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Incorporates the assumptions and values of the profession while maintaining accountability and self-awareness Nursing skills and knowledge integrated with dignity and respect for all human beings. Attributes and behaviors of a nurse as a representative of the profession and as a healthcare professional.

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Professionalism

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To act professional you must:

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Administer quality patient-centered care in a safe, conscientious and knowledgeable manner.

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True or False: Nurses are responsible and accountable to themselves and their patients:

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True. That is a part of professionalism

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Attributes of Professionalism in the nursing profession

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(Eating Candy Effects The Cells) Education Clinical Judgment Ethics Therapeutic Communication Comportment

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Professional Identity consists of what?

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(Austin Cant Continue Helping Students Learn): ;) Accountability Communication Clinical Judgement High Ethical Standards Specific Knowledge Leadership Competence

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How Nurses Describe a "Professional Nurse

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(Without Passing I cannot Help Contribute) -Well-educated, with a minimum of a bachelor's degree -Passionate about nursing -Innovative -Confident -Highly experienced -Certified in a specialty area

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How Patients Describe a "Professional Nurse"

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(Cant Get Enough) Good interpersonal skills Critical thinking ability Empathetic-- caring practices

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Professionalism Elements:

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(Kinzee Cant Continue Paper Copying Austin's Answers): Knowledge Competence Professionhood Accountability Advocacy Collaborative Practice Commitment

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Most Trusted Profession since 1999 EXCEPT for in 2001:

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Nursing

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Roles of Professional Nurses

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(Come Meet Austin Any Time) Collaborate with other members of health care team Manage Care Assess Advocate Teach

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______________________ is when Nurses collaborate with other health care professionals to improve the care and outcomes for patients.

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Interprofessionalism

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The following are examples of ___________________________ -Has current knowledge of emerging trends in health care -Maintains awareness of world health issues and political decisions affecting health care -Incorporates evidence in care (evidence-based practice) -Has ethical comportment

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Are examples of Professional Behavior

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Interrelated Concepts of Professionalism:

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(Lexi Cant Eat Cats) Critical Judgement Ethics Leadership Communication

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Personal concept of right and wrong

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Morals

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Behaviors of a group or individual based upon morals

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Ethics

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____________ Is the set of beliefs about the standards of right and wrong that help a person determine the correct or permissible action in a given situation.

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Personal morality

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_______________ refers to self determination and the right to make one's own decisions:

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Autonomy

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___________________ are ideas or beliefs a person considers highly important and are learned through interactions with social systems as described previously.

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Personal Ethics

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What does having Ethics commit to:

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Having standards beyond personal preferences

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___________________ are values held by a group deemed as having generalizable application and standards of conduct to be upheld in all situations.

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Professional Ethics

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A Nurse describing surgery to a client before the consent is signed is an example of what?

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Autonomy

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Ethical Principle: Autonomy

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(Is Caring And Respecting Patients Rights) Informed consent (free to make informed choice), Competency, Advocacy- honors pt.'s autonomy, Respect for Person, Patient confidentiality- (right to control information), Right to Self-determination

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An example of Autonomy would be:

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A nurse reading The Patient Care Partnership to a visually impaired client. • A nurse collaborates with other health care team members to ensure the best possible treatment for a client.

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Beneficence:

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DESIRE TO DO GOOD. -Compassion: taking positive action to help others. -Patient advocate

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Nonmaleficence:

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Do No Harm

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Justice

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EQUAL AND FAIR distribution of resources

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Fidelity

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Agreement to keep our promises

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Veracity

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Truth telling

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Example: A physician orders a medication that is too high a dosage for the patients age/physical condition. The nurse calls to clarify the order.

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Nonmaleficence

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A patient decides not to do any treatment and wants to leave the hospital against the advice of the physician. The nurse knows that this would not be in the best interest of the patient

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Beneficence, autonomy

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A nurse gives a pain medication to a patient 30 minutes prior to completing a complicated dressing change.

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nonmaleficence

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Criteria such as a patient's medical urgency, blood and tissue type and size match with the donor, time on the waiting list and proximity to the donor help to guide the distribution of organs. Factors such as a patient's income, celebrity status, and race or ethnic background play no role in who is placed on a list to receive a donor organ.

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Justice

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An elderly patient came into the emergency room with a fractured hip and was given pain medication. Thirty minutes later the patient developed compartment syndrome which requires surgery immediately to prevent nerve damage. The surgeon explains the need for surgery and its associated risks and complications to the patient's daughter who signs the consent form.

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Autonomy

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A patient asks the nurse not to reveal the fact that she is dying or give her diagnosis to her family. The nurse asks why she does not want her family advised. The patient explains that her family is very emotional and has stated they would do everything to keep her alive, even if it required long-term mechanical ventilation. The patient has explained multiple times that she does not want mechanical ventilation. The nurse recognizes the need to keep this information in confidence, while supporting the family.

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Autonomy, Fidelity

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What is Written in the ANA Code of Ethics?

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The nurse advances the profession by actions such as meeting continuing education requirements. • The nurse advocates for clients and encourages clients to advocate for themselves. • The nurse delivers care in a nonjudgmental manner that is sensitive to client diversity. • The nurse takes action to promote safe and appropriate care environments.

