Test 1 objectives .docx

CHAPTER 8: Communication Blocks to Communication #1 Failure to perceive the patient as a human being Failure to listen Nontherapeutic comments and questions Using clichés: Everything will be okay etc. Using closed questions Using questions containing the words “why” and “how” Using questions that pr...

CHAPTER 8: Communication Blocks to Communication #1 Failure to perceive the patient as a human being Failure to listen Nontherapeutic comments and questions Using clichés: Everything will be okay etc. Using closed questions Using questions containing the words “why” and “how” Using questions that probe for information Blocks to Communication #2 Using leading questions: You assume you know more/better Using comments that give advice Using judgmental comments Changing the subject Giving false assurance Using gossip and rumors Using disruptive interpersonal behavior Steps of the Communication Process (Berlo)- Communication is Initiated based on stimulus Sender or source of the message is the encoder who begins the process. Message- the communication product from the source Channel of communication is the type of communication. There are three different types of channels which include: Auditory- talking, things you can hear Visual-demonstrating, pamphlets, PowerPoints, books, apps Kinesthetic-touching. An example of this involves the patient grabbing the needle. The Receiver or decoder- translates and interprets the message being received Confirmation of the message- provides feedback. This is one of the most important steps, for example, if a patient doesn’t understand or speaks in a different language, the patient wont understand. This is why you always ask the patient to repeat it back to you. Make sure the message got through to that person by asking for confirmation of the message to make sure they understand. Forms of Communication Verbal communication- verbal. Example, a nurse telling a patient “You have to wash your hands.” Non-Verbal communication- Touch. Example, when you’re taking care of a patient, you must touch them. You must hold their hands or hold them to help them go to the restroom. A patient guarding their abdomen because they are in pain is also nonverbal. The face they make when they are in pain is nonverbal, eye contact. If you step into somebody’s personal space and you can see they are not comfortable so nonverbal also includes space, time, boundaries, body movements, posture, gait, their general physical appearance and more of dress or grooming. Also, hearing sounds like moaning, crying, gasping, sighing. Factors Influencing Communication Developmental level- taking the patients’ developmental level into consideration. For example, when taking care of a child, using stuffed animals to maybe explain a procedure. You are not going to talk to an adult the same way you would talk to a child. Etc. Sociocultural differences- We all have different beliefs and values. for example, some patients don’t believe in accepting blood and this is something we must respect regardless of our individual beliefs. Roles and Responsibilities- We want to know the role of the family. Is this the bread winner who now cannot work for the next three months? His is something we want to know. Space and territoriality- we must consider the patients personal space, if we are too close or invading personal space, the patient might be thinking “oh my god, she’s too close” instead of listening to what we are saying because they are uncomfortable. Physical, mental, and emotional state- this is how the patient’s physical, mental, or emotional state are currently affecting the patient. For example, if a patient just received bad news that they were diagnosed with cancer and are sitting there crying, are they going to be listening to what we are saying or the message we are trying to get across? Values-taking the patient’s values and beliefs into consideration. These are things we need to know. Environment- we must take the environment into consideration because if we are trying to convey a message in a busy area like the ER hallway there’s noise everywhere. Can the patient even hear you? And if they can hear you, are they really paying attention because of the distractions? The Therapeutic Relationship- sets the climate for the participants to move towards common goals. The therapeutic relationship does not occur spontaneously, it is characterized by an unequal sharing of information where the patient overshares. The reason the patient is oversharing is to give us information on their background, medication background, beliefs, what’s wrong with them, how are they feeling? The patient should always be the one oversharing. This is because the therapeutic relationship is built on the patients’ needs where the nurse is the carer, and the patient is the person being cared for. Communication is the means used to establish rapport and trust, leading to therapeutic relationships. This is a PATIENT CENTERED relationship and Dynamic WHERE BOTH people involved are active participants. Developing Conversation Skills Control the tone of your voice- the tone of voice can show you if someone is mad, happy