NURS110 ppt 2

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NURS110 ppt 2
2010-10-21 12:41:56

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  1. Institute of Medicine
    • —Goal is a consistent framework across healthcare professions education that emphasizes interdisciplinary care
    • rather than workng isolation.
    • *—Created in 1970 to serve as a source of science-base advice on matters of biomedical science, medicine, and health

    *—Should be the core of all nursing programs

    • *—Focus is on healthcare professions education, not on specific healthcare
    • professionals.
  2. # 1 Core Competencies
    1.Provide patient–center care; focus on the patient rather than disease or the clinician.
  3. # 2 Core Competencies
    2. Work in interdisciplinary teams; use the best healthcare professionals for the needs of the patients and work together to accomplish effective patient care outcomes.
  4. # 3 Core Competencies
    3.Employ evidence-based practice; integrate best research results, clinical expertise, and patient values to make patient care decisions.
  5. # 4 Core Competencies
    4.Apply quality improvement (QI); not only apply QI but make it effective.
  6. # 5 Core Competencies
    5.Use informatics; apply it to reduction of errors, management of knowledge and information, decision-making, and communication
  7. Communication
    —Essential part of all core competencies

    —Impacts patient care and safety

    —Enhances or impedes professional relationships
  8. Who Originated the "Therapeutic Use of Self"
    Hildegard Peplau

    —Originated the term “therapeutic use of self” in 1952.
  9. What are the three traditional Nurse-Patient Relationship Phases
    —Orientation Phase: Introductory phase

    —Working: Accomplishes tasks toward goals

    —Termination: Ends the relationship constructively
  10. Orientation Phase
    —Introductory phase: “Getting to know you”

    —Begins the development of trust building in the relationship

    —Four tasks of the orientation phase

    *—Trust enables continued participation in the relationship

    *—Patient and nurse regard each other as individuals

    Identification of major problems and needs

    *—Approximate length of the relationship will be estimated
  11. Working Phase
    —Nurse and patient tackle tasks outlined in the first Phase.

    —Patients may exhibit alternating periods of intense effort and periods of resistance to change.

    —Regression is an ego defense mechanism that occurs as a reaction to stress.

    —Regression often precedes positive change.
  12. Termination Phase
    *—Nurse and patient take on those activities that enable them to end the relationship in a therapeutic manner.

    *—Positive and negative feelings often accompany the termination process

    *—Positive feelings about gains made

    • *—Negative feelings of sadness, anger, fear
    • —Must be discussed toward acceptance
  13. Developing Self Awareness
    Goal of self-awareness: Nurses can distinguish their own emotional needs from their patients’ needs and get their own emotional needs met outside the nurse-patient relationship
  14. Factors Involved in Self Awareness
    • *—Professional boundaries
    • *—Reflective practice
    • *—Avoiding stereotypes
    • *Becoming nonjudgmental
  15. Professional Boundaries
    • The spaces between the nurse’s professional power and the patient’s
    • vulnerability

    • —National Council of State Boards of Nursing (1996)
    • *Boundary violations occur with confusion between needs of the nurse and those of the client.
  16. Reflective Practice
    *—Taking time to focus on own thoughts and feelings

    *—Understand how these can affect behaviors toward patients
  17. Avoiding Stereotypes
    —Prejudices and attitudes that are biased toward clients

    • —Goal: Accept all patients as individuals of dignity and worth who deserve the best nursing care
    • possible
  18. Becoming Nonjudgemental
    *—Nurses acknowledge all patients’ rights to be different and express these differences

    *—Nurse conveys acceptance to patients
  19. Levels of Communication
    —Verbal: Consists of all speech

    —Nonverbal Includes all non-speech: grooming, clothing, gestures, posture, facial expression, eye contact

    —Unconscious: Considered a more reliable expression of feeling
  20. —Congruent vs. Incongruent communication
    —Congruent: Verbal and nonverbal are consistent and reinforce each other

    —Incongruent: Speech and non-speech do not match
  21. 3 Communication Factors
    • *Perception
    • *Evaluation
    • *Transmission
  22. Perception Factor
    Selection,organization, and interpretation of incoming signals into meaningful messages
  23. Evaluation Factor
    Analysis of information received
  24. Transmission Factor
    —Expression of information, verbal or nonverbal
  25. Communication is complex. These three factors are influenced by:
    *—Gender, age, culture, interest, mood, value, clarity, length of the message

