CPCT: Professionalism and Communication

Why is it important to weigh patients accurately

Weight can determine treatments and medication dosages

Which patients can gain many pounds very quickly due to fluid retention?

Congestive heart failure (remember that in heart failure fluid accumulates in either the lungs or the body)

Make sure a scale is set to ______ before use.

Zero

How to use a mechanical scale

Zero scale (move all weights to the left)

Have patient step on

Move bottom (larger) weight first

Move top (smaller) weight first

Adjust weights until balance bar is floating in the middle of the frame

Add the two weights together to determine the weight

If using a bed or wheelchair scale, what must do you to determine the actual weight of the patient?

Subtract the weight of the bed/sheets/equipment/wheelchair.

Empathy

sensitivity to and identification with another person's feelings

Most important communication skill

Listening

Signs of active listening

smile

eye contact

erect posture

attention to what the speaker is saying

nonverbal communication

communication using body movements rather than speech

gestures

mannerisms

facial expressions

body posture

stance

eye contact

movements

touch

personal space

therapeutic communication

Verbal and nonverbal communication techniques that encourage patients to express their feelings and to achieve a positive relationship

health literacy

knowledge of health information needed to make good choices about your health

patients need to know basic medical terminology for this, or medical words need to be explained to them

What should you do if your patient speaks a different language than you?

Get an interpreter

Patients with vision loss

Explain everything that is happening

Escort them if necessary to prevent injury

Patients with hearing loss

Face them when speaking

Speak at a normal volume and tone

Enunciate words without over-enunciating

If they cannot hear at all, provide written communication

Use a sign language interpreter if needed

Service animals

Do not speak to, touch, or talk about the animals

They are not "pets"

Patients with mental health issues

Do not act as a counselor

Patients with developmental delays

Allow them to do as much as they can

Rounding on patients

Routine checking on patients

It is an opportunity to observe for any changes in patient's condition and report them to the nurse

intake and output (I&O)

nursing procedure that documents the total amount of fluid intake and the total amount of fluid output

always document in mL (1 oz = 30 mL)

document anything that is liquid at room temperature

numerical pain scale

FACES pain scale

for children, mentally disabled, or language barrier

Who determines a patient's pain level?

The patient

Pain is subjective

Nonverbal signs of pain

Moaning

Rocking

Pacing

Crying

Grimacing

Clenching jaw or teeth

Biting lips

Restlessness

Insomnia

Rigid or flaccid posturing

Holding, rubbing, guarding the area of the body

Inability to focus or concentrate

Avoidance of conversation

Five Rights of Delegation

a) Right Task

b) Right Circumstance

c) Right Person

d) Right Direction/Communication

e) Right Supervision

CPCT scope of practice

Things CPCT are trained and allowed to do

-measuring vital signs

-assisting with ADLs

-performing EKGs

-drawing blood

not in your scope of practice:

-administering medications

-performing sterile procedures (alone)

-invasive procedures (NG/Foley insertion)

-diagnosing

Maslow's Hierarchy of Needs

Patients need the lower levels to achieve the higher levels

(level 1) Physiological Needs

-food

-water

-shelter

-oxygen

-elimination

-temperature regulation

-sleep

(level 2) Safety and Security

-helping patient feel secure and well cared for

(level 3) Relationships, Love and Affection

-taking an interest in patients

-showing respect for their preferences

-speaking kindly to them

-friends and family

(level 4) Self Esteem

-confidence

-privacy

-hygiene

-allowing them to choose/assist

(level 5) Self Actualization

-set and achieve goals

-reaching your highest potential in life

Palliative care/Hospice

supportive medical and nursing care that keeps the patient comfortable but does not cure the disease

-oxygen

-fluids

-nutrition

-hygeine

-pain control

Can occur in the home, hospital, long term care facility, hospice facility

Usually patients enter hospice when they are terminally ill or decline life saving intervention and are expected to live < 6 months

Coping mechanisms

strategies to protect yourself from negative feelings

Kubler-Ross stages of grief

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

People can grieve using these stages in any order, they can skip stages. Everyone grieves differently and there is no correct way to grieve.

