Unit II Flashcards
confidentiality
- keeping information private
- privacy standards
- HIPAA
process of communication, communication flow: sender
- 2
- person who conveys message
process of communication, communication flow: message
- 3
- information sent
process of communication, communication flow: channel
- 4
- the way it is sent
- visual, audio, tactile
process of communication, communication flow: receiver
- 5
- person to whom message is sent
process of communication, communication flow: feedback
- 6
- receiver shares perception of meaning of message
- allows for correction
elements of verbal communication
- spoken/written
- vocabulary
- pacing
- tone
- clarity
- time
- relevance
elements of non-verbal communication
- facial expressions
- voice cues
- eye contact
- gestures
- posture
- touch
- odor
- physical appearance
- silence
- time
elements of therapeutic communication
- improves relationship between nurse and client
- professional
- courtesy
- confidential
- trusting
- acceptance/respect
non-therapeutic communication
- hinders the nurse/client relationship
- judgmental
- accusatory
- inflammatory
- self-servicing
therapeutic communication
communication between client and nurse to enhance the health status and improve health of the client
social communication
communication that is personal and has no relevance to health status of the client and does not improve health of the client
factors that hinder communication
- inattentive listening
- poor listener
- using terms unfamiliar to client/family
- prying/personal questioning
- approval/disapproval
- changing the subject
- automatic responses
- think before you speak
- false reassurance
- don’t tell patient everything will be ok
- asking for explanations
- don’t ask “why” questions
- arguing with client/family
- being defensive
- sympathy
implement therapeutic communication
- sharing empathy
- active listening
- no yes or no questions
- sharing observations
- using silence
- providing accurate information
- clarifying
- focusing
- only on patient
- paraphrasing
- summarizing
- self-disclosure
- sharing
- hope
phases of caring nurse/client relationship
- pre-interaction phase
* prior to meeting - orientation phase
* meet and introduce - working phase
* working together to solve problems and accomplish goals - termination phase
* ending of relationship
communication skills to enhance patient/client relationship
- professionalism
- courtesy
- conveys respect, begins with introduction
- confidentiality
- HIPAA
- empathy
- active listening
- eye contact
- acknowledge patients
professional nursing values
- strong commitment to service
- belief in the dignity and worth of each person
- commitment to education: lifelong learning
- autonomy
* free to make decisions - altruism
* always promote good
* always to do good with the patient - freedom
- truth
* varisity
autonomy
- free to make decisions
- independence
- self-determination
- self-reliance
altruism
- always promote good
- always to do good with the patient
truth
varisity
ethics
- principles and standards governing proper conduct as applied to an issue
- what one ought to do in a situation
- format for making logical and consistent decisions based upon moral beliefs
professional code of ethics guides practice
- individuals agree to follow these rules and to codes of conduct by accepting the professional credential
- members agree to monitor others in the profession
- allows people outside the profession to be assured that a member of the profession will consistently act in a certain way
ethical issues
- arise when there is more than the one way to proceed with care
- neither way is clearly right or wrong
- conflicting moral claims
- conflicting wishes
determine if an issue is an ethical issue
- it cannot be resolved by scientific data alone
- is it perplexing?
- do others disagree about the best course of action?
- will the answer to the question have a profound relevance for several areas of human concern?
* will it affect the patient in a positive way?
