Topic 6 Flashcards
what are the characteristics of a therapeutic relationship?
client centered
partnership
professional boundaries/violations
involvement/active participation
use of self (authenticity, presence, self awareness)
client centered
includes clients individuals preferences, values, beliefs and needs
partnership
honors clients right to self-determination, giving client and family maximum control over health care decisions- advocate for client and encourage independence
professional boundaries
protect function integrity of alliance between nurse and client
violations
take advantage of clients vulnerability and represent a conflict of interest
involvement/ active participation
degree of nurses attachment and active participation in clients care
over involvement
loss of essential objectivity need to support client meeting health goals
authenticity
requires admitting mistakes and recognizing vulnerabilities
presence
in the moment
self-awareness
reflective process seeking to understanding ones values, feelings, attitude, motivations, strengths and limitations
What is effective communication?
a 2 way exchange of information among clients and health care providers, patients and families ensuring that the expectations and responsibilities of all care are clearly understood
who created the original 5 c’s
the Joint Commission
6 C’s
clear
concise
concrete
complete
courteous
correct
professional standards for effective communication are set by which organizations?
Institute of Medicine (IOM)
the Joint Commission (TJC)
World Health Organization (WHO)
International Council of Nurses (ICN)
what did the IOM create and its goals in regards to effective communication
5 reports for safety and equality of health care
accurate, complete communication is one of its goals
what did the TJC create and its goals in regards to effective communication
regulates hospitals and evaluates safety fro accreditation
effective communication (6 C’s)
what did the WHO create and its goals in regards to effective communication
offered 9 solutions for increased health care safety
includes correctly identifying the patient and better communication during patient hand off
what did the ICN create and its goals in regards to effective communication
set expectations for communication in nursing goals including “ensuring confidentiality”
the ANA scope and standard of practice model of professional nursing practice regulation includes…
quality of care
safety
evidence (EBP)
Agency for Healthcare Research and Quality (AHRQ)
The branch of the US Public Health Service that is involved in patient safety by funding research and compiling evidence to publish best evidence-based standards of practice
American Association of Colleges of Nursing (AACN)
makes recommendations for nursing curricula- standard hand off report (SBAR)
what are the safety incidences? (where mistakes are made)
miscommunication
errors are usually system problems (multiple smaller events)
fatigue and hand off (up to 70% preventable)
high financial and human cost
under reporting med errors (90% go unreported)
what are some examples of unprofessional nursing conduct?
- breaching client confidentiality
- assuming nursing responsibility for actions without having sufficient preparation
- delegating care to unlicensed personnel, which could lead to client injury
- following a doctor order that would result in client harm
- failing to assess, report or document changes in client health status
- falsifying records
- failing to obtain informed consent
- failure to question physicians orders, if not clear
- failure to provide required health teaching
- failure to provide for clients safety (like not putting up bed rails)
what are some ways to ensure safer practices?
use of checklist
timely documentation
standardized tool for better communication (SBAR)
technology oriented solutions (electronic IDs, barcoding tech)
avoid work arounds
understand role relationships
EBP research and promote safer policies/procedures
safer practices from team strategies
transforming care at bedside
interdisciplinary rounds
huddles
change of shift reports done at bedside
call outs and time outs (surgery)
TeamSTEPPS “IPASStheBATON”
resource management with other team members to promote concise effective communication
communicate with other HCP to creates a team culture of collaboration and cooperation
SBAR
Situation
Background
Assessment
Recommendation
situation
patient name, age, room #
attending and consulting physical involved in care
diagnosis and admission date
description of pt. current situation
(SBAR) background
pertinent procedures/ test completed
allergies, code, most recent VS, BS, labs
basically head to toe assessment
current meds and comorbidities
assessment
any changes in respiratory status most important (medical) any changes in mental status (psych)
what happened during todays shift
last pain med given
any meds held/rationale
recommendation
suggestion of actions to be taken (plan of care, what patient needs, procedures/tests pending or to be scheduled)
any recommendation for discharge
at the end of SBAR what should happen
ask receiving nurse if they have any questions
therapeutic communication
-the purposeful use of communication to build and maintain helping relationships with the client, families, and significant others
-client centered: not social or reciprocal
-purposeful, planned, and goal-directed
characteristics of professional conversation include
specific rules and boundaries relates to function and privacy
define therapeutic goals
pt. centered
individualized strategies related to health related goals
nonverbal communication
tone of voice, inflections, facial expressional, body language, active listening (maintain eye contact, leaning forward, nodding, etc.)
TeamSTEPPS model
emphasizes improving patient outcomes by improving communication and using evidence based practices
clear
brief
timely
complete
the teamSTEPPS “I PASS the BATON” is used for..
more effective communication between health care teams and handoffs
I PASS the BATON
Introduction
Patient
Assessment
Situation
Safety Concerns
Background
Actions
Timing
Ownership
Next
introduction
introduce self and role
assessment (I PASS the BATON)
chief complaint, VS, symptoms, diagnosis
patient
patient name, identifiers, sex, location
(IPASSBATON) situation
current status, level of certainty, recent changes, response to treatment
safety concerns
critical labs, allergies, alerts (falls)
(BATON) background
comorbidities, previous episodes, current meds, family history
actions
what actions taken and why
timing
level of urgency, explicit timing and priorities
ownership
state who is resposible
next
state the plan: what will happen next, any anticipated changes
