102 Final Flashcards
1
Q
Define and describe Partnership:
A
Reciprocal exchange btwn nurse and client.
Built through trust, respect and effective communication.
2
Q
Define Self-Concept:
A
- Organized NETWORK of ideas, feelings and actions.
- SUBJECTIVE sense of the self and a complex mixture of thoughts, attitudes and perceptions.
- Key to UNDERSTAND the behaviours of clients/ourself
3
Q
Characteristics and functions of self-concept:
A
- Dynamic: constantly changing
- Holistic: mind, body and spirit
- Unique: Physiological, personality, ethnicity, environment, social/cultural norms will all play a role
4
Q
Role of Self-awareness in relation to self-concept.
A
Self-Awareness: means by which a person gains an Understanding and Knowledge
Occurs through interpersonal communication
Evaluating self (Professional Self-Awareness) is key:
- Educational needs
- Accountability accepted for actions taken
- Assertive ability with colleagues
- Advocate for client
- Objectivity in client situations
5
Q
Physiological components of Emotions:
A
- HR Inc.
- BP Inc.
- Adrenaline secretion Inc.
- Blood Glucose Inc.
- Slowing of Digestion
- Dilation of pupils
- Blushing/Sweating
6
Q
Define Emotions:
A
Verbal/non-verbal EXPRESSIONS of SUBJECTIVE feelings.
7
Q
4 Types of emotions
A
- Positive: Happiness, Joy, Hope, Excitement
- Negative: Sadness, Fear, Grief, Guilt
- Primary: Sadness, Fear, Anxiety
* *deal with the primary** - Secondary: Anger, Frustration, Aggression, Irritability
* *caused by primary**
8
Q
Factors that influence emotional expression
A
- Culture
- Personal Characteristics
- Family
- Social roles
- Fear of Self-Disclosure
9
Q
Explain ways to improve effectiveness of emotional expression
A
- Acknowledge/Own the emotion
- Develop language to express emotions
- Seek to identify underlying feelings
- Use emotions constructively - productive action
- Differentiate between Feelings, Talking, Acting
10
Q
Importance of feedback
A
Corrective/Evaluative Information
Objective view on behaviour
Opportunity of Change/Growth
11
Q
Strategies for seeking, giving and receiving feedback
A
Gain permission Honesty Choose time and place offer suggestions Verbal behaviour = Non-Verbal behaviour Invite comments from receiver
Listen respectfully Avoid becoming defensive Clarify when you don't Understand Ask for guidance on future performance Demonstrate appreciation Integrate feedback
12
Q
Reason for Identifying your own values during communication
A
To make sure that a bias does not occur to cloud judgement/solution.
13
Q
3 Ways in which values are learned or acquired
A
- Inside of Family: Rituals, Direct, Indirect
a. Direct:
i. Moralizing: strict guidelines/rules
ii. Laissez-faire: no restrictions
b. Indirect:
i. Modelling: setting the example - Outside Of Family: Culture, religious beliefs, schools, peers, environment, community
- Individual Experience
14
Q
Personal vs Professional Values
A
Personal: Learned for experience, guide behaviour, individual beliefs about good vs bad
Professional: Shared by all members of a profession, standard for right vs wrong, based on society beliefs, ensures consistency, governs behaviour, protects nurses and patients.
15
Q
Define Ethics
A
Good Conduct, Character, and Motives
What is good/valuable for all people
DYNAMIC process of dialogue and action
16
Q
Types of values conflict in nursing
A
- Ethical Violation: Neglecting appropriate action
- Ethical Dilemma: Ethical reasons for and against a decision
- Ethical Distress: When nurses obligation cannot be fulfilled
- Moral Residue: Times when compromised from choices made previously
- Ethical Uncertainty: not sure which ethical practice to apply
17
Q
Define Nursing Informatics
A
The application of computer science and information science to nursing.
NI promotes the generation, management and processing of relevant data in order to use information and develop knowledge that supports nursing in all practice domains.
18
Q
Potential function of groups with which nurses may be involved.
