foundations

learn

Swanson’s Theory of Caring components

Swanson’s Theory of Caring- can assist the nurse to have

  - Maintaining belief – uplift patient, give them hope and encouragement, all while maintaining a good attitude

- knowing – your own knowledge and experience to give patient to make the best actions

 - being with -  physical presence with patient, such as sitting down and having a conversation with patient

- Doing for – physically doing a task that’ll improve comfort and showing them I care basic comfort things, getting them extra   blankets, helping them with the tv, ordering them a meal/feeding

 - enable – give them the tools and overall guidance to navigate whatever situation they're in

Caring behaviors and examples/application of each

•Listening- active listening ( listening to understand), Ask to listen to vent or listen to give advice

•Touch- depends on relationship whether a person is okay or not okay with it, Culture, Ambulation, vital signs- getting consent and letting patient know why you’re touching them

•Being present- some may be lonely so being physically there with them

•Providing comfort- doing for

•Showing compassion- humanize patients and have a personal connection. Don’t objectify 

Age related considerations

•Older population isnt as comfortable with technology – what communication preference and age

•Silent generation –80 to 90s – value loyalty. Prefer face to face and written instructions

•Baby boomers – 60 to 80 – also prefer face to face, don’t understand that younger gens can multitask and might find typing on computers as offensive very much follows orders

•Generation x – 40 to 60- start to question healthcare providers, advocate more and more comfortable with technology

•Generation y – 20-40 – more educated due to the fact that more people this age followed through with education and upping up their health literacy, don’t have a problem voicing opinion or challenging authority

Generation z – digital natives, expect instant feedback, can multitask, communicate via text message or email

Spiritual assessment and support

Spiritual assessment when patient is first admitted

-For us to get a grasp of mental wellbeing, culture, help us determine if there's any gaps in spiritual care, respect

-Ask them what religion they practice, special religion considerations like dietary constrictions, set time to pray, what their schedule looks like

-On hospice- determine if there's religious practices that’s help their end of life care, any ceremonies they’ll like to have

-Overall maintained respect regarding spiritual 

Pastoral care

Client-focused service that provides support to clients, families, and staff with ethical, spiritual, and religious needs

•Provides a responsive and multifaith service that is focused on an individual’s relationship with self, others around the person, and whatever higher power the client believes in

•Chaplains: pastors, rabbis, imams, or other religious leaders

Telehealth

Connecting with health care providers over the internet

-A variety of health services including behavioral health counseling, primary care, school health

-Safe, effective, and a cost-effective mechanism for providing client care

-Beneficial for patients in rural areas or with limited transportation

-Extending acesss to healthcare

-Mainly impactful to rural areas

-Might be more effective to meet inperson due to circumstance 

Modes of communication, examples of 

Verbal – ex. face-to- face, oral, can be over the phone, interpersonal rounds, make sure to document (written info) or chart, usually baby boomers/older generation

•Nonverbal – physical gestures, eye contact, facial (rbf), posture, overall appearance, rolling eyes, looking uninterested, tired , \\consider that a patient can recognize these cues and they’re very important

•Electronic- email, text (teams) , charting, social media in general, quick communication however remember hippa ( own password, logout, don’t have someone else did it for you, email attachments have to be indecipherable like no screenshots or copy and paste) prescriptions, discharge always offer a paper copy

•Written- letter, tie back into charting and emails, disadvantages are  if you email or text it often can get taken out of context such as your tone ( periods or exclamation marks) or message. Baris are your barriers of language and literacy , visual impairments

Communication styles, examples of

Passive – a person will do anything to avoid conflict, very common in new nurses when it comes to being nervous and lack confidence. Ever when you have an opinion you feel fearful to state It and how people will perceive it. Ex. Parent, sibling, friend , when you don’t agree with what they say but are too scared to stand up you basically walk on eggshells. Disagree but keeps the peace

-Assertive – most effective, the person who is talking advocates for themselves or the rights of your patient, you do this by not crossing any lines. Use “I” statements not “you”,express yourself but are pleasant even when things don’t go your way

-Aggressive  - they can be verbally or sometimes physically abusive, they use ”you” statements,interrupts, don’t like to be challenged, don’t stop to think its their way or the highway

-Passive-aggressive – just as damaging as aggressive. Can act good but they boil up , don’t interrupt but harbors resentment be they don’t feel included even when they are. Telling patient they’ll come but doesn’t actually see what they need

Therapeutic techniques

Student state this is one of the most difficult things to do when you’re new. You don’t want to make a mistake or come off dumb

•Techniques to use to build relationships, trust, repour.

