Fundamentals of Nursing - Lecture --> Exam 1

Scope of practice

services a trained health professional is deemed competent to perform and permitted to undertake according to the terms of their professional nursing license

Florence Nightingale

Established sanitary nursing care units. Founder of modern nursing. began professional education of nursing.

Quality of Practice

one of the ANA Standards of Professional Practice

- emphasizes that nursing practice is safe, effective, efficient, equitable, timely, and person-centered

Quality

the degree to which nursing services for healthcare consumers, families, groups, communities, and populations increase the likelihood of desirable outcomes and are consistent with evolving nursing knowledge

Quality and Safety Education for Nurses (QSEN)

a project that encourages future nurses to continuously improve the quality and safety of the health care systems in which they work

- "inspire health care professionals to put quality and safety as core values to guide their work."

Quality improvement (QI)

the combined and unceasing efforts of everyone-- health care professionals, clients and their families, researchers, payers, planners, and educators -- to make the changes that will lead to optimal client health, improved care, and enhanced learning

Evidence-based practice (EBP)

A lifelong problem-solving approach that integrates the best evidence from well-designed research studies and evidence-based theories; clinical expertise and evidence from assessment of the healthcare consumer's history and condition, as well as health care resources; and client, family, group, community, and population preferences and values

-- provide client care based on research studies and clinical expertise and do not just do something because "that's the way it always has been done"

Effective communication

one of the ANA Standards of Professional Performance

- states that the registered nurse communicates effectively in all areas of practice

Nonverbal communication

Verbal communication

What are the two types of communication?

Verbal communication

an exchange of information using words understood by the receiver in a way that conveys professional caring and respect

Nonverbal communication

communication without the use of words: includes facial expressions, tone of voice, pace of the conversation, and body language

- 80% of communication

Eye contact

Face the client

Lean slightly forward

How do nurses use nonverbal communication to show clients they care and are paying attention?

Sit

Open posture

Lean in

Eye contact

Relaxed

The mnemonic SOLER (nonverbal communication) stands for...

Passive, aggressive, assertive

What are the 3 types of communication styles?

Passive communication

Putting other persons needs ahead of their own.

- tend to be apologetic or sound tentative when they speak and don't often speak up if they feel they're being wronged

Aggressive communication

Come across as advocating for their own rights despite possibly violating the rights of others.

- tend to make it seem like others' feelings don't matter

- "you" messages

Assertive communication

A way of conveying information that describes the facts and the sender's feelings without disrespecting the receiver's feelings

- "I" messages --> "I understand..." "I feel..." "Help me to understand..."

Proxemics

study of personal space & provides guidelines for professional communication

Public zone

10+ feet of distance between people

- generally avoids physical contact

Social zone

4-10 ft of distance between people

- used during social interactions & business settings

** nurses often usually communicate within this zone to maintain professional boundaries

Personal zone

18in-4 ft of space

- reserved for friends & family

** nurses often move into this zone when assessing clients & performing procedures

Jargon

Avoid using medical terminology, complicated, or unfamiliar words. When communicating with clients, explain information in plain language that is easy to understand by those without a medical or nursing background

- Common barrier to communication in health care

Lack of attention

Nurses are typically very busy with several tasks to complete for multiple clients. It is easy to become focused on the tasks instead of the client. When entering a client's room, it is helpful to pause, take a deep breath, and mindfully focus on the client in front of you to give them your full attention. Clients should feel as if they are the center of your attention when you are with them, no matter how many other things you have going on

- Common barrier to communication in health care

Noise & other distractions

Health care environments can be very noisy with people talking in the room or hallway, the TV playing, alarms beeping, and pages occurring overhead. Create a calm, quiet environment when communicating with clients by closing doors to the hallway, reducing the volume of the TV, or moving to a quieter area, if possible

- Common barrier to communication in health care

Light

A room that is too dark or too light can create communication barriers. Ensure the lighting is appropriate according to the client's preference

- Common barrier to communication in health care

Nurse-client relationship

crucial for holistic, compassionate nursing care

- the nurse builds rapport and establishes trust with the purpose of actively engaging the client in discussions about their feelings, emotions, care process, and decision-making

Rapport

Establishing ___ with clients is of the utmost importance because it facilitates an open and honest dialogue between the client and the nurse

Preinteraction phase

Orientation phase

Working phase

Termination phase

What are the 4 phases of the nurse-client relationship?

Preinteraction phase

The nurse reviews the medical record or other data in preparation for the next phase.