ethical/issue dilemma
- good people can disagree about the correct course of action without any malice or ill being present
- health care agencies have ethics committees to help treatment teams deal with these tough issues
- you are not on your own
teaching process
interactive process that promotes learning, consisting of a conscious and deliberate set of actions that helps an individual gain new knowledge, change attitudes, adopt new behaviors, or perform new skills
learning process
acquisition of new knowledge, attitudes, behaviors, or skills through reinforced practice and experience
process of communication, communication flow: referent
- 1
- reason that communication is occurring
cognitive domain (understanding/thinking)
- knowledge
* acquire facts or information and recall it - comprehension
* ability to understand the meaning - application
* applying newly learned abstract ideas in concrete ways - analysis
* organize ideas according to degree of importance - synthesis
* ability to recognize parts of information as a whole - evaluation
* ability to judge the worth of information, for a given purpose
knowledge
acquire facts or information and recall it
comprehension
ability to understand the meaning
application
applying newly learned abstract ideas in concrete ways
analysis
organize ideas according to degree of importance
synthesis
ability to recognize parts of information as a whole
evaluation
ability to judge the worth of information, for a given purpose
affective domain (attitudes)
- receiving
* attend to another’s words - responding
* reacting verbally and nonverbally to the other’s words - valuing
* attaching worth to an object - organizing
* developing a value system by identifying and organizing values and resolving conflicts - characterizing
* acting and responding with a consistent value system
receiving
attend to another’s words
responding
reacting verbally and nonverbally to the other’s words
valuing
attaching worth to an object
organizing
developing a value system by identifying and organizing values and resolving conflicts
characterizing
acting and responding with a consistent value system
psychomotor domain (motor skills)
- perception
* awareness of objects or qualities through the use of senses. associating sensory cue with action - set
* readiness to take a particular action. know exactly what to do, be committed - guided response
* performance of an act under guidance of another - mechanism
* higher level behavior when a person has gained confidence and skill in performing the behavior - complex overt response
* performing a motor skill involving a complex movement pattern - adaptation
* person is able to change a motor response when problems arise - origination
* highly complex. creating a new movement pattern based on existing skills and abilities - give access to reading materials before teaching
- if you can’t answer a question, say so and offer to help find an answer. don’t bluff
- if teaching a new skill, demonstrate and allow return demonstration after practice
perception
awareness of objects or qualities through the use of senses. associating sensory cue with action
set
- readiness to take a particular action
- know exactly what to do
- be committed
guided response
performance of an act under guidance of another
mechanism
higher level behavior when a person has gained confidence and skill in performing the behavior
complex overt response
performing a motor skill involving a complex movement pattern
adaptation
person is able to change a motor response when problems arise
origination
highly complex. creating a new movement pattern based on existing skills and abilities
principles of teaching-learning
- know the subject, present information and answer questions
- know what language your client uses
- know your audience
* teach according to assessment of client - match your methods to client needs
* cognitive: lecture
* affective: discussion
* psychomotor: demonstrarion - know yourself
* use strategies and styles you are comfortable with - don’t overwhelm with too much information. expose gradually, over time
principles of learning
- motivation to learn
- attentional set
* mental state that allows learner to focus and comprehend
- motivation
* internal impulse that causes a person to take action
- psychosocial adaptation to illness
- active participation - ability to learn
- developmental capability
* reading
- age group
- physical capacity - learning environment
- milieu
* environment: lighting, noise, temperature
attentional set
mental state that allows learner to focus and comprehend
motivation
internal impulse that causes a person to take action
milieu
- environment
- lighting
- noise
- temperature
assessing learning needs
- questions raised by client/family
- client’s level of understanding of current health status, treatment, etc.
- information or skills needed to care for themselves or family
- experiences that influence client/family
- necessary information needed
incorporating teaching with routine nursing care
- informal
- during ADLs
- during feeding
- whenever client/family ask questions
- formal
- set up time with client when they will be at optimal learning
- organize teaching, including items needed
- cover required information before addressing other topics
teaching: informal
- during ADLs
- during feeding
- whenever client/family ask questions
teaching: formal
- set up time with client when they will be optimal at learning
- organize teaching, including items needed
- cover addressing other topics
assess client
- learning needs
- motivation to learn
- ability to learn
- teaching environment
- resources for learning
identify client’s learning needs in three domains
- cognitive
- what the patient knows - psychomotor
- skills - affective
- attitude
- beliefs
- values
establish learning objective
- set priorities
- write teaching plan
- what do you want them to do?
- how will you know they have done it?