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A nurse provides client care within a philosophy of ethical decision making and professional expectations. What is the nurse using as a framework for practice?

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ANA Code of Ethics

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A registered nurse has had her license suspended after being convicted of being impaired at work. What governing body has the authority to revoke or suspend a nurse's license

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State Board of Nurse Examiners

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Professional regulations and laws that govern nursing practice are primarily in place for which reason

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Protect Public Safety

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Moral Distress

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Occurs when one knows the ethically correct action to take but feels powerless to take that action *Not everyone will be distressed about the same situation*

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Unsuccessful advocacy Continued life support even though it is not in the best interest of the patient Inadequate communication about end of life care between providers and patient and families Inappropriate use of healthcare resources Inadequate staffing or staff who are not adequately trained to provide the required care Inadequate pain relief provided to patients False hope given to patients/families Are all examples of:

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Moral Distress

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Consequences of Moral Distress

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Providers become burned out, morally numbed to ethically challenging situations, engage in different ways of doing what is right

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A nursing faculty is presenting a lecture on ethics. The correct definition of ethical distress is: a) Belief about worth as a standard to guide behavior. b) Being aware of the principles of right and wrong. c) Knowing the correct action, but unable to perform due to constraints. d) Supporting the rights of a client during hospitalization.

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C.

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What is the term for the beliefs held by the individual about what matters? a) Bioethics b) Morals c) Ethics d) Values

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D. Values

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An emergency department nurse and health care team are caring for a semiconscious child age 2 years with numerous fractures and evidence of cigarette burns. They suspect child abuse. The nurse reports the family to the child abuse hotline. The nurse is following which ethical principle? a) Nonmaleficence b) Justice c) Beneficence d) Fidelity

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A: Nonmaleficence

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Which of the following words is best described by the following: the protection and support of another's rights? a) Paternalism b) Advocacy c) Ethics d) Autonomy

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B Advocacy

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A nurse working on a critical care unit was informed by a client with multiple sclerosis that she did not wish to be resuscitated in the event of cardiac arrest. The client is no longer able to express her wishes, and the family has informed the physician that they want the client to be resuscitated. Aware of the client's wishes, the nurse is involved in a situation that may involve what? a) Ethical distress b) Deception c) Confidentiality d) Paternalism

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A. Ethical Distress

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A client rings the call bell to request pain medication. Upon performing the pain assessment, the nurse informs the client that she will return with the pain medication. The nurse's promise to return with the pain medication is an example of which principle of bioethics? a) Justice b) Autonomy c) Nonmaleficence d) Fidelity

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D. Fidelity

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A nurse who provides the information and support that patients and their families need to make the decision that is right for them is practicing what principle of bioethics? a) Autonomy b) Nonmaleficence c) Fidelity d) Justice

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A. Autonomy

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Which of the following are examples of virtues that can exemplify character and conduct as a professional nurse? Select all that apply. a) Conflict b) Humility c) Compassion d) Trustworthiness e) Deception

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B C E Humility Compassion Trustworthiness

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What would be an example of the nurse practicing fidelity? The nurse: a) Stays with the patient during his or her death as promised b) Regulates visitors c) Provides continuity of care d) Withholds information as requested

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A Stays with the patient during his or her death as promised

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Which word is best described by the following: the protection and support of another's rights?

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Advocacy

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A nurse educator understands that his teaching was effective regarding the Code of Ethics for Nurses when students state which of the following? a) "The code critiques existing patterns of oppression and domination in society." b) "The code provides nurses with specific action guides for practice." c) "The code enables nurses to provide good care to clients." d) "The code is an expression of nursing's own understanding of its commitment to society."

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D "The code is an expression of nursing's own understanding of its commitment to society."

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Which ethical principle refers to the obligation to do good? a) Nonmaleficence b) Veracity c) Fidelity d) Beneficence

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D Beneficence

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A client continues to complain of pain despite receiving medication. The family states, "in our culture it is acceptable to complain out loud." What would be the best response by the nurse? a) Describe your home situation to me. b) Tell me more about your cultural beliefs. c) It is not necessary to complain so loud. d) The pain medication should have worked by now.

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B Tell me more about your cultural beliefs.

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Which of the following is a characteristic of the care-based approach to bioethics? a) The need for an orientation toward service b) The promotion of the dignity and respect of clients as people c) The need to emphasize the relevance of clinical experience d) The rightness or wrongness of an action is independent of its consequences

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B The promotion of the dignity and respect of clients as people

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Nursing students in an ethics class have been asked to define "ethics". What would be the best definition of ethics? a) The informal, systematic study of moral beliefs. b) The formal, systematic study of moral beliefs. c) The adherence to informal personal values. d) The adherence to formal personal values.

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B The formal, systematic study of moral beliefs.

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Which nursing actions best describe the use of the professional value of altruism? (Select all that apply.) a) A nurse becomes a mentor to a student nurse working on her floor. b) A nurse is accountable for the care provided to a mentally challenged patient. c) A nurse lobbies for universal access to health care. d) A nurse respects the right of a Native American to call in a shaman for a consultation. e) A nurse protects the privacy of a patient with AIDS. f) A nurse demonstrates an understanding of the culture of his or her patient.

