341 Midterm
Medical errors are the _______ leading cause of death in the US
3rd
which of the following is a non-therapeutic statement during the orientation phase of a relationship? a) "I am the nurse who will be caring for you today" b) "My job is to make you better" c) "I will be talking with you while I provide care" d) "You will be receiving care from an assistant and myself"
B
The three phases of NCR, when the client is present are a) confidentiality, trust, empathy b) listening, hearing, feeling c) orientation, working, termination
C
A set of cultural behaviors and attitudes integrated into practice methods that enable care provides to work effectively in cross cultural situations
Cultural competence
shared patterns of values, customs, language, behaviors that characterize a particular group of people not a genetic trait powerful influence on one's interpretation of and responses to healthcare Individual's first; members of culture second
Culture
Which of the following best describes the role of theory in the nurse client relationship? a) theory provides a common language for the nurse and the client b) theory is the essence of the nurse-client relationship c) theory varies with changes in health care delivery d) theory guides nursing practice
D
Who is the current theorist?
Larry Purnell
Who came up with the sunrise theoretical model
Madeline Lenininger
Client perseveres with positive behavioral change, help client identify sustaining strategies, accept temporary setbacks. Role-play
Maintenance phase
All of the factors that influence how the message is being perceived The most important thing in communication is to hear what isn't being said (Peter Drucker) Verbal Nonverbal Influenced by culture
Meta communication
Theoretically congruent with trans theoretical model
Motivational interviewing
SCREENING interventions to promote early diagnosis or timely treatment after the onset of the disease BP screens, pulse screens, osteoporosis screens
Secondary Prevention
asking the client for more information in order to understand their message
Seeking clarification
ability to recognize moods and how your behavior affects other people
Self awareness
Basic human needs
Shelter food safety
Culture is a community concept Culture provides community with its strength and vitality Each person connects with the larger community through their cultural definitions lack of social support and culture can foster a sense of alienation and helplessness
Sunrise theoretical model of culturally congruent nursing care
Predetermined ending known to both parties Examine meaning/value of your working together Follow up on interventions Expect a range of client reactions
Termination Phase
REHABILITATION designed to minimize the handicapping effects of a disease Care class, PT/OT
Tertiary Prevention
Focus on the client Specific purpose not always a choice to enter the relationship Nurse takes responsibility for the process Client and nurse are both experts
Therapeutic Relationships
Precontemplation contemplation Preparation Action Maintenance
Trans theoretical Model stages of change
cooperative but nonassertive, i lose you win. Surrender own needs in desire to smooth over, quick compromise or false reassurance.
accommodation
Asking open ended questions, focused questions, closed ended questions
active listening
Values and attitude
affective domain
validating or normalizing emotional responses encouraging the telling of illness narratives drawing forth family support
affective interventions (VALUES)
Sigmund Freud
anxiety defense mechanisms such as denial
What are the steps of the nursing process
assessment diagnosis planning implementation evaluation
withdrawal, prolongs lose lose, nurses distances self from patient, team member, less support
avoidance
Lack of caring Conflicting values stereotyping lack of personal space anxiety failure to empower mistrust
barriers to relationship
encouraging family members to be caregivers and offering caregiver support encouraging respite devising rituals and routine
behavioral interventions
Less serious infraction, context is everything
boundary crossing
involves active "tuning in" on an ongoing basis. involves constant communication, sensitivity to the dynamics of relationships within a culture. comes from a position of cultural humility Active and vigilant practice of maintain cultural humility
cultural attunement
Three modes of action
cultural care preservation/mainenance Cultural care accommodation/negotiation Cultural care repatterining/ restructuring
Use precise language and avoid jargon, validation be aware of nonverbal meanings caring behaviors may be universally understood allow time for mental language processing
cultural communication cues
Patient's want care that is
