NURS1003 study guide (midterm-> final)

Transactional model of communication:

Model of communication with reciprocal interaction between communicators.

Feedback loops:

Provides information about the output and relates it to data received or acted upon. Further validates information received or expresses a need to correct or modify input information

Systems theory:

Everything exists within a system. Consideration given to interrelationships within a system and is based on the whole being greater than the sum of its parts.

Health promotion: .

Focus is being able to function normally, experience well-being, and having a healthy lifestyle.

Disease prevention:

: Actions designed to reduce or eliminate the onset, progression, complications, or recurrence of chronic disease. Focus is on communicating in relevant situations

Motivational inerviewing

Communication model helps people to incorporate the functional abilities and skills they will need to fully engage in health promotion and disease prevention activities. Emphasizes the person’s capacity to take charge of their personal health and control lifestyle factors that interfere with their optional health and well being. Change comes from within.

Empowerment:

A goal and a process. People need to take initiative to make change.

Communication disorder:

An impairment in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal, and graphic systems.

Deaf:

Very little useable hearing, rely on visual communication

Hard of hearing:

Hearing loss, use of amplification

Oral deaf:

Severe or profound loss  use speech to communicate with residual hearing, hearing aids, and lip/speech reading

American sign language:

Visual-gestural language, no written form

Fingerspelling:

Signing specific names, places, in ASL. Someone may have literacy issues. Can also be difficult to understand.

Homemade signs or pantomime:

Could be used in areas with little access to ASL instruction, individuals not able to learn it. 

Speech reading or lipreading:

Not preferred to communicate with somebody with hearing loss. Can be exhausting

Written communication:

Can be a challenging and time-consumin way to communicate with someone with hearing loss

TTY

Text telephone

Speech disorders:

Challenge to produce the sounds of speech

Language disorders:

People are challenged to formulate, express, and comprehend spoken and written language.

Aphasia:

One of the most common language disorders in adults, resulting from damage to one or more of the language areas of the brain, most often after a stroke. Affects ability to express verbally and in writing, in understanding others when they speak or read.

Collaboration

: The development of partnerships to achieve best possible outcomes that reflect the particular needs of the patient, family, or community, requiring an understanding of what others have to offer. Involves a joint responsibility for patient outcomes

Conflict

: Disagreement between people when there are differences in values, attitudes, or needs.

Poor communication:

Often the cause of conflict. Can cause misinterpretation and unfounded conclusions.

Dysfunctional conflict

Conflict occurs when information is withheld, feelings are expressed too strongly, the problem is obscured by a double message, or feelings are denied or projected onto others.

Assertive behavior

: Confronting an issue or addressing a conflict with a colleague or patient requires this behavior (not aggressive behavior)

Continuity of Care

: A multidimensional, longitudinal process. Emphasizes seamless provision and coordination of person-centered quality care across clinical settings. Goal to ensure reliable, coordinated transition of people from one health care setting to another.

Relational continuity:

Ongoing trusting therapeutic relationships between a person and a primary care physician and their team where the person sees this primary care physician the majority of the time.

Informational continuity:

Use of data to tailor current treatment and care for each person’s evidence needs. Includes accurate record sharing to share information in real time.

Management continuity:

Consistent, coherent, person-specific care management approach. Flexible to a person's needs; can be adjusted. Involves care coordination and case management.

Documentation

: The process of obtaining, organizing, and conveying people’s health information to others in print or electronic format. 

Interoperability

: Need to smoothly exchange information between health systems. Different systems need to be able to communicate with each other (Interagency accessibility).

Portability

: E-records are more durable than paper and are easily transferable.

Adverse events:

An unexpected and undesired incident directly associated with the care provided to patient: an incident during health care that results in patient injury or death; and a patient outcome such as injury or complication.

Miscommunication

A major causative agent of adverse events

Group

: An open system comprised of three or more people who are held together by a common bond or interest.

Primary group:

Informal structure and close personal relationships, where membership is automatic and there are no determined end dates. Influences self identity and social skill development (ex: family).

Secondary group:

: Time limited group relationships with an established beginning and end. Group size determined by goal and function. Has a leader and specific goals, and when those goals are met, the group ends.

Forming

: Understanding the purpose of the group and who the other team members are.

Storming

: Identifying what individuals expect from each other and how they expect to work together in the group

Norming

: Resolve differences in what members expect of each other and how they will work together in the group

Performing

: Activities that will lead the group to accomplish its mandate

Adjourning

: Final phase of group development, termination occurs after achievement of desired outcomes.

Family theory:

Family is a system, created of systems, acting within systems. Information is coming into the system and being outputted into other systems.

Stress (Hans Seyle)

: Non-specific response to the body to any demand made upon it, regardless of whether it is caused by a pleasant or unpleasant situation

Stress (McEwan)

: A state of mind involving both brain and body as well as their interactions.