•silence - so they have someone to listen too, give them the opportunity to say their thoughts

•Active listening- gives patient the opportunity to talk, you're not listening to respond but to listen.  Asking open ended question like how youre feeling not just yes or no questions but ones that open up ways for patient to dive into what they’re thinking or saying and gives you more information

•Restating/summarizing- after exchange has been made you're going to revisit topics and summarize what happened back to the client so they know you were listening and and caught onto message they’re trying to say

•Reflection- reveals patient feeling behind message they were saying. If patient ask you what they should do you shouldn’t tell them what to do but summarize their feelings like how it makes them feel to give ownership back to them 

Strategies to overcome communication barriers

•Psychosocial- patient mental state and overall wellbeing. Everything going on outside of hospital . You can overcome this by having conversations, social workers 

•Physiological– looking at hearing and vision loss. Making sure they have the accommodations they’re need like brail or glasses  

•Developmental/Cognitive Disorders

•Situational

•Environmental

•Cultural/Demographic

Clinical Judgement Model/Nursing Process (CJMM)- (~12 questions)

1. Recognize Cues (Assessment)

Filter information from different sources (e.g., signs, symptoms, health history, environment).

- Subjective data

2. Analyze Cues (Analysis)

Link recognized cues to a client’s clinical presentation and establish probable client needs, concerns, or problems. 

Step 2a- Occurs as the nurse analyzes and interprets the information/data to determine the patient’s nursing problems and needs (actual and potential)

• What client conditions are consistent with the data? Why is this a concern?

• Prioritize the client’s highest risk and arrive at a conclusion to guide care (may need additional data)

Step 2a- etermine what is the most concerning and establish priorities of care based on the client’s health problems

• Environmental factors

• Risk assessment

• Urgency

• Signs/symptoms

• Diagnostic tests

• Lab values

3. Prioritize Hypotheses (Analysis)

Establish priorities of care based on the client’s health problems (e.g., environmental factors, risk assessment, urgency, signs/symptoms, diagnostic tests, lab values).

4. Generate Solutions (Planning)

Identify expected outcomes and related nursing interventions to ensure clients’ needs are met. 

identifies the interventions or actions that the nurse may take to manage or resolve problems, monitor the patient, decrease risks of injury or illness, promote health, support patient self-management, and provide patient-centered care.

• What could help? What should I do?

• Do I need to collaborate with other team members?

• What do you anticipate being ordered?

• What interventions/actions are indicated or contraindicated? Short-term or Long-term

5. Take Actions (Implementation)

Implement appropriate interventions based on nursing knowledge, priorities of care, and planned outcomes to promote, maintain, or restore a client’s health.

• Implementation of the solution(s) that address the highest priority

• Nurses use evidence-based rationales and patient preferences to select the appropriate action.

  • What do I do? How do I do it?

  • What factors could impact the treatment plan?

  • Which interventions should the nurse delegate?

  • What steps should the nurse take to administer a medication/perform a procedure? 

6. Evaluate Outcomes (Evaluation)

Evaluate a client’s response to nursing interventions and reach a nursing judgment regarding the extent to which outcomes have been met. 

• Evaluate clients’ responses to nursing interventions and form a clinical judgment about the extent to which clients have met the goals and outcomes

• Continuously evaluate clients’ progress toward outcomes, and use data to determine whether to modify the plan of care.

  • How’d it go? Did it help?

  • Which assessments should the nurse make to determine if the treatments were effective?

  • Do the trends in vital signs/lab results trends indicate the client’s condition improved or worsened?

  • Which assessment findings indicate that the client’s condition has improved, stayed the same, or declined?

  • What additional intervention should the nurse implement based on the finding

SMART goal components

 Goals must be realistic, measurable, and attainable in a timely manner. Goals can be either short term or long term. Short-term goals can be achieved within a few days, whereas long-term goals may only be attained within weeks or months. This will ensure that the client realizes the best possible outcome. Analysis of the assessment data that were collected, including all of the holistic information, is needed for appropriate planning.

• Specific

• Measurable

• Attainable

• Realistic

• Timely