NUR 101 Unit Two Communication, Nurse-Patient Relationship, Legal Aspects – Flashcards
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Communication and Therapeutic Relationships
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-Communication is a critical nursing skill used to gather assessment data for nursing diagnoses, to teach and persuade, and to express caring and comfort. -Therapeutic communication promotes understanding and can help establish a constructive relationship between the nurse and the client. Unlike the social relationship, where there may not be a specific purpose or direction, the therapeutic helping relationship is client and goal directed. -Many techniques facilitate therapeutic communication: using silence, providing general leads, being specific and tentative, using open-ended questions, using touch, restating or paraphrasing, seeking clarification, perception checking or seeking consensual validation, offering self, giving information, acknowledging, clarifying time or sequence, presenting reality, focusing, reflecting, summarizing, and planning.
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Communication Definition
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Communication is any means of exchanging information or feelings between two or more people. It is a basic component of human relationships, including nursing.
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Communication Purpose
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-The intent of any communication is to obtain a response.Thus, communication is a process. - It has two main purposes:1) to influence others and 2) to gain information * The way we collect data
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Communication Types
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-Verbal communication uses the spoken or written word; -Nonverbal communication uses other forms, such as gestures or facial expressions, and touch. **Although both kinds of communication occur concurrently, the majority of communication is nonverbal. **Non verbal Communication is a more important and honest means of communication
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Communication Verbal
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PACE AND INTONATION The manner of speech, as in the" rate or rhythm and tone", will modify the feeling and impact of the message. -The tone of words can express enthusiasm, sadness,anger, or amusement. -The rate of speech may indicate interest, anxiety, boredom, or fear. *For example, speaking slowly and softly to an excited client may help calm the client.
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Communication Non-verbal
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Nonverbal communication, sometimes called body language, includes gestures, body movements, use of touch, and physical appearance, including adornment. Nonverbal communication often tells others more about what a person is feeling than what is actually being said, because nonverbal behavior is controlled less consciously than verbal behavior. **Body Language/ Facial Expression/ Eye Contact/Personal Appearance/ Posture/ Touch
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Basic Elements of Communication
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•Sender- example Patient •Message- What patient wants to say •Receiver- Nurse •Response (feedback)
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Sender (Pg 464)
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The sender, a person or group who wishes to communicate a message to another, can be considered the source-encoder. This term suggests that the person or group sending the message must have an idea or reason for communicating (source) and must put the idea or feeling into a form that can be transmitted. **Source of Message
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Encoding
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Encoding involves the selection of specific signs or symbols (codes) to transmit the message, such as which language and words to use, how to arrange the words, and what tone of voice and gestures to use. ** To put the idea in a form in which it can be transmitted ( done by sender)
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Message
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The second component of the communication process is the message itself—what is actually said or written, the body language that accompanies the words, and how the message is transmitted. ** Content Face to face , by phone, letter includes all verbal and non verbal forms of communication
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Receiver
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The receiver, the third component of the communication process, is the listener, who must listen, observe, and attend. This person is the decoder, who must perceive what the sender intended (interpretation). -To decode means to relate the message perceived to the receiver's storehouse of knowledge and experience and to sort out the meaning of the message **Listener and Decoder
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Response (feedback)
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The fourth component of the communication process, the response, is the message that the receiver returns to the sender. It is also called feedback. Feedback can be either verbal, nonverbal, or both. *** Recieves Encoded message Decodes and responds/feedback to sender **Feedback can be a positive or negative response
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Factors That Influence Verbal Communication
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• Simplicity • Clarity and Brevity • Timing and Relevance • Adaptability • Credibility • Humor
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SIMPLICITY
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Simplicity includes the use of commonly understood words, brevity, and completeness. Nurses need to learn to select appropriate, understandable, and simple terms based on the age, knowledge, culture, and education of the client. *Easy to understand Concreate
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CLARITY AND BREVITY
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A message that is direct and simple will be effective. Clarity is saying precisely what is meant, and brevity is using the fewest words necessary. The result is a message that is simple and clear.An aspect of this is congruence, or consistency, where the nurse's behavior or nonverbal communication matches the words spoken. *To the point brief
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TIMING AND RELEVANCE
