NSE 101 Exam Preparation PDF

NSE 101 EXAM PREPARATION Week One: Communication  “A complex process”  Sharing of information, ideas, and feelings  Aimed at mutual understating  Must consider the sender, recipient, and the transaction o Sender: person sharing the message o Recipient: person recei...

NSE 101 EXAM PREPARATION Week One: Communication  “A complex process”  Sharing of information, ideas, and feelings  Aimed at mutual understating  Must consider the sender, recipient, and the transaction o Sender: person sharing the message o Recipient: person receiving and interpreting the message o Transaction: the way the message is is delivered and the factors that influence the context and environment of the communication Types of Communication (3)  Verbal Communication o Oral communication o Spoken words, sounds, vocal intonation, and pace o Can occur face-to-face, one-on-one, or in groups, over the telephone, or video conferencing  Non-verbal Communication o Facial expressions, eye contact, gestures, body positions and movements o Important because it can both reinforce or contradict what you say verbally o Used more often than verbal communication  Written Communication o Written words, symbols, pictures, and diagrams o Informal type of written communication  Texting, emailing, posting a picture on instagram, or using an emoji o Scholarly form of written communication  Letters and papers  As a nurse: documentation notes, essays, peer-reviewed publications, protocols, practice standards, and best practice guidelines Professional Communication  Important part of becoming a nurse as you are entering a “profession”  It involves a level of formality  Applies to verbal and written communication including emails  Principles of professional communication: o Being truthful, accurate, clear, concise and comprehensive  In order to be professional, know your audience Tips:  Introduce your full name and role/institution   Address the person you are speaking to formally and do not assume the gender (ask how the recipient wants to be addressed if unsure)  Clearly articulate your message  Speak in full sentences  Be honest  Be polite Scholarly Writing  A form of communication  Important to consider both the content of your writing and the presentation of your ideas  Fundamentals: o Presentation of ideas in clear, succinct, and congruent ways o Incorporation of your original thought and a critical lens o Credible evidence to support your thoughts  Scholarly sources (peer-reviewed journals) o Attention to structure, paragraph construction, grammar, language, tone, voice, audience, etc Reading and Comprehension  Reading can make you a better writer  Involves understanding, evaluating, and reflecting on a text  Becoming a good reader —> read as much as possible  Practice the skills of reading critically and reflecting  Have a primary goal in your mind before reading, then break it down into numerous simples tasks or chunks of reading  Keep reading Effective Reading Skills  Setting o Good time and place w/o distractions  Pre-reading strategies o Skimming the text before reading in full  Efficiency o Engage actively with a piece of material  Annotate o Take notes about main points  Research o Investigate content you don’t understand  Discover o Ask questions (what is the author’s main point?)  Reflect o What does the text mean to you? Critical Reading  Begins with learning to think critically  “Reading as a writer” o Approaching a text with variety of tools that help prepare you to write about it These tools include reviewing related assignments or lectures prior to reading, specific note taking methods while reading, and ways of thinking about an organizing information after completing the reading  Read through the writer's eyes  o seeking to understand the deeper, interwoven meanings layered with a text  How you read and the types of notes you take will be influenced by what kind of writing you will do (critical analysis, self reflection, etc)  Grapple with and immerse yourself into the text to fully interact with it When critically reading:  Analyze the structure of the piece o Paragraph structures, the thesis, language used, etc  Analyze the text itself o Explore content and use of rhetoric  Capture main points by summarizing  Critique the text to assess quality, believability, and effectiveness  Reach conclusions  Combine your own ideas with the textual analysis to create new ideas  Ask yourself how the text relates to what you are studying (clinical practice) Information Literacy  Having the skills to competently evaluate various types of knowledge  Expected to “seek new information, knowledge and best practices for use in the provision of nursing care” CNO  Important skill because there are vast quantities and varying qualities of nursing and health- related information  As a nurse, you need to determine whether the information you are viewing is high quality, reliable, and relevant to your practice  Need to know how to sift through information and critically evaluate it  Combination of skills that involve o Recognizing when information is needed o Identifying relevant information o Searching and locating the information o Evaluating the information Researching tips  Search specific peer-reviewed journals and review the issues and volume  Be familiar with common databases o CINAHL o Medline o Proquest o Nursing o Evidence Based Medicine (EBM)  Decide on the keywords to search Search Operators  Tools to help you optimize your searches  Important search operators include: o Boolean operates (AND, OR, and NOT)  AND: combine terms so your search has both terms in it  OR: combine more than one keyword you are interested in (the terms won’t necessarily be in the article together)  NOT: filter out certain keywords you’re not interested in  o Truncation  Use the asterisk/star at the end of a word if interested in variations of the word o Quotations marks  Use quotations marks surrounding phrasing to group words together so that individual words are not found separately  Ex. “Chronic disease” excludes articles related to diseases only o Parentheses  Group similar terms you are searching  (older OR elderly) AND (isolation OR loneliness) AND illness Critical Evaluation  CRAAP: tool that helps you determine a source’s quality, analyze your sources and determine if they are appropriate for your research o C: Currency o R: Relevance o A: Authority o A: Accuracy o P: Purpose/Point of view Scholarly Sources  Can be classified into primary and secondary sources  Primary Sources o Direct, first-hand sources of information or data o Typically research articles  Literary texts, historical documents (diaries/letters), autobiographies or other personal accounts o In scholarly writing, it is best to go to a direct