Unit 3 Flashcards
Responsible for language, taste, touch, and smell
Important in regards to communication because this is where we process language
Parietal Lobe Function
Responsible for vision, color, letters, and direction
Important for communication in written form
Occipital Lobe Function
Anything that has influenced you life that is not based on genetics
Experimental knowledge
Exs: Values, beliefs, attitudes
CULTURE/RELIGION, social status, gender, age, development, environment (setting)
A-posteriori Influences
The imparting or exchanging of information or news
Means of sending or receiving information
EXCHANGE of information (listening and talking)
Communication definition
Responsible for thinking, speaking, memory, and movement
Higher level of cognitive processes take place/separates us from other species
Frontal Lobe Function
Responsible for hearing, learning, feelings, and fear
Temporal Lobe Function (IMPORTANT)
Emotional center
Decision Maker
Located near temporal lobe
Amygdala
Territoriality: Who owns the space?
Density: How many people are around?
Distance: How close am I to the person I’m talking to?
Environment’s Influence on communication
Use play-transitional objects, be honest, DO NOT LIE, allow them to express concerns , avoid abstract concepts so do not try to explain to them things that will happen later, kids are also talked over by their parents a lot
Influences on communication (Childhood)
Very concrete on the view of the world, do not do abstract concepts well, have a difficult time differentiating fantasy from reality so be careful using euphemisms
( Example: If you tell a child that you are going to put a stick in their arm (IV) they will think you are putting a tree)
Influences on communication Under 6
Children are starting to develop morals, tend to see the world in black and white/ wrong and right, may see pain as a result from them being bad
Influences on communication 7-10
Moral crisis, peers become a huge influence
Influences on communication Adolescents
Be aware of sensory deficits
Influences on communication Older Adults
- Accidental
- Unpredictable: You do not know what results you are going to get
- Unreliable: Do not know if this is actually going to work
- Unrepeatable
Unintentional Communication
- Purposeful
- Predictable
- Reliable
- Repeatable
Intentional Communication
- We often assume sensation dictates what we know or observe but that is not the case
- What we attend to often dictates what we sense, therefore it is easy to miss things we do not attend to
Sensation and Perception
- Communicating without the use of words.
- Eye Contact: Important to allow pt to feel comfortable/ connected to you and that you are paying attention to them
- Facial Expression: Helps people understand the intent of your words, make sure you acknowledge your RBF
- Body position: Example: Backing up towards door, standing over someone
- Body language: Can affect how the patient views you (that you are nervous, uninterested etc), also shows how you feel about what you are talking about
Non-Verbal Communication
-They way in which people show what they mean other than by the words they use
- Examples: Vocal cues, volume, emphasis, rate, tone, pitch, pauses
Paralanguage (IMPORTANT)
- Why
- How
- What
- Start with why! Explain why we are doing what we are doing, how we are doing it, and what we are doing
- Example: The way apple markets: Saying they are making the best products, with the best people etc
The Golden Circle (Simon Sinek) (IMPORTANT)
- Empathic listening in which the listener echoes, restates, and clarifies.
How?
> Pay attention
> Demonstrate attention: Reflect back what pt is saying
> Clarify statements: Ask for clarification, “Who is they/ who are we talking about”
> Defer judgement: Wait to make judgement about what pt is saying until the end (Example of MR. Brown’s pt saying a man is peaking in her window but it was actually him in the reflection of the window)
> Respond appropriately: Be aware of parallel conversations
Active Listening
- Find little things that you can deal with early on in the day and make it a priority
- Example: Getting water for pt when asked first before doing your assessment
How we let the client know we are on their side
- Asking a pt “how you doing” and getting a simple response of “good”. You then need to follow up with “how are you feeling, how did you sleep, how was your night”
Rephrase how you communicate: Examples
- Verbal and nonverbal communication techniques that encourage patients to express their feelings and to achieve a positive relationship.
- Examples:
> Silence: Ask a question and wait for response
> Open ended questions
> Clarifying: Go back through what you said and reflect back what you said
> Paraphrasing: Say back what they said to make sure you heard them correctly
> Reflecting
> Sequencing: What came first?
