Communication and the nursing process
types of notes
DAR-data, action, response--F focus Pie(problems, intervention, evaluation) Soap(subjective, objective, assessment, plan---E evaluation) ADPIE(assessment, diagnosis, planning, impentation, evaluation)
The nurse finds the client sitting in a chair while staring out the window with diagnosis of lung cancer. What statement by the nurse communicates concern and caring about the client?
"I can imagine you have many concerns about your health. Tell me what is on your mind."
Reasons for license suspension
-drug or alchohol -fraud -deceptive practice -criminal acts -previous disciplinary actions
legal regulation of nursing
"The nurse practice law is most imporatnt law, state laws that make sure nurses provide professional and competent care and establishes the board of nursing(BON)" standards set in 1991
Which nurse would most likely be the best communicator?
A nurse who easily develops a rapport(close,harmonious relationship) with clients
A nurse is caring for an older adult client hospitalized following a hip fracture. Which actions by the nurse will promote the development of a therapeutic relationship? Select all that apply.
Asking the client when the client would like to have the bed linens changed Encouraging the client to talk about the client's life
if has hearing impairment:
Assess how the client would like to communicate
Client doesn't speak dominant language, child is acting as interpreter. Which is the best action for the nurse to take?
Contact a professional interpreter.
empathy vs. sympathy
Empathy is a term we use for the ability to understand other people's feelings as if we were having them ourselves. ... Sympathy refers to the ability to take part in someone else's feelings, mostly by feeling sorrowful about their misfortune.
Which is the best example of establishing a therapeutic nurse-client relationship?
Show respect for the client, and engage in open communication in getting to know the client.
Which guideline should a nurse use when choosing a position (location) in relation to a client during a verbal interaction?
Take note of the client's cues when choosing a position and act on these cues.
A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process? Select all that apply.
The nurse keeps communication simple and concrete. The nurse maintains eye contact with the client. The nurse shows patience with the client and gives the client time to respond.
agressive vs assertive
agressive is standing up for ones rights in negative manner assertive ability to stand up for oneself with honesty, and direct
A nurse is attempting to complete an admission database. While taking the history, the nurse notices the client appears uncomfortable and slightly tachypneic. The nurse should:
allow the client to set the pace.
power of communication
can result in good or harm. failure to communicate increases liability, threatens professional credibility self-awareness is important
CUS(communication tool)
communication tool to assist in effective communication related to patient safety concerns; the acronym CUS stands for I'm Concerned, I'm Uncomfortable, This is unSafe (or This is a Safety issue)
Foster communication with a young child
involve the child's stuffed animal in the educational session.
use military clock
less room for error since not asking if its AM or PM
A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by:
swaddling the child and gently stroking its head.
scientific problem solving:
systematic problem-solving process that involves (1) problem identification, (2) data collection, (3) hypothesis formulation, (4) plan of action, (5) hypothesis testing, (6) interpretation of results, and (7) evaluation resulting in conclusion or revision of the study
professional communication in nursing
Assessing Diagnosing Outcome identification and planning Implementing Evaluating
Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. Which is an example of the proper use of social media by a nurse?
A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's.
nursing process
Assessing(establish database:history,phy app,review record. update database,validate and communicate data)Diagnosing(interpret+analyze data,, identify strengths/problems, formulate nursing diagnosis)Outcome/planning(establish priorities,communicate plan, develop evaluative strategy)Implementing(carry out plan, continue data collection, document care)Evaluate(decision about termination:terminate if outcome has been reached, contract or modifying plan care, follow up, self evaluation-reflective practice)
Client shows anger about previous medical history
Be silent and allow the client to continue speaking when ready.
A nurse and an older adult client with chronic back pain are beginning to communicate. What activity should the nurse focus on at this point?
Being sensitive to the client's emotional barriers
A client is diagnosed with diabetes. The client's adult child offers to serve as an interpreter, because the client does not speak the dominant language. Which is the best action for the nurse to take?
Contact a professional interpreter.
