UNIT 1 TEST Flashcards
Intrapersonal
Occurs within an individual
Interpersonal
One-to-one interaction between a nurse and another person
Transpersonal
Interaction that occurs within a person’s spiritual domain
Small Group
Interaction that occurs with a small number of persons; goal directed
Public/interdisciplinary
Interaction with an audience/team consist of patient family and all health care personnel involve in providing care
Referent
Motivates one person to communicate with another
Sender
who encodes and delivers a message
Receiver
Person who decodes the message and interprete
Message
Content of the communication/ using verbal or non verbal symbols
Channels
Means of conveying and receiving messages through the senses
Feedback
Indicates whether the receiver understood the meaning of the sender’s message
Interpersonal variables
Factors within both the sender and the receiver that influence communication
Environment
Setting for the sender -receiver interaction
Verbal Communication
code that conveys specific meaning through the combination of words
Connotative meaning
Interpretation of a word’s meaning influenced by the thoughts and feelings that people have about the word
Intonation
Tone of voice
Timing
When a pt expresses an interest in communicating
Pacing
Thinking before you speak and developing an awareness of the rhythm of your speech
Clarity and brevity
Simple brief and direct
Active Listening
being attentive to what the pt is saying bother verbally and nonverbally
Sharing observations
helps the pt communicate without the need for extensive questioning
sharing empathy
ability to understand and accept another persons reality
sharing hope
sense of possibility
sharing humor
coping strategy to adjust to stress
using touch
most potent form of communication
sharing feelings
subjective feelings that result from one’s thoughts and perception
using silence
useful when people are confronted with decisions that require much thought
providing information
pt’s have the right to know about their health status ans what is happening in their environment
clarifying
restating an unclear or ambiguous message
focusing
used to center on key elements or concepts of the message
paraphrasing
restating another’s message more briefly using one’s own words
asking relevant questions
seeking info needed for decision making
summarizing
concise review of key aspects of an interaction
self-disclosure
subjectively true, personal experiences about self that are intentionally revealed to another
confrontation
helping the pt become aware of inconsistencies in his or her feelings, attitudes, beliefs, and behaviors
asking personal questions
“why don’t you and john get married?:
giving personal opinions
“If i were you i’d put your mother in an nursing home.”
changing the subject
“Let’s not talk about your problems with the insurance company. it’s time for your walk.”
autonomic responses
“older adults are always confused”
false reassurance
“dont worry; everything will be all right”
sympathy
“im so sorry about your mastectomy ; it must be terrible to lose a breast”
asking for explanations
“why are you so anxious?”
approval or disapproval
“you shouldnt even think about assisted suicide; it is not right”
defensive responses
“no one here would intentionally lie to you”
passive responses
“things are bad, and there’s nothing i can do about it”
arguing
“how can you say you didnt sleep a wink? you were snoring all night long.”
