nurs 1003 midterm

Experiential Learning

learning through doing, conscious use of self

Validation Therapy

therapeutic communication used in later stages of dementia

Catastrophic Reactions

reactions in older people with memory loss that may appear as temper tantrums in response to real or perceived frustration

Sundowning

agitated behavioral symptoms that people with dementia experience later in the day

Patient-centred care model

working with all members of the health care team to achieve maximum health outcomes for patients

Self-concept

the totality of each person’s beliefs about their inner self

Kolb Learning Cycle

concrete experience → reflective observation → abstract conceptualization → active experimentation

Therapeutic communication

a goal directed form of dialogue used as a tool in health care to promote a client’s well-being and positive response to treatment

Communication

interactions between people in which
symbols are used to create, exchange, and interpret
messages about ideas, emotions, and states of mind

Denotation

literal meaning of words

Connotation

personalized meaning of words or phrases

Self-esteem

a person’s personal sense of worth and well-being

Why is self-concept important

• It is a protective factor when coping with illness

• It helps explain behaviour

• It can serve as a source of strength

• It can be a conceptual framework for decision-making

• It shapes expectations

Characteristics of self-concept

• Dynamic

• Holistic

• Unique

Self-clarity

the extent to which a person clearly and confidently knows who they are

Self-efficacy

a person’s beliefs about their ability and capacity to accomplish a task and to deal with the challenges of life

Factors influencing self-concept

• society and cultural norms

• intrapersonal and interpersonal influences

• life experiences

• social media

Maslow’s Hierarchy of Needs

everyone has basic needs but the overall goal is self-actualization

Carl Roger’s Humanistic Theory

when the “actual self” and the “ideal self” are similar, a person is likely to have a positive self-concept

Carl Jung

the “self” as a public persona versus the true nature of a person; introvert versus extrovert

Erik Erikson’s Theory of Psychosocial Development

personality develops through nine stages of psychosocial development, from infancy to adulthood

Nine stages of psychosocial development

during these stages a person experiences a psychosocial crisis which could positively or negatively impact their development; there are specific goals a person needs to achieve to develop and maintain positive identity

Self-awareness

the ability to see yourself clearly and objectively through reflection and introspection

Four aspects of self-concept

• Physical

• cognitive

• emotional

• spiritual

Why we need to develop self awareness

• to discover more about ourselves

• to learn the conscious use of self

• to become more fluent with the use of therapeutic communication

Nurse-client relationship

a planned, time-limited and goal directed connection between a registered nurse and a client for the purpose of meeting a client’s needs

Therapeutic relationship

based on trust, respect, and personal integrity; includes the provision of physical care, emotional support and health education

RN’s must adhere to

• Standards of Practice

• Code of Ethics

• employer policies

Goals of therapeutic relationships

• enhance the clients well-being

• promote recovery and growth

• promote self-care and client independence

Client-centered approach

client’s needs are the focus of the professional relationship

Establishing trust

• convey respect

• show warmth and caring

• actively listening

• use and attending posture

• maintain confidentiality

Professional boundaries

invisible structures imposed by legal, moral, and professional standards of nursing that respect nurse and patient’s rights

Responsibilities of the professional

• defining the length and time of the contact

• maintaining confidentiality

• providing as appropriate setting

Warning signs of over involvement

• extra time and attention to certain clients

• visiting outside of regular work hours

• discounting the actions/care of other staff

Therapeutic use of self

requires the nurse to be authentic and clear about their personal values, feelings and thoughts in response to the client; requires a keen sense of self-awareness

Self-awareness

the ability to see yourself clearly through reflection, and to understand how and why you react in different situations

Empathy

the ability to be sensitive and to communicate your understanding of the patient’s feelings

Presence

to know when to provide help and when to stand back, when to speak frankly and when to withhold comments

Self-disclosure

when the nurse intentionally reveals personal experiences or feelings to a client

Phases of a therapeutic nurse-client relationship

• pre-interaction phase

• orientation phase

• working phase

• termination phase

Pre-interaction phase

• client is not involved

• information about the client is obtained

• preparation for the first meeting

• anticipates potential client issues

Orientation phase

• nurse-client relationship begins

• simple introduction to establish rapport and build trust

• nurse’s nonverbal behavior must support the words used in conversation

• clarify the purpose, roles and process of the interaction

Working phase

• the focus is on mutual clarification of ideas and expectations

• define the problem/challenge/concern

• develop realistic goals

• implement the plan

Termination phase

• the end of the nurse-client relationship

• preparation for this phase must begin in the orientation phase

• time to summarize the major achievements, progress and goals

• establish a plan for continuing support

Patient characteristics

sensory impairment, personality, disability, and psychological barriers

Nurse characteristics

time, organizational values, socio-demographic characteristics

Active listening

a cognitive and emotional process that may be based on the listener’s values, attitudes and feelings; validation and self-awareness is required