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Nurses need to be aware of both relevance and timing when communicating with clients. No matter how clearly or simply words are stated or written, the timing needs to be appropriate to ensure that words are heard. Moreover, the messages need to relate to the person or to the person's interests and concerns. * Make sure the patient can absorb the information keep things relevant
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ADAPTABILITY
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ADAPTABILITY The nurse needs to alter spoken messages in accordance with behavioral cues from the client. This adjustment is referred to as adaptability. What the nurse says and how it is said must be individualized and carefully considered. This requires astute assessment and sensitivity on the part of the nurse. * Adapt and Adjust to the Situation / Change Style
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CREDIBILITY
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Credibility means worthiness of belief, trustworthiness, and reliability. Credibility may be the most important criterion of effective communication. Nurses foster credibility by being consistent, dependable, and honest. The nurse needs to be knowledgeable about what is being discussed and to have accurate information. Nurses should convey confidence and certainty in what they are saying, while being able to acknowledge their limitations (e.g., "I don't know the answer to that, but I will find someone who does"). *** Be self confident not Authoritarian need to be credible and trustworthy
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HUMOR
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The use of humor can be a positive and powerful tool in the nurse-client relationship, but it must be used with care. Humor can be used to help clients adjust to difficult and painful situations. The physical act of laughter can be an emotional and physical release, reducing tension by providing a different perspective and promoting a sense of well-being. **Use Humor at proper moment adapt to individual situation
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Factors that influence Non-Verbal Communication
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-Personal appearance -Posture and gait -Facial expressions -Gestures
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PERSONAL APPEARANCE
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Clothing and adornments can be sources of information about a person. Although choice of apparel is highly personal, it may convey social and financial status,culture, religion, group association, and self-concept. ** Appearance is symbolic often people judge a book by its cover
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POSTURE AND GAIT
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The ways people walk and carry themselves are often reliable indicators of self-concept, current mood, and health. Erect posture and an active, purposeful stride suggest a feeling of well-being. Slouched posture and a slow, shuffling gait suggest depression or physical discomfort. Tense posture and a rapid, determined gait suggest anxiety or anger. **It is important to show or view a persons moood with the use of Posture and Gait.
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FACIAL EXPRESSION
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No part of the body is as expressive as the face. Feelings of surprise, fear, anger, disgust, happiness, and sadness can be conveyed by facial expressions. Although the face may express the person's genuine emotions, it is also possible to control these muscles so the emotion expressed does not reflect what the person is feeling. ** Watch for facial expressions and eye contact
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GESTURES
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Hand and body gestures may emphasize and clarify the spoken word, or they may occur without words to indicate a particular feeling or to give a sign. *** Watch movements keep in mind professionalism
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Factors that Influence the Communication Process
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•Developmental level --Age •Culture--be aware of differences •Gender-- Individuality •Values--Psycho socio cultural be aware of personal feelings so they do not come in to play with the patient •Perceptions-- interpretations of event or message •Ability to communicate-- Make sure patient has the ability to hear and speak •Personal Space- The distance in which we communicate Between nurse and patient (see explanation below) •Territoriality- patients material belongings (see explanation below) •Roles and relationships-- understand and respect roles ad relationships (See explanation below) •Environment -- noise (See explanation below) •Congruence-- the matching of verbal and non verbal communication (See explanation below) •Timing-- •Educational background-- Patients abiliuty to read or wright •Interpersonal Attitudes-- be caring, warm, nurturing,respect, acceptance •Trust
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Personal Space
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-Personal space is the distance people prefer in interactions with others. - Proxemics is the study of distance between people in their interactions. 1. Intimate: Touching to 1 1/2 feet 2. Personal: 1 1/2 to 4 feet 3. Social: 4 to 12 feet 4. Public: 12 to 15 feet.
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Territoriality ( Pg 469)
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Territoriality is a concept of the space and things that an individualconsiders as belonging to the self
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Roles and Relationship (Pg 469)
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The roles and the relationships between sender and receiver affect the communication process. Roles such as nursing student and instructor, client and primary care provider, or parent and child affect the content and responses in the communication process. Choice of words, sentence structure, and tone of voice vary considerably from role to role.
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Congruent Communication ( Pg 470)
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In congruent communication, the verbal and nonverbal aspects of the message match. Clients more readily trust the nurse when they perceive the nurse's communication as congruent. This will also help to prevent miscommunication. Both nurse and client can easily determine if there is congruence between verbal expression and nonverbal expression.
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Environment (pg 470)
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People usually communicate most effectively in a comfortable environment. Temperature extremes, excessive noise, and a poorly ventilated environment can all interfere with communication. Also, lack of privacy may interfere with a client's communication about matters the client considers private.
