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Caring - Correct Answer-sharing deep and genuine concern about the welfare of another person. Caring practice - Correct Answer-mutual recognition, connection, involvement between nurse and client Examples of Caring - Correct Answer-• A client experiencing postoperative pain is given medication to control her symptoms, and then the nurse talks quietly and holds her hand for a few minutes as the pain resolves. The nurse's presence, in itself, provides comfort for the client.
- After the student nurse washes the hair of an older woman who is immobilized and applies her makeup, she helps the woman into a wheelchair to greet her daughter and grandchildren. The woman is extremely grateful and her sense of dignity is enhanced by this personal care. Nursing - Correct Answer-nurturance or care Culture Care Diversity and Universality (Leininger) - Correct Answer-- emphasizes care as "distinct, dominant, unifying, and central focus of nursing"
- Her theory of culture care diversity and universality is based on the assumption that nurses must understand different cultures in order to function effectively.
- When nursing care fails to be reasonably congruent with the client's beliefs, lifeways, and values, signs of conflict, noncompliance, and stress may arise.
- Culturally congruent care involves three action-decision care approaches: (1) preservation of the client's familiar lifeways (2) accommodations that help clients adapt to or negotiate for satisfying care (3) repatterning nursing care to help the client move toward wellness
- further defines caring as "assistive, supportive, and enabling experiences or ideas towards others with evident or anticipated needs, to ameliorate or improve a human condition or lifeway" Theory of Bureaucratic Caring (Ray) - Correct Answer-- The theory suggests that caring in nursing is contextual and is influenced by the organizational structure and the role and position a person held.
- the meaning of caring varied: an intensive care unit had a dominant value of technologic caring (i.e., monitors, ventilators, treatments, and pharmacotherapeutics), and an oncology unit had a value of a more intimate, spiritual caring (i.e., family focused, comforting, compassionate)
- Staff nurses valued caring in terms of its relatedness to clients, whereas administrators valued caring as more system related, such as safeguarding the economic well-being of the hospital
- spiritual-ethical caring influences each aspect of the bureaucratic system (technologic, physical, legal, political, economic, social-cultural, and educational). Each of these aspects is different, but they make up a whole bureaucratic system (e.g., a hospital).
- Nurses make these choices with the interest of the client at heart and use ethical principles as the foundation for the basis of professional decision making.
- "Spiritual-ethical caring for nursing does not question whether or not to care in complex systems, but intimates how sincere deliberations and ultimately the facilitation of choices for the good of others can or should be accomplished" Caring, the Human Mode of Being (Roach) - Correct Answer-- All individuals are caring, and develop their caring abilities by being true to self, being real, and being who they truly are. Thus, caring is not unique to nursing.
- visualizes caring to be unique in nursing however, because caring is the center of all attributes she uses to describe nursing.
- Roach defines these attributes as the six C's of caring: compassion, competence, confidence, conscience, commitment, and comportment. Compassion - Correct Answer-Awareness of one's relationship to others, sharing their joys, sorrows, pain, and accomplishments. Participation in the experience of another. Competence - Correct Answer-Having the "knowledge, judgment, skills, energy, experience and motivation required to respond adequately to the demands of one's professional responsibilities" Confidence - Correct Answer-Comfort with self, client, and others that allows one to build trusting relationships. Conscience - Correct Answer-Morals, ethics, and an informed sense of right and wrong. Awareness of personal responsibility. Commitment - Correct Answer-The deliberate choice to act in accordance with one's desires as well as obligations, resulting in investment of self in a task or cause. Comportment - Correct Answer-Appropriate bearing, demeanor, dress, and language that are in harmony with a caring presence. Presenting oneself as someone who respects others and demands respect. Nursing as Caring (Boykin and Schoenhofer) - Correct Answer-- purpose of the discipline and profession of nursing is to know people and nurture them as individuals living and growing in caring
- Respect for people as caring individuals and respect for what matters to them are assumptions underlying the theory of nursing as caring.
