Fundamentals Unit 3- Therapeutic Communication, Client Education, Health Promotion & Disease Prevention

What is Evidence Based Practice?

the use of evidence to inform nursing practice and positively impact client outcomes; a problem solving approach to client care that uses the most accurate scientific evidence partnered with clinical expertise and client values

What does evidence-based practice involve?

reviewing current credible scientific literature and evaluating those findings to form evidence

What are the benefits of EBP?

Improved client outcomes, lower costs, and delivery of high-quality health care

What is the Spirit of Inquiry in Nursing?

the desire to clarify complex issues through research and trends that influence client outcomes

According to the American Nurses Association, what does EBP involve?

providing holistic, quality care based on the most up to date research and knowledge rather than traditional methods, advise from colleagues or personal beliefs

Examples of EBP in nursing

Oxygen use in hypoxia, Antibiotic stewardship, Alarm fatigue protocols, ABCDE bundle in ICU, Fall prevention guidelines, Pain management.

How can the nurse ensure that EBC is provided?

staying up to date on EBP and interventions, when delegating explain why it is important, follow clinical practice guidelines, utilize critical pathways

What are the 6 steps of EBP?

Identifying a Problem, Searching for Credible sources of Evidence, Evaluating the Findings, Implementing recommendations, Reviewing their Effectiveness, Disseminating the Results

What is PICOT?

population, intervention, comparison, outcome, time

What is Scientific Method?

a systematic research process whereby new knowledge is applied to nursing practice and outcomes are reevaluated

What is Qualitative research?

uses numerical data to evaluate outcomes; consists of numbers, counts or measures that are collected and analyzed using statistics

What is Quantitative research?

seeks to increase understanding, describe, explore, or illuminate value-laden issues in healthcare

What are Clinical Practice Guidelines?

evidence-based recommendations to be used as guidelines in the medical management of disease processes and in preventative care; methodical statements that focus on a specific plan of care for specific client population; optimize client outcomes or improve cost effectiveness

What is Mixed Methods research?

Combines qualitative and quantitative studies, which explore experiences, and qualitative designs which enumerate findings

What is Translation research?

focuses on determining the most effective methods to implement EBP across diverse client populations and settings

What is Research and Scientific Literature?

peer reviewed, published scientific research articles examined and prior to publication by a panel of experts with similar licensure education

What is a scholarly database?

an efficient portal that enables researchers to obtain access to a wide variety of research articles and academic information

Examples of scholarly databases to use?

Agency for Healthcare Research and Quality, Cochrane Database of Systemic Review, Cumulative Index of Nursing and Allied Health Literature, Google Scholar, and websites ending in .gov, .edu, and some .org (need to research the organization)

What are Critical Pathways?

Clinical tools used within a health care organization that use evidence based guidelines to manage the delivery of client care; treatment routines based on a specific circumstance

Critical pathways have been shown to ________

enhance collaboration, reduce the cost of care, and improve client outcomes

What are standards of care?

they reflect the interventions that are typically implemented when caring for a client with a specific disorder

What is communication?

the process by which information is transferred from one person to another; through verbal connection, body language, emotions and the use of technology or other equipment

What is Intrapersonal Communication?

communication within one's self (self talk); the internal discussion when thinking but not outwardly verbalizing thoughts; helps nurses think critically before verbalizing

What is Interpersonal Communication?

communication between two people; requires an exchange of information with another individual; however the receiver can perceive a message differently than the sender intended

What is Public Communication?

communication to, within, or between large groups of people; this communication allows nurses to teach, give community presentations, or write about nursing or health care topics and issues

What is Small Group Communication?

communication within a group of people often working toward a mutual goal (in committees, research teams and support groups)

Referent

the incentive or motivation for communication between two people

Sender

the person who initiates and transmits the message

Receiver

the person to whom the sender aims the message and who interprets the sender's message

What is a message?

the verbal and nonverbal information the sender expresses and intends for the receiver

What is a channel?

the method of transmitting and receiving a message (sight, hearing, touch, facial expression, body language)

What is the environment of communication?

the emotional and physical climate in which the communication takes place

What is Feedback?

can be verbal, nonverbal, positive and negative; message the receiver returns to the sender that indicates the receipt of the message

What are interpersonal variables?

factors that influence communication between the sender and the receiver

What is Denotative?

