Lecture 2 Exam Review Week 6 Flashcards
Dimensions of Self Concept
Self Knowledge - Who am I?
Self Expectation - Who or what do I want to be?
Self- Evaluation- How well do I like myself?
Three Major self evaluations feelings
Pride - Based on positive self- evaluation
Guilt - Based on behaviors incongruent with the ideal self
Shame - Associated with low global self- worth
Stages of Development
Self- Awareness(infancy)
Self- Recognition- (18 months)
Self- definition- (3 years)
Formation of Self- Concept
Infant learns physical self different from environment
Basic needs are met, positive feelings of self
Child internalizes other people’s attitudes toward self
Child or adult internalizes standard
Factors Affecting Self- Concept
Developmental Considerations
Culture
History of success and failure
Crisis of life stressors
Aging, illness, disability, or trauma
Nursing strategies to Identify Personal Strengths
Encourage PT to identify their strengths
Replace self- negation with positive thinking
Notice and reinforce patient strengths
Encourage patients to will for themselves
Help patients cope with necessary dependency
Helping Patients Maintain Sense of Self
Communicate with looks, speech, and judicious touch
Acknowledge patient status, role, and individuality
Speak to the patient respectfully. Address by preferred name
Converse with the patient about their life experiences
Respect their privacy
Acknowledge negative feelings and allow for expression
Help the patient recognize strengths and explore alternatives
Examples of Physiologic Stressors
Chemical Agents
Physical Agents
Infectious Agents
Nutritional imbalances
Hypoxia
Genetic or immune disorders
Physiological Homeostasis
Local Adaptation Syndrome
Involves only one specific body part
- Reflex pain response
- Inflammatory Response
General Adaptation Syndrome
Biochemical model of stress
Alarm Reaction
Stage of Resistance
Stage of Exhaustion
Local Adaptation Syndrome
Localized response of the body to stress
Involves only a specific body part ( such as tissue or organ) instead of whole body
Stress precipitating the LAS may be traumatic or pathologic
Primarily homeostatic short- term adaptive response
Two types:
Reflex Pain Response
Inflammatory Response
Alarm Reaction
Person perceives stressor, defense mechanisms activated
Fight or Flight response
Hormone levels rise, body prepares to react
Shock and counter-shock phases
Stage of Resistance
Body attempts to adapt to stressor
Vital signs, hormone levels, and energy production return to normal
Body regains homeostasis or adaptive mechanisms fail
Stage of Exhaustion
Results when adaptive mechanisms are exhausted
Body either rests and mobilizes its defenses to return to normal and dies
Examples of Psychosocial Stressors
Accidents
Stressful or traumatic experiences of family members and friends
Horrors of history
Fear of aggression or mutilation
Events of history that are brought into our homes through television and the internet
Rapid changes in the world
Inherent stressors, social isolation, political divides, and change in work life separation brought on the pandemic
Psychological Homeostasis
Mind- Body interaction
Anxiety
Coping Mechanisms
Defense Mechanisms
Coping Mechanisms
Crying, laughing, sleeping, cursing
Physical Activity, exercise
Taking a deep breath, mindfulness exercises
Smoking, drinking
Lack of eye contact, withdrawal
Limiting relationships to those with similar values and interests
Task- Oriented Reactions to Stress
Attack Behavior
Withdrawal Behavior
Compromise Behavior
Attack Behavior
Attempts to overcome obstacles to satisfy a need
Constructive- Assertive problem solving
Destructive- Aggression, hostility
Withdrawal Behavior
Physical withdrawal from the threat
Admitting the defeat, apathetic, feeling guilty, isolated
Compromise Behavior
Substitution of goals or negotiation to partially fulfill needs ( usually constructive)
Compensation
Person attempts to overcome a perceived weakness by emphasizing a more desirable trait or overachieving in a more comfortable area.
Denial
A person refuses to acknowledge the presence of a condition that is disturbing.
Displacement
Transfers an emotional reaction from one object or person to another object or person
Dissociation
Person subconsciously protects themself from the memories of a horrific or painful event by allowing the mind to forget the incident.
