N124 - Final

What are professional values?

Fundamental beliefs that the profession holds & how the work ought to be conducted

Aspects of a covenant

• Fidelity

• Mutual

• Fiduciary

• Rooted in morals

Aspects of a social contract in health care

• Establishes the relationship & the transaction

• Mutually beneficial

• Obligations are outlined in Code of Ethics

What is communication?

Sharing of ideas, information, feelings, & is an embodied process

What is caring service?

Service that involves compassion, kindness, dignity, & respect

What is primacy of the patient

Dedication to serving the best interests of the patient

What is knowledge, skill, and competence?

Ensures all levels and roles are individuals with the proper training that has been accredited

What is hazardous service?

That nurses will provide care under circumstances not expected of those outside the profession

What is responsibility & accountability?

That nurses are transparent, engage in self-regulation, and peer-review regarding their practice

What is progress and development?

That nursing will incorporate humanities & scientific advances to expand the knowledge base of the profession

What is ethical practice?

That the profession will uphold the Code of Ethics

What is collaboration?

That nursing will contribute its perspective to worldwide conversations regarding health

What is promotion of the health of the public?

The expectation that nurses will address problems faced by individual patients

What are society’s expectations of the profession of nursing?

1. Caring service

2. Primacy of the patient

3. Knowledge, skills, & competence

4. Hazardous service

5. Responsibility & accountability

6. Progress & development

7. Ethical practice

8. Collaboration

9. Promotion of health to the public

What are the profession of nursing’s expectations of society?

1. Autonomy of practice

2. Self-governance

3. Title & practice protection

4. Respect & just remuneration

5. Freedom to practice

6. Workforce sustainability

7. Protection in hazardous service

What is autonomy of practice?

That society will authorize nursing to practice within its scope and standards

What is self-governance?

That society will allow nursing authority to self-regulate itself such as their practice

What is title & practice protection?

That the title “registered nurse” is protected

What is respect & just remuneration?

Society will respect and support the profession in research & education

What is freedom to practice?

That nurses have the authority & freedom to practice to the extent of their education & preparation

What is workforce sustainability?

That society will development and implement plans to address workforce shortages

What is protection in hazardous services?

That society & other organizations will minimize risk to nurses in face of hazardous services

What are explicit values?

Beliefs that are considered for the greater good

What are implicit values?

Beliefs that are expressed indirectly or subconsciously

Aspects of person-centered care

• Knowing the person not as a patient but a person

• Learning the patient’s goals, beliefs, & values

• Holistic caring: emotional, spiritual, physical, social

• Engaging authentically

• Shared decision-making

What are the elements of the Fundamentals of Care Framework

1. Trust

2. Focus

3. Anticipate

4. Know

5. Evaluate

What is trust (in the context of NPR)?

Becoming someone trustworthy by providing care competently & timely

What is focus (in the context of NPR)?

Being attentive to the patient and considering their self-care needs in their perspective

What is anticipate (in the context of NPR)?

Being knowledgeable in your practice & collaborating with the patient to understand what is important to them and anticipate their needs, concerns, & values

What is know (in the context of NPR)?

Learning about your patient to act appropriately & using the information to inform care decisions respecting the patient

What is evaluate (in the context of NPR)?

Prioritizing the situation of caring & continuously working on the quality of the relationship

Importance of self-reflection

Recognize your emotional state & minimize unintentional miscommunication with clients

What is the relationship approach?

Care delivery that prioritizes building trust by focusing on their priorities & understanding their differences and responsiveness

What are the phases of a therapeutic relationship?

1. Orientation

2. Working

3. Resolution

Aspects of the orientation phase of the therapeutic relationship

• Gathering information, establishing trust

• Determining how the client views the problem

• Basic listening & attending

Importance of the orientation phase of the therapeutic relationhip

Sets the tone for the relationship

Aspects of the working phase of the therapeutic relationship

• Determining & planning outcomes

• Figuring out the client’s goals

• Feedback, observations

Importance of the working phase of the therapeutic relationship

Encourages the patient to express their feelings & help set the goals they desire

Aspects of the resolution phase of the therapeutic relationship

• Problems resolved

• Evaluation of effectiveness

• Validation for patient

Importance of the resolution phase of the therapeutic relationship

Evaluating achievement of the goal & relinquishing responsibility for the patient’s care

Importance of setting professional boundaries (NPR)

• Minimize emotional burnout

• Ensure a safe, therapeutic connection

• Avoids excessive self-disclosure

• Prevents developing friendships or romantic relationships

What is trauma?

Experienced that overwhelm the individuals’ capacity to cope

What are trauma-informed approaches?

Taking into account an understanding of trauma & how it affects the person, placing priority on the individual’s safety, choice, & control

Trauma-informed Practice Principles

• Engaging

• Preparing for trauma-informed approaches

• Asking about trauma

• Make the links with trauma

• Skill building & empowerment

What is single incident trauma?