Engaging the self of both BEING WITH Being emotionally present to the other Being there Conveying ability Sharing feelings Not burdening DOING FOR Doing for the other as he/she would do for the self if it were at all possible Comforting Anticipating Performing competently/skillfully Protecting Preserving dignity ENABLING Facilitating the other's passage through life transitions and unfamiliar events Informing/explaining Supporting/allowing Focusing Generating alternatives/thinking it through Validating/giving feedback MAINTAINING BELIEF Sustaining faith in the other's capacity to get through an event or transition and face a future with meaning Believing in/holding in esteem Maintaining a hope-filled attitude Offering realistic optimism "Going the distance" Empirical Knowing - Correct Answer-- nursing requires scientific competence
- ranges from factual, observable phenomena (e.g., anatomy, physiology, chemistry) to theoretical analysis (e.g., developmental theory, adaptation theory)
- for the purpose of describing, explaining, and predicting phenomena of special concern to the discipline of nursing Personal Knowledge - Correct Answer-- concerned with the knowing, encountering, and actualizing of the concrete, individual self
- Because nursing is an interpersonal process, the nurse's view of self, as well as the client, is a critical factor in the therapeutic relationship.
- promotes wholeness and integrity in the personal encounter, achieves engagement rather than detachment, and denies the manipulative or impersonal approach.
Ethical Knowing - Correct Answer-- Goals of nursing include the conservation of life, alleviation of suffering, and promotion of health.
- focuses on "matters of obligation or what ought to be done" and goes beyond observing the nursing code of ethics.
- Nursing care involves a series of deliberate actions or choices that are subject to the judgment of right or wrong.
- Occasionally, the principles and norms that guide choices may be in conflict. The more sensitive and knowledgeable the nurse is to these issues, the more "ethical" the nurse will be. Aesthetic knowing - Correct Answer-- the art of nursing and is expressed by the individual nurse through his or her creativity and style in meeting the needs of clients.
- The nurse uses aesthetic knowing to provide care that is both effective and satisfying.
- Empathy, compassion, holism, and sensitivity are important modes in the aesthetic pattern of knowing. Caring pattern - Correct Answer-knowing the client, nursing presence, empowering the client, compassion, and competence Knowing the client - Correct Answer-- The nurse asks: Who is this person? What is the client's history? Needs? Desires? Dreams? Spiritual beliefs? Who loves and cares for this person at home? Where is home and what resources are there? What does this person need today, from me, right now? Can this person tell me what is needed? Personal knowledge of the client is a key in the caring relationship between nurse and client.
- The nurse aims to know who the client is, in his or her uniqueness. This knowledge is gained by observing and talking with the client and family while using effective listening and communication skills.
- Knowing the client and family ultimately involves the nurse and client in a caring transaction. By attending broadly to personal, ethical, aesthetic, and empirical knowledge, the nurse understands events as they have meaning in the life of the client. The nurse's knowing the client ultimately increases the possibilities for therapeutic interventions to be perceived as relevant. Nurse Presence - Correct Answer-- As nurses and students increase their self- awareness and commitment to nursing, the ability to be authentically present to the other grows
- Healing presence requires an openness and consciousness of the self and the client.
- The nurse must create some space for awareness by being truly present and focused on the moment. The nurse is aware of his or her own thoughts and feelings, while also aware of an interconnectedness with the client.
