Harding University Professional Nursing Therapeutic Communication PDF

NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication Professionalism: Therapeutic Communication Harding University - Active Learning Guide, Module 1 Name: Sean Whitfield Instructions Complete the module active learning guide as you work through the module content. Take notes,...

NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication Professionalism: Therapeutic Communication Harding University - Active Learning Guide, Module 1 Name: Sean Whitfield Instructions Complete the module active learning guide as you work through the module content. Take notes, answer the questions on the guide, and respond to any case studies and client scenarios. All of these activities will assist in your preparation for exams, help you plan and implement care in the clinical setting, and facilitate your development as a Christian nurse servant. You will submit your completed guide to the instructor at the end of the week. The completed learning guide will be worth a maximum of 10 points. If you have questions or are unsure about your answers you may email your instructor for clarification. Note: The Active Learning Guide provides a general outline of topics covered in this module; it is not all-inclusive of all information needed for the exam. You are responsible for all content in readings and activities throughout the module. I. Professionalism: Chapter 1: Historical and Contemporary Nursing Practice 1. a. What/Who is a professional nurse? What image comes to your mind? p. 10-11 A professional nurse has graduated from an accredited nursing program that satisfies the requirement for a BSN, LPN, and MECP. The graduate would also have passed the NCLEX exam and satisfied other requirements for that particular state and discipline. The image of nursing has ranged from the heroines that showed bravery in WWII, to the tyrannical, cold and heartless character of Nurse Ratched, from the movie One Flew Over the Cuckoo’s Nest. b. Look in your textbook at Evidence-Based Practice Box, p. 3, “What Motivates Men to Choose Nursing?” What are your thoughts regarding strategies to recruit more males into professional nursing? First Theme → Early discovery of nursing and other professions have been found to influence men to decide on the nursing profession. Men being encouraged by family and friends, that were nurses to join the nursing field. Men fulfilling nursing duties while taking care of a dying or sick family member or friend. Second Theme → Men make the decision to become nurses due to certain conditions that compel the decision to be made. Third Theme → Outside forces as in job opportunity, salary and benefits. NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication Fourth Theme → Motivation from within, job satisfaction, joy from helping others. Altruism. 2. What is meant by the phrase Christian Nurse? p. 4. The religious values of self denial, spiritual calling, commitment to hard work and duty are the bedrock of nursing. The parable of the Good Samaritan, the value of love thy neighbor as thyself, drove several wealthy women of the Roman Empire from the third and fourth centuries to use their wealth to open houses to care for the sick, poor and homeless after converting to Christianity. The Knights of Saint John of Jerusalem (Knights Hospitalers), The Knights of Saint Lazarus and The Teutonic Knights all formed during The Crusades. These orders of Knights cared for the sick and injured fellow knights. These groups set the standard for organization, governance and administration of hospitals built all over Europe during the time. The Knights of Saint Lazarus devoted their time to people that suffered from chronic skin conditions, leprosy and syphilis. What is the distinction between a Christian nurse and a professional nurse? Why do you want to become a nurse? I am a person that likes learn new things and help people when possible. I volunteer at a food bank and a second hand store, loading and unloading donated merchandise. The field of nursing holds both of those opportunities and encourages them both. Why did you choose Harding, a faith-based college of nursing? I received both my undergrad and masters degrees from faith based institutions. Earned my undergrad from John Brown in Siloam Springs, AR and masters degree from Liberty University in Lynchburg, VA. The undergrad was also an accelerated program. The high NCLEX pass rate also was a contributing factor for applying to Harding. 