The nurse is visiting a hospice client in the client's home. The client is explaining difficulties with a home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is using which therapeutic nurse-client communication technique?
Encouraging elaboration
When assessing a client's nonverbal communication, the nurse should assess which aspect as being the most expressive?
Facial expressions
Nurses on a hospital burn unit meet as a group to discuss procedures. Which statements accurately describe effective functioning in a group? Select all that apply.
Group members support, praise, and critique one another. Group members elicit mutually respectful relationships. The leader or other group members confront any member who dominates or thwarts the group process.
Which statement best conveys the role of intuition in nurses' problem solving?
Intuition can be a clinically useful adjunct to logical problem solving.
Which is a characteristic of person-centered care?
It is a framework for providing care.
The nursing process is based upon the process of problem solving. The nurse attempts to obtain a blood pressure on the client's right arm, then on the left arm, then on the left leg, and finally on the right leg, where the blood pressure is obtained. What type of problem solving did the nurse use?
Trial-and-error problem solving
signs of effective delegation(teamwork)
assess knowledge and skills to person delegating match tasks to assistants skills communicate clearly listen provide feedback
overview
be caring explain ask why and listen to feelings be silent when appropriate
legal safeguards of nurses
competent practice informed consent or refusal contracts collective bargaining patient education adequate stafing whistle blowing(report something see-mandated reporter) prof liability insurance risk managment programs where/how report incients never events(event of death due to mishaps in practice) good samaritan rights
The nurse is caring for a postoperative client who refuses a blood transfusion due to religious beliefs. The nurse is demonstrating trustworthiness when taking which action in response to the client's treatment wishes?
contacting the interprofessional care team to discuss alternative treatment options
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should:
eliminate as many distractions as possible.
HIPAA
ensure patient's rights are protected breach could be communicating about patient situation where others can hear you
characteristics of effective communication
factual, legally prudent, organized, timely, concise, consistent with professional standards, reflective
hearing impaired, the nurse must take into account that the client's hearing serves as a:
filter
hand off report
identifying info appraisal of health status current orders(need med before surgery) abnormal occurrences unfilled orders that need to be carried over to new shift patient family concerns/questions/needs report on transfers/discharges
therapeutic phases
orientation phase(establish guidelines, identify, clarify roles, contract, orientation to healthcare system) working phase(working to meet patient's needs, establish fears and concerns provide assistance to meet goals, provide teaching and counseling) termination phase(review goals, make suggestions, assist with transfer/termination)
when give report
patient transferred one unit to another(ex:NPO,then move to lab and tech gives food) Change of shift
situational issues
patients with communicational issues, stroke need white board, adjusement because of educational level, child speak differently too or diff language
duties of RN receiving telephone orders
provider cant enter order itself, only for emergency situations record in patient's med records read back, verify accuracy date and note and time ordered record telephone orders sign
SBAR-report to physician, provider, new providers
situation, background, assessment, recommendation
methods of documentation
source orientated problem oriented charting by exception(docucare only do assessments, don't make stuff up) case management model EHR paper or electronic!!
Quality and Safety Education for Nurses (QSEN)
stands for Quality and Safety Education for Nurses, a project for preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the health care systems within which they work
types of reports
telephone reports or orders(SBAR,read back every call) incident or occurence reports
Carl Rogers (1961) studied the process of therapeutic communication. Through his research, the elements of a "helpful" person were described. They include all of the following except which choice?
analysis
horizontal violence
anger and aggressive behavior between nurses or nurse-to-nurse hostility
influencing factors on communication
developmental level psychophysiological(food insecurity, abusive relationship) role and relationships(get confused so want fam here) environment culture
nontherapeutic communication
dismissive, over using med term, false reassurance, sympathy, prying personal questions, not argumentaive:Explain why
When communicating with clients, nurses need to be very careful in their approach. This is particularly true when communicating using:
medical terminology.
communication zones
new pateint:public zone 12-18ft, unless cant hear ask if can come closer
Which statement regarding critical thinking in nursing is true?
It is a systematic way of thinking.