Health Assessment quiz #2

The nurse employment in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbors ask the nurse, " How is Mary doing? She is my best friend and is seen at your clinic every week."Which is the most appropriate nursing response? a. " I cannot discuss any patient situation with you" b. "If you want to known about Mary, you need to ask her yourself" c. "only because you are worry about your friend, I'll tell you that she is improving" d. "Being her friend, you know she is having a difficult time and deserves her privacy."

" I cannot discuss any patient situation with you"

Presenting Reality examples

" I see no one else in the room", " That sound was a car backfiring" and " your mother is not here; I'm a nurse"

Validating examples

"Do you feel relaxed" or "Are you feeling better now?"

Clarifying examples

"I'm not sure I follow.." or "Are you using this word to mean"

Using broad opening statement examples

"Is there something you'd like to talk about"

Exploring examples

"Tell me more about that" or "would you describe it more fully?"

Voicing Doubt example

"isn't that unusual?", " Really?", "that's hard to believe"

Suggesting Collaboration examples

"perhaps you and I can discuss and discover what produces your anxiety ( pain, frustration, etc.)"

Using General Leads example

"yes" or "uh hum" or "go on"

Sharing Observations example

"you are trembling" or "you seem upset"

when the community health nurse visits a patient at home, the patient states,"I haven't slept the last couple of nights." which response by the nurse illustrates a therapeutic communication response to this patient? a. " I see" b. "really?" c. " you're having difficulty sleeping?" d. "sometimes I have difficulty sleeping too."

"you're having difficulty sleeping?"

Blocks to Therapeutic communication

- Using reassuring Cliches - Giving advice - giving approval - requesting and explanation - agreeing with the patient - expressing disapproval - belittling the patients feelings - disagreeing with the patient - defending - making stereotyped comments - changing the subject - giving literal responses - challenging

What questions to ask about gender identity?

- What is your full name? - what sex were you assigned at birth? -what gender do you identify as now? - what is your sexual orientation? - what name do you prefer we call you?

Teach back

- encourages verification of understanding - opens the door for clarification if needed

Non verbal skills for active listening

- face the other person squarely - lean forward - head nodding - open posture - good eye contact - appear relaxed - silence allows patient time to collect thoughts

Written material

- no higher than 5-6 grade level - use of 12 point font, avoid all caps

Why is LGBT health important?

- reductions in disease transmission and progression - increased mental and physical well-being - reduced health care costs - increased longevity

what are the techniques for therapeutic communication?

- using broad opening statements - using general leads - reflecting - sharing observations - acknowledging the patients feeling - using silence - giving information - clarifying - verbalizing implied thoughts and feelings - exploring - presenting reality - voicing doubt - suggesting collaboration - validating

Conditions essential for developing a therapeutic relationship

-Rapport - Trust - Respect - Genuineness - Empathy

Techniques to improve health literacy

-oral teaching - written materials - teach back

oral teaching

-provide simple, easy instructions - use conversational structure rather than medical jargon

Phases of the Interview

1. pre interview 2. introduction 3. working 4. Termination

ethics

A set of principles crafted through reflection and discussion to define what is right and wrong

The ladder of Inference

Action, Beliefs, Conclusions, Assumptions, Select Data

Analysis

Analyze cues/ prioritize hypotheses

What is the nursing process?

Assessment, Analysis, Plan, Intervention, Evaluation (AA PIE)

Plan

Generate solution

Clarifying

If the nurse has not understood the meaning of what the patient has said, she clarifies immediately.

Using silence

In certain circumstances, an accepting, attentive silence may be preferable to a verbal response

Reflecting

In reflecting, all or part of the patient's statement is repeated to encourage him to go on.

Suggesting Collaboration

Offering to share, to strive, to work together with the patient for his benefit.