Before an RN/CPCT begins postmortem procedures, what do they need to make sure has happened?

Doctor has certified the death and recorded the time and date of death

How to prepare a body for family to view

-Remove all equipment and supplies from room

-Prepare the body as soon as possible to prevent disfigurement or tissue damage

-Try to make the body look as natural and peaceful as possible

Postmortem care: eyes and mouth

Close the eyes and mouth

Keep dentures in place

Place small towel under chin if mouth will not close

Postmortem care: tubes and drains

Remove

If there is an autopsy scheduled: cut them to 1 inch and secure with tape

Postmortem care: body position

supine with small pillow under head to prevent pooling of blood in the face

Postmortem care: arms/hands

Arms at side of body, palms down

or

Arms across the abdomen without placing one hand on top of the other

Postmortem care: bandages/dressings

replaced soiled dressings/bandages with new ones

Postmortem care: hygeine

Bathe body

Comb hair

Place clean gown on body and cover with a clean sheet up to the shoulders, leaving face exposed

Postmortem care: Valuables

Place them in a bag/envelope with documentation

Offer to family

Postmortem care: Identification tags

One on the right big toe

One on the shroud (fabric wrapped around patient)

One on belongings

chain of command

the vertical line of authority that clarifies who reports to whom throughout the organization

CPCT reports directly to supervising nurse, then charge nurse, then nurse manager/supervisor, then chief of nursing

proceed up the chain of command if a problem is not being addressed appropriately

Abuse

the physical, mental, financial, emotional, or sexual mistreatment of one person by another

violation of basic rights (freedom, speech, privacy, expression worship)

neglect

failure to deliver care and maintain basic needs

exploitation

taking advantage of other people for selfish purposes

indications of abuse

lack of personal care

signs of malnourishment

signs of dehydration

pressure sores

signs of trauma

restraint trauma

inconsistent explanation of injuries

signs of anxiety

caregiver control

overmedication/oversedation

unusual repetitive behaviors

reports of abuse, neglect, exploitation

If a CPCT suspects abuse/neglect/exploitation, what should they do?

They are not obligated to investigate further or confirm suspicions

They should report it to the supervising nurse and then follow the chain of command if needed

Respite care

a type of care provided for caregivers of homebound ill, disabled, or elderly patients

designed to give caretakers of patients a break so that they don't feel stressed

caregivers who receive respite care are less likely to abuse/neglect/extort the patient

Patient's Bill of Rights/Patient Care Partership

outlines rights and responsibilities patients have in healthcare facilities

summarizes legal, ethical, and moral responsibilities of healthcare workers must adhere to when caring for patients

patients have the right to:

privacy

confidentiality of documentation of their care

information about their options

review and receive copies of their own medical records

prepare advance directives and have staff honor them

receive respectful care

make decisions about their care

refuse treatment

receive information about their diagnosis, treatment plan and prognosis

patients have the responsibility to:

provide correct and complete information about their health

offer insurance information or ensure payment for services

cooperate with health care staff

respect other patients and their privacy

try their best to understand and comply with instructions for treatment and self-care

ethics committee

committee made up of individuals who are involved in a patient's care, including health care practitioners, family members, clergy, and others, with the purpose of reviewing ethical issues in difficult cases

electronic health record (EHR)

AKA electronic medical record (EMR)

Systematic collection of a patient's health care and treatment in a digital format

how to protect patient information when using an electronic health record

use your own login and password to access the EHR

log off when leaving your computer

never share your login/password with anyone

shred anything you have printed

position the screen so that other people cannot see it

how to identify a patient

do not use room number/bed number

always ask the patient to state the information, do not say it for them (they may just agree or misunderstand you)

use at least two of the following identifiers:

-full name

-date of birth

-home address

-phone number

-social security number

-photo ID

how to document in an electronic health record

document something after you've done it, not before

document something as soon as you can after you've done it

without documentation there is no record that you have done something

only chart what you have done, not what you have observed someone else doing

chart specifics

never chart an assumption, only chart what you have done or seen

if documenting something someone says, use quotes