etc. Be knowledgeable about the topic of conversation- for example don’t try giving patient information on a subject you don’t know about or a specialty you don’t know about. Be flexible Be clear and concise Avoid words that might have different interpretations Be truthful Keep an open mind Take advantage of available opportunities Characteristics of Effective and Ineffective Groups Interviewing Techniques Open-ended questions or comments: Opens the conversation, NO yes or no questions. Closed questions or comments: Yes or No questions Validating questions or comments: This type of question or comment serves to validate what the nurse believes they have heard or observed. Clarifying questions or comments: The use of the clarifying question or comment allows the nurse to gain an understanding of a patient’s comment. Reflective questions or comments: The reflective question technique involves repeating what the person has said or describing the person’s feelings. Sequencing questions or comments: Sequencing is used to place events in a chronologic order or to investigate a possible cause-and-effect relationship between events. Directing questions or comments: It might become necessary at times to obtain more information about a topic brought up earlier in the interview or to introduce a new aspect of the current topic. Characteristics of the Assertive Nurse’s Self-Presentation Confident; open body posture; eye contact Use of clear, concise “I” statements Ability to share effectively one’s thoughts, feelings, and emotions Working to capacity with or without supervision Remaining calm under supervision Asking for help when necessary Giving and accepting compliments Admitting mistakes and taking responsibility for them Dispositional Traits Warmth and friendliness Openness and respect Empathy- being sensitive to the patients feelings but still being objective enough to be able to help the patient. Honesty, authenticity, trust Caring Competence Phases of the Therapeutic Relationship -Orientation Phase sounds like “hi, my name is Jiovonne Robinson, I will be your nurse today, my shift ends at 630 pm, I will be with you until then, I will check on you about every hour, if you need me earlier, there is your call light. Give me a call. “ -Working Phase- the patient will participate so if the nurse wants the patient to walk down the hall, then the patient will try, they will also express how they feel. For example, if they can’t make it down the hall, they will let the nurse know. -Termination- eventually we must let the patient go, whether it’s because they have completed all of their goals. The patient will verbalize feelings about the termination of the relationship. Rapport Builders Specific objectives-when we are building rapport, what are we going to do? What are the objectives? Make these goals clear. Comfortable environment- always in a comfortable environment Privacy- in a private area. Confidentiality- unless it is like harm to oneself or another or abuse. Patient versus task focus-we take care of the patient as a whole. We don’t take care of the disease; we take care of the patient. Using nursing observations Optimal pacing-using your time wisely. Developing Listening Skills Sit when communicating with a patient Be alert and relaxed and take your time Keep the conversation as natural as possible Maintain eye contact if appropriate Use appropriate facial expressions and body gestures Think before responding to the patient Do not pretend to listen Listen for themes in the patient’s comments Use silence, therapeutic touch, and humor appropriately CHAPTER 9: Teaching and Counseling Aims of Teaching and Counseling Maintaining and promoting health Preventing illness Restoring health Facilitating coping Promoting outcomes Teaching Outcomes Optimal level of wellness and related self-care practices Disease prevention or early detection Quick recovery from trauma or illness with minimal or no complications Enhanced ability to adjust to developmental life changes and acute, chronic, and terminal illness Key Teaching Concepts Listen to your patients and their families Every interaction is an opportunity to teach Keep education patient (person) centered Begin teaching at the first patient encounter Engage and motivate Outcome Identification & Planning- Involves the development of a teaching plan, determine patient learning outcomes and teaching content and determine teaching methods and materials. Providing Culturally Competent Patient Education Develop an understanding of the patient’s culture Work with multicultural team Be aware of personal assumptions, biases, and prejudices Understand the core cultural values of the patient or group Develop written material in patient’s preferred language Assessment of the Learner Identify learning needs Assess learning readiness Assess learning style Assess learning strengths Consider the patient’s motivation Promoting Patient and Family/Caregiver Adherence Adherence is preferred over the term compliance Refers to the extent to which a person’s behavior corresponds with the agreed-upon recommendations from a health care provider, uses a team approach to the treatment plan, reflects