culturally congruent, responsible, compassionate, and helpful
Moderate anxiety
decreased sensory perceptions, with guidance, able to expand sensory fields, increased muscle tone and respiration
agreeing with what is being said despite reservations blaming indirect communication family communication rules that leave out needs of one or more members speaking for another member without validation
dysfunctional communication
Carl Rogers
empathy is essential for therapeutic relationships
learner focused objectives (GOALS) teach back Documentation is essential -client preferences, previous knowledge, values -clinical issues or barriers to compliance -family involved and roles
evaluating and documenting teaching
birth, graduate leaving home, retire
expective crisis
who makes decisions; who is the central communicator
expressive functioning
health literacy developmental level culture
factors affecting ability to learn
Level of anxiety level of social support emotional issues of loss and change active involvement of learner
factors affecting readiness to learn
Change in one member affects the whole
family
two or more persons in a social system may or may not be related by blood lines or law strong emotional ties
family
Many family relationships organized around triangles Triangle is more stable and flexible than twosome with higher tolerance of anxiety Involvement of 3rd person through -twosome reaches out and pulls in 3rd person -emotions overflow to third person -third person initiates involvement
family alliances and coalitions
mutual goal setting family's perception of problems and priorities negotiate plan of care realistic goals plan small, achievable steps
family assessment planning
summarize activités and accomplishments refer individuals for consultation or ongoing treatment give family credit for change promote family interdependent functioning and family esteen
family assessment termination and evaulation
external: control flow between family and rest of the world internal: keep family members appropriately placed in relation to each other permeability: -flexible: little control -rigid: lots of control
family boundaries
Triangular alliances can be helpful or unhelpful Many shifting alliances within families, as they adjust to new arrivals, deaths or illness, nurse helps to assess if alliances are problematic or enriching
family triangles
a response message related to specific client behaviors and words
feedback
require specific short response rather than a yes or no answer
focused questions
families pass ways of behaving and communication from generation to generation: multi-
generational transmission
Two systems of caring existed in every culture Meininger studied
generic folk practice, define culturally therapeutic, professional
can remove blame from the family scapegoat, most families enjoy the process, visual can enhance verbalization of the interview; can foster communication; can help to normalize/reframe issues
genogram
Eliminate preventable disease, disabilty, injury, and premature death achieve health equity, eliminate disparities, and improve the health of all groups create social and physical environments that promote good health for all promote quality of life, healthy development and healthy behaviors across all life stages
healthy people 2020; goals
Mild anxiety
heightened state of alertness; increased acuity of hearing, vision, smell, touch; walking, eating, mild restlessness
Abraham Maslow
hierarchy of human needs help to prioritize care
who is the income provider? who is the care giver?
instrumental functioning
Interacting with individuals of cultures other than one's own A way for nurses to understand cultural strangers; provide cultural-specific care; examine commonalities as well as differences
intercultural nursing
Verbal communication
language communication
Nursing Theory guides
nursing practice
Permit client to express health problems and needs in their own word
open ended questions
a listening response which focuses on the cognitive component of a message
parapharasing
the nurse transforms the original message into his or her own words without changing the client's meaning
paraphrasing
The nursing meta paradigm consists of
person environment Health nursing
Non verbal communication
physical expressions and behaviors not expressed in words
The leading cause of errors lies in
poor communication
nurses expresses a different interpretation of situation than patient's interpretation of reality
presenting reality
Manage our own response to clients provocations professional calm demeanor anxiety to anger to aggression anxiety breeds anxiety
preventing conflict
personal or environmental, delay emergency of disease or lessen its impact, include healthy lifestyle, adequate support, health insurance, etc.