- Authentic presence involves empathy and openness to positive or negative feelings, nonpossessive warmth, a relaxed posture, and facial expressions that are congruent with other communications
for nursing in settings ranging from intensive care to hospice, and serves as a motivator for nursing interventions. Nurses are challenged to be crea Caring for Self - Correct Answer-Mayeroff (1990) describes caring for self as helping oneself grow and actualize one's possibilities. Self-care, when defined as responding to one's own needs to grow, is the opposite of the self-complacency that often accompanies egocentricity. Caring for self means taking the time to nurture oneself. This involves initiating and maintaining behaviors that promote healthy living and well- being. Although different activities may be helpful to different people, some examples of these activities include:
- A healthy lifestyle (e.g., nutrition, activity and exercise, recreation)
- Mind-body therapies (e.g., guided imagery, meditation, yoga). Self-care focuses on care of the self in the deepest sense. Self-awareness and self- esteem are intimately connected to self-care. MIND-BODY THERAPIES - Correct Answer-The interconnectedness of the mind and body is the basis for the complementary therapies. Imagery, meditation, storytelling, music therapy, and yoga are examples of complementary therapies that bring balance to thoughts and emotions. Practice of one or more mind-body therapies is an effective self-care strategy to help restore peace and balance. GUIDED IMAGERY - Correct Answer-Imagery is a mind-body intervention that uses the power of the imagination as a therapeutic tool. Imagery is used to promote relaxation, decrease anxiety, and enhance psychological or spiritual insight. Through forming mental images of an object, event, or situation, the individual can reframe negative responses into positive images, enhancing healing and emotional well-being. Meditation - Correct Answer-Through quieting the mind and focusing it on the present, meditation assists the individual in releasing fears, worries, and doubts. The technique involves both relaxation and focused attention. Guidelines for mindful meditation include choosing a quiet space, sitting comfortably, achieving progressive relaxation through deep breathing, and focusing attention on breathing or a mental image. Telling stories - Correct Answer-As expressions of human consciousness, stories help individuals gain a greater understanding of life. Stories communicate life experience and are often shared with clients and others to inspire and comfort. The language of stories allows nurses to begin to understand the deeper meaning of clinical situations. Stories are also a mechanism to deal with stress and move toward wholeness. Music Therapy - Correct Answer-Using music as therapy includes listening, singing, rhythm, and body movement. Quiet, soothing music is often used to induce relaxation. Active rhythms can awaken feelings of power and control. Familiar music allows the listener to recall past events or feelings. Music can also serve as an effective distraction technique. Each person's likes and dislikes are taken into account in order to achieve the desired emotional response.
yoga - Correct Answer-The practice of yoga unites the body, mind, and spirit. Through daily practice of the various postures and breathing practices of yoga, an individual can achieve increased balance and flexibility, mental alertness, and calmness. The bending, stretching, and holding properties of the postures help to relax and tone the muscles and improve function of the internal organs. Breath control is designed to still the mind and enhance awareness. Eliopoulos (2010) sums up the goal of yoga: to "create balance between movement and stillness, which is said to be the state of a healthy body" Caring - Correct Answer-Caring practice involves connection, mutual recognition, and involvement between nurse and client. Caring is central to nursing practice. Caring for self is central to caring for others. Mayeroff - Correct Answer-knowing, alternating rhythms, patience, honesty, trust, humility, hope, and courage (a) knowing means understanding the other's needs and how to respond to these needs; (b) alternating rhythms signifies moving back and forth between the immediate and long-term meanings of behavior, considering the past; (c) patience enables the other to grow in his own way and time; (d) honesty includes awareness and openness to one's own feelings and a genuineness in caring for the other; (e) trust involves letting go, to allow the other to grow in his own way and own time; (f) humility means acknowledging that there is always more to learn, and that learning may come from any source; (g) hope is belief in the possibilities of the other's growth; and (h) courage is the sense of going into the unknown, informed by insight from past experiences. Reflection on Practice - Correct Answer-Critical thinking, self-analysis, and reflection are required in order to learn from one's experience. The student develops as a practitioner by thinking about how values and standards guide practical experience. Reflection is thinking from a critical point of view, analyzing why one acted in a certain way, and assessing the results of one's actions. To develop oneself as a caring practitioner, reflection on practice must be personal and meaningful. American Heart Association guidelines recommend that healthy adults, ages 18 to 65 years, engage in the following activities to promote and maintain health: - Correct Answer-• At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150 minutes OR
- At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of the two AND
- Moderate to high intensity muscle-strengthening activity at least 2 or more days per week for additional health benefits. communication - Correct Answer-any means of exchanging information or feelings between two or more people. It is a basic component of human relationships, including nursing.
