Exam 1 Flashcards
Benner and Colleagues
- Caring is the essence of professional nursing practice
- Caring- a word for being connected
- Caring facilitates ability to understand a client
- Caring facilitates individualized solutions to clients problems
Transcultural Perspective
- Madeleine Leininger (1978): Cultural aspects of caring
- Need for caring is universal
- E.g. some cultures prohibit some touching, etc.
Cultural Aspects of Caring: implications for practice
- Know clients cultural norms for caring practices
- Determine the need for gender-congruent caregivers
- Know clients cultural practices regarding end-of-life care
Transpersonal Caring
- Jean Watson
- High quality human interaction
- Promotes healing and wholeness
- Stress care over cure
- Caring is transformative
Swanson’s Five Processes of Caring
- Knowing (Avoiding assumptions about the life of the other person)
- Being with (being emotionally present)
- Doing for (physically completing tasks for a person that they would normally do for themselves if they were able)
- Enabling (facilitating the other persons passage through life transitions)
a. Offering info about procedures patient is unsure about
b. Help with decision making - Maintaining belief (sustaining faith in the other persons capacity to get through an event or transition; offering realistic optimism)
Roach’s Human Act of Caring: Five Concepts
• Compassion (being sensitive to the pain and suffering of another)
• competence(when you care about someone you show competence in everything you do, eg starting an IV and doing it right the first time so you don’t cause more pain)
• confidence(quality that forms a trusting relationship)
• conscience(state of moral awareness)
• commitment (commitment to nursing as a whole and to the patient)
(First Canadian code of ethics for Canadian nurses was developed based on these caring techniques)
Caring Behaviours
Providing Presence Touch Listening Spiritual Caring Family Care
Types of Touch
Caring touch (hold hand, back massage, etc. Task-oriented touch (skillful performance of a procedure) Protective touch (protects nurse, client, or both, e.g. preventing a fall)
Listening
Silence yourself.
Give your full attention to client.
Through active listening, you begin to truly know the client.
Spiritual caring
Nurse connects with the patient through
• Mobilizing hope
• Finding an understanding of illness that is acceptable to the patient
• Assisting the patient to access social, emotional, or spiritual resources
Family Care
- Family is an integral resource
- Caring for a client does not occur in isolation from family
- Family nursing
Challenges of Nursing
- Aging population
- Institutional demands
- Uncooperative patients
- Emotional connections with patients
- Cultural or language barriers
- Protective family members
Potential solutions to challenges of caring
- Canadian Nurses Association (CNA) is striving to promote healthy work environments
- Nurses must make caring a part of the philosophy in workplace
- Nurses need to be committed to caring.
Therapeutic Relationship
- Professional, interpersonal alliance in which the nurse and client join together for a defined period to achieve health-related treatment goals
- Goal: Promotion of client’s health and well being
- Interdependent relationship.
- Nurse, a professional helper
- Sees client as an individual with unique healthcare needs
- Characterized by the nurse’s non-judgmental acceptance
Phases of Interaction (4 goal directed phases)
1) Pre-interaction
2) Orientation
3) Working
4) Termination
Pre-interaction Phase
- Only phase in which the client does not directly participate
- Having an idea of potential client issues before meeting with the client is helpful
- The nurse identifies the most appropriate setting that will foster comfortable, private interaction with the client
Orientation Phase
• Nurse provides basic information to the client
o Name and professional status
o Purpose
o Time available for the relationship
• Nurse identifies the client’s goals (should directly revolve around the client’s needs and preferences)
Working Phase
- Nurse and client work together to actively problem solve and achieve health related goals
- Nurse uses therapeutic communication skills to facilitate successful interactions
- Nurse uses appropriate self-disclosure
Termination Phase
- Remind client that termination of relationship is near
- The nurse and the client evaluate the client’s responses to treatment
- To provide the client with even a hint that the relationship will continue is unfair
Components of client assessment
- Communication
- Cognitive
- Emotional/ behavioral
- Medical
- Functional assessment
Referent
something that motivates one person to communicate with the other (sigh, moan, sad face, etc)
Sender and receiver
one who encodes and one who decodes the message
Message
content of the communication
Channels
means of conveying and receiving messages
Feedback
message the receiver returns
Interpersonal variable
factors that influence communication
Environment
the setting for sender-receiver interactions
Levels of Communication
