Module 4- Caring and Communication

During rounds, a charge nurse hears the patient care technician yelling loudly to a patient regarding a transfer from the bed to chair. Upon entering the room, what is the nurse's BEST response?

"When your patient is safe and comfortable, meet me at the desk."

A nurse in the rehabilitation division states to the head nurse: "I need the day off and you didn't give it to me!" The head nurse replies, "Well, I wasn't aware you needed the day off, and it isn't possible since staffing is so inadequate." Instead of this exchange, what communication by the nurse would have been more effective

"I would like to discuss my schedule with you. I requested the 8th of August off for a doctor's appointment. Could I make an appointment?"

A nursing student is preparing to administer morning care to a patient. What is the MOST important question that the nursing student should ask the patient about personal hygiene?

"May I help you with a bed bath now or later this morning?"

A nurse enters a patient's room and examines the patient's IV fluids and cardiac monitor. The patient states, "Well, I haven't seen you before. Who are you?" What is the nurse's BEST response?

"My name is John Smith, I am your nurse and I'll be caring for you until 11 PM."

A public health nurse is leaving the home of a young mother who has a special needs baby. The neighbor states, "How is she doing, since the baby's father is no help?" What is the nurse's BEST response to the neighbor?

"New mothers need support."

A patient states, "I have been experiencing complications of diabetes." The nurse needs to direct the patient to gain more information. What is the MOST appropriate comment or question to elicit additional information?

"What specific complications have you experienced?"

What are some nonverbal ways to communicate?

-Facial expressions, touch, eye contact -Posture, gait, gestures -General physical appearance -Mode of dress and grooming -Sounds, silence -Electronic communication

During an interaction with a patient diagnosed with epilepsy, a nurse notes that the patient is silent after communicating the nursing care plan. What would be appropriate nurse responses in this situation? Select all that apply.

*Discuss the silence with the patient to ascertain its meaning. *Allow the patient time to think and explore inner thoughts. *Determine if the patient's culture requires pauses between conversation.

Annie seeks the help of the nurse in the student health clinic because she suspects that her roommate, Angela, suffered date rape. She is concerned because Angela chose not to report the rape and does not seem to be coping well. (1) After talking with Annie, the nurse learns that although Angela blurted out that she had been raped when she first came home, since then she has refused verbalization about the rape ("I don't want to think or talk about it"), has stopped attending all college social activities (a marked change in behavior), and seems to be having nightmares. After analyzing the data, the nurse believes that Angela might be experiencing (2) rape-trauma syndrome: silent reaction. Fortunately, Angela trusts Annie and is willing to come to the student health center for help. A conversation with Angela confirms the nurse's suspicions, and problem identification begins. The nurse talks further with Angela (3) to develop some treatment goals and formulate outcomes. The nurse also begins to think about the types of nursing interventions most likely to yield the desired outcomes. In the initial meeting with Angela, (4) the nurse encourages her expression of feelings and helps her to identify personal coping strategies and strengths. The nurse and Angela decide to meet in 1 week (5) to assess her progress toward achieving targeted outcomes. If she is not making progress, the care plan might need to be modified. (1) _____________________ (2) _____________________ (3) _____________________ (4) _____________________ (5) _____________________

(1)assessing: the collection of patient data (2)is an illustration of the identification of a nursing diagnosis: a health problem that independent nursing intervention can resolve. (3) is an illustration of planning: outcome identification and related nursing interventions. (4) is an illustration of implementing: carrying out the care plan. (5) is an illustration of evaluating: measuring the extent to which Angela has achieved targeted outcomes.

What does transpersonal caring mean?

Activities that promote healing, preserve dignity, and respect the nature of holistic nursing practice

Why is therapeutic communication important?

All nurses need skills in therapeutic communication to effectively apply the nursing process and to meet standards of care for their clients.• Therapeutic communication can help nurses to accomplish many goals.

in Nightingale's holistic approach,

the ROLE OF LOVE AND EMPATHY was considered PARAMOUNT....

What is assertive communication?

Assertive communication is the ability to express positive and negative ideas and feelings in an open, honest, and direct way.

The nurse practices using critical thinking indicators (CTIs) when caring for patients in the hospital setting. The best description of CTIs is:

Evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, and skills that promote critical thinking in clinical practic

What is CARING

Caring is the human mode of being. NO UNIVERSAL DEFINITION, SENSITIVE TO OTHERS Caring is the essence of nursing and the moral imperative that guides nursing praxis (EDUCATION. PRACTICE, RESEARCH)

Why is it important to communicate with a child effectively?

Child- and parent-centered communication enhances child outcomes and child and family satisfaction with nursing care.