> Voice Observations: Give pt your impression of what they said
Therapeutic Communication
- Being defensive: Acting like you are being personally attacked- shuts client down
- Passing judgement: “ You do not listen, you’re not compliant”, these phrases shut down communication
- Challenging: Just hear pt out
- Giving false reassurance: Destroys trust
- Changing topic
- “Trite” Statements: Meaningless statements- gives off impression that you are done talking
- Giving common advice
- Implying external source of power
Barriers for communication
- Family members should NOT serve as interpreters
- Explain intent to interpreter
- Engage with individual
- One question at a time
- Considering collaborating with interpreter after session
Considerations for using an interpreter
- Material Boundaries: Territoriality, do not cross boundaries without pt permission
> Examples: Doors, blankets, bed rails, sitting in a chair across from the pt rather than standing above the pt - Social Boundaries: Do not over share your personal stories, do not share anything on social media
- Personal Boundaries: Nurse has an obligation to be a professional with client
Nurse Client Boundaries (IMPORTANT)
- Expressive: Trying to express how one feels
- Instrumental: Trying to get something done
> Example: Making an appointment
Expressive Behavior vs Instrumental Behavior
Trying to express how one feels
Expressive
Trying to get something done
Instrumental
- Disrespectful treatment, including behaving in an aggressive manner, interrupting the person, or ignoring his or her opinions
> Lateral Violence - We are on the same level, there is no power struggle
> Bullying (IMPORTANT) - Requires power differential (ranks or experience)
> Harassment
Incivility
- Trying to move pts from Expressive Behavior to Instrumental Behavior by active listening
- Empathy: Pay attention to what pt is saying
- Trust and Rapport: Paraphrase what pt is saying
- Influence:
- Behavioral Change
Behavioral Influence Stairway Model
- Be assertive by being honest, direct, and appropriate to individual that you have the issue with
- Give feedback
- VERBS not adjectives
How to deal with conflicts
- A form of communication in which the individual fails to say what is meant
- Contributes to bad behavior
Passive communication
- Escalates situation
- Forfeits moral high ground
Aggressive Communication
- Communication style which is characterized by the desire to avoid conflict but still manipulates the situation to meet the end goal
- Enables behavior and behind the back it creates hostile work environment
Passive-Agressive Communication
- For nurse to provider
- Introduction/ Identity: Who you are, who is the pt, where are they
- Situation: Brief description of the problem
- Background: Pertinent history/ hospital course
- Assessment: What do you think is going on? What have you done so far? Pt response
- Recommendation/Request
I-SBAR
- Used for nurse to nurse report
- S: Name, age, allergies, code stats, Dx, Isolation
- H: Hx present illness, pertinent medical hx
- A: Assessment, give by system, only give abnormal and pertinent negatives, include drains, lines etc
- M: Medications pertinent to care
- L: Labs, abnormals, pertinent negatives, pending/need to be collected
- D: Diagnostic testing, abnormals, pertinent negatives, pending/ need to be collected
SHAMLD (IMPORTANT)
- A file that contains documents that describe a specific patient’s medical history and medical care within one healthcare organization; also known as a chart or file
- Formal Legal Document
Medical Record
- Communication
- Planning
- Auditing
- Research
- Education
- Reimbursement (really why we use medical records haha)
- Liability
- Healthcare Analysis
Purpose of a medical record
- Health Insurance Portability and Accountability Act
- Applies to ALL health records
- Anything that is unintentionally shared is your fault
HIPPA
- EHR requires passwords
- WE do not leave terminal unattended
- WE shred any unneeded paper doc with PHI
- Be careful where you talk/ who you talk to (If pt tells you can share the information with the person then you can, if pt is mentally incapacitated then you can share if you feel it is beneficial to the pt)
- No PHI on social media
- Use fax coversheet
- If someone lies about their identify to get health information that is not your fault
How do we protect patient information
- Documentation system in which each health care group records data on its own separate form/ section
- How traditional charts were organized
Source-Oriented Record
- Records organized according to the client’s health problems
- Documentation addresses each problem
- Components:
> Database
> Problem List
> Plan of care
> Progress notes-> SOAP notes
Problem Oriented Record
-Subjective: What client pt says/ experiencing
- Objective: Vitals, assessment data, what we see etc
- Assessment: What we think is going on/ nursing judgment/ interpretation of the data we gathered (IMPORTANT)
- Plan
SOAP notes (IMPORTANT)
- Patient concerns first
- Only assessing what client is complaining about
- DAR
> Data: What we gathered
> Action: What we did
> Response: How the pt responded
Focus Charting (IMPORTANT)
- Use of predetermined standards and norms to record only significant assessment data
- Presumes nurse performed assessment
- Limited doc may raise risk of liability
Charting by exception
Needs to be:
- Accurate and confidential
- Date an Timed
- Legible
- Permanent
- Concise and precise
- Complete
> Assessment
> Interventions/ notification
>Pt/ Provider response
> Anything you held
> Important pt statements
Documenting Nursing Actions
- A comprehensive admission assessment, completed when the client is admitted to the nursing unit.