Eustress

: Mild level of stress with protective and adaptive functions. Increases awareness and motivates

Distress

: Negative stress level. Anxiety created exceeds person’s normal coping abilities. Diminishes performance and quality of life. 

Chronic stress:

distress over time that can result in adverse health outcomes

Acute stress:

Requires immediate attention. Very intense form of anxiety which is disabling. If unresolved, can develop into PTSD.

Seyle-General Adaptation Syndrome:

Alarm-resistance-exhaustion model of stress. Alarm: stress is experiences, resistance: body accomidates exhaustion: body failed to adapt in resistance and person is at higher risk for illness. 

Allostasis

: Short term adaptation to stress. 

Allostatic load:

When stress becomes maladaptive or toxic. Brain interprets whether or not the person is threatened. Greater the threat, the more the person will be stressed. 

Lazarus and folkman’s transational model:

Prominent in health care and is widel used. Two processes: the stressor and the individuals response. Primary appraisal is individual’s interpretation, secondary is their perception of how to resolve the situation.

Coping

: Constantly changing cognitive and behavioral efforts to manage specific external or internal demands that are appraised as taxing or exceeding the resources of the person.

Defensive coping:

Copin strategy that can can be maladaptive, especially if used frequently or to the exclusion of other more health adaptive means of coping.

Resilience

: The ability of individuals who are exposed to highly disruptive stressors to remain relatively stable and functional despite stress. Strong internal sense of control, a positive attitude, empowerment, creativity. Positive coping mechanisms

Hardiness

: Protective factor that can reduce the effects of stress. Involves challenge, commitment, and taking control.

Burnout

: Results from emotional exhaustion, compassion fatigue, and disenfranchised grief. Affects interpersonal relationships and functioning of individual/team/organization.

Crisis

: Time limited response to a life event that overwhelms a person’s usual coping mechanisms. People experience an actual or perceived overwhelming threat to self-concept, an insurmountable obstacle, or a loss that conventional coping measures cannot handle.

Developmental crisis:

Can occur as people move or attempt to move through Erikson’s stages of psychosocial development

Situational crisis:

Stressful life event, disaster that do not occur in one’s normal everyday life events.

Behavioural emergencies:

As the nature of crisis overwhelms one’s ability to cope, individuals might behave in ways they would not normally.

Critical incident stress debrieing:

Led by trained individual in the area of critical incident stress debriefing. Gathering of individuals who experienced/are affected by a crisis situation to discuss what they experienced, how they feel, how they are coping, and how they can improve their coping. 

De-escalation

: Communication and other interventions used to reduce the level of agitation and /or the potential for violence to occur. Goal is to reduce risk for individuals becoming violent.

Grief

: encompasses the painful emotions and related behavioral and physical responses to a major loss and the process of adaptation and recovery.

Loss

: When someone or something is taken away or denied. Absence of an object, position, ability, attribute.

Acute grieving:

Physical feelings of grief (tightness of throat, shortness of breath, emptiness in abdomen, sense of heaviness, lack of muscle power, intense muscle pain) and intense feelings.

Anticipatory grief

: Emotional response that occurs before the actual death or loss.

Chronic sorrow

ongoing grief that accompanies ongoing losses

Complicated grief (absence of grief, long-term grief):

Intense expression of grief, significantly longer, and emotionally incapacitating. Mental health complications can occur. Crief can be delayed in nature- a person might not experience it until some time after a loss.

Palliative care

: Patient centered care with an emphasis on care of patients with diagnosed, progressive, life-limiting health conditions. Focuses on support and comfort rather than a cure.

Stage 1, Novice:

Stage of Benner’s clinical competence. A nursing student in their first year of clinical education, behavior in the clinical setting is very limited and inflexible. Has very limited ability to predict what might happen in a particular patient situation. Signs and symptoms, such as change in mental status, can only be recognized after experience with patients with similar symptoms

Stage 2, Advanced beginner:

Stage of Benner’s Clinical competence. New grads in their first jobs: nurses have had more experiences that enable them to recognize recurrent, meaningful components of a situation. They have the knowledge and the know-how but not enough in-depth experience

Stage 3, Competent

: Stage of Benner’s clinical competence. These nurses lack the speed and flexibility of proficient nurses, but they have some mastery and can rely on advance planning and organizational skills. Nurses recognize patterns and nature of clinical situations more quickly and accurately than advanced beginners. 

Stage 4, Proficient

: Stage of Benner’s Clinical competence. At this level, nurses are capable to see situations as “wholes” rather than parts. Proficient nurses learn from experience what events typically occur and are able to modify plans in response to different events

Stage 5, Expert:

Stage of Benner’s clinical competence. Nurses who are able to recognize demands and resources in situations and attain their goals. These nurses know what needs to be done. They no longer rely solely on rules to guide their actions under certain situations. They have an intuitive grasp of the situation based on their deep knowledge and experience. Focus is on the most relevant problems and not irrelevant ones. Analytical tools are used only when they have no experience with an event, or when events don’t occur as expected

Interprofessional practice:

When two or more colleagues from different disciplines coordinate their expertise in providing care to patients/clients.