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A D F • A nurse demonstrates an understanding of the culture of his or her patient. • A nurse becomes a mentor to a student nurse working on her floor. • A nurse respects the right of a Native American to call in a shaman for a consultation.

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The International Council of Nurses (ICN) Code of Ethics for Nurses (2005) has which of the following elements? Select all that apply. a) Family b) Co-workers c) Profession d) Practice e) People

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B C D E • People • Co-workers • Practice • Profession

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____________________ is treating others with consideration. The principle is violated when when a nurse disregards client's subjective accounts of their symptoms

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Respect for the Person

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_________________ is fairness and treating people equally. Nurse provides the same level of care regardless of their socioeconomic background.

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Justice

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____________________ is to be faithful to an agreement and responsibilities one has undertaken. Maintaining confidentiality. If a nurse tells a patient she will be back in one hour she should remain faithful to that promise

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Fidelity

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_________________ is telling the truth.

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Veracity

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_____________________________ is a formal statement of a group's ideals and values. Set of ethical principle that is shared by members of the group, reflects their moral judgments over time and serves as a standard for their professional actions

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Code of Ethics

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Code of Ethics for International Council of Nurses (ICN)

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4 principle elements = 1. Nurses and people. 2. Nurses and practice. 3. Nurses and the profession. 4. Nurses and coworkers. 4 responsibilities = 1. promote health. 2. Prevent illness. 3. Restore health. 4. Alleviate suffering

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The purpose of ______________________ is to: 1. Inform the public about the minimum standards of the profession and to help them understand professional nursing conduct. 2. To provide a sign of the profession's commitment to the public it serves. 3. To outline the major ethical considerations of the profession. 4. To provide general guidelines for professional behavior. 5. To guide the profession in self regulation. 6. To remind nurses of the special responsibility they assume when caring for clients.

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Purpose of Nursing Code of Ethics

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_________________________ is an example of two opposing courses of action may be justified, but the nurse cannot tell which one to choose

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Moral Dilemma

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__________________________ is an example of the nurse knows the right action to take but feels powerless to implement it due to other forces

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Moral Distress

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The nurse teaches a student nurse about how to apply the ethical principle of autonomy. Which of the following selections demonstrates an understanding of this principle? A. The nurse explores alternative solutions and then makes a choice. B. The nurse collaborates with the health care team. C. The nurse empowers the patient through education. D. The nurse delegates vital signs to a unlicensed professional.

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B C B. The nurse collaborates with the health care team. C. The nurse empowers the patient through education.

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A homeless man presents to the emergency room with hypothermia. He tells the nurse that he is positive for human immunodeficiency virus (HIV) and sought revenge by deliberately having sex with his mate, who does not know of his HIV status. This patient is violating the ethical principles of___________ A. Veracity. B. Beneficence. C. Nonmaleficence. D. Autonomy.

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A. B. C. Veracity Beneficence Nonmaleficence

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Which of the following ethical terms matches this statement: A problem for which in order to do something right you have to do something wrong. A. Justice. B. Veracity. C. Ethical dilemma. D. Fidelity.

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C Ethical Dilemma

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You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. What is the best nursing action to take first ? 1. Call the nursing supervisor to discuss the situation. 2. Discuss the problem with a colleague. 3. Leave the nursing unit and go home. 4. Say nothing and begin your work

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1. Call the nursing supervisor to discuss the situation.

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Statutory Law

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developed by FEDERAL, STATE, and LOCAL GOVERNMENTS

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Regulatory Law

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Decision made by an administrative body (regulations) Example: Iowa Board of Nursing

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Common Law

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Judicial decisions made in court. developed in RESPONSE TO SPECIFIC LEGAL QUESTIONS brought before the court and usually follow precedent (previous rulings on an issue)

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Civil Law

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conduct violates a PERSON'S RIGHTS conduct is DETRIMENTAL TO THAT INDIVIDUAL involves and offense that is against an individual law's purpose is to make the aggrieved person whole again, to restore them to where they were

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Criminal Law

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conduct in issue is OFFENSIVE TO SOCIETY in GENERAL conduct is DETRIMENTAL TO SOCIETY AS A WHOLE involves PUBLIC OFFENSES (robbery, murder, assault) law's purpose is to punish for the crime and deter and prevent further crimes

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Unlawful touching of another person without informed consent

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Battery

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-A full disclosure of the facts the patients need to make an intelligent decision before any invasive treatment or procedure performed -Patient's understanding of the reason for the proposed intervention, aware of the benefits of the treatment, the risks involved, any alternative treatments, & the consequences of refusing the treatment by signing the consent. -The patient has the right to accept or reject the proposed care

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Informed Consent-- -Failure to secure informed consent may result in civil liability for battery.

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An intentional threat to cause bodily harm to another, does not have to include actual bodily contact

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Assault

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-occurs when a client is not allowed to leave a health care facility when there is no legal justification to detain the client -occurs when restraining devices are used without and appropriate clinical need

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False Imprisonment

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Wrongful termination of providing patient care

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abandonment

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A legal presumption that a person who has reached the age of majority can make decisions for themselves unless provided otherwise

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Competency

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spoken or written statements made maliciously or intentionally that may injure the subjects reputation

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Defamation

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Injury to a person or their property that gives rise to a basis for a legal action against the person who caused the damage.