Asking questions

is a fundamental component of any nursing assesment

Open-ended questions

• prompt a patient to share more information

• cannot be answered by “yes” or “no”, or one word response

Close-ended questions

• can be answered with “yes” or “no”

• can limit a patients response thought expression

• may take several questions to obtain information

Focused questions

• requires more than a “yes” or “no” response

• limit the topic to be addressed

• can be useful in emergency situations

Clarifying questions

• a type of open ended question used by the nurse to ensure they fully understand what the patient means'

• enhance an understanding of the patient’s frame of reference

• when asked, the patient has the opportunity to confirm if the nurse does or does not understand them

Active listening response

• therapeutic responses which allow you to partner with patients and carry out the nursing process

• essential component of patient-centered communication

Clarification

the nurse seeks more information or elaboration on a point

Restatement

allows the patient to elaborate on their concerns and the nurse to obtain more information

Paraphrasing

takes the patient’s original message and transforms it into your own words without losing the original meaning

Reflection

reflects and mirrors what the nurse believes the client’s feelings to be underneath the words

Summarization

pulls several ideas and feelings together; should be completed before the end of the conversation

Broad openings

an open-ended question that allows patients to direct the flow of conversation and decide what to talk about

False reassurance

can lead to sever and significant damage to the relationship, especially if the desired outcome is not achieved

Caring

an intentional action characterized by commitment and a sufficient level of knowledge and skill to allow you to support the basic integrity of your client

The ability to care is influenced by:

• communication skills

• self-awareness about feelings and attitudes

• previous thoughts, attitudes, and involvement

The six C’s of caring

• compassion

• competence

• confidence

• conscience

• commitment

• comportment

Steps in the caring process

• C - connect

• A - appreciate

• R - responde

• E - empower

Empowerment

the process of becoming more stronger and more confident, especially in controlling one’s life and claiming one’s rights

Respect and trust

accepting people for who and ‘where’ they are; makes individuals feel important and cared for

Barriers to relationships result in:

• poor communication

• reduced quality of care

• less favourable health outcomes

• lower patient and nurse satisfaction

Nurse-related barriers

• emotions

• conflicting values

• lack of a strong sense of self

• lack of value placed on caring

• conflicting professional commitments

Patient-related barriers

• anxiety

• stereotyping

• personal space

Culturally competent care

a willingness to try to understand and respond to a patient’s values and beliefs

Cultural competence

• respect

• valuing differences

• equality

• inclusivity

• commitment

How do we overcome barriers

recognize that the barrier exists

Communication theory

the study of how information is transmitted between senders and receivers, focusing on the adaptive significance of communication and the role of signals in conveying information

Key elements in communication theory

• sender

• receiver

• message

• channel

• feedback

• context

Referent

a variable that motivates a person to communicate

Sender

the individual who initiates the interpersonal communication

Message

verbal and non-verbal cues

Channel

the medium used to convey the message to another

Receiver

the individual who receives the message

Feedback

the verbal and non-verbal response the receiver returns to the sender

Models of communication theory

• linear

• interactional

• transactional

Transactional model

• most dynamic of the communication models

• communication is a cooperative action

• there must be some overlap of experience to build meaning

• messages are interdependent

Freud’s theory of personality

situations and feelings have a positive effect on reducing tension and resolving maladaptive behaviour

Transference

projection of irrational beliefs and attitudes from the past onto people in the present

Counter-transference

nurse’s attitudes and beliefs that develop about a client

Ego defence mechanisms

self talk, denial, rationalization

The nursing metaparadigm

• person

• environment

• health

• nursing

Florence Nightingale

founder of modern nursing and environmental theory; defined nursing as “ the act of utilizing the environment of the patient to assist him in his recovery”

Hildegard Peplau

theory of interpersonal relations; defined nursing as “ an interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help”

Virginia Henderson

need theory

Dorothy Johnson

Behaviour system model

Martha Rogers

unitary human beings

Dorothea Orem

self-care theory

Jean Watson

theory of human caring, “nursing is concerned with promoting health, preventing illness, caring for the sick, and restoring health”

Communication impairment

an impairment in the ability to send, receive, process, and comprehend concepts or verbal, non-verbal, and graphic symbol systems

Types of communication impairments

• hearing loss

• vision loss

• impaired verbal communication

• impaired cognitive processing

• mental disorders

• environmental deprivation related to illness

Potential impacts of ineffective communication

• increased risk for adverse events

• less satisfaction with healthcare

• feeling excluded from care and decision-making

• loss of independence

• being treated as intellectually impaired

Signs of hearing loss

• trouble hearing clearly

• group conversations are difficult to follow

• sounds are muffled

• avoiding social interactions

Untreated hearing loss can result in:

• Less alertness to environment

• less adaptability to learning new tasks

• reduced psychological health

• increased anxiety

• impaired memory

• depression

• danger to personal safety

Communicating with development delays

adapt communication to an understandable level