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NUR 3180 COMMUNICATION EXAM 1 CHAPTER 1-11 Exam 1 Chapter 1 Foundations of professional nursing practice • initially women practice nursing informally with care traditions passed down through the generation • Florence Nightingale made nursing a profession • nursing has not always been identifiable as a distinct occupation Florence Nightingale • America's first professional nurse • establish the first nursing school- Saint Thomas hospital of London • demonstrated nursing profession as a research • use statistical data to document the need for hand washing to prevent infection during the Crimean war • effective interpersonal communication supports the safety and quality in health care • communication connects people and ideas through words, nonverbal behaviors, and actions evidence based nursing practice • a problem-solving approach to clinical decision making that incorporates a search for the best and latest evidence, clinical expertise and assessments. principles of team-based health care • sharing goals • clear roles • mutual trust • effective communication • measurable processes and outcomes the future of nursing • leading change and advancing health • nurses should practice to the full extent of their education and training • nurses should achieve higher levels of education and training, through an improved education system that promotes seamless academic profession • nurses should be full partners with physicians and other health professionals and redesigning health care in the US chapter 2 checklist NUR 3180 COMMUNICATION EXAM 1 CHAPTER 1-11 • create expectation that organizations assess effective communication and safe practices • WHO and Joint Commission encourage use of checklist prior to surgical procedures considerations for patient safety • multiple studies have pinpointed miss communication as a major cause in sentimental events, that is errors resulting in unnecessary death and serious injury. • Recognizing that human errors occurs, everyone's focus needs to be on correcting system flaws to avoid future adverse events, rather than finding the one to blame (ex. Falls) innovations that foster safety • create a culture of safety • support effective health care teamwork • create a team culture of collaboration in cooperation o involve shared responsibility for maintaining open communication and engaging in mutual problem solving, decision making, and coordination of care. • Create a non-punitive culture o staff are encouraged to report errors, mistakes, and find near misses • compiling a database that includes near miss situations that could have resulted in injury is important in preventing future errors (ex. Wrong pt., wrong specimen). tools for safer care • SBAR- situation, background, assessment, recommendation • improves communication and creates collaboration • any member of the health care team is empowered to speak up if they have a safety concern (example. a cancer patient declining a biopsy). chapter 3 effective communication • 7 C’s for effective and safe communication o correct o clear o concise o concrete o complete o confidential o contemporary QSEN • quality and safety education for nurses • patient centered care o focus on fully partnering with patients to provide care that incorporates his or her values and preferences to give safe, caring, compassionate effective care. Online guidelines for nurses using social media • refrain from posting identifiable patient information NUR 3180 COMMUNICATION EXAM 1 CHAPTER 1-11 o Muslims believe death is part of Allah’s plan, so to fight the dying process with treatment is wrong ▪ they believe that the dying person should not die alone ▪ a close relative should be present, praying for God's blessing or reading the Quran ▪ once a person actually dies, it is important to perform the following • turn the body toward Mecca • close the person's mouth and eyes and cover the face • straighten the legs and arms • unanswered after relatives and friends • bathe body (men bathing men and women bathing women) • cover the body with white cotton Health disparities • healthy people 2020 defines a health disparity as a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. • they create an increase health burden on certain segments of the population, particularly those with the least ability to correct their health situation. cultural competence • a set of cultural behaviors and attitudes integrated into the practice of methods of a system, agency, or its professionals that enables him to work effectively in cross cultural situations. • Cultural humility o defined as a process of openness, self-awareness, being egoless, and incorporating self-reflection and critique after willingly interacting with diverse individuals. • Self-awareness allows you to own your own biases and not projecting them onto patients. • Cultural awareness- include self-examination of in-depth exploration of 1's culture and professional background. • Cultural knowledge- involve seeking and obtaining an information based on different cultural and ethnic groups. • Cultural skill- includes the nurse’s ability to collect relevant cultural data regarding the patients presenting problem inaccurately perform a culturally specific assessment. • Cultural encounter- is defined as a process that encourages nurses to directly engage in cross cultural interactions with patients from culturally diverse backgrounds. Care of the culturally diverse patient • Building rapport o Calling pt. by title and last name shows respect o Speak clearly and spend time with the patient before asking assessment questions to make the patient and/or family comfortable. o Explain treatment procedures at every opportunity. o Ask permission and explain the necessity for any physical examination or use of assessment tools. NUR 3180 COMMUNICATION EXAM 1 CHAPTER 1-11 • Madeleines Leininger’s Theory of Culture Care o Nurses must have knowledge about diverse cultures to provide care that fits the patient. o Viewed as an essential component of patient centered model • Purnell’s model o Understanding the patient's cultural explanation for the health problem is essential, as different cultures from illness and its causes in various ways. ▪ Asian culture - depression is characterized as sadness rather than a mental disorder ▪ Arab Israeli culture- women believe that breast cancer is God's will or fate. Chapter 9 Spirituality and Self-Concept • Self-chosen beliefs and values that give meaning to a person’s life. They may or may not be associated with a particular faith. • Spiritual rituals and practices can be used to promote hope, support, and relieve anxiety for a patient experiencing spiritual pain. • An important component of nursing care is helping patients address their spiritual identity by providing time for spiritual practices and referral to chaplains or spiritual directors. • Respect spiritual practices of patience Chapter 17 Communication Deficit • Communication is necessary for safe health care but can be problematic for patients with communication impairments. • Impairment in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal, and graphic symbol systems. • Any impairment of patient’s abilities to send and or receive information from health care providers may compromise their health, safety, health care, and rights to make decisions. types of communication deficits • hearing loss o a common problem with approximately 15% of the world's population reporting trouble hearing o children o older adults NUR 3180 COMMUNICATION EXAM 1 CHAPTER 1-11 o patients with hearing loss may try to hide deficits, withdraw from relationships, become depressed, or be less likely to seek information from health care providers. • Vision loss o nearly 5 million Americans are blind or have uncorrectable visual impairments o children- requires traditional vision screening o older adults- presbyopia, macular degeneration o all of the nonverbal cues that accompanied by speech communication are lost to those who are blind. • Impaired verbal o a speech disorder impaired articulation, whereas a language disorder is impaired comprehension or use of spoken words. o Aphasia ▪ neurological linguistic deficit, such as occurs after a stroke o expressive aphasia ▪ I can understand what is being said but cannot express thoughts or feelings in words. o Receptive aphasia ▪ create difficulties in receiving and processing written and oral messages o global aphasia ▪ the patient has difficulty with both expressive language and reception of messages • impaired cognitive processing o can interfere with the communication process and leads to anxiety and confusion o children- mental retardation, autism, an affective disorder o older adults- memory loss Patients with treatment related communication disabilities • When a patient is not fully alert, it is not uncommon for nurses to speak in his or her presence in ways they would not if they thought the patient could fully understand what is being said, forgetting that hearing can remain acute. • Good practice suggest you never say anything you would not want them to hear. Always calling them by name, orienting to time, place, and location, explaining our procedures, using touch are considered best practice. Chapter 18 Regression as a form of childhood communication • The quiet, overly compliant child who does not complain may be more frightened than the child who screams or cries. • You need to obtain detailed information regarding the usual behavioral responses of the family and child. Age appropriate communication NUR 3180 COMMUNICATION EXAM 1 CHAPTER 1-11 • preference for direct versus indirect disclosure of information • individual versus family-based decision-making about treatment • disclosure of life-threatening diagnosis • providers choice of words and verbal exchanges • reliance on physician as the ultimate authority • specific rituals or practices performed at time of death • role of religion spirituality and coping an afterlife • views about suffering addressing cultural and spiritual needs • nurses need to take an honest look at their own spirituality • self-awareness allows nurses to enter their patient’s spiritual world from an authentic position, without imposing personal values and beliefs. Unit 3 Chapter 5 Obstacles to effective communication within the patient • preoccupied with pain, physical discomfort, worry, contraindicatory personal beliefs • unable to understand nurses use of language, terminology, frame of reference • feeling defensive, insecure, judged • confused by message complexity • deprived of privacy • sensory or cognitive deficits obstacles to effective communication within the nurse • preoccupation with personal agendas • hurrying to complete physical care • making assumptions about patient motivations • cultural stereotypes • defensiveness, personal insecurity about being able to help the patient • thinking ahead to the next question • intense patient emotion or aggressiveness Additional factors that influence communication • personal factors • self-awareness of personal vulnerabilities and prejudices- allow nurses to maintain neutrality and understanding needed for therapeutic exploration of patient issues • self-reflection or self-awareness o empowers nurses to continually access his/her communication skills o first take a moment to reflect on your behaviors o take responsibility for how you communicate both verbally and nonverbally o understand your own role o do you treat each of them in a courteous manner? Active listening • intentional form of listening NUR 3180 COMMUNICATION EXAM 1 CHAPTER 1-11 • involves more than simply hearing words • involves noting feelings and looking for underlying themes • encourage patient to