The dictionary definition of a word

What is Connotative?

someone's implied meaning of something

What is Therapeutic Communication?

the purposeful use of communication to build and maintain helping relationships with clients, families and significant others

What are the characteristics of therapeutic communication?

client centered communication, not social or reciprocal; purposeful, planned and goal directed

What are the Therapeutic Communication Techniques?

open ended, restating/ summarizing/ paraphrasing, reflection

What are the essential components of Therapeutic Comminication?

time, attentive behavior, active listening, caring attitude, honesty, trust, empathy, nonjudgemental attitude

What is Passive Communication?

avoiding conflict and agreeing with someone rather than standing up for themselves

What is Assertive Communication?

honest and clear communication that does not violate the rights of others, advocates for themself

What is Aggressive Communication?

communication that is verbally and sometimes physically abusive, usus you statements, controlling and interruptive

What is Passive Aggressive communication?

communication that appears passive on the surface but often is demonstrating anger in a subtle, indirect or secretive way; feels powerless, resentful and sarcastic

What is Motivational Interviewing?

a form of therapeutic communication that allows the nurse and client to develop plans to promote the client using several techniques

What is the mnemonic for Motivational interviewing?

OARS; Open ended questions, Affirmations, Reflective listening, Summarizing

What are examples of Communication Barriers?

language and cultural differences, physical and physiological factors, developmental disorders, environmental factors

Assessment/ Data collection step of Communication

determine verbal and non verbal communication needs for client centered care, consider physical status and the developmental level and alter communication accordingly

Planning step of Communication

identify mutually agreed upon outcomes, set priorities according to the client's needs, minimizing distractions, providing privacy, plan adequate time for interventions, collaborate with other health care professionals when necessary

Implementation step of Communication

establish a trusting nurse-client relationship, provide empathetic responses and explanations by using observations, giving information, conveying hope and using humor, demonstrate an empathetic presence by appearing relaxed, comfortable, and facing the client

Effective Skills and Techninques for Therapeutic Communication

allow client time for meaningful reflection, present reality, active listening, asking questions, open-ended questions

Clarifying techniques of Therapeutic Communication

restate using the client's exact words, reflect focus back to the client for them to examine their feelings, parasphrase and restate the clients feeling so they can confirm what they have communication, explore and allow the nurse to gather more information about important topics the client mentioned

Effective skills for Therapeutic Communication

offering broad opening statements, showing acceptance and recognition, focusing, giving information, summarizing, offering self/ being available, touch, sharing feelings

Ineffective Skills and Techniques of Communication

asking irrelevant personal questions, offering personal opinions, stereotyping, being defensive, arguing, changing the topic

What is Incivility?

rude dialogue or actions (sarcasm, eye rolling)

What is Lateral Violence?

abusive words or actions of peers (gossiping, exclusionn of information, threats of harm, acutal harm)

What is Client Education/ Teaching?

an ongoing, goal-driven and interactive process that involves purposeful actions to help individuals aquire knowledge, modify attitudes and behavior, and learn new skills

What is the purpose of Client education?

promotes the building of skills and assists clients in being accountable for their self care; provides clients with knowledge needed to make healthy lifestyle changes such as weight loss and better sleeping habits

What are the goals of Client Education?

health promotion, restoration of healthm and adaption to permanent illness or injury

What is the Cognitive Domains of Learning?

the thinking domain; thinking through information and be able to comprehend it, knowledge, comprehension, application, analysis, synthesis and evaluation

What is the Affective Domain of Learning?

the feeling domain; involves the client's feelings regarding values, attitudes, emotions and beliefs

What is the Psychomotor Domains of Learning?

the doing domain based on action; the physical or mental activities required to learn skills; guided response, mechanism, complet, adaptation

What Cognitive behaviors does Cognitive Learning involve?

remembering, understanding, applying, analyzing, creating, evaluating

What are the Characteristics of Affective/Affectionate learning?

hearing the instructor's words, responding verbally and nonverbally, valuing the content or believing that it is worth learning, creating a method for identifying values and resolving differences, employing values consistently in decision-making

What does Psychomotor learning rely on?

perception, readiness to learn, increased confidence to allow for more complex learning, adaptation, origination

What is Relevance?

the client's understanding of why they should be learning the information being provided of them

What is Motivation

the client's ability to engage in the learning process by deciding when, where, why and how they will learn

What are the benefits of teaching in small groups?

often increases learning and learner satisfaction, nurses can teach more than one client or family, use several types of learning strategies at once, learners can learn from each other, may not work for all clients

Developmental and emotional status for Infants/ Toddlers for education?

teaching is primarily directed toward the parents, can involve the child by using pictures, dolls and puppets, completed in brief sessions near the time of the event due to limited attention span and time perception

Developmental and emotional status for Preschooler for education?

parents continue to provide support to children aged 3 to 6 and should be included in the teaching process by use of play and sensory experiences, the have a vivid imagination and it is importan to let them express their fears and help them cope with them openly

Developmental and emotional status for School-age children education?

capable of logical reasoning, games, roleplay, showing iten and objects, reading books (ages 6-12)

Developmental and emotional status for Adolescents education?