hour." However, if experience has taught him that he can receive the pain medication early if a certain nurse is on duty, he will interpret the intent of the message differently. response - Correct Answer-is the message that the receiver returns to the sender. It is also called feedback. Feedback can be either verbal, nonverbal, or both. Nonverbal examples are a nod of the head or a yawn. Either way, feedback allows the sender to correct or reword a message. In the case of Mr. Johnson, the receiver may appear irritated or say, "Well, the nurse on the other shift gives me my pain medication early if I need it." The sender then knows the message was interpreted accurately. However, now the original sender becomes the receiver, who is required to decode and respond. VERBAL COMMUNICATION - Correct Answer-Verbal communication is largely conscious because people choose the words they use. The words used vary among individuals according to culture, socioeconomic background, age, and education. As a result, countless possibilities exist for the way ideas are exchanged. An abundance of words can be used to form messages. In addition, a wide variety of feelings can be transmitted when people talk. Nurses need to consider the following when choosing words to say or write: pace and intonation, simplicity, clarity and brevity, timing and relevance, adaptability, credibility, and humor. Pace and Intonation - Correct Answer-the manner of speech, as in the rate or rhythm and tone, will modify the feeling and impact of a message. The tone of words can express enthusiasm, sadness, anger, or amusement. The rate of speech may indicate interest, anxiety, boredom, or fear. For example, speaking slowly and softly to an excited client may help calm the client. Simplicity - Correct Answer-Simplicity includes the use of commonly understood words, brevity, and completeness. Many complex technical terms become natural to nurses. However, laypersons often misunderstand these terms. Words such as vasoconstriction or cholecystectomy are meaningful to the nurse and easy to use but are ill advised when communicating with clients. Nurses need to learn to select appropriate, understandable, and simple terms based on the age, knowledge, culture, and education of the client. For example, instead of saying to a client, "I will be catheterizing you for a urine analysis" it may be more appropriate and understandable to say, "I need to get a sample of your urine, so I will collect it by putting a small tube into your bladder." The latter statement is more likely to elicit a response from the client asking why it is needed and whether it will be uncomfortable, because the client understands the message being conveyed by the nurse. Clarity and Brevity - Correct Answer--Clarity is saying precisely what is meant -brevity is using the fewest words necessary.
The result is a message that is simple and clear. An aspect of this is congruence, or consistency, where the nurse's behavior or nonverbal communication matches the words spoken. When the nurse tells the client, "I am interested in hearing what you have to say," the nonverbal behavior would include the nurse facing the client, making eye contact, and leaning forward. The goal is to communicate clearly so that all aspects of a situation or circumstance are understood. To ensure clarity in communication, nurses also need to enunciate (pronounce) carefully. Timing Relevance - Correct Answer-Nurses need to be aware of both relevance and timing when communicating with clients. No matter how clearly or simply words are stated or written, the timing needs to be appropriate to ensure that words are heard. Moreover, the messages need to relate to the person or to the person's interests and concerns. This involves sensitivity to the client's needs and concerns. For example, a client who is fearful of the possibility of cancer may not hear the nurse's explanations about the expected procedures before and after gallbladder surgery. In this situation it is better for the nurse first to encourage the client to express concerns, and then to deal with those concerns. The necessary explanations can be provided at another time when the client is better able to listen. Another problem in timing is asking several questions at once. For example, a nurse enters a client's room and says in one breath, "Good morning, Mrs. Brody. How are you this morning? Did you sleep well last night? Your husband is coming to see you before your surgery, isn't he?" The client no doubt wonders which question to answer first, if any. A related pattern of poor timing is to ask a question and then not wait for an answer before making another comment. On the other hand, by allowing the client to respond to the social talk or chat, the nurse develops a rapport with the client that can help facilitate effective therapeutic communication. Adaptability - Correct Answer-e nurse needs to alter spoken messages in accordance with behavioral cues from the client. This adjustment is referred to as adaptability. What the nurse says and how it is said must be individualized and carefully considered. This requires astute assessment and sensitivity on the part of the nurse. For example, a nurse who usually smiles, appears cheerful, and greets the client with an enthusiastic "Hi, Mrs. Brown!" notices that the client is not smiling and appears distressed. It is important for the nurse to then modify his or her tone of speech and express concern by facial expression while moving toward the client. Credibility - Correct Answer-Credibility means worthiness of belief, trustworthiness, and reliability. Credibility may be the most important criterion of effective communication. Nurses foster credibility by being consistent, dependable, and honest. The nurse needs to be knowledgeable about what is being discussed and to have accurate information. Nurses should convey confidence and certainty in what they are saying, while being
