NUR 201 Exam 1 Review

- Gift giving - Spending more time than needed with the patient - Strenuously defending or explaining patient's behavior in team meetings - Keeping secrets - The nurse feels that he/she is the only one that understands the patient

Indicators of boundary issues

Need to be well thought of by oneself as well as by others

Maslow's Hierarchy of Needs: Esteem

Need for affection, feelings of belonging, and meaningful relationships with others

Maslow's Hierarchy of Needs: Love

Someone who undergoes treatment or care, Passive Comes from the Latin for "to suffer or bear", they accept what is done to them

Patient

- Pre-interaction Phase - Orientation Phase - Working Phase - Termination Phase - Have to follow in a sequence, they will build on each other

Phases of the therapeutic relationship

- Occurs before meeting the client - Review available data - Talk to other care givers who have information about the client - Anticipate health concerns or issues that arise - Identify a location and setting that fosters comfortable, private interaction - Plan enough time for the initial interaction - The nurse explores her own feelings

Preinteraction Phase

Put others ahead of themselves

Altruism

-The nurse must assist the client to be specific and not speak in generalities

Concreteness

Nurses, nursing, the client, environment, and looking at an intended outcome

Things that nurse theory and nurse theorists had in common

The professional organization that guides nursing practice in the United States is the: A) National League for Nursing B) American Nurses Association C) American Academy of Nurses D) International Council of Nurses

A) American Nurses Association

The nurse observes an adolescent clients peers calling the client names. Which statement by the nurse exemplifies the concept of empathy? A) "I can see that you are upset. Tell me how you feel." B) "Your peers are being insensitive. I would be upset also". C) I used to be called names as a child. I know it can hurt feelings". D) I get angry when people are treated cruelly".

A) " I can see that you are upset. Tell me how you feel".

Building a therapeutic relationship with the clients family and loved ones is.....

A key component of effective nursing care

"I don't know the answer right now, but I will find out in about an hour". This is an example of being honest with a client which is essential in: A) Developing a trusting relationship with the client B) Developing a friendship with the client C) Helping the client with termination D) Believing that you are a competent nurse

A) Developing a trusting relationship with the client

The nurse's ability to be open, honest, and real in interactions with clients is described as which characteristic that enhances the achievement of the nurse-client relationship? A) Genuineness B) Empathy C) Objectivity D) Harmony

A) Genuineness

A nursing student has a special feeling toward a client that is based on acceptance, warmth, and a nonjudgmental attitude. The student is experiencing which characteristic that enhances the achievement of the nurse-client relationship? A) Rapport B) Trust C) Respect D) Professionalism

A) Rapport

States that nurses take care human response to illness and stress as opposed to disease itself. Nurses are focused on things caused by the disease not the disease itself. Nurses take care of the patients response to the diagnoses, educate about diagnosis, take care of pre-op and post-op patients, administer chemotherapy, and treat the symptoms associated with chemotherapy.

American Nurses Association

The nurse is attempting to establish a therapeutic relationship with an angry, depressed client. Which is the most appropriate nursing intervention? A) Work on establishing a friendship with the client B) Use humor to defuse emotionally charged topics of discussion C) Show respect that is not based on the clients behavior D) Sympathize with the client when the client shares sad feelings.

C) Show respect that is not based on the clients behavior

Focused on the worth and dignity of others Says that everyone we interact with has equal worth and dignity

Code of Ethics

The opposite of caring; detachment, the belief that nothing can make a difference

Apathy

A nurse wonders why some surgical wounds heal better than others in clients who are the same age. This is an example of: A) A hypothesis B) A clinical question C) Results of a literature review D) A PICO question

B) A clinical question because it does not have all of the components of PICO.

A client states, "I want to learn better ways to handle my anger." This is most likely to occur in which phase of the nurse-client relationship? A) Pre-interaction phase B) Orientation phase C) Working phase D) Termination phase

B) Orientation phase

-Lack of respect - Lack of caring - Mistrust - Anxiety - Stereotyping - Lack of personal space - Violation of confidentiality

Barriers in the Therapeutic Relationship

- Guidelines, rules or limits that a person creates to identify what are reasonable, safe and permissible ways for other people to behave around him or her and how he or she will respond when someone steps outside those limits - Cultural bias - Dating coworkers - Personal space/information - The nurse does not attempt to have their needs met, they are there to meet the needs of the client.

