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153 Cards in this Set

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Phases of Nurse- Client Relationship
Initial /introductory phase
introduce yourself
tell what you are there to do
discuss the patient's problems/What brought you to the hospital?
Phases of Nurse- Client Relationship
Working/middle phase
here you problem solve
Phases of Nurse- Client Relationship
Termination phase
at the end of shift or at discharge of patient
Levels of Communication
Intrapersonal
talking things through to yourself
Levels of Communication
Interpersonal
one to one communication with a patient or staff meneber.
Levels of Communication
Small Group
communicating with a small group
Levels of Communication
Organizational
delivering communication to a large group.
Interpersonal Level of Communication
Sender---Message---Channel---Receiver

Verbal Auditory
Nonverbal Visual
Written Kinesthetic
arts
Group Level Communication
Task Group
there's a specific purpose to the talk, a task to be accomplished is what is discussed.
Group Level Communication
Therapeutic
Alcoholics Anonymous
other support groups
no group leader need be present
Group Level Communication
Therapy Group
a healthcare professional leader is present with a specific topic to be discussed.
Group Level Communication
Self Help Group
no leader present,
Communication Development
infant --cries
toddler- limited language "No", "why?"
Pre-school-child mimics language of others.
School Age- learn to communicate with eachother-another language.
Adolescent-may be a lack of communication with a lot of attitude.
Adult-skills are honed and applied
Older Adult-may withdraw due to sensory deprivation or be loud and demanding.
Factors Influencing Communication
Developmental level-age
Gender differences affect communication.
Sociocultural differences- personal space' touching.
roles- your professional status in a group
Space and territoriality-personal space, cultural differences
Physical, emotional,mental state of person- pain may affect one's communication level.
environment-a hospital unit may not be conducive to a patient's communication level.
values-may be difficult to communicate with some one with differing values than your own.
Communication Methods
it's not just verbal
non-verbal communication is extremely important-body language.
art-colors, images may convey messages.
music- singing,soothing music may relax.
touch-holding a hand may convey a message, if culturally acceptable.
Non-verbal Communication
Actions speak louder than words.
appearance-image of professionalism .
facial expressions- you can say something but your face can tell another story.
posture-leaning towards or away from the person.
gestures-may have cultural meaning
touch-cautious,aggressiveness,suspicious, can be interpreted in many ways.
Personal Space
intimate- 0 to 18 inches
personal - 1.5 to 4 feet.
social/public - 4 feet and beyond.
Effective Therapeutic Communication

Active Listening
Stop talking- actively listen to patients
sit down- less threatening to patient, shows interest.
allow time for communication
give eye contact- shows interest,trust.
think before you speak
Effective Therapeutic Communication

reflection/paraphrasing
- "I don't like the food here" - don't say "why or how" this can intimidate, instead,
say"Tell me what you don't like about the food" - a problem can be fixed.
Effective Therapeutic Communication

Clarifying
"I thought I heard you say you don't like the food here"
Effective Therapeutic Communication

Stating observations/perception sharing
"You seem displeased with your meal"
Effective Therapeutic Communication
Focusing
stay to the point
Effective Therapeutic Communication

Open-ended questions
"do you like to travel?" will probably elicit a yes or no answer.
instead, ask " where have you traveled?"
Effective Therapeutic Communication

Silence
let people talk or cry, allow their form of communication. or maybe you are at a loss for words and it is best to stay silent.
Effective Therapeutic Communication

Accepting
do not convey your negative feelings on a topic even if you feel it is not an acceptable opinion they are expressing
Effective Therapeutic Communication

Give recognition
complement,
Effective Therapeutic Communication
offering of self-
"I'm hear to help you"
Effective Therapeutic Communication

Sharing observations
"I see you're looking better today"
Effective Therapeutic Communication

Empathy
imagine yourself in their situation.
Effective Therapeutic Communication

Validation
agree with the patient
'it must be difficult to be in the hospital"
Effective Therapeutic Communication

Sharing hope
terminal patient says"I'm going to my daughter's wedding next year" - you can't take away their hope.
Say "that's going to be wonderful"
Effective Therapeutic Communication

Humor
breaks the ice
Effective Therapeutic Communication

Sharing emotions
it's ok to laugh and cry with your patient. it makes you "human"
Effective Therapeutic Communication

Trust
if you say you'll be back in an hour you need to make sure you will.
Effective Therapeutic Communication
Providing information
your role is to help and provide/teach.
Effective Therapeutic Communication

Encourage spontaneity and expression of feelings.
you must seize the moment- if patient wants to express feelings, even if you are pressed for time, stay and listen-that moment may never be recreated.
Effective Therapeutic Communication