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Interviewing
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** Initial part of the process of communication between the nurse and Patient this establishes and creates a relationship •Directive interview -Collecting Data -Gathering Specific Information •Non-directive interview -Therapeutic -Meets Patient Needs
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Directive interview
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-Collecting Data -Gathering Specific Information *** Collecting data specific information such as DOB , rate of pain, and medical history
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Non-directive interview
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-Therapeutic -Meets Patient Needs *** Focusing on building rapport usinf open ended questions and statements
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Therapeutic Communication Techniques (1)
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•Attentive listening •Paraphrasing •Reflecting •Clarifying •Open-ended questions/statements •Focusing •Direct questioning •Touching •Silence •Summarizing
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Attentive listening
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-Attentive listening is listening actively, using all the senses,as opposed to listening passively with just the ear. It is probably the most important technique in nursing and is basic to all other techniques. Attentive listening is an active process that requires energy and concentration. It involves paying attention to the total message, both verbal and nonverbal, and noting whether these communications are congruent. - Attentive listening means absorbing both the content and the feeling the person is conveying, without selectivity. The listener does not select or listen solely to what the listener wants to hear; the nurse focuses not on the nurse's own needs but rather on the client's needs. Attentive listening conveys an attitude of caring and interest, thereby encouraging the client to talk ***Pay attention to whole message verbal and non verbal communication and if the are or are not congruent
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Paraphrasing (pg 472)
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-Actively listening for the client's basic message and then repeating those thoughts and/or feelings in similar words. This conveys that the nurse has listened and understood the client's basic message and also offers clients a clearer idea of what they have said -Example Client: "I couldn't manage to eat any dinner last night—not even the dessert." Nurse: "You had difficulty eating yesterday." Client: "Yes, I was very upset after my family left." Client: "I have trouble talking to strangers." Nurse: "You find it difficult talking to people you do not know?"
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Reflecting (pg 473)
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-Directing ideas, feelings, questions, or content back to clients to enable them to explore their own ideas and feelings about a situation. -Example Client: "What can I do?" Nurse: "What do you think would be helpful?" Client: "Do you think I should tell my husband?" Nurse: "You seem unsure about telling your husband." ***Directing ideas back to patient in order to help them explore their own feeling and ideas "What do you" and " You Seem "
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Clarifying
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-Helping the client clarify an event, situation, or happening in relationship to time. -Example Client: "I vomited this morning." Nurse: "Was that after breakfast?" Client: "I feel that I have been asleep for weeks." Nurse: "You had your operation Monday, and today is Tuesday." ***** to make sure the patients message is understood and to make sure the nurses message is understood
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Seeking Clarification (Pg 473)
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-A method of making the client's broad overall meaning of the message more understandable. It is used when paraphrasing is difficult or when the communication is rambling or garbled. To clarify the message, the nurse can restate the basic message or confess confusion and ask the client to repeat or restate the message. Nurses can also clarify their own message with statements. -Example: "I'm puzzled." "I'm not sure I understand that." "Would you please say that again?" "Would you tell me more?" "I meant this rather than that." "I'm sorry that wasn't very clear. Let me try to explain another way."
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Open-ended questions/statements
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-Asking broad questions that lead or invite the client to explore (elaborate, clarify, describe, compare, or illustrate) thoughts or feelings. Open-ended questions specify only the topic to be discussed and invite answers that are longer than one or two words. -Example: "I'd like to hear more about that." "Tell me about. . . ." "How have you been feeling lately?" "What brought you to the hospital?" "What is your opinion?" "You said you were frightened yesterday. How do you feel now?" ** Questions that start with " How can I help you? and Tell me More - this makes patient dig deeper
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Focusing
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-Helping the client expand on and develop a topic of importance. It is important for the nurse to wait until the client finishes stating the main concerns before attempting to focus. The focus may be an idea or a feeling; however, the nurse often emphasizes a feeling to help the client recognize an emotion disguised behind words. Example -Client: "My wife says she will look after me, but I don't think she can, what with the children to take care of, and they're always after her about something—clothes, homework, what's for dinner that night." Nurse: "Sounds like you are worried about how well she can manage." *** Assists to lead patients to important topics
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Direct questioning
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*** Specific questions during a direct interview (name, medical history, ect)
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Touching
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Providing appropriate forms of touch to reinforce caring feelings. Because tactile contacts vary considerably among individuals, families, and cultures, the nurse must be sensitive to the differences in attitudes and practices of clients and self. Example Putting an arm over the client's shoulder. Placing your hand over the client's hand. **If appropriately used helps build nurse patient relationship