- helpful to identify preconceived notions about a client situation, acknowledge feelings, and make a conscious effort to avoid biases

Orientation phase

A brief encounter where the nurse addresses the client by name and then introduces themself to the client, including their name and role **IMPORTANT FOR ESTABLISHING RAPPORT & TRUST**

- Estimated time frame, explanation of what will happen, ensure privacy

Working phase

Phase where the nurse spends most of their time with the client, using client-focused therapeutic communication to explore their concerns, feelings, coping mechanisms, and goals for care. The nurse remains nonjudgmental and focuses on the client's thoughts and feelings

Termination phase

The last phase of the nurse-client relationship, occurring when the goals of the therapeutic communication session have been met. The nurse prepares the client for the ending, reviews goals and achievements, and discusses available support.

- Ending should be clear and concrete rather than abrupt.

Therapeutic communication

Type of professional communication used by nurses with clients that is purposeful and interpersonal, using words and behaviors to promote client understanding and participation

Competitive listening

Passive listening

Active listening

What are the 3 main types of listening?

Competitive listening

Happens when we are focused on sharing our own point of view instead of listening to someone else.

Passive listening

Occurs when we are not interested in listening to the other person and we assume we understand what the person is communicating correctly without verifying

Active listening

Communicating verbally and nonverbally that we are interested in what the other person is saying while also actively verifying our understanding with the speaker

Touch

A therapeutic communication technique to convey caring, empathy, and comfort through physical contact, while respecting the client's cultural beliefs, personal boundaries, and comfort level.

- should be avoided if the client is not receptive or if it may cause discomfort or distress.

Therapeutic communication techniques

specific methods used to provide clients with support and information while focusing on their concerns

- encourage clients to explore their feelings, solve problems, and use coping responses for medical conditions and life event

Active listening

By using nonverbal and verbal cues such as nodding and saying, "I see," nurses can encourage clients to continue talking. Involves showing interest in what clients have to say, acknowledging that you're listening and understanding, and engaging with them throughout the conversation. Nurses can offer general leads such as "What happened next?" to guide the conversation or propel it forward.

- Therapeutic communication technique

Providing silence (silence)

Can give both nurses and clients an opportunity to think through and process what comes next in the conversation. Gives clients the time and space they need & allows quiet time for self-reflection. The nurse does not verbally respond after a client makes a statement, although they may nod or use other nonverbal communication to demonstrate active listening and validation of the client's message.

- Therapeutic communication technique

Acceptance

To acknowledge a client's message and affirm that they've been heard. Isn't necessarily the same thing as agreement; it can be enough to simply make eye contact and say, "Yes, I hear what you are saying." Clients who feel their nurses are listening to them and taking them seriously are more likely to be receptive to care.

- Therapeutic communication technique

Giving recognition (recognition)

Acknowledges a client's behavior and highlights it without giving an overt compliment. A compliment can sometimes be taken as condescending, especially concerning routine tasks. An example of a nurse doing this: "I noticed you took all of your medications today." This statement draws attention to the positive action and encourages it.

- Therapeutic communication technique

Offering self

Hospital stays can be lonely and stressful at times. When nurses are present with their clients, it shows clients they value them and are willing to give them time and attention. Offering to simply sit with clients for a few minutes is a powerful way to create a caring connection.

- Therapeutic communication technique

Open-ended questions

Clients direct the flow of conversation and decide what to talk about. To that end, giving clients a broad statement such as "Tell me about your concerns," can be a good way to allow clients an opportunity to discuss what's on their mind.

- Therapeutic communication technique

Clarification

Asking clients for clarity when they say something confusing or ambiguous is important. Saying something such as "I'm not sure I understand. Can you explain it to me?" helps nurses ensure they understand what's actually being said

- Therapeutic communication technique

Sequencing

Asking questions about when certain events occurred in relation to other events can help clients (and nurses) get a clearer sense of the whole picture. It forces clients to think about the order of events and may prompt them to remember something they otherwise wouldn't

- Therapeutic communication technique

Making observations (observation)

Calling attention to a client's appearance, demeanor, or behavior to encourage them to explain possible problems or changes in their condition.

- Therapeutic communication technique

Encouraging descriptions of perception (encouraging description)

Asking clients to describe what they are seeing, hearing, or experiencing in a supportive and nonjudgmental way, especially when they have sensory issues or hallucinations. "It looks like you may be hearing something. What do you hear now?"

- Therapeutic communication technique

Encouraging comparisons (comparisons)

Helping clients connect past experiences to current problems so they can identify coping strategies or possible solutions that have worked for them before. Nurse: "It must have been difficult when you went through a divorce. How did you cope with that?" Client: "I walked my dog outside a lot." Nurse: "It sounds like walking your dog outside helps you cope with stress and feel better?"

