Intro to Prof Exam 2 Notes PDF

9/26 Chapter 9/10 What's a theory o Group of concepts, definitions, statements Why is it important o Nursing as a profession is strengthened when nursing knowledge is built on sound theory ▪ Metaparadigm (things that we have looked...

9/26 Chapter 9/10 What's a theory o Group of concepts, definitions, statements Why is it important o Nursing as a profession is strengthened when nursing knowledge is built on sound theory ▪ Metaparadigm (things that we have looked at before): Concepts of person, environment, health, and nursing ▪ Primary source = original writing of theorists. Avoid telephone phenomena o Critical thinking develops with experience Philosophies of nursing o A philosophy is a set of beliefs about the nature of how the world works o Puts together some or all concepts of metaparadigm Florence Nightingale Philosophy o Relationships between patients, health, environment, surroundings o Wrote Notes On Nursing: What it is and what it is not o Understood relationship between pt. Health and environment --> lowered death rate during crimean war Hendersons Philosophy o 14 basic needs of patient (primarily communication!) o Breath normally, eat and drink adequately, eliminate body wastes, move and maintain desireable position, sleep and rest, select suitable clothes and dress and undress, maintain body temp, keep body clean and well groomed, avoid dangers in environment and avoid injursing others, communicate with others in expressing emotions needs fears opinions, worship to ones faith, work in such a way theres a sense of accomplishment, play or participate in forms of recreation, learn/discover/satisfy curiosity that leads to normal developemtn and health and use the available health facilities Watson’s philosophy o The 10 caritas processes: caring is key to the processs o Touches on altruism, kindness, faith, hope in others, trusting relationships, use of creative scientific prolems, shared teaching and learning  How would they respond o Florence: what needs to be adjusted in this environment to protect the patient o Henderson: what could i help this patient with that he would do for themselves if they could o Watson: how can i create an environment of trust, understanding, and openness so that the patient and i can work together in meeting their needs? Conceptual models of nursing o Provides organizational structures for critical thinking about the nursing processes o Models that are less abstract and more formalized than the philosophies o Models are more abstract than theories of nursing Dorothea orem’s self care model o Focuses on patients capacity for self care o What deficits does this patient have in providing his or her own self care Imogene King’s interacting system framework theory and theory of goal attainment o Nurse focuses on goal attainment for and by the patient o What goals can we set together to restore the patient to health Callista Roy’s adaptation model o Comprehensive understanding from the perspective of adaptation o How can i modify this patients environment to facilitate his or her adaptation Grand to middle range theories Grand theory is a broad conceptualization of nursing phenomena Middle range theory is narrower in focus and making connections between the gran theories and nursing practice o Neither overly broad nor narrow in scope o Incorportate a limited number of concepts and focus on a specific aspect of nursing o Typically merge practice and research o Based in empirical reseach and are embedded within a larger theory Theories are less abstract than models and usually propose specific outcomes o What you can do to become measureable  Peplau’s Theory of interpersonal relations in nursing o Based on the premise that the relationshi between patient and nursing is the focus of attention, rather than the patient only as the unit of attention ▪ Relationship between pt. And nurse, rather than just the nurse Orlando’s nursing process theory o Specific to nurse patient interactions o Goal of nurse is to determine and meet patients immediate needs and to improve their situation by relieving distress or discomfort o It emphasized deliberate action rather than automatic action based on observation of the patients verbal and nonverbal behavior, which leads to inferences ▪ Inferences are confirmed or discomfired by the patient, leading the nurse to identify the patients needs and provide effective nursing care Leininger’s theory in practice: the sunrise model o Nursing outcome of culturally congruent nursing care is health and well- being for the patient o Guides assessment of cultural data for an understanding of its influence on the patients life o Nurse plans care, recognizing health beliefs and folk practices of pt culture o Focused on culture care preservation, accomodation, repatterning, depending on the patients needs Examples of middle range theories of nursing o Swanson’s Caring theory: based on couples experiencing miscarriages o Mishel’s Uncertainty in Illness Theory: studied men with prostate cancer who were watchfully waiting for advancing their disease rather than seeking aggressive therapies o Jezewski’s Cultural Brokering Theory: based on qualitative research on politically and economically powerless or those who were vulnerable as a function of advanced disease o Dobratz Theory of Psychological adaptation in death and dying : notes that death and dying is a social phenomenon that involves