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Silence (pg 472)
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Accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response. Example Sitting quietly (or walking with the client) and waiting attentively until the client is able to put thoughts and feelings into words. *** Gives patient time to process and the sense that the nurse is there for them
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Summarizing
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*** At the end of shift summarize the day , let your patient know that you are leaving summarizing ends with the introduction of the next nurse with a compliment made about the nest nurse
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The Helping Relationship (pg 475)
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-Nurse-client relationships are referred to by some as interpersonal relationships, by others as therapeutic relationships,and by still others as helping relationships. Helping is a growth-facilitating process that strives to achieve two basic goals 1. Help clients manage their problems in living more effectively and develop unused or underused opportunities more fully. 2. Help clients become better at helping themselves in their everyday lives. -A helping relationship may develop over weeks of working with a client, or within minutes. The keys to the helping relationship are (a) the development of trust and acceptance between the nurse and the client and (b) an underlying belief that the nurse cares about and wants to help the client
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Phases of the Helping Relationship (pg 476)
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•Preinteraction •Introductory •Working phase •Termination
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Preinteraction Phase
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-Task The nurse reviews pertinent assessment data and knowledge, considers potential areas of concern, and develops plans for interaction. -Skill Organized data gathering; recognizing limitations and seeking assistance as required. *** Nurse must be self aware of feelings before entering patients room
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Introductory Phase
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The introductory phase, also referred to as the orientation phase or the prehelping phase, is important because it sets the tone for the rest of the relationship. During this initial encounter, the client and the nurse closely observe each other and form judgments about the other's behavior. The goal of the nurse in this phase is to develop trust and security within the nurse-client relationship Task 1. Opening the relationship -Both client and nurse identify each other by name. When the nurse initiates the relationship, it is important to explain the nurse's role to give the client an idea of what to expect. When the client initiates the relationship, the nurse needs to help the client express concerns and reasons for seeking help. Vague, open-ended questions, such as "What's on your mind today?" are helpful at this stage 2. Clarifying the problem -Because the client initially may not see the problem clearly, the nurse's major task is to help clarify the problem. 3. Structuring and formulating the contract (obligations to be met by both the nurse and client) -Nurse and client develop a degree of trust and verbally agree about (a) location, frequency, and length of meetings, (b) overall purpose of the relationship, (c) how confidential material will be handled, (d) tasks to be accomplished, and (e) duration and indications for termination of the relationship. SKILLS -A relaxed, attending attitude to put the client at ease. It is not easy for all clients to receive help -Attentive listening, paraphrasing, clarifying, and other effective communication techniques discussed in this chapter. A common error at this stage is to ask too many questions of the client. Instead focus on priorities. -Communication skills listed above and ability to overcome resistive behaviors if they occur. *** Introduction made with patient 2 identifiers , build rapport, clarify needs, and establish contract
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Working phase Phase
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During the working phase of a helping relationship, the nurse and the client begin to view each other as unique individuals. They begin to appreciate this uniqueness and care about each other. Tasks Nurse and client accomplish the tasks outlined in the introductory phase, enhance trust and rapport, and develop caring. 1. Exploring and understanding thoughts and feelings -The nurse assists the client to explore thoughts and feelings and acquires an understanding of the client. The client explores thoughts and feelings associated with problems, develops the skill of listening, and gains insight into personal behavior. 2. Facilitating and taking action -The nurse plans programs within the client's capabilities and considers long- and short-term goals. The client needs to learn to take risks (i.e., accept that either failure or success may be the outcome). The nurse needs to reinforce successes and help the client recognize failures realistically. SKILLS -Listening and attending skills, empathy, respect, genuineness, concreteness, self-disclosure, and confrontation. Skills acquired by the client are nondefensive listening and self-understanding. -Decision-making and goal-setting skills. Also, for the nurse: reinforcement skills; for the client: risk taking. **** Open ended questions establish relationship in order to work things out with client
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Termination Phase
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The termination phase of the relationship is often expected to be difficult and filled with ambivalence. However, if the previous phases have evolved effectively, the client generally has a positive outlook and feels able to handle problems independently. Task -Nurse and client accept feelings of loss. The client accepts the end of the relationship without feelings of anxiety or dependence. SKILL -For the nurse: summarizing skills; for the client: ability to handle problems independently. *** Summarize and accept feelings of loss and plan follow up
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Non-Therapeutic Responses (See Chart pg 474)
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•Stereotyping •Agreeing/Disagreeing •Giving advice •False/Unwarranted reassurance •Defensiveness •Asking "Why?" •Changing the subject •Rejecting a topic/minimizing feelings •Being judgmental
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REVIEW ACTIVITY -A patient states," I can't take this pain any more. The doctors can't seem to find what is wrong. I don't know what to do!"