- Intrapersonal (inner thought) – to develop self-awareness and a positive self concept
- Interpersonal – (1:1 interaction)
- Transpersonal (within spiritual domain) – what is meaningful, important, significant to the person within a unique context
- Small group – share common purpose, goal directed
- Public (audience)
Empathy
Expressed when you seek to explore the perspective of another person
Self-concept
being aware of our own biases, personality, strengths and weaknesses in communication, etc (self reflect)
Concepts of Therapeutic Communication
Empathy, self-concept, caring
Suggestions for facilitating empathy
- Actively listen
- Do self-checks, often for stereotypes or judgments
- Ask for validation
- Give yourself time to think about what the client has said before responding or before asking the next question
- Mirror the clients level of energy and language
- Be authentic in your responses
Verbal communication
- Vocabulary e.g. jargon
- Denotative (definition) and connotative (meanings people associate with a word) meaning
- Pacing (speed) – speak slowly enough…
- Intonation – tone of voice can affect the meaning of a message
- Clarity and brevity (fewer words)
Non-verbal communication
- Personal appearance
- Posture
- Facial expressions
- Eye contact
- Gestures
- Sounds
- Personal space
- Touch
Proxemics
Intimate Zone, Personal Zone, Social Zone, Public Zone
Intimate Zone
o 2 fists away from your body
o people emotionally close to you are allowed to enter this zone (bathing etc are also allowed)
Personal Zone
o 1 handshake away
o the distance you would stand during friendly gatherings
Social Zone
o About 2 arm lengths away
o The distance you stand with people you don’t know well
Public Zone
o Over 3.6 m away
o Distance you feel comfortable when addressing a big group
Zones of Touch
- Social: hands, arms, shoulders, back (assess for permission)
- Consent: feet, mouth, wrists (consent needed)
- Vulnerable: face, front of body, neck (consent and special care)
- Intimate: genitalia, rectum (consent and great sensitivity)
Elements of professional communication
- Courtesy (knock, say good-bye- state purpose)
- Use of names (avoid “dear” and “honey”)
- Trustworthiness (follow through on promises)
- Autonomy
- Assertiveness
Therapeutic Communication Techniques
- Active listening
- Sharing observations
- Sharing empathy
- Sharing hope
- Sharing humor
- Sharing feelings
- Using touch
- Using silence
- Providing information
- Clarifying
- Focusing
- Paraphrasing
- Asking relevant questions
- Summarizing
- Self-disclosure
- Confrontation
Non-therapeutic responses
- False responses
- Sympathy
- Unwanted advice
- Biased questions
- Changes of subject
- Distractions
- Technical or overwhelming language
- Interrupting
- Asking personal questions
- Giving personal opinions
- Automatic responses
- Asking for explanations
- Approval or disapproval
- Defensive responses
- Passive or aggressive responses
Information-sharing interview
Used specifically to discuss clients perceptions about personal issues, health concerns, and coping strategies
Therapeutic Interview
Used specifically to discuss client’s perceptions
about: Personal issues, Health concerns, Coping strategies
Used to assist the client to gain problem solving
strategies
Types of questions-
• Closed-to get concise info
• Open- to get clients view
• Focused- to get clients perception
• Circular- to focus on interpersonal context
• Neutral- no pressure to answer a certain way
Elements of professional communication
- Courtesy (knock, say good-bye- state purpose)
- Use of names (avoid “dear” and “honey”)
- Trustworthiness (follow through on promises)
- Autonomy
- Assertiveness
Active Listening (SOLAR)
S = sit facing O = open posture L = lean forward A = appropriate and intermittent eye contact R = relax
Ten traps of interviewing
- Providing false assurance or reassurance
- Giving unwanted advice
- Using authority
- Using avoidance language (“passed on” instead of died)
- Engaging in distancing (lump in YOUR left breast, not THE left breast)
- Using professional jargon
- Using leading or biased questions
- Talking too much
- Interrupting
- Using “why” questions
Gordans functional health patterns purpose
To conduct a more comprehensive nursing assessment and understand the effects of health or illness on the client’s quality of life
General Survey
Take note of clients physical appearance, body structure, mobility, and behavior
Physical Appearance (General Survey)
Overall appearance, body type (thin, obese, muscular), hygiene, grooming, and dress
Body Structure (General Survey)
Height/weight, sexual development, body mass index (BMI), limitations, and waist circumference.
Mobility (General Survey)
Posture, gait, range of motion (ROM)
Behaviour (General Survey)
Signs of distress, facial expressions, affect (feelings as they appear to others), mood, level of consciousness (LOC), speech, note confusion, agitation, lethargy, and inattentiveness,
Assessing level of consciousness
•Tell me your full name. •Where are you now? •What is today’s date? •What time of day is it?
How much do words, voice cues, and body language each contribute to the meaning of a message?
