RN 169 sstudy guide wk 4 .docx

**Ch 25 Patient Education 7/9/24** **Purposes of Patient Education** - The primary goal of patient education is to help individuals, families, or communities achieve optimal levels of health. - Maintenance and promotion of health and illness prevention - Restoration of health e...

**Ch 25 Patient Education 7/9/24** **Purposes of Patient Education** - The primary goal of patient education is to help individuals, families, or communities achieve optimal levels of health. - Maintenance and promotion of health and illness prevention - Restoration of health eg. eg. Patients recovering from and adapting to changes resulting from illness or injury - Coping with impaired functions eg. Dabd/resolution/ a **Teaching and Learning (1 of 2)** - Teaching - Imparting knowledge through a series of directed activities - Learning - Process of understanding and applying newly acquired concepts - Role of the nurse in teaching and learning - Nurses are legally responsible for providing education to all patients. **Teaching and Learning (2 of 2)** - Teaching as communication - Effective communication involves feedback from the sender and receiver. Figure 25.1, The communication process. Illustration showing the interaction between a message sender and a message receiver. **Domains of Learning (1 of 2) Box 25.2** - **Cognitive learning\*\*\*** - Discussion (one-on-one grp) - Lecture - Question & Answer (Q & A) - Role-Play, Discovery - Independent Project (computer-assisted instruction) - **Affective learning\*\*\*** - Role-Play - Discussion (group) :allows patient to receive support frm others in grp, helps patient learn frm others experiences - Discussion (one-on-one) - **Psychomotor learning\*\*\*** - Demonstration - Practice - Return Demonstration - Independent Projects, Games - **Domains of Learning (2 of 2)** **Blooms Taxonomy 25.2**  **Domains of Learning (3 of 3) \*\*\*CEA AUR** - Remember-recalling knowledge from memory - Understand- constructing meaning - Apply- carrying out or using a procedure - Analyze- breaking materials or concepts into parts and determining how the parts and then determining how the parts relate to one another or how they interrelate - Evaluate- making judgments based on criteria and standards through checking and critiquing - Create- putting elements together to form a coherent or functional whole; generating, planning, or producing **Culture Factors for Learning \*\*\*MEMORIZE** **Access** - **Assessment**-patients lifestyle, cultural traditions and health beliefs - **Communication**- with an awareness of many variations in verbal and nonverbal responses - **Cultural**- negotiation and compromise that encourages awareness of characteristics of patients from diverse backgrounds perceive their care needs and patterns of communication they use. - **Establishment**- of respect for a patients cultural beliefs and values; creating a caring support - **Sensitivity**- to how patients from diverse backgrounds perceive their care needs and patterns of communication they use. - **Safety**- that enables patients to feel culturally secure and avoids disempowerment of their cultural identity **Basic Learning Principles (1 of 2)** - Motivation to learn - Use of theory to enhance motivation and learning - Cultural factors - Active participation - Readiness to learn is affected by each stage of grieving. Denial Anger Bargaining Resolution-patient begins to express emotions openly, realizes that illness has created changes, and begins to ask questions. acceptance **Basic Learning Principles (2 of 2)** - Ability to learn a patient\'s developmental level and cognitive and physical capabilities influence the ability to learn. - Developmental capability- assess a patients level of knowledge & intellectual skills before beginning a teaching plan. Eg. 2 grade level down - Learning in children - Adult learning - eg. assess patients on a literacy level - Health literacy and learning disabilities- eg. Age, poverty, employment status, educational level, and race - Physical capability- Many factors impari the ability to learn, including preexisting physical or mental illness, fatigue, body temp., electrolyte imnalance, oxygenation status, and blood glucose level. - Learning environment- the ideal setting helps a patient focus on the learning task **Clinical Judgment in Patient Education (1 of 2)** - Your knowledge of a patient's health condition and the patient information you gain from assessment will allow you to predict the topic and level of instruction required. - In clinic, home care, and rehabilitation settings, nurses have more time to identify patients' learning needs and to provide comprehensive ongoing education. **Clinical Judgment in Patient Education (2 of** **2)** - In an acute care setting, learn the resources a patient has as early as possible, engage those individuals early in instruction, and confirm with patients and family caregivers what is most important for them to learn and be prepared to return home. **Nursing Process (1 of 5)** - **Assessment** - Through the patient's eyes- asses the patient's preferences, values, and expressed needs in order to see the health the health care situation through the patient's eyes. - Learning needs-identify patient's learning needs, asses what patient's view as important information to know. - Motivation to learn- ask questions to identify & define a patient's motivation. - Readiness and ability to learn- Determine a patient's cognitive ability to learn. - Environmental factors- assess the environment for any barriers to learning - Resources for