3. Nursing’s Background Why is Florence Nightingale credited with improving/elevating the status of nursing? Florence Nightingale was focused on improving the image and respectability of the profession. She took up the task of improving hospitals and assessing, implementing and evaluating public health policies. Why is she considered the first nurse researcher? Florence Nightingale was able to reduce deaths during the Crimean War by implementing new interventions that benefited the wounded soldiers. Her focus on hand washing, assisted and supported stopping the spread of germs and disease, also improving conditions and better patient outcomes. What was the focus of her theory of nursing? Florence Nightingale focused on holistic, individual and personalized patient care. For the following nursing leaders, what is one of their key contributions to the nursing profession? NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication          Barton – Established the American Red Cross. Volunteered as a nurse in the Civil War. Spoke with Congress to have the Treaty of Geneva ratified in 1882 to allow the American Red Cross permission to work during peace time. Richards - First trained nurse in America. Introduced the concept of doctor’s orders and nursing notes. Mahoney - First African American professionally trained nurse. Worked to increase opportunities for black nurses. Wald – Brought trained nursing services to the slums in New York to improve public health and provide social services. Dock – Women’s rights activist that protested for the 1920s passage of the 19th amendment that granted women the right to vote. Helped found the American Society of Superintendents of Training Schools for Nurses of the US. Sanger – Founder or Planned Parenthood. Jailed for opening first birth control information center in America. Focusing on unwanted pregnancies in working poor demographic. My opinion, possible eugenicists. Breckinridge – Founded Frontier Nursing Services to offer healthcare to rural populations in America. Founded a training school for midwifes. Christman – A contributing founder of AAMN. Graduated from Penn Hospital School of Nursing for Men. Went through gender discrimination. First male dean of students at Vanderbilt nursing school. In the AAN Hall of Fame. Johnson – Considered nursing as a science discipline and a art form. Created and implemented the Behavior Systems Model for nursing. 4. Education Programs a. What are the differences in the 3 educational pathways to becoming a registered nurse?  ADN → Two year associates program.  Diploma → Three year program  BSN → Four year program Differentiation can include type of job (BSN direct into administration), varied pay structure, varied responsibilities and varied time frames for completion. b. What do all 3 in the list above have in common? All three completed programs and passed state requirements provide an opportunity for nurses to practice. And depending on licensure, opportunities to continue education and become an advanced practice nurse are available. NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication c. List and describe the 4 advanced practice roles in nursing. See also Box 1.1 p. 18 1) Certified Nurse Practitioner → Independent care provider for multiple settings and 6 specific patient communities: Psychiatric, Adult Gerontology, Women’s health and gender related health, pediatrics, neonatal. 2) Clinical Nurse Specialist → Specific area of practice with defined limitations for example medical specialty or type of disease. 3) Certified Registered Nurse Anesthetist (CRNA) → Anesthesia provider for medical procedures and deliver pre/post anesthesia support for patients over the lifespan. This type of support can be administered at hospitals and surgical sites. 4) Certified Nurse Midwife (CNM). d. What is certification? Official document or proclamation of education, experience, skills of a professional nurse. Continuing education? Training that is job specific, shorter and intentionally designed to elevate and enhance skill and knowledge of practicing nurses. In-service education? Specifically designed education that is given by an employer. A particular type of CE. 5. List the concepts common to most definitions/theories of nursing. p. 14 Nursing is the following: caring, an art, client centered, a science, adaptive, holistic, health promoting, maintaining health, and restoring health. 6. What is meant by theorists when they refer to nursing as both an art and a science? p.14 The science, nursing is the combination of pharmacology, biology and medical knowledge. The art, is the compassion, caring and love that is given to a stranger in a vulnerable position. 7. Discus the broad aims of nursing. pp. 16-17 Nursing is to protect the public’s health. 8. Briefly discuss the various roles of a nurse. pp. 17-18 Teacher, advocate, communicator, caregiver, change agent, case manager (assist with behavioral modification), research consumer, leader and manager. 9. What are the criteria of a profession? p. 19 Specific education or training, ongoing research, body of knowledge, code of ethics, autonomy and professional organization. NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication What does autonomy mean concerning a profession? A body of membership that has legal authority to do the following; a profession that self-regulates, creates, enforces and sets standards for its members. In chapter 2 pp. 27-28 What is evidence-based practice? Quality, holistic care that is created and based on the most up to date research rather than previously conceived traditional methodology, advice from others or personal biases and beliefs. What are the 7 steps listed? Grow a spirit of inquiry, Ask questions that are clinical in nature, Search for the best most accurate evidence, Be critical when appraising the evidence, Integrate and combine the evidence with clinical expert contributions along with family preferences and values, Evaluate the outcomes of the interventions implemented, Share the outcomes. Disseminate the results with peers. 