Exam 3 fundamentals. Flashcards
(ACE) inhibitors? aka Angiotensin-converting enzyme
Angiotensin-converting enzyme (ACE) inhibitors are medications that help relax the veins and arteries to lower blood pressure. ACE inhibitors prevent an enzyme in the body from producing angiotensin II, a substance that narrows blood vessels.
Gastroenteritis?
inflammation of the stomach and intestines, typically resulting from bacterial toxins or viral infection and causing vomiting and diarrhea. Aka stomach flu. has a limited course meaning it only takes a few days to heal. important to take a lot of water.
DKA diabetic ketoacidosis
DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down fat and protein for fuel. This process produces acids called ketones. When too many ketones are produced too fast, they can build up to dangerous levels in your body. The reason your body does this is because even though there’s glucose in the blood it thinks that there is not any glucose because it can’t enter the cell. Also when there’s a lot of glucose in the blood your body tries to get rid of it in the form of urine taking water and electrolytes with it in a process called in osmotic diuresis. This results in excessive amounts of urine, dehydration, and excessive thirst. 
Planning a teaching session for a patient. SMART
SMART
Specific
Measurable
Attainable
Relevant
Time Frame
What is healing by secondary intention?
Secondary intention healing means a wound will be left open (rather than being stitched together) and left to heal by itself, filling in and closing up naturally. It will mean you need regular dressings to the area for up to six weeks, but the time to full healing depends on the size, depth and site of the wound.
The Joint Commission
Standards?
Patient Needs Assessment
The ability of the patient assessment
Readiness to Learn
Educational Plan
Educational Intervention
Evaluation of Effectiveness of Teaching
Documentation
Needs assessment
Interventions
Methodology
Whether pt required return demonstration
Pt stated or demonstrated understanding
Appropriate referrals made
How pt has met goals
Evaluation
This is after you implement the teaching. What is the understanding? Remember teach back show back. This is part of the evaluation. You are evaluating what the patient understood and how they are progressing towards the expected outcomes. It is not a given that they are going to meet the goal right away. It will take time and multiple teachings.
Discharge Teaching?
Any instruction necessary i.e. Danger signs
Specific instructions outlined by MD
Provide written material/ phone numbers/
appointments
Equipment & supplies necessary
Document response to education
Factors that influence
teaching/learning?
Nurse
Knowledge of material
Communication skills
- Verbal: Should match educational level
of pt.
Avoid medical jargon
Nonverbal communication: Don’t
appear hurried
Cultural Issues
- Active listening skills: nonverbal clues
- Ability to demonstrate empathy
Readiness to learn
- Emotional readiness
- Experiential readiness
Ability to learn
- Physical Condition
- Cognitive Ability
- Level of Education
Ability to Learn (con’t)
- Literacy/Health Literacy
- Communication skills
- Primary language
Important to assess learning abilities in order to
ID teaching strategies
Learning Strengths
- Successful learning in the past
- Above average comprehension/
reasoning, memory, psychomotor
skills
- High motivation
- Strong network
- Adequate financing
Factors that can interfere with
learning?
Lack of Time
- Shorter hospital stays
- Begin teaching on admission
Lack of Knowledge
- More specialties
- Floating
- New equipment
Disagreement with patient or family
- Set goals with pt
- Realistic goals
Powerlessness, frustration
- Nurse
- Patient
Language Barrier
- Interpreter
- Set aside time
- Assess cultural influences
Planning?
Goal Setting
- Write clear and measurable learning objectives
- Long term goals
- Short term goals
Planning?
Goal Setting
- Write clear and measurable learning objectives
- Long term goals
- Short term goals
Case Scenario:
20 year old, s/p I&D (incision & drainage) for a left
leg abscess. The wound is healing by secondary
intention. Before she is discharged, she will need
to perform her own wound care
Pt will be able to describe the rationale and importance of performing a wet to moist dressing change on her first post-op day
Pt will be instructed on the importance of performing a wet to moist dressing change
Pt will perform a wet to moist dressing change in front of the nurse using the correct technique before discharge on 9/7
Pt will be able to perform her own dressing changes
Teaching strategies:
Teaching Strategies:
“Teach Back”
“Show Back”
Peer teaching in a support group for patients with eating disorders.
Effective teaching using demonstration and return
demonstration increases successful learning by the patient.
Using an app or a tv program.
What is communication?
The Oxford American College Dictionary defines communication
as “ the successful conveying or sharing of ideas and feelings.”
Communication is the basic element of human interactions that
allows people to establish, maintain, and improve contact with
one and other
Why is communication especially vital in nursing?
- Communication is vital in all nursing activities
such as care planning, interventions,
discharge, education, and health promotion - Generates trust
- Enhances therapeutic relationship
- Strong communication is required for patient
advocacy and safety - Effective communication is essential for
collaboration of care with the interdisciplinary
team
Why is communication especially vital in nursing?
- Communication is vital in all nursing activities
such as care planning, interventions,
discharge, education, and health promotion - Generates trust
- Enhances therapeutic relationship
- Strong communication is required for patient
advocacy and safety - Effective communication is essential for
collaboration of care with the interdisciplinary
team
Poor communication in healthcare
The 2016 US Malpractice study found that:
1. 30 % of all malpractice claims filed between 2009 and 2013 involve
communication failures.