    *—Presence or absence of feedback

    *—Atmosphere of the context
  26. How Communication Develops
    • *—Somatic language
    • *Action language
    • *Verbal language
  27. Somatic Language
    —Early development; crying, facial expressions, reddening of the skin, fast or shallow breathing
  28. Action Language
    —Behaviors; reaching out; pointing; crawling toward a desired object; turning or nodding the head
  29. Verbal Language
    —Repetitive noises and sounds; syllables, words, phrases, and then complete sentences
  30. Criteria for Successful Communication
    • *Feedback
    • *Appropriateness
    • *Efficiency
    • *Flexibility
  31. Feedback
    —When a receiver relays to a sender the effect of the sender’s message
  32. Appropriateness
    When a reply fits the circumstances and matches the message
  33. Efficiency
    —When the speaker uses simple, clear words that are timed at a pace suitable to participants
  34. Flexibility
    When the speaker bases messages on the immediate situation rather than preconceived expectations
  35. Becoming a Better Listener
    • *Listen Well
    • *Convey Empathy
    • *Ask Open-ended Questions
    • *Give needed Information
    • *Use reflection
    • *Communicate meaningfully with silence
  36. Listening Well
    —Active listening involves focusing solely on a person and acknowledging feelings in a nonjudgmental manner

    —Includes open posture

    —Ventilation: Describes verbal “letting off steam” about frustrations
  37. Conveying Empathy
    —Awareness of and sensitivity to others; identification of feelings of another person
  38. Giving Needed Information
    —Sharing appropriate knowledge that patients are not expected to know
  39. —Use Reflection
    —Encouraging patients to think through situations by reflecting their questions back to them to develop their own solutions.

    —Use judiciously
  40. Communicating Meaningfully with Silence
    —Used expertly, it prevents “filling the gap” with distracting conversation that can prevent acceptance and “being with” the patient
  41. —Use culturally sensitive communication
    —Must take cultural differences into consideration when planning and implementing care

    —Consider: Dialect, style, differences in meaning and interpretation, space needs, eye contact, emotional tone, use of touch, gestures, stance
  42. —Avoiding communication breakdown
    —Prevent the following failures:

    —Failure to see the uniqueness of each individual

    —Failure to recognize levels of meaning

    —Using value statements and clichés

    —Giving false reassurance

    —Failure to clarify
  43. Holistic Communication
    The art of sharing emotional and factual information

    —Involves letting go of judgments and appreciating the patient’s point of view.
  44. —Actively attend to patients through intentional means, such as:
    —Accepting facial expression

    —Warm eye contact

    —Open posture

    —Turning toward patient

    —Encouraging patients’ expressions of concern

    —Use principles of active listening
  45. Aggressiveness in Communication
    • — try to dominate others
    • - use humiliation to control others
    • - criticize, blame, or attack others
    • - be very impulsive
    • - have low frustration tolerance
    • - speak in a loud, demanding, and overbearing voice
    • - act threateningly and rudely
    • - not listen well
    • - interrupt frequently
    • - use “you” statements
    • - have piercing eye contact and an overbearing posture
  46. Assertiveness in Communication
    • state needs and wants clearly, appropriately, and respectfully
    • - express feelings clearly, appropriately, and respectfully
    • - use “I” statements
    • - communicate respect for others
    • - listen well without interrupting
    • - feel in control of self
    • - have good eye contact
    • - speak in a calm and clear tone of voice
    • - have a relaxed body posture
    • - not allow others to abuse or manipulate them
    • - stand up for their rights
  47. Collaboration
    working jointly with other professionals

    —All of whom are respected for their unique knowledge and abilities

    To improve a patient’s health status or to solve an organizational problem.
  48. Collaboration Involves??
    —Civil behavior

    —Willingness to work together

    —Supportive attitude and behaviors of the organization
  49. Collaborative Processes Include: ....
    —Identify stakeholders

    —Identify problems to be solved

    —Identify barriers or roadblocks to solutions

    —Clarify desired outcomes

    —Clarify the process that will be used to accomplish task

    —Identify who will be responsible for each step in the task

    —Evaluate the degree of success in meeting the goals and generating a solution
  50. Nurse-Physician Collaboration —Can be a frequently problematic relationship because of:
    —Education, status, and gender differences

    —Different levels of willingness to work collaboratively

    —Hierarchical and control-oriented model for physicians in medical schools

    —Significantly different personality structures between nurses and physicians

    *—Female focus on collaboration, sharing, equality, and empathy

    *—Male focus on dominance or inferiority, control, justice, and winning
  51. —Patients often feel intimidated in health care settings
    —Fail to say what is on their minds

    —Fail to convey important feelings
  52. —Their dependent, vulnerable role in relation to health care professionals can make them:
    —Reluctant to ask questions





    —Challenge authority