Elderspeak - Correct Answer-a speech style similar to baby talk that gives the message of dependence and incompetence and is seen as patronizing by older adults. it doesn't communicate respect Many health care providers are not aware that they use elderspeak or that it can have negative meanings to the client. The characteristics of elderspeak include inappropriate terms of endearment (e.g., "honey", "grandma"), inappropriate plural pronoun use (e.g., "Are we ready for our bath"), tag questions (e.g., "You want to wear this dress"), and slow, loud speech Boundaries - Correct Answer-"limits of individuals, objects, or relationships" Attentive Listening - Correct Answer-listening actively and with mindfulness, using all the senses, and paying attention to what the client says, does, and feels as opposed to listening passively with just the ear. It is probably the most important technique in nursing and is basic to all other techniques. Attentive listening is an active process that requires energy and concentration. It involves paying attention to the total message, both verbal and nonverbal, and noting whether these communications are congruent. Attentive listening means absorbing both the content and the feeling the person is conveying, while putting aside your own judgments and ideas to really hear and focus on the client's needs. Attentive listening conveys an attitude of caring and interest, thereby encouraging the client to trust you, open up, and talk The nurse must be careful not to react quickly to the message. The nurse should not interrupt the speaker, and the nurse (the responder) should take time to think about the message before responding. As a listener, the nurse also should ask questions either to obtain additional information or to clarify. The message sender (i.e., the client) should decide when to close a conversation. When the nurse closes the conversation, the client may assume that the nurse considers the message unimportant. It is also important for nurses to be aware of their own biases. A message from a client that reflects different values or beliefs should not be discredited for that reason. Kneisl and Trigoboff (2013) point out the following blocks to listening that may prevent the nurse from hearing what the client is saying and hinder therapeutic communication:
- Correct Answer-• Rehearsing—being too busy thinking about what you want to say
- Being concerned with yourself—the focus should be on the client
- Assuming—thinking that you know what the client "really means" without validation
- Judging—framing what you hear or see in terms of your judgment about the client as being immature, depressed, etc.
- Identifying—focusing on your own similar experiences, feelings, or beliefs
- Getting off track—changing the subject if you become uncomfortable, bored, or tired
- Filtering—tuning out or only hearing certain things
- Common responses are nodding the head, uttering "Uh huh" or "Mmm," repeating the words that the client has used, or saying "I see what you mean." Each nurse has characteristic ways of responding, and the nurse must take care not to sound insincere or phony. Box 26-1 Guidelines for Visibly Tuning in to Clients: Empathic Presence Egan (2014) suggests specific nonverbal skills that a nurse can use to portray empathic presence through use of the acronym SOLER: - Correct Answer-• S: Face the other person squarely. Adopt a posture that indicates involvement. This position says, "I am available to you." Moving to the side lessens the degree of involvement.
- O: Adopt an open posture. The nondefensive position is one in which neither arms nor legs are crossed. It conveys that the person wishes to listen to what the other has to say.
- L: Lean toward the person. People move naturally toward one another when they want to say or hear something—by moving to the front of a class, by moving a chair nearer a friend, or by leaning across a table with arms propped in front. The nurse conveys involvement by leaning forward, closer to the client.
- E: Maintain good eye contact. In North American culture, mutual eye contact, preferably at the same level, recognizes the other person and denotes willingness to maintain communication. Eye contact neither glares at nor stares down another but is natural. In other cultures, too much eye contact, especially with someone in a position of authority, is out of order (Egan, 2014, p. 78).
