Midterm #1 - Week 2 Flashcards
Communication and Delirium, Dementia, and Depression
Health Equity
o Elimination of systematic health disparities
o Associated with social advantage and disadvantage
an aspirational concept that reflects the values of social justice and is a fundamental part of achieving global health. It means that all people are able to achieve maximum health potential with any economic, social, or environmental disadvantages.
Health disparities
a health difference that is linked with economic, social, or environmental disadvantages. It affects people who have systematically experienced greater hardships to their health due to racial or ethnic group; gender; age; socioeconomic status; mental health; religion; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics that have been historically discriminated against.
Health inequities
inequalities in health that unfair or come from some kind of injustice
intersectionality
a theoretical idea that looks at the influence of multiple social characteristics like race, gender, ethnicity, class, and socioeconomic factors affect a particular phenomenon such as the experience of health and its outcomes
gender equality
o Equal treatment of all, regardless of gender.
o No discrimination.
the notion that people should be discriminated based on their gender and should be given equal treatment
cultural safety
o Recognize power and resource distribution. Awareness of institutional discrimination.
creating is safe environment for all people
cultural humility
o Lifelong learning. Interpersonal respect and reflection.
a personal commitment to evaluating yourself about other backgrounds
cultural conflicts
when people of different cultural values, beliefs, or practices clash
(when people have biases and discrimination against other cultures)
communication
the exchange of information between individuals, groups, or organizations
Alzheimer’s
most common type of dementia. Fatal disease that overtime affects all aspects of a person’s life
Trauma informed practice (definition)
- Trauma is often closely tied to substance use, mental illness, stigma, health care access barriers, and other challenges
- understanding the link between trauma with substance abuse, mental illness, stigma, barriers to health care, and other challenges. As well as making people feel safe and not re-traumatize them through their care
Autonomy
the ability to be self directed and independent in accomplishing goals and advocating for other people
Denotative meaning of a word
the meaning of the word that everyone knows
Connotative meaning of a word
the meaning of a word that is influenced by peoples thoughts, feelings
Aphasia
the inability to produce or understand language
Prefix- hypo and hyper
hypo - below or under
hyper - excessive or high
Implicit bias
unconscious biases that are thoughts and feelings outside our awareness and hard to acknowledge and control
Explicit bias
the biases that people deliberately think about and make conscious reports about. Often stereotypes.
Perceptual bias
perceptual biases are human tendencies that interfere with accurately perceiving and intercepting messages, attitudes, and values from other people
verbal and nonverbal communication
verbal communication – uses spoken or written word
nonverbal communication – uses all five senses and refers to the transmission of messages that do involve the spoken or written word.
non-verbal supplements, reinforces, undermines verbal communication.
Dementia
gradual and progressive decline in mental processing ability/cerebral dysfunction. It affects short term memory language, judgement, reasoning, and abstract thinking, and eventually long term memory and familiar task
Delirium
A potentially reversable condition of cognitive impairment that often has a physiological cause
Depression
described as the presence of a cluster of depressive symptoms that last for at least two weeks for most of the day and most of the time. With a high intensity compared to normal
How does this knowledge about trauma informed practice improve our nursing communication?
Helps to build trust, by being mindful of how trauma affects people better relationships can be built
Ethnocentrism
the idea that one’s own group, ethnicity, nationality, etc. is superior to others
Cultural Safety (lack of and definition)
o Western medicine at the forefront.
o Benefits do not often cover alternative medicine (or not as well)
o This leads to fear of discrimination and lack of trust in the health care system. Necessary interventions are prolonged leaving the client and families to suffer consequences.
o Do not make assumptions that all individuals from one group act the same way
o “Awareness of social, political, and historical contexts of other groups of people and knowledge of the groups experiences”
Discrimination
prejudice against other people, especially about ethnicity, age, etc.
Stereotypes
oversimplified ideas about a person or thing that are widely held
racism
discrimination based on race
Different parts of Cultural Humility
o Ensuring culturally congruent and equitable care
o Personal self-awarenesses
o Profession self- awarenesses
o Organizational awarenesses
o Community awarenesses
How do we make change?
o Education, equity guidelines, self-advocacy, research, equity policy, and accountability.
o Understanding relationships; recognizing power imbalances; awareness of institutional discrimination; eliminate systemic disparities.