a wide range of human response across a variety of settings Using theory: theory based education  o Nursing curricula are built on one or more specific conceptual models of concepts ▪ Beavis and Watson 2000 ▪ Lewis 2006 o When nurses intentionally sturcture practice around a particular nursing theory and use it to guide them as they use the nursing process to assess, plan, diagnose ,intervene, and evaluate o Nursing profession evolved from applied vocation dependent on knowledge from other disciplines to its current stage of development with its own knowledge base o This period of growth has stimulated—and been stimulated by—the development of the nursing PhD degree, a research degree that generates new, discipline-specific knowledge. o PhD—research degree that generates new, discipline-specific knowledge. o PhD work—The nurse is concerned with the philosophy of science—the nature of knowledge and how it is known; the philosophy of nursing science and the generation of nursing knowledge; theory testing; and the development of new theory through research. o Doctor of nursing practice (DNP) or an MSN degree may be a primary provider in advanced practice, going beyond the generic nursing process. o These advanced practice nurses use theoretical perspectives focused on the patient for specific nursing outcomes. o BSN nurse is introduced to the research process, evidence-based practice, and use of theory as a guide. o The focus of BSN: use and application of nursing theory to guide nursing practice. o Associate degree—use nursing theory to teach the unique perspectives of nursing. o Benefits: shapes, facilitates, contributes, and helps develop Nursing theory ultimate goal o Support excellence in practice Nursing research tests and refines the knowledge base of nursing. Enables nurses to improve the quality of care and understand how evidence-based practice influences improved patient outcomes Chapter 10 Scientific method o Systematic way of thinkign and solving problems  Bias o Refers to systematic distortion of a finding from data, often resulting from a problem with the sample Quantitative research o Measurable variables that have outcomes from standardized experimental designs with hypothesis Qualitative research o Relies on data collection techniques like narrative interviews and participant observatin Mixed methods o Both qualitative and quantitative Science o Pure science: explains universe without regard whether info is useful o Applied science: practical application of scientific theories and law o Translational research: takes findings we see in lab/research to develop how we use in bedside Inductive reasoning o Small to big o Process begings with a particular experience and proceeds to generalizations o Inferences that are made that lead to further research Deductive o Big to small o Conclusions are drawn by logical inference from given premises Limitations of strict definition of scientific method in nursing o Health care settings are not comparable with laboratories o Human beings are more than a collection of part that can be dissected and subjected to examination or experimentation o The claim for objectivity Where does nursing research come from o Clinical practice o Theories o Literature Nursing research o Systematic investigation of phenomena related to improving patient care o A problem may be amenable to being addressed by research if ▪ Conceptual framework exists or can be constructed ▪ Based on related research findings ▪ Carefully designed.  Building knowledge but barriers o Expensive o Research has to be interesting, significant, and needs support from reviewers o No previous work or violates human rights o Hard to get IRB approval (institutional review board) National Institute of Nursing Research (NINR) o Support basic, clinical, translational research o Prevention o Manage and eliminate illness symptoms o Enhance end of life care o Train next gen of scientisits EBP o Element of critical thinking and improves clinical judgmenet o Effective interventions, not just routine care o Stay current o learn how to seek out and critique research findings to implement best practices in one;s own nursing practice o PICOT as a tool for evaluation interventions ▪ P: population of interest ▪ I: intervention ▪ C: comparison, what is already being done ▪ O: outcome ▪ T: time frame in which patient problem is relevant o Done well can change practice o Sigma theta tau international honor society endorses EBP, lead developing disseminating knowledge to imrpvoe nursing practice Research process o Nursing process: pt response focused o Research in general: planned, implemented, analyzed, and every ste pis carefully and meticulously done o Steps on research ▪ 1)Find researchable problem ▪ 2)Review lit ▪ 3)Develop hypothesis ▪ 4)Design study ▪ 5)Implement study ▪ 6)Conclusions drawn ▪ 7)Discuss and/or clinical application  ▪ 8)Disseminate result (IE change practices) Relationship of research to theory and practice o Used with confidence in different situations o Generates interest in further studies o Made a difference in patient care o Findings affect the health care system o Enhances the status of nursing as a profession Financial support for nursing research o National institute of nursing research (NINR) o National institutes of health (NIH) o Nursing associations like american nurse foundation, sigma theta tau international honor society of nursing o Difficult