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4 Components of Communitcation
- Sender (encoder)
- Message
- Receiver (decoder)
- Response
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Intrapersonal Communication
- self talk, happens within an individual
- Ex. "Calm down, you can handle this"
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Interpersonal Comm.
- Between 2+ people with goal of exchanging message
- ex. nurse talking with patient about outcome goals
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Small Group Comm
- nurses interact w/2+ individuals
- staff meeting, pt care conference, teaching session, support group
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Transpersonal Communication
- something almost spiritual/aura
- Not concrete or tangible
- More like unseen inner energy
- Spiritual motivation, inspiration, encouragement
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Organizational Communication
- large, formal setting
- council meeting
- committee meeting
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3 channels of communication:
Auditory
- (spoken words or cues)
- Patient states “I feel nauseated”
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3 Channels of Comm:
Visual
- (sight, observations and perceptions)
- nonverbal cues: furrowed brow, flushed face, pursed lips lead to perceived message of anger
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3 Channels of Comm.
Kinesthetic
- (touch)
- squeeze of shoulder, rub back conveys message of comfort
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Group Identity
- members value and "own" the aims of the group
- aims are clearly articulated
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Group Cohesiveness
- members generally trust and like one another
- loyalty to the group
- high commitment
- high degree of cooperation
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Group Patterns of Interaction
- Honest
- Direct communication flows freely
- Members support, prain, and critique one another
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Group Decision Making
- problems are identified
- appropriate method of decision making is used (i.e. indiv, minority, majority, consensus, unanimous)
- decision is implemented and followed through
- group commitment to decision is high
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Group Responsibility
members feel strong sense of responsibility for group outcomes
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Group Leadership
effective style of leadership to meet desired aims
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Group Power
- Sources of power are recognized and used appropriately
- needs or interest of those with little power are considered
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Verbal Communication
- using words, either spoken/written
- depends on language
- (interactions with patient and family, giving oral reports to other nurses, writing care plans, charting progress, composing signs and posters)
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Nonverbal Communication
- transmitting without use of words
- often body language: subtle and hidden meanings behing verbal statement
- generally more accurate when there in an incongruence
- (touch, eye contact, facial expressions, posture, gait, gestures, general physical appearance, mode of dress/grooming, sounds, silence)
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Phases of N-P Relationship:
PreInteractions
looking at all the information needed before you meet with the patient
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Culturally Competent Proxemics
- Appropriate range can be anywhere from 18in-4ft, depending on the nonverbal cues picked up by the nurse
- Nurse mst be sensitive to the offensiveness of many interventions within close proximity and show always ask permission/warn the patient
- Social Zones: hands, arms, shoulders, back
- Personal Zones: (1) mouth and feet (2) face, neck, front of body (3) genitalia (most personal)
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Phases of Nurse-Patient Relationship:
Orientation Phase
- introductions
- roles are clarified
- agreements made about goals of relationship
- location/frequency/length of contacts
- duration of relationship
- includes orientation to facility and environment
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Phases of N-P Relationship:
Working Phase
- work together to meet patient’s physical and psychological needs
- nurse provides whatever assistance is needed
- sentiments and feelings about people affect cooperativeness
- roles of teach and counselor take place
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Phases of N-P Relationship:
Termination Phase
- when conclusion of initial agreement is acknowledged
- participation in identifying goals accomplished or progress made
- verbalized feelings about termination of relationship
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Empathy
- identifying with the way a person feels
- nurse is sensitive to patient feeling but objective enough to provide the care needed
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Rapport
feeling of mutual trust experienced by people in a satisfactory relationship
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Silence
- can be contentedness
- reflection
- efense/fear mechanism
- display of anger
- filled with excessive talking
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Listening
- active participation
- open body posture
- facing patient without crossed arms/legs
- eye contact as appropriate
- nonverbal cues given and received
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Touch
for comfort or with appropriateness during care
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Humor
as a healing strategy and positive interpersonal interaction
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Open-Ended Question
- allows for wide range of responses
- "How does that make you feel?"
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Closed-Ended Question:
- yes or no
- specific answer
- used appropriately or it becomes a barrier
- "What medicines have you been taking at home?"
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Validation
- validate what nurse believes she is hearing
- "At home you've been taking a water pill and a blood pressure pill. Have you taken them today?"
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Clarification
- gain understanding of a comment
- Pt: "I have never needed medicine before."
- Nurse: "Is this the first health problem you've ever had?"
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Reflective
- repeating to promote elaboration
- pt: "I've been really upset about my blood pressure."
- nurse: "You've been upset..."
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Sequencing
- chronological order to find a possible cause and effect relationship
- "Your tiredness began after you started taking your medicine?"
