301 Week 1 Notes: Nursing Communication and Medication Safety

Communication

• Definition: A lifelong learning process essential for establishing nurse–patient relationships and delivering patient-centered care.
  • Helps to reduce the risk of errors and maintain effective relationships.
  • Therapeutic communication promotes personal growth and helps patients reach health-related goals.
• Communication and nursing practice: communication is central to delivering holistic nursing care and ensuring patient safety and satisfaction.

Communication and Interpersonal Relationships

• Nurses demonstrate caring by being with, doing for, and enabling patient well-being.
  • Becoming sensitive and supportive to self and others.
  • Being present and encouraging the expression of positive and negative feelings.
  • Developing caring relationships.
  • Instilling faith and hope.
  • Promoting interpersonal teaching and learning.
  • Providing for nursing care needs in a supportive way.
  • Respecting and allowing for spiritual expression.

Developing Communication Skills

• Nurses who develop critical thinking skills make the best communicators.
• They form therapeutic relationships to gather relevant and comprehensive information about their patients.
• They draw on theoretical knowledge about communication and integrate this with knowledge from personal clinical experience.
• They interpret messages received from others to:
  • obtain new information,
  • correct misinformation,
  • promote patient understanding,
  • plan patient-centered care.

Levels of Communication

• Intrapersonal
• Interpersonal
• Small group
• Public
• Electronic

Forms of Communication

• Verbal communication:
  • Vocabulary
  • Denotative and connotative meaning
  • Pacing
  • Intonation
  • Clarity and brevity
  • Timing and relevance
• Nonverbal communication:
  • Personal appearance
  • Posture and gait
  • Facial expressions
  • Eye contact
  • Gestures
  • Sounds
  • Territoriality and personal space

Elements of the Communication Process

• Interpersonal variables
• Referent
• Channel
• Message
• Sender
• Receiver
• Feedback
• Environment

Circular Transactional Model

• Components:
  • Referent
  • Sender and receiver
  • Message
  • Channels
  • Feedback
  • Interpersonal variables
  • Environment

Forms of Communication (Summary)

• Verbal and nonverbal forms interact to convey meaning in clinical settings.

MEDICATION SAFETY

• Medication safety is a critical component of nursing practice.
• Medication safety content includes definitions, rights, routes, equipment, orders, abbreviations, ordering components, time formats, labeling, documentation, and regulatory considerations.

Medication Error

• Definition (NCCMERP): A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.
  • Events may relate to professional practice, health care products, procedures, and systems, including prescribing, order communication, product labeling, packaging, and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use.

The Rights of Medication Administration

• Right client
• Right medication
• Right dose
• Right route
• Right time
• Right documentation
• Right indication
• Right to know
• Right to refuse
• Right response

ROUTES OF ADMINISTRATION

• Oral (PO): by mouth; may be tablet, capsule, caplet, or liquid solution.
• Sublingual (SL): placed under the tongue for absorption.
• Buccal: placed in the mouth between the gums and inner lining of the cheek.
• Parenteral: route other than mouth or gastrointestinal tract (injections).
• Insertion: medication placed into a body cavity.
• Instillation: introduced in a liquid form into a body cavity.
• Inhalation: inhaled through the mouth or nose into the respiratory tract.
• Intranasal: instilled into the nostril.
• Topical: applied to the external surface of the skin.
• Percutaneous: applied to skin or mucous membrane for absorption.
• Transdermal: patch or disk applied to the skin.

EQUIPMENT – ORAL MEDICATIONS

• Medicine cup: for oral administration of liquids.
• Soufflé cup: for solid medications like tablets or capsules.
• Calibrated dropper: for small amounts of medication; can be used for eye, nose, and ear medications.
• Nipple: can be used for oral medications for infants.
• Oral syringe: to administer liquid medications; no needle attached.
• Calibrated spoon: for pediatric oral medications.
• Parenteral syringe: used for intramuscular (IM), subcutaneous (subcut), intradermal (ID), and intravenous (IV) medications.

EQUIPMENT – SYRINGES

• A) 3-mL syringe
• B) Tuberculin syringe
• C) Insulin syringe
• D) Lo-Dose Insulin syringe

TYPES OF ORDERS

• Standing: routine, set number of doses.
• PRN: as needed.
• Stat order: given immediately.
• Single order: one-time only.

ABBREVIATIONS (Table 10.2 reference)

• Abbreviation Symbol Meaning
• c, C Cup
• g Gram
• gtt Drop
• kg Kilogram
• L Liter
• mcg Microgram
• mEq Milliequivalent
• mg milligram
• mL milliliter
• oz ounce
• pt pint
• qt quart
• T, tbs tablespoon
• t, tsp teaspoon

PARTS OF AN ORDER

1. Client's full name
2. Date and time the order was written
3. Name of the medication
4. Dosage of the medication
5. Route of administration
6. Frequency of administration
7. Signature of the person writing the order

READING AN ORDER (EXAMPLE)

• Rubraca = trade name; Rucaparib = generic name (chemical name).
• Usual dosage: See prescribing information for dosage information.
• Storage: Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F) [see USP Controlled Room Temperature].
• Distributed by: Clovis Oncology, Inc., Boulder, CO 80301; Made in Switzerland.
• Each tablet contains 430 mg rucaparib camsylate equivalent to 250 mg rucaparib.
• NDC: 69660-202-91; Rx only; Keep out of reach of children.

DOCUMENTATION AND SCHEDULING ABREVIATIONS

• Abbreviation Meaning
• a.c. Before meals
• b.i.d Twice a day
• p.c. After meals
• p.r.n. As needed
• q Every
• q.h. Every hour
• q2h, q3h, q4h Every 2, 3, 4 hours
• q6h, q8h, q12h, q24h Every 6, 8, 12, 24 hours
• q.i.d. Four times a day
• stat Immediate, at once
• t.i.d Three times a day

MILITARY TIME

• Hour 12:01am = 0001
• 1pm = 1300
• Date format example: August 25th, 2025 = 8/25/2025

READING LABELS

• GTIN, S/N, EXP, LOT
• Active Ingredient
• Made in Germany; Mfg. for: Janssen Pharmaceuticals, Inc.; Titusville, NJ; Licensed from: Bayer HealthCare AG; 2.5 mg rivaroxaban per tablet; 60 tablets; Rx only.
• Usual Dosage: See package insert for full prescribing information.
• Storage: Store at 25°C (77°F) or room temperature; excursions permitted to 15–30°C (59–86°F).
• NDC: 50458-577-60; Brand: Xarelto®.

CONTROLLED SUBSTANCES (EXAMPLE CONTENT)

• Dropper fill guidance and storage:
  • Fill dropper to the level of the prescribed dose; for ease, add to approximately 30 mL (1 fl oz) or more of juice or other liquid; may also be added to applesauce, pudding, or other semi-solid foods; mix should be used immediately and not stored for future use.
  • Return dropper to bottle after use.
  • Protect from light.
  • Discard opened bottle after 90 days.
  • Dispense only in this bottle and only with the calibrated dropper provided.
• Example product: Lorazepam Oral Concentrate, USP, 2 mg/mL; store refrigerated at 2° to 8°C (36° to 46°F); Rx only.
• Label: NDC 65162-687-84; 30 mL; 0.85" x 0.57" unvarnished area for Lot & Exp.

CONCLUDING NOTES

• The material covered emphasizes safe communication, patient-centered care, and foundational pharmacology practices including safe medication administration, proper documentation, and understanding of common nursing workflows.
• Practical implications include reducing medical errors, ensuring patient autonomy and rights, and promoting ethical practice through accurate and transparent documentation and labeling.