Body- 55%
Words-7%
Voice cues-38%
Gordon’s Functional Health Patterns
- Health Perception/Health Management
- Nutrition
- Elimination
- Activity/mobility
- Cognitive/perceptual
- Sleep/rest
- Self-esteem/self-concept
- Interpersonal Relationships
- Sexual/Reproductive
- Coping/Stress
- Spiritual resources (values/beliefs)
Guidelines for documentation and reporting
Must be factual, accurate, complete, current, organized, and complies with standards
Long-term care charting
- Residents rather than clients
- Residents’ health is often stable - daily documentation completed on flow sheets
- Assessments performed several times a day in acute care settings are required only weekly or monthly in long-term care
q q1h, qh q2h qd qid qod qs hs
q-every q1h, qh- every 1 hr q2h- every 2 hr qd- every day qid- 4X/day qod- every other day qs- sufficient quantity hs- hour of sleep
ac pc po NPO stat bid tid prn
ac- before meals pc- after meals po- by mouth NPO- nothing by mouth stat- immediately bid- 2X/day tid-3X/day prn- as needed
Methods of Charting
Narative, SOAP(Subjective, objective, assessment, plan), PIE(Problem, intervention, evaluation), Focus charting (DAR[Data, action, response])
Charting by Exception (CBE)
Focuses on documenting deviations
Efficient – no duplicate charting
Expensive to develop May pose legal challenges, because details areoften missing
Culture
Shared patterns of learned values and behaviors that are transmitted over time and that distinguish members of one group from another
*can be resisted or redefined
Ethnicity
People with a shared social and cultural heritage
*can change
Race
A person’s physical characteristics (e.g. skin color, eyes, hair type, facial features)
*cannot change
Racial Microaggrassion
Subtle verbal and non-verbal insults toward people of color from well-intentioned Whites
Visible Minority
Persons who are identified according to the Employment Equity Act as being non-Caucasian in race or non-white in color.
Multiculturalism
A heterogeneous society in which diverse cultural worldviews can coexist with some general characteristics shared by all cultural groups
Ethnocentrism
type of cultural prejudice in which one believes that his or her own cultural values and beliefs are the best
Stereotyping
occurs when generalizations are applied to an individual without exploring their values, beliefs, and behaviors.
Cultural Competence
Process of acquiring specific knowledge, skills, and attitudes that ensure delivery of culturally congruent care
• Two principles:
a. Maintaining a broad, objective, and open attitude toward individuals and their cultures
b. Avoid seeing all individuals as alike
Communication with infants and newborns
o consider-
• parents sleep deprived
• information overload
o strategies-
• listen to infant’s nonverbal language to communicate
• observe interactions and assess appropriateness
• assess for depression and anxiety
Communication with children
o Address children by first names
o Ask child first, parents can fill in details
o Use words familiar to child
o Communicate through play, story-telling
o Don’t ask a yes/no question, unless either answer is acceptable
o Nonverbal communication is important (quick to notice distress/anxiety)
Communication with adolescents
o Developmental task is to achieve independence
o Increased value on peer group
o May involve sensitive issues (sexuality, drugs, alcohol)
o Strategies-
• Use hobbies as a communication strategy
• Poetry, music, drama, etc
• Privacy is important and they may need assessment time separated from parents
Communication with older adults
o Interview may take longer because of complex histories
o Allow time for response
o Prioritize questions
o Interview over a few visits rather than all at once
o Reduce environmental distractions while conversing
Strategies for patients with hearing difficulties
- Sit or stand so that you face the client so they can see your expression and mouthing of the words
- Good lighting
- Speak clearly in a moderate, even tone
- Write important ideas
- Gently touch or use visual signals before speaking to verify that they are paying attention
- Close-captioned tv
- Help elderly client adjust hearing aids
- Limit background noise
- Validate understanding
- Provide written info
- Regular volume and lip movement but speak slightly more slowly
Strategies for patients with mental disorders
o Client will rarely approach you directly
o Generally responds to questions but answers may be brief
o Easily overwhelmed by external environment
o Unresponsiveness to words, failure to make eye contact, unchanging facial expression, and monotonic voice are parts of the disorder, not a commentary on your ability to communicate
o Neither challenge their validity of hallucinations directly nor enter into a prolonged discussion about illogical thinking
o Introductions may need to be repeated, particularly for cognitively disabled clients
Strategies for patients with anxiety
o Use active listening, honesty, calm, unhurried demeanor
o Therapeutic touch
o Breathing and relaxation exercises
o Provide structure
Strategies for crying patients
o Show empathy
o Silence
o Acknowledge feelings
o Avoid false reassurances
Strategies for angry patients
o Avoid becoming defensive
o Validate and encourage expression of feelings
o Help patients connect their emotions to related events
Strategies for patients under the influence
o Direct and simple questions
o Recognize they may have impaired memory, not necessarily “lying”
Qualities for effective reporting
Organized
Complete, yet concise
Accurate
Respectful
Tool to ensure complete and organized reporting (ISBAR)
- Identify yourself and your patient
- Situation-state concisely why you’re communicating
- Background- describe circumstances leading up to current situation
- Assessment- give objective and subjective data pertinent to situation
- Recommendations-make suggestions for what needs to be done to manage the issue
Telephone communication: Physician Call
- Have the clients chart and important info ready for reference
- Document the call, who was called, what info the nurse gave, what info nurse received
- If orders are given, write down the order and then read it back to make sure its correct