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•Open ended response: •Paraphrasing response: •Reflecting response: •Reflection response: •Clarifying response: •Direct question response: •Nontherapeutic response:
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Interpersonal Roles of the Nurse (pg 16)
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1) Stranger 2) Caregiver 3) Communicator 4) Teacher 5) Resource 6) Advocate 7) Leader 8) Counselor 9) Change agent 10) Manager 11)Researcher
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Stranger
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***First phase when meeting patient
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Caregiver
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-The caregiver role has traditionally included those activities that assist the client physically and psychologically while preserving the client's dignity. -Caregiving encompasses the physical, psychosocial, developmental, cultural, and spiritual levels. The nursing process provides nurses with a framework for providing care *** Most central act is to preserve dignity of the individual
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Communicator
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In the role of communicator, nurses identify client problems and then communicate these verbally or in writing to other members of the health team. The quality of a nurse's communication is an important factor in nursing care. The nurse must be able to communicate clearly and accurately in order for a client's health care needs to be me
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Teacher
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As a teacher, the nurse helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health. The nurse assesses the client's learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies, and measures learning. -Nurses also teach unlicensed assistive personnel (UAP) to whom they delegate care, and they share their expertise with other nurses and health professionals. **Interactive process with client , help others learn, never stop learning
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Resource
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***** Inform Patient about their care as well as inform them of available resources
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Advocate
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A client advocate acts to protect the client. In this role the nurse may represent the client's needs and wishes to other health professionals, such as relaying the client's request for information to the physician. They also assist clients in exercising their rights and help them speak up for themselves ***make sure client is getting proper care and their rights are met
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Leader
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A leader influences others to work together to accomplish a specific goal. The leader role can be employed at different levels: individual client, family, groups of clients, colleagues, or the community. ***A leader influences others accomplish a specific goals
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Counselor
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*** Nurses assist others in stressful situations through therapeutic communication
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Change agent
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The nurse acts as a change agent when assisting clients to make modifications in their behavior. Nurses also often act to make changes in a system, such as clinical care, if it is not helping a client return to health.
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Manager
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The nurse manages the nursing care of individuals, families, and communities. The nurse manager also delegates nursing activities to ancillary workers and other nurses, and supervises and evaluates their performance. Managing requires knowledge about organizational structure and dynamics, authority and accountability, leadership, change theory, advocacy, delegation, and supervision and evaluation. ***Direct and supervise subordinates and manage units to run smoothly
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Researcher
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Nurses often use research to improve client care. In a clinical area, nurses need to (a) have some awareness of the process and language of research, (b) be sensitive to issues related to protecting the rights of human subjects, (c) participate in the identification of significant researchable problems, and (d) be a discriminating consumer of research findings. *** this helps with evidence based nursing practices in order to provide better care
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NURSING AS A PROFESSION (pg 13)
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-Florence Nightingale defined nursing nearly 150 years ago as "the act of utilizing the environment of the patient to assist him in his recovery" (Nightingale, 1860/1969). Nightingale considered a clean, well-ventilated, and quiet environment essential for recovery. Often considered the first nurse theorist, Nightingale raised the status of nursing through education. Nurses were no longer untrained housekeepers but people educated in the care of the sick. -In 1973, the ANA described nursing practice as "direct, goal oriented, and adaptable to the needs of the individual, the family, and community during health and illness" (ANA, 1973, p. 2). In 1980, the -ANA changed this definition of nursing to this: "Nursing is the diagnosis and treatment of human responses to actual or potential health problems"
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Organizations (pg 23)
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•International -ICN, STT,NANDA-I •National -ANA, NLN, NLNAC, NSNA, AACN -Specialty Practice, e.g. Holistic Nurses, Informatics Nurses -Other: Black Nurses, Catholic Nurses •State -NYSNA •Local -NACLI
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International Organizations
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-ICN -The International Council of Nurses -STT-Sigma Theta Tau, the international honor society in nursing -NANDA-I- North American Nursing Diagnosis Association
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National Organizations (notes)
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-ANA -American Nurses Association (oldest) -NLN -National League for Nursing -NLNAC -National League for Nursing Accrediting Commission -NSNA -National Student Nurses Association -AACN- American Association of Colleges of Nursing American
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State Organizations
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-NYSNA- New York State Nurses Association
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Local Organizations
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-NACLI- Nurses Association Counties of Long Island
