NUR1 222 Strengths-Based Nursing & Professional Practice PDF

NUR1 222 Strengths-Based Nursing & Professional Practice Prof. Maria Di Feo November 16, 2023 Quiz #5 Why is it important for a nursing student/nurse to be aware of a patient's strengths (capacities/resources/qualities)? To help individuals/families use their strengths to help them cope with life...

NUR1 222 Strengths-Based Nursing & Professional Practice Prof. Maria Di Feo November 16, 2023 Quiz #5 Why is it important for a nursing student/nurse to be aware of a patient's strengths (capacities/resources/qualities)? To help individuals/families use their strengths to help them cope with life challenges, promote healing, achieve their goals and get the most out of living (develop and grow). Nurses need to know what the individual’s and family’s strength are to be able to support them during health and illness, and in times of suffering, recovery and healing. Identify the Person and Family’s Strengths Working with Strengths Determine which strengths could be helpful in the situation; to help person/family meet their goal. Identifying Strengths We all face challenges/struggles in life.. part of the human experience Can you tell me about a challenging situation that you have faced in the past and tell me what/who helped you get through it? When faced with challenges what/who helps you cope? Working with Strengths Nurse assesses which strengths are available and which strengths can be developed. Nurses consider three sources of strengths: Existing strengths. Potential strengths (can be developed into a strength). “Capacity to be, to do..” Deficits that can be turned into strengths. Any chance that this “deficit” can be turned into a strength? Turning a Potential Strength into a Strength • In a family of five children, one teenage son shows an interest/curiosity (strength) in helping his father learn how to perform peritoneal dialysis at home. After being trained by the nurse, and having opportunities to practice the medical procedures, the son becomes very good at assisting his father perform home dialysis. The teenage son now sees himself as an important caregiver to his father and an invaluable resource (strength) to the family. Deficits That Can be Turned into Strengths • Nurse needs to understand why deficit exists to turn it into a strength. Explore • Reframe behavior (see behavior in a new light). • Help person gain insight into behavior (deficit). Example: An angry mother intimidating healthcare staff to get “the best care” for her son. • “How do you feel about what happened?” • “Do you think you were successful in getting what you wanted?” • “How could you have done it differently?” • Caring, advocating – strength SBNH - Retraining the Eight Senses for Nursing Practice SBNH - Nursing’s Professional Gaze Outline Quiz A person does not just become a nurse by acquiring a set of skills….. Becoming a nurse requires a new way of being…. Educating Nurses Benner et al. (2010) Important impact on Nursing Education. The book focuses on how to prepare student nurses to become caring, competent and ethical nurses. Nursing requires expertise within the context of a nurse- patient relationship Educating Nurses Benner et al. (2010) Need to acquire/develop and demonstrate • A broad knowledge base in nursing science that draws knowledge from health sciences, social sciences, humanities.. • Skills (technical, communication…) • Clinical Reasoning Skills • Ethical Comportment Benner et al. (2010) Integrating “nurse” into your identity In the process of becoming a nurse, one must learn new roles, assume new responsibilities, and revise one’s own identity so that it includes “nurse” (Benner, 2011). A New Approach to Nursing Education Benner et al. (2010) Experiential learning: learning that is gained while nursing (in clinical settings) • Combines theory & practice • Clinical instructor/preceptor provides students with learning opportunities Situated learning: learning that is gained in a specific context & with a specific patient • Being aware of the context/uniqueness of the person and situation • Clinical Instructor/preceptor coaches students (points things out, asks questions, encourages reflection….) Nursing is Situational and Contextual Need to consider the uniqueness of person/situation and the context Benner et al. (2010) Formation • Term used to describe the learning and educational experiences involved in learning to nurse • Involves training and retraining the senses as well as reforming social engagement and social involvement skills • Clinical conversation vs Social Conversations • Develops over