Preinteraction Phase

(stages of helping relationship)

-Planning stage

-nurse gathers information about patient before face-to-face conact

- may cuase anxiety but allows nurse to identify specfic information to be discussed

Introductory Phase

(helping relationship)

-orientation phase

-sets the tone for rest of relationship

-Goal of the nurse- develop trust and security

-may cause see resistive behavior but can be overcome by showing competence, care and genuine interest

-at the end of this phase pt should: trust, view nurse as competent, understand purpose and roles in relationship, and feel they are active participants in devolping a mutual agreeable plan of care

Working Phase

(stages of a helping relationship)

-Stage 3

-patient and nurse view each other as individual; caring and empathy develop

-two major stages

1)exploring and understanding thoughts and feelings- nurse assist pt in expressing feelings toward problem, develop skill of listening and gains insight into personal behavior

2) Faclitating and taking action- nurse helps and reinforces decision making and goal- setting

Termination Phase

(helping relationship)

-fourth and final stage

-nurse and client accept feelings of loss

-client accepts the end of relationship without feelings of aniety or dependce; referals may be needed

-follow up phone calls or emails may help to ease transition of independence

Using silence

(therapeutic communication techniques)

providing general leads

(therapeutic communication techniques)

using statments or questions that

1) encourage the client to verbalize

2)facilitate continued verbalization

being specific and tentative

(therapeutic communication techniques)

making statements that are specific rather than general, and tentative rather than absolute

Example-

Specific- "rate your pain form 1-10

General- "are you in pain"

using open ended questions

(therapeutic communication techniques)

using touch

(therapeutic communication techniques)

restating or paraphrasing

(therapeutic communication techniques)

seeking clarification

(therapeutic communication techniques)

method of making the clinets broad overall meaning of the message more understandable

-nurse can clarify the massage of confess confusion

perception checking

(therapeutic communication techniques)

offering self

(therapeutic communication techniques)

Giving information

(therapeutic communication techniques)

acknowledging

(therapeutic communication techniques)

Reflecting

(therapeutic communication techniques)

summarizing and planning

(therapeutic communication techniques)

stating the main points of a discussion to clarify the relevant points discussed

-end of interview

Focusing

(therapeutic communication techniques)

clarifying time or squence

(therapeutic communication techniques)

helping patient clarify an event, situation, or happening in relationship to time

Example-

client- i vomited this morning

nurse- was that after breakfast

Presenting reality

(therapeutic communication techniques)

Boundaries

chapter 26 communication

- to keep clear boundaries, nurse keeps focus on patient

-avoid sharng personal information

-no gift giving, spending more time than necessary with a client or believing you are the only one that understands the client.

Personal space

(Factors influencing communication)

1) intimate - touching to 1 1/2 feet, body contact, vocalizations are low

2)personal- 1 1/2 to 4 feet, tones are moderate, physical contact like handshking. example- giving medication

3)social - 4 to 12 feet, clear visual perception, tones are overheard by others. (making rounds)

4) Public- 12 to 15 feet, loud clear vocalization, individualty is lost

Territoriality

(Factors influencing communication)

Development

(Factors influencing communication)

Gender

(Factors influencing communication)

Females- use language to seek confirmation, mimimize differance and establish intimacy

Males- establish independence and negotiate status

values and perceptions

(Factors influencing communication)

Congruence

(Factors influencing communication)

Verbal communication

(models of communication)

-spoken or written word

1)pace and intonation- rhythm and tone

2)simplicity- use commonly understood words, and completetnes

3)clarity and brevity- message that is direct and simple

4)timing and relevence

5)Adaptability- adapt to behavioral cues from pt

6)credibilty- worthiness of belief, trust and relabiltiy

7)humor

nonverbal communication

(models of communication)

-body language

Personal apperance

Posture and gait

Facial expressions

gestures

Stereotyping

(cultural concepts)

making assumptions that an individual reflects all characterisitcs associated with being a member of a group

barrier to communication

Racism

(cultural concepts)

prejudice

(cultural concepts)

preconceived notion or judgement that is not based on sufficient knowledge

may be favorable or unfavorable

Ethnocentrism

(cultural concepts)

belief in the superiotiyy of ones own culture and lifestyle

others ideas are not only different but wrong and not important

Ethnicity

(cultural concepts)

may be viewed as a relationship between individuals who believe that they have distinctive characteristics to a group

-self0 defined

-share language, religion, values beliefs and customs

subculture

(cultural concepts)

composed of people who have a distinct identity and yet are related to a larger cultural group

shares ethnic orgin or physical characteristics

subcultural groups - nursing students

involuntary process

people incorporate traits from another culture

members of nondominant group are forced to adopt the new culture to survive

process by which an individual develops a new cultural identity

becoming like the members of the dominant culture

conscious effort

Cultural competence

(cultural models of nursing)

-lifelong process where nurses continuosly strive to achieve ability and availibilty to work within cultural context

Cultural desire- motivation to "want to" engage in the prcess of becoming culturally aware

Cultural awarness- self examination of ones own prejudices and biases

Cultural knowledge- having a sound education of world views

Cultural skills- ability to collect culturally relevant data

Cultural encounters- engaging in face to face cultural interactions

Family patterns

Chapter 18

family- basic unit of society

cultural values influence patterns within family group

nurse needs to distinguish who is the authority in the family

naming systems are different

cultural values determine the extent of families involment in hospitalzation

1) avoid asking members of the family

2) be aware of giner and age differences

3)chose interpreter who is politically or socially compatable

4)address questions to client; not interpreter

5)speak slowly and distinct

6)observe facial expressions and body language

nutritional patterns

(culture)

each culture has its staple food

food can be considered a remedy of illness

religious practice also effect diet

nurses most be sensitive to nutritional patterns

Space orientation

(culture)

the concept of space is learned and influenced by culture.