Confidentiality

Paramount importance in the nurse patient relationship. information may only be shared with appropriate health care team members

Verbalizing Implied Thought and Feelings examples

Pt:"It's a waste of time to do these exercises" Nurse: "You fell they aren't benefiting you?"

which action would the nurse take to obtain subjective data about a client's respiratory status? ( SATA) a. inspect their chest b. question the client about shortness of breath c. check the lab values for pulmonary forced breathing d. inspect the skin and nails for a change in color e. ask the client about color and quantity of sputum

Question the client about shortness of breath , ask the client about color and quantity of sputum

Assessment

Recognize cues

The nurse in an outpatient clinic recognizes which of the following as therapeutic communication techniques? Select all that apply. a. restating b. listening c. Ask the patient "why?" d. Maintaining neutral responses e. providing acknowledgement and feedback f. giving advice and approval or disapproval

Restating, listening, maintaining neutral responses, proving acknowledgement and feedback

Standardized communication

SBAR -situation -background - assessment - Recommendation or Request

Recommendation or Request

State what you need or want for the patient in terms of medical treatment and/or assistance

Voicing doubt

Statements like the following express uncertainty as to the reality of the patient's perceptions

Intervention

Take action

which teaching method is most effective when providing instruction to members of special population? a. Teach-back b. Video instruction c. Written materials d. Verbal explanation

Teach-back

Sharing observations

The nurse shares with the patient her observations regarding behavior. The patient who has a need is often unaware of the source of this distress, or reluctant to communicate it verbally.

Verbalizing Implied thought and feelings

The nurse voices what the patient seems to have fairly obviously implied, rather than what he has actually said.

Broad opening statements

The use of questioning that allows patients to set the direction of the conversation. This gives the patent an opportunity to begin expressing themselves.

do bilingual team members or trained medical interpreters prefer same gender patients/

True

Presenting reality

When it is obvious that the patient is misinterpreting reality, the nurse can indicate that which is real

Validating

When the nurse feels that the patient's need has been met, she should validate her impression with him

back channeling

active listening prompts

Using silence examples

after several minutes of silence, the nurse can help the patient to resume verbal activity with statements such as "you were saying that.."

What actions should the nurse take to effectively communicate with a patient?(SATA) a. provide bright lighting in the room b. avoid standing while communicate c. avoid facing the patient across a desk while communication d. keep a 4 to 5 feet distance between them and the patient e. avoid placing chairs at a 90 degree angle

avoid standing while communicate, avoid facing the patient across a desk while communication, keep a 4 to 5 feet distance between them and the patient

Exploring

dealing further into a subject or idea

validation of the message

demonstrates that the message has been understood. ( body language helps to validate the message)

probing

encourages more detail w/o controlling the conversation

Introduction

establish trust

Evaluation

evaluate outcomes

feedback

express an understanding of what is said

humor

if used appropriately can break the ice

The nurse should recognize that some minority groups are hesitant to seek health care because of which most likely factor? a. low income, household b. lack of insurance coverage c. ineffective communication with the primary health care provider (PHCP) d. compliance with health care follow up is not an issue for minority groups

ineffective communication with the primary health care provider (PHCP)

Deadnaming

is intentionally or unintentionally referring to someone that is transgender bu their birth name or given name

Leading questions

most risky as they may limit what the patient tells you

working

obtain patient story and health information

Situation

provide a brief description of pertinent patient variables demographics, clincial diagnosis, and location

Background

provide pertinent history as it directly relates to patient's current health status

acknowledging the patient's feelings example

pt: " I hate it here. I wish I could go home" nurse: "It must be difficult to stay in place you hate"

Reflecting examples

pt: "I feel so tired, I don't like it here" nurse: " tired?" or "you don't like it here"

Pre-interview

set intention

Perception checking

similar to clarifying but verifiers the meaning of specific words

Assessment

state pertinent assessment findings obtained with interpretation of data

Provide general leads

statements which encourage to patient to verbalize, allow the client to choose a topic, or continue to talk

Giving information

studies have shown that a major cause of anxiety or discomfort in hospitalized patients is lack of information or misconceptions about their condition, treatment, or hospital routines.

termination

summarize important points

acknowledging the patients feelings

the nurse helps the patient to know that his feelings are understood and accepted and encouraged him to continue expressing them

General Leads

these encourage the patient to continue the conversation. they also convey to the patient that the nurse is listening and interested in what they will say next.

closed ended

try to avoid using except with ROS

A transgender client is following up with the primary health care provider (PHCP). The nurse caring for this client recognizes the best way to deliver care is to employ which approach a. Use a same sex PHCP to assess the client b. Use the client's preferred pronoun to address him or her c. Ask if the client is more likely to choose male or female d. recognize that the client is confused and therapeutically address his or her concerns

use the clients preferred pronoun to address him or her

reframing

using active listening, restating what patient said in different words

Empathy

you communicate back to the patient the feelings and meaning as expressed to you