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Nursing Licensure
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•Licensed Practical Nurse (LPN)- Under RN 1-2 vocational school cannot hang IV Bag •Licensed Vocational Nurse (LVN)- Under RN 1-2 vocational school cannot hang IV Bag •Registered Professional Nurse (RN)- Specialized Educational Approved program include Biological and Psychological aspects so we have the fundamentals on which to build ( science and Social Science)
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Registered Professional Nurse (RN) Educational Preparation
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National Council Licensure Examination (NCLEX-RN). This examination is administered in each state and the successful candidate becomes licensed in that particular state, even though the examination is of national origin. •Entry Level 1)Diploma- Florence Nightingale 2-3 year hospital based education hands on the emphasis was learning by doing 2) Associate- **NINAC Regulates AS Grograms In the United States, associate degree nursing programs were started after** "Mildred Montag" published her doctoral dissertation,"The Education of Nursing Technicians," in 1951. **This study proposed a 2-year education program for RNs in community colleges as a solution to the acute shortage of nurses that came about because of WWII 3) Baccalaureate- **CCNE Accredits BN Programs
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Advanced Practice Registered Nursing ( see notes)
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-Certification e.g. Emergency nursing -Master's Degree e.g. Administrator, Clinical Specialist, Nurse Educator -Doctorate (PhD, EdD,) e.g. Nurse Researcher -Doctorate (DNP) e.g. Nurse Practitioner
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Providers of Health Care AKA Health Care Team (pg 104)
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The providers of health care, also referred to as the health care team or health professionals, are nurses and health personnel from different disciplines who coordinate their skills to assist clients and their support persons. Their mutual goal is to restore a client's health and promote wellness. The choice of personnel for a particular client depends on the needs of the client. Health teams commonly include the nurse and several different personnel
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Interdisciplinary Health Care Team (PG 105 See Definitions)
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•Physician •Nurse •Dietician •Pharmacist •Physical/Respiratory therapist •Social Worker •Lab tech •Nursing assistant •Clergy •Housekeeping PATIENT, PATIENT!!! *** An Effort to coordinate activities of all those involved in patient care
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Intradisciplinary Nursing Team (pg 18)
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1) RN 2) LPN 3) NA 4)Nurse Manager 5)Supervisor 6)Clinical Specialist 7)Nurse Practitioner 8)Director of Nursing 9)Nursing Students ** RN leads team RN focuses and delegates individual tasks in the correct " ORDER OF SCOPE"
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Functioning of the Nursing Team
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•Team Nursing •Primary Nursing •Functional Nursing
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Team Nursing (pg 110)
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Team nursing is the delivery of individualized nursing care to clients by a team led by a professional nurse. A nursing team consists of registered nurses, licensed practical nurses, and unlicensed assistive personnel. This team is responsible for providing coordinated nursing care to a group of clients. The registered nurse retains responsibility and authority for client care but delegates appropriate tasks to the other team members. Proponents of this model believe the team approach increases the efficiency of the registered nurse. ** A team communicates and coordinates activities of all involved with the patient
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Primary Nursing
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Primary nursing is a system in which one nurse is responsible for overseeing the total care of a number of hospitalized clients 24 hours a day, 7 days a week, even if he or she does not deliver all of the care personally. It is a method of providing comprehensive, individualized, and consistent care. **One nurse responsible for patients 24/7
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Functional Nursing
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The functional nursing method focuses on the jobs to be completed (e.g., bed making, temperature measurement). In this task-oriented approach, personnel with less preparation than the professional nurse perform less complex care requirements. It is based on a production and efficiency model that gives authority and responsibility to the person assigning the work, for example, the head nurse. Clearly defined job descriptions, procedures, policies, and lines of communication are required. The functional approach to nursing is economical and efficient and permits centralized direction and control. **Task oriented , jobs are delegated not as patient centered but more of an economical advantage
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Intradisciplinary Communication I PASS
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I PASS •Introduction- Who am I, My role,and My job •Patient- Identify name / DOB / Medical record # •Assessment- complaint/ vitals/ symptoms/ Diagnosis •Situation-Current status ( what is the issue - High BP) •Safety-Psyco socio cultuaral - single / live alone? ** How to address each other relevant to the patient
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Intradisciplinary Communication BATON
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BATON •Background - know comorbidity ex Diabetes and arthritis so no med interaction •Actions-what was done what needs to be done ex hemoglobin low ... what was it before •Timing- Level of emergency so you can advocate •Ownership-who is responsible ? most time RN •Next- What is the plan ** comorbidity -the simultaneous presence of two chronic diseases or conditions in a patient.
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Intra/Interdisciplinary Communication SBAR
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SBAR •Situation •Background •Assessment •Recommendation *** RN recommendation What do i think will correct it
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NY State Nurse Practice Act
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•"diagnosing" and "treating" human responses to actual or potential health problems, through such services as "case finding", health "teaching", health "counseling", and the provision of "care" supportive to or restorative of life and well-being, and executing "medical regimens" prescribed by a licensed or otherwise legally authorized physician or dentist. A nursing regimen shall be consistent with and shall not vary any existing medical regimen.