When interacting with a patient, the nurse answers, "I am sure everything will be fine. You have nothing to worry about." This is an example of what type of inappropriate communication technique?

Cliché

A nurse is assessing a patient who is diagnosed with anorexia. Following the assessment, the nurse recommends that the patient meet with a nutritionist. This action best exemplifies the use of:

Clinical judgment

Clinical Reasoning, Judgment, and Decision Making

Clinical reasoning is the process for analyzing a situation, making a judgment, deciding on possible alternative reasons, and choosing an action to be taken. It is built on a foundation of knowledge, experience, and the personal attributes of the person doing the reasoning. Critical thinking is fundamental in the process of clinical reasoning. Care can become ritualistic and depersonalized when nurses fail in clinical reasoning.

What is DOCUMENTATION

Continual assessment of the patient's needs and conditions requires accurate documentation in the appropriate place.

What is the difference between Curative vs. Carative: (medicine vs. nursing)

Curative factors aim at curing the patient of disease, CARATIVE factors aim at the caring process that helps the person attain (or maintain) health or die a peaceful death

What are OPEN-ENDED QUESTION?

Definition: elicit more descriptive information Example: Example: How did you fall?

A nurse caring for a patient who is hospitalized following a double mastectomy is preparing a discharge plan for the patient. Which action should be the focus of this termination phase of the helping relationship?

Determining the progress made in achieving established goals

What is empathy?

Empathy is an objective understanding of the way in which a patient sees his or her situation, identifying with the way another person feels, putting yourself in another person's circumstances, and imagining what it would be like to share that person's feelings

What are the parts of the communication process

Five parts : -Stimulus -Sender or source of message (encoder) -Message itself -Medium or channel of communication-Receiver (decoder)

What is Watson's Theory of Human Care

Genuine caring relationships have a positive impact on client's health & healing process •Caring is at the core of nursing •Involves mind, body and spirit

A nurse is providing instruction to a patient regarding the procedure to change a colostomy bag. During the teaching session, the patient asks, "What type of foods should I avoid to prevent gas?" The patient's question allows for what type of communication on the nurse's part?

Information clarification

The nursing process ensures that nurses are person centered rather than task centered. Rather than simply approaching a patient to take vital signs, the nurse thinks, "How is Mrs. Barclay today? Are our nursing actions helping her to achieve her goals? How can we better help her?" This demonstrates which characteristic of the nursing process?

Interpersonal

An experienced nurse tells a beginning nurse not to bother studying too hard, since most clinical reasoning becomes "second nature" and "intuitive" once you start practicing. What thinking below should underlie the beginning nurse's response?

Intuitive problem solving comes with years of practice and observation, and novice nurses should base their care on scientific problem solving.

What is GROUP COMMUNICATION?

Nurses must communicate with team members in a manner that promotes open communication and mutual respect. Communication and collaboration between the nurse, patient, and other health care professionals results in quality person-centered care.

REFLECTIVE PRACTICE LEADING TO PERSONAL LEARNING

Reflective practice occurs when the carer has a profound awareness of self; awareness of one's own biases, prejudgments, prejudices, and assumptions; and understands how these may affect the therapeutic relationship. This awareness is developed through the process of reflection, thinking back on what has occurred for the purpose of learning in order to improve.

WHATS IS S.B.A.R.

S-SITUATION B-BACKGROUND A-ASSESSMENT R-RECOMMENDATION

COMMUNICATION PROCESS EXAMPLE (look at the powerpoint for the actual visual diagram )

Steps: 1.Patient sends a message 2.Message is related to what the patient's needs are 3.Channel is how the message is sent/received. 4.Nurse receives the message 5.Feedback is the nurse's way of acknowledgment

A nurse working in a long-term care facility bases patient care on five caring processes: knowing, being with, doing for, enabling, and maintaining belief. This approach to patient care best describes whose theory?

Swanson's

What is Sympathy?

Sympathy is the expression of sorrow for someone's situation, involving compassion and kindness. Sympathy shifts the emphasis from the patient to the nurse as the nurse shares feelings and personal concerns and projects them onto the patient.

The Nurse's Action in Response to Individual Clinical Need

The healing action that occurs in response to individual need completes the cycle of thoughtful practice when it is considered, personalized, appropriate, valued, and effective.

A nurse enters the room of a patient with cancer. The patient is crying and states, "I feel so alone." Which response by the nurse is the most therapeutic action?

The nurse holds the patient's hand and asks, "What makes you feel so alone?"

A 3-year-old child is being admitted to a medical division for vomiting, diarrhea, and dehydration. During the admission interview, the nurse should implement which communication techniques to elicit the most information from the parents?