- Therapeutic communication technique

Summarizing

Restating the main points a client has shared to show that the nurse was listening and to verify information. The client is given an opportunity to correct or clarify anything. Nurse: "You haven't been taking your medications this month because of the side effects of fatigue and weight gain. Is that correct?

- Therapeutic communication technique

Reflecting

Asking clients to consider what they think they should do instead of giving them direct advice, helping them take responsibility and develop their own solutions. Nurse: "What do you think are the pros and cons for the new treatment plan?

- Therapeutic communication technique

Focusing

Directing attention to an important statement or topic the client mentions and encouraging them to explore it further. Client: "I am nervous about going home." Nurse: "You're feeling anxious about going home, tell me more about that."

- Therapeutic communication technique

Confronting

Presenting reality, challenging a client's assumptions, or pointing out inconsistencies between their thoughts, feelings, or behaviors. Should be used after trust has been established. Client: "I haven't drunk much alcohol this year." Nurse: "Yesterday you told me that every weekend you go out and drink so much that you don't know where you are when you wake up."

- Therapeutic communication technique

Voicing doubt

Gently expressing uncertainty about a client's incorrect or unrealistic ideas or perceptions, encouraging them to examine their assumptions.

- Therapeutic communication technique

Offering hope

Encouraging clients by reminding them of their strengths, past successes, and ability to cope with difficult situations, without giving false reassurance. "I remember you shared with me how well you have coped with difficult situations in the past"

- Therapeutic communication technique

Using humor (humor)

Using appropriate jokes or lighthearted comments to improve the client's mood and build rapport, while making sure not to minimize their feelings or situation.

- Therapeutic communication technique

Offering empathy (empathy)

Recognizing, understanding, and sharing another person's feelings and perspective, showing that you understand their situation.

- Therapeutic communication technique

Paraphrasing

Restating a client's words or key ideas in different words to clarify their message and encourage them to communicate more.

- Therapeutic communication technique

Presenting reality

Correcting a client's distorted thoughts or perceptions by providing accurate and factual information about reality. a client who is hallucinating states, "I can't go into that room, there are spiders on the walls," nurse can say, "I see no evidence of spiders on the walls."

- Therapeutic communication technique

Restating

Repeating the client's main idea using different words to encourage them to explain or elaborate further. Client: "The nurses hate me here,". Nurse: "You feel as though the nurses dislike you?"

- Therapeutic communication technique

Nontherapeutic responses

Responses that often block the client's communication of their feelings or ideas

Asking personal questions

Asking questions about a client's personal life that are not relevant to their care or are asked out of curiosity rather than for a therapeutic purpose. "Why have you and Mary never married?"

- Nontherapeutic response

Giving personal opinions (personal opinions)

Sharing your own beliefs or advice can take decision-making away from the client. The nurse should instead help the client explore their options and make their own decisions. "If I were you, I'd put your father in a nursing home"

- Nontherapeutic response

Changing the subject

Switching to a different topic when a client is trying to communicate, which can show lack of empathy and block further communication. "Let's not talk about your insurance problems; it's time for your walk now"

- Nontherapeutic response

Stating generalizations and stereotypes (generalizations and stereotypes)

Making assumptions about clients based on age, background, or other characteristics instead of focusing on the individual client and their specific concerns. "Older adults are always confused."

- Nontherapeutic response

False reassurance

Giving unrealistic statements intended to make the client feel better, such as saying everything will be okay. This can minimize the client's feelings and discourage them from expressing concerns.

- Nontherapeutic response

Showing sympathy (sympathy)

Focusing on the nurse's feelings of pity or sadness rather than helping the client express and cope with their own feelings and situation. "I'm so sorry about your amputation; I can't imagine losing a leg."

- Nontherapeutic response

What/why questions

Asking questions using "what" or "why" can make clients feel accused or judged, causing them to become defensive. Instead, encourage clients to explain their feelings without using these questions.

- Nontherapeutic response

Showing approval or disapproval

Expressing personal approval, disapproval, values, or beliefs about a client's decisions or behaviors. Nurses should remain nonjudgmental and help clients explore their own values, beliefs, and choices.

- Nontherapeutic response

Defensive responses

Becoming defensive or argumentative when a client or family member expresses criticism, anger, or dissatisfaction. Nurses should listen without judgment, avoid defensiveness, and encourage the client to explain their concerns.

- Nontherapeutic response

Passive or aggressive responses

Responding in a way that either avoids conflict or provokes confrontation. Nurses should instead use assertive communication that addresses the issue respectfully and directly. "It's your fault you are feeling ill because you don't take your medication."

