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.
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.
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.