Introjection
Person incorporates qualities or values of another person into their own ego structure. Important in the formation of conscience during childhood.
Projection
Person attributes thoughts or impulses to someone else.
Rationalization
Person tries to give a logically or socially acceptable explanation for questionable behavior.
Reaction Formula
Person develops conscious attitudes and behavior patterns that are opposite to what they would really do.
Regression
Person returns to an earlier method of behaving
Repression
Person voluntarily excludes an anti- anxiety producing event from conscious awareness
Sublimation
Person subs. a socially acceptable goal for one whose normal channel of expression is blocked
Undoing
Person uses an act or communication to negate a previous act or communication.
Steps of Communication Process
Initiated based on stimulus
Sender-(Encoder)
Begins the process
Message
Communication product from the source
Channel Communication
\Auditory, visual, kinesthetic
Receiver( Decoder)
Translates and interprets the message being received
Confirmation of the message provides feedback
Verbal Communication
Depends on understanding language
Nonverbal
Facial Expressions, gestures, eye contact, touch,
Space, time, boundaries
Body movements, posture, and gait
General Physical Appearance and mode of dress or grooming
Sounds
Moaning, crying, gasping, sighing
Communication Technologies
Electronic Communication\
Social Media
Email and Texts
Telehealth and telemedicine
Electronic Communication
Social Media
Both the ANA and NCSBN have issued guidelines for RNs regarding the use of social media
Emails and Texts
Risk for violating patient privacy and confidentially exists any time a message is sent electronically
Health care agencies usually have security measures in place to safeguard e-mail and text communications
Four Levels of Communication
Intrapersonal
Self- talk, communication within a person
Calming, soothing with nerves
Interpersonal
Occurs between two or more people with a goal to exchange messages
Patient family members, health care team
Group
Small group
Patient- care conferences, teaching sessions, support groups
Organizational Communication
Factors Influencing Communication
Developmental Level
Sociocultural Differences
Roles and Responsibilities
Space and territorially
Physical, mental, and emotional state
Values
Environment
SBAR
S situation
B background
A assessment
R recommendation
Therapeutic Relationship
Set the climate for participants to move toward common goals
Does NOT occur spontaneously
Characterized by an unequal sharing of information
Built on the Pt needs
The nurse is the caregiver and the patient is the person being cared for
Communication is the means used to establish rapport and trusting, therapeutic relationships
Characteristics of the Therapeutic Nurse- Patient Relationship
Caring
Person Centered relationship
Dynamic
Both people involved are active participants
Purposeful and time limited
The person providing the assistance is professionally accountable for the outcomes
Goals are determined cooperatively and defined in terms of the PTs needs
Three Phases of the Therapeutic Nurse- Patient Relationship
Orientation Phase
PT will call the nurse by name
PT will accurately describe the roles of the participants in the relationship
PT will establish an agreement about:
Goals of relationship
Location, frequency, and length of contacts
During relationship
Working Phase
PT will:
Actively participate in the relationship
Cooperate in activities that work toward achieving mutually accepted goals
Express feelings and concerns to the nurse
Termination
PT will participate in identifying goals accomplished or progress made toward goals
PT will verbalize feelings about the termination of the relationship
Factors Promoting Effective Communication
Dispositional Traits
Warmth and friendliness
Openness and respect
Empathy
Honesty, trust, and authenticity
Caring
Competence
Rapport Builders
Specific objectives
Comfortable environment
Privacy
Confidentiality
PT versus Task focus
Using Nursing observations
Optimal Pacing
Developing Conversation skills
Control the tone of your voice
Be knowledgeable about the topic of conversation
Be flexible
Be clear and concise
Avoid words that might have different interpretations
Be truthful
Keep an open mind
Take advantage of available opportunities
Developing Listening Skills
Sit when communicating with the patient
Be alert and relaxed and take your time
Keep the conversation as natural as possible
Maintain eye contact if appropriate
Use appropriate facial expressions and body gestures
Think before responding to the patient
Do not pretend to listen
Listen for themes
Use silence, therapeutic touch, and humor appropriately
Interviewing Techniques
Open Ended
What did your health care provider tell you about your need for this hospitalization?