the patient’s right to choose, and supports inclusive and active patient role Adherence is promoted when instructions are clear and support patient goals, patient/caregivers are included as partners in the process, interactive teaching strategies are used, and strong interpersonal relationships are developed with the patient and their families Suggested Teaching Strategies for three Learning Domains Cognitive domain: lecture, panel, discovery, written materials Affective domain: role modeling, discussion, audiovisual materials Psychomotor domain: demonstration, discovery, printed materials Factors Affecting Patient Learning Age and developmental level Family/caregiver support networks Financial resources Cultural influences and Language Health literacy Teaching Plans for Older Adults Identify learning barriers Allow extra time Plan short teaching sessions Accommodate for sensory deficits Reduce environmental distractions Relate new information to familiar activities or information Effective Communication Techniques Be sincere and honest; show genuine interest Avoid giving too much detail; stick to the basics Ask if the patient has questions Be a cheerleader for the patient; avoid lecturing Use simple words Vary the tone of voice and keep content clear and concise Ensure the environment is conducive to learning and free from interruptions Be sensitive to the timing and length of the session Teaching Strategies Methods Lecture Discussion Panel discussion Demonstration Discovery (something new) Role playing Materials Audiovisual materials Printed materials Programmed instruction Web-based instruction and technology Role of the Nurse as Coach Establishing relationships and identifying readiness for change Identifying opportunities, issues, and concerns Establishing patient-centered goals Creating the structure of the coaching interaction Empowering and motivating patients to reach goals Assisting the patient to determine progress toward goals (Hess et al., 2013) CHAPTER 10: Leading, Managing, and Delegating Leadership Styles Autocratic: Involves the leader assuming control over the decisions and activities of the group. Democratic: Is characterized by a sense of equality among the leader and other participants. Decisions and activities are shared. Laissez-faire: The leader relinquishes power to the group, such that an outsider could not identify the leader in the group. Servant: It begins with the natural feeling that one wants to serve. Quantum: Views an organization and its members as interconnected and collaborative—a helpful approach when unpredictable events and changing environments present themselves Transactional: Is based on a task-and-reward orientation. Transformational: Often described as charismatic, transformational leaders are unique in their ability to inspire and motivate others. Leadership Qualities Charismatic Dynamic Enthusiastic Poised Confident Self-directed Flexible Knowledgeable Politically aware Leadership Skills Commitment to excellence Problem-solving skills Commitment to and passion for one’s work Trustworthiness and integrity Respectfulness Accessibility Empathy and caring Responsibility to enhance personal growth of all staff Conflict Resolution Strategies Lewin’s Theory of Change Unfreezing: The need for change is recognized Moving: Change is initiated after a careful process of planning Refreezing: Change becomes operational Achieving Self-Knowledge Identify your strengths Evaluate how you accomplish work Clarify your values Determine where you belong and what you can contribute Assume responsibility for relationships ANA Principles for Delegating Care The RN is responsible for the initial patient assessment, discharge planning, health education, care planning, triage, interpretation of patient data, care of invasive lines, and administering parenteral medications The RN can delegate tasks such as assistance with basic care activities, collecting patient data such as vital signs, simple dressing changes, transfers, and postmortem care The RN is responsible and accountable for nursing practice and supervises any AP providing direct patient care The purpose of AP is to work in supportive role to the RN Considerations When Delegating Nursing Care Stability of the patient’s condition Complexity of the activity Potential for harm Predictability of the outcome Overall context of other patient needs Developing Leadership Responsibilities Knowledge of the administrative structure Mentorship Preceptorship Participation in nursing and other professional organizations Continuing education Overcoming Resistance to Change #1 & 2 Explain proposed change to all affected List the advantages of the change Relate the change to the person’s existing beliefs and values Provide opportunities for open communication and feedback Indicate how change will be evaluated Introduce change gradually Provide incentives for commitment to change Explain the proposed change to all affected people in simple, concise language List the advantages of the proposed change Relate the proposed change to the person’s or group’s existing beliefs and values Provide opportunities for open communication and feedback