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Nurse Practice Act Scope of Practice
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•Independent - •Dependent- •Interdependent/Collaborative- actions delegated by PCP but need some judgement from nurse
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Independent
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What RN can do without PCP order
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Dependent
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RN needs PCP order
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Interdependent/Collaborative
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Actions that are delegated by PCP but need some judgement from nurse
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American Nurses Association Standards of Practice
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**Describes responsibilities and behaviors for when nurses are held accountable RN must do a head to toe assessment •Assessment- •Diagnosis •Outcomes •Planning •Implementation -Coordination of Care -Health Teaching -Consultation -Prescribing •Evaluation 1)Ethics-The registered nurse practices ethically. 2)Education-The registered nurse attains knowledge and competence that reflects current nursing practice. 3)Evidence Based Practice- The registered nurse attains knowledge and competence that reflects current nursing practice. 4) Quality of Practice- The registered nurse contributes to quality nursing practice. 5) Communication-The registered nurse communicates effectively in all areas of practice. 6) Leadership-The registered nurse demonstrates leadership in the professional practice setting and the profession 7) Collaboration-The registered nurse collaborates with healthcare consumer, family, and others in the conduct of nursing practice. 8) Self Evaluation-The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. 9) Resource Utilization-The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible. 10) Environmental health-The registered nurse practices in an environmentally safe and healthy manner.
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Assessment (pg 16)
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Assessment The registered nurse collects comprehensive data pertinent to the healthcare consumer's health and/or the situation.
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Diagnosis
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Diagnosis The registered nurse analyzes the assessment data to determine the diagnoses or issues.
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Outcomes
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Outcomes Identification The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation.
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Planning
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Planning The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.
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Implementation
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1)Coordination of Care -The registered nurse coordinates care delivery. 2) Health Teaching and Health Promotion The registered nurse employs strategies to promote health and a safe environment 3) Consultation- The graduate-level prepared specialty nurse or advanced practice registered nurse and the nursing role specialist provide consultation to influence the identified plan, enhance the abilities of others, and effect change. 4) Prescribing-Authority and Treatment The advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations
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Evaluation
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The registered nurse evaluates progress toward attainment of outcomes.
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ANA Code of Ethics
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•Compassion- respect for human dignity •Respect •Commitment- to patient care as individual •Patient rights- Confidentiality HIPPA •Accountability- for patient and professor •Collaboration-with team members •Professional growth- responsibility to grow as a person •Advancement of the profession- stays current with education and continued edu
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NLN CORE VALUES
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•Caring •Diversity •Integrity •Excellence •Ethics •Patient-Centeredness •Holism
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National League for Nursing (NLN) Program Outcomes
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•Human Flourishing •Nursing Judgment •Professional Identity •Spirit of Inquiry
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Human Flourishing
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Recognizes the uniqueness of the individual patient's background, personal preferences, culture, values, traditions, and family.
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Nursing Judgment
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Recognizes that critical thinking provides a framework for the development of clinical judgment for evidenced based practice
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Professional Identity
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Recognizes the importance of core values to implementing the role of the nurse to meet fundamental patient needs
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Spirit of Inquiry
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Identifies relevant sources of evidence based research and knowledge as a basis for nursing practice.
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QSEN COMPETENCIES Quality and Safety Education for Nurses
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•Patient-Centered Care- developing ways for RNs to give better Care •Teamwork & Collaboration- Knowledge and scope for every level of team care •Evidence Based Practice- •Quality Improvement-improve quality of care given to patient •Safety- improvement •Informatics- developed computer software for charting **Bottom line to improve quality of patient care *from web site Defined quality and safety competencies for nursing and proposed targets for the knowledge, skills, and attitudes to be developed in nursing pre-licensure programs for each competency: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.