time- learning, experience… Student nurse build on existing knowledge, skills, strengths… • Have life experience, knowledge, skills, strengths… • Professional learning • Involves retraining and re-forming that builds on the person’s existing knowledge, skills, capabilities, strengths… that will be used in a new context (health care) and for a new purpose (caring for people & families) • Retraining of sensory system Nurses need to develop the ability to “grasp” situations for effective clinical reasoning. Grasp - Understanding the nature/meaning of the situation you are observing Professional Learning Nurses need to have excellent observational skills Through • Observation • Attunement to sounds, smells, touch, observations … • Listening to patients and families • Discriminating and identifying salience (importance) from observations Attunement involves… • Paying attention to another’s needs • Paying attention to cues • Noticing and identifying what information is important, what needs immediate attention, and being able to respond accordingly • Making a connection with the person • Taking in information, appraising it, and interpreting it • Being open to, sensing, and monitoring one’s own internal state and bodily sensations Five “Outer” Senses (Perceive outside world) Noun: Five traditional senses; sight, hearing, smell, taste, and touch Verb: Perceiving something, become aware of something, and recognizing something Senses assist us in knowing and understanding our environment & knowing and understanding ourselves. Three Additional Senses for Nursing Daniel Siegel (2007) Book that Dr. Gottlieb draws on in SBN book Eight Senses for Nursing Practice Auditory System: hearing & sound Olfactory System: smells and odors Somatosensory System: touch Three “Inner” Senses Visual System: sight and images Awareness of Internal Bodily Sensations (What is happening inside us) Awareness of an Awareness (One’s feelings & thoughts) Relational Sensing (Effect of environment on us) Gustatory System: taste & flavors Nurses make sense of the information obtained through their senses and they base their clinical decisions on their understanding of the situation. Auditory System: Hearing & Sound Crying Yelling Moaning Equipment Beeping Auditory System: Hearing & Sound Somatosensory System: Touch Visual System: Sight and Images Visual System: Sight and Images Urine Stool Breath Wound Discharge Vaginal Discharge Olfactory System: Smells and Odors Awareness of Internal Bodily Sensations (Siegel, D. 2007) • Sensations in our limbs, our body’s motion, the tension or relaxation of our muscles, the state of our internal milieu, including our organs such as the lungs, heart, and intestines. Giving attention to and reflecting on our physical sensations/reactions (self- awareness) Awareness of an Awareness (Siegel, D. 2007) • Aspects of mind—thoughts, feelings, intentions, attitudes, concepts, images, beliefs, hopes, dreams—of oneself or others to be brought into the focus of attention. Giving attention to and reflecting on our thoughts, feelings… (self- awareness) Relational Sensing (Siegel, D. 2007) • Represents our sense of relationship, our connection, with some being. • Perceiving non -verbal emotional signals Giving attention to and reflecting on how we are relating with others, connecting with others, ability to from relationships with others. (self- awareness) Retraining the Eight Senses • Building on existing knowledge and skills and using sensory system in a new way/new purpose. • Using your eight senses to understand the patient and his clinical situation. • Learning to interpret information gathered through your eight senses using a Nursing lens & SBN lens. • Need to be a sharp observer as well as to be aware of your internal bodily sensations; be aware of your thoughts and feelings and how you are connecting/not connecting with patients, families and other health care workers. How would you be feeling? What would you be thinking? What would you be looking for? How would your understanding of the situation be different? How would what you observed be different? Imagine entering room · Prior to being a nursing student · Present time (nursing student 3 months) · End of third year ISoN Nursing Process & Eight Senses Outcomes & Follow UP Assessment Interventions Nursing Analysis Information gathered from the Eight Senses 34 Eight Senses Through your experiences and interactions in the clinical setting you will learn how to use your eight senses in an effective way. You will learn what to observe for, what to attend to, how to organize the information gathered to arrive at clinical