CMS: Communication, Coping, Self-Concept, Sexuality, Cultural and Spiritual Nursing Care

ineffective communication skills

• Asking irrelevant personal questions

• Offering personal opinions

• Stereotyping

• Giving advice

• Giving false reassurance

• Minimizing feelings

• Changing the topic

• Asking “why” questions or asking for explanations

• Challenging

• Offering value judgments

• Asking questions excessively (probing)

• Responding approvingly or disapprovingly (refusing)

• Being defensive

• Testing

• Judging

• Offering sympathy

• Arguing

• Making automatic responses

• Reacting with passive or aggressive responses

incivility

rude dialogue or actions (sarcasm, eye rolling)

bullying

repeated words or acts of intimidation

lateral violence

abusive words or actions of peers (gossiping, exclusion of info, threats of harm, actual harm)

communication techniques for kids

simple, straightforward language, sensitive to nonverbal communication, be at eye level, incorporate play into interactions

communication techniques for older adults

may need assistive devices, face pts while speaking, speak in short and simple sentences, allow plenty of time for response, ask family or caregiver about communication deficits

factors influencing an individual’s ability to cope:

• The number, duration, and intensity of stressors

• pt’s past experiences

• pt’s current support system

• available resources

ego defense mechanisms

assist a person during a stressful situation or crisis by regulating emotional distress, protects self esteem, prevents excessive anxiety

general adaptation syndrome

3 stage response system that the body uses to maintain equilibrium when an individual is disrupted by stress, several body systems respond immediately to the stressor.

• Alarm

• Resistance

• Exhaustion

alarm stage

• body functions are heightened to respond to stressors (fight or flight response). 

• Hormones (epinephrine, norepinephrine, and cortisol) are released

• Causing elevated BP, HR, increased secretion of epinephrine and norepinephrine and increased blood flow to the muscles

resistance stage

• Body functions normalize while responding to the stressor

• The body attempts to cope w/ the stressor and return to homeostasis

• BP, HR, and hormones will stabilize

exhaustion stage

• Body functions are no longer able to maintain a response to the stressor and the pt cannot adapt

• End of this stage either results in recovery or death

what increases adherence?

• commitment to regimen

• involvement of pt and support in planning stage

• positive coping mechanisms

• available resources

what interferes w/ adherence?

• complicated regimen

• adverse effects of medications

• negative coping mechanisms (ex. denial)

5 realms of processes involved in family function:

interactive, developmental, coping, integrity, and health

self-concept

the way individuals feel and value themselves, includes:

• self-identity

• body image

• attitudes

• role performance

• self-esteem

what emotions are normal and expected reactions when adjusting to body changes?

denial, anger, depression, and sadness

identity

inner sense of individuality that implies the person’s uniqueness compared w/ others, important for maintaining intimate relationships

sexuality

physical, mental, emotional, social well being regarding sexuality and sexual activity

PLISSIT assessment tool

a model used to guide discussions about sexual health

PLISSIT: P

permission, obtaining permission to discuss w/ pt

PLISSIT: LI

Limited information, provide general information about sexual health and wellness

PLISSIT: SS

specific suggestions, using assessment data to make appropriate suggestions, providing more tailored advice

PLISSIT: IT

intensive therapy, if previous suggestions are not sufficient, the pt may be referred for deeper therapy (couple’s therapy, etc.)

role conflict

when a person must assume opposing roles w/ incompatible expectations, can be interpersonal or inter-role

sick role

expectations of others and society regarding how one should behave when sick

role ambiguity

uncertainty about what is expected when assuming a role, creates confusion

role strain

the frustration and anxiety that occurs when a person a feels inadequate for a assuming a role (ex. caregiver burden)

role overload

more responsibility and more roles than are manageable, very common

situational role changes

caused by situations other than physical growth and development, can disrupt one or more of the pt’s roles in life

how does culture apply to nursing?

can influence health beliefs, practices, and manifestations of, responses to, and treatment of illness or injury 

culturally responsive nursing care

• care that transcends cultural boundaries, considers a pt’s personal beliefs as they affect health, illness, lifestyle

• pt decision making is encouraged

• pt is more likely to adhere to a treatment plan