The use of clarifying questions

What is THERAPEUTIC COMMUNICATION?

Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client's specific needs to promote an effective exchange of information.

What are CLOSE-ENDED QUESTION?

They are more direct and can be answered with a yes or no or simple answers. Example: Do you live alone?

Empathy versus Sympathy ( from the powerpoint)

When the patient and family sense that you have some idea of what they are experiencing, and that you are committed to helping, the basis is set for a trusting therapeutic relationship.

What is a therapeutic relationship?

is between the caregiver and patient and is FOCUSED ON PROMOTING OR RESTORING HEALTH AND WELL-BEING OF THE PATEINT.

What is thoughtful Practice

is nursing practice that is considerate and compassionate. A thoughtful nurse always keeps the person at the center of caregiving in order to promote the humanity, dignity, and well-being of the patient.

What is the nursing process

is a five step systematic method that directs the nurse, with the patient's participation, to accomplish the following that involves assessing, diagnosing, planning, implementing, and evaluating

What is COMMUICATION ?

is the process of sharing information; process of generating and transmitting meanings

What is ACTIVE OBSERVATION

it means watching the speaker's nonverbal actions as he or she communicates.

To receive the sender's simultaneous messages,...

the nurse must use ACTIVE LISTENING and ACTIVE OBSERVATION.

What are characteristics of the assertive nurse's self-presentation?

•Confident; open body posture •USE OF CLEAR, CONCISE "I" STATEMENTS •Ability to share effectively one's thoughts, feelings, and emotions •Working to capacity with or without supervision •Remaining calm under supervision •Asking for help when necessary •Giving and accepting compliments •Admitting mistakes and taking responsibility for them

COMMUNICATION WITH CHILDREN (think about how to speak with kids)

•Considerations: - age of the child -child's cognitive and developmental level -the nurse also needs to communicating at an APPPORPRIATE LEVEL with the parents. • Use specific and clear phrases in an unhurried, quiet, yet confident manner •Communicate at the child's eye level. • Spending time and incorporating PLAY with younger children •Older children need privacy. •Be HOENST • Allow children to EXPRESS their thoughts and feelings. •Offer the child choices when possible, but only when they truly exist.

DEVELOPING GOOD COMMUNICATION SKILLS

•Control the tone of your voice. •Be knowledgeable about the topic of conversation .•Be flexible. •Be clear and concise. •Avoid words that might have different interpretations. •Be truthful. •Keep an open mind. •Take advantage of available opportunities

During a nursing staff meeting, the nurses resolve a problem of delayed documentation by agreeing unanimously that they will make sure all vital signs are reported and charted within 15 minutes following assessment. This is an example of which characteristics of effective communication? Select all that apply.

*Group decision making *Group identity *Group patterns of interaction *Group cohesiveness

A nurse uses critical thinking skills to focus on the care plan of an older adult who has dementia and needs placement in a long-term care facility. Which statements describe characteristics of this type of critical thinking applied to clinical reasoning? Select all that apply.

*It is based on the principles of the nursing process, problem solving, and the scientific method. *It is driven by patient, family, and community needs as well as nurses' needs to give competent, efficient care. *It is constantly re-evaluating, self-correcting, and striving for improvement.

The nurse uses blended competencies when caring for patients in a rehabilitation facility. Which examples of interventions involve cognitive skills? Select all that apply.

*The nurse uses critical thinking skills to plan care for a patient. and... *The nurse learns the correct dosages for patient pain medications.

In study after study,...

...social contact, the richness of one's interactions with others, is correlated with positive health outcomes.... We're being asked to integrate a HOLISTIC APPROACH AND EXTEND LOVE, COMPASSION AND EMPATHY"

What are the 10 Vital person-centered care principles

1. All team members are considered caregivers. 2. Care is based on CONTINUOUS HEALING RELSTIONSHIPS. 3. Care is customized and reflects patient needs, values, and choices. 4. Knowledge and information are freely shared between and among patients, care partners, health care providers, and caregivers. 5. Care is provided in a healing environment of comfort, peace, and support. 6. Families and friends of the patient are considered an essential part of the care team. 7. Patient safety is a visible priority. 8. Transparency is the rule in the care of the patient. 9. All caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient. 10.The patient is the source of control for his or her care.

What are components of thoughtful Person-Centered Practice

1. The person 2.The Professional Nurse 3.Refelctive Practice leading to personal learning 4.Clinical Reasoning, Judgment, and Decision Making 5.Person-Centered Nursing Process 6.The Nurse's Action in Response to Individual Clinical Need

A nursing student is nervous and concerned about working at a clinical facility. Which action would BEST decrease anxiety and ensure success in the student's provision of patient care?