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Harm

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- one who will defend or plead a cause or issue on behalf of another -The nurse accepts the role of an advocate for the patient (acting on the behalf of the patient, protecting the patients' rights to make their own decisions, and upholding the principle of fidelity) - represent the patient's viewpoint to others - A nurse advocate has a legal & ethical obligation to safeguard patient's interests

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Advocacy

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Being responsible for one's own actions

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Accountability

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_______________ are a type of civil law that involves wrongs against a person or property. They include: 1. intentional (action is substantially certain to cause an effect): fraud, defamation, assault & battery, false imprisonment, invasion of privacy 2. unintentional (violation of standard of care): negligence, malpractice

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Torts

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when violated it is the legal concept that involves a person's right be left alone and remain anonymous by choice

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Invasion of Privacy

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Laws created by the federal legislative branch Advanced Directives (living wills/ Durable Power of Attorney for health care) DNR orders Health Insurance Portability and Accountability Act (HIPAA) Restraints Other laws: ADA, Emergency Medical Treatment and Active Labor Act, Mental Health Parity Act Are all examples of:

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Issues With Federal Statutory Law

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Laws created by the state legislative branch Licensure Iowa Board of Nursing NCLEX exam Good Samaritan Laws Other laws: Public Health Laws, Uniform determination of death act, autopsy laws, physician assisted suicide

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Examples of State Statutory Law

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Laws that result from judicial decisions: Intentional Tort (intentional harm) Assault Battery False Imprisonment Quasi-intentional Tort Invasion of privacy Defamation of character Unintentional Tort Negligence Malpractice

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Violations of Common Law

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Failure to assess and/or monitor, including making a nursing diagnosis Failure to monitor in timely fashion Failure to use proper equipment to monitor the patient Failure to document the monitoring Failure to notify the health care provider of problems Failure to follow orders Failure to follow the six rights of medication administration Failure to convey discharge instructions Failure to ensure patient safety, especially for patients who have a history of falling, are heavily sedated, have disequilibrium problems, are frail, are mentally impaired, get up in the night, and are uncooperative Failure to follow policies and procedures Failure to properly delegate and supervise

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Common Malpractice Acts

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What is an example of Malpractice/Negligence:

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Nurse owed a duty to the patient Nurse did not carry out the duty Patient was injured Nurse's failure to carry out duty caused injury

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Legal guidelines that define nursing practice and what is the minimum acceptable nursing care Reflects knowledge/skills ordinarily possessed by nurses Examples: Nurse Practice Act for State of Iowa (defines scope of nurses practice, education/licensure requirements) ANA standards of care Joint Commission (defines policies/procedures for nurses in order for the hospital to be accredited) Institutional policies and procedures Professional organization standards of care (Critical care nurses, certified nurse midwives etc)

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Standards of Care

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Living Wills and /or Durable Power of Attorney for Healthcare Patient Self-Determination Act (1991) Right to refuse care Hospital must document if patient has ______________________ Legally incompetent or lack of decisional capacity to enforce Are all examples of:

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Advanced Directives

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- the laws (series of statutes) that have been formally defining and enacting by each state legislature to regulate the scope of nursing practice. - set educational requirements for the nurse, distinguish between nursing practice and medical practice, and define the scope of nursing practice - cover licensure requirements for protection of the public, grounds for disciplinary action, rights of the nurse licensee if a disciplinary action is taken

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Nurse Practice Act

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Enacted to protect privacy of health care information Patients must be offered or have access to a notice of their rights Only share protected health information with those who need to know Never share information in public areas

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HIPPA

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Can be physical or chemical Use only to ensure safety of pt. or others Must try other less restrictive measures first Need healthcare provider order Assess continuously document, document, document

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Restraints

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A. Any competent individual 18 years of age or older for himself or herself B. Any parent for his or her unemancipated minor C. Any guardian for his or her ward D. Any adult for the treatment of his or her minor brother or sister (if an emergency, and parents are not present) E. Any grandparent for a minor grandchild (if an emergency, and parents are not present)

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Adult Consent

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A. Any competent individual under the age of 18 that can give consent for his or her child and any child in his or her legal custody B. For himself or herself in the following situations: 1. Lawfully married or a parent (emancipated) 2. Pregnancy (excluding abortions) 3. Venereal disease 4. Drug or substance abuse

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Minor Consent

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The nurse is assessing a post-surgical client who is in acute pain. The client is not willing to change position for X-rays. The nurse tells the client that a sedative injection would be administered if the client does not cooperate for the procedure. Which tort has been suggested? 1. Assault 2. Battery 3. Invasion of privacy 4. False imprisonment

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Assault/False imprisonment?

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A patient who is hospitalized with chronic illness is depressed and demands to go home. A member of the hospital staff applies a physical restraint and administers medication to the patient. What does this nursing intervention indicate? 1. The staff member is following Good Samaritan laws. 2. The staff member may be charged with malpractice. 3. The staff member is guilty of invading the patient's privacy. 4. The staff member may be charged with false imprisonment.