source  Secondary sources o Second-hand information o They rework primary sources o Commonly literature reviews (scoping reviews, systemic reviews)  Magazine articles, biographical books, encyclopedias, television documentaries, textbooks o Appropriate for getting an overall sense of a topic o Can help understand current statistics or standards of practice Week Two: Types of writing  Descriptive, Reflective, Analytical, Persuasive, Critical, Editorial, Literature Reviews Descriptive writing  Describe or write a summary of a text  Does not include personal opinion or critique Steps:  Consider the reason you are writing this paper and the audience you are writing for   Do some pre-reading followed by a full reading of the text (take notes)  Document in point form (main and supporting points)  Write the summary o General overview of the text o Exclude minor details  Begin the summary by identifying the text source (author and text title) and complete the summary with a bibliographic citation Keep in mind  Use complete sentences  Write in a neutral voice  Paraphrase in your own words and avoid direct quotations  Length of summary depends on audience and reason for completing it Reflective Writing  Think deeply/critically about an experience or a text you have read  At the center of reflective writing is the “self o A deep analysis of you in relation to the topic  Part of what is called “reflective practice”  Recently, reflective writing has been described in the context of narrative writing in which you engage in professional and personal storytelling Steps: LEARN  Look back o Recall a situation that was meaningful to you in your practice  Elaborate o Describe the situation from both an objective and a subjective perspective (what did you see, hear? What did you think/feel?)  Analyze o Examine why and how the situation happened the way it did  Revise o Consider how and why your practice should remain the same and how it should be changed  New trial/perspective o Think and move forward (what will you do differently?) Keep in mind  Choose a topic or situation that is meaningful to you  Be vulnerable  Description and analysis are important to gain new insights  Think critically about your experience and be open to new perspectives Analytical Writing  Detailed examination of multiple elements related to your topic  Purpose is to clarify a complex topic Steps:  Start with a question or debate  Review the literature to gain basic understanding of the topic o Establish criteria that will help u assess the literature and determine what evidence is applicable to your topic  Begin your analysis  Present what is known about the topic in a concise and informative manner o Start with a full overview of the topic  Examine the concept/issue closely  Include a discussion section providing room for analytical commentary to reflect on issues such as gaps in knowledge Keep in mind  Devoid of overt opinion o Opinion is conveyed in terms of what and how information is presented  Consider different points of view  Avoid over-quoting one source  Set aside your values initially and start by learning the facts  Don’t fall trap to reductionism. Balance is key, be concise but allow for complexity Persuasive Writing  Persuade, influence, convince, and inspire readers towards a certain viewpoint  Present a well-rounded, fact-based point of view from multiple angles  Common genera of writing in nursing  “Argument” in writing means refers to “a reasoned opinion” supported and explained by evidence Steps:  Approach the subject from an angle that interests you  Read and prepare as much as you can about the topic  Begin with an engaging introduction outlining your main point  Begin with most important points o Provide explanations and evidence to support your points o Use a balance of facts and opinions from a wide range of sources  Identify opposing points of view and challenge them with evidence  Leave the reader with a strong impression or call to action o Write a conclusion summarizing the main argument and reinforces the thesis Keep in mind  Ensure viewpoint is apparent  Stay focused on main point  Avoid value-based language like good/evil o Risks evoking emotions that could cloud critical thought  Appropriate tone and style for audience  Use key transitional words such as: most importantly, finally  Proving an argument is often not possible o No evidence proves debatable topics o Facts can be proved, but opinions can only be supported, explained, and persuaded Critical Writing  Detailed assessment or evaluation of a text  Involves critical thinking  Go beyond a statement of facts and take a stance o Insert your own ideas into the text’s conversation Steps:  Provide a clear picture of the issue  Critically evaluate the phenomenon or the text in question by identifying strengths and limitations  Synthesize and connect ideas, arrive at your own conclusions, and develop new directions for discussion o Show that you have used sources to develop ideas of your own  Evaluate texts related to research studies o Ask questions like: is the purpose of the research clear? Are the study methods clearly defined? Does the data support the research findings? Are the nursing implications clearly identified? Keep in mind  Adopt the language used in the original source when summarizing an issue  Clearly and concisely argue one point at a time  Highlight strengths, limitations, and recommendations in a respectful way o Wrong ex: the nursing implications were unclear o Correct ex: it would be useful to explicate the nursing implications Editorial Writing  Share your educated opinion  Referred to as an opinion or perspective piece  The author has expertise on the topic  You may combine other types of writing (persuasive writing is best used) o Critical voice or analytical voice when comparing and contrasting or evaluating an issue, or use a persuasive style to convince the reader  May be written for newspapers, blogs, websites, or nursing magazines/journals Steps:  Choose a specific topic that is current, timely, and controversial in the nursing and healthcare field  Always consider the audience because they will influence the language used and points you emphasize  Think about your purpose. Editorials purpose can be two types o Type 1: express your opinion about an issue o Type 2: propose a solution to an issue  Based on your informed opinion, choose a side and state your opinion early in the editorial  Structure is similar to other types of writing: intro, body, conclusion Keep in mind  Use professional tone  Choose clear and simple language  Create a short title that emphasizes your main point  Do your research  Keep it concise Reader  The person reading your paper (usually instructor) Audience  Person or group that you are trying