Boundaries

Interpersonal guidelines that when stepped outside of would compromise the clients recovery

Boundaries

A major cause of errors in the workplace

Breakdown in communication

Which is the goal for the "orientation phase" of the nurse-client relationship? A) Explore self-perceptions B) Promote change C) Establish trust D) Evaluate goal attainment

C) Establish trust

The term client, when used by nurses refers to a person who: A) Is a passive object of care B) Is being treated in a community setting C) Participates actively in his care D) Purchases health care services from the home

C) Participates actively in his care

Requires effective communication among members of the heath care team

Client Safety

One of nursing's core values: giving of self, meeting the needs of clients in a timely manner, and providing comfort measures for clients and family

Caring

Engages the services or advice of a qualified health care person to deliver service. Active participant in their care.

Client

- An ethical obligation to share medical information about a person only with other persons who have a professional need to know the persons health status - If there are signs of abuse you cannot promise this because it has to be reported

Confidentiality

The ethical obligation to share medical information about a person only with other persons who have a professional need to know of the person's health status

Confidentiality

The nurse points out discrepancies between thoughts, feelings, and actions that inhibit the clients self-understanding or exploration of specific areas. This is done empathetically not judgmentally

Confrontation

To point out discrepancies between thoughts, feelings, and actions that inhibit the clients self-understanding

Confrontation

Individual, group of people, or anyone who uses a health care service

Consumer

The feelings and thoughts that a nurse or other health care provider has toward a client that may be related to the providers own unconscious or repressed emotions, feelings, and experiences

Counter-transference

-A continuous process characterized by open mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true - Recognize that an issue exists, analyzing information, evaluating information, and making conclusions

Critical thinking

The client's goals of therapy have been met, but the client cries and states, "I have to keep coming back to therapy to handle my anger better". This interaction occurs in which phase of the nurse-client relationship? A) Pre-interaction phase B) Orientation phase C) Working phase D) Termination phase

D) Termination phase

-Qualities, principles, attitudes, or beliefs about the inherent worth of an object, behavior, or idea - Guide action by sanctioning certain behaviors and disavowing/disregarding others - Essential factors in design and implementation of nursing interventions - Evolve, they are not static and change

Definition of Values

- Purposeful Communication - Goal direction - Trust - Confidentiality - Rapport - Empathy - Respect - Genuineness - Confrontation - Transference - Counter transference

Elements of a Therapeutic Relationship

-The intellectual process that involves understanding correctly another persons emotional state and point of view - The end result is comforting and caring for the client and a helping, healing relationship

Empathy

The ability to understand anothers feelings without losing personal identity and perspective

Empathy

- The process by which nurses make clinical decisions using the best available research evidence, their clinical expertise, and patient preference - Made up of three things: - Best available research - Your own clinical expertise - Patient/family preferences and values - There is not always research available

Evidence based nursing practice

- Integrating best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. - Process of using current evidence to guide practice and clinical decision making

Evidence based practice

-Nose: nasal flare, wrinkling -Lips: grin, smile, grimace, compressed, snarl, pout, frown, pursing, sneer -Brows: frown, raised -Eyes: widen, narrow, stare, eyes downcast, lack of eye contact

Facial Expression

1. Ask the burning clinical question 2. Collect the most relevant and best evidence 3. Critically appraise the evidence 4. Integrate all evidence with one's clinical expertise, patient preferences, and values in making a practice decision or change 5. Evaluate the practice decision or change 6. Share the outcomes of EBP changes with others

Five steps of evidence - based practice

"Mother of Nursing" First person to talk about and use the environment around her. Completed a lot of work during the Crimean War The first to focus on hygiene and cleanliness The first nurse scientist The first person to determine that by incorporating cleanliness the patients had better outcomes and rehab.

Florence Nightingale

-Care giver - Clinical decision maker - protector and client advocate - Case manager - Rehabilitator - Comforter - Communicator - Teacher - Does not include friend

Functions of the professional nurse

- The person does not take refuge in or overemphasize the role of the counselor - The person is spontaneous - The person in non defensive - The person displays few discrepancies- that is the person is consistent and does not think or feel one thing but say another - The person is capable of self-disclosure when appropriate

Genuineness

True engagement in knowing and interacting with clients in an open, human exchange

Genuineness

The relationship exists solely to meet the needs of the client

Goal direction

- Achieve optimal personal growth related to personal identity - Ability to form relationships - Ability to satisfy needs - Achieve personal goals

Goals of a therapeutic relationship

-Identify the individuals values - Use reflection to restate the value and make it explicit - Identify value conflicts (conflicts between values and actions) - Talk about the clients values with them but do not be judgmental

How we can assist individuals to clarify their values.