capable of abstract reasoning, nurse may include parents or peers in education, but the adolescent should be the major focus due to their increasing independence, take form of guidence rather than lecturing (preteen/ teenager)

Developmental and emotional status for Older Adults education?

decline in sensory with advancing age is normal, client may process new information more slowly, reduce distractions, speaking in a low tone, allow more time for instruction, present information in smaller segments

What is cultural diversity?

demonstrated by clients from varying cultures who have diverse languages, beliefs, customs, values adn ways of communication

What are cultural beliefs?

they impact how a client may view health or illness, how a condition can be treated and who should be involved in the treatment process; important for nurse to assess personal beliefs, customs and values of client

Assessment and Data Collection of Effective Teaching Plan?

assess learning needs, evaluate environment, identify learning style, identify areas of concern/ literacy levels/ pain/ distractions, available resources, developmental levels, determine physical and cognitive ability, determine motivation and readiness to learn, consider cultural and personal values, identify client's ability to make health decisions by determining their basic understanding of health

Planning step of Effective Teaching Plan?

identify mutually agreeable outcomes, prioritize learning with clients' needs in mind, use methods that emphasize learning style, age appropriate learning styles, speak and provide print materials at 6th-8th grade reading level, avoid medical terminology, speak and write in second person, avoid all capital letters, speak clearly/ no confusion, provide electronic resources, use reliable internet sources to access information, organize learning activities to move from simple to more complex tasks and known to unknown concepts, active participation, schedule teaching at optimal times for learning

What are SMART goals?

Specific, Measurable, Attainable, Realistic/ Relevant, Timely

Implementation step of Effective Teaching Plan?

create environment that promotes learning, use therapeutic communication/ develop trust and promote sharing of concerns, consider client's values, help client understand why the information is relevant or important, review previous knowledge and use this information to relate context, communicate important information and repeat as needed, explain therapeutic regimen or procedure, present steps that build toward more complex tasks, demonstrate psychomotor skills, allow time for return demonstrations, positive reinforcements

Evaluation step for Effective Teaching Plan?

ask clients to explain information in their own words, observe return demonstrations, use written tools to measure accuracy, evaluate client's progress without judgement, encourage and support, ask clients to evaluate their own progress, observe nonverbal communication, reevaluate learning, revise care plan accordingly, teaching sessions might need to be repeated

Factors that promote learning?

perceived benefit, enhanced health literacy, cognitive and physical ability, ongoing client participation, age and educational level appropriate methods, nonjudgmental support, quiet and low stimulus environment, and repetition

Factord that Hinder Learning

fear, anxiety, depression, lack of motivation, environmental distractions, psychomotor deficits, physical discomfort, timing, language, culture, mental disabilities

What is Client Health Literacy?

the clients ability to obtain, read, and understand basic health information

What do the levels of prevention do?

address health related activities that are primary, secondary, tertiary

What is Disease Prevention?

encompasses measures taken to limit exposure or effects of illness or disease; activities aimed at preventing specific disorders

What is Health Promotion?

consists of actions taken by nurses, health care workers and others to empower clients and enhance people's influence over improvement of their health

What are Health Outcomes?

result of health promotion and disease prevention measures

What is the healthy people 2030?

provides a list of national objectives to promote health and prevent disease among the national population; updated every 10 years and involve collaborative effort for implementation by government, voluntary and professional organizations, businesses and individuals

What is the purpose of Healthy People 2030?

improve health priorities, improve awareness and understanding of the progress involving health, disease and disability, apply measurable health goals, apply best practice to strengthen policies and improve practice, identify the need for research, evaluation and data collection of health disparities

What does Health Communication entail?

requires verbal and written approaches to inspire and make healthier choices, promotes positive attitude and behavior, needs to be evidence based, culturally sensitive, understandable, easily accessed, and delivered through a variety of media

What are Public Health Policies?

they influence the health of a nation through health promotion and disease prevention programs

What are Public Health Policies influenced by?

Institutions, interests, and ideas

What is Nurse Self Care?

practices that nurses do to maintain their emotional well-being and prevent burnout, moral distress or lack of compassion, activities to promote one's mental health and overall well-being

What is Burnout?

a progressive loss of idealism, energy or purpose experienced by people in the helping profession as a result of the conditions of their work

What is Routine Physical Examination?

generally every 1-3 years for females and every 5 years for males ages 20-40, more often after age 40

Tuberculosis screenin health promotion?

screening for all health care personnel upon hire, higher risks include weak immune system and drug use

When are blood pressure screenings done?

regularly at each health care visit and at home

When should body mass index be checked?

at each routine health care visit

When should blood cholesterol be checked?

Starting at age 20, a minimum of every 5 years

When should blood glucose be checked?

starting at age 45, a minimum of every 3 years