learning- a patient requires the support of fam. Members or significant others. - Health literacy-it is critical for you to assess a patients health literacy before providing instruction **Nursing Process (2 of 5)** - **Analysis and nursing diagnosis-** after assessing info. Related to a patient's motivation, readiness, & ability to learn, interpret data & cluster assessment findings to form diagnoses that reflect specific learning needs or factors affecting the ability to learn - **Planning and outcomes identification-**after determining the nursing diagnoses that identify a patient's learning needs, develop a teaching plan, determine expected outcomes, & involve the patient in selecting learning experiences - Outcomes- identify what a patient needs to achieve to obtain a better understanding of a health care topic and to better manage illness - Setting priorities -set a patinet's learning needs in order of priority - Timing - Organizing teaching material -we can obtain educational materials from social worker etc. other members from the care team of the patient (from providing simple material to complex) - Teamwork and collaboration- capable of making referrals to other health care professionals **Nursing Process (3 of 5)** - Implementation- continuinly assess the patients response and judge if its appropriate to continue instruction, adapt, a strategy, or delay. Create a teaching plan based on a patients nursing diagnoses. - Maintaining learning attention and participation- provide visuals, group discussions, role-playing, etc. - Building on existing knowledge and ability - Teaching approaches - Telling-when there's limited time for teaching - Participating- the nurse and the patient set objectives and become involved in the learning process together - Entrusting- provides a patient the opportunity to manage self-care. - Reinforcing- requires the use of a stimulus to increase the probability of a desired response. - Incorporating teaching with nursing care **Nursing Process (4 of 5)** - Implementation - Instructional methods - Verbal one-on-one discussion - Group instruction - Preparatory instruction- providing info. About procedures prior decreases anxiety and provides a better idea of what to expect - Demonstrations - Analogies- supplement verbal instruction with familiar images that make complex info. More real and understandable. - Simulation-teaches problem-solving, application, and independent thinking - Illiteracy and other disabilities- accommodate patients that are illiterate/ disabilities **Nursing Process (5 of 5)** - **Implementation** - Cultural diversity-accept a patient's cultural background and beliefs - Using teaching tools - Special needs of children and older adults - **Evaluation** - Patient outcomes - Teach-back **Ch 21 Managing Patient Care 7/9/24** **Building a Nursing Team (1 of 6)** - A strong nursing team works together to achieve the best outcomes for patients. - Effective team development requires team building and training, trust, communication, and a workplace that facilitates collaboration. **Building a Nursing Team (2 of 6)** - **Empowered teams begin with the nurse executive** - Transformational leadership- focuses on change & innovation through team development, serves as a mentor for staff, & develops & supports the moral agency of nurses. - Servant leadership- work closely with their team to understand individual membe's strengths & weaknesses. **Building a Nursing Team (3 of 6)** - **Magnet Recognition Program^^ standards** - Shared decision making - Leadership - Safety - Quality - Well-being - Professional development eg. In-services, modules, skills, paid your school - Research and evidence-based - BSN requirement **Building a Nursing Team (4 of 6) \*\*\*MEMORIZE** - **Nursing care delivery models** - **Patient- and family-centered care** 1.Dignity and respect-ensuring that the care provided is given based on a patient's and fam. Knowledge, values, beliefs, and cultural backgrounds. 2\. Information sharing, meaning that health care providers communicate and share info. So that patients & fam. Receive timely, complete, & accurate info. To effectively participate in care & decision making 3\. Participation, whereby patients & families are encouraged & supported in participated in care & decision making 4\. Collaboration, demonstrated by the health care leaders collaborating w/ patients & families in policy & program dev., implementation, & evaluation, as well as by patients who are fully engaged in their health care - Case management **Building a Nursing Team (5 of 6)** - Decision making - Shared governance - Responsibility eg. Duties and activities that you're employed to perform - Autonomy- freedom of choice & responsibility for the choices - Authority- the legal ability to perfom a task - Accountability- being answerable for their actions - Staff involvement **Building a Nursing Team (6 of 6)** - **The nursing manager supports staff involvement through a variety of approaches:** - Establishing nursing practice through problem-solving committees (establish ash & maintain care standards for nursing practice on their unit) or professional (shared governance councils)-is a dynamic process that promotes decision making, accountability, & empowerment in staff nurses & enables them to make meaningful & sustainable changes in patient care. - Interprofessional collaboration among nurses and health care providers- to communicate constantly. The nurse is often viewed as the team leader because of communication coordination. - Interprofessional rounding- its an extension (patient is