NURS110 ppt 2

• —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.

1.Provide patient–center care; focus on the patient rather than disease or the clinician.

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.

3.Employ evidence-based practice; integrate best research results, clinical expertise, and patient values to make patient care decisions.

4.Apply quality improvement (QI); not only apply QI but make it effective.

5.Use informatics; apply it to reduction of errors, management of knowledge and information, decision-making, and communication

—Essential part of all core competencies

—Impacts patient care and safety

—Enhances or impedes professional relationships

Hildegard Peplau

—Originated the term “therapeutic use of self” in 1952.

—Orientation Phase: Introductory phase

—Working: Accomplishes tasks toward goals

—Termination: Ends the relationship constructively

—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

—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.

*—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

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

• *—Professional boundaries
• *—Reflective practice
• *—Avoiding stereotypes
• *Becoming nonjudgmental

• 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.

*—Taking time to focus on own thoughts and feelings

*—Understand how these can affect behaviors toward patients

—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

*—Nurses acknowledge all patients’ rights to be different and express these differences

*—Nurse conveys acceptance to patients

—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

—Congruent: Verbal and nonverbal are consistent and reinforce each other

—Incongruent: Speech and non-speech do not match

• *Perception
• *Evaluation
• *Transmission

Selection,organization, and interpretation of incoming signals into meaningful messages

Analysis of information received

—Expression of information, verbal or nonverbal

*—Gender, age, culture, interest, mood, value, clarity, length of the message

*—Presence or absence of feedback

*—Atmosphere of the context

• *—Somatic language
• *Action language
• *Verbal language

—Early development; crying, facial expressions, reddening of the skin, fast or shallow breathing

—Behaviors; reaching out; pointing; crawling toward a desired object; turning or nodding the head

—Repetitive noises and sounds; syllables, words, phrases, and then complete sentences

• *Feedback
• *Appropriateness
• *Efficiency
• *Flexibility

—When a receiver relays to a sender the effect of the sender’s message

When a reply fits the circumstances and matches the message

—When the speaker uses simple, clear words that are timed at a pace suitable to participants

When the speaker bases messages on the immediate situation rather than preconceived expectations

• *Listen Well
• *Convey Empathy
• *Ask Open-ended Questions
• *Give needed Information
• *Use reflection
• *Communicate meaningfully with silence

—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

—Awareness of and sensitivity to others; identification of feelings of another person

—Sharing appropriate knowledge that patients are not expected to know

—Encouraging patients to think through situations by reflecting their questions back to them to develop their own solutions.

—Use judiciously

—Used expertly, it prevents “filling the gap” with distracting conversation that can prevent acceptance and “being with” the patient

—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

—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

The art of sharing emotional and factual information

—Involves letting go of judgments and appreciating the patient’s point of view.

—Accepting facial expression

—Warm eye contact

—Open posture

—Turning toward patient

—Encouraging patients’ expressions of concern

—Use principles of active listening

• — 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

• 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

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.

—Civil behavior

—Willingness to work together

—Supportive attitude and behaviors of the organization

—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

—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

—Fail to say what is on their minds

—Fail to convey important feelings

—Reluctant to ask questions

—Fearful

—Angry

—Argumentative

—Unappreciative

—Challenge authority