to influence  Should tailor the content and style of writing to your audience  Choose appropriate words by paying attention to semantics  Audience varies depending on topic and purpose of writing Writing Purpose  Identify purpose before writing  This will guide your writing process and you decisions about what to include  Sometimes purpose is give by instructor, sometimes it depends on the what effect you want your writing to have on your audience  To figure out the purpose: o Look at course assignment guidelines o Verbs in guidelines can help determine purpose  Possible purposes include: o Persuade/inspire audience to act/think about an issue o Challenge audience to make them question their thinking o Argue for or against something (change audience mind) o Teach your audience something o Connect with audience emotionally and help them feel understood  When writing a purpose statement: o Consider the audience o Be clear, concise, and use present tense o Limit the number of verbs you use Point of View  It is the perspective used when writing a text  Best understood through pronoun usage and described as: o First person  I, Our, We  Helps to avoid anthropomorphism o Second person  You and Your  Used for informational and instructional resources for clients o Their person  She, He, It, They, Their  Used when the intention is to provide an objective perspective to the writing and eliminate subjectivity   Used in policy papers or when presenting quantitative findings  Whatever PoV is used, stay consistent. Do not move back and forth from second person to third person  Choice of PoV is influence by the purpose and audience  Watch out for gender assumptions  All POVs are considered scholarly writing Sentence and Paragraph Construction  You should construct your sentences and paragraphs with intention  These elements are the building blocks of scholarly writing  Plan your writing by briefly outlining the main idea of each paragraph  Each paragraph should convey one main point o Usually identified in the first sentence - topic sentence o Include several sentence supporting this main point o The end of paragraph should link to the next one enhancing flow  Paragraph and sentence length vary depending on the length of paper and complexity of idea  Overly long paragraphs and sentences can confusing  Length guideline: o Sentences should be no longer than 3 lines o Paragraphs should be 3-8 sentences o In a double spaced paper, paragraphs should be one-half to three-quarters of a page Common Writing Errors  Anthropomorphism o When human traits are assigned to non-human actor/object o Ex. The chapter outlines the steps of the research process  The chapter is non-human and cannot “outline” anything  Gendered pronouns o Avoid stamens like “a nurse should assess her clients…”  Assumes that all nurses are female  Gendered binary o Assuming a binary in which only two genders exist o There have been recent movements to embrace the pronoun “they”  Verb tenses o A verb that is in the incorrect form or in the incorrect tense  Incorrect ex. The nurse speaked with the client’s family  Correct ex. The nurse spoke with the client’s family  Modifiers o Modifiers are adjectives and adverbs that describe nouns and verbs o Excessive use of these words to describe something that is already descriptive is distracting to the reader  Incorrect ex. The nursing interventions were extremely effective  Correct ex. The nursing interventions were effective o Avoid use of words such as very, quite, and extremely  Semi-colons o Some-colons are used to connect two closely related independent clauses o They are also used separate items in a long list o Use them correctly!   Incorrect ex. RN prescribing has a potential to increase access to care; as well as increase healthcare system efficiencies  Correct ex. RN prescribing has a potential to increase access to care; this shift in practice can also increase healthcare system efficiencies o *Note: the words after the semi-colon do not form a complete clause  Incorrect ex. Examples of determinants of health include; income; education, gender, culture.  Correct ex. Example of determinants of health include: income; education; gender; amd culture  Listing comma o Two independent clauses (i.e., complete sentences) joined with a comma  Incorrect ex. It is important for clients to receive sufficient sleep, researchers have found that lack of sleep has been shown to slow healing  Correct ex. It is important for clients to receive sufficient sleep. Researchers have found that lack of sleep has been shown to slow healing  Run-on sentences o Two independent clauses joined with no intervening punctuation (i.e., run together)  Incorrect ex. Clients who are at risk for premature death due to risky health behaviours such as unprotected sex and illegal drug use may benefit from attending nurse and peer facilitated health promotion programs because these programs can provide opportunities for clients to receive support from nurses and for clients to speak with other clients who have had similar experiences  Correct ex. Clients who engage in risky health behaviours such as unprotected sex and illegal drug use are at risk of premature death. These clients may benefit from attending nurse and peer facilitated health promotion programs. These types of programs provide opportunities for clients to receive support from nurses and for clients to speak with other clients who have had similar experiences.  Non-inclusive language (ie, the disabled patient) o Labels are phrases and words that describe and categorize people o They can be used to oppress or subjugate populations and reduce person to their pathology  Non-inclusive ex. The demented patient  Correction: the person living with dementia  Non-inclusive ex. The autistic child  Correction: the child living with autism Week Three: The writing process:  Prewriting: Ideas, reading the assignment, determining requirements, research  Outline: Determine the papers overall structure, organize the ideas o Think audience, purpose, length o Mindmap? List?  Rough draft: use ^^ to start writing your rough draft, cover all ideas and structures o Have intro, body, conclusion o Get ideas on paper check it later o Complete not final version of paper  Revise: Check for flow, details, rephrase, run on sentences, etc.  