2. Hospitals and doctors’ offices nationwide could have avoided nearly 2,000
patient deaths — and $1.7 billion in malpractice costs — if medical staff and
patients communicated better
3. 70-80% of medical errors are related to interpersonal interaction issues
Poor communication in healthcare
The 2016 US Malpractice study found that:
1. 30 % of all malpractice claims filed between 2009 and 2013 involve
communication failures.
2. Hospitals and doctors’ offices nationwide could have avoided nearly 2,000
patient deaths — and $1.7 billion in malpractice costs — if medical staff and
patients communicated better
3. 70-80% of medical errors are related to interpersonal interaction issues
Levels of communication.
- Intrapersonal: Communication that occurs within an individual. *
Also known as self-talk, self-verbalization, inner thought
* Provides mental rehearsal for difficult tasks or situations;
increase confidence.
* NURSING RELEVANCE: – internal critical thinking and planning - Interpersonal:
* Between 2 or more people
* A 1:1 interaction between the nurse and another person.
e.g patient, family, physician, colleague
* Meaningful interpersonal communication results in an exchange of
ideas and goal accomplishment.
* NURSING RELEVANCE: Assessment, teaching, providing
comfort and support - Transpersonal: Interaction that occurs within a spiritual domain.
Communication with a higher power/God
Nurses have a responsibility to assess a person’s spirituality - Group Communication: Between two or more people
* A. Group communication: Interaction that occurs when a small number of
persons meet – usually goal-directed and requires understanding of group
dynamics; exchanges of ideas
* E.g staff meetings, committee meetings, educational grps, self help grps,
goals of care meetings
* NURSING RELEVANCE: Provide patient advocacy
* B. Public speaking: Involves interaction with an audience with varying
degrees of interaction
* e.g. presenting scholarly work in conferences and lectures
* NURSING RELEVANCE: Educating nurses with evidence based studies,
change of practice or policies and procedures, lobbying for new legislation
Levels of communication.
- Intrapersonal: Communication that occurs within an individual. *
Also known as self-talk, self-verbalization, inner thought
* Provides mental rehearsal for difficult tasks or situations;
increase confidence.
* NURSING RELEVANCE: – internal critical thinking and planning - Interpersonal:
* Between 2 or more people
* A 1:1 interaction between the nurse and another person.
e.g patient, family, physician, colleague
* Meaningful interpersonal communication results in an exchange of
ideas and goal accomplishment.
* NURSING RELEVANCE: Assessment, teaching, providing
comfort and support - Transpersonal: Interaction that occurs within a spiritual domain.
Communication with a higher power/God
Nurses have a responsibility to assess a person’s spirituality - Group Communication: Between two or more people
* A. Group communication: Interaction that occurs when a small number of
persons meet – usually goal-directed and requires understanding of group
dynamics; exchanges of ideas
* E.g staff meetings, committee meetings, educational grps, self help grps,
goals of care meetings
* NURSING RELEVANCE: Provide patient advocacy
* B. Public speaking: Involves interaction with an audience with varying
degrees of interaction
* e.g. presenting scholarly work in conferences and lectures
* NURSING RELEVANCE: Educating nurses with evidence based studies,
change of practice or policies and procedures, lobbying for new legislation
Albert Mehribian’s Communication
Model – 7-38-55 Formula
Research study in 1971; “ Silent
Messages”
Formula applies to communication
of feelings and attitudes; not to ALL
communications
Only 7% of meaning is in the words
that are spoken
38% of meaning is in the tone of
voice
55% of meaning is in facial
expression
Albert Mehribian’s Communication
Model – 7-38-55 Formula
Research study in 1971; “ Silent
Messages”
Formula applies to communication
of feelings and attitudes; not to ALL
communications
Only 7% of meaning is in the words
that are spoken
38% of meaning is in the tone of
voice
55% of meaning is in facial
expression
Forms of communication:
- Verbal Communication:
Uses spoken or written words:
Influenced by educational
background, culture, age and
experiences, influenced by:
Vocabulary
Denotative Meaning - literal
Connotative Meaning - implied
Clarity and Brevity – appropriate
words
Intonation - tone
Pacing -speed
Credibility
Humor-Use cautiously - Non-Verbal Communication
Facial expression
Gestures
Personal Appearance
provides clues to professionalism, culture, religion,
socioeconomic status, livelihood and feelings
Touch
May convene affection, concern, or encouragement
Factors that affect comunication:
- Environment
Quiet, private, comfortable
Developmental differences
Physical and cognitive
development
Language skills
Level of Education
Maturity
Gender
Difference in
communicating and
interpreting
Males tend to be goal/task
focus
Females also seek to
establish personal
relationship - Personal Space
Varies according to
relationship with the
other person
Intimate distance – <18”
Personal distance – 18”
to 48’’
Social distance – 4-12’;
formal or with a group
Public Distance - > 12’;
when communicating
loudly, focus on group
not on individual
Professional nursing relationships:
Nurse-Healthcare team:
Teamwork and
collaboration
Nurse-Patient:
Involve
patient in care
management
Nurse-Family:
Involve
family in care of patients
and discharge teaching
Nurse-Community:
health
fairs, and public bulletin boards.