explore potential concerns, expand on ideas, voice confusion • use open-ended questions Listening responses • minimal cues and leads o nonverbal signals are transmitted through body action, (smiling, nodding, and leaning forward, encourage patients to continue their story) o short phrases such as ‘go on’, or ‘and then?’, can you say more about it? • Clarification o Defined as brief question or a request for validation o ‘you stated earlier that you were concerned about your blood pressure. Tell me more about what concerns you? • Restatement o Active listening strategy used to broaden a patient’s perspective when the nurse needs to provide a sharper focus on a specific part if the message • Paraphrasing o Is listening response used to check whether the nurse’s translation. Of the patient’s words represent an acute interpretation of the message o Allows you to summarize or streamline a message, and/or highlight key points of the longer message. • Reflection o Offers nurses a way to empathetically mirror their sense of how a patient may be emotionally experiencing their health situation, • Summarization o Is an active listening skill used to review content and process Verbal responses • Focusing- it is important for nurses and patients to select the most pressing or relevant health care topics for discussion • You should not force a patient to discuss unless it is an emergency situation • Presenting reality o Presenting reality to a patient who is misinterpreting it can be helpful if the patient does not perceive that the nurse is criticizing the patient’s perception of reality. Chapter 8 Two types of groups of communicating • Primary groups o Characterized by an informal structure and close personal relationships (family, ling-term friendship) • Secondary groups o Represent time-limits relationships with an established beginning and end (formal work groups, clinical teams, education groups). Characteristics of small groups NUR 3180 COMMUNICATION EXAM 1 CHAPTER 1-11 • Group size- group purpose dictates group size o Pt centered therapeutic groups consist of six to eight members • Group member composition o A person’s capacity to derive benefit from the group and to contribute to the group is a critical requirement for patient therapy groups. • Group norms o Refer to the unwritten behavioral rules of conduct expected of group members Group process • Storming o Focuses on power and control issues • Norming o Individual goals become aligned with group goals ▪ Makes the group ‘safe’ and members begin to experience the cohesiveness of the group as their group • Performing o Characterized by interdependence, acceptance of each member as a person of value, and the development of group decision. ▪ Members feel loyal • Adjourning o Characterized by reviewing what has been accomplished o Reflecting o Making plans to move forward. Therapeutic activity groups • Discussion groups o Equal group participation should be a group expectation o Referred to as social loafing, when individual group members fail to do their part of the works or skip or come late to group project meetings o b/c the primary purpose of a discussion group is to promote the learning of all group’s members, all members are charged with the responsibility of contributing their ideas and encouraging participation of more silent members. Chapter 10 Difference between helping and social relationships • Therapeutic relationships are established for professional health related purposes within a specific time setting • Social relationships are established and maintained to meet mutual need, and/or friendship process • Major distinction o The focus of attention is always on patient outcomes, and the actions needed to help patients identify and resolve issues related to health and well-being. Phases of a patient centered relationship • Orientation phase NUR 3180 COMMUNICATION EXAM 1 CHAPTER 1-11 o As a caring nurse, you give patient centered care, recognizing and assisting the patients in their struggle for health and well-being rather than simply doing things for them o Your ability to care develops from a natural response to help those in need, from the knowledge that caring is a part of nursing ethics, and from respect for self and others. • Empowerment o Assisting patients to take charge of their lives o Out nursing goal is to use communication skills to build bridges to form partnership. o Empowered patients feel valued and are more likely to adopt successful coping methods o Studies demonstrate that the more involved people are in their own care, the better the health outcome. • Trust o Establishing trust is the foundation in all relationships o The Development of a sense of interpersonal trust, a sense of feeling safe, is the keystone in the nurse-patient relationship. • Empathy o Ability to be sensitive and communicate understanding of the patient's feelings o ability to put yourself into another position o an empathetic nurse perceives and understands patients’ emotions accurately o maintain direct eye contact, use attending open body language, and keep it calm tone of voice. Proxemics • Placing oneself at the same level allows more access to the patient's personal space because such a stance is perceived as less threatening (sitting on patients are sitting, or standing at eye level when they're standing) violations of personal space • when patients lose control over personal space, they may experience a loss of identity and self esteem • examples o explain why procedure is needed o provide privacy-” close my door please” o ask permission from patients before entering their room • usually people will tolerate a person standing close to them at their side more readily than directly in front of them • direct eye contact causes a need for more space • do not provide client direct eye contact during hands-on care NUR 3180 COMMUNICATION EXAM 1 CHAPTER 1-11