- Must be done in 24 hours
- Where you find clients risk factors
Admission Nursing Assessment (IMPORTANT)
- Skelton that supports documentation
- Do not really use this
Nursing Care Plans
- Quick reference
- Varity of information
- NOT part of medical record
Kardexes
- Majority of our documentation
- Example:
> Vital Signs (Vital flowsheet)
> Intake and output ( I and O flowsheet)
> Medications: MAR
> Lung sounds (Assessment)
> Volume of fluid run from antibiotic ( I and O flowsheet)
Flowsheets (IMPORTANT)
- Narrative
- SOAP
- ADPIE
Progress Notes
- Documents patient discharge plans and instructions
- If pt is being referred to another care facility
Nursing Discharge Summar
- U: Units
- IU
- QD, QOD: Write daily/ every other day
- Trailing zero
- Lack of leading zero
- MS: Write morphine sulfate or magnesium sulfate
DO NOT USE medical abbreviations
AC
Before Meals
HS
At bedtime
BID
Twice a day
Abd
Abdomen
ad lib
As desired
ADL
Activities of daily living
amb
Ambulate
BRP
Bathroom Privileges
DAT
Diet as tolerated
Dx
Diagnosis
gtt
Drop
LMP
Last menstrual period
OOB
Out of Bed
OS
Left Eye
P
After
pc
After Meals
qid
4 times a day
TO
Telephone Order
TPR
- Temp
- Pulse
- Resp
ECD
Esophagogastroduodenoscopy
- Nurse may accept telephone orders from person designated by physician
- Have to read order back to physician
- Can not take telephone order over text/ perfect serve
- Nurse cannot make medical judgements- order must be complete
- When range is given, suffcient instructions should be included
- If desired effect has not been achieved, nurse is obligated to notify physician
Telephone and Verbal Orders (IMPORTANT)
- Anyone that acts on the behalf of someone else
- Holistic in its approach
- Goal is to protect the clients rights
- Remain objective
- Accept and respect the client’s rights to decide, even if the nurse believes the decision to be wrong
Advocates
- Client may revert to old habits, may be seen as noncompliant, client autonomy must be respected
- Client has limited resources
- Lack of client care services
- Consider finances
Advocacy in Home Care Considerations
- Self-care: Massage, vent, etc.
- Speak UP: Marches
- Participation: Debriefing
- Education: Make sure that we are competent to provide care, continuing education,, advanced degree, literature
Advocacy for Self
- Be assertive and not aggressive
- Have respect for others
- Consider social and economic factors: Get them in contact with the right people, food banks
- Ethical Considerations
- Know the chain of command
- Remain objective
- Respect others
How to be an effective advocate
- Can provide orders
- Examples:
> Attending physician: Can be medical or a specialty
> Consulting Physician: Infectious disease, nephrology, Psych, Surgical
> Nurse practitioner
> Physician’s assistant
Health Care Provider
- Plan and oversee care
- Special Nursing Roles
> Wound Ostomy Care
> Vascular Access Team
> Critical Care Resource RN
> Diabetes educator
> Pain management
Registered Nurse
- Provide care with some limitations
- “supervised” by RN
- Do not to admits/discharges
Licensed Practical Nurse
- Certified Nursing Assistant
- Patient Care Tech: Does not have to have CNA but depends on facility
- Medication Techs: Can give almost all oral medications
- Behavioral Health Techs
- Dept. Specific Techs
Unlicensed Assistive Personnel
- Pharmacy
- Physical Therapy
- Occupational Therapy
- Recreational Therapy
- Respiratory Therapy
- Nutrition/ Dietitian
- Interpreters
Professional Partners
- Radiology/ CT/ MRI/ ENDO (have to get report for ENDO)
- Phlebotomy
- Lab
Diagnostic/ Procedures
- Massage Therapy
- Music therapy/ healing arts
- Pet therapy
Alternative/ Complimentary
- Special Police
- Environmental services/ housekeeping
- Maintenance
Support Staff
- Community organizations
- Halfway houses
Outside Resources
- Share personal expertise with other nurses and elicit the expertise of other to ensure quality of care
- Develop a sense of trust and mutual respect with peers
Nurse Collaborating with other nurses
- Recognize the contribution that each member of the interprofessional team can make
- Listen to each individual’s views
- Share healthcare responsibilities in exploring options, setting goals, and making decisions with clients and families
- Participate in collaborative interprofessional research to increase knowledge of a clinical problem
Nurse collaborating with other healthcare professionals
- Seeks opportunities to collaborate with and within professional organizations
- Serves on committees in state and national nursing organizations
- Supports professional organization in political action to create solutions for professional and healthcare concerns
Nurse collaborating with professional nursing organization
- Offer expert opinions on legislative initiatives related to healthcare
- Collaborate wit other healthcare providers and consumers on health care legislation to best serve the needs of the public
Nurse collaborating with legislators
- Communication: Understand roles
- Mutual Respect: Verbal/nonverbal
- Mutual Trust: Verbal/nonverbal
- Decision Making: Share responsibility
Competencies
- Used for bullying, incivility, diverting drugs
> Problem
> Charge Nurse
> Nurse manager
> Nursing supervisors
> Chief Nursing Officer
> CEO
Others:
> Human Resources: Abuse, sexual harassment
> Compliance: Fraud, improper business practices
> Ethic’s Committee
Chain of Command
> Problem
Instructor
Level Coordinator
Brenda
CFCC Chain of Command
