ❖ Answer - Goes beyond communicating with clients to being authentically and fully present as they engage in their health journey. ❖ Requires nurses to gain an appreciation of the whole client and their health experience. ❖ Requires collaboration with the client and healthcare team. In what ways can relational practice contribute to patient-centered care? a) Answer - Actively including the client in their care and care planning. b) Understanding the client’s needs and expectations that the client has for their care. c) Directing all nursing interventions towards the therapeutic needs of the client d) Demonstrating sensitivity and respect for the client’s choices e) Effectively managing stress f) Evaluating the effectiveness of nursing interventions to meet the client’s needs. g) Acknowledging and transferring care when a relationship is not evolving therapeutically. Why are relational practice skills essential for the practice of nursing? Answer - Specifically, relational practice refers to the ability to communicate skillfully and appropriately, while being mindful of factors such as context and interplay. This is an especially crucial in the health care setting, and therefore the development of communication skills is a critical component of nursing education.  What are the relevant regulatory standards and guidelines related to professional development. Week 2 What is regulated proffesions ? ► A regulated profession requires the holder to be licensed or registered by a regulatory body. The purpose of regulating a profession is to protect the public by ensuring that those practicing are qualified and competent. ► Regulation protects consumers from fraud or abuse by professionals. ► Regulation ensures everyone who uses a specific title (registered nurse): ► has attended an accredited education program, ► has passed a licensing exam. ► practices according to the standards and ethics of the profession ► maintains competency to practice through self-reflection and continuing education. What is regulated health professions act (RHPA act) ⮚ Answer - better protect and serve the public interest. ⮚ be a more open and accountable system of self-governance. ⮚ provide a more modern framework for the work of health professionals. ⮚ provide consumers with freedom of choice; and provide mechanisms to improve quality of care. Purpose of RHPA Answer - Protecting the public from harm. Promoting high quality care Making regulated health professional accountable to the public Giving provincial residents access to the health care professions of their choice Equality where all health professions adhere to the same principles. 1. Explore how reflective practice is a part of our Professional Role and is linked to clinical judgement. Answer - - Reflect on your practice to identify your strengths and areas that need improvement. - Feedback from a colleague can support your reflective process - Reflective questions are intended to help you reflect on your experience as a nurse and support you in identifying areas in your practice for your continued learning. - Goal of practice reflection is to identify areas in your practice for your continued learning Learning needs: - Clear and concise description of an area of learning that requires further development - Lifelong learning is essential to supporting competence - A commitment to improving competence is part of our nursing code of conduct ► 2. Review and understand the College of Nurses (CNO) Quality Assurance (QA) Program Answer - The CNO maintains a Quality Assurance Program (QA) to meet its mandate of protecting the public by making sure nurses are taking responsibility for practicing nursing safely throughout their careers. As professionals, all nurses are accountable to reflect on their practice to determine their learning needs and actively update their knowledge and skills to maintain their continued competence. CNO’s QA Program consists of three components: 1. Self-Assessment 2. QA Assessment 3. Coaching support a. Create a learning plan using the QA learning plan process. i. Examine our own learning needs using a SWOT Analysis Answer - SWOT Analysis: ► Strengths: ► Examining your strengths or enablers ► Can be personality traits or external factors that empower you (ex. Support system) ► Weaknesses: ► Examine your weaknesses and areas for improvement. ► Can be internal (ex. Disorganization, lack of focus) or external (ex. Something going on in your personal life) ► These will be things that may prevent you from accomplishing your goals. ► Opportunities: ► External factors that will support you to learn new ways of working and achieving your goals. ► Threats: ► External factors that will get in the way of achieving your goals ii. Re-examine SMART goals and explore how they can be used to set our own learning goals iii. Review and link learning goals to the Code of Conduct iv. Identify learning activities to support achievement of your learning goal. ► Answer –  ► Learning activities should have a timeline for completion. ► Complete the learning activities to reach your learning goals. ► Peer reviewed journal articles (Use academic databases such as CINAHL) ► - Practice standards and BPGs from professional organizations ► - Only use websites from credible sources (ex. Government organizations, Canadian Cancer Society, Alzheimer Society of Canada, etc.) ► - Information published where possible in the last 5 years ► v. Describe how you would evaluate achievement of your learning Answer - Evaluate Your Progress: - After completing the learning activities reflect on what you have accomplished - Identify any new learning gaps or goals Consider: - How will this new knowledge improve your ability to provide safe nursing care? - How will you apply what you have learned to your practice? 