Confrontation
"If you do that, this is going to happen to you.."
used often with a patient in substance abuse who is in denial."you've been drinking heavily and that's what brought you to the hospital"
Effective Therapeutic Communication

Clarity and brevity
make sure your communication is clear and brief.
Effective Therapeutic Communication

Rate and tone of your speech
patient can sense if you are in a hurry.
Effective Therapeutic Communication

Self disclosing your own feelings
sometimes.
it's not your purpose to pour your heart out to patient.
you can say "I'm feeling badly about that"
Barriers to Communication

Age
differing values
and mode of speaking.
you don't speak to a young child the same way you would speak to an adult.
Barriers to Communication

Gender
can pose problems to some.
Barriers to Communication

Physical and health status
pain and illness can block you out.
they may not want to communicate.
Barriers to Communication

intellectual factors
levels of education
vocabulary
may intimidate
slang/jargon may not be understood.
Barriers to Communication
Emotional factors
patient may be too upset to communicate with you.
Barriers to Communication

Language differences
if the patient speaks a different language, a lack of comprehension may hinder communication.
a translator may be needed. depending on a family member or friend may not get your message across, and you'll never know it.
Barriers to Communication

Cultural factors
meanings may be misconstrued.
An islamic person may not allow a man to discuss topics with his wife.
Barriers to Communication

Environmental factors
a noisy room may not be conducive to a conversation.
lack of privacy
clutter.
Barriers to Communication

Asking personal questions/probing
you are not there to find out about there love life, for instance.
Barriers to Communication

Automatic responses
don't "yes" someone to death.
Barriers to Communication

Sympathy
differs from empathy. don't condescend or pity them.
be sincere.
Barriers to Communication

asking for explanations or probe
cues that they are becoming anxious from your questions
Barriers to Communication

Arguing
don't argue.
it creates a stalemate, no-win situation.
Barriers to Communication

Changing the subject
you may not feel comfortable and try to change the subject, thus losing that period of communication.
Barriers to Communication

False reassurance
don't promise things you know are not true, even if you mean well.
Say "we'll be there for you"
You can't say "you're not going to die"
Barriers to Communication

Giving personal opinions
" if I were you..."
Barriers to Communication

Inattentive listening
pay attention to patient
Barriers to Communication

not showing approval
"you should not do that"
Barriers to Communication

Being defensive
patient says " I hate this place"

Do not respond with "why? this is a beautiful place!"
Barriers to Communication

Belittleing feelings
don't say "you shouldn't feel that way" to a patient.
you are negating their feelings.
Barriers to Communication

Cliches
avoid these.
Barriers to Communication

Topping it off
patient tells you his back hurts and you respond "you, my back hurts all the time!"
Barriers to Communication

Asking questions containing why or how
always a wrong approach.
makes patient feel he has to defend their reasoning.
"I hate this place"
don't ask "Why do you hate it"
instead ask
"Tell me why you hate this place"
Barriers to Communication

Transference
between patient & nurse-
patient says " you look just like my son" they'll treat you like their son.
Barriers to Communication

Counter transference
between nurse & patient-
nurse says "oh my goodness, she looks just like my grandmother"
so, will nurse treat her like she treats her grandmother?
Barriers to Communication

Gift giving
patient may insist on giving you a gift.
we are not allowed to accept.
how do you handle this situation without insulting patient?
cannot impart the idea that if gift isn't accepted they will not be treated well.
Barriers to Communication

difficult client
may be in pain, lonely
Communicating with Clients with Special needs
Hearing impaired
face patient directly
do not raise voice.
Communicating with Clients with Special needs
Visually impaired
touch
point
provide ample lighting
do not raise voice, they are not hearing impaired.
Communicating with Clients with Special needs

Aphasic
if patient cannot speak back,use writing.
Communicating with Clients with Special needs

Confused client
you need to get into their world
If they insist it's Monday and it's actually Wednesday, go along.
Communicating with Clients with Special needs

Unconscious patient
you need to tell them everything that is going on because they still can here you.
Communicating with Clients with Special needs

Angry clients
be calm
do not create a shouting match.
silence
Communicating with Clients with Special needs
Non English speaking clients
provide a translator.
Client Education

definition
explain what you are doing and teach them to take care of themselves.
This applies to a family member or caretaker, as well.
Client Education

health promotion
- DARE Program
Client Education

Prevent illness
teach hand washing
Client Education

restoration of health
teaching a diabetic how to give himself insulin or stay on a diet
Client Education

coping with impaired functions
teaching skills to deal with an impairment.
the Role of the Nurse in Client Education