- Need for air, nutrition, water, elimination, rest and sleep, and thermoregulation. - Sex is unnecessary for individual survival, but it is necessary for the survival of humankind

Maslow's Hierarchy of Needs: Physiological

Need for shelter and freedom from harm and danger

Maslow's Hierarchy of Needs: Safety

Need to be self-fulfilled, learn, create, understand, and experience one's potential

Maslow's Hierarchy of Needs: Self-Actualization

A therapeutic relationship

Milieu

A set of behaviors that conveys messages either without words or by supplementing verbal communication: gestures, facial expression, touch, and para-language

Non-verbal Communication

- Gestures - Facial expression - Eye contact - Posture and gait - Personal appearance - Use of touch - Silence - Sounds - Territoriality and personal space

Non-verbal communication

Legal acts for professional nursing practice, regulate the practice of nursing in the United States with each state having its own act. Purpose: To protect the public Nurses are responsible for knowing and complying with their state's practice act as it governs their practice. Over ridden by the standards of nursing practice set forth by the ANA.

Nurse Practice Acts

Based on theory and clinical practice Focus is on the response of the individual and family to actual or potential health problems. Attuned to the whole person, not just presenting health problems. (Holistic) Autonomy in decision making Profession has code of ethics for practice. Identify and take care of potential problems. Restore and promote health Scope of nursing tells us what we can and cannot do.

Nursing

Distinguished by: - Prolonged specialized training to acquire body of knowledge pertinent to the role - Orientation of individual towards service - Ongoing research - Code of Ethics - Autonomy - Professional organization

Nursing as a profession

-When the nurse and client meet and get to know each other - Sets the tone - Recognize that the initial relationship is often superficial, uncertain and tentative - Expect your competence and commitment to be tested - Closely observe the client, knowing that they client will be closely observing you - Establish trust (most important) - Begin to make inferences and form judgements about client messages and behaviors - Assess the clients health status - Prioritize the clients problems and identify goals - Clarify yours and the clients roles - Form contracts that will specify who will do what - Let the client know when to expect termination - Determine the clients goals

Orientation Phase

A nursing student who is working with first graders wants to know whether there is a relationship between doing well in shcool and eating a healthy breakfast. Write a PICO question.

P - First grade students I - Eating healthy breakfast C - Not eating a healthy breakfast O- improved grades in school - For first grade students (P) does eating a healthy breakfast (I) compared with students who do not eat a healthy breakfast (C) improve their grades in school (O)?

- The nurse focuses communication for a particular aim. - Communication with a goal - Discuss things important to their care - Should not consist of social chitchat or communication without a goal

Purposeful Communication

- A harmony and affinity between people in a relationship

Rapport

Harmony and an affinity between people in a relationship

Rapport

- Interpersonal skills (be able to talk to others) - Personal insight (how you feel) - Accountability - Mutual respect - Supportive working milieu

Requirements for a successful therapeutic relationship

- The nurse must show this for the clients willingness to be available, desire to work with the client, and a manner that conveys the idea of taking the clients point of view seriously

Respect

Taking the clients point of view seriously

Respect

- Caregiver - Educator (teaching is the backbone of nursing) - Communicator - Client advocate (the most important role) - Counselor - Change agent - Leader - Manager

Roles of the Nurse

Promoting health and wellness (i.e. smoking cessation classes) Preventing illness (i.e. immunization, prenatal care, AIDS prevention) Restoring health (i.e. direct care, diagnostic/assessment procedure) Caring for the dying (i.e. care for the patients and the families) Tells us what we can and cannot do; if you go outside of it you will be in legal trouble.

Scope of Nursing

- Refers to how individuals feel about the way that they see themselves - Learned from experience - How we feel

Self - esteem

- A mental picture of the self - A composite view of personal characteristics, abilities, limitations, and aspirations. -Evolves throughout life - Who we think we are and what we strive to be

Self Concept

-Self disclosure or providing personal information or intimate details about oneself or one's life is generally discouraged because the focus of any interaction should be on the client and not the nurse.

Self-Disclosure

- Intimate and on-going - Know from many perspectives - Focus on the needs of both - Difference in use of communication skills - Unstructured - Non-accepting (never approve or disapprove). - Between friends and family - A give and take relationship

Social Relationship

- Tradition: passed from generation to generation - Authoritative from experts - Clinical experience - Trial and error - Intuition - Logical reasoning - Scientific research

Sources of Nursing Knowledge

Describe responsibilities for which nurses are accountable Generic: use nursing process as a foundation Provide for practice of nursing regardless of area of specialization Specialty organizations may develop specific standards for their area. Non-negotiable Cannot be re-worded or changed Encompasses all nursing activity

Standards of Nursing Practice

-Assessment (collect data, form problem list) - Diagnosis (Analyze data to determine diagnosis) - Outcome identification (Determine the outcome individualized to the patient) - Planning (form a plan that prescribes interventions) - Implementation (The way a nurse intervenes with patient/client who has a problem to meet the goal (implement the plan)) - Evaluation (Happens throughout all steps to ensure everything is working (check progress))