10.Professional Identity Why is a personal philosophy of nursing important? A personal philosophy can shape and mold you into the type of nurse you become. 11.Professional Nursing Organizations pp. 23-24 Table 1.1 Briefly note each one’s purpose/function. ANA (Review the ANA Code of Ethics: www.nursingworld.org) How are these applicable in the client care setting? Build and create an atmosphere of nursing standards in practice and to push the advancement educationally and professionally of nurses to promote better outcomes for patients. NLN → Encourage the increased development and improvement of the total nursing services and education that are provided. ICN → It’s members work together toward the representation of nurses worldwide to promote and improve the profession and affect nursing policy. NSNA → Inform nursing students to issues that are affecting the nursing profession, while also promoting leadership. International Honor Society → Membership is granted via academic achievement over social. Sigma Theta Tau or (love, courage and honor). CCNE → Validation and accreditation for nursing school programs. NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication QSEN → Devoted to improving the quality of nursing student knowledge, skills and attitudes to benefit the quality of care and safety of the healthcare system. Nursing Specialty Organizations → Devoted to promoting safety, health and wellness to nurses in the workplace. State Board of Nursing (One in each state) → The governing body responsible for licensing and regulation that creates and enforces standards for safe care. This body also determines the scope of practice for nurses within it’s state and jurisdiction. The governing body also issues licenses to candidates, and is responsible for discipline regarding nursing practice violations. 12.NSNA Code of Academic and Clinical Conduct p. 20 Box 1.3 Why is this important to you as a student? This code of conduct allows us as students to enter and participate in nursing duties under the supervision and license of a nurse. There are eighteen principles and guidelines to follow during clinical hours. As nurses we are held to a higher standard and these codes of conduct are available as guides. 13.Standards of Professional Performance Standards of Practice: Importance to Clients? To Nurses? Standards of care are there to define the diagnostic, intervention and evaluation of nursing competencies. Benefits clients to have knowledge that the nursing care will be professional and consistent due to their vulnerability. 14.Nurse Practice Act p. 16 Fill in the following information: Developed by whom? Each states legislature. Purpose? Protect the public health Look at your state’s Nurse Practice Act. What are the educational requirements to apply for licensure as an RN in your selected state? RN’s → Required to have at least an ADN, or bachelor’s degree for BSN degree. How many CEs does your state require for license renewal as an RN? www.ncsbn.org (find the link for your state’s state board of nursing website. CE’s → LPN’s, RN’s are expected and required to obtain 15 contact hours in each area of nursing practice every two years. NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication 15.Review the HCCN’s Philosophy of Nursing and Mission Statement in the HCCN Undergraduate Student Handbook located on the canvas course site. What is the HCCN’s Mission Statement? “Developing Nurses as Christian Servants” What does the phrase “Christian Nurse Servant” mean to you? The ability of a nurse to center their faith and honoring Christ while serving and encouraging others to thrive. Consider this: Professionalism is all-encompassing, influencing our actions with:     Other health team members Other disciplines Clients and families The public We are role models. As Christian servants we must do our best in whatever we do, allowing the Lord to use us as He desires in ministering to those who are hurting, vulnerable, and forgotten. II. Therapeutic Communication: Chapter 16: Communicating 1. James 3: 1-12 has a lot to say regarding what we say. James says the tongue can be used both as a blessing and as a curse. How is the tongue like a fire? Do you believe words can hurt? If so, how does this apply to us as healthcare professionals? The tongue is like a fire due to the ability of person to tear someone down by being critical in a way that is not constructive. As a healthcare professional we are dealing with patients and their family members at a vulnerable time. If we do not cultivate and prune our presentation and what we say, anyone of those stakeholders can misinterpret and not be able to receive the message. This misinterpretation has the possibility to impact patient outcomes. 2. Please review the following sections in the HCCN Undergraduate Student Handbook regarding professional communication: ANA Code of Conduct, Professional Boundaries, Social Media, Lines of Communication, including student-to student and student-to-faculty. 