Edit: More detailed check for grammar, writing conventions, style, etc. Thesis Statements:   A thesis is the controlling idea of a text and often the argument o A main idea and your opinion on it o Typically one sentence and appears near end of intro o When working on thesis you need to form an opinion and make it into a controlling idea o Qualities of strong thesis include specificity, precision, arguability, demonstrability, confidence o Thesis is spine of paper o Should be broader is your paper is longer and more specific for a shorter paper  To write your thesis: o You need to have thesis before outlining and organizing o It can be a working thesis (changes as you do your paper) o To revise thesis take out nonspecific words, clarify ideas, replace linking verbs with action verbs, and omit claims that are hard to support o Should not be declaring the topic of paper, unreasonable claims, stating the obvious, or too broad Topic Sentences and Transition Statements:  A topic sentence helps you introduce a paragraph  Controls development and flow, shapes paragraph, usually the first sentence and broad  A good topic sentence includes: o Topic + ideas in paragraph o Provides unity o Links to thesis o Omits details o Engages  Transitions emphasize relationships betweens ideas, help reader move from one idea to another, weaves thoughts o Sentence level transition:  Words to relate sentences together. Examples:  Words for similarity: also, likewise  Contrast: despite, on the other hand  Examples: for instance, specifically  Cause and effect: therefore, thus  Additional support: also, additionally, besides Intro and Conclusion:  Introduction o must catch the attention of reader o They introduce focus and purpose of paper o Provide brief overview of paper o Good intro = new info + ideas that everyone may not agree w  Conclusion o Final choice to make impression on reader o Leave readers w something to think about o Clarify why your topic matters o A good conclusion = a call to action + a connection between topic and reader o Week Four: Academic Integrity:  Truthful presentation of your own ideas and identifying when you are incorporating the work of others  A citation is a reference to another persons work  Plagiarism is not giving credit when using another person's work o Self plagiarism = submitting your own work twice o Failing to cite = plagiarism even if it was not intentional o To avoid plagiarism:  Write what you know before using sources  Take notes from sources carefully marking where you got the information from including paragraph or page  Changing a few words is still plagiarism, reword the sentence  Style Rules  These rules are a way of organizing  Allow for uniform writing  We use American Psychological Association (APA) 2020  Style rules for APA 2020 --->: o 1 inch margin w left justification o Double space o TNR 12 o Pg # top right starting on title pg o Indent first line of para 0.5 inch o Title of paper - bold, title case, centered Headings   Level of heading depends on the number of headings you have  They allow paper to be organized  Short papers don't need headings  Intro does not have heading  Title is the first level 1 heading Formatting  Refer to picture -----> Paraphrasing, Direct Quotes, In - Text Citations  Paraphrasing is presenting ideas from source in own words o You need to make sure that after changing it up it still conveys what the author was trying to say. Don’t change it to the point where its not factual or does not represent the authors words  Direct quotations involve using the exact wording from a source and should only be used when paraphrasing the original text would weaken the point of the sentence. o Only if paraphrasing not available  In text citations o You only have to cite authors once within a paragraph IF, it is clear that other sentences that are paraphrased are by the author you previously cited  It must be clear when a sentence is your own original idea and when it is paraphrased. If not clear, cite o Each source you cite must be in reference list and each source in the reference must be cited in paper o APA used author date citation  Ex: Citing is an important part of demonstrating academic integrity. Hart and Lu- Ann (2019) argued that many students do not cite appropriately. They further stated that students often fail to indicate where a reference begins and ends. In my experience, I have found that students do not reference enough. Many students lose grades because of poor citations, and this is often because they do not understand the nuances of APA citation (Hart & Lu-Ann, 2019).  Citing Dos and Don’t  Do not have quote alone, ease it into your sentence  Use ellipses to eliminate a part of quote you don't want to use, use brackets [ ] to change something like tense in the quotation  Double quotation marks for the quotation and single for a quote inside the quotation  In-Text Citations (multiple authors) o One or two authors:  Intext citation: (Garrison & Gould, 2019)  Paraphrasing: Garrison and Gould….. o Two or more works by same author:  Rodriguez (2019a) stated ….  Rodriguez (2019b) stated …. o Two authors with the same last name:  J.S. Williams (2017) ….  C.G Williams (2017)... o Two plus authors:  Ballo et al., (2021)  Add the name of first author only unless you have two citations from authors w the same last name, then add as many names needed to differentiate the two citations Reference Page:  Refer to the picture above  Must be clear so reader can find reference  Must be a new page  Double spaced  Flush left & hanging indent Week Five: Revising VS Editing Revising  Focus on organization, cohesion, and style and tone  Organization: argument flow logically from one point to the next  Cohesion: elements of your paper work together smoothly and naturally  Style and tone create the voice of your paper  You might need to add, cut, move, or change information to make your ideas more clear, accurate, interesting, and convincing  Sources are seamlessly integrated Editing  Focus on how you expressed your ideas  Add or change words, and fix any problems with grammar, punctuation, and sentence structure  You will improve your writing style to make your paper into a publishes, mature piece - the end product of your best effort Organization (revising)  Look at the flow of ideas o Within individual paragraphs, check to see that your paper moves logically from the intro to body paragraphs to the conclusion o Each section should reinforce your main idea/thesis Steps:  Print out a hard copy and read paper paragraph by paragraph o Highlight main ideas, thesis, and topic sentences of each paragraph  Outline the ideas you presented o Don’t look at the outline during prewriting. Write in the margins of your draft or use a separate sheet of paper  Read your paragraph again more slowly, looking at the flow of ideas o Identify places where adding a transition or recreating a sentence would make ideas flow more smoothly  Review the topics on your outline  Begin revising to improve organization o Start with major issues (moving a paragraph) then proceed to minor revisions (adding a transitional phrase) Cohesion (revising)  Use transitions to help the writing flow smoothly o Ex. Given X, the