Standards of Professional Nursing Practice

- Convey respect - Consider the clients uniqueness - Show warmth and caring - Use the clients proper name - Use active listening - Give sufficient time to answer questions - Maintain confidentiality - Show congruence between verbal and non-verbal behaviors (make sure what you say matches your facial features/activities) - Use a warm friendly voice - Use appropriate eye contact - Smile - Be flexible - Be honest and open - Follow through on commitments - Set limits - Control distractions - Use an attending posture: arms, legs, and body should be relaxed; lean slightly forward

Techniques to promote trust

- During the end of the relationship - Remind the client that termination is near - Reminisce about the relationship - Separate from the client by relinquishing responsibility for care - Achieve a smooth transition for the client to other caregivers

Termination Phase

- P - patient population that you are looking at - I - intervention- what you think you might do, what the issue is - C - Comparison - compare with standard care or other method - O - Outcome desired

The Iowa Model of EBP: How to Frame the Question

-problem focused or knowledge focused - Is the problem a priority? - If yes? - Form a team - Review and critique relevant literature

The Iowa Model of EBP: Identifying A Trigger

- Is there evidence to make a change in the practice, pilot the change - Select outcomes to be achieved - Collect baseline data - Design evidence- base practice guideline - Implement EBP on pilot units - Evaluate process and outcomes - Modify the practice guideline in accordance with results

The Iowa Model of EBP: Piloting the Change in Practice

-It is a helping relationship - "Knowing the patient" is essential before nursing interventions can occur and/or be successful. -Began around the early 1900's

Theories on Therapeutic Relationship

The environment in which nursing care occurs

Therapeutic Relationship

- A close and helping relationship based on trust - Th foundation of all nursing care - Promotes a psychological climate that facilitates positive change and growth - Established between a health care professional and the client for the purpose of assessing the problem and helping the client overcome it.

Therapeutic relationship

- The application of one's cognition's, perceptions, and behaviors to create interpersonal encounters that promote health in another person, family, group, or community. - Where we get rid of our stigmas, stereotypes, perceptions and behaviors to be better able to help the client and be non-judgmental.

Therapeutic use of self

- Clear boundaries - Mutually dependent - Focus on the clients needs - Use of therapeutic communication skills - Structured goal oriented - Accepting - Self-awareness - Confidentiality - Between nurse and client - A giving relationship directed at the client

Therapeutic/Helping Relaltionships

-Feelings and thoughts that a client has toward the nurse or other health care provider that are rooted in the clients unconscious or repressed emotions and feelings toward people in his/her past

Transference

- A reliance on someone without doubt or question, or the belief that the other person is capable of assisting in times of distress and in all likelihood will do so. - Key building block in a therapeutic relationship - Key to the kind of nurse you are

Trust

Taking the risk to share yourself with another. The foundation of all close relationships

Trust

- A personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior - Are learned and determine how we respond to things - Learned from the environment, observation, and experiments - Guide us to where we want to be in our lives

Values

The qualities, principles, attitudes, or belief about the inherent worth of an object, behavior, or idea

Values

- Vocabulary (make sure to use language/and terms the client understands) - Denotative and connotative meanings (words can have different meanings to people) - Pace (speak slowly and clearly) - Intonation (tone of voice) - Clarity and brevity (clarity - be clear and say precisely what you mean; brevity- use the fewest words you can to make your message clear) - Timing and relevance

Verbal Communication

- Involves the use of words to convey messages. - Includes speaking and writing.

Verbal communication

The first person to talk about healthy and sick individuals. Said that healthy people can benefit from nursing care. One of the first to address nursing for those who will not get better and peaceful death.

Virginia Henderson

-The client -The clients family/significant others - Other healthcare providers

Who the nurse communicates with

- Patients who receive care based on the best and latest evidence from well defined studies experience 28% better outcomes - Health care providers who use this approach to delivering patient care experience higher levels of satisfaction than those who deliver care that is based in tradition. - Not always based on tradition - Issues in health care delivery - Practice variations - Systems issues - Improvement in patient outcomes - Decrease adverse events - Improve practice cultures - Gives a consistent approach with good evidence despite system and practice variations

Why evidence based nursing practice

- When the nurse and client work together to solve problems and accomplish goals - Encourage and help the client express feelings - Encourage and help the client with self-exploration - Provide information needed to understand and change the behavior - Encourage and help the client set goals - Take action to meet the goals - Use therapeutic communication - Use appropriate self-disclosure and confrontation - The goals should be achievable and realistic

Working Phase