TIP
o Understanding and responding to the impact of trauma. Ensure physical, psychological, and emotional safety
o Prevention: prevent more harm and triggers
o Safety: take down barriers and reduce stigma
reflexivity
the ability of someone to examine their own feelings, reactions, and motives
perception
based on information from the five senses
Trauma Informed Practice – How to
o Safety – doing point of care risk assessments to make sure patient is okay and not in distress
o Trust and transparency – gain the patients trust, if you said you were going to do something go through with it
o Peer support – peer support groups for patients for more support
o Empowerment, voice, and choice – advocacy
o Collaboration and mutuality – working with the patient and with the healthcare team
o Cultural, historical, and gender issue – try to understand and learn about other peoples/perspectives
Why is communication important in nursing practice?
o Therapeutic relationships: Individualized care; Safety, trust, caring; Good nursing care
o Have uncomfortable conversations
o The basis for the nursing process
o Client autonomy
o Better client outcomes
o Increases professional credibility
5 Levels of Communication
o Intrapersonal – with yourself
o Transpersonal – spiritual
o Interpersonal – between people
o Small-group – small group of people
o Public – having an audience
contextual knowledge
the skill of knowing when it is relevant to apply specific rules or concepts in a specific context
The Communication Process
o Sender – is the person who encodes and delivers the message, the senders messages acts as a referent for the receiver
o message – the content of the communication, two nurses can provide the same information yet deliver 2 different messages, to send effective messages express yourself clearly, directly, and in a manner familiar to the receiver
o channel – ways to conveying and receiving messages through visual, auditory, and tactile senses
o receiver is the person who receives and decodes the message, they are responsible for attending to decoding, and responding to the senders message
o Feedback – the message sent by to the sender by the receiver which indicates if the receiver got the intended message and understood it
o noise – noises in the environment?? a
o Environment – the place where the communication takes place
o interpersonal variables – anything that can affect the message/communication
o Referent (motivates one person to communicate with another)
Strategies for communicating with the older adult
- Try to find a quiet room with little outside noises
- Sit facing the patient so they can see your lip and facial movements
- If masks must be worn consider other ways to creating a warm, inviting environment
- Make sure glasses or hearing aids are worn if needed
- Speak slowly and clearly (do not speak loudly)
- Keep the tone of your voice low (older persons can her lower tones better)
- Periodically summarize what has been said to clarify and repeat important points
- Ask the older person what they understood and invite questions to clarify
- Emphasize and integrate emotional and personal values in the acquisition of skills and ideas
What are three possible outcomes when nurses communicate ineffectively?
- Poor patient outcomes
- Increases in adverse incidents
- decreases in professional credibility
The 4R’s
- The 4 Rs: realize, recognize, respond, resist
o Realization: an organization wide realization of how trauma affects people
o Recognize: the ability to recognize the signs of trauma
o Response: a system wide response to trauma that informs all behaviours, language, programs, and polices
o Resistance: resisting re-traumatization of patients, clients, and staff. Organization can unintentionally create conditions that will re-traumatize people
How can Verbal communication impact a message?
the message can be impacted by vocabulary – word choice, denotative and connotative meaning – the different meanings of a single word, pacing – the speed of the message, intonation – the tone of voice, clarity and brevity – effective communication through simple, brief, and direct messages, timing and relevance – timing is critical
How does Nonverbal communication impact a message?
the message can be impacted by general appearance – physical characteristics, facial expression, manner of dress, etc., posture and gait – the way people move, sit, stand, etc., facial expression – the face is the most expressive part of the body, eye contact – shows the readiness to communicate, gestures – emphasize and clarify spoken word, sounds – communicate feelings and thoughts, personal space – the right of someone to need and defend their own space, if it becomes threatened communicate is harder. It provides people with a sense of security, identity, and control
Therapeutic communication strategies
o Active listening
o Sharing observations
o Sharing empathy
o Sharing hope
o Sharing humor
o Sharing feelings
o Using touch
o Using silence
o Providing information
o Clarifying
o Focusing
o Paraphrasing
o Asking relevant questions
o Summarizing
o Self-disclosure
o Confrontation
What are therapeutic communication techniques?
- Therapeutic communication involves using specific response that encourage the expression of feelings and ideas and convey acceptance and respect
What is nontherapeutic communication?