included) is at the bedside - Staff communication-leaders are always communicating to staff in diff. ways - Staff education-continuing professional dev. **Leadership Skills for Nursing Students (1 of 2) \*\*\*MEMORIZE** - **Clinical care coordination** - Good clinical judgment-you will use clinical judgement & make clinical decisions through application of the nursing process - Strong priority setting-act on priorities, ABC's - Organization skills-time management, efficient, and effective - Appropriate use of resources-don't waste things and ask for help - Good time management- how, where, and when - Continual evaluation- evaluate a patients codition & progress - Effective team communication SBARR (situation,background, assessment, recommendation, readback) - Appropriate delegation- the process of assigning part of your responsibility to another qualified person in a specific situation. **Leadership Skills for Nursing Students (2 of 2)** - Knowledge building - Lifelong learning - Maintaining competency - Actively pursue learning opportunities - Respectfully interact with professional colleagues **Ch 15 Critical Thinking & Clinical Judgement 7/11/24** **Clinical Judgment in Nursing Practice (1 of 3)** - Nurses must make accurate and appropriate clinical decisions or judgments. - Clinical judgment - Observed outcome of critical thinking and decision making - Clinical decision making - Separates professional nurses from technicians or other assistive personnel (AP) - A model for clinical judgment - Models help to explain concepts. - Critical thinking in nursing is complex - A model explains the many variables involved in making decisions and clinical judgments about patients - Clinical judgements are influenced more by a nurse's experience & knowledge than by the objective data about the situation at hand. - Sound clinical judgement partly relies on "knowing the patient" - Clinical judgements are influenced by the context of clinical situations & culture of patient care settings - Individualized plan of care - Most patients have health care problems for which there are no clear textbook solutions. Each patients health problems are unique Figure 15.1, Clinical judgment model for nursing. Flow chart showing the interactions between patient needs, clinical decisions, clinical judgment, nursing process, and critical thinking.**15.1 clinical judgment model** **Critical Thinking (1 of 2)** - **Critical thinking** - The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process. - The aim of critical thinking is the ability to focus on the important issues in any clinical situation and make decisions that produce desired patient outcomes.  **Critical Thinking Competencies** Are the cognitive processes as a nurse uses to make judgements about the clinical care of patients. - **General critical thinking** - Scientific method-is a methodical way to solve problems by using reasoning - Problem solving-requires you to obtain information that clarifies the nature of a problem, suggest possible solutions, & evaluate the solution. (intuition is one approach) - Decision making**-** choose a course of action - **Specific critical thinking** - Diagnostic reasoning-is a form of decision making that involves understanding & thinking through clinical problems, gathering info., analyze clues - Clinical decision making-choosing a course of action **Levels of Critical Thinking** - Basic critical Thinking- Early step in critical thinking. Task-oriented, right or wrong, doesn't think outside the box. - Complex critical thinking- Rely less on experts' trust own decisions. Considers different options for routine procedures. - Commitment- Anticipate when to make choices without assistance & accept accountability for decisions made. **Components of Critical Thinking in the Clinical Judgment Model** - Competence-the ability to perform nursing skills proficiently - Knowledge base-varies according to educational experience that includes basic nursing education, continuing education courses, & additional college degrees. - Experience-is necessary to acquire decision-making skills & clinical judgment & gain competence in performing nursing skills. - Environment-environmental factors influence clinical decision making **Critical Thinking Attitudes\*\*\*MEMORIZE** - Confidence- - Thinking independently- - Fairness - Responsibility and accountability - Risk taking - Discipline - Perseverance - Creativity- look for different approaches - Curiosity- ask why - Integrity- - Humility and self-awareness **Evaluation of Clinical Judgments (2 of 2)** - Reflection-reflect on your shift,instant replay, to be better - Meeting with colleagues- ask for help - Concept mapping-a visual representation of patient problems & interventions that shows their relationships to one another - Critical thinking synthesis-is a reasoning process by which you cognitively apply & analyze your thoughts, actions, knowledge to make sound clinical judgements. Figure 15.3, Synthesis of critical thinking with the nursing process. Illustration showing the nursing process in the center, surrounded by knowledge base, attitudes, environment, standards, and experience. **Ch 24 Communication 7/11/24** **Communication and Nursing Practice (1 of 4)** - Communication is a lifelong learning process. - Competent communication maintains effective relationships within the entire sphere of professional practice and meets legal, ethical, and clinical standards of care. - Communication and interpersonal relationships - Caring relationships are at the core of nursing. - Being able to relate to others is important