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Code of Academic and Clinical Conduct: NSNA 2001
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•Advocate •Maintain confidentiality •Ensure safety •Care for and communicate in respectful, timely, ethical, compassionate manner •Moral, ethical •Collaborates with faculty, staff •Accepts responsibility including own learning needs and maintains school policies •Substance free **** National Student Nursing Association almost identical to NLN Core Values
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Bill of Rights
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-written by American Hospital Association, 1973, rev 1992 (replaced in 2010 with Pt. Care Partnership) 1.Considerate, respectful care 2.Information regarding diagnosis, treatment, prognosis 3.Identification of health team members 4.Financial implications of care 5.To make decisions and participate in care 6.Advance directive & proxy 7.Privacy and confidentiality 8.Review of own records 9.To medically indicated care 10.Continuity of care 11.To consent to or decline to participate in research *** Everyone receives a copy of the bill of rights and it is the RN's responsibility to make sure the patient understand it
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AHA Patient Care Partnership
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-High quality hospital care -Clean, safe environment -Involvement in your care -Informed choices -Need to get/give proper information -Make and agree to goals -Consider spiritual beliefs -Health care proxy -To consent to care -Help when leaving -Understainding directions -Following directions -Getting assistance after discharge -Help with billing claims ****America Health Association care is Parallel to the patient bill of rights ***it is important for the patient to inform the nurse of everything such as allergies this is necessary to protect the patient
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Informed Consent
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•Agreement by a client to accept care after being provided with information ** (Give client time to digest what you have informed them) •Providing information is responsibility of the individual performing the procedure **(doctor) •Nurses often witness that a patient has signed the "informed consent" document ***( this mean RN is aware that Client understands everything so RN can witness signature)
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Advanced Directives
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•Living Will- specific instructions about health care •Do Not Resuscitate- DNR •Do Not Intubate- DNI •Health Care Proxy-person who is legally allowed to make decisions for you •Organ Donation- AKA anatomical gift act
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HIPAA
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-Health Insurance Portability and Accountability Act -Individuals have increased control over health information -Limits use and release of health information -Health information must be protected -Penalties (fines) delineated for infractions, both criminal and civil *For test know Name and basic facts ** Developed by Dept health human servics to protect a patients medical information
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Derivation of Laws (pg 54)
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•US Constitution •Court Decisions (Common Law) •Legislative Action (Statutory Law) •Administrative Law
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Constitutional Law
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The Constitution of the United States is the supreme law of the country. It establishes the general organization of the federal government, grants certain powers to the government, and places limits on what federal and state governments may do. The constitution creates legal rights and responsibilities and is the foundation for a system of justice. For example, the constitution ensures each U.S. citizen the right to due process of law -Due process -Equal protection
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Court Decisions (Common Law)
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Laws evolving from court decisions are referred to as common law. In addition to interpreting and applying constitutional or statutory law, courts also are asked to resolve disputes between two parties.
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Legislative Action (Statutory Law)
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Laws enacted by any legislative body are called statutory laws. When federal and state laws conflict, federal law supersedes. Likewise, state laws supersede local laws. -Nurse practice acts -Good Samaritan acts -Child and adult abuse laws -Living wills -Sexual harassment laws -Americans with Disabilities Act
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Administrative Law
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When a state legislature passes a statute, an administrative agency is given the authority to create rules and regulations to enforce the statutory laws. For example, state boards of nursing write rules and regulations to implement and enforce a nurse practice act, which was created through statutory law.
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Categories of Liability
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•Criminal Law •Civil Law
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Criminal Law Liability
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-violations against the public -Punishable by fine or imprisonment -Designated as "felony" or "misdemeanor" depending on seriousness
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Civil Law Liability
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-Violations against a private individual -Punishment determined by judge and/or jury -Private law, or civil law, is the body of law that deals with relationships among private individuals. It can be categorized into a variety of legal specialties such as contract law and tort law. Contract law involves the enforcement of agreements among private individuals or the payment of compensation for failure to fulfill agreements. Tort law defines and enforces duties and rights among private individuals that are not based on contractual agreements.
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Civil Laws
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•Contracts -agreements between individuals -restitution sought when contract broken Example Nurse and client Nurse and employer Nurse and insurance Client and agency •Torts -between individuals but not based on contracts -May be "intentional" or "unintentional
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Unintentional Torts
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•Negligence- conduct that fails to meet standard of care •Malpractice (professional negligence)- professional misconduct lack of ability to perform care •Omission- not doing something that should have been done ex did not give medication •Commission- doing something that is harmful ex gave wrong medication
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Intentional Torts
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•Assault- attempt to do something verbal or physical •Battery- Actual touching •Defamation of character- Slander •False imprisonment- unjustifiably detaining a patient against their will •Fraud-false presentation of fact •Abandonment-leaving patient with out leaving someone attending •Invasion of privacy-HIPPA
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Respondeat Superior (pg 58)
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"Let the master (employer) answer" -In other words, the master (employer) assumes responsibility for the conduct of the servant(employee) and can also be held responsible for malpractice by the employee. By virtue of the employee role, therefore,the nurse's conduct is the hospital's responsibility
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Protection Against Liability
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•Documentation •Professional Liability Insurance •Good Samaritan Acts •Safe practice •IPR
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Legal Protection for Nurses
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•Good Samaritan Acts •Professional Liability Insurance •Safe practice •Communication •Documentation
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Guidelines for Documentation
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•A legal record •Documents patient progress •Black, non-erasable ink •Legibility is important-write neatly and legibly •Use proper grammar and spelling, choice of words •Do not alter, add , or omit entries •Do not rewrite a record •Do not add to someone else's notes •Do not criticize other health care professionals or patient in the chart