3. Examine how information literacy and the hierarchy of evidence support learning within our profession ► Answer – literacy - A set of abilities requiring individuals to recognize when information is needed and have the ability to locate, evaluate, and use effectively the needed information. ► - Information comes in unfiltered formats, raising questions about its authenticity, validity, and reliability. 4. Review the E-Learning Portfolio. Week 3 1. How does engaging in relational practice and therapeutic relationships support our ability to provide person centered nursing care? Answer - The therapeutic relationship is based on trust, respect, empathy and professional intimacy. Relational practice helps the nurse to develop a deeper understanding of patient suffering. Without having those bases we wouldn't be able to care for our patients adequately. 2. What are the requisite capacities that are required to engage in Relational Practice?  Answer - Background Knowledge: what you bring with you – training and experience. Knowledge of Interpersonal, Caring and Development Theory Knowledge of Culture, Diversity Influences and Determinants of Health Effect of difference, social, cultural and racial diversity Knowledge of Person Finding time to know the other (Essential for person centered care) Knowledge of Health and Illness Best practice, standards, and guidelines Knowledge of the influences on health care and health care policy Awareness of forces that may influence the context of care Knowledge of Systems - How the health care system functions 3. What does it mean to be self-aware and have self-knowledge? ► Answer – ► Self-aware - Recognize your emotions. See yourself honestly. Recognize your strengths and weakness. Commit to personal growth. ► Knowledge Helps nurses: Differentiate between his/her own experience and values, and those of the client. Appreciate the unique perspective of the client, avoid burdening the client with personal issues and prevents superimposing own beliefs and preferred solutions on the client. 4. How do we clarify our own cultural values, beliefs, assumptions, and biases? Answer - Everyone has their own biases based off our life experiences. When going into nursing it is your responsibility to put these aside in order to provide equal and fair care for all. 5. What is confidentiality and privacy?  ► Answer – Privacy - Privacy is about people. A patient has the right to privacy and to disclose only those details about his/her life, illness, feelings, finances & family or not disclose at all. ► Confidentiality - Confidentiality is about the duty to protect information; what the nurse does with the information. 6. How do these concepts link to our professional boundaries and obligations as nurses? Answer - these are applied to the therapeutic relationship by the HCP following and maintaining the guidelines with C&P allowing the patient to know that they have a safe environment for their health information. b Core value in CNA code ► Provide safe, compassionate, competent and ethical care ► Promote health and well-being ► Promote and respect informed decision making ► Honour dignity ► Maintain privacy and confidentiality ► Promote justice ► Be accountable. 6 Principles 1. Nurses respect clients’ dignity. 2. Nurses provide inclusive and culturally safe care by practicing cultural humility. 3. Nurses provide safe and competent care. 4. Nurses work respectfully with the health care team. 5. Nurses act with integrity in clients’ best interest. 6. Nurses maintain public confidence in the profession. ► Quality of Care Information Protection Act (QOCIPA) provides protection to quality of care information produced by a healthcare facility. ► Personal Health Information Protection Act (PHIPA) governs healthcare information privacy. Rules for managing health information Clients rights to use and disclosure of their information What is personal heath information – ► Relates to an individual’s physical or mental health;  ► Care provided and identifying who provided care. ► Plan of service under Long-Term Care Act, 1994. ► Payments or eligibility for health care. ► Donation of body parts or bodily substances; ► The individual’s health number. ► Name of a clients substitute decision maker. Scenarios – Ansswer 1 - Privacy settings don’t guarantee that people