communication techniques for those who cannot speak clearly
listen, do not interrupt; ask simple questions; use visual ques; allow time for them to answer ; do not shout
communication techniques for those who are cognitively impaired
use simple sentences; be attentive ; include family/friends; listen
communication techniques for the who are hearing impaired
check for hearing aids; reduce noise; rephrase; speak in a normal voice
communication techniques for those who are visually impaired
check for glasses; identify yourself; use 14 pt font; speak in a normal tone
communication techniques for those who are unresponsive
call pt by name; explain all procedures; orientate; speak as if they were responsive
Communication techniques for those who do not speak English
use an interpreter; avoid using family ; develop communication aids; use normal tones
Communication
ongoing dynamic series of events that involves meaning from the sender to receiver; life long process; not natural/needs to be learned; ongoing and multidirectional
purposes of communication in nursing
assessing the health status of clients of;being a patient/family/professional advocate;helps to meet legal ethical clinical standards;alleviates anxiety and fear in patients and their love ones;teaching ;problems solving/critical thinking;aid in coordination of the health care team; facilitates expression of feelings
assessing the health status of the client
gathering a history; its a base line to plan/identify problems
being a patient/family/professional advocate
speak for those who cant speak for themselves
helps to meet legal ethical and clinical standards
documentation about patient progress;
teaching
call light; urinal;teaching familys about care
problems solving/critical thinking
communication with each other to solve problems
developing communication skills
practice;have a good understanding of the communication practice;have good critical thinking skills
Good critical thinking skills
know the theory behind communication;evaluate and rationalize
factors that influence communication
values and perceptions,culture,territoriality, space and distance,time,nursing attitudes,development,roles in relationships,gender
values and perceptions
behavior and personal views of an event;clarification is a must
culture
blueprint for thinking and behaving ex.. eye contact;learn through experience
territoriality, space and distance
boundaries maintain our right to space; easily violated
intimate zone
0-18” ex. dressing changes/ADLs/assessment
personal zone
18”-4’ usual zone for communication ex. shift change teaching
Social zone
4’-12’very little sharing of thoughts ex. rounds
public zone
12’+ ex. clear verbalization
social zone
generally permission not needed ex. behands arms back
consent
permission needed ex. mouth feet and wrist
vulnerable
permission needed ex. face kneck front of body
intimate
permission needed genitalia and rectal
time
hardest for nurses;uneven between all pts.;good orginizations skills needed
nursing attitudes
a positive atitude is caring and warmth; a negative attitude would be condescending and cold
development
cognitive ability
roles in relationships
assume authority; past experience will influence this
gender
females seek confirmation and are eager to share; males dont speak directly
vocabulary
medical term used appropriately ex. jargons or trends
denotative
meaning due to common language
relevance
they have to see it explain
credibility
reliable;trust worthy;persistent;consistent
NON VERBAL COMMUNICATOINS:
PERSONAL APPEARANCE
grooming; first impression;
posture and gate
reflect our attitudes
facial expression
pts watch our faces;
eye contact
signals a readiness to communicate;differs from culture to culture;can show respect or lack of;can show lack of confidence
gestures
can communicate safely; clarify
sound
active listening
non verbal communications accounts for
55% of communications
verbal
accounts for 7% of communications
social cues accounts for
38% of communications
phases of therapeutic relationships
pre-interactions; orientations;working and termination
pre-interaction phase
reviews records anticipate plans; become aware of other person
orientation phase
meet and greet; sets tone
working phase
client and nurse work together;work to solve problems and set goals
termination phase
during the end of the relationships; reminds pts. that termination is near evaluate goal achievement relinquish responsibility
elements of professionalism related to communication
courtesy;use of names; trustworthiness;autonomy; and responsibility;assertiveness
courtesy
knocking adressing pts. and family
use of names
call them by their formal name. avoid elder speak and call them by room number
trustworthiness
rely on someone without doubt
autonomy and responsibility
respect for pts. responsible for outcomes and actions
assertiveness
expression without judgement
assessing the communication situations
developmental status socio-cultural status;physical and emotional status;values and perceptions;environment
life span considerations
infants;todlers and preschoolers;school age; adolescents;elderly;
infants
crying smiling posture expression
toddlers
simple;use play to communicate
school age
include them in communications;get on their eye level; honesty and word choices
adolescent
be nonjudgmental; active listening
elderly
avoid elder speak; be aware of sensory deficit
socio-cultural status
their age ethnic and religious practices
physical and emotional status
address their pain;and pick up on cues/clues
values and perceptions
individualize cultural differences and their motivations
environment
privacy and noise;distractions free,space
Goals and outcomes
establish trust;state the side effects
priority setting
how to communicate urgent needs; tone
continuity of care
share info with staff, keep the info private that should be though
LEVELS OF COMMUNICATIONS WITH YOUR PATIENTS
first level; second level; third level;fourth level
first level
cliche conversation; requires least involvement as it does not require much thought ex. introducing oneself : “ how are you?”