A
Therapy
Support
Activity
Education
19
Q
5 Phases of group development
A
- Forming phase:
- Anxiety present
- Members seek acceptance
- Time and effort needed to develop trust
- Get to know each other OR Identification with others
- Commitment/Group-Contract - Storming phase:
- Members feel comfortable
- Transition stage
- Development of norms
- Leader: Models behaviour, focuses on positive, limits behaviour, accepts differences. - Norming phase:
- Feedback becomes more spontaneous
- Group standards emerge
- Individual goals become aligned with group
- Members share more leadership responsibilities - Performing phase:
- Most work occurs
- Cohesiveness increases
- Collective sharing
- Affirmation experienced - Adjourning phase:
- Termination
- Encouragement to express feelings re: contributions
- Leaders seek feedback/evaluation of group
- Confidentiality reminded
20
Q
Factors which may affect the effectiveness of a group
A
Vague Goals Guarded COMMUNICATION POWER struggles Decision making without, little or no CONSULTATION No Tolerance for Controversy Individual RESOURCES are not used Low MORAL ONE-SIDED focus on task or maintenance roles
21
Q
Task & Maintenance roles of group members
A
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
22
Q
Evaluate group process including the use of a sociogram.
A
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
23
Q
- Define Assertiveness:
2. 5 Characteristics of assertive communication strategies”
A
- Ability to communicate your preferences, ideas, and feelings in a manor that is clear and direct.
- Lets other people known who you are as a person and what is important to you.
- Openness
- Confidence
- Self-Awareness
- Respect for others
- Independence
24
Q
Assertive, non-assertive, and aggressive styles of communication
A
Assertive:
- Ability to communicate your preferences, ideas, and feelings in a manor that is clear and direct.
- Lets other people known who you are as a person and what is important to you.
- Allowing individuals to act in their own best interests without infringing on or denying the rights of others.
Non-Assertive:
- Inability to do above stated actions.
Aggressive:
- Strong opinions
- Express self at expense of others
- Overbearing
- Angry
- Put others down
25
Principle for increasing assertive communication
- Describe problem
- State how problem effects you
- Solution proposition
- Confirm understanding
- Observe & Analyze the message of others
- Analyze situation where you are assertive, non-assertive, aggressive.
- Reflect on your own assertiveness
26
Describe the behaviour of an assertive nurse.
- Recognizes that everyone communicates with different degrees of assertiveness
- Self-confident and composed
- Maintains eye-contact
- Clear & Concise Speech
- Genuine & non Sarcastic Speech
- Firm & Positive Speech
- Non-Apologetic
- Initiative taken to guide situations
- Message congruency Verbally & Non-Verbally
27
Relationship between assertiveness and caring
- Treat others fairly while taking care of your own needs
- People respect clear, open, honest communication
- Helps to facilitate a change in behaviour
28
Therapeutic vs Social Relationships
Therapeutic: "A therapeutic relationship is a professional alliance in which the nurse and the patient join together for a defined period of time to achieve health-realted treatment goals"
- Nurse takes Responsibility for relationship
- Focus on Patient Needs
- Has specific Purpose and Goal
- Entered out of necessity
- Terminates when goal is met
- Self-disclosure is Limited for Nurse, Encouraged for Patient
Social:
- Equal responsibility
- Needs should receive equal attention from both parties'
- May not have a specific goal
- Spontaneous
- Feelings of "likeness"
- can last a Lifetime or end abruptly
- Self-disclosure is Expected
29
Role of nurse in establishing Therapeutic relationship
- Self-Awareness: Limits, When to ask for help, How you word things.
- Professional Boundaries
- Level of involvement
- Therapeutic use of self (Healing presence, not "all up in their face")
- Empathy (Understanding what patient is telling you)
- Self-Disclosure Limited
- Empowerment
30
4 Phases of a Therapeutic relationship
1. Pre-Interaction: Before meeting Patient
- Data gathering
- Psychological and Physical 'stage' is set
- Timing chosen
- Self-awareness analyzed
2. Orientation: Meeting Patient
- Purpose clarified
- Needs assessed
- Goals defined
- Communication strategies
- Observation of patient
3. Working: Begins when Patient Engages in care plan
- Problem defined
- Timing / Pacing
- Realistic Goals developed
- Alternative Solutions planned
- Plan implemented
- Challenge resistant behaviour
4. Termination: Closing of relationship (Prep bagan in Orientation phase)
- Goals met
- Acknowledge the termination
- Asses emotions and understanding
- Review / Summarize
- Referral
31
Bridges and barriers to developing therapeutic relationships
Bridges:
- Respect
- Caring
- Empowerment
- Trust
- Empathy
- Mutuality
- Ethics
Barriers:
- Anxiety
- Stereotyping / Bias
- Over-involvement
- Disengagement
- Violation of space
- Culture / Language
- Fear
32
Acceptable boundaries of the therapeutic relationship