will not see your post. Sometimes the size of a unit, or rareness of a particular condition can make the client identifiable. Need to protect all information about a client and their dignity. Breaching the trust can damage the nurse client relationship. What are the risks to client privacy and confidentiality in this situation? we know where the patient is, we know almost everything about this information How can the nurse prevent, eliminate or manage these risks? If you are that frustrated with patient talk to someone at work about it, don't post pictures, you will risk losing your license. What harm is present if the situation is not addressed? you will risk losing your license. your losing trust in your patient What CNO standards and resources guide your action and decision making in this situation? A breach of confidentiality is broken. Answer 2- Does she have permission to use the pictures  Pictures can provide information that make it possible to identify the client in the scenario. The conference attendees are not in the clients circle of care so should not be receiving this information. Need to have consent to share the photo – documented consent. Also look at the agencies policies. Answer 3 - Can you confirm identity? They are both considered health information custodians – therefore implied consent to share health information. Can give updates, because it is in the circle of care. Ensure that the patient or family has not asked you to not share the information. So in this situation it would be ok to share the information. Answer - Adam is not in the circle of care – therefore, he cannot access the record. He’s not providing care or assisting in providing care. This would be crossing the line and his grandfathers right to privacy and confidentiality. If you don’t need the information to be able to provide care then you shouldn’t be accessing a record. Adam may not be in the circle of care (USE LINGO OF COURSE) Answer 5- Technology may affect the security of information that is being transmitted. Are the phones secure – password protected and encrypted? See documentation standard. the nurse respects clients dignity. Answer 6 - Unless you are still providing or assisting in providing healthcare to David, you are no longer in his circle of care. There's more privacy being involved as it is mainly curiosity not professional based. Curiosity or concern are not professional reasons to access the health record, even if it is a former client. davide has not given don't look at his chart and don't go around asking other healthcare works about his chart the privacy and confidentiality Practice questions – Question - PHIPA includes provisions that allow a healthcare provider to disclose private health information without the client permission in which of the following situations ( select all that apply): 1. In an emergency situation when consent cannot be obtained quickly 2. To eliminate or reduce a significant risk or har to a person 3. To contact a relative or friend of an injured, incapacitated or ill client to obtain consent 4. To a parent of a teenager who has positive STI results. ► Question - A nurse is caring for a 35 year old client with a history of intravenous drug use. The client is diagnosed with endocarditis and is receiving iv antibiotics. The nurse is frustrated with the client because even with an acute illness the client shows no interest in stopping their IV drug use. The nurse recognizes they need to stop and reflect on their feelings to ensure they do not impact on the ability to care for the client. This demonstrates: A. Empathy B. Self awareness C. Authenticity D. Alignment with PHIPA regulations ► Question - A client calls there family physician and makes an appointment to have their blood pressure checked and medications reviewed. This is an example of: A. Active consent B. Implied consent C. Express consent D. Informed consent Week 4 1. Phases of the Therapeutic Relationship What are the phases of the therapeutic relationship and how does the nurse use relational practice skills to engage in each phase. Answer – Pre-Interaction Phase – The only phase of the therapeutic nurse-client relationship in which the client does not directly participate. Nurse - During this phase, the nurse prepares to meet the client by gathering relevant client information and anticipating client concerns prior to the first interaction. Orientation – Defines the purpose, roles, and rules of the process, and provides a framework for assessing client’s needs. Nurse - The LPN begins to build a sense of trust by providing the client with basic information (name, professional status and essential information about the purpose and nature of the relationship). Working - The problem-solving phase of the relationship, paralleling the planning and implementation phases of the nursing process. Nurses engage clients in a therapeutic nurse client relationship as active partners for mutual planning of decisions about their care. Resolution/Termination (Peplau, 1997, RNAO, 2006). - When the care provided by the LPN is no longer required for the context of care; for example, a client who was hospitalized for pneumonia has recovered and no longer requires nursing care is now discharged home. Nurse and client evaluate the client’s response to treatment and explore the meaning of the relationship and what goals have been achieved. 