second level
fact reporting; basically objective and does not reveal much about the persons involved in the interations ex. PTS report symptoms
Third Level
sharing personal ideas and judgments; some sharing of self is taking place: ex.. guide PTs. into next level
fourth level
sharing of feelings(fears hopes,illness,dying,sex,death,etc.);some may not reach this level due to fear and rejection, appearing weak: ex.. ask whats wrong and build a relationship
IMPLEMENTING NURSING INTERVENTIONS FOR COMMUNICATION
INTRODUCE YOURSELF,FOCUS CONVERSATIONS ON PATIENT, EXPLAIN THE PURPOSES OF THE INTERACTIONS
introducing yourself
a.always introduce your professional position of nursing.b. Explain your purpose for being there.C. explain the duration you will be there EX. “good morning, I am Jane, an ivcc nursing student. i am going to be participating in your nursing care today till 11a.m”
focus conversation on the PTS., not yourself
redirect; refocus when necessary
explain the purposes of your interaction
validate confidentiality .” mrs. jones i am going to ask you some questions in order to get informations to plan your care for the day”
TO ENCOURAGE POSITIVE INTERACTIONS
- encourage the patient to begin to continue to express feelings and ideas. 2. pick up on cues/clues. 3. accept the patients exactly as is. 4. ask questions to better understand what the patient thinks and feels rather than just to get or give specific factual information.5. wait for validations of how your pts is understanding before proceeding. 6. follow up on your promises
Be aware of negative influences on communication
- ignoring or missing patients cues; verbal or nonverbal; doing anything on or to the pts without an appropriate explanations/communication; responding only to the literal meaning of the pts words; ignoring the importance of the pts questions and statements;assuming that you understand the pts feelings and ideas and not validating your understanding; using any of the non therapeutic techniques of communication; not follow up on your promises
CHALLENGING COMMUNICATIONS SITUATIONS
dealing with anger
dealing with anger
be aware of nonverbal communication.. be aware of cues that reflect anger, hostility, etc; validate the presence of anger if possible; do not close the anger down too soon.. anger is a feeling not logical reasoning; listening for the cause and meaning of the individuals anger. at the last of control it may not always be.search for sollution if situations escalate offer a time out. discuss with individual other ways to deal with the anger
dealing with dependency and manipulation
be calm, firm, nonjudgmental attitude; dont accept derogatory remarks; set limits on attention-seeking behaviors; what can we do; allow time for the person to express feelings; manipulation; reinforce independent behavior and successes
CULTURE
thoughts,m communication, actions,customs,beliefs,values & Institutions of racial ethnic, reliqious or social groups
ethnicity
within a culture, shaved identity related to social and cultural heritage
subculture
distinct characteristics from dominant culture; socioeconomics “nurse”
Socioeconomic culture
group simnilar in financial position or wealth, education and/or occupation who have similar status, lifestyle, feelings, attitudes, language usage, and/or behavior
religious culture
refers to type of religious group what have specific values, attitudes, and/or behaviors
family culture
consists of ways of living and thinking that constitute the family and sexual aspects of group life.
Religion
is a major component of one’s heritage. religion is defined as a system of beieifs, practices and ethical values a person practices to express spirituality.
CULTURAL CONCEPTS
emic,etic,enculturation,acculturation,assimilation
Emic worldview
insider(native) ex. Korean woman wants seaweed soup
etic worldview
outsider view.ex. nurse doesnt understand
enculturation
socialization; ex. two different sides of parents. two different languages
acculturation
adapting new culture; involuntary; ex. affiliation in dominant culture
assimilation
adopts dominant culture-lose their culture; ex. facial covering of the muslim women, then in the US they remove them
biculturalism
identify-with 2 or more cultures; ex. canadians
cultural backlash
rejects a culture; connotation; ex. Rum Springer
Diversity
facts or state of being different. ex. race gender, religion
race
classification of people according to shared biologic characteristics, genetics markers, or features; different ethnic group can belong to the same race; not all people of the same race share the same culture; ex. skin color
transcultural nursing
comparative study of cultures to understand similarities and differences across human groups..goal is; culturally congruent care.