to get funding A BSN-prepared nurse o Reads interprets and evaluates research for use in supporting EBP o Identify nursing problems that need to be addressed o Participate in the implementation of scientific studies o Help disseminate EBP by sharing useful findings with colleagues o Research makes the nurse better! Master’s degree prepared nurse o Ready to replicate studies that have been previously conducted o Some nurses are better prepared to conduct research PhD or DNP nurse o More favorable positioned to recieve research funding than are nursing without doctorates o Only nurses with PHD;s may recieve funding from the NIH, although other funding sources are pen to nurses with other doctoral degrees 10/3 Chapter 6: legal issues Branches of government o Executive: implement laws, including president o Legislative: creates the law, includes congress and agencies o Judicial: charged to interpret the law, includes supreme court and federal court system. Not to create laws Laws: rules of conduct enforced by formal authorities o Common law: decisional. Judges ruling becomes law  o Statutory law: established through formal legislative processes. Nursing practice. Regular laws through legislative process. o Administrative law: delegated authority to government agencies. Like FDA approving food for safety Branches of law in american legal system o Civil law: recognized and enforces the rights of individuals in disputes over legal rights or duties of individuals in relation to one another. Like suing o Criminal law: involves public concerns regarding an individual's unlawful behavior that threatens society ▪ Defines what constitutes a crime and may mandate specific punishments within limits set by legislative bodies and the constitution. ▪ Constrained to what the legislature says Administrative cases o When a person violates the regulations and rules established by administrative law Licensure o Purpose: protect public health, safety and wellfare o Nursing practice act: defines and controls nursing ▪ Whats within and out of our scope of practice ▪ Objectives Defines practice of prof. Nursing Sets minimum educational qualifications and other requirements for licensure Determines the legal titles and abbreviations nurses may use Provide for disciplinary action of licensees for certain causes In many states, NPA is statutory law affecting nursing practice within the bounds of the state. Important to professional nurses ANA and NCSBN have developed and suggested language for the content of the state nurse practice act 1996 ANA model practice act: encourages consideration of the many issues inherent in a nursing practice act and political realities of state legislature and regulatory processes o States board of nursing: regulatory bodies within each individual state ▪ Administrative law  ▪ Legislature establishes and amends laws regarding nursing practice ▪ The legislature delegates authority to enforce the law to an executive agency – board of nursing ▪ Board of nursing enforces the laws and publicizes rules and regulations that expand the law o Does not protect you, protects the public safety o Model nursing practice act ▪ Differentiation between adbanced and generalist nursing practice ▪ Authority for boards to regulate anp, like prescriptin writing ▪ To oversee unlicense assistive personell ▪ Clarification of nurses responsibilities for delegation to and supervision of other personnel ▪ Support for mandatory licensure for nurses while retaining sufficient flexibility to accommodate the changing nature of nursing practice o Executive authority of state boards of nursing ▪ State boards of nursing authority is limited Can adopt that can clarify general provisions of NPA but cannot enlarge the law Executive – authority to administer the nursing practice act Legislative – authority to adopt rules necessary to implement the act Judicial – authority to deny, suspend, or revoke a license or to discipline a licensee or to deny an application for licensure o Licensure powers of state boards of nursing ▪ Mandatory: everyone has to be licensed ▪ Permissive: protects and limits the use of title granted in the law but does not prohibit persons from practicing the occupation/profession if they do not use the title ▪ Only licensed nurses can practice. o State boards of nursing and nursing education ▪ Authority to set and enforce minimum criteria for nursing education criteria ▪ Applicant for licensure must graduate from a state-approved nursing education program Schools of nursing must have state-approval to operate State-approvals are less stringent than national accreditation standards  Some states are undertaking rule changes to require nursing programs to have national accreditation to achieve state approval State boards of nursing and sanctions o Power to probation, suspension, revocation o Most common reason for disciplining nurses, like practicing while under influence of alcohol or drugs o State boards of nursing has the powert to sanction nurse for performing professional functions that are dangerous to the patient or general public Rehabilitation of nurses who are impaired by mental health issues or substance abuse o ANA (1990) and nursing disciplinary diversion act o NCSBN (2015) substance abuse disorder of nursing ▪ Comprehensive resource to assist with evaluation, treatment, and management of nurses with substance problem NCLEX o Minimum 75q maximum 265 o Duration 6 hours o