protective factors
Exercise and teaching
psychomotor domain
a listening response, focused on the emotional implications of a message
reflection
this listening skill puts into words the feelings and emotions that the nurse hears in the client's comments
reflection
"changing the frame in which a person perceives events in order to change the meaning" (Bandler and Grindler, 1997)
reframing
Nurse provides pisitive interpretation designed to broaden client's perspective
reframing
active listening strategy used to broaden a client's perspective
restatement
nurse highlights a specific part of client's message and repeats it
restating
Families may project their tension/anxiety unto one member, the family
scapegoat
The cultural competence begins for the nurse at
self awareness
an organized network of ideas, feelings, and actions, which every person has a consequence of experiences and interactions with other people
self concept
support system
self efficacy
power to suspend judgment before responding to emotion
self management
the degree to which one feels valued, important, or satisfied with one's self
self-esteem
Erik Erikson
series of human psychosocial development
periods of no verbal communication which communicates nurses acceptance of the client
silence
when used purposefully, is a powerful listening response
silence
sense of puprose
strong faith
an active listening skill used to pull several ideas and feelings together
summarization
an active listening skill that pulls together content before moving to a new topic
summarizing
Aaron Beck:
thoughts determine feelings and behaviors
Helping profession, client is reminded of what they are missing
transference
__________ are 3 person emotional systems that begin when there is tension between two members
triangle
divorce, death of family member, birth defect, loss of a job
unexpected crisis
Marked mobility of people worldwide Increase of migrants Rise in cultural identities changing roles in men and women
world factors of change
unresolved feelings from previous relationships or life events
countertransference
Metacommunication
nonverbal cues are used to enhance or negate the meaning of word
Do or say nothing in private or public which cannot be documented in the client's record
Golden rule of boundaries
Severe anxiety
Greatly diminished perceptions; decreased sensitivity to pain; purposeless, incongruent verbal response
Cognitive perceptual factors: health beliefs and perceptions Modifying factors: Demographic, Biological, interpersonal, Situational Cues to action Final outcome is the likelihood of engaging in health promoting behavior
Health promotion model Nola Pender
goal of dominating, suppresses other person's rights, "you" statements, blame is focused on the other person
Aggressive communication
Patient Centered Care Teamwork and Collaboration Evidence based practice Quality Improvement Safety Informatics
6 QSEN Categories
How many indian reservations are in MT?
7
Client engages in concrete actions to effect needed change. Review progress and give feedback. More interactions with patient
Action stage
setting goals, acting clearly, consistently, taking self-responsibility, ability to say no, ask for what you want, express feelings, does not violate needs of others, "I" statments
Assertive communication
A major difference between social and therapeutic relationships is: a) therapeutic relationships meet mutual needs b) therapeutic relationships have client centered health goals c) therapeutic relationships require mutual self disclosure d) therapeutic relationships depend on reciprocal liking
B
In a therapeutic relationship, the nurse first begins discussing termination of the relationship during which phase: a) pre interaction b) Orientation c) Working d) Termination
B
take advantage of the client's vulnerability and represent a conflict of interest that is harmful to the goals of the therapeutic relationship
Boundary violation
A male nurse is caring for a client. The client states, "You know, Ive never had a male nurse before". Your best reply would be: a) does it bother you to have a male nurse b) there aren't many of us; we're a minority" c) how do you feel about having a male nurse d) you sound upset. I will get a female nurse to care for you
C
When administering medications for human immunodeficiency virus to Mr. George, he tells you, "I should stop taking them and get it over with". A therapeutic response would be: a) "You have to take these! If you stop, you will get very sick" b) "You're just feeling depressed right now. You'll feel better later" c) "Let's talk about what seems to be making you feel this way" d) "You have the right to refuse treatments"
C
You ask a client "How are you" which of the following is an incongruent response? a) Mary states "I am fine" and you note that she is humming as she moves about b) julie does not respond to your question c) Juan states, " I have been making progress and you note he is moving with great difficulty d) Andy states, "I am okay how are you"
C
according to the most recent census data, how many montanans report having a native american hertage a) 25,000 b) 10,000 c) 60,000
C
Internal structure: family composition, gender, rank, order, -genogram External: family's relations with extended family and larger social system -ecomap
Calgary Model
focus on the impact of illness or injury on the family function difference, behavior effect, hypothetical or future oriented
Circular questions
Affirm the dignity, intelligence, and pride of elderly clients ask clients to introduce themselves and ask how they would like to be called Make use of humor but never at the expense of the individual call attention to life experiences in relation to personal strengths
Communicating with older adults
What three things foster safety
Communication Clarity Cooperation Collaboration
CARE mnemonic
Connect with your client Appreciate Respond Empower
Client thinks there may be a problem, thinking about change; discussion of pros and cons; tip the balance
Contemplation stage
Great Diversity among 12 tribal nations Continuum of Indian identity; no generic American Indian Language and oral histories Reservations were not given to the Indians Federal Policies have affected Indian peoples History is subjective Tribal sovereignty is complex
Essential Understandings Regarding MT Indians
Greeting, introduction, open ended questions, listening, noticing nonverbal behaviors, establishing and addressing concerns, agreeing with plans
Establishing rapport
listening to the family engaging in participatory dialouge recognizing patterns assessing family's potential for active, positive change families do not present themselves to be assessed encountered by nurses when coping with illness, stressor, crisis, or to improve quality of life.
