NURS 110 WEEK 4 SLIDES
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.