1. Deaf

2. hard of hearing

3. Oral deaf

What are examples of hearing loss? [3]

1. American Sign Lanugage (ASL),

2. Fingerspelling,

3. Homemade signs or pantomime,

4. Speech reading or lipreading (not preferred),

5. Written communication (not preferred, time consuming).

What are some strategies of communicating with a patient with hearing loss? [5]

1. Turn lights on and off or tap on table or patient’s shoulder to gain attention.

2. Try to communicate naturally. Allow sufficient time.

3. Determine patient’s communication method

4. An ASL interpreter is essential

5. Speak directly to patient

6. Use gestures and body movements to explain locations or directions

7. Make sure person has clear view of face

8. Avoid jargon

9. Have pen and paper ready

10. Use visual aids and graphics. 

11. Continue to build relationship with family

What are some communication considerations for a patient with hearing loss? [11]

1. TTY: Text telepone

2. Cell phone texting

3. Close captioning phone texting

4. Special walk in line for people with disabilities.

5. CT scan with visual cues

6. Medical video relay services

Technical aids for patient with hearing loss to be considered [6]

1. Room orientation: describe layout of room

2. Keep noise to a minimum

3. Avoid relying on nonverbal communication

4. Don’t play with assistive devices

5. Offer assistance filling out forms

6. Be prepared to write out information for them

7. When in doubt, ask the individual

Communication considerations for patients with visual impairments: [7]

1. Speech issues: Challenge to produce sounds of speech

2. Language disorders: challenge to formulate, comprehend, express written or spoke language

What are the two main issues for patients with language disorders?

1. Developmental disabilities

2. Traumatic brain injury

3. Dementia (various types)

4. Mental illness

Four examples of cognitive impairments

1. Patients who are intubated

2. Surgery to mouth, neck (vocal cord involvement)

3. Surgeries to eyes and ears

Describe situation that may make it difficult for a patient to communicate [3]

1. Relational continuity

2. Informational continuity

3. Management continuity

Three Types of continuity of care

Electronic health records are part of computerized Health Information Technology (HIT)

System used for documenting:

1. Interoperability 

2. Portability

3. Ease of access 

What are three advantages of Electronic Health Records?

Documentation shows a person’s response to care and communicates their information. Documentation compiles data from many people to identify best practice and provide proof of quality care. It makes a permanent record of care given, and gives evidence for reimbursement 

Why do we document?

1. Clarity: accurately, based on assessment. 

2. Includes objective and subjective

3. Efficiency: Done in a timely manner.

4. Safety: Standardized documentation, policy driven, reduces risk for human errors. 

5. Adherence to professional standards

   1. Confidentiality and privacy: secure information, where you are documenting

   2. Legal considerations: Health record is a legal document

   3. Accountability: person, community, government, profession, health authority (many levels)

What are some essentials to consider when documenting [5]

1. Practice standards and other regulatory requirements

2. Specialty standards

3.  Employer policies

4. Legislative requirements

What are standards of documenting (Nurses document according to what?) [4]

1. Document care YOU provide.

2. First-hand knowledge only.

3. Document all aspects of care (entire nursing process).

4. Clear, concise, unbiased, and accurate manner. 

5. Document date, time, signature, and designation. 

6. Document in patient chart (electronic or paper)

7. Document in a timely, frequent, and chronological fashion. 

List performance expectations for documentation: [7]

A family is what it says it is.

What is a family?

1. Use circular questions

2. Focus on family interrelationships

3. Think how the illness/concern will affect the family (system) as a whole

What are some family communication considerations? (3)

1. Encourage telling illness narratives

2. Commend family AND individual strengths 

3. Offer information and professional opinions

4. Validate or normalize emotional responses

5. Encourage family support 

6. Support family members as caregivers

7. Encourage respite

How to implement communication with families: [7]

1. Keep to key points

2. Be prepared

3. Note timing

4. “Work up” to bad news

5. Be factual and concise

6. Be respectful

7. Give people time

8. Assess understanding

How to communicate with a family when there is bad news: [8]

1. Nurses often act as supports for caregivers

2. Incorporate therapeutic communication skills

3. Know resources and supports

4. Acceptance, non-judgement

Considerations for family caregiver support: [4]

1. Failure to create context for change

2. Taking sides

3. Giving too much advice prematurely. Can provide information and give opinions based on  sound data.

Things to avoid when communicating with families [3]

1. Therapy: interpersonal skills, personal growth

2. Support: Coping skills, sharing information, problem solving

3. Activity: Focus on physical activities, fostering self-esteem, supporting creativity

4. Health education: learning new information, providing support and feedback, discussing health issues

What are some types of secondary groups? [4]