implications for this topic include X o Ex. It’s important to consider X as we move forward with… o Ex. X sheds light on the timeliness of this work because…   Analyze how parts of paper work together  Look for anything that seems awkward or out of place o Delete unnecessary material or rewrite parts of the paper  Integrate source material properly o Dropping facts or quotations randomly can distract the reader o Overusing paraphrase and quote materials can also be confusing Steps:  Print out a hard copy  Read the body paragraphs first (READ ALOUD) o Identify unnecessary information o Asses the information and citings  Identify places where you need to revise so reader can understand the significance of the details cited from sources  Skim the body paragraphs again  Review introduction and conclusion  Revise as needed to improve cohesion Creating unity  All the ideas in each paragraph and in the entire paper clearly belong and are arranged in order that makes logical sense Paper Title  Frames what your paper is about  Captures reader’s attention  Creating a title is important because it is the first thing your reader sees  Title conveys your tone to your audience  Must be clear, concise, informative, and inviting  Title often has two parts separated by a colon (:) o Most important part should come first o In a scientific paper, first part might focus on topic, and the second part might focus on your methods  Ex. Nurse’s Experiences of Grief: A Literature Synthesis  If you choose a title before writing, you should refine it in the final stages of writing  Make sure title says what you need it to say o Ask a friend what they expect the paper to be about just by reading the title Strategies to consider  Avoid abbreviations  Limit it to 10 to 15 words  Choose words purposefully  Avoid unnecessary words such as “Exploring Nurse’s Experience of Grief”  Re-read the intro o Your main points can help you develop a title Giving Feedback (peer review)  Listen to the writer o What kind of feedback are they asking for?  Be kind and respectful  Comment on important issues first  Use I statements to help focus on your own reactions o Instead of saying “you aren’t clear in this paragraph” say “I’m confused in this paragraph, did you mean X or Y?”   Be specific o Never say “I liked it” or “it was good”  Offer advice based on your own experience  Don’t try to make the writer sound like you  Correcting errors is important, but there is no point to edit an entire paper when it might be deleted or changes o Remind the writer about spell check and grammar if you notice minor errors, but otherwise, only ask about errors if they make the meaning unclear Receiving Feedback  You get to decide what feedback to accept o If you don’t think the feedback is correct, ask your instructor what they think  Listen with an open mind  If you feel upset about feedback, take a break o It’s okay to say “I'll think about it later”  Closely review feedback from instructor Week Six: Conflict  Variance in perceptions and opinions that involves a perceived or actual threat  Can trigger strong emotions  Negatively affects how you respond and communicate  Understanding/addressing conflict is important as it is part of any relationship  Threat: an unfavorable situation and force that may adversely affect you o Don’t consider threat as an intention to inflict physical harm upon someone  Threat is embedded in conflict because a person’s perception or position quickly becomes part of who they are (their self concept) o An opposition to this perception is considered a “threat to self” Ineffective ways to deal with conflict o Ignore/avoid conflict o Take it personally o Post about it on social media or gossip with a friend rather than addressing it with the person causing conflict Positive Lens of Conflict  It transforms how you perceive and address conflict  Approach conflict as an opportunity o You can learn and grow by listening to another point of view o Understand what the perceived threat is for you and the other person  It can create a connection that cultivates your relationship  It can also add to a positive resolution related to the conflict with the potential creative and divergent thinking Conflict Resolution  Finding a reasonable solution to varying perspectives  May involve you and the other person sharing your perspectives o Helps enhance understanding of the issue  May result in you and others to shift your perspective and arrive upon a reasonable solution   Professionalism should always guide how you approach and manage  Reflection after conflict resolution is important Strategies  Approach the situation with a “spirit of inquiry” (RNAO, 2007) o Enter discussion with an open mind o Reflect on perceived or actual threat for you and the other person  Assume the goodwill of another person o Avoid entering the situation with a negative attitude  Use “I” statements o Important because they convey how you feel and open the opportunity for discussion o “I” statement are difficult to counter argue  Do not raise your voice  Be clear and provide rationale for your perspective Models of Communication  They simplify the complex process of communication by providing a visual representation of the various aspects of a communication encounter  They define communication  Allow you to see specific concepts and steps  The three models are: o Transmission model o Interaction model o Transaction model  Processes of encoding and decoding o Encoding: turning thought into communication o Decoding: turning a communication message into thoughts The Transmission Model  Linear, one-way process  Sender intentionally transmits a message to a receiver  Focused on the sender and the message  Not representative of effective communication o Because even though the receiver is included in the model, this role is viewed as a target or end point o One presumes that receiver either successfully receives and understands the message or does not  In this model, responsibility is put on the sender to ensure message is successfully conveyed  There are barriers to effectively sending communication o Noise: anything that interferes with the message  Environmental noise: physical noise such as other people talking in a crowded hallway  Semantic noise: interference in the encoding and decoding process such as lack of understand, clarity, and confusion of words and meanings The Interaction Model  More interactive, two-way process  Process in which participants alternate positions as sender and receiver and generate meaning by sending messages and receiving feedback o Feedback: messages sent in response to other messages  More interaction focused  In this model, communication isn’t judged as effective or ineffective. Instead, it acknowledges the fact that communication