- R: Try to be relatively relaxed or natural. Total relaxation is not feasible when the nurse is listening with intensity, but the nurse can show relaxation by taking time to respond, allowing pauses as needed, balancing periods of tension with relaxation, and using gestures that are natural. Table 26-1. Therapeutic Communication Techniques - Correct Answer-Using silence Accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response. Sitting quietly (or walking with the client) and waiting attentively until the client is able to put thoughts and feelings into words. Providing general leads Using statements or questions that (a) encourage the client to verbalize, (b) choose a topic of conversation, and (c) facilitate continued verbalization. "Can you tell me how it is for you?" "Perhaps you would like to talk about. ..." "Would it help to discuss your feelings?"
Nurse: "Dr. Broad is head of the department of surgery and is an excellent surgeon." Being defensive Attempting to protect a person or health care services from negative comments. These responses prevent the client from expressing true concerns. The nurse is saying, "You have no right to complain." Defensive responses protect the nurse from admitting weaknesses in the health care services, including personal weaknesses. Client: "Those night nurses must just sit around and talk all night. They didn't answer my light for over an hour." Nurse: "I'll have you know we literally run around on nights. You're not the only client, you know." Challenging Giving a response that makes clients prove their statement or point of view. These responses indicate that the nurse is failing to consider the client's feelings, making the client feel it necessary to defend a position. Client: "I felt nauseated after that red pill." Nurse: "Surely you don't think I gave you the wrong pill?" Client: "I feel as if I am dying." Nurse: "How can you feel that way when your pulse is 60?" Client: "I believe my hus Nurse-client relationships are referred to by some as interpersonal relationships, by others as therapeutic relationships, and by still others as helping relationships. Helping is a growth-facilitating process that strives to achieve three basic goals - Correct Answer-1. Help clients manage their problems in living more effectively and develop unused or underused opportunities more fully.
- Help clients become better at helping themselves in their everyday lives.
- Help clients develop an action-oriented prevention mentality in their lives. A helping relationship may develop over weeks of working with a client, or within minutes. The keys to the helping relationship are (a) the development of trust and acceptance between the nurse and the client and (b) an underlying belief that the nurse cares about and wants to help the client. Characteristics of a Helping Relationship - Correct Answer-• Is an intellectual and emotional bond between the nurse and the client and is focused on the client.
- Respects the client as an individual, including maximizing the client's abilities to participate in decision making and treatments, considering ethnic and cultural aspects, and considering family relationships and values.
- Respects client confidentiality.
- Focuses on the client's well-being.
- Is based on mutual trust, respect, and acceptance. Phases of the Helping Relationship - Correct Answer-PREINTERACTION PHASE The nurse reviews pertinent assessment data and knowledge, considers potential areas of concern, and develops plans for interaction. Organized data gathering; recognizing limitations and seeking assistance as required. INTRODUCTORY PHASE- also referred to as the orientation phase or the prehelping phase, is important because it sets the tone for the rest of the relationship. During this initial encounter, the client and the nurse closely observe each other and form judgments about the other's behavior. The goal of the nurse in this phase is to develop trust and security within the nurse-client relationship
- Opening the relationship Both client and nurse identify each other by name. When the nurse initiates the relationship, it is important to explain the nurse's role to give the client an idea of what to expect. When the client initiates the relationship, the nurse needs to help the client express concerns and reasons for seeking help. Vague, open-ended questions, such as "What's on your mind today?" are helpful at this stage. A relaxed, attending attitude to put the client at ease. It is not easy for all clients to receive help.
- Clarifying the problem Because the client initially may not see the problem clearly, the nurse's major task is to help clarify the problem. Attentive listening, paraphrasing, clarifying, and other effective communication techniques discussed in this chapter. A common error at this stage is to ask too many questions of the client. Instead focus on priorities.
- Structuring and formulating the contract (obligations to be met by both the nurse and client) Nurse and client develop a degree of trust and verbally agree about (a) location, frequency, and length of meetings; (b) overall purpose of the relationship; (c) how confidential material will be handled; (d By the end of the introductory phase, clients should begin to: - Correct Answer-• Develop trust in the nurse.