- Protect a clients Dignity, Autonomy, and Privacy
- Separate Professional and Non-Professional behaviours
- Allow nurses to practice ethically
- Prevent Misuse of Power
- Use Professional Judgement (when needed)
33
Define Communication
Complex INTERPERSONAL activity
Transmits messages from Source to Receiver
Composed of VERBAL and NON- VERBAL behaviours
INFLUENCES behaviour
SHARES information
34
Principles of communication
- Communicate with others
- Intended or Unintended
- Always sending messages
- Communication is IRREVERSIBLE and UNREPEATABLE
- Sent message isn't always the Received message
- More communication Isn't always Better
- Learned skill
35
Communication models
Linear Model: Sender, Message and Receiver
- Sender ENCODES and EXPRESSES message
- Receiver observes/hears/decodes message
- Message sen in ONE-direction
Limitations: Not all Conscious or flows in One Direction
```
Circular Transactional Model: Sender, Message, Receiver, Contact, Feedback, Validation
- CONTINUOUS Communication
- RELATIONSHIPS play a role
- Multiple factors affect message
- Communication influences BEHAVIOUR
Limitations:
- Environmental factors
- Physical (Noise), Physiological (Fatigue), Psychological (Emotions)
- Subjectivity & Complexity
```
36
Define Therapeutic Communication
"Purposeful form of communication that involves the Specialized Application of basic communication principles in order to promote patients' health and wellbeing"
Purpose:
- Provide New Information
- Correct Misinformation
- Promote understanding of health problems
- Explore options for care
- Assist in decision making
- Facilitate patient wellbeing
37
Describe the 'active' listening process
Active Listening: "Dynamic, interactive process that involves hearing and decoding messaged and providing feedback to convey understanding"
Involves: Receiving, Observing, Perceiving, & Interpreting
PROCESS:
Receiving Information:
- Decrease external / Internal Interferences (Quiet Room / Put aside Biases, Beliefs, & Values)
- use Attending behaviour (posture, eye-contact, direction, ect.)
Observing Information:
- Observe Non-Verbal cues of individual
- Indicate Acknowledgement
Perceiving Information:
- consider Context (who, what, when. where)
- identify underlying Feelings
Interpreting information:
- listen for Themes
- work towards Understanding
38
```
Describe Silence and its use in therapeutic communication.
What?
How Long?
When?
Who?
```
What: Powerful communication tool
How Long: 15sec MAX
When: After hard information, During decision process on what shall be said
Who: Knowing the context you are in and how they will perceive silence.
DONT be silent to:
- Avoid subject
- Reassuring someone
- Bringing up something awkward
39
Define Understanding in the context of nurse-patient relationships
"View of someone's world from their perspective"
Nurses: Understanding is tentative until validated or corrected. Always seek internal and external understanding.
Also plays a role in Trust formation
Internal: Subjective (What they tell you)
External: Objective (Things you observe)
40
Describe 5+5 ways of responding
1. Advising and Evaluating: Offering a solution, opinion or advice.
2. Analyzing and Interpreting: Reading info a patient's message to convey that the nurse knows what the patient feels or thinks.
3. Reassuring and Supporting: statements that attempt to remove a patient's doubts or fears.
4. Questioning and Probing: Gathering more information and exploring a situation.
5. Paraphrasing and Understanding: Rephrasing a patient's expressions into the nurse's own words to convey understanding and seek clarification.
41
Describe therapeutic responses of:
1. Paraphrasing
2. Clarification
3. Reflection of feelings
4. Touch
1. Paraphrasing: Restating a patient's primary words / thoughts in other words.
- Communicates understanding of patient's words
- Acknowledges what the patient has said
- Demonstrates Listening
- Build Trust
- Allows patient to correct nurse if paraphrasing is Incorrect
2. Clarification: Useful if message is UNCLEAR or not understood
- Nurse takes Responsibility for understanding
- Expressed as a Question for the patient to Rephrase
3. Reflection of feelings: Mirroring of feelings expressed by the Patient.
- Recognition of feeling
- Confirms the existence of EMOTIONS
- Identifies Destructive / Constructive emotions (Delay / Progress recovery)
4. Therapeutic Touch: FIRST biological experience of communication
- Powerful listening response: Allows for human CONNECTION
- Used when words may fail to convey DEPTH
- can Deepen the meaning of LANGUAGE
42
Specific communication strategies to use with older adults
Hearing Impaired:
- Find good ear
- Adjust hearing aids
- Normal voice
- address by Name, helps person focus
- Lower pitch
- Face person for expression
- Keep background noise to a minimum
- Obtain occasional Feedback
Vision Impaired:
- Eyeglasses are clean and in place
- Identify self by Name
- Stand in front and use hand movements
- Verbally express information
- Use appropriate Lighting
- Remove any Hazards, Lighting glares
- Use words to describe landmarks
43
Communication strategies for Exploring
Prompting: Encourages patient to elaborate on partially expressed ideas.