2. Trust, Respect, Empathy: How do nurses convey trust, respect, and empathy within the therapeutic relationship? Answer –  Trust - greet the patient by name, make eye contact, and display confidence and professionalism. Respect - listening to the client and in the effort to understand the client. Empathy - nurses' ability to understand the feelings and needs. Why is the development of trust an essential component when working with vulnerable and marginalized populations? Answer – Development of trust is important because patients are more likely to open up and disclose information if they trust their pharmacist or healthcare professional, and a better quality of interaction may result in greater patient autonomy and shared decision-making. How does trust, respect and empathy support us to learn about the client? 3. Professional Intimacy: What is professional intimacy? Answer - It may relate to the physical activities, such as bathing, that nurses perform for, and with, the client that creates closeness. How does a nurse engage in professional intimacy within the care relationship? Answer – By meeting the patient’s needs, don’t making any relationship outside the hospital, 4. Power What constitutes power in the nurse-client relationship? Answer - The nurse-client relationship is one of unequal power. Although the nurse may not immediately perceive it, the nurse has more power than the client. The nurse has more authority and influence in the health care system, specialized knowledge, access to privileged information, and the ability to advocate for the client and the client’s. significant others.7 The appropriate use of power, in a caring manner, enables the nurse to partner with the client to meet the client’s needs. A misuse of power is considered abuse. What constitutes abuse of power? Answer - Crossing a boundary means that the care provider is misusing the power in the relationship to meet her/his personal needs, rather than the needs of the client, or behaving in an unprofessional manner with the client. The misuse of power does not have to be intentional to be considered a boundary crossing. 5. Compassion: What is compassion and why is it integral to nursing practice? Answer - Compassionate care is a process in which nurses interactively communicate with patients, try to explore patients' concerns by putting themselves in their positions and understanding their situations, and do their utmost to eliminate these concerns. How does the nurse demonstrate compassion for others?  Answer - greeting patients with a smile or simply making eye contact. Each positive gesture further solidifies the commitment to providing patient-centered quality care aimed at improving patient outcomes. What is self-compassion and how does it reduce burnout and stress for nurses? Answer - Self-compassion training, which includes self-kindness, common humanity and mindfulness, could reduce the adverse effects of emotional, psychological and physical burnout in nurses. 6. Mindfulness: What is mindfulness and how do we integrate it within our practice? Answer - Mindfulness is a type of meditation in which you focus on being intensely aware of what you're sensing and feeling in the moment, without interpretation or judgment. Practicing mindfulness involves breathing methods, guided imagery, and other practices to relax the body and mind and help reduce stress. WEEK 5 1. Review strategies to support the nurse to use communication techniques to gather data and information to understand the patient’s goals for care Answer - Goal to level the playing field so patient can be partner in care Many elements - Body language - Tone of Voice - Use of exclusive language ( medical terminology, technical terms) - Ability to understand ( Literacy level) - Competing “noise” - Need for communication aids ( hearing aids, glasses, voiceless patients) What does PHIPA stand for? A) Personal Health Information Privacy Act B) Public Health Information Protection Act C) Personal Health Information Protection Act D) Provincial Health Information Privacy Act what is the primary purpose of the personal health information protection act (PHIPA) a. to regulate the use of social media by healthcare professionals b. to govern healthcare information privacy c. to provide funding for healthcare facilities  d. to standardize medical terminology which of the follow is considered personal health information (PHI) a. patients favorite color b. patients health number c. patients preferred vacation destination d. patients favorite food Which of the following scenarios would require mandatory reporting by a nurse? a. a patient shares their favorite movie b. a patient expresses suicidal ideation c. patient discusses their weekend