3. What is meant by the phrase Therapeutic Communication? p.278 Therapeutic communication increases understanding and helps to build a trusting relationship between nurse and patient. Why is this important to the nurse-client relationship? Therapeutic communication is patient and goal focused. Can a nurse be a client advocate in the absence of a therapeutic relationship? NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication To effectively be a patient/client advocate, I believe a trusting relationship needs to be established to have an understanding of the patients needs and wanted outcomes. 4. What are the factors that can influence verbal communication? And nonverbal communication? pp.271-272 The type of vocabulary and tone used to convey a message can impact how a message is received. Non-verbal communication is not necessarily as controlled as verbal communication. Non-verbal communication can impact if a person is as believable as they want to be. What is the relationship between verbal and non-verbal communication? Verbal and non-verbal communication, literally go hand in hand. The type of posture, hand movements and stance can greatly impact how a person or crowd receives a message. Why is the non-verbal element of a message often more “believable” than the verbal element of that same message? Non-verbal elements are representation of how one actually feels about a subject. It could be a simple facial grimace, eye-roll or a welcoming smile that reaches the eyes. 5. How can the nurse’s posture convey interest in the client? Directing and point their body toward the patient/client, including feet. Maintaining eye contact with a “proud” chest and shoulders that are not rounded, but pulled back. All they aspects represent a healthy individual that is capable and willing to help them. 6. List factors which influence the communication process. p. 275-277 Gender → Women use language to seek confirmation and establish intimacy. Men use language to build independence and negotiate hierarchy inside of a group. Both genders receive and interpret information in different ways. Development → Intellectual development, language and psychosocial over the lifespan can have an impact on how effectively the nurse will communicate. Values and Perceptions → Values are the guidelines that can influence an individuals behavior and perceptions are the specific pov of an individual. Territoriality → An idea that space and things that are considered by an individual belong to self. Nurses need to be aware of this when removing furniture or rearranging a room. Roles and Relationships → Understanding the role of family members will assist with the vocabulary used, sentence structure and tone of voice. Environment → Communication is best in a comfortable environment. Temperature, nose color and ventilation of the space is important. Congruence → This will help to prevent miscommunication with style of language and vocabulary compatibility of nurse and client. Interpersonal Attitudes → Attitudes pass on beliefs, feelings and thoughts. NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication Boundaries → Professional boundaries for nurses are important and critical in the context of nurse/client relationship. Clear boundaries need to be maintained. The nurse keeps the focus on the patient and does not share personal information or meeting needs from nurse/client interaction or relationship. 7. Personal Space: List and describe the 4 distance designations. pp. 275-276 Intimate: 0 to 1½ feet Personal: 1½ to 4 feet Social: 4 to 12 feet Public: 12 feet and over 8. Why is ‘elderspeak’ not an effective speech style? Elder speak too similar to baby speak, that can convey the message of dependence, incompetence and can be seen as patronizing by the older client. 9. Therapeutic Communication Examples: Providing general leads, using silence, being tentative and specific, using open ended questions, the use of touch, restating or rephrasing for clarification. 10.Describe Attentive Listening p. 278 Listening with mindfulness, using all the senses and paying attention to what the client and stakeholders may say or do. The complete opposite of passive listening. 11.Box 16.1 Therapeutic Communication Techniques: Review the techniques and examples p 270 NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication 12.Box 16.2 Barriers to Communication: Review techniques and examples p 270. 13.Communication and the Nursing Process: Clients with severe hearing impairments – how can the nurse better communicate? The nurse can gain attention with hand gestures. Speak directly to the client to assist with lip reading. Clients with cognitive impairments – how to communicate? P 284 NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication The nurse can use large, clearly written words to try and establish communication and build trust with the client. 