for interpersonal communication. - Therapeutic communication occurs within a healing relationship between a nurse and patient. - Developing communication skills - Nurses who develop critical thinking skills and clinical judgment make the best communicators. - Critical thinking applied during any patient interaction helps to overcome perceptual biases or stereotypes that interfere with accurately perceiving and interpreting messages from others. - Levels of communication - **Intrapersona**l-self-talk - **Interpersonal** 1:1 interaction between a nurse & another person that occurs face to face or via text or other electronic format - **Small-group communication-** small number of ppl meet - **Public communication-**interaction with an audience - **Electronic communication-**emails, fax, technology use **Elements of the Communication Process\*\*\*MEMORIZE** - Circular transactional model - Referent-a motivator - Sender and receiver- encodes & decodes - Message-content - Channels- send and receive messages through visual, auditory, & tactile senses. - Feedback-the message received - Interpersonal values/ variables-factors within both the sender & receiver that influence communication - Environment-the setting  **Forms of Communication** - Verbal communication - Vocabulary - Denotative (meaning) and connotative (perceived/interpretated meaning) - Pacing- appropriate speed or pace - Intonation-tone of voice - Clarity and Brevity-clear & direct - Timing and relevance-timing is critical and patient has to express interest - Nonverbal communication - Personal appearance- characteristics, facial expression, & manner of dress & grooming. - Posture (the way we stand) and gait (the way we walk) - Facial expression be mindful - Eye contact-maintaining eye contact - Gestures-emphasize, punctuate, and clarify - Sounds-help clarify messages - Territoriality and personal space -- Box 24.3 vulnerable zone, intimate zone \*\*\*Know this Box - Zones of personal Space - Sitting at a patients bedside - Taking a patient's nursing hx - Teaching a patient individually - Metacommunication refers to all factors that influence communication **Professional Nursing Relationships** - Nurse-patient caring relationships-are the foundation of clinical practice - Motivational interviewing-is a technique that encourages patients to share their thoughts, goals, beliefs, fears, and concerns with the aim of changing their behavior - Nurse-family relationships require you to form caring relationships with entire families - Nurse-health care team relationships- effective communication with other health care team members affects patient outcomes, patient safety, and the work environment. SBAR-situation, background, assessment, recomendation - Lateral violence-workplace bullying, withholding info., being hypercritical, raising blame, put-downs, criticizing, excluding,... - Nurse-community relationships- being a part of community groups, participating in local organizations, volunteering, or be politically active **Elements of Professional Communication** - **Courtesy** **AIDET** common courtesy (Acknowledge, Introduce, Duration, Explain, Thank you) \*\*\* - Use of names-ask how they rather be called (Last name) - Trustworthiness-helping others without hesitation - Autonomy (being self-directed) and responsibility (accept the responsibility) make decision based on our assessment, do whats right - Assertiveness express feelings & ideas **Nursing Process** - Assessment - Through the patient's eyes- individuality - Environmental factors-ensuring privacy & confidentiality, reducing distractions - Physical and emotional factors- asses the psychophysiological factors that influence your patient. Eg. Difficulty hearing, visual, breathing - Gender-recognize a patients gender communication pattern eg. Men, women - Developmental factors-take in consideration the patients\' growth and development eg. Infant, child, communicate with older adults on adult level. (make modifications) - Analysis and nursing diagnosis- Using clinical judgement, analyze your assessment findings, and look for patterns or cues to help you identify nursing diagnoses or collaborate problems surrounding patient communication - Planning and outcomes identification - Outcomes-select an outcome that's relevant, measurable, & achievable for patient - Setting priorities- establishing nursing care priorities for communication based on assessment data, your knowledge, diagnoses, & outcomes - Teamwork and collaboration-effective plan of care **Therapeutic Communication Techniques (**Just read through it) - Active listening - Sharing observations - Sharing empathy - Sharing hope - Sharing humor - Sharing feelings - Using touch - Using silence - Providing information - Clarifying - Focusing - Paraphrasing - Validation - Asking relevant questions - Summarizing - Self-disclosure - Confrontation **Nontherapeutic Communication Techniques** - Asking personal questions - Giving personal opinions - Changing the subject - Automatic responses - False reassurance - Sympathy don't be sympathetic - Asking for explanations no why questions - Approval or disapproval don't approve or disapprove - Defensive responses - Passive or aggressive responses - Arguing **Evaluation** - Through the patient's eyes - One form of evaluation is to determine a patient's perception of the success of the plan of care in facilitating communication. - Patient outcomes - If expected outcomes for the patient's plan of care are not met or if progress is unsatisfactory, you determine which factors influenced the outcomes and modify the plan of care.