- Non-therapeutic communication techniques damage or hinder professional relationships and often cause recipients to active their defenses to avoid being hurt or negatively affected
Non-therapeutic communication techniques
o Asking personal questions
o Giving personal opinions
o Changing the subject
o Automatic responses – such as stereotypes and clichés
o False reassurance
o Sympathy – it is a feeling of concern, sadness, pity for the patient that generated by personal identification with the patient’s needs. It is not as therapeutic or responsive as empathy
o Asking for explaination – why questions can feel like accusations or make the patient feel like you are testing them.
o Approval or disapproval
o Defensive responses
o Passive or aggressive responses
o Arguing
Different parts of verbal communication
o Vocabulary
o Pacing
o Tone
o Brevity
o Timing
o Relevance
What are the principals of TIP
- Safety
- Trust and transparency
- Peer support
- Collaboration and mutuality
- Empowerment, voice, and choice
- The importance of cultural, historical, and gender issue
Different parts of nonverbal communication
o Personal appearance
o Facial expression
o Posture and gait
o Eye contact
o Touch, gestures, and sound
o Personal space
Personal Space (other spaces)
o Intimate 0 – 1.5ft (consent privacy)
o Personal 1.5 – 4ft (it is okay for the nurse to enter this space)
o Social 4 – 12ft
o Public 12+ ft
Elements of Professional Communication
o Courtesy
o Use of names
o Trustworthiness
o Autonomy and responsibility
o Assertiveness
(“I” language/ “I feel _ about _ because _”)
Strategies for active listening
o S – Sit facing the pt
o O – Open posture
o L – Lean forward
o E – Eye contact
o R – Relax
Older Adult Client Needs: Age specific approach
o Physical and psychosocial
o Function impacted by disease and disability
o Decreased homeostasis
o Lack of standard norms
o Altered manifestations and response
Cognitive Changes in aging truths
Symptoms such as disorientation, loss of language skills, loss of the ability to calculate, and poor judgement are not normal changes with aging – can indicate something is wrong.
Delirium symptoms
o Confused/disorientated
o Visual hallucinations (auditory hallucinations – less common)
o Difficulty thinking/focusing attention
o Behavior or personality different than usual
o Day/nights are mixed up
o Drift between asleep and awake
o More alert or more tired
o Older persons tend to experience hypoactive delirium – making it harder to recognize – it might seem like depression
Delirium
o “out of the track”
o Delirium is an acute, reversible state of disorientation, inattention, and confusion
o Rapid onset (hrs. – days)
o Increased prevalence with age & more likely to occur in acute care settings
o MEDICAL EMERGENCY
why does delirium happen?
o Infection: causes inflammation- confusion in the older adult,
o Low Na+ (sodium): cell swelling- confusion,
o Impaction: dehydration, nausea, irritation, constipation can lead to bowel perforation
why is it a medical emergency?
o Poor outcomes (can lead to falls, injury etc.),
o Increase L.O.S. (Length of stay),
o Death.
Delirium Management
o Find and treat the underlying cause
o Include family and friends
o Keep the clients routine as simple as possible
o Keep the environment calm – reduce distractions
o Encourage healthy eating and promote drinking fluids
o Keep sentences short and simple
o Make sure the pt has their glasses, hearing aids etc.
o Do not argue with the pt re: hallucinations
What is dementia
o Broad term for a set of symptoms that affect the brain
o Generalized impairment of intellectual functioning, gradual deterioration
what are the warning signs of dementia
o Memory loss affecting day-to-day abilities
o Difficulty performing familiar tasks (ADL’s)
o Problems with language
o Disorientation in time and space
o Impaired judgment
o Problems with abstract thinking
o Misplacing things
o Changes in mood/behavior
o Changes in personality
o Mini-mental (MMSE) score of 23 or less= cognitive impairment
Communicating with people living with Dementia
o 1. Identify yourself, e.g. ”My name is…
o I’m here to help you get into your wheelchair.”
o 2. Approach the person from the front.
o 3. Move slowly; maintain eye contact.
o 4. Address the person by name; speak slowly and clearly.
o 5. Present one idea at a time.
o 6. Repeat/rephrase responses to clarify what the client is trying to tell you.
o 7. Ask “yes” or “no” questions & allow time for a response.
o 8. Back up your words with actions using gestures.
o 9. Listen actively/ acknowledge the person’s emotional state.
o 10. Touching too roughly quickly could cause increased stress.
What is depression
o A mood disorder characterized by feelings of sadness and despair
o 2 or more weeks
o Not a normal part of aging
what are depression risk factors
o Health challenges
o Chronic disease
o Chronic pain
o Loss
o Social isolation
o Changes in independence
Signs and Symptoms of Depression
o ADLs
o Loses interest
o Feelings of worthlessness and sadness
o Sleep changes
o Nutritional changes
o Physical symptoms
o Lethargy
o Difficulty concentrating
o Spends more time alone
o Suicide
o GDS – geriatric depression scale
Depression Management
o Diet
o Exercise
o Manage Stress
o Avoid drugs/alcohol
o Medications (anti-depressants)
o Suicide risk?
- report to your instructor/RN,
- refer to resources.