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Directing
- returning to an earlier topic or introducing a new aspect
- tactfully and repectfully
- "You mentioned your dad earlier. Did he develop complications related to blood pressure?"
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Assertive Behaviors:
4 Components
- open, honest, direct communication
- 1. Empathy: "I guess it must be hard for you to balance this workload while taking care of your family at home"
- 2. Description: "I must be honest in that I’m feeling so overwhelmed with this workload that I sometimes experience signs of high anxiety"
- 3. Expectation: "I understand this program requires a vigilant work ethic, but I might need some help with time management skills"
- 4. Consequences: "I expect to overcome this feeling, but I fear I won’t be prepared to provide safe and
- adequate patient care"
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Barriers to Communication
- Failure to perceive patient as a human being (not a diagnosis or dysfunction)
- Failure to listen (nurse may focus on nurse’s needs, not patient’s need)
- Inappropriate comments and questions (clichés, yes/no, why/how, probing, leading questions [lead to nurse’s desired response], comments of advice, judgmental comments)
- Changing the subject
- Giving false assurance
- Gossip and rumor (hinders group building and teamwork)
- Aggressive Interpersonal Behavior (horizontal violence- nurse to nurse hostility, anger and aggressive behavior between nurses, bully/blame/criticize/bicker)
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Cliches
- stereotyped, trite, pat answer
- suggest no cause for anxiety or concern
- offer false assurance
- "everything will be alright"
- "don't worry"
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Questions only requiring yes or no
- "Did you have a good day?"
- cut the discussion of
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Questions with "Why" or "How"
- intimidating, accusing
- "Why weren't you tired enough to sleep?
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Questions that Probe for Information
- getting the "third degree", interrogation
- pt usually stops talking, avoids further conversation
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Leading Questions
- suggest what response the speaker wishes to hear
- unlikely to get an honest answer without feeling indimidated
- "You're going to smoke that cigarette, aren't you?"
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Comments that Give Advice
- implies that the nurse knows what's best for the patient
- denies patient the right to make decisions and have feelings
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Judgemental Comments
- impose the nurse's standards on the patient
- "You aren't acting very grown up. You shouldn't be crying like a child."
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4 Most Common Communication Probs w/Elderly:
Aphasia, Hearing Probs, Dysarthria, Voice Probs
- Aphasia: varies is degree of inability to understand others’ words, express self, or be understood
- Hearing Problems: (presbycusis- loss by aging) can’t hear, or can hear but can’t understand
- Dysarthria: abnormal control of speech mechanism (several contributing diseases)
- Voice Problems: (larygenctomy- must learn esophygeal speech via electronic device or surgical prosthesis) most can be treated
- Others: brain diseases affecting brain cognitive function
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Appropriate Techniques:
Visually Impaired
- acknowledge presence
- identify self
- normal tone
- explain reasons for touch
- indication termination
- keep call light close
- orient to environment and sounds
- keep glasses clean
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Appropriate Techniques:
Hearing Impaired
- orient patient to your presence
- talk directly to patient
- facing them and maintain positive nonverbal communication
- demonstrate procedures
- sign language
- write it down
- keep ear aids clean and functioning
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Appropriate Tecniques:
Speech Impaired
- select means of communication through blink/hand squeeze/writing on board
- assure everyone communicates with patient
- assure effective means of signaling for assistance
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Appropriate Techniques:
Unconscious
- be careful of what is said (they might be able to hear you)
- assume patient can hear you
- speak before touching
- quiet low volume environmental surroundings
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Appropriate Techniques:
Non-Native
- interpreter
- dictionary translation
- simple sentences with normal tone
- demonstrate ideas
- maintain positive nvb communication
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4 Purposes of Client Education:
- Promote Health: develop specific health practices idiosyncratic to that patient to promote wellness
- Prevent Illness: (many forms) making home environment safe, counsel those at risk for disease, disease prevention or early detection
- Restore Health: self-care practices to promote recovery with no complicationsFacilitate
- Coping: patient and family adjustment/acceptance of lifestyle changes/illness
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4 Assumptions of Adult Learners
- As person matures, self-concept is likely to move form dependent to independent
- previous experiences are a rich resource for learning
- readiness to learn is often r/t a developmental task/social role
- material should be useful immediately, rather than at some time in the future
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Factors that Affect Learning:
Motivation, Ability, Environment
- Motivation: very important to process of learning, greatly affected by patient’s health beliefs model
- Ability: note factors—age/development, cognitive ability, do they understand? (same language/able to communicate)
- Environment: support of family members or lack thereof, long-term caregivers as part of learning process, financial resources; any limitations
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Cognitive Verbs
- (storing/recalling new knowledge in brain)
- acquisition
- comprehension
- application
- analysis
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Affective Verbs
- (changes in attitudes, values, feelings)
- chooses
- displays
- initiates
- revises
- values
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Psychomotor Verbs
- (learning physical skill)
- integration of mental and muscular activity
- demonstrates
- shows