Culturally Congruent Care
care that fits the persons life patterns, values, and a set of meanings
cultural competent care
process of acquiring specific knowledge, skills and attitudes to ensure delivery of culturally congruent care.. 5 components; ability to bridge cultural gaps in caring, address cultural differences/assist to achieve supportive care.
Cultural conflicts
ethnocentrism, discrimination, cultural imposition, prejudice, stereotyping,culture shock
ethnocentrism
holding ones own way of life as superior to others. view from own cultural perspective. ex. nurse refusing to give meds to african bcuz she thinks they all use drugs
discrimination
action of prejudice ex. all Mediterranean are terrorists
cultural imposition
use own values/lifestyles as absolute guide in dealing w pts. and interpreting their behaviors. ex. nurse refuses pts. discomfort because she believes they should bare the pain quietly
prejudice
negative belief or preference that is generalized about a group that leads to a “pre-judgment” ex. passenger iraq was asked to exit the plane after other passengers complained
stereotyping
assuming all members of a culture or ethnic group are alike. ex. all men are weak. mean dont cry
culture shock
disorder that occurs in response to transition from one cultural setting to another; former behavior patterns are ineffective in such a setting and basic cue for social behavior are absent.ex. change of culture and adapt study at home
WHY DO NURSES NEED TO KNOW ABOUT VARIOUS CULTURES?
to provide people of other cultures with nursing care; improve pts/familys compliance; become cultural competent
cultural assessment
systematic and comprehensive exam of the cultural care values, beliefs, and practices of individuals families and communities- this allows nurses to gather info that enables the nurse to implement culturally congruent and safe pts care.
cultural assessment
NURSES NEED TO BE AWARE OF THE POPULATION DEMOGRAPHICS IN THE COMMUNITY SETTING IN WHICH THEY PRACTICE
Communication
Ask questions establish relationships and Take into consideration Beliefs about Eye contact space and touch
Asking questions
What is their dominant language ?are they willing to share thoughts ?know the meaning of touch and personal space; use their name
Establishing relationships
Miscommunication is common; do you need an interpreter ? use touch and expressions ;watch for cues and clues
Heritage and ethnohistory
Heritage includes their country of origin; if they are younger they may be more Americanized Ethnohistory is the significant historical experiences of a particular group ;older Americans save everything because of the Great Depression
Bio cultural
Certain diseases based on culture and race
Social organization
Know the roles of family members and determine the hierarchy
Religious and spiritual beliefs
Ask about special diets and rituals with death
Communication pattern
Determine different linguistics nonverbal patterns and cues and close
Time orientation
Is what is happening right now more important are they present time orientated; Attached meds two events to get them to take them better
Cultural care preservation and maintenance
Retain or preserves relevant care values so patient maintains their well-being recover from illness or face handicaps and/or death
Cultural care accommodation or negotiation
Adapt or negotiate with others for beneficial or satisfying health outcome
Cultural care repatterning or restructuring
Reorder change or greatly modify the patient’s lifestyle for a new different and beneficial healthcare pattern
Professional standards review organization(PSRo)
Created by federal government reviews quality quantity and cost of healthcare
Utilization review UR
Reviews admissions ,plans of care ;identifies eliminates over use or misuse of resources
(PPS)prospective payment system
1983, what medicare will pay for
(DRG) Diagnostic Related Group
fixed rate- decreased stay ; classification or grouping of PTS. according to med diagnosis ; over 500 DRGs
(RUG)Resources Utilization groups
used in long term care same as a DRG
Capitation
fixed amount per client; payment plan based on best standards and care practices
managed care
administrative control over primary health care services; predetermined payment; cost containment/reduction; client satisfactory; health /functional status
Medicare
federal funded health insurance 1965 social security act ; 1972 permanently disabled added; 1988 increase to major illness/drugs/ 2006 part D-MED; no dentures, glasses ,hearing aids, 2 parts A med/surg B voluntary partial-Dr. visit
Medicaid
1965 Federal State funded welfare; partial health care services to indigent people; SSI Diability; state should be reimbursed by the Federal Govt.