Engaging in self-talk to plan the day and decrease fear

Why is assertive communication important ?

It recognizes the rights of both parties, and is useful in a variety of situations, such as resolving conflicts, solving problems, and expressing feelings or thoughts that are difficult for some people to express. •Assertive communication can help a person deal with issues with coworkers, family, or friends. •It is particularly helpful for people who have difficulty refusing another's request, expressing emotions of anger or frustration, or dealing with persons of authority.

WHAT IS PERSON- CENTERED CARE

It is a model of patient care based on holistic roots in which the nurse or other caregiver uses every clinical encounter to assess how the person is doing and to communicate respect, compassion, and care

What is ACTIVE LISTENING

It means refraining from other internal mental activities and concentrating exclusively on what the client says *Active listening helps the nurse guide the questions by taking cues from the client's answers.

A nurse notices a patient is walking to the bathroom with a stooped gait, facial grimacing, and gasping sounds. Based on these nonverbal clues, for which condition would the nurse assess?

Pain

The Professional Nurse

Professional nursing requires cultivated personal attributes, mastery of the science of nursing, and reflective clinical experience in which nurses develop the blended competencies and QSEN competencies that promote thoughtful and effective person-centered practice.

A nurse is caring for a patient who has complications related to type 2 diabetes mellitus. The nurse researches new procedures to care for foot ulcers when developing a care plan for this patient. Which QSEN competency does this action represent?

Quality improvement

Nurses who practice person-centered care are committed to developing caring professional relationships ARE BASED ON WHAT?

RESPECT AND MUTUAL TRUST

A female patient who is receiving chemotherapy for breast cancer tells the nurse, "The treatment for this cancer is worse than the disease itself. I'm not going to come for my therapy anymore." The nurse responds by using critical thinking skills to address this patient problem. Which action is the first step the nurse would take in this process?

The nurse reassesses the patient and decides how best to intervene in her care.

Person-Centered Nursing Process

The nursing process describes the way in which care is organized through a series of actions undertaken in response to the individual needs of the patient. The components of the nursing process are ASSESSING, DIAGNOSING, PLANNING, IMPLEMENTING, EVALUATING

Why is communicating important?

The process of communication is an essential component of life and the primary aspect of a nurse-patient interaction. •Communication skills are the building blocks of professional relationships between nurse and patient, nurse and nurse, and nurse and other health care team members. •Without communication, it would be impossible to share family experiences, gain knowledge, establish and maintain practice protocols, and enhance caregiving .•Communication also assists in meeting our psychosocial needs of love, belonging, and self-esteem. The ability to communicate is basic to human functioning and well-being.

Why is documentation important?

This documentation helps promote the continuity of care given by nurses and other health care providers. Because one nurse cannot provide 24-hour coverage for patients, significant information must be passed on to others through nursing progress notes and care plans. REMEMBER :If you don't document it, it wasn't DONE!

What is the holistic approach?

which is consistent with theories based on human caring, SEEKS TO PROMOTE HUMANISM, HEALTH, AND QUALITY OF LIVING.

What are the 10 carative factors that are needed to exist within the nurse-client relationship?

• Humanistic altruistic system of values • Instillation of faith/hope • Sensitivity to self and others • Helping/trusting human care relationship • Expressing positive and negative feelings • Creating problem-solving caring process • Transpersonal teaching/learning • Supportive, protective, and/or corrective mental, physical, societal, and spiritual environment • Human needs assistance • Existential-phenomenologic-spiritual forces

What are the factors influencing communication?

•Developmental level •Gender •Sociocultural differences •Roles and responsibilities •Space and territoriality •Physical, mental, and emotional state •Values •Environment

What are the BLOCKS TO COMMUNICATION

•Failure to perceive the patient as a human being •Failure to LISTEN •NONTHERAPUTIC comments and questions •Using clichés •Using closed questions •Using questions containing the words "why" and "how" •Using questions that probe for information •Using LEADING QUESTIONS •Using comments that give advice •Using JUDGEMENTAL COMMENTS •Changing the subject •Giving false assurance •Using gossip and rumors •Using disruptive interpersonal behavior

what are the LEVELS OF COMMUNICATION ( Know the difference between intra & inter personal)

•Intrapersonal-Self-talk; communication within a person •Interpersonal-Occurs between two or more people with a goal to exchange messages •Group-Small-group •Organizational communication-Group dynamics

What are the MODES OF COMMUNICATION?

•Verbal (language) •Nonverbal (body language)