is nuanced and complex  This model takes physical and psychological context that influence communication into account o Physical context: environmental factors such as the size, layout, temperature, and lighting of a space o Psychological context: mental and emotional factors such as stress, anxiety, and emotions The Transaction Model  Communicators generate social realities within social, relational, and cultural contexts  In this model, nurses communicate to: o Create relationships o Form intercultural alliances o Shape self-concept o Engage with other in dialogue to create communities  You don’t communicate about your realities, you communicate to construct your realities  Instead of labeling participants as sender or receiver, this model refers to people in a communication encounter as communicators  In this model you are simultaneously a sender and receiver  More complete understanding of contexts o Social context: stated rules or unstated norms that guide communication o Cultural context: various aspects of identity such as gender, ethnicity, sexual orientation, class, and ability Trauma-informed Approach to Communication  Integrating and understanding the need for: o Physical and emotional safety o Choice and control o Empowerment  Involves o Emphasizing confidentiality o Identifying interview purpose o Letting the client set the shape and pace of interview o Engaging in collaborative intervention so the client is in control and empowered  This approach assumes the presence of trauma, therefore, patient is not required to disclose their experiences and risk re-traumatizing them Relational Inquiry Approach to Communication  “The complex interplay of human life, the world, and nursing practice” o Means that nurses should avoid looking at patients on a merely individual level  Helps you understand client’s situation more fully and focus on what is important to them  It is the lens you use to perceive the world  Involves the following elements of communication: o Intrapersonal: assess what is occurring within all people involved o Interpersonal: asses what is occurring among and between all people involved o Contextual: asses what is occurring around the people and situation  Focuses on: o Internal dialogue of the client o Their social system o The broader context influencing client’s and nurse’s actions Anti-racist Approach to Communiaction   Race: variable of difference, whereby people are ascribed to designated groups based on biology, culture, and characteristics  Racism: ideology and practice of sustaining, maintaining and reinforcing difference based on race  Anti-racism: active process of changing attitudes, beliefs, practices, and policies  This approach involves: o Identifying and challenging racism with institutions o Taking specific and directed action towards eliminating racism o Recognizing self as an agent for change towards quality  Focus on addressing power inequities and systemic biases CNO Therapeutic Communication Indicators  Introducing self to client (name/designation/discussing role in client’s care)  Addressing client by the preferred name and title  Giving client time and ability to explain and truly listening  Informing client that info will be shared with the healthcare team  Being aware of verbal and non-verbal communication style and how client perceives it  Modifying communication style as needed (diff language, literacy level, etc)  Helping client find the best possible care solution by assessing their knowledge and discussing their beliefs/wishes  Considering client’s preferences  Providing info to promote client choice  Listening to, understanding and respecting client’s values, opinion, etc  Recognizing that all behavior has meaning and seeking to understand client’s unusual behavior, comment, or attitude  Listening to concerns of family and significant others and acting on them when appropriate  Refraining from self-disclosure unless it meets a specific therapeutic client need  Reflecting on interactions and putting time and effort to improve  Discussing ongoing plans for meeting the client’s care needs after the termination of the nurse- client relationship CNO Confidentiality and Privacy Indicators  Seeking info about issues of privacy and confidentiality of personal health info  Maintaining confidentiality of client’s personal health info with members of healthcare team  Maintaining confidentiality after the professional relationship has ended  Ensuring clients or substitute decision-makers are aware of general composition of the healthcare team that has access to confidential info  Collecting only personal health info that is needed to provide care  Not discussing client info with colleagues or client in public places  Accessing info for clients only and not for any unprofessional purpose  Denying people who are not part of healthcare team access to personal info  Safeguarding the security of computerized, printed or electronically displayed or stored info against theft, loss, unauthorized access or use, disclosure, copying, modification or disposal  Not sharing computer passwords  Ensuring that explicit consent has been obtained to keep a client’s personal health inf in the home  Not using standard email to send personal health info  Ensuring that security-enhanced email is effective before sending personal health info   Using confidentiality warnings on facsimile cover sheets and in email to instruct those who receive the info in error to destroy it immediately before reading it  Communicating to the recipient of the info that a particular record is incomplete  Advocating for policies and practices that ensure confidentiality during storage, transmission or transfer, or disposal of personal health information, whether in hard copy or electronic form  Complying with retention policies or advocating for these when none exist  Ensuring that personal health info is destroyed in a way that protects the confidentiality of that info  Notifying the contact person within the practice setting when she/he becomes aware that there has been a breach of confidentiality Week Seven: Therapeutic Communication:  A learned activity  One of the four standard statements in the therapeutic nurse client relationship o Legal obligation Client Interview:  Communication w the client to collect subjective data  Primary source and secondary sources o Primary is what the client tells you o Secondary is what family or friends tell you  Care partners are family or friends present with the client  Subjective data is data the client tells you  Objective data is data you observe or find out Preparing for the interview:  Review the client's record  Make the environment comfy, make sure they know this information is confidential but there is exceptions to this such as abuse cases  Clients have the right to have their personal health information kept private  The healthcare team can access the data o If you are working on the same floor or if your friend is working with that client does not mean you can look at the history  Disclose info if case of child abuse or neglect, elder abuse, must report to CNO if you see a client w serious risk of harm to patients Self Reflection Before Interview:  Awareness of your own emotional state  Self reflecting: o How are you feeling? Thoughts? Are you expressing your emotions physically? How is your health and well being? Environment around you? Interview:  Introduce yourself and address client  Identify purpose of you being there: o Hello, I am Harleen Athwal, I am a nursing student from Ryerson University. My pronouns are she/her. How would you like me to refer to you? o What pronouns do you use? o Okay, today I am here to learn about your health. It will involve asking you some questions and takes about 20 minutes.  