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4. False imprisonment.

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The nurse enters a patient's room with the morning medications and forgets to get the patient's scheduled pain medication. The nurse gets busy with other duties and signs the pain medication out as given. What is the legal significance of a nurse's action? A. The nurse has been negligent. B. The nurse committed a medication error. C. The nurse fulfilled the standard of care. D. The nurse can be charged with battery.

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A.

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When witnessing informed consent being given to a client about to undergo surgery, which actions should the nurse perform? Select all that apply. 1. If the client refuses to sign the consent, leave the situation as it is. 2. Confirm with the client that he or she has understood the information about the surgery. 3. Inform the health care provider if the client refuses to undergo the surgery. 4. Sign the consent form as a witness, once the client voluntarily gives consent. 5. Ask a nursing student to witness the informed consent if the nurse is busy.

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2. 3. 4.

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A nurse is evaluating the need for the use of restraints when managing a client with delirium. Under which circumstances should the nurse use restraints? Select all that apply. 1. When the client is improving 2. When the client refuses to undergo a chest-X ray 3. To ensure physical safety of the client 4. With a written order from a health care provider 5. When less restrictive interventions have failed

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3,4,5

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A nursing student is learning about the standards of care for nursing. What should the student do to maintain high nursing standards? Select all that apply. 1. Learn about the Nurse Practice Act in the state. 2. Follow the updates in laws and policies practiced. 3.Read current nursing literature in specified practice areas. 4. Know the policies and procedures for your employment agency. 5. Understand current legal issues affecting nursing practice.

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1, 2, 5 The Nurse Practice Act defines the scope of nursing practice, and all nurses should be aware of the particular laws in their respective states. Laws and policies can change with time, so keeping current with them is important. Reading current nursing literature in specified practice areas keeps the nurse up to date with the latest nursing knowledge; ignorance of such updates is not an acceptable excuse for malpractice. Understanding current legal issues affecting nursing practice is important; doing so helps the nurse practice in a fashion that avoids legal problems. Nurses should follow procedures given by the employment agency.

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Identify the legal issue in each of the following situations 1. The nurse has threatened the client with the use of physical restraints to control the client. 2. The nurse has published the wrong assessment findings of a client in a scientific journal. 3. The nurse has given an excessive dose of hepatotoxic drug to a client with liver failure. 4. The nurse has informed the spouse about the client's disease without the client's consent.

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1. assault. 2. defamation of character. 3. malpractice. 4. invasion of privacy.

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What should a nurse do to avoid malpractice and the resulting professional negligence? Select all that apply. 1. Strictly follow the given standards of care. 2. Regularly update current nursing knowledge. 3. Properly document all assessments and interventions. 4. Avoid explaining medical procedures to clients. 5. Complete health documentation at the end of the shift.

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1, 2, 3 As a rule, nurses should follow given standards of care to avoid malpractice. Regularly updating current nursing knowledge keeps nurses well informed of the latest medical knowledge and techniques and health care policies and laws. Properly documenting all assessments, interventions, and evaluations is necessary for future reference and communication with other healthcare team members. Nurses should clearly explain medical procedures to patients and obtain consent when necessary. Health documentation should be completed at the right time to ensure timely communication to other healthcare team members and to avoid negligence.

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The reciprocal process in which messages are sent and received between people

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Communication

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Purpose of Communication

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To establish/maintain a relationship with the client To ensure quality care To ensure continuity of care To ensure patient safety To accurate assess patient care needs For patient education

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Sender

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The person conveying the message

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Receiver

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The individual/individuals to whom the message is conveyed.

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Categories of Communication

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Linguistic Paralinguistic Metacommunication

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Linguistic Communication

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Use of Sound

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Paralinguistic Communication

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Body language, gestures, facial expressions, tone and pitch of voice are all examples of paralinguistic features.

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Metacommunication

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context of the communication setting. It is a broad term that refers to all the factors that influence communication This includes things like the person's mood, environmental factors like noise, the person's educational level or the relationship between the two people talking.

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Nonverbal Communication

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Messages transmitted without the use or words (either verbal or written)

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Forms of Linguistic Communication

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Written Interprofessional/SBAR-situation, background, assessment, reccomendation Therapeutic Communication

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Forms of Paralinguistic Communication

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Facial expressions, tone of voice, posture

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Active listening includes:

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(SOLER)-Communicates acceptance and respect. S-sit facing the patient O-observe and open posture L-lean forward E-eye contact R-relax

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thumbs up, wringing hands, tapping foot, crossing legs, crossing hands, pointing fingers Are all examples of:

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Gestures

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_____________________________ may give you cues about a persons pain level or if they are tense. A bouncy purposeful walk my tell you a person feels good or confident. Shuffling may tell you someone is sad or discouraged.

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Posture and Gait

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Consists of an exchange of information that facilitates the formation of a positive nurse-patient relationship AND actively involves the patient in all areas of her/his care.

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Therapeutic Communication

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Usually blocks the development of a trusting and therapeutic relationship

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Non-therapeutic Communication

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Initiating and Encouraging Interaction: Allows the client to choose the topic of discussion according to circumstances and needs. Examples: "Is there something you would like to talk about?" "What is your biggest concern?" "What can I do for you today?