The essential function of every nurse
a doctor's order is not needed to teach a patient.
the Role of the Nurse in Client Education
Legally bound
nurse must teach how to do essential skills to patient, and it must be thoroughly documented.
the Role of the Nurse in Client Education
ANA
ANA considers patient education one of our Standards of Nursing.
the Role of the Nurse in Client Education
JCAHO
JCAHO will not certify an institution unless there is evidence that patient education is being done.
the Role of the Nurse in Client Education
Documentation
all teaching must be documented, making it part of the legal record.
Factors Affecting Client Learning

Age/Developmental level
in the case of a dementia patient, the nurse needs to teach the caregiver.
children and adults are not taught the same way
Factors Affecting Client Learning
Family support
very often there are families that are willing to help with client education. this is good family support.
Factors Affecting Client Learning

Financial resources
this is very important.you can teach a diet, but the family may not be able to afford it.
Factors Affecting Client Learning

Cultural influences
does the client believe or agree with the treatment being taught?
Factors Affecting Client Learning

Literacy
can the client read and comprehend any reading material provided to them?
do not assume that they can.
Domains of Learning

Cognitive
thinking - what is the disease and how does the client control it.
Factors Affecting Client Learning

Affective
emotional- how to emotionally deal with the implications of the disease.
Factors Affecting Client Learning

Psychomotor
actually doing - how to physically handle the tasks required to handle their treatment.
Factors Affecting Client Learning

Teaching Strategies for all Domains
each client is different and their strengths and weaknesses must be identified.
Preparing to Teach Use of the Nursing Process
Assessment-identification of learning needs
determine what client knows and what needs to be taught.
Preparing to Teach Use of the Nursing Process

Planning
need to set goals for the client
Preparing to Teach Use of the Nursing Process
Implementing of teaching Strategies
interventions-how are we actually going to do this teaching?
Preparing to Teach Use of the Nursing Process
Evaluation of the Goals
are the interventions effective?
Assessment of Learning

Source of information
interview patient, doctor and family as well as other healthcare professionals
Assessment of Learning

Learning needs
what information does patient need to know now?
what is the information that is nice that the patient knows-complications,additional care information that may not be able to be taught in a short stay in the hospital.
what does the patient already know about his condition? is there misinformation?
Assessment of Learning

Motivation
does patient want to learn?
look at behavior being exhibited.
is patient eager, inquisitive?
Assessment of Learning

Health beliefs and lifestyles
is patient's lifestyle conducive to his achieving wellness?
Assessment of Patient's Ability to Learn
physical
does patient have the physical dexterity to perform tasks, manipulate equipment?
Assessment of Patient's Ability to Learn

Sensory
can patient hear, see, feel?
Assessment of Patient's Ability to Learn

Reading level
is material provided at patient's reading level?
Assessment of Patient's Ability to Learn

Developmental level
attention span may vary
Assessment of Patient's Ability to Learn

Cognitive function
not everyone can be taught.may have to teach a caregiver for the dementia patient, for instance.
Assessment of Patient's Ability to Learn

Learning style
does patient prefer visual, auditory or doing?
Assessment of Patient's Ability to Learn

Compliance
does client want to learn?
Assessment of Patient's Ability to Learn
interference
financial limitations
Assessment of Patient's Ability to Learn
pyschosocial issues
is there undue stress in the home making learning difficult?
Assessment of Patient's Ability to Learn

Client's strengths and weaknesses
physical weakness hampering their willingness to learn?
Assessment of Patient's Ability to Learn
Assessment of Teacher
does teacher know subject matter?
Nursing Diagnosis

knowledge deficit - of what?
why is there a knowledge deficit?

is it related to a lack of knowledge?
is this a new experience?
Planning
take this information gathered from the assessment:
need to know
what to know
already knows
what to teach
who will teach
when
where
strategies
and create a plan..
Planning
Short term goals
Long term goals
what do we want the patient to accomplish?
in the hospital?
at home?
Setting Goals

Single behavior
set goal for a single behavior:

"Patient will be able to inject himself with insulin", for instance.
Setting Goals

observable or measurable
must see that patient knows how to perform task.
Setting Goals
Time measured
by when?
mutually set by nurse and client.
patient will be able to inject himself with insulin by discharge"
Setting Goals