Types of questions: o Closed ended questions are specific and looking for an answer. Ex. include age, when did symptoms occur. You want a clear answer  o Open ended questions are neutral and do not imply anything. You are not looking for an answer, you are simply looking for information. Ex. tell me about what was happening when your headache started. o Probing questions are in need of more information  Communication strategies: o Clear, simple language o Active listening o Silence o Empathetic response o Honesty o Avoid false reassurance o Unconditional positive regard o Avoid q starting with why o Permission statements o One q at a time o Vocal qualities o Work collaboratively o Do not give unwanted advice  Non verbal communication: o Facial expressions, hand gestures, eye contact, body language, positioning, aligning with verbal behaviour, physical touch. S - sit at an angle to client U - uncross legs and arms R - relax E - eye contact T - touch Y - your intuition Cultural Considerations:  Culture is socially transmissible  From indigenous pov, culture is an emergent property of individuals interacting w their natural and human environements  A relationship inquiry approach to culture: o Tell me about ur culture o Tell me about a typical day for you o Tell me what is imp to know about your culture to care for you Development Considerations:  Chronological age and developmental stage  Young children o 5 yrs and younger including infants (under 1), toddlers (1-2), preeschoolers (3-5)  Older children 6-12 yr of age and adolescents 13 - 17  Adults are 18 yrs of age or older  Older adults are 65 + Additional information:  Language discordance, emotions, violence and trauma, hearing and visual impairment, intellectual impairment, substance impairment, escalation, inappropriate communication from client  Keep these things in mind when interviewing Week Eight: The Complete Subjective Health Assessment (the health history)  Collection of subjective data combined w objective data  Primary source and secondary source  Considerations: o developmental stage - of person your interviewing is young make sure they understand you o Care partners - involve them o Influencing factors - trauma o Ask one q at a time  Categories of Subjective Health Assessment o Demographic and biographic data  name/contact info and emergency info  Birth date, age  Gender  Allergies  Languages spoken and preferred language  Relationship status  occupation/school status  Resuscitation status o Main health needs/reasons for seeking care  Option 1: tell me about what brought you here today  Option 2: tell me about your main health concerns today  Probes: tell me more, how is that affecting you?  Think about if this is normal,abnormal, critical finding o Exploring Symptoms:  Use the Mnemonic PQRSTU  P- provocative, palliative  Q- quality, quantity  R- region, radiation   Sseverity  T- timing, treatment  U - understanding  Can use wong baker faces pain rating scale or sun cloud pain rating school for kids or people having a hard time understanding o Current and past health  Health rn, Childhood illness, chronic illness, acute illness, accidents, injuries, obstetrical health o Mental health and mental illnesses  Avoid making assumptions about clients mental health based on appearance, facial expression or capacity to function o Functional health  The physical and mental capacity to participate in activities  Nutrition, elimination, sleep and rest, mobility, activity, exercise, violence and trauma, relationships and resources, intimate and sexual relationships, substance use and abuse, environemtnal health and home/occupation/school health, self concept and self esteem, other instrumental activities of daily living (iADL) o Preventative treatments and examinations  Meds, examination and diagnostic, vaccinations  Immunization:  Vaccinations provide protection, boost immune system, build antibodies and immune memory by using a tiny amount of dead or weakened germ  Vaccine hesitancy should not be judged instead collaborate o Family health  Current and past health of clients family  Health of blood relatives  Causes of death and age  Genogram  Close encounters w or live w  Health status o Cultural health  I am interested in ur background as it relates to your health   How does … affect your health and illness  Create safe cultural space  Critical self reflective approach  How do 1 describe my own culture  What assumptions or biases do I hold about culture?  How might historical legacies affect and inform the healthcare I provide?  How does my use of language affect cultural safety? o Care Partners:  Family and friends involved w client care  Treat as recipient of care as well Clinical Judgement:  When conducting an assessment, as a nurse you need to notice and act on findings based on whether they are normal or abnormal findings o This involves critical thinking and clinical reasoning WATCH VIDEOS FOR DEMONSTRATION OF INTERVIEW Week Nine: What is documentation?  