Closed
What medications have you been taking at home
Validating
At home, you have been taking BP pill and water pill every day. Did you take them today
Clarifying
I have never needed this med.. Is this the first health problem you have had?
Reflective
You’ve been upset
Aggressive Behavior
Involves asserting one’s rights in negative manner that violates the rights of others
Can be verbal or physical
Communication is marked by tension and anger, inhibiting the formation of good relationships and collaboration
Characteristics include using an angry tone of voice, being condescending, and threatening
Focus is usually “ winning at all costs”
Blocks to Communication
Failure to perceive the patient as a human being
Failure to listen
Nontherapeutic comments and questions
Using cliches
Using closed questions
Using leading questions
Using comments that give advice
Using judgmental comments
Changing the subject
Giving false assurance
Using gossip and rumors
Disruptive Interpersonal Behavior
Incivility
Horizontal Violence
Lateral Violence
Nurse Bullying
Professional Activity
Organizational response to disruptive behaviors
Verbally and Physically Aggressive Patients
Workplace Violence
Verbal harassing, threatening, yelling, bullying, hostile sarcasm
Nurses should:
Respond by maintaining a professional demeanor, responding assertively, addressing the issue directly with those involved
See guidance and support through nurse managers or other appropriate channels
Workplace Violence
Violent acts, including physical assaults and threats of assault, directed toward persons at work on duty
Includes verbal harassing, threatening, yelling, bullying, and hostile sarcasm
Patterns of Interaction
Effective
Honest and direct flows freely
Ineffective
Communication is sparing and or one way , self serving roles and may be unchecked
Leadership
Effective
Meets desired aims, participation and leadership are distributed among members
Ineffective
Leadership delegated on authority.
Documentation
Written or electronic legal record of all pertinent interactions with the patient
Includes data related to assessing, diagnosing, planning, implementing, and evaluating
Facilitates quality, evidence- based patient care
Serves as financial and legal record
Helps in clinical research
Supports decision analysis
Characteristics of Effective Documentation
Consistent with professional and agency standards
Complete
Accurate
Concise Factual
Organized and Timely
Legally prudent
Confidential
Elements of Documentation
Content
Timing
Format
Accountability
Confidentiality
Using 24 hr military time
What is confidential?
All information about patients written on paper, spoken aloud, saved on computer
Name, address, phone, fax, social security number
Reason the person is sick
Treatment PT receives
Information about past health conditions
Potential Breaches in Patient Confidentiality
Displaying information on a public screen and not logging out of the computer
Sending confidential email messages via public networks
Sharing printers among units with differing functions
Discarding copies of the PT information in trash cans
Holding conversations that can be overheard
Faxing confidential information to unauthorized persons
Patient Rights
Patients have the right to:
See and copy their health record
Update their health record
Get a list of disclosures
Request a restriction on certain uses or disclosures
Choose how to receive health information
Policy for Receiving Verbal Orders
Must be given directly by physician or NP to a registered nurse or registered professional pharmacist
Record the orders in PTs medical record with intials VO
Read back the order to verify
Date and note the time orders were issued
Record verbal order and name of the physician or NP , followed by nurse’s name and initials
Should be limited to urgent situations
Policy for Physician or NP Review of Verbal Orders
Review orders for accuracy
Sign orders with name, title, and page number
Date and note time orders signed
Methods of Documentation
Computerized Documentation
EHRs
Source Oriented Records
Progress notes, narrative notes
Problem Oriented Medical Records
SOAP notes
PIE Charting
Problem
Intervention
Evaluation
Focus Charting
Charting by Exception
Formats for Nursing Documentation
Initial nursing assessment
Care plan, patient summary
Critical Collaborative Pathways
Progress Notes
Flow Sheets and graphic records
MAR record
Acuity Record
Discharge and transfer summary
Home Health Care documentation
Long Term Documentation
Reporting Care or Requesting Action
Change of shift/ handoff report
ISBARR
