NURS 110 WEEK 4 SLIDES

Page 1

  • Week 4 focuses on Communication, Collaboration, Teamwork, and Documentation in nursing practice.
  • It emphasizes understanding fundamentals of effective communication for first-year nursing students.
  • Topics covered include basic models, therapeutic techniques, impact on patient outcomes, collaboration, teamwork, documentation practices, and delegation principles.
  • The goal is to provide clear definitions and practical applications to develop these essential skills.

Page 2

  • Definition of Communication: the process of sending and receiving information between individuals or groups.
  • Importance in Nursing: effective communication forms the foundation of quality patient care, ensuring accurate information transfer among healthcare providers, patients, and families.
  • Patient Outcomes: clear communication directly impacts patient safety, satisfaction, and health outcomes by reducing errors and improving care coordination.

Page 3

  • Shannon-Weaver Model: Linear model with sender, encoder, channel, decoder, receiver, and noise. The sender initiates the message, transmitted through a channel, potentially affected by noise, reaching the receiver.
  • Wilbur Schramm Model: Modified Shannon-Weaver model with feedback; communication is an engaged process where sender and receiver exchange messages and receive responses (positive or negative).
  • Theodore Newcomb\u2019s ABX Model: Explores communication from a social standpoint with sender, receiver, and topic; examines the role of communication in society and social relationships.
  • David K. Berlo\u2019s S-M-C-R Model: Sender-Message-Channel-Receiver; elements can affect messages, aiding or hindering communication through skills, attitude, culture, and education.

Page 4

  • Forms of Communication:
    • Verbal Communication: Oral communication through spoken words, tone, and voice inflection; includes face-to-face, phone, and video.
    • Non-Verbal Communication: Physical gestures and body language conveying meaning without words (facial expressions, posture, eye contact, hand movements).
    • Written Communication: Information conveyed through written words (handwritten, typed, email, online posts); includes patient charts and care plans.
    • Visual Communication: Use of images, graphics, videos, and symbols to convey information; visual aids enhance understanding of complex concepts.

Page 5

  • Communication Styles in Nursing:
    • Assertive: Displays confidence and self- assurance while respecting others\u2019 rights; expresses needs and opinions without aggression.
    • Aggressive: Hostile or forceful; may disregard others\u2019 feelings and harm therapeutic relationships.
    • Passive: Does not act or openly express discomfort; avoids conflict but may incur personal cost.
    • Passive-Aggressive: Indirectly expresses unhappiness (sarcasm or subtle resistance); undermines trust.
    • Collaborative: Actively engages and shares information; promotes teamwork and comprehensive patient care.
    • Empathetic: Demonstrates understanding of others\u2019 feelings; essential for therapeutic relationships.

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  • Factors Influencing Communication:
    • Cultural Differences: Language, religion, orientation, age, gender.
    • Emotional State: Fatigue, anxiety, fear, frustration, anger.
    • Patient\u2019s Health Condition: Cognitive, intellectual, developmental deficits.
    • Environmental Factors: Noise, temperature, lighting, privacy.
    • Time Constraints and Staffing: Scheduling pressures, workloads.
  • Impact: Each factor can significantly affect nurse-patient communication; awareness helps adapt approaches and overcome barriers.

Page 7

  • Building Therapeutic Relationships:
    • Trust: Consistency, honesty, reliability in all interactions.
    • Respect: Acknowledging patient autonomy, dignity, and values.
    • Empathy: Understanding and sharing patient feelings without judgment.
    • Genuineness: Authentic and sincere interactions.
    • Confidentiality: Protecting patient information and maintaining privacy; ethical and legal compliance.
    • Professional Boundaries: Establishing appropriate limits to protect patient and nurse while ensuring effective care.

Page 8

  • Therapeutic vs Nontherapeutic Communication:
    • Therapeutic Communication: Use of listening, empathy, and professional relationship-building to provide holistic, patient-centered care.
    • Characteristics: active listening, empathy, open-ended questions, clarification, respectful attitude, attentive body language.
    • Benefits: enhances patient trust and cooperation; improves assessment accuracy; promotes autonomy and dignity.
    • Nontherapeutic Communication: Techniques that hinder communication, causing misunderstandings and reduced quality of care.
    • Examples: interrupting, judging or moralizing, false reassurance, offering personal opinions, changing subjects, being dismissive.
    • Consequences: barriers to effective care, diminished patient trust, potential incomplete assessments.

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  • Characteristics of Therapeutic Communication:
    • Active Listening: Focusing intently on understanding the speaker\u2019s message.
    • Open-ended Questions: Require more than yes/no answers.
    • Clarification: Restating, paraphrasing, and summarizing.
    • Respectful Approach: Non-judgmental attitude and acceptance.
  • Summary: Therapeutic communication is essential for rapport, gathering information, and individualized care plans; practice and conscious application are required in every patient interaction.

Page 10

  • Communication Barriers in Healthcare:
    • Physical Barriers: Noise, distance, poor lighting that hinder clear communication.
    • Emotional Barriers: Fear, anger, anxiety, mistrust, pride, apathy, past traumas that interfere with communication.
    • Language and Cultural Barriers: Differences in language, styles, values, nonverbal cues; risk of misunderstandings.
    • Cognitive Barriers: Deficits affecting comprehension beyond language or speech problems.