Licensure exam is updated regularly and tests critical thinking and nursing competence in all phases of the nursing process Licensure by endorsement o The RN may practice in different states without having to take another licensing exam o Requirements: proof of licensure in another state, licensure fee o Compact ▪ NCSBN (2000) developed the nurse licensure compact 2015: NLC has been adopted by 24 states 6 states with pending legislation: illinois, massachusetts, minnesota, new jersey, new york, oklahoma 1 state (montana) has enacted but implementation is pending Each state that wishes to participate in the compact must pass legislation enabling the board of nursing to enter into the interstate NLC. o Compact state can practice in their own state and in any other compact state without applying for licnesure by endorsement o A nurse who is licensed in a compact state and changes permannt resident have 90 days o 2005: NCSBN began administering liencsure exam internationally to recrut  Malpractice o The biggest legal concern for health care professionals o Negligence is the central issue in malpractice ▪ The failure to act as a reasonably prudent person would have acted in the same circumstances ▪ Basically ignoring ur patient ▪ Responsible for their own practice o 4 elements of negligence ▪ Professional has assumed the duty of care ▪ Professional breached duty of care by failure to meet the standard ▪ Failure of the professional to meet the standard of care was the proximate cause of the injury ▪ The injury is proved. o Malpractice is negligence applied to the acts of a professional o Negligence is the central issue in malpractice ▪ commission – doing something that that should not have been done ▪ omission – failing to do things that should have been done o Requirements of malpractice ▪ Has specialized knowledge and skills ▪ Causes the patients injury through the practice of that specialized knowledge and skills o Captain of the ship: doctrine implies that the physician is ultimately in charge of all patient care and thus should be financially responsible o If you make an error as a nurse, the hospital can and will get sued. Croke (2003) o Croke (2003) – review of 350 trial, appellate, and supreme court cases summaries o Criteria: o A nurse was engaged in the practice of nursing as defined by his or her state’s nurse practice act. o A nurse was a defendant in a civil lawsuit as the result of an unintentional action (no criminal cases were considered). o A trial was held between 1995 and 2001. Croke (2003) – review of 350 trial, appellate, and supreme court cases summaries o 60% occurred in acute care hospitals o Six major categories of negligence resulted in malpractice lawsuits against nurses ▪ Failure to follow standards of car  ▪ Failure to use equipment in a responsible manner ▪ Failure to communicate ▪ Failure to document ▪ Failure to assess and monitor ▪ Failure to act as a patient advocate ▪ Professional nurses may delegate independant nursing activities State nurse practice acts do not give LPNs or LVNs the authority to dlegate Do not delegate what you can eat o Evaluate o Assess o Teach Delegation and ethical implications ANA’s Code of Ethics for Nurses, Provision 4.4 Delegation of Nurse Activities (2015) states, “The nurse must make reasonable efforts to assess individual competence when assigning selected components of nursing care to other healthcare workers. This assessment involves evaluating the knowledge, skills, and experience of the individual to whom the care is assigned, the complexity of  the assigned tasks, and the health status of the patient  … Nurses may not delegate responsibilities such as assessment and evaluation; they may delegate tasks. …. Employer policies or directives do not relieve the nurse of responsibility for making judgments about the delegation and assignment of nursing care tasks” (p. 2). The Code of Ethics is clear that workplace policies or directives do not supersede the ethical standards described in the Code. Dont set people up for failure, make sure whoeber youre assigning to a task has the competency to complete that task, If you have 20 patients and only 2 nurses, theyre putting you in a bad position, dont ever let someone tell you u have to assume care of that patient. Number 1 complaint against management is retaliation aka reprisal 5 rights to ensure safe delegation o 1.Right task: Is the task appropriate for delegation in a specific care situation? o 2.Right circumstances: Is delegation appropriate in this case? Consider the patient’s health status, care delivery setting, complexity of the activity and delegate’s competency, and available resources, and determine any other relevant factors. o 3.Right person: Can the nurse can verify that the person delegated to do the task is competent to complete this task? o 4.Right direction/communication: Has the RN given clear, specific instructions? These include identifying the patient clearly, the objective of the task, time frames, and expected results. o 5.Right supervision/evaluation: Can the RN or other licensed nurse provide supervision and evaluation of the patient and the performance of the task?  o o Informed consent Consent must be given voluntarily Consent must be given by an individual with the capacity and competence to understand The patient must be given enough information o Elements of informed consent to be legally o Elements of informed consent to be