Happens once which is unexpected

What is complex or repetitive trauma?

Ongoing trauma, being trapped emotionally/physically

What is developmental trauma?

Early trauma that is ongoing or repetitive

What is intergenerational trauma?

Psychological or emotional effects that can be experienced by people who live as trauma survivors

What is historical trauma?

Wounding across generations from a massive group trauma

Effects of trauma

Anxiety, depression, dysregulation, dissociation, asthma, PTSD

What are the three models of communication?

1. Transmission

2. Interaction

3. Transaction

What is encoding?

Process of turning thoughts into communication

What is decoding?

Process of turning communication message into thoughts

What is semantic noise?

Interference that occurs in the encoding & decoding process resulting in different interpretations

Describe the transmission model

• Linear, one-way process (responsibility on the sender)

• Focuses on the sender & the message

• Not representative of effective communication

Pros of the transmission model

Spotlights the sender & the possible noise that can affect the transmission of communication

Cons of the transmission model

How the message is received is not considered

Describe the interaction model

• Interactive, two-way process

• Feedback is provided

• Takes physical & psychological contexts

Pros of the interaction model

Allows the user to reflect on the environment

Cons of the interaction model

It is too focused on the environment and not enough on the individual

Describe the transaction model

• Complete understanding of context

• Both groups are simultaneously a sender & a receiver

• Adaptation of communication

Pros of the transaction model

Offers more breadth & understanding of intra-personal, inter-personal, & contextual factors in communication

Cons of the transaction model

Requires analysis & critical reflection

What is social context?

Stated rules or unstated norms

What is relational context?

Interpersonal history & type of relationship you have with the person

What is cultural context?

Various aspects of identity such as gender, ethnicity, sexual orientation, class, & ability

What are the theoretical approaches for communication?

1. Trauma-informed approach

2. Relational inquiry

3. Anti-racist communication

What is relational inquiry?

Recognizing the intrapersonal, interpersonal, & attending to the contexts of the situation

What is the anti-racist communication?

Recognizing its existence & changing one’s attitudes, beliefs, & judgement

What is the relational approach?

Patient-centered approach that focuses on building trust & understanding patient’s experiences

Aspects of verbal communication

• Vocabulary

• Denotative & Connotative meaning

• Pacing

• Intonation

• Clarity & Brevity

• Timing & Relevance

Define denotative

The main meaning of the word without influence of feelings or ideas

Define connotative

Words that have a secondary meaning based on influence of feelings or ideas

What is clarity & brevity

Showing conciseness in the exact use of words

Aspects of nonverbal communication

• Appearance

• Posture

• Eye contact

• Personal space

• Gestures

• Sounds

Meaning of SOLER

• Squarely face patient

• Open posture

• Lean toward patient

• Eye contact

• Relax

Benefit of clarifying

To check whether understanding was accurate

Benefit of paraphrasing

Let’s the other person know you are actively trying to understand them

Benefit of summarizing

Brings a sense of satisfaction and closure to the conversation & is helping in the termination phase of the NPR

What are some non-therapeutic communication techniques?

• Asking personal questions

• Giving personal opinions

• Changing the subject

• Aggressive responses

• False Reassurance

• Arguing

What are the different automatic responses?

• Stereotypes

• Parroting

Why are automatic responses negative

They dismiss the other person’s feelings and minimize the importance of their message

Who is considered the primary source?

The client

What is collected from the primary source?

Subjective data

Who is considered secondary sources?

Family, friends, care partners, & other healthcare providers

What is something you should do before an interview?

Review client’s health record

Ways to leverage the environment of the interview location

• Create a quiet location

• Welcoming environment

• Attend to the client’s physical comfort

• Create an inclusive space

• Ensure a private space

• Maintain professional boundaries

What are close-ended questions?

Direct questions seeking precise information

What are open-ended questions?

Invites the client to share descriptive answers

What are probing questions?

Allows you to gather more subjective data based on the client’s response

What does SURETY stand for?

• Sit at an angle to the client

• Uncross arms & legs

• Relax

• Eye contact

• Touch

• Your intuition

What is false reassurance?

When you assure or comfort a client about something that is not based on fact

What are some aspects of therapeutic communication?

• Self-awareness

• Integrated nature of the body

• Verbal & non-verbal cues

• Communication skills

Contextual factors that influence communication

• Psychophysiological

• Relational

• Situational

• Environmental

• Cultural

Describe respect

Being considerate of the person and their knowledge, values, opinions, & life experiences.

Describe empathy

Communication understanding on another’s feelings

Describe caring

Intentional human action that allows you to exhibit basic integrity

Define mutuality

The recognition of reciprocity, in which we value & support the well-being of people

Define reciprocity

Exchanging things for mutual benefit

Effects of anxiety in communication

Can become a personal barrier through lowering one’s self-concept, anxious feelings, change in perceptions, behavior, and coping skills