plans d. a patient mentions there favorite sports team Why is confidentiality important in nursing practice? a. it helps nurses avoid legal issues b. it maintains professional boundaries and builds trust c. it ensures nurses can share patient information freely d. it allows nurses to control patient information What should a nurse do if they accidentally access a patient's health information that they are not authorized to view? a. ignore it and continue working b. report the incident to their supervisor immediately c. share the information with a colleague d. delete the information from the system what is the purpose of the quality of care information protection act (QOCIPA) a. to protect personal health information shared on social media b. to provide protection to quality of care information produced by a healthcare facility c. to regulate healthcare marketing practices d. to ensure healthcare facilities receives proper funding what is meant by “circle of care” in the context of PHIPA? a. a group of friends and family members involved in a patients care b. all healthcare providers directly involved in the patients care  c. a social media group discussing healthcare topics d. the administrative staff at a healthcare facility which of the following best describes express consent in healthcare a. consent given verbally or written in writing by the patient b. assumed consent based on the patients actions c. consent given only through legal documents d. implied consent based on the patients non verbal cues Why is documentation important in nursing? a. it helps in maintaining a professional appearance b. it provides a legal record of care provided c. it ensures all patient information is shared on social media d. it allows nurses to avoid accountability 2. Focus on the development of the following communication skills: - Opening a conversation Provide patient with full name and title (student nurse) Asks how the patient would like to be addressed including personal pronouns Identify patient with two identifiers ( full name and date of birth) Confirm reason for visit Ask about any other concerns they would like to address Explain what will happen- ask questions, examine, time required, right to stop or ask questions at any time Ask the patient if they have any questions Confirm that it is okay to proceed, consent to go ahead - Verbal and non-verbal communication strategies non-verbal acronyme sit at an angle by client uncross legs and arms relax eye contact touch your intuition  a). Use of body language b). Therapeutic touch - Discuss with clients during care where, when and how they may be touched during an examination. ▪ Remember that not all clients will be comfortable with touch ▪ Always ask permission, explain before making contact c). Asking open ended questions Answer – Open-ended questions are used to elicit the person’s thoughts and perspectives without influencing the direction of an acceptable response, for example: “Can you tell me what brought you to the clinic today?” d). Active listening e). Paraphrasing Answer - the nurse taking the person’s original message and transforms it into their own words, without losing the meaning. f). Clarifying – answer - a brief question or a request for validation used to better understand a person’s message e.g - “You stated earlier that you were concerned about your blood pressure. Tell me more about what concerns you.” g). Restating Answer - strategy used to broaden a person’s perspective or when the nurse needs to validate or clarify the person’s statement. For example, a person may say, “I am so sad” and the nurse would respond, “You’re sad?” h). Empathic Reflection Answer - active listening response that focuses on the emotional part of a message. offers nurses a way to empathetically mirror their sense of how a person may be emotionally experiencing their health situation i). Silence Answer - Silence, delivered as a brief pause, is a powerful listening response. Intentional pauses can allow the person to think.. A short pause lets the nurse step back momentarily and process what has been heard, before responding. j). Summarizing – Answer - Summarization pulls several ideas into a few brief sentences. This would be followed by a comment seeking validation, such as, “Tell me if my understanding of this agrees with yours.” k). Providing feedback – Answer - Specific and directed to the behavior Address only the topic under discussion Clear, honest and reflective Support with relevant examples Feedback should be used to advance the goals of the relationship. 3. Identify the goals of a focus interview and the types of data that the nurse would aim to collect while they engage in the interviewing process Answer – Goal - Purpose of the interview is to collect information from the client that will inform future care. - This information includes subjective data and objective data. Data – Biographical data Reason for seeking care Current health history or history of current illness Past health History Family History Review of System Functional Assessment