legally valid Completeness refers to the quality of the info provided Competency considers the capability of a particular patient to understand the information given and make a choice Voluntariness refers to the freedom the patient has to accept or reject alternatives Autonomy, minors, under the effects of drugs and alcohol, mental deficits, and competency to consent In the state of Louisiana a nurse CANNOT obtain an informed consent for a medical procedure or the administration of blood. Implied consent = no signature but they understand Unless the primary providers, nurses collaborate with the primary provider  Nurse may witness but not responsible for explaining the proposed treatment, for evaluating wether the physician has truly explained the significant risks, benefits, alternative treatments Nurse is responsible for determining that the elements for valid consent are in place, providing feedback if the patient wishes to change consent, and communicating the patients need for further information to the primary provider Key issues of the informed consent o Voluntary o Competend o Include risks, benefits, side effects, costs, alternative procedure o Must be in language the patient can understand o HAS THE RIGHT TO REJECT OR REFUSE TO SIGN A CONSENT Confidentiality Legal and ethical concern, protection of private info gathered about a patient during provision of care Code of ethics for nurses' provision Code acknowledges exceptions to obligation of confidentiality o Others involved in direct care, quality assurance activities (insurance coding etc), legally mandated to public health authorities, info required by third party payers o TARASOFFF LAW: Disclosing info without the patients consent when the safety of innocent parties is in question ▪ Duty to warn of impending danger. Protected by state and federal statues, there are exceptions and limitations Protected privileged communication, such as attorneys and priests, nurse are usually not included in such a statues Nurses may be ordered by a court to share information without the patients consent Nurses are mandatory reporters! o Suspected abuse, neglect, child/elder abuse, gunshot wounds, certain communicable diseases, threats towards third parties o Laws vary by state and may be responsibility of institutions providing health care services and not of an individual practitioner HIPAA Bill clinton due to arther ash, a tennis player, who contracted hiv/aids, in hospital bed did not want public to know due to stigma, espn someone reported it. Before 1996 all medical records were public.  Requires all health care providers, including physicians, hospitals, health plans, pharmacies, public health authorities, insurance companies, billing agencies, information systems sales and service providers, and others, to ensure privacy and confidentiality of patients Health, insurance, portability, accountability, act HIPAA regulations require several major patient protections: o Patients are able to see and obtain copies of their medical records, generally within 30 days of their request, and to request corrections if they detect errors. Providers may charge patients for the cost of copying and mailing the records. o Providers must give patients written notice describing the provider’s information practices and explaining patients’ rights. Patients must be asked to agree to these practices by signing or initialing the notice. o Limitations are placed on the length of time records can be retrieved, what information can be shared, where it can be shared, and who can be present when it is shared. o Need to know. Assault and battery o Assault is a threat of physical violence. U do not have to touch someone to assault them. o Battery is the assault carried out. Unprivileged touching of one person by another Evolving legal issues affecting nursing o Role changes ▪ Updating NPA ▪ Support the work of professional organizations to advocate for profession of nursing ▪ Legal nurse consult ▪ Prescriptive authority Generalist nurse Advanced practice nurses o Supervision of unlicensed assistant professional ▪ Risk for patient jury Issues with patient self-determination act (PSDA) o Encourages patients to consider and document life prolonging treatment options o PSDA basic assumptions: each person has legal and moral rights to informed consent about medical treatments with a focus on the person’s right to choose (ethical principle of autonomy)  o Acute and long term facilities must ▪ Provide written info to all adult patients about their rights under state law ▪ Ensure institutional compliance with state laws ▪ Provide for education of staff and the community ▪ Document in the medical record whether the patient has an advance directive like dnr o Agency for health care policy research ▪ Advanced directives were not guiding end of life care due to several factors Patients were not considered hopelessily ill Family members were not available, were too overhwlemed or disagreed. ▪ Advanced directives must be extremely explicit and clear o To prevent leegal action ▪ Practice in a safe setting Qualities of safe agencies Risk management ▪ Communicate with other heath prof., patients, families includin accurage documentation ▪ Meet the standard of care ▪ Carry and understand professional liability insurance ▪ Promote positive interpersonal relationships Basic types of professional liability insurance policies o Occurrence policies: cover injuries