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Broad Opening Statements

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Initiating and Encouraging Interaction: Allows client to choose the topic of discussion according to circumstances and needs. Encourages the client to elaborate and talk more about their concerns. These cannot be answered with a one word response. Examples: "What is your biggest concern?" "Tell me about your health." "Tell me about your accident." "What did your doctor say?" "How do you feel about your son's diagnosis?"

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Open Ended Questions

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Initiating and Encouraging Interaction: Verbal and nonverbal responses which acknowledge or indicate awareness of people by using their names/by calling attention to what is observed, the nurse encourages the client to be aware of their behavior. These techniques convey interest and concern. OFTEN USED AT BEGINNING OF A CONVERSATION. Examples: "You are smiling." "I see you are up already." "You've been pacing the hallway this morning." "I noticed you combed your hair."

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Giving Recognition/stating observations

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Initiating and Encouraging Interaction: Encourages client to continue talking. Shows that the nurse is listening to the client and is interested in what they have to say. Examples: "And then?" "Go on..." "Say more..." "Uh hummmm" Nodding

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General Leads

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Initiating and Encouraging Interaction: Responses in which all or part of client's statements are repeated or slightly rephrased. This indicates that the nurse is listening and validates, reinforces or calls attention to something important that the client said. Encourages the client to describe the situation more fully. Examples: Client:" I tossed and turned all night." Nurse:" It was hard for you to sleep." Client:" I am feeling so much better today than yesterday." Nurse: "You feel better today."

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Paraphrasing/Restatement

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Helping Client Identify and Express Feelings: Reflecting back to the client feelings they are expressing. This shows recognition and acceptance of the client's feelings and ideas and communicates that they have value. Verbal and nonverbal cues may be used. Examples: Client:" To tell you the truth, I'm a little nervous about getting my Hepatitis shot today." Nurse: "Getting a shot makes you anxious." Client:" I guess I'm worried about what could happen if my blood pressure gets too bad." Nurse: "You're blood pressure concerns you."

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Reflection/Sharing Empathy

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Helping Client Identify and Express Feelings: Let's the client know that you are present for them and available if they would like to talk. It is done to help comfort and provide support. You can offer self as well by non-verbal communication such as touch. Examples: " I am here if you need me" "I will stay with you awhile."

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Offering Self

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Helping Client Identify and Express Feelings: It gives the nurse and client time to gather their thoughts. Often used in very emotional situations. Be careful using this technique- silence can make some clients very uncomfortable. Don't let silence go so long that it becomes awkward.

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Silence

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Ensuring Mutual Understanding: Allows clarification of ideas that nurse may have interpreted differently than intended by client. It also lets the client know that the nurse heard them and acknowledges their concerns. It is used to verify the accuracy of the nurse's listening skills. "Did I understand you correctly that...?" "What I heard you say is...Is that correct?" "In other words..." "Tell me if I heard you correctly. You are most concerned about how this affect your ability to do your job when you get home?"

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Validation

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Ensuring Mutual Understanding: Encourages client to expand on a topic that is unclear or that seems contradictory or ambiguous. Examples: "I don't quite follow you..." "I'm not sure I understand what you mean." "What else happened?" "When you say hard, what do you mean?"

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Seeking Clarification

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Informs client of facts needed to understand situation. Provides a means to build trust and develop a knowledge base for clients to make decisions. It also includes giving information to correct a misconception. Examples: Describe your pain for me; is it sharp, stabbing, burning or does it radiate? "Let's talk more about your relationship with your father." "How has your family reacted?" "What's your biggest fear?"

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Giving Information

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Reduces the interaction to several main points identified by the nurse as significant and allows the client to agree or add other concerns. This technique helps to bring closure and is useful towards the end of a conversation. Examples: "So there are three things you are upset about, your family being too busy, your diet, and being in the hospital so long." "Let's review what we've talked about today."

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Summarizing

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Non Therapeutic These are highly focused questions that tend to elicit a specific, brief response. They restrict the client's expression of thoughts, feelings and ideas. Can be answered in one or a few words Examples: "How many children do you have?" "What church are you from?" "Is everything okay?"

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Close ended questions

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Asks client to justify reasons. Implies criticism and makes client feel defensive. Clients may interpret why questions as accusations or think the nurse knows the answer and are testing them. Examples: "Why did you go back to bed?" "Why do you feel that way?" "Why did you do that?

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Why questions

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Eases nurse's own discomfort and avoids exploring topic identified by client. This shows disinterest and lack of empathy. Examples: Client: "I'm having a hard time with my family." Nurse: "Do you have any grandchildren?" Client: "The tests that they ordered frighten me." Nurse: "We need to get you to PT."

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side stepping or changing subject

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This keeps client from actively engaging in finding a solution. Often clients know what should/should not be done and need to explore other ways of dealing with the issue. Examples: "Everything will be okay." "There is nothing to this procedure; we do it all the time."

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False reassurance/Unwarranted reassurance

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The nurse expresses their opinion about what is right/wrong or good/bad, especially on a topic that concerns a client. These responses convey approval or disapproval about what people have said. Examples: "You should keep the baby." "It's good you decided to breast feed." "With your determination, you'll be able to handle this." "God will help you get through this."