- Minimal prompt (nodding, "mhm")
- Accent (repeating key words/features in sentence)
- Open-ended Statement ("oh... I see you had a rough night, last night" (looking at chart))
Probing: Open-ended (Patient led convo.)
and Closed-ended (Interrogative = Fact, but no detail)
Cues / Inferences:
- Cues (Objective data): small amount of information represents larger issue.
- Inferences (Drawing conclusion based on cues): Putting all cues together. and making inference.
44
Compare Open and Closed-ended questions for the purposes of exploration
Open-ended: Good for starting conversation and giving choice to the client.
Can gain Comfort and Trust of client
Closed-ended: allow for more Specific answers. usually a "Yes" or "No" kind of question.
may feel like an interrogation.
45
Purposes & objectives of a nurse-patient interview
Interview: This is a Conversation with a PURPOSE
Purpose:
- Obtain HISTORY
- Identify NEEDS / Risk Factors
- Determine CHANGES in patient's wellness
Objecties:
- Initiate
- Obtain Information
- Observe / Assess
- Education / Evaluation
46
Sources of Nurses' images
- Nurses
- Media (movies, telivision, books, magazines)
- Nursing Education
- Personal contact with nurses
- Others' experiences
- External images - varies depending on purpose. eg. Recruitment vs Legislators
47
Historical image of the nurse
(1854-1919) Nightingale Times: Noble, Self-sacrificing, Altruistic, Religious
1900's - Public health nurse
(1900 - 1920) - Male nurses are accepted
(1920 - 1929) - Handmaiden, subservient, modest
(1930 - 1945) - Heroine
(1945 - 1965) Mother era - Nurturing, sympathetic, domestic
48
Factors which have influenced the image of the nurse today
Feminism - gender related
History
Physician/Nurse relationship (care vs. cure)
Hospital hierarchy
Socialization of women's roles - domestic, nurturing
Lack of knowledge re what nurses do
49
Describe how nurses are viewed today
(1960's - ) Sex objects - Sensual, romantic, frivolous, irresponsible
1980's - Careerists
50
Define Professional socialization
Educational process which prepares members of the general public to become nurses by assuming the knowledge, functions, skills and critical thinking abilities necessary to function as a nurse.
LIFELONG PROCESS
51
**Describe theories of socialization into nursing**
PROCESS of acquiring knowledge, skills, and attitudes
Davis' Model of Educational Socialization:
Stage 1 : Initial Innocence
Stage 2: Incongruities
Stage 3: Identify (observation and identification of given subject - what is it exactly that is done in the role)
Stage 4: Role Simulation (start to take on some of the characteristics and behaviours that are part of the role)
Stage 5: Vacillation (back-and-forth between thoughts of what you thought it was and what you see it as now)
Stage 6: Internalization (internalized/embodied values and acceptance of characteristics/skills/behaviours of role)
52
Professional identity of nurses
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
53
Strategies to change the nursing image
```
Grassroots
Organization
Education (We have our own nursing knowledge)
Collective Bargaining (unions)
Media
Recruitment
```
Word of Mouth
54
Professional caring Definition:
Professional caring is:
- Art of nursing
- Relational - Authentic
- For the benefit of the patient
- Expressed through Knowledge, Skills, Attitudes and Behaviours
- Organized around the Nursing Process
55
7 Key aspects of professional caring
1. Relationships
2. Commitments
3. Connectedness
4. Concern for / Valuing other
5. Belief in others and their abilities
6. Nurturing
7. Supportive
56
How caring is demonstrated in our 6 BEHAVIOURS & 6 PRACTICE of nursing
"Those assistive, enabling, supportive, or facilitative behaviours toward or fore another individual or group to promote health, prevent disease, facilitate healing.... to improve a human condition or lifeway, ameliorate suffering, or to face death"
Behaviours:
- Providing Presence
- Touch
- Listening
- Knowing the Person
- Spiritual Caring
- Family Care
Practice:
- Suspend role and status
- Speak and listen without judgement
- Listen with compassion without interrupting
- Recognize the caring relationship transcend the self
- Honour that we are each part of the journey
- Demonstrate professional competence
57
Barriers to caring
1. Organizational:
- Workplace Culture
- Structure & Function
- Efficiency & Effectiveness
- Reliance of Technology
2. Personal / Professional
- Burn-out
- Incongruence of Values of Self vs Organization
- Lack of time
- Stereotyping
58
Individual components of the UFV framework for caring and their relationship to the nursing process.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
59
Define nursing research, evidence-based (informed) practice and research utilization
x
60
Purpose and goals of nursing research and EBP
x
61
Identify sources of nursing knowledge
x
62
Qualitative vs Quantitative research
x
63
Roles of nurses in EBP and research
x
64
Barriers to utilization of EBP
x
65
Barriers to professional nursing image.