that occur during the period covered by the policy whether or not the policy is still in effect at the same tme the suit is brought o Claims-made policies: cover injuries only if the injury occurs within the policy period and the claim is reported to the insurance company during the policy period or during the tail. A tail is an uninterrupted extension of the policy period and is also known as the extending reporting endorsement 10/10/24 leadership, communication, and collaboration in nursing Foundation of nursing o Person  o Environment o Health Components of a system o Input/raw materials --> Through put --> Output/product --> evaluation --> feedback --> back to input Implications of systems to nursing o Systems: interrelated, in hospital setting. Open: exchange, closed: no exchange/interaction o Subsystems: is all of the diff health departments o Synergy: when all various subsystems work together to create a result that is not independently achievable. Interconnected at several points o Homeostasis: internal stability Systems and nursing practice o Hospital system Maslows hierarchy of needs o Physiological needs, safety, social, esteem, self-actualization o Published in 1954 – rejected freud and pavlov  o Presented human needs theory – motivated by intrinsic needs o Assumptions about needs ▪ Needs vary ▪ Rogers: becoming a person, how adaptations very, consider nurses and patient examples ▪ Homeostasis: threatened when needs not met Environmental systems o Family ▪ Most direct influence on a person ▪ Types, trends o Cultural ▪ Increase number of diverse groups ▪ Ethnocentrism: making judgements o Social ▪ Increased illness following social change ▪ Support, social networks o Community, national, and the world ▪ Impact of nurses, hospitals ▪ National, global Health o A state of complete physical, mental, social well being and not merely the absence of disease or infirmity, WHO o Holistic view ▪ Focuses on interrelationship of all parts that make p the person ▪ Nursing embraces a holistic view of health ▪ Jan christian smuts – modern western model, harmony between people and nature. o o Health is affected by health beliefs and health behaviors o Rosenstock Health beliefs model ▪ Vulnerability to a condition ▪ How effective health maintenance ▪ Trigger event o Bandura Self Efficacy ▪ Cognitive psychologist ▪ Assist in health-related behaviors ▪ Self-efficacy – leads to change 4 components needed for effective program of lifestyle change Information Skill development Skill enhancement through practice and feedback Social support o Health is constantly changing ▪ Impacts the entire person ▪ Individual health beliefs are powerful ▪ Individuals desiring change may lack knowledge, motivation, sense of self efficacy and support ▪ Knowledge does not always help  ▪ Change is often very slow ▪ Burden of actual is mutually shared by patient, care provider, and population focused entities ▪ Influence of the internet and health Cyberchondria: believe they have diseae they read about online o Assessing health related sites ▪ Who sponsors the site ▪ Be skeptical: evaluate the source to determine whether there is self interest ▪ Check authors name and credentials ▪ What is the purpose of the site ▪ Last date of revision ▪ Editorial review ▪ Material consistent with science, not testimonials ▪ Who runs the site ▪ Unbiased o Nurses and wellness ▪ Social policy statement by ANA Essence of profession Guides our social responsibility ▪ Code of ethics for nurses Nurses and values/beliefs o Evolve with aging ▪ Cognitive Intellectual, weigh alternatives ▪ Prizing Emotional, feeling good about a choice ▪ Acting Behavioral, affirm publicly and act on choice, mark of a real value when consistent o Beliefs ▪ Description Shown to be true or false ▪ Evaluative Judgement about good or and ▪ Prescriptive  Actions are judged to be desirable or undesirable Philosophy o Study of the principles underlying conduct, thought, and nature of the universe. Contemplate or wonder about something o Epistemology ▪ What is known? What is knowlege o Logic ▪ What should our thinking methods be in order to reach true conclusions o What happens when we fail to communicate o Up to 80% of serious medical errors can be attributed to miscommunication (joint communication) Communication o Peplau (1952) interpersonal relations ▪ Nurse pioneer ▪ Book: interpersonal relations, therapeutic use of self ▪ Orientation phase: trust ▪ Working phase : tasks ▪ Termination phase o Joseph priestley ▪ The more or elaborate our means of communication, the less we communicate ▪ Chemist in 1700’s discovered oxygen o George bernard shaw ▪ The single biggest problem with communication is the illusion that it has aken place Key elements o Self-awareness o Professional boundaries  o Reflective practice o Avoid stereotypes o Non-judgmental ▪ Acceptance o Patient centered care ▪ Caring is key Communication theory o Verbal o Nonverbal o Congruence : verbal and nonverbal match o You have to listen to the non verbal Communicaton process o Perception o Evaluation o Transmission o Individualized and impacted by gender, age, culture, interest, mood, value, clarify, length of message, feedback, intellect, sociocultural conditioning, very complex Development of human communication: baby pov o Somatic language: crying, facial expressions, cant talk actions o Action language: pointing, reaching out, o Verbal language :words phrases complete sentences