set priorities
what goals should be prioritized first?
Learner's Ability to Retain Information
retaining rates for learning:
reading retains 10%
hearing " " 26%
Sight " " 30%
Seeing and hearing retains 50%
talking retains 70%
teaching retains 90%
Teaching Tools
printed material must be at the correct literacy level.
programed instruction involves class,bedside instruction.
computers
visual aids allow seeing and hearing of material for good retention.
audiovisuals - CD's
Contracts-agreements binding client to promise to learn.
Interventions - Teaching Strategies.
set priorities- teaching the need to know material first.
where will it be taught?
timing depends on patient
graduated regime- information needs to build in steps.
practice makes perfect.
sometimes the support system(caregiver) learns along with patient.
teacher/learner relationship needs to develop and flourish.
Teaching Strategies.
what worked before?
provide models for teaching.
sequential steps
explain in terms the client understands.
adjust to clients needs- is he tired/ doesn't want to do any for at this time- must postpone till a later time.
Teaching Strategies.
types of teaching models:
discussion is most common.
role play -
role model
group/ individual setting
independent study with a CD.
Demonstration/return demonstration -I show you now you show me.
Use of games.
positive Reinforcement.
incorporate teaching while giving actual nursing care - talk them through the procedures.
Theory of Adult Learners
Androgogy-teaching the adult learner..
Pedagogy- teaching children
Geragogy-teaching the older adult.
Andragogy
adults are independent in self concept-they are going to learn only what they want to learn.
Their life's experiences can be related to what they need to learn.
their orientation to learning is the present.
their readiness to learn will be shown by their questions, eagerness.
Geragogy strategies
teach when alert and rested.
use appropriate sensory aids when needed.
control the environment-noise/temperature.
face the client
use a slow pace
attention span is about 20 minutes/give small amounts of information at one time.
cover 1 topic at a time.
Geragogy strategies
audiovisual material works well.
allow time for expression. how do they feel about the material?
set realistic goals.
focus on their strengths.
base teaching on previous knowledge.
use analogies.
summarize important points.
have family/caregiver present as their backup.
Strategies fo, r Teaching Children
infants are taught to trust by consistent routine.
pre-schoolers- role play, pictures, demonstration.
school age- psychomotor skills discussion.
adolescent- self expression, problem solving, allow them to make decisions, being a role model.
Evaluation
most important step.
was outcome met?
post-test.
return demonstration- show me you know how to do it.
observation- changes in behavior-did diabetic patient pick the right foods? VERY IMPORTANT.
get feedback from patient-what does he think/feel?
Does Plan Need Revision?
are goals realistic?
Documentation
Document assessment of learning needs.-What does patient need to know?
What information did you teach?
what method did you use?
Who was taught? Patient and Family?
What was response/outcome to teaching?
Is there a need for more teaching?
Is there the ability to manage needs after discharge?
T.E.A.C.H
T-tune into the client

E-edit client information

A- act on every teaching moment

C- clarify often

H- honor client as a partner in the education process.
non verbal communication ia also known as
body language
touch is viewed as
one of the most effective non verbal ways to express feelings of:
love
affection
security
anger
frustration
aggression
excitement
the most expressive part of the body is the
face
posture can express
positive attitude-held in good alignment
depression-slouched
rigid- pain
intrapersonal communication
self talk
interpersonal communication
between two or more people with a goal to exchange messages.
hand off communication involves
the accurate presentation of all patient related information to another caregiver.
TJC recommends the use of SBAR
S -situation
B- background
A - assessment
R- recommendations
SBAR
Situation & Background provide objective data
Assessment & Recommendation provide subjective data.
Helping Relationship
occurs between the nurse and patient
is not spontaneous
characterized by an unequal sharing of information, based on the patient's needs.-unlike a social relationship which information shared is usually equal and spontaneous,
The Helping relationship is described as having three phases:
ORIENTATION-
patient calls nurse by name and describes the roles of the participants in the relationship
patient and nurse will agree upon the goals, frequency of contacts and duration of the relationship
WORKING PHASE-
patient expresses feelings and concern to nurse
patient actively participates in achieving mutually accepted goals
TERMINATION
patient identifies the goals accomplished
patient verbalizes feelings about the termination of the relationship
empathy
identifying with the way another person feels
rapport
a feeling of mutual trust experienced by people in a satisfactory relationship.
semantics
the study of the meaning of words-their interpretations.
Using "why" or "how" in a question
do not use- can be intimidating to the patient.
dysarthria
impaired control of speech
may be slurred or otherwise difficult to understand.
aphasia
a reduced ability to understand what others are saying, express oneself, or be understood with an impaired ability to speak.
Health Literacy
the ability to read, understand and act on health information.
the average American reads at the 8-9th grade level. meanwhile, most healthcare literature and directions are written at a 10th. grade level.
the COPE model
a method of helping family members to become effective problem solvers and supporters of your nurse-patient teaching effort.
C - CREATIVITY-help family overcome healthcare management and overcome obstacle.
O-OPTIMISM-help family view the situation with confidence.
P- PLANNING_help family plan for future problems and develop a contingency plan.
E-EXPERT INFORMATION-help family learn how to obtain expert information and how to handle specific situations.
Patients learn in three domains
cognitive
psychomotor
affective
Cognitive learning
storing of information that includes:
acquisition of knowledge
comprehension
application of knowledge
analysis of knowledge
psychomotor learning
learning a physical skill