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Moralizing/Value Judgment (similar to approval/disapproval in Potter and Perry)

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By telling the client how the nurse would feel in a similar situation, the focus is taken off the client and their feelings and concerns. A nurse's own emotional issues can decrease their objectivity and prevent effective listening and problem solving. Examples: Client: "I don't know how I will manage without Mark." Nurse: "I know what you mean. I lost my husband two years ago. It was very lonely." "The same thing happened to me..."

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Sympathizing

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Moves focus away from client's feelings without acknowledging concerns. It implies that the client has no right to their opinion. Examples: "The nurses here work very hard." "Your doctor is extremely busy." "This is a great hospital."

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Defensiveness

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These are cliche responses that deny the uniqueness of each client. These do not encourage the client to respond. Examples: "All clients with cancer worry about that." "You know how men are." "Mothers always worry about their children."

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Stereotyped responses/ automatic responses

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Responses in which nurses make unsubstantiated assumptions about what people mean, such as interpreting people's behavior without asking for validations or jumping to conclusions. Can lead to misunderstanding and lack of trust in the nurse. Examples: "What you really mean is you don't like your doctor?" "Subconsciously you are blaming your husband for the accident."

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False Inferences

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1. Nurse: Mr. Smith, I see you haven't eaten your breakfast yet". Patient: "Yes, I just don't feel like eating today." Communication technique: Therapeutic or Non-therapeutic

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Stating an observation Therapeutic

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2. Nurse: "You need to eat to keep up your strength. You won't get any better if you don't eat." Patient: "I know, but my stomach's upset. ( does not maintain eye contact, looking at the floor and picking at the linens) Communication technique: Therapeutic or Non-therapeutic

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Approval/disapproval Non therapeutic "You don't feel like eating?"

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3. Nurse: "You seem upset; would you like to talk about it?" Patient: "No, I'm okay. I'm just a little nervous about my upcoming surgery. I know it will be fine; I need the surgery. I just need to get through it and then I can get on with my life." Communication technique: Therapeutic or Non-therapeutic

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Stating an observation and closed-ended questions. Both "You seem upset. Tell me what's going on."

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4. Nurse: "Well, if you need to talk about anything I am here to listen. (gets blood pressure cuff and puts it on the patient's arm) Let's get your blood pressure and check you all over to make sure you are ready for surgery tomorrow." Communication technique: Therapeutic or Non-therapeutic

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Offering self and changing the subject Both It would have been better to try to get the patient to discuss their concerns a little more. "Well, I am here to talk about anything and listen. Tell me what concerns you have about the surgery."

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1. Mr. Green: "Did you know, when I was talking to the doctor yesterday, he told me that I might have to have my foot amputated?" Nurse: (the nurse stops what she is doing, turns to Mr. Green, and using good eye contact says) "Tell me about what he said." Communication technique: Therapeutic or Non-therapeutic

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Open ended question Therapeutic

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2. Mr. Green: (Wringing his hands) "He said if this infection doesn't get under control, the infection could spread to my blood. He said if it doesn't get better soon, they may have to amputate part of my leg" Nurse: (sets down the dressings and gives good eye contact) "That makes you very concerned." Communication technique: Therapeutic or Non-therapeutic

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Reflection Therapeutic

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3. Mr. Green: "Yes, it scares me to think that I might lose my leg or my life because you can't get the infection to go away."(Mr. Green gets very emotional and fights back tears) Nurse: (the nurse remains silent for a minute and puts her hand on the patient's leg) Nurse: "Well, we are doing everything we can to make sure that doesn't happen. I'm sure the doctors will find the right drug to stop this infection. (starts to organize the dressings)Let's take a look at that wound. Do you need any pain medication before I get going?" Communication technique: Therapeutic or Non-therapeutic

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Silence False reassurance Non Therapeutic Instead of using false reassurance you could have said something like: "Tell me more about what the doctor said to you." This may help to open up the conversation more and allow you to more fully understand what the physician said. Maybe the patient needs more information to understand what is happening with his foot.

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4. Mr. Green: "Well, I hope you are right. Yes, I could use a little medication. It hurts quite a bit when they take the dressings out." Nurse: "Okay, I'll be right back with that medication and then we'll plan to do the dressing in about 30 minutes so we allow time for the medication to start working." (nurse leaves the room) Communication technique: Therapeutic or Non-therapeutic

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Giving information Therapeutic

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1. Nurse: "Good afternoon, how are you feeling after you ate your lunch? I know earlier today you said you were really hungry." (walked over to bedside table to grab the empty meal tray) Mrs. Thompson: "Oh I feel much better now. (puts lid on meal tray and smiles at the nurse) Now I have a question for you; why did I only get two medications before lunch, usually I take more than that?" Communication technique: Therapeutic or Non-therapeutic

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Broad opening question Therapeutic

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2. Nurse: "The reason is because two of the meds need to be taken 30 minutes prior to the other meds. Here are the other two now."(sets meds down on table) Mrs. Thompson: (looks down at cup of meds) "yes that looks more like it." (looks up at nurse) "To be honest, I'm not sure what all I'm taking. This is more than I take at home, but I trust they are doing what is best for me." Communication technique: Therapeutic or Non-therapeutic