Paper and electronic record keeping  Client chart/health record  The nursing process  Info and communication technologies (ICT)  Everyone uses same chart to add info Reasons for documenting:  Legally you are obliged to document, it is a CNO standard  It allows for communication, continuity of care and clinical judgment  Client safety  Quality improvement   Funding and research  Population and clinical health insights  If you didn't chart it you didn't do it Documentation Components:  Admission sheet (contacts, personal info)  Progress notes (unstructured) / interdisciplinary notes (notes between doctors, nurses, specialists)  Referrals and consultations  Diagnostic, laboratory and therapeutic orders  Medication administration record (MAR)  Flow or graphic sheets (Vitals) --->  Kardex or summary (done in pencil initially)  Nursing care plans  Operative procedures  Discharge plans  Incident reports  Workload measurement tools Electronic Documentation:  Electronic medical record and health record  They allow different HCP to collaborate  Benefits include real time data, seamless care which means we can look at trends, interprofessional communication, analysis  Structured (vital signs) and unstructured data (nurse progress notes) Principles of Documentation  Communication: o Nurses ensure documentation is accurate, clear, and comprehensive pictures of the clients needs, nurses interventions and clients outcomes  Accountability: o We are accountable for the documentation of client care and for its accuracy, and timely completion. Any mistakes are your fault and you will be responsible, write clearly, avoid signatures, abbreviations.  Security: o Safeguard client health info, maintain confidentiality, act according to policies and procedures that are consistent with the standards o Privacy rights os personal info and persons right to access info  The personal health protection act (PHIPA, 2004) legislates collection, use and disclosure of personal health information by health information custodians (you) Methods of Documentation:  Charting by exception o Charting when finding is not normal  Narrative o Chronological documentation  Nursing process focused on issue/concern/problem o Data action response (DAR) o Assessment plan intervention evaluation (APIE) o Subjective objective assessment plan intervention or evaluation (SOAPIE) How to Document:  You start off with your discipline, date and time (military time)  Starting writing everything the patient has told you clearly but concisely  Any errors made need to be crossed out once and initialed and dated   Make a line at the end if there is space between edge of sheet and where you wrote (shown in example below)  At the end sign your full name and designation Week Twelve: Interprofessional Communication  Communication among members of a client care team o various professional groups  Involves verbal, written, and non-verbal communication  Fundamental component of interprofessional collaboration o Effective teamwork among members of a care team o Ensuring client safety National Interprofessional Competency Framework  Defined as “knowledge, skills, attitudes, and values that shape the judgments essential for interprofessional practice”  Includes: o Interprofessional communication o Patient/client/family/community-centered care o Role clarification o Team functioning o Interprofessional conflict resolution o Collaborative leadership  The first two competencies have a strong influencing role in all healthcare situations, they encircle the other four competencies Interprofessional communication (continued)  Central role in interprofessional collaboration as it supports the other 5  HCPs must learn to “communicate with each other in a collaborative, responsive and responsible manner”  Principles: o Speak clearly o Use simple and clear language o Maintain eye contact o Be efficient  o Incorporate timely information o Engage in active listening o Speak up o Seek clarification o Put clients first o Show respect Ineffective Interprofessional Communication  Disrespectful communication  Failure to communicate one’s concerns  Failure to communicate rationale for an action or decision  Unclear/incomplete communication or miscommunication  Ineffective conflict resolution on a plan of care Factors Affecting Interprofessional Communication/Barriers  Physical Environments o Noise such as beeping machines an overheard announcements o Moving parts such as clients, families, HCPs o This can cause sensory overload  Complex Context o A lot of information and dynamic and complex clinical situations  Require high level of acuity o Can be very intense (death, fear, anxiety, uncertainty) o Can influence interprofessional communications o Hierarchies and imbalances of power can also affect that  Communication Styles o HCPs have their own culture and communication style  May not align with other HCPs  Ex. Nurses are taught to be descriptive but physicians are thought to be efficient and more concise Harassment and Bullying  Repetitive actions that harm or humiliate another person o Can include one-time incidents of unwanted verbal and physical behavior  Usually occur in the context of real or perceived power imbalance  May occur between nurses as forms of horizontal violence  Most take the form of verbal harassment, bullying and aggression  Bullying can be overt and covert  Can be caused by interprofessional conflicts or personal issues  You have the right to a workplace that is free from any form of harassment When You Observe Bullying/Harassment  If another HCP is being harassed, step in and support them  Have a discussion with the bully if you feel safe and comfortable o Avoid confrontational dialogue o Engage in an inquisitive discussion  If harassment continues, report and document the incident to manager and the Human Resources department  o If manager is the one harassing, Human Resources department should be your main point of contact If you’re the one being harassed  Recognize that it is not your fault and you don’t deserve this  Speak with whoever you feel most comfortable talking to o Better to do it with a trusted individual within school or university so the can provide appropriate support  As a ryerson student, contact Office of Discrimination and Harrasment Prevention Services, or the Office of Sexual Violence Support and Education SBAR/ISBAR  Common communication tool that can facilitate effective verbal communication when communicating with another healthcare professional about a client or during a handover  Provides framework so communication is focused, concise, and complete  First introduced by the military in the US  I - Introduction o Hello, I am calling about Zina Mills, a 45-year-old female client on 3C. I am Aria Moteghaed, a registered nurse on the unit  S - Situation o The client is experiencing shortness of breath with a productive cough, and green mucus times three days. Currently, she has moderate crackles throughout the left lobe. 02 sat is 90%, respiratory rate is 26, temp is 38.3, pulse 98, blood pressure 134/88, and she is on 4 liters oxygen via nasal prongs  B - Background o The client has been in this facility for 4 days following hip surgery. Her incisions show no signs of infection. However, her mobility has been limited due to moderate dementia. She has a history of hypertension, no previous lung disease, and is a non-smoker  A - Assessment o Based on my assessment, her symptoms may be associated with pneumonia  R - Recommendation o Would you like a chest x-ray done? And when do you have time to see the client?