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  • Overcoming Communication Barriers:
    • Language & Cultural Barriers: Use plain language, minimize medical jargon, speak clearly and slowly, utilize interpreter services; respect cultural differences in communication styles and etiquette.
    • Physical & Cognitive Barriers: Provide well-lit, quiet environment; ensure patient can see and hear the speaker; allow medication effects to fade when appropriate; provide readers or alternative formats for information.
    • Emotional Barriers: Use awareness, active listening, and empathy; recognize distress and adjust communication; seek professional help when needed (eg guidance from therapist or counselor in complex cases).

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  • Collaborative Healthcare:
    • Client-Centered Approach: Different healthcare teams work toward common goals.
    • Shared Knowledge: No single team member possesses all needed information.
    • Referrals & Consultations: Directing clients to specialists or seeking expert input.
    • Coordinated Care: Preventing fragmentation and duplication of services.
  • Benefits and Risks: Collaborative care leads to comprehensive treatment and reduced errors; poor collaboration can cause fragmentation, duplications, wasted resources, higher costs, and negative health outcomes.

Page 13

  • Discharge Planning Process:
    • Assessment Phase: Evaluate home environment, potential challenges, support system, living conditions, and ability to manage self-care.
    • Education Phase: Educate patient and caregiver about medications, disease process, signs of complications; use teach-back to confirm understanding.
    • Coordination Phase: Introduce case manager, arrange equipment delivery, schedule follow-ups, confirm supplies and support services.
    • Documentation Phase: Document all discharge planning and education; create a written discharge summary for continuity of care.

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  • I-SBAR-R Communication Framework:
    • I (Introduction): Identify yourself, your role, and the patient.
    • S (Situation): Describe the current situation or issue.
    • B (Background): Provide relevant background information.
    • A (Assessment): Share your assessment of the situation.
    • R (Recommendation): Offer your recommendation for next steps.
    • R (Read-back): Confirm the information and actions agreed upon.

Page 15

  • Effective Handoff Reports:
    • 100% Patient Identification: Always verify correct patient information. 100\%
    • 6 Critical Components: Key elements in every handoff report. 6
    • 80% Error Reduction: Percentage of errors reduced with structured handoffs. 80\%
    • 2x Information Retention: Improved information retention with interactive handoffs. 2x
  • A well-organized handoff should cover: patient identification, medical history and relevant background, allergies, current status (vital signs, pain, recent changes), medications, treatment plan, goals for the next shift, concerns or alerts.
  • Best practices: use SBAR or structured tools; ensure accuracy; engage in interactive communication; use technology appropriately.

Page 16

  • Health Records and Documentation:
    • Electronic Health Records EHRs: Replaced paper, enable real-time access across teams; benefits include built-in clinical alerts, increased care coordination, elimination of illegible records.
    • Documentation Methods within electronic systems:
    • EHRs: Digitized patient records integrating data from multiple sources; secure access by authorized providers.
    • Source-Oriented Records: Documentation organized by source (nursing notes, physician notes, lab reports), with separate records per discipline.
    • Problem-Oriented Records: Documentation organized around patient problems; SOAP format with numbered problems tracked throughout care.
    • PIE Documentation: Problem, Intervention, and Evaluation format focusing on nursing problems, interventions, and effectiveness.
    • Other Methods: Focus charting (DAR: Data, Action, Response), Charting by Exception, Narrative charting.

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  • Documentation Methods in Nursing (examples):
    • SOAP: Documentation with Subjective data, Objective data, Assessment, and Plan.
    • PIE: Focuses on Problems, Interventions, and Evaluations.
    • Focused Charting: Centers on specific problems and condition changes; uses Data, Action, Response (DAR).
    • Charting by Exception: Documents only abnormal findings.
    • FACT Charting: Emphasizes factual, accurate, complete, timely documentation; includes concrete descriptions, exact measurements, and chronological order.

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  • Legal Considerations in Documentation:
    • HIPAA Privacy Rule: Regulations to protect patient privacy; providers must protect personal health information.
    • Documentation Standards: Legal requirements for accurate, timely, and complete documentation; records may be used in legal proceedings.
    • Abbreviation Cautions: Avoid certain abbreviations to prevent misinterpretation; organizations maintain approved and prohibited lists.
    • Verbal Orders: Taken only in emergencies; read-back required for accuracy; transcription should be directly into the patient\u2019s chart.

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  • Prohibited Abbreviations in Documentation:
    • Dangerous Dose Designations: Never use U for units, IU for international units, or trailing zeros (1.0) to prevent tenfold errors; misreadings can cause harm. U, IU, 1.0 are singled out; avoided.
    • Medication Abbreviations: Avoid QD (daily), QOD (every other day), MS (morphine sulfate vs magnesium sulfate) and other drug name abbreviations.
    • Route Abbreviations: Do not use symbols like @, >, or <; write out directions (eg right ear instead of AD, left ear instead of AS, both ears instead of AU).
    • Joint Commission Do Not Use List: Prohibit these and other abbreviations; facilities may have additional lists.

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  • Delegation: Direction and Supervision:
    • The Five Rights of Delegation provide a framework for safe delegation of tasks to nursing assistants and other personnel.
    • Right Task: The task must be delegatable and appropriate for the patient; should not require professional nursing judgment; routinely performed to standard.
    • Right Person: Delegatee must have appropriate skills, competence, and legal authority; delegator must verify qualifications and match task to capabilities.
    • Right Direction/Communication: Clear instructions and open communication; instructions should be specific, detailed, and allow questions.
    • Right Supervision/Evaluation: Delegator remains responsible for outcome; must supervise and evaluate; provide feedback and document the process.
    • Right Circumstance: Setting and resources must be appropriate for the delegated activity; environment must have necessary support.