Indicate clearly how the change will be evaluated Introduce change gradually; involve everyone affected Provide incentives for commitment to change CHAPTER 27: Physical Assessment Types of Health Assessments Comprehensive: conducted upon admission to health care facility Ongoing partial: conducted at regular intervals Focused: conducted to assess a specific problem Emergency: conducted to determine life-threatening or unstable conditions Preparing the Patient for Physical Assessment Consider the physiologic and psychological needs of the patient Explain the process to the patient Explain that physical assessments should not be painful (decrease patient fear and anxiety) Explain each procedure in detail as it is conducted Explain that privacy will be maintained using drapes Answer patient questions directly and honestly Preparing the Environment for Physical Assessment Make sure patient is as free of pain as possible Prepare the examination table Provide a gown and drape for the patient Gather the supplies and instruments needed Provide a curtain or screen if the area is open to others Provide a comfortable room temperature Positions Used During a Physical Assessment Standing: assessment of posture, balance, and gait Sitting: allows visualization of upper body Supine: allows relaxation of abdominal muscles Dorsal recumbent: used for patients having difficulty maintaining supine position Sim’s: assessment of rectum or vagina Prone: assessment of hip joint and posterior thorax Lithotomy: assessment of female genitalia and rectum Knee–chest: assessment of anus and rectum All assessments (Integument, head/neck, thorax/lungs, Cardiovascular/Peripheral, Abdominal, Musculoskeletal, and Neuro) Integument Identify risk factors History of rashes, lesions, bruising, allergies Exposures to sun, chemicals Piercings or tattoos Degree of mobility Nutritional status Inspection and palpation Integumentary Assessment Terminology Erythema—redness Ecchymosis—collection of blood in subcutaneous tissue Petechiae—hemorrhagic spots/capillary bleeding Cyanosis—bluish or grayish color Jaundice—yellow color Pallor—paleness Diaphoresis—excessive perspiration Turgor—elasticity Edema—excess fluid Head and neck Identify risk factors Changes in vision or hearing History of allergies, chronic illnesses Exposure to harmful substances or smoking History of infection or trauma Inspection and palpation Visual acuity, extraocular movements, peripheral vision Hearing and sound conduction Thyroid gland and lymph nodes Thorax and lungs Identify risk factors History of trauma or lung surgery Number of pillows used when sleeping Cough, chest pain, allergies Exposure to chemicals or smoke Inspection, palpation, auscultation, and percussion Posterior thorax excursion/chest expansion LUNG SOUNDS Bronchial or tubular Bronchovesicular Vesicular Adventitious Wheeze Rhonchi Crackles Stridor Friction rub Cardiovascular and peripheral vascular systems Identify risk factors History of chest pain, palpitations, dizziness Swelling in ankles or feet Medications Personal or family history Type and amount of exercise Inspection, palpation, and auscultation Carotid arteries, heart sounds, peripheral pulses Neurovascular status Characteristics of sound head when using auscultation Pitch: ranging from high to low Loudness: ranging from soft to loud Quality: for example, gurgling or swishing Duration: short, medium, or long Abdomen Identify risk factors Abdominal pain, indigestion, nausea Changes in bowel habits Appetite Alcohol ingestion Menstrual history Inspection, auscultation, percussion, palpation Characteristics of Masses determined by palpation Shape Size Consistency Surface Mobility Tenderness Lung Sounds Bronchial or tubular Bronchovesicular Vesicular Adventitious Wheeze Rhonchi Crackles Stridor Friction rub Common Thorax and Lung Variations in Older Adults Difficult-to-palpate apical pulse Difficult-to-palpate distal arteries Dilated proximal arteries More prominent and tortuous blood vessels; varicosities common Increased systolic and diastolic blood pressure Widening pulse pressure Characteristics of Sound Heard When Using Auscultation Pitch: ranging from high to low Loudness: ranging from soft to loud Quality: for example, gurgling or swishing Duration: short, medium, or long Muskoskeletal System Identify risk factors Trauma, arthritis, neurologic disorders History of pain or swelling in muscles or joints Frequency and type of exercise Dietary intake of calcium Smoking, exercise, and diet history Inspection, palpation Neuro Identify risk factors History of numbness, tingling, seizures, trembling Headaches or dizziness Trauma to head or spine History of HTN or stroke Changes in vision, hearing, taste, or smell History of diabetes or cardiovascular disease Alcohol and medications Health history interview Mental status Memory Emotional status Cognitive abilities and behavior Cerebellar function—motor skills, coordination, and balance Cranial nerve function Motor and sensory function; reflexes Mental Status Level of consciousness: awake and alert, lethargic, stuporous, comatose Glasgow Coma Scale (GCS) Level of awareness: time, place, person Memory Language