Family assessment
family and cultural ties are significant sources of comfort and support to people in times of stress and illness
Foundational Premise
The good of the colony is priority
Gesaltheit
Reduce health disparities enhance client's comfort in times of stress and illness; possibly foster "compliance"
Goals of intercultural nursing
Verbal and nonverbal approval active listening demonstration of empathy acknowledgement of content and feelings of messages
Increasing client responsiveness
Panic anxiety
No response to sensory perception, no cognitive or coping abilities; without intervention, death is imminent.
Open-ended questions Affirmation Reflective listening Summarizing
OARS mnemonic for motivational interviewing
PREVENTION actions taken to prevent illness health promotion and specific protection immunizations, education, clean air and water
Primary prevention
When NCR formally begins Building of trust Clarification of purpose Establish nurse credibility Superficial talking with client and family Define problem and establish contract This phase is most evident during your professional nurse intake observations
Orientation Phase
Who was the first nursing theorist to describe nurse client relationship?
Peplau
Before the nurse actually meets with the client Careful preparation Creating environments Clear pictures of role/responsibilities
Pre interaction phase
Target population-based assessments/plans Addresses policy, social, environmental changes that facilitate individual change Acknowledges multi factorial model Although the nurse is responsible for the quality of health teaching, It is up to the client to assure the outcome Teaching for health promotion is a more concentrated form of therapeutic communication
Precede proceed model
Client does not think there is a problem, not Considering changing informational feedback raised doubt, denial
Precontemplation stage
Client decides there is a problem; willing to make a change but may not know how, Help client choose best course of action
Preparation stage
Postive Counsellor behaviors: Attempts to explore and clarify feeling Responds to feelings Provides client with direction Negative Counsellor Behaviors: Leads, directs, and diverts judgemental and opinionated
Reynolds Empathy Scale
personal or environmental, increase probability of having health problem, many modifiable
Risk factors
Focus is on both or shared generally a mutual liking may last a lifetime Often intimate relatively equal power balance
Social Relationships
Empathy and recognition of others needs and cultres
Social awareness
Motivators that promote learning or behavior change Social incentives: Family or peer pressure Physical: internal or external Cognitive: self efficacy
Social learning theory bandura
valuing collaboration and valuing others' worth
Social skills
Frame teaching to match clients preference, Beliefs, concerns Fully informed client of purposes and expected outcomes and when to expect effects Suggest small changes and baby steps Be specific Link to new behaviors and old behaviors refer client to appropriate community resources monitor progress through follow up contact
Strategies in health education
Identification of strengths and needs Mutual planning Empowering client for interdependence Trust is tested Developing realistic goals, alternative solutions Problem solving
Working phase
Nurses are
change agents
a listening response
clarification
Informed Consent Components
client based decision voluntarily signed know the purpose, risk, benefits Competent to make decision know alternative procedures right to refuse or discontinue care written consent (if risk is involved)
require yes or no short answer response
close ended questions
Commending family and individual strengths offering information and opinions
cognitive interventions
knowledge, comprehension, application, analysis, evaluation, synthesis health literacy
cognitive thinking language domain
solution oriented response; mutual satisfaction, may take time, win, win
collaboration and compromise
Use of power, suppressed conflict increases stress, I win now, but then lose, you lose. effective when needed for quick decision, can lead to problems long term
competition
goal: prevent or reduct levels of conflict conflict attention and resolution can lead to improved relationships lack of communication is the main cause of misunderstanding and conflict Value differences, personality clashes, stress, poor communication
conflict communication
"Each RN is directly accountable and responsible to the _______________ for the quality of nursing care provided"
consumer
health care worker finds missing piece from past in client
countertransference
People's theory was more aimed for _____ _______ Care
long term
brief, encouraging phrases and nonverbal prompts which communicate interest
minimal cues
body actions that encourage clients to continue their stories
minimal cues and leads
False reassurance, giving unsolicited advice, jumping to conclusions, demoralizing, failure to listen or probe, changing topics
negative listening responses