14. Lifespan Considerations: Communication with Older Adults p. 284 alidate that assistive devices, glasses, and hearing aids are used and are in good working order and have power. Only use referrals to valid resources, such as speech therapy. Only use communication aids, such as communication boards, computers, or pictures, when possible and needed. Decrease the environmental distractions. Use short, simple sentences, only one subject or thing, at a time—reinforce or repeat what is said when needed. Face the client when speaking—coming up behind someone may be frightening. Include family and friends and other stake holders during conversation. The use of reminiscing, with individual conversations or in groups, can maintain memory connections and to enhance self-identity and self-esteem in the older adult. When verbal expression and nonverbal expression do not match, believe the nonverbal. Clarification of this and attentiveness to client feelings will help promote a feeling of caring and acceptance. Research what has been important and is meaningful to the client. Try to maintain and care for these things as much as possible. The small simple things to us, such as bedtime rituals become very important while clients are admitted into a hospital or long term care setting. 15.Table 16.3 Sample Process Recording p.286-287 Review; What is the purpose of a Process Recording? It is a verbatim account of a conversation between a nurse/client that has been taped or written that includes all of the non-verbal/verbal interactions between the client/nurse. 16.Communication Among Health Professionals: Disruptive Behaviors: Incivility and Bullying; Describe p 288 NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication Incivility → The disrespectful behaviors that are rude, promote conflict and increase stress. Bullying → The repeated, mistreatment resulting in health harming from one person or group to another person or group. Evidence-Based Practice: What are the Experiences of Bullying Encountered by Nursing Students in the Clinical Setting? Nursing students during clinical hours can be “pimped” or asked quiz like question by the nurse they are paired with, to put them on the spot to see if they are prepared and know nursing concepts and processes. These types of encounters may occur in front of a client/patient or other stakeholders, when they should not. What are some strategies you think might help prevent bullying of students in the clinical setting? Constructive criticism and constructive instruction can be a strategy to help prevent bullying. The nurse holding the hand of a student nurse to help guide a catheter placement and install can be very helpful in understanding and learning that task. 17. Critical Thinking Checkpoint p. 291 Read the scenario and respond to the questions. -Interpret Mrs. Manasovitz’s nonverbal behavior in response to the news about her husband’s surgery. Mrs. Manasovitz’s is in shock and is worried about he husband outcome. -Evaluate the nurse’s response toward Mrs. Manasovitz based on the concepts of caring and comforting. The nurse showed care through verbal and non verbal communication to inform the clients wife that the nurse is there to comfort her during this vulnerable time. The nurse also got her a beverage to help comfort. -Why is it important for the nurse to effectively communicate with Mrs. Manasovitz at this time? Mrs. Manasovitz is experiencing a vulnerable time and is emotionally stretched. The nurse using effective communication can have a calming affect with her emotional state. As a stake holder Mrs. Manasovitz mind can be occupied and filled with distraction and worry. The nurse using effective communication can have a centering affect. -The nurse was described as listening attentively to Mrs. Manasovitz. Cite actions that portray attentive listening. Using the Sullivan nod while listening, pointing your body directly to the person talking and maintaining eye contact. NURS 3000 - Professional Nursing Professionalism: Therapeutic Communication III. Caring : Chapter 15 1. Watson’s Theory of Human Care Box 15.1 The Six Cs of Caring in Nursing: p. 260 List and describe each one Compassion → The awareness of one’s relationship to other people. Sharing sorrow, pain, joy and other accomplishments. Competence → Using knowledge, skills, energy, experience, and motivation needed to respond properly to the client’s demands and professional responsibilities. Confidence → Being comfortable with oneself, client, and others that promotes the building of trusting relationships. Conscience → Ethics, Morals a sense of right and wrong and having a recognition of personal responsibility. Commitment → Making the choice to act in congruence with one’s desires and obligations, resulting in an investment or buy in from self into a task or cause. Comportment → Acting appropriate with demeanor, dress, language that are congruent and in harmony with a caring presence. Presenting oneself as a person that respects others and demands respect. 2. Caring Encounters p. 261-262 a. Describe ways the nurse can demonstrate caring and compassion. Establishing a trusting relattionship, being attentive, compassionate, empowering the client and being able to perform and complete the duties and responsibilities of the job. b. What are some interpersonal communication techniques that can demonstrate caring to the client? Maintain eye contact when speaking with the client, using active listening techniques, appropriate non verbal communication and coping with worries. c. Describe a Biblical example of caring/compassion. God’s compassion conquers our sin. Micah 7:19 He will again have compassion on us, And will subdue our iniquities.