Telephone? Telemedicine Report
Transfer and Discharge reports
Reports to family members or significant others
Incident/ Variance Reports
Hand- Off Communication/ ISBARR
Identify/ Introduction
Situation
Background
Assessment
Recommendation
Read back of Orders/ response
Change of Shift/ Hand -Off Reports
Basic identifying information about each patient: name, room, number, bed designation, diagnosis, and attending and consulting physicians
Current Appraisal of each Patient’s health status
Current Orders
Abnormal occurrences during your shift
Any unfilled orders that need to be continued onto the next shift
PT/ Family questions, concerns, needs
Reports on transfers/discharges
Telephone/ Telemedicine Reports
Identify yourself and the patient and state your relationship to the patient
Report and accurately the change in PTs condition that is of concern and what has already been done in response to this condition
Report the PTs current vital signs and clinical manifestations
Have the PT record at hand to make knowledgeable responses to any physician’s inquiries
Concisely record time and date of the call, what was communicated, and physician’s response
Conferring About Care
Consultations and referrals
Nursing and interdisciplinary team care conferences
Nursing Care Rounds
Purposeful Rounding
Eight Behaviors of Purposeful Rounding
Use Opening Kew Words ( C-I-CARE) with PRESENCE
Accomplish scheduled tasks
Address four Ps
Address additional personal needs, questions
Conduct environmental assessment
Ask: is there anything else I can do for for you? I have time
Tell the PT when you will be back
Document the round
Meaningful Use of EHR
Improves quality, safety, efficiency, and reduce health disparities
Engage patients and family
Improve care coordination and population and public health
Maintain privacy and security of PT health information
Results of Meaningful Use Compliance
Better Clinical rotations
Improved population health outcomes
Increased transparency and efficiency
Empowered individuals
Most robust research data on health systems
ANA Definition of Nursing Informatics
The specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice.
Components of System Development Lifecycle
Analyze and Plan
Design and develop
Maintain
Evaluate
Test, Train, Implement
Analyze and Plan
What is the purpose of this new technology or change to the current technology?
What problem do we hope to solve?
What data do we have to indicate the current state of the issue?
How will its use be incorporated into the current workflow of the nurse?
Will it streamline nursing documentation or will it increase the burden of documentation?
Will it improve the overall usability and experience with the EHR?
What technologic options are available if there are more than one?
Important Informatics Concepts
System usability
System optimization
Standard terminologies
Interoperability
Security and Privacy
Blockchain
Emerging Areas in the Field of Informatics
Patient Portals
Health Care Analytics
Data Visualization
Predictive Analytics
Big Data
Telehealth
Use of electronic information and telecommunications technologies to support and promote long distance clinical health care, patient and professional health education, public health, and health administration
Telemedicine
Use of telecommunications technologies to support the delivery of all types of medical, diagnostic, and treatment- related services, usually by physicians and NPs
Telecare
refers to technology that allows consumers to stay safe and independent in their own homes
Uses of Patient Portals
Access medical history and other health information
Complete various forms and questionnaires
Communicate securely and conveniently with providers
Schedule appointments
Receive reminders for appropriate screenings
Enter clinical data, such as blood pressure, glucose levels, weight, fitbit data and other activity tracking data
Review progress notes
Benefits of Patient Portals
Better health outcomes
Chronic condition management
Timely access to care
Patient Retention
Patient Centered medical home recognition
Types of Health Care Analytics
Clinical
Populations
Administrative
Financial
Genetics and Genomics
Precision Medicine
The field of genomics has the potential to significantly change the way health care is delivered
Genomics play a role in 9n out of 10 leading causes of death, including heart disease, cancer, stroke, diabetes, and Alzheimer’s disease
Because genomic health care is heavily dependent on data storage and interpretation, no other area is better suited than informatics to support this evolving work .