- View the nurse as a competent professional capable of helping.
- View the nurse as honest, open, and concerned about their welfare.
particular social or health problem have an understanding of that condition which those without it do not.
- Members can experience almost instant kinship because the essence of the group is the idea that "you are not alone."
- Members can talk about their feelings and listen to the concerns of others, knowing they all share this experience.
- The group atmosphere is generally one of acceptance, support, encouragement, and caring.
- Many members act as role models for newer members and can inspire them to attempt tasks they might consider impossible.
- The group provides the opportunity for people to help as well as to be helped—a critical component in restoring self-esteem after significant losses. Self- awareness and growth groups - Correct Answer-The purpose of self-awareness and growth groups is to develop or use interpersonal strengths. The overall aim is to improve the person's functioning in the group to which they return, whether job, family, or community. From the beginning, broad goals are usually apparent, for example, to study communication patterns, group process, or problem solving. Because the focus of these groups is interpersonal concerns around current situations, the work of the group is oriented to reality testing with a here-and-now emphasis. Members are responsible for correcting inefficient patterns of relating and communicating with each other. They learn the group process through participation, involvement, and guided exercises. therapy groups - Correct Answer-Therapy groups work toward self-understanding, more satisfactory ways of relating to or handling stress, and changing patterns of behavior toward health. Members of a therapy group are chosen by health professionals after extensive selection interviews that consider the pattern of personalities, behaviors, needs, and identification of group therapy as the treatment of choice. Duration of therapy groups is not usually set. A termination date is usually mutually determined by the therapist and members. WORK-RELATED SOCIAL SUPPORT GROUPS - Correct Answer-Many nurses, for example, hospice, emergency, and acute care nurses, experience high levels of vocational stress. Various types of group support can buffer such stress. Group members who know about the work of others can encourage and challenge members to be more creative and enthusiastic about their work and to achieve more. For example, a nurse may help another team member consider alternative strategies for intervention. Members also can share the joys of success and the frustration of failure through active
listening without giving advice or making judgments. This type of social support is best given outside of the work environment. impairments to communication - Correct Answer-Various barriers may alter a client's ability to send, receive, or comprehend messages. These include language deficits, sensory deficits, cognitive impairments, structural deficits, and paralysis. The nurse must assess each to determine their presence language deficits - Correct Answer-Determine the client's primary language for communicating and whether a fluent interpreter is required. The language skills of some clients who use English as a second language may be inadequate to meet their needs. sensory deficits - Correct Answer-The ability to hear, see, feel, and smell are important adjuncts to communication. Deafness can significantly alter the message the client receives; impaired vision alters the ability to observe nonverbal behavior, such as a smile or a gesture; inability to feel and smell can impair the client's abilities to report injuries or detect the smoke from a fire. For clients with severe hearing impairments, follow these steps:
- Look for a medical alert bracelet (or necklace or tag) indicating hearing loss.
- Determine whether the client wears a hearing aid and whether it is functioning.
- Observe whether the client is attempting to see your face to read lips.
- Observe whether the client is attempting to use hands to communicate with sign language. COGNITIVE IMPAIRMENTS - Correct Answer-Any disorder that impairs cognitive functioning (e.g., cerebrovascular disease, Alzheimer's disease, and brain tumors or injuries) may affect a client's ability to use and understand language. These clients may develop total loss of speech, impaired articulation, or the inability to find or name words. Certain medications such as sedatives, antidepressants, and neuroleptics may also impair speech, causing the client to use incomplete sentences or to slur words. lateral violence - Correct Answer-also known as horizontal violence and horizontal hostility, are terms that describe physical, verbal, or emotional abuse or aggression directed at RN coworkers at the same organizational level. It usually includes verbal or nonverbal (rather than physical) aggressive behaviors. Examples of these behaviors include gossiping, verbal abuse (speech that is intended to humiliate or embarrass another person), withholding information, snide remarks, abrupt responses, sabotage, scapegoating, not available to help, complaining to others about one individual, ostracism, and failure to respect the privacy of others
