NURS 307 lecture 1 9/8

holistic health

• consideration of the whole person

  • mind

  • body

  • spirit

• interdependent & fxning as a whole within envrionment

nursing process

• taking care of pts!

  • assessment

  • analysis/diagnosis

  • planning

  • implementation

  • evaluation

clinical judgement

1. the process where the nurse decides data to be collected

2. makes an interpretation

3. arrives at a diagnosis

4. identifies appropriate actions

   • involves problem solving, decision making, critical thinking

assessment

• a collection of data abt the person’s health

  • the info itself!

purpose of assessment

• to make a judgement/diagnosis

  • data has to be accurate & complete

  • watch for cues! (pieces of info)

    • sign, symptom, lab/imaging data

database elements

• pt record

• lab studies

• subjective data

• objective data

subjective data

• what pt tells you!

  • history taking

objective data

• physical exam findings

• number data

• observations

four types of databases

• depends on clincal situation!

  • complete

  • focused

  • follow-up

  • emergency

complete database

• total health!

• describes current + past health

• provides baseline for future changes

• provides info leading to nursing/medical diagnoses

complete database components

• complete health history

  • subjective!

• full physical exam

  • objective!

focused database

• aka problem centered

• ONE problem, cure, or body system

  • ex: cough, rash

follow-up database

• status of previously identified problem

• evaluated at regular intervals

  • ex: diabetes

emergency database

• urgent, rapid, crucial!

• info coming concurrently w/ lifesaving measures

  • ex: opioid overdose

culture assessment

• integral part of full database

• very complex phenomenon

culture components

• attitudes

• beliefs

• self-definitions

• norms

• roles

• vaules

cultural characteristics

• learned

• shaped

• adapted

• dynamic

learned characteristics

• from birth via aquisition & socialization

shared characteristics

• learned by all members of same cultural group

adapted characteristics

• from specific conditions related to environmental/technical factors & availability to resources

dynamic characteristics

• ever changing!

ethnicity

• social group w/ shared traits

  • common

    • geographic origin

    • migratory status

    • religion

    • food

    • language

    • values

    • traditions/symbols

race

• means of self-identification

• group of ppl w/ similar physical characteristics

religion

• organized system of beliefs concerning

  • cause

  • nature

  • purpose of universe

  • attendance of services

spirituality

• focuses on smth larger than oneself

• belief in transcendance

culturally sensitive

• caregivers aware of different cultures in healthcare setting

culturally appropriate

• caregivers apply knowledge of culture to provide best pt care possible

cultural sensibility

• what’s important!

• caregivers deliberately & proactively examining pts cultural situations

culturally competent

• unrealistic

• caregivers understanding ALL aspects of pt’s cultural being

  • includes this info in pt care

cultural domains for pt care

• heritage

• health practices

• communication

• family roles

• social orientation

• nutrition

• pregnancy

• birth

• childrearing

• spirituality

• religion

• death

• role of providers

pain

• universally recognized phenomenon experienced by all

culture influence on pain

• expectaions

• manifestations

• expression

spiritual assessment FICA

• Faith - religious?

• Importance/influence - how important is it to you?

• Community - are you part of religous communities?

• Address/Action - what can i do to help?

  • open-ended questions!

the interview

• a contract btwn you and pt

• establish a rapport

• build trust

• collect complete & accurate data abt health state

  • w/ description & chronology of symptoms

• subjective & objective data

  • what they tell u & what YOU observe

rapport

• close & harmonious relationship where ppl/groups understand e/os feelings + ideas and communicate well

communication

• exchanging info so everyone understands e/o

  1. sending

     • verbal & nonverbal

  2. recieving

  3. verifying

internal communication factors

• liking others

• empathy

• ability to listen

• self awareness

liking others

• warm

• caring

• respectful

• unconditional acceptance

empathy

• viewing world from pt’s POV while staying you

• how do/would they feel?

  • names a feeling & allows expression

  • allows person to feek accepted + strengthens rapport

  • useful when clients haven’t identified feelings or aren’t ready to discuss

ability to listen

• active

• focused attention

• asking Qs

• verifying info

• aware of nonverbal cues

self-awareness

• recognizing biases

  • knowing what grinds your gears

external communication factors

• ensuring privacy

• refusing interruptions

• good physical envrionment

• FOCUSING on person

physical envrionment factors

• temp

• lighting

• sound

• distractions/clutter

• distance of 4-5ft

• equal seating

  • 90 degress & eyelevel

• dress professionally!

indroducing the interview

• address by SURNAME

• shake hands if appropriate

• introduce self & state role & reason for this

• think of cultural sensitivity !

communication techniques

• data gathering phase!

  • open ended Qs

  • close ended Qs

  • direct Qs

  • assisting narrative w/ verbal responses - guide!

• reacting to pt’s words (lead by them)

• expressing thoughts and feelings (lead by you)

close ended Qs

• any Qs not yes/no

open ended Qs

• yes/no Qs

9 types of verbal responses

• assist the narrative!

  • facilitation, general leads, minimal cues

  • silence

  • reflection

  • empathy

  • clarification

  • confrontation

  • interpretation

  • explanation

  • summary

facilitation, general leads, minimal cues

• encourages clients to say more

• shows you’re interested

silence

• communication that pt has time to think

• can be uncomfortable at first, but interruption can make pt lose train of thought

• provides chance to observe client + note nonverbal cues

reflection

• echoes pts words by repeating what they just said

• can help express feelings behind words

• mirroring can help person elaborate on problems

clarification

• useful when word choice is ambiguous/confusing

• summarzie pt’s words, simplify, & ensure you’re on right track

confrontation

• clarifies inconsistent info

• focusing pt attention on observed behavior, action, feeling

interpretation

• links events, makes associations, implies cause

• not based on direct observations but rather on inference/conclusion

• may be inforrect, but helps prompt convo further

explanation

• informs pt

• shares factual & objective info

summary

• condenses facts, validates what was discussed

• signals termination of interview is imminent

• both client + examiner should be active participants

10 traps of intervewing

1. providing false assurance/reassurance

2. giving unwanted advice

3. using authority

4. using avoidance language

5. engaging in distancing

6. using professional jargon

7. using leading/biased Qs

8. talking too much

9. interrupting

10. using “why” questions - seems accusatory/offputting

effective communication

• occurs btwn 2+ ppl on interdisciplinary healthcare team

  • hospitals are all abt teamwork!

• creates envrionment of mutual respect & enhances collaboartion

• maintain open lines!

  • timely updates in organized manner

ineffective communication

• linked to poor outcomes

• delays treatment

• causes med errors, misdiagnosis

• pt injury & death possible

nonverbal communication

• listening with EYES

• match up w/ verbal communication

  • professional appearance/image

  • posture

  • gestures

  • facial expressions

  • eye contact w/ glances away

  • voice

  • touch

voice

• composes of

  • tone

  • intensity

  • rate of speech

  • pauses

touch

• boundaries influenced by

  • age

  • gender

  • cultural background

  • past experience

  • current setting

• don’t use unless you know person well

special communication circumstances

• caregiver/parent giving info

• deaf

• blind

• crying

• angry

• violent

• requires interpreter

• limited health literacy

• cultural/spiritual considerations

• dont assume everyone can read/write!

closing interview

• use a closing statement

• summarize what you learned & what you both agree health state to be

• positive health aspect - always say smth positive!

• problems

• plans

• education

• explanation of physical exam