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Giving information Therapeutic

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3. Nurse: You don't know what medications you are taking?" Mrs. Thompson: "Well, I have an idea, I'm assuming it has something to do with my broken leg, but no one has really told me." (looks down at meds on the table with eyebrows raised) Communication technique: Therapeutic or Non-therapeutic

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Clarification Therapeutic

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4. Nurse: "You're uneasy about it."(the nurse touches patient's hand and smiles)." I would be happy to go over your medications with you so that you understand what you are taking and why." Mrs. Thompson: "No, that's okay. I know you nurses are really busy. I trust you."(pats nurse's hand) Communication technique: Therapeutic or Non-therapeutic

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Reflection I would call this second part "giving information", but the nurse is sort of suggesting a solution to her unease, instead of letting the patient decide what she wants to do about it. Therapeutic

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5. Nurse: "Oh, I have the time. Don't worry. I know I would like to know if I were you. I know I would not like if I felt like the staff didn't have time to explain things to me." Mrs. Thompson: "Well, if you have the time, I would appreciate you telling me about my medication." (interlocks fingers and sets them across abdomen and looks up at the nurse with a smile) Communication technique: Therapeutic or Non-therapeutic

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Sympathizing or you could also call it "giving a personal opinion" Non therapeutic I would use "offering self" which allows the patient to decide if they want to pursue the issue. I would probably say something like: "I have the time if you would like to go over your medications" or you could also say: "Just let me know if you would like to go over them. I am available whenever you would like to talk."

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6. Nurse: "What meds are you already taking?" (looks down at the medication administration record) Mrs. Thompson: "Well, I can't remember the names off the top of my head. Just read them off to me and I'll tell you the ones I don't know." Communication technique: Therapeutic or Non-therapeutic

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Focused question Therapeutic

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7. Nurse: (the nurse reads off the list stating the names and their indications for use) "Which ones don't you recognize?" Mrs. Thompson: "I know all but the two that you said were a laxative and an antibiotic." Communication technique: Therapeutic or Non-therapeutic

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Focused question Therapeutic

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8. Nurse: "So the Senokot and the Ciprofloxacin?" (looks at the MAR and then at the patient) Mrs. Thompson: "Yes, those two." Communication technique: Therapeutic or Non-therapeutic

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Clarification or could also call it focused question Therapeutic

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9. Nurse: (the nurse explains about the two medications) Do you have any questions about what I just said?" Mrs. Thompson: "No, no. I'm just glad to know what's going on. (leans back in the bed) Communication technique: Therapeutic or Non-therapeutic

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Giving information Closed-ended question Therapeutic and non therapeutic Instead of using a closed ended question, the nurse could have used an open ended question and said: "What other questions do you have?"

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10. Nurse: "What other questions do you have for me today?" Mrs. Thompson: "Nothing else right now. Thank you so much for your time." Communication technique: Therapeutic or Non-therapeutic

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Open-ended question Therapeutic

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11. Nurse: "My pleasure. If you need anything else just press the call light. Communication technique: Therapeutic or Non-therapeutic

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Offering self Therapeutic

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Nurse: (Shakes patient's hand) "I am Linda Davis. I am your nurse and I am here to meet you and learn about your current health." Patient: (shakes head) Communication Technique used:

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Giving recognition Giving information

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Nurse: "What brings you here today?" Patient: " I have had a lot of stomach pain" (holding abdomen)

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Open ended question

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Nurse: "What do you mean by a lot of stomach pain?" Patient: Well, for the last week, after I eat, I can have stomach pain that lasts up to 2 hours.

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Clarification

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Nurse: "Have you had any changes in your diet?" Patient: Well, no... but I notice, I know I'm not eating regular meals."

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Focused question (could also say it is side-stepping)

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Nurse: "So you have been having pain for about a week and its worse after you eat and it's even worse when you don't have any regular meals? What do you mean by regular meals?" Patient: "Well, like if I don't eat breakfast, I skip it and then I have lunch; it's really bad after lunch if I've skipped a meal."(continues to hold abdomen)

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Validation and clarification

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Nurse: "I can tell you are having pain right now. On a scale of 0 to 10, with zero meaning no pain and 10 meaning the worst pain you've ever had, what number best describes your pain?" Patient: "Eight, and I don't think I can take much more of this!"

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Stating an observation Focused question

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Nurse: "You know sometimes stress makes your stomach pain worse. Is there anything going on in your life right now?" Patient: "Well, I lost my job, I live alone. And my daughter has cancer and I have been trying to help her as much as I can with my grandchildren." ( begins to tear up)

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Giving information Closed ended question

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Nurse: (hands a tissue to the patient) "I know you have a lot of worries right now with losing your job and taking care of your daughter and grandchildren." Nurse: "I am really impressed by what you are doing." Nurse: "I can tell it has been really hard." Patient: (shaking head yes)

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Validation

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Nurse: "We are going to figure out what's causing you pain and we are going to make you more comfortable." Patient: ( patient shakes head yes) "Thank you" Nurse: (leaves room with patient still crying)

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False inference

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