nurse needs to be aware of pts response and explain the procedure

clients in long term care may want to personalize their space

having personal and cultural items in their enviroment can increase self esteem and promote self and cultural idenitiy

Time Orientation

(culture)

individuals focus on the past, present and future 

one aspect is always more dominant

health care focuses on punctuality and is future oriented

Developing Self- awarness

(culture)

to develop cultural consciousness-

Awareness- am i aware of my biases and prejudices

Skill- do i have the skill to conduct a cultural assessment

Knowledge- am i knowlegable of the world views

Encounters- do i seek face to face encounters with people different from me

Desire- do i really want to become culturally competent

focuses on predicting health

3 elements

1)agent- any enviromental factor or stressor that leads to illness

2) host- person who may or may not be at risk for illness

3) environment- all factors external to the host that may or may not pre dispose the host with illness

all elements interact with each other

focuses on promotion

nurse can determine whether clients are likely to take action regarding health, that is, wheather clients believe that their health status is under their own or others controls

nurses can use LOC results to plan internal reinforcement training if necessary in order to inprove clients efforts toward better health

Environment- location, pollution,  chemicals, smoking

Standard of living- reflecting occupation, income and education

Family and cultural beliefs- family passes on patterns of daily living. culture and social interactions influence how a pt percieves, experiences and copes with health and illness

Social support networks- having a support network and job statisfaction help avoid illness. also families can help motivate

characterized by symptoms of relativly short duration

symptoms appear abruptly and subside quickly

may or maynot need medical intervention

after acute illness people return to their normal level of wellness

one that last for an extended period of time usually 6 months or longer; often a person life time

slow onset

 remission- symptoms disappear

exacerbation- symptoms reappear

pt needs to modify activities

care needs to be focused on promoting highest level of independence

-based on notion of maintaing an optimun level of wellness

-address areas such as adequate and proper nutrition, weight control and exercise and stree reduction

-illness prevention: providing immunizations, identifying risk factors for illness and helping people take measures to prevent illness

example- smoking cessation compaign

-largest segment of health care services has been dedicated to diagnosis and treatment

-testing such as MRI and surgury

Goal- help people move to their previous level of health or to highest capable level

Rehab- assist clients to function adquately in the physical, mental, social, economic and vocational areas of life

Palliative- providing comfort and treatment symptoms. end of life care.

Managed care

(Frameworks for care)

goals- to provide cost-effective, quality care

-focuses on decresed cost and improved outcomes for patients

Case management

(frameworks for care)

health teams assume collaborative responsibility for planning, assessing needs, and coordinating, implementing and evaluating care from admission to discharge.

-maybe a nurse, social worker

-use critical pathways

tool that specifies interdisciplinary assessments, interventions, treatments and outcomes

-recovery plans and action plans

Team nursing

(framework for nursing)

delivery of individualized nursing care to clients by a team led by a RN

-RN has responsibility and authority for pt, but delegates task to other members

Functional Method

(framework for care)

- focuses on the jobs to be completed ( task oriented)

-based on production and efficiency

Patient- focused Care

(frameworks for care)

-brings all services and care providers to the clients

-brings personal to patients: therefor decreasing number of people and steps involved  

available to people over 65 years and older.

Part A)provides insurance toward hospitalization, homecare and hospice

Part B) voluntary partial coverage of outpatient and physicans service

Part D) voluntary precription drug plan

-protects the privacy of the individuals by safeguarding individually identifiable health care records ( including those housed in electronic media)

- Protection extends not only to clinical health care sites, but also to all ancillary health care providers ( pharmacies, labs, third party payers)

-coordination of health care services by health care providers

-provides uninterupted and consistant care

needs of nurse

1) initiate discharge planning for all clients when admitted

2)involve the client and family

3)collaborate with other professionals to make sure needs are met

communication

mutual repect and trust

decision making process

Health Promtion Model

Pg 283

motivational source for behavioral changed based how the client perceives the benifits of changing the given health behavior

-model does not include fear as a motivation source

caregiver

 communicator

teacher

client advocate

counsler

change agent (assisting pt to make modification in their behavior)

leader

manager

case manager

research consumer

specialized education

Body of knowledge

service orientation- service to others

on going research

code ethics- do whatever is right regardless of the personal cost

autonomy- regulates itself and sets standards for members (nursing policies)

professional organization-

Economics-

(Factors influencing contemporary practice of nursing)

- people are better educated about illness, and assume responsbility for illness

- adapt to new needs to clients, nurses need to be highly specialized in computers and equipment, increasing education for changing education

-clients becoming more informed of their health care concerns due to the internet. Telecommunications ( transmission of info from one site to another using equipment to transmit info in the form of signs,signals, words or pictures by cable, radio or other systems) Telenursing (uses telecommunication technology to provide long distance health care)

Legislation

(factors influencing contemporary practice)

-population increasing

-shifting from rural to urban

-mortality and morbidity

Collective bargaining

(factors influencing contemporary practice)

Nursing associations

(factors influencing contemporary practice)

-provide leadership

-influence policy making for healthcare