Private Health Insurance
3rd party payers; purchased as individual/group;payments for services varies;premiums/deductible/ x> 40% on insured
managed care organizations
focuses on health maintenance/primary care; needs referral; gait keeper PCP
Preferred Provider (PPO)
select physicians within system; networks of providers give discounts
Health Maintenance Organizations(HMO)
littel/no deductible-cheap; wellness prevention;only PCP can refer PTS. to specialist ; limited service provisions
Exclusive Provider (EPO)
limits choices; less access to specialist
Long-term care Insurance
supplemental for LTC;expensive; may covered skilled care, assisted living home care
factors influencing delivery of health care
Cost;Access:Quality
Costs
driving force for change in the health care system; spend more on this than any other people needs; increase costs due to; oversupply of specialized providers;surplus of hospital beds; passive consumer;inequitable financing of services
access
americans cannot afford to get sick because they have no insurance; people have limited transportation.; many people are underinsured
quality
30-40% of diagnostic and medical precedures in USA are unnecessary : Health institution are focused on cost containment. 80% of hyster. unnecessary
Primary Care
focuses on health services provided on individual basis
Primary Health Care
focuses on improved health outcomes for entire POP.
Primary Care services
Schools;Occupational health;physicians office;parish nursing;community settings
schools
school nurses
occupational health
within workplace
physician offices
Nurse Practitioner and P.A. B/P screenings
community settings
outpatient clinics WIC
secondary & tertiary care
Acute Care; hospitals; critical care access
Psychiatric Facilities
Choices; Very limited for mental health services
Restorative care
Home Care Agencies; Home Health care
Rehabilitation facilities
PT
Skilled Nursing Facilities
Bounce Back; Intermediate Care
Extended Care Facilities
Intermediate Nursing Care; Kindled
Continuing Care Facilities
Assisted Living; No Nursing Care
Nursing Centers (ex. Gateway. Horizon house)
24 HR Custodial Care
Hospice
Family centered care 6month or less survival rate
Respite
relief for care givers
Adult Day Care
day time services for people who are not ready for long term care
challenges within Healthcare System
disillusionment with professionals;lost of control;decreased hospital use;changing practice setting; ethical issues; vulnerable populations
Disillusionment with professionals
think HCP are greedy untrusting of drug companies; publicity of errors
Loss of control
jobs based on benefits
decreased hospital use
pt going home more quickly
changing practice settings
70-80% of care in home
ethical issues
compassion vs. cost
Vulnerable Populations
elderly/children/disabilities/poor
trends affecting Healthcare
Listed below
“Graying of America”
more long term illness 95% of elderly at home; 85+ Increases population
Number of children decreasing
23% in 2010 less children
greater family diversity
single parent home 90% mom ; 26% live with biological parents
changing life style
increase obesity; drug/alcohol
unstable economy in the USA
1/4 children in poverty
greater demand for primary care providers
decrease Physicians
advances in technology and demands for them in outpatient settings
Decrease PHY
More emphasis on disease prevention
PTs discharged sooner; outpt care
more emphasis on individuals assuming more responsibility for their care
globilizations of health care;internet; recruitment of foreign nurses; outsourcing
Community based Health Care
model of health care; focuses on primary care; health prevention; outside traditional health care institutions
list some of the challenges in community based health care that you believe affects area
underimmunilized
community-based nursing
focus is on individual within community; promotes autonomy acute/chronic care
vulnerable population
\most likely to develop problems; illegal;abusive sit.; mentally ill
Major Aspects Of A Community Assessment
Listed Below
Physical Environment
boundaries of community; houses;vandalizm; substances abuse
Education
Schools; Lunch Programs?;Library?