- Nontherapeutic response

Arguing

Challenging or disagreeing with a client's perceptions or statements, which can make them feel that their experience is being dismissed or that they are being called dishonest or uninformed. Nurses should provide information or present reality without doing this.

- Nontherapeutic response

Impaired hearing

The following are strategies you should use when communicating with a patient who has ___:

Get the client's attention first, reduce background noise, face them directly, speak clearly without shouting, and give them time to respond. Use simple language, gestures, or their preferred communication method (such as writing or sign language).

Impaired vision

The following are strategies you should use when communicating with a patient who has ___:

Identify yourself when entering the client's space, provide good lighting and low glare, and make information easier to see or hear using large print, labels, magnifiers, or reading aloud. Use the clock method to describe where food or objects are located.

Aphasia

a communication disorder that results from damage to portions of the brain that are responsible for language, impairs the client's expression and understanding of language

-usually occurs suddenly, often following a stroke or head injury

Expressive aphasia

difficulty putting thoughts into words. The client may cognitively know what they want to say but are unable to express their thoughts

- communication disorder that results from damage to portions of the brain that are responsible for language

Receptive aphasia

difficulty in understanding what is being communicated to them. The client may be able to verbalize their thoughts and feelings but do not understand what is spoken to them

- communication disorder that results from damage to portions of the brain that are responsible for language

Global aphasia

Client may be unable to say even a few words or may repeat the same words or phrases over and over again. They may have trouble understanding even simple words and sentences.

- communication disorder resulting from injuries to multiple language-processing areas of the brain, including those known as Wernicke's and Broca's areas

Broca's aphasia

What's the most common type of aphasia?

Broca's aphasia

clients often understand speech and know what they want to say, but frequently speak in short phrases that are produced with great effort. For example, they may intend to say, "I would like to go to the bathroom," but instead the words, "Bathroom, Go," are expressed.

- type of aphasia

Impaired speech

The following are strategies you should use when communicating with a patient who has ___:

Reduce noise and stress, ask simple yes/no questions, and give the client extra time to communicate. Use alternative communication methods like writing, pictures, gestures, or a communication board, and repeat what the client says to confirm accuracy.

Health Insurance Portability and Accountability Act

What does HIPAA stand for?

Health Insurance Portability and Accountability Act (HIPAA)

provides standards for ensuring privacy of client information that are enforceable by law. **CONFIDENTIALITY**

- Nurses must always be aware of where and with whom they share client information.

ISBARR

A common format used by health care members to exchange client information; stands for Introduction, Situation, Background, Assessment, Request/Recommendations, and Repeat back

SBAR

A simplified format used by health care members to exchange client information; situation, background, assessment, recommendations

Introduction

State your name, role, and agency you are calling from.

- step of ISBARR

Situation

Explain who the client is, where they are, why you are calling, and their current status, including recent vital signs.

- step of ISBARR/SBAR

Background

Give important client information such as diagnosis, code status, allergies, and recent lab or test results.

- step of ISBARR/SBAR

Assessment

Report abnormal findings and explain what you think is happening with the client.

- step of ISBARR/SBAR

Recommendation

Tell the provider what you need them to do, such as reassess the client, order a test, or change a medication.

- step of ISBARR/SBAR

Repeat back

Repeat new orders back to the provider to make sure they are correct, then document the communication.

- step of ISBARR

Handoff reports

A transfer and acceptance of client care responsibility achieved through effective communication. A real-time process of passing client specific information from one caregiver to another, or from one team of caregivers to another, for the purpose of ensuring the continuity and safety of the client's care.

Bedside handoff reports

Typically occur in hospitals and include the client, along with the off-going and the oncoming nurses in a face-to-face handoff report conducted at the client's bedside; increase client safety, client and nurse satisfaction, by effectively communicating current, accurate client information in real time.

Transfer reports

Provided by nurses when transferring a client to another unit or to another agency.

Contain similar information as bedside handoff reports but more detailed when the client is being transferred to another agency.

- Checklists are often provided by agencies to ensure accurate, complete information is shared.

Intranet

a private computer network within an institution

Electronic health record (EHR)

A real-time, client-centered, electronic record that makes information available instantly and securely to authorized users.

History and Physical (H&P)

A document found in the EHR completed by the healthcare provider when the client is admitted. It includes the client's reason for admission, health history, allergies, medications, diagnoses, physical findings, and treatment plan.

Provide orders

A section found in the EHR containing the provider's prescriptions and medical orders that the nurse must follow or communicate according to facility policy.

Medication Administration Records (MARs)

Used to record medications given to the client and connect provider medication orders with the pharmacy.

- medicine charting