Professional nursing relationships:
Nurse-Healthcare team:
Teamwork and
collaboration
Nurse-Patient:
Involve
patient in care
management
Nurse-Family:
Involve
family in care of patients
and discharge teaching
Nurse-Community:
health
fairs, and public bulletin boards.
Nurse-to-nurse communication:
Transition of Care
-High-alert Medications
-Recognizing Fatigue
* Be assertive, not aggressive
* Advocate for patients
* Advocate for yourself
* If needed, decline
respectfully and explain
* Use a proper chain of
command
SBAR
Introduce yourself
S – Situation
What is going on with your patient? What are you concerned about?
B – Background
Clinical background and data
A – Assessment
What is your assessment of the situation
R – Recommendation
What is your recommendation for the situation
Creating a therapeutic relationship
The client is the center of focus.
The therapeutic relationship focuses on improving the health of the
client.
Therapeutic communication is client-centered communication
directed at achieving client goals.
Phases of the patient-nurse therapeutic relationship
- Pre-interaction Phase: Before meeting patient
Review chart/pre-lab
Talk with caregivers/nursing handoff
As Student- prelab for clinical
As patient – anxiety may be high as pt acknowledges the need
for healthcare
Goal – Get info about patient to establish plan of care - Orientation Phase: When nurse and patient first meet
Introduce yourself
Ask how pt wants to be addressed
Set tone by adopting a warm and empathetic manner
Students often tentative and uncertain
Expect to test your competence and commitment
Goal – establish rapport and trust using verbal and non-
verbal communication; leads to more openness from patient
Clarify roles
Once relationship/ role is defined, orientation phase ends - Working Phase:
Bulk of therapeutic relationship occurs in this phase – active part
Goals: pt able to clarify feelings and concerns honestly
Mutual respect maintained
Active listening, providing clear instructions
Professional relationship requires trust, confidentiality mutual respect
Work together towards a goal - Termination Phase:
Evaluate goals achievement with the patient
Reviewing the care achieved and care needed to be passed on to
the next shift
Achieve a smooth transition for the patient to other caregivers
Prepares for future interaction
Affects patient outcome and nurses’ job satisfaction
Therapeutic communication:
- Active Listening:
-Pay attention
-Show that you are listening
-Use clarification
-Respond appropriately - Share Observations: “You
seem quiet today. What’s in
your mind?” - Reflection of feeling: “I see
that you are upset with the
phlebotomist.” - Restating/Clarifying
- Use open-ended questions
- Focusing: pursing a topic
until its importance is clear - Using silence – allows
a person time to organize
thoughts
Non-Therapeutic communication:
Excessive use of closed-ended questions
Avoid asking “why”; Say “what concerns you” instead
Giving advice – giving solution negates pt’s participation in decision making
False reassurance: “everything will be alright”
Showing approval and disapproval- don’t impose your personal beliefs on someone else
Stereotyping: assumptions made based on patients background, education, culture etc.
Patronizing – communicates superiority or disapproval
“You should have called before getting up”
Non-Therapeutic communication:
Excessive use of closed-ended questions
Avoid asking “why”; Say “what concerns you” instead
Giving advice – giving solution negates pt’s participation in decision making
False reassurance: “everything will be alright”
Showing approval and disapproval- don’t impose your personal beliefs on someone else
Stereotyping: assumptions made based on patients background, education, culture etc.
Patronizing – communicates superiority or disapproval
“You should have called before getting up”
Other barriers to effective communication :
Medications that might interfere with speech, cognition, or LOC
Language barriers such as primary language, whether an interpreter (native language or sign language) is needed
Health literacy
Baseline cognitive function/LOC
Hearing, vision impairment
Expressive or receptive aphasia
Physiological barriers such as dyspnea, artificial airway, anxiety, pain
Other barriers to effective communication :
Medications that might interfere with speech, cognition, or LOC
Language barriers such as primary language, whether an interpreter (native language or sign language) is needed
Health literacy
Baseline cognitive function/LOC
Hearing, vision impairment
Expressive or receptive aphasia
Physiological barriers such as dyspnea, artificial airway, anxiety, pain
How to treat a patient with Aphasia
Use yes/no answers
Visual cues
Communication aids such as a
writing board or keyboard
Allow for extra time
Let the patient know if you have
not understood them
How to treat a patient with Aphasia
Use yes/no answers
Visual cues
Communication aids such as a
writing board or keyboard
Allow for extra time
Let the patient know if you have
not understood them
How to treat a patient with a cognitive impairment?
Use simple sentences
Present one question,
instruction, or statement at a
time
Involve the patient’s family
Allow for extra response time
How to treat a patient with mental health issues?
Avoid denying or arguing with them
about their reality
Use short sentences in a calm and non-
threatening voice
Validate the person’s own experience of
frustration or distress
Reflection of feelings
Re-direct focus to the person’s positive
experience