- when will you know? - select teaching methods
do the teaching
- select a good time
- organize your material
- start simple then go to complex - approaches
approaches
- telling
- only in emergencies
- selling
- participating
- set your learning objective
- entrusting
- trusting what the patient says
- reinforcing
- need a stimulus
- helps respond
- activities
- pamphlets, hand-outs
effectiveness of the teaching plan
- evaluate outcome of teaching
- teaching is not complete until outcomes are evaluated
- evaluation methods
* client can answer questions
* return demonstration
* discussion
- if new learning needs are identified during evaluation, may need to do more teaching - document the teaching
- be specific
- document evidence of learning
- describe method(s) used
evaluation methods
- client can answer questions
- return demonstration
- discussion
process of communication, communication flow: referent
- 1
- reason that communication is occurring
document teaching
- be specific
- document evidence
- describe method(s) used
telling
only in emergencies
participating
set your learning objective
entrusting
trusting what the patient says
reinforcing
- need a stimulus
- jelps respond
- activities
- pamphlets, hand-outs
cognitive: discussion
- one-on-one or group
- involves nurse and patient or nurse with several patients
- promotes active participation and focuses on topics of interest to patient
- allows peer support
- enhances application and analysis of new information
cognitive: lecture
- more formal method of instruction because teacher controls it
- helps learner acquire new knowledge and gain comprehension
cognitive: question-and-answer session
- designated specifically to address patient’s concerns
- assists patients in applying knowledge
cognitive: role-play, discovery
allows patient to actively apply knowledge in controlled situation
-promotes synthesis of information and problem solving
cognitive: independent project (computer-assisted instruction), field experience
- allows patient to assume responsibility for completing learning activities at own pace
- promotes analysis, synthesis, and evaluation of new information and skills
affective: role play
allows expression of values, feelings, and attitudes
affective: discussion (group)
- allows patient to acquire support from others in group
- permits patient to learn from others’ experiences
- promotes responding, valuing, and organization
affective: discussion (one-on-one)
allows discussion of personal, sensitive topics of interest or concern
psychomotor: demonstration
- provides presentation of procedures or skills by nurse
- permits patient to incorporate modeling of nurse’s behavior
- allows nurse to control questioning during demonstration
psychomotor: practice
- gives patient opportunity to perform skills using equipment
- provides repetition
psychomotor: return demonstration
- permits patient to perform skills as nurse observes
- is excellence source of feedback and reinforcement
psychomotor: independent project, game
- requires teaching method that promotes adaptation and origination of psychomotor learning
- permits learner to use new skills
patient’s behavior: denial or disbelief
- patient avoids discussion of illness (“there’s nothing wrong with me”) and disregards physical restrictions
- patient suppresses and distorts information that has not been presented clearly
learning implications: denial or disbelief
- provide support, empathy, and careful explanations of all procedures while they are being done
- let patient know you are available for discussion
- explain situation to family
- teach in present tense (explain current therapy)
rationale: denial or disbelief
- patient is not prepared to deal with problem
- any attempt to convince or tell patient about illness will result in further anger or withdrawal
- provide only information patient pursues or absolutely requires
patient’s behavior: anger
patient blames and complains and often directs anger at nurse
learning complications: anger
- do not argue with patient, but listen to concerns
- teach in pressent tense
- reassure family of patient’s normality
- continue to introduce only reality
- teach only in present tense
- reassure family of patient’s normality
rationale: anger
- patient need opportunity to express feelings and anger
- patient is still not prepared to face future
patient’s behavior: bargaining
patient offers to live better life in exchange for promises of better health (“if God lets me live, I promise to be more careful”)
learning implications: bargaining
- continue to introduce only in reality
- teach only in present tense
rationale: bargaining
patient is still unwilling to accept limitations
patient’s behavior: resolution
patient begins to express emotions openly, realizes that illness has created changes, and begins to ask questions
learning implications: resolution
- encourage expression of feelings
- begin to share information needed for future, and set aside formal times for discussion
rationale: resolution
patient begins to perceive need for assistance and is ready to accept responsibility for learning
patient’s behavior: acceptance
patient recognizes reality of condition, actively pursues information, and strives for independence
learning implications: acceptance
- focus teaching on future skills and knowledge required
- continue to teach about present occurrences
- involve family in teaching information for discharge
rationale: acceptance
- patient is more easily motivated to learn
- acceptance of illness reflects willingness to deal with its implications
health care ethics: justice
fairness or equity
health care ethics: fidelity
- faithfulness
- striving to keep promises
health care ethics: beneficence
- actively seeking benefits
- promotion of good
health care ethics: nonmaleficence
actively seeking to do no harm