Safety & Transportation
Public; Fire/Police; EMS System; Air Quality
Politics & government
Democrat? or Republican?
Health & Social Services
Average life Expectancy
Communication
Newspaper/Radio/Postal Service
Economics
Main industry- Stable?
Recreation
Church; Parks; Sports
Preparing Pts. to return home
listed below
Personal Health Data
Pts. history. Background
abilities to perform ADLs
needed help?
disabilities/limitations
comfortable
care responses/ abilities
whats their relationship to the patient
Financial Resources
any increase concerns; how do you get food; diabetic education
community resources
legal monetary
home hazard appraisal
lock at safety lighting; grab bars
need for healthcare assistance
meals on wheels; ADL assistants
Health Wellness
Health is a multidimensional concept and difficult to define
Health
Environment: complete physical, mental, and social well being; not absence of disease/illness
holism
views health according to mind body, spirit
physiologic
maslows, air, food,water
psychological
mental health,anxiety
socioculture
interaction of ppl
intellectual
ability to learn use info
spiritual
belief in source that gives our life meaning
health beliefs
ideas,convictions,attitudes about health,illness, influences health behavior
Health Behaviors
actions taken by the individuals based on health beliefs
Models of health and illness
listed below
1.Basic human needs model
based on maslow hierarchy of need-physiological-safety and security-love and belonging-self-esteem-self-actualization
2.Health belief model
Listed below
addresses relationships between persons belief and behaviors: aids in understanding and predicting
3 listed Below
individual perceptions
susceptibility to disease
modifying factors
perceive it as serious
likelihood of action
person changes behavior based on beliefs
3.Health Promotion Model
Below
Defines health as a positive, dynamic state, not merely absence of disease
individual characteristics and experience, behavior-specific cognitions and affect;behavior outcome
INFLUENCING VARIABLES
Below
1.INTERNAL
?Below
Developmental
children, fearful, anxiety
intellectual
beliefs shaped by knowledge/ lock of
perceptions
gathered-subjective; verified-objective
emotional
stress fear, coping abilities
spiritual
what do they value
EXTERNAL
below
family
perceptions of seriousness
socioeconomic
increase risk for illness
cultural
influences values
Health Promotion
help PT. maintain/enhance present level of health
Wellness
state of well being
Comprehensive of wellness
social,emotional,intellectual,spiritual,occupational, environmental??
Prevention
protect clients from threats to health avoid decline in health
passive vs. active strategies for health promotions
P-gain from others; A- choose
Levels of Prevention Care
Below
Primary Prevention
True prevention: ex. Immunizations
Secondary Prevention
Diagnosis prevent complications; Ex. Screenings
Tertiary Prevention
Rehab irreversible: ex. Rehab
risk Factor
any situation that puts a person at risk
Non-modifiable risk factors
Age;Gender;Sex
Modifiable Risk Factors
Environment:Lifestyle:Stress
Illness
physical, emotional, intellectual that diminished person
Acute VS.Chronic Illness
A-Heal; C-6month + lead to disability
illness behavior
how behaviors affect illness; coping mechanism;internal/external variables.
Travis wellness-illness continuum
Below
Highest death level of wellness——Dichotomy——–
“normal”
——-Premature
throughout life, an individual can travel back and
forth among this continuum
Impact of Illness
below
Behavior and emotions
mild illness; extreme anxiety
body image
physical appearance
self-concept
mental self image of strength/weakness
family roles
sandwich system
family dynamics
death;divorce
HEALTH MAINTENANCE
below
Health promotion activities
are actions to improve a person health status. this means every person , even without disease present; bike safety
health protection activities
are actions usually taken by gov. and community agencies for the betterment of all individuals. these are done for the good of all
Disease Prevention Activities
are actions to protect people from actual or potential threats to their health status. individual may have one or more risk factors for certain diseases or have an actual disease that could be better controlled to prevent further problems from developing: HEALTH THREAT