- manipulates
- creates
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Stages of Change:
Precontemplation
- recommend lifestyle change
- provide appropriate information
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Stages of Change:
Contemplation
- identify willingness
- discuss pro/con
- examine barriers
- explore motivators
- alternatives
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Stages of Change:
Action
- set a start date
- outline plan/strategy
- discuss potential problems
- strategy to overcome them
- negotiate achievable plan
- use of support systems
- discuss potential for relapse
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Stages of Change:
Maintenance
- identify helpful parts
- revise/reset if needed
- make schedule for periodic contact/follow-up
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Stages of Change:
Relapse
- identify triggers
- discuss and re-evaluate motivation
- revisit counseling steps for precontemplation and contemplation
- additional referrals if needed
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Purpose of Patient Records
- It is the only permanent legal document that details nurse’s interactions with patients
- Best defense for nurse if patient alleges nursing negligence
- Communication
- Education
- Quality of care reviewing
- Diagnostic and therapeutic orders
- Research
- Decision analysis
- Care planning
- Reimbursement
- Legal and historical documentaion
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Source-Oriented Record
each healthcare group keeps data on its own separate form
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Narrative
address routine care, normal findings, and patient problems identified in plan of care
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Problem-Oriented Record
- organized around problems rather than sources of info
- defined database
- problem list
- care plans
- progress notes
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SOAP Format
- Subjective data
- Objective data
- Assessment
- Plan
- (SOAPIER):
- Intervention
- Evaluation
- Response
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PIE Charting
- Problem
- Intervention
- Evaluation
- Unique: does not develop a separate plan of care
- uses pre-printed flow sheets to complete assessment at beginning of each shift
- plan of care is incorporated into progress notes, in which problems are identified by number
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Focus Charting
- brings focus of care back to patient an patient concerns
- holistic
- may be patient concern/behavior, therapy/response, change in condition, significant events
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DAR format
- Data: "Pt states pain in right rib area"
- Action: "Tylenol 3 admin'd as ordered"
- Response: "Pt reports relief from pain"
- Narrative portion of focus charting
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Charting by Exception (CBE)
only significant findings or “exceptions” to standards of practice are documented in narrative notes
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Case Management Model
clearly identify outcomes that select groups of patients are expected to achieve on each day of care
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Critical/Collaborative Pathway
- (computerized)
- integrates pathways and documentation flow sheets designed to match each day’s expected outcomes to event
- discharge planning
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Variance Charting
- (patient fails to meet outcomes)
- chart unexpected event, cause of event, actions taken in response
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Mimimum Data Sets (MDS)
- Nursing care elements (nrsg dx + intrvn)
- Pt Demographic elements (sex, DOB, ethnicity)
- Service elements (admin/discharge dates, expected payer for services)
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Progress Notes
any variety of methods of notes that relate how a pt is progressing toward expected outcomes
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Flow Sheets
- graphic rcord of abbreviated aspects of patient's condition
- (eg. vital signs, routine aspects of care)
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Graphic Record
- records specific patient variables
- (pulse, respiratory rate, blood pressure readings, body temp, weight, fluid intake and output, bowel movements)
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24 Hour Fluid Balance Record
intake and output
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Medication Record
- documentation of all meds administers
- nurse administering drug
- sometimes reason for administration
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24 Hr Patient Care Records/Acuity Charting Forms
ability to rank patients in high to low acuity
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Discharge/Transfer Summary
information necessary for immediate care to patient
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Home Healthcare Documentation
OASIS: Outcome and Assessment Information Set
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LongTerm Care Docmentation
- RAI: Resident Assessment Instrument
- (minimum data set, triggers, resident assessment protocols, utilization guidelines)
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Report Formats:
Change of Shift
each patient summary and status information
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Report Formats:
Telephone/Telemedicine Reports
enable nurses to receive and give critical information about patients quickly and easily
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Report Formats:
Transfer and Discharge Reports
concisely summarize all the patient data that caregivers need to provide immediate care
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Report Formats:
Incident Reports
anything out of the ordinary that results in or has potential to result I harm to patient, employee, or visitor
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HIPAA
- clients have rights to access records and see exactly what you wrote
- (important to you use quoted responses and not judgments about the client)
- protocols to each agency/setting determine how client access is achieved
- client can consent who can see the chart, who can know that they are there
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Counseling
- Long-Term/Short-Term
- Motivational
- Specialized
- interpersonal process of helping pts to make decisoins that promote overall well-being
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