decisions and take action. • Nursing students learn to select sensory inputs that are salient (important) in a particular context and interpret (make sense of) the sensory information. Training & Retraining Senses • Reflecting on what your learnt & discussing what you learnt with others will help you learn and retrain your senses. • Teachers, clinical instructors/preceptors/other nurses will assist you in your learning.. Retraining senses.. What we look for changes as we gain experience A patient is experiencing tachycardia.. Nurse explores different causes that could be causing tachycardia. Discovers that tachycardia started after pt started medication X. Verifies medication in CPS discovers that tachycardia is a possible side effect of medication X. • Next time nurse has a patient on medication X she will…. Retraining senses.. What we look for changes as we gain experience An adolescent diagnosed with schizophrenia is taking an anti psychotic medication. The nurse observes that adolescent is limping while walking to his room. Nurse follows patient to his room. Adolescent describes feeling muscle cramps and stiffness in his leg. Nurse notifies psychiatrist, psychiatrist examines adolescent. Suspects patient is experiencing dystonia from antipsychotic medication. Medication administered and symptoms resolve. • Next time nurse observes a patient on antipsychotic experiencing similar symptoms ….. Retraining senses.. What we look for changes as we gain experience • An adolescent is admitted to a psychiatry in patient unit and the nurse notices that the areas behind the adolescent’s ear are red. She doesn't believe it is a salient observation. The next day she returns to work and discovers that the patient has a severe case of head lice. The redness was a reaction to the lice bites… • Changes in practice? Training and Retraining Your Senses Differs depending on your practice domain • All nurses need to develop their senses for practice in the basic clinical domains of nursing practice (e.g. providing comfort, safeguarding and ensuring patient safety, alleviate suffering, managing symptoms, etc) • Specialized knowledge and skills must be developed depending on the domain of practice, e.g., Acute and Critical Care, Neonatal Nursing, Operating Room Nursing, Community Health Nursing, etc. (Retraining senses) (Benner in Gottlieb, 2013, p. 175-177) Experiences that Help to Re-train the Senses • Exposure to novel experiences • Benefiting (Learning) from mistakes and obstacles • Practice and experience Gottlieb, 2013, p. 189-201 Exposure to Novel Experiences • Take time to reflect on what is new and novel • What did I already know? • What was new? • What surprised me? • Had I ever seen, heard, smelled or felt anything like this before? • Write down your observations – causes you to slow down, process and review information, reflect on what’s been learned, and may lead to an awareness of new details. • Share observations with others – their comments and questions are a source of feedback, which leads to reflection. • Identify, what, if anything “feels” familiar, and build on that knowledge. Gottlieb, 2013, p. 189-201 Benefitting (Learning) from Mistakes and Obstacles • Historically, and sometimes culturally, mistakes were sources of shame. They can threaten our sense of self. • Today, there’s a growing trend to try and learn from mistakes. • Each mistake, is an opportunity to learn! • Mistakes can result in new skills and insights, because they force you to slow down, think, focus and correct a mental process. • Seek feedback. Timing and tone will impact its effectiveness. • Face mistakes, don’t avoid them. • Work to reflect on mistakes and try to understand what happened and what factors contributed to the mistake. Gottlieb, 2013, p. 189-201 You will be retraining your senses throughout your nursing studies and you will continue to retrain your senses when you are practicing nurses. Diverse experiences, practice and reflection foster the retraining of your senses and assist you in being effective clinicians. Developing a Professional Nursing Gaze Engaged and sharp observer Clinical Judgment and Decision Making Nursing Actions Quality care begins with accurate and detailed observations References • Benner, P. (2010). Educating nurses : A call for radical transformation (1st ed., The jossey-bass higher and adult education series). San Francisco: Jossey-Bass. • Siegel, D. J. (2007). The mindful brain: Reflection and attunement in the cultivation of well-being. WW Norton & Company. • Siegel, D. J. (2010). Mindsight: The new science of personal transformation. Bantam.