A negative image makes it difficult to recruit students into nursing.
Disparity among nurses. Eg. Education; Specialty Preparation; Unionism; Research to improve practice; Budget restraints.
Lack of knowledge of other medical professionals that are part of our multidisciplinary team.
Disparity in nurses education ---- Diploma vs Bachelor nurses.
66
Define Self-Esteem:
- How much one feels VALUED, IMPORTANT, SATISFIED
- Highest in Childhood and Adulthood
- Lowest in Adolescence and Old-Age
67
Functions of self-concept:
1. Explains behaviour (ours &others)
2. Provides a framework for decision making
3. Shapes expectations for the future
4. Provides bridges to meaning
68
Elements of self-concept:
```
Values
Social identity
Emotions
Perception
Cognitive decision making skills
Relationships
Achievements
Body Image & Illness
Role Performance
Personality Traits
```
69
Sources of Self concept:
1. Family
2. Peers
3. Society
70
Steps of Changing our Self-Concept
1. Commitment to change
2. Gain knowledge
3. Set realistic goals
4. Assess yourself fairly (Find Strengths/Weaknesses)
5. Seek supportive context
71
2 Types of Values:
1. Conceived values: conceptions of ideal, taught by ones culture.
eg. Taught verbally, Family, Social groups, Religion, Equality
2. Operative values: Used on a daily basis, to make choices about actions, examined and evaluated in terms of behaviour.
72
**8 KEY NURSING VALUES**
1. Safe, Competent, and Ethical care: Ability to provide care that allows to fulfil ethical and professional obligations to clients.
2. Health Promotion and Well-Being: Assisting persons to achieve their optimum level of health in normal health, illness, injury, disability or palliative.
3. Choice: Respect and Promote Autonomy of persons and help them to express their health needs/values and also obtain information and services so they can make Informed Choices.
4. Dignity: Recognize and Respect the inherent worth of each person and advocate for respectful treatment of all persons.
5. Confidentiality: Safeguard information unless consent is given, or you have a legal obligation to disclose (or else harm may come to patient).
6. Justice: Equity and Fairness to assist persons in receiving a share of health services and resources proportionate to their needs and in promoting social justice.
7. Accountability: Answering to practice. Act in manner that is consistent with professional responsibilities and standards of practice
8. Quality practice environments: Organizational structures and resources necessary are present to ensure safety, support and respect for all persons in the work setting.
73
Groups: Primary vs Secondary
```
Primary:
- Spontaneous Formation
- Membership (Natural, automatic, or freely chosen)
- Informal structure and social process
(family, religious group, hobby group)
```
Secondary:
- Artificially made
- Formally established to achieve agreed-upon goals
(Support group, work group, committee)
74
Why are Groups important in Health Care?
| 2+ reasons
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
75
Principles of Setting limits
1. Explain exactly which behaviour is inappropriate
2. Explain why it is inappropriate
3. Give reasonable choices & Consequences
4. Allow time
5. Enforce consequences
76
3 Types of Communication:
(7%) Verbal: Words you choose
- Brief, clear, timely, relevant, adaptable, credible, appropriate
(38%) Vocal: How you say
- Intonation, rate, pitch, volume
(55%) Non-Verbal: How you express it
- Physical appearance, posture, gait, body orientation, eye contact, facial expression, gestures
77
Nursing Process & Framework of Caring:
1. Assessment:
- Theory
- Helping process
- Personal Knowledge
2. Diagnosis:
- Critical thinking
- Theory
3. Goals:
- Helping Process
4. Interventions:
- Research
- Theory
- Resources
- Nursing Activities
- Standards
5. Evaluation:
- Theory
78
4 Caring Characteristics
Caring is:
1. Primary
2. Universal
3. Transformative
4. Nurturing
79
The 5 "C"s of Caring
1. Compassion (Empathy)
2. Competence (Knowledge/Education/Training)
3. Confidence (Confidentiality)
4. Conscience (Ethics)
5. Commitment (Decision/Responsibility/Accountability)
"6" Comportment (Demeanour)
