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NURS 101 Midterm: NURS101-Midterm-Review

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NURS 101
Cheryl Pulling

NURS101 Midterm Review Bracken Health Sciences Library Information Literacy • Information literacy is a set of abilities requiring individuals to “recognize when information is needed and have the ability to locate, evaluate, and use effectively the needed information.” Why are IL skills important for nurses? • “As we move into the next millennium, we expect nurses to care with their hearts and minds; identify patients' actual and potential health problems; and develop research‐based strategies to prevent, ameliorate, and comfort. ACLR Standards • The information literate student… 1. Determines the nature and extent of the information needed 2. Accesses needed information effectively and efficiently 3. Evaluates information and its source critically and incorporates selected information into his or her knowledge base and value system 4. Uses information effectively to accomplish a specific purpose 5. Understands many of the economic, legal and social issues surrounding the use of information ethically and legally The Literature Search Process 1. Define your topic 2. Look for background information 3. Formulate your specific question 4. Look for specific information 5. Evaluate your findings Citations • A citation is basically a description of a published item, whether in print or electronic, that allows another person to locate them What is in a Citation? • Authors’ names • Book title • Date of publication • Journal title • Volume number • URL • Page number • The information which is included depends on the type of information being described o Book vs. Journal vs. Website Boolean Operators • Simple words (AND, OR, NOT or AND NOT) used as conjunctions to combine or exclude keywords in a search, resulting in more focused and productive results. • AND o Combines different terms when you want both to appear o Narrows a search • OR o Combines terms which are the same or similar in meaning when either could appear o Broadens a search Office of Interprofessional Education & Practice (OIPEP) Interprofessional Care: A Blueprint for Action in Ontario (2007) • Mounting evidence for IP care: o Increased access to health care o Improved outcomes for people with chronic diseases o Less tension and conflict among caregivers o Better use of clinical resources o Easier recruitment of caregivers o Lower rates of staff turnover The National Interprofessional Competency Framework Queen’s Interprofessional Education Framework Therapeutic Relationships What does this mean? • Relationship with our patients, patients family, etc. • Core to nursing practice Queen’s Five Fundamental Values • Honesty • Trust • Fairness • Respect • Responsibility Foundational Concepts of Our Nursing Program • Quality • Client • Health • Environment • Transitions Caring • Leininger • Swanson • Watson • Bener, Benner, Wrubel • Can you teach someone to care? • Everyone does care but we can learn ways to demonstrate that you care. Professional Relationships • Nurse-client • Nurse-family • Nurse and Health Care team • Nurse with community • Nurse with different organizations Nurse-Client Relationship • The nurse establishes, directs & takes responsibility • Client needs are priority • Confidentiality • Nurse is non-judgmental The Helping Relationship • A partnership • Different than social relationship (because your goal is to obtain optimal health) • Boundaries • Very rewarding profession Components • Trust • Respect • Professional Intimacy • Empathy • Power • Patients are in a vulnerable position • You need to keep the promises that you make • Be empathetic • Respect each person regardless of any differences • Power imbalance -> be sure not to abuse it • Empathy – put yourself in someone else's shoes, be understanding, mirror? • Sympathy – a feeling The Nurse is Accountable for the Professional Relationship • The nurse establishes, maintains, and terminates the relationship • Patient centered care—What does this mean? o Modifying procedures based on what the patient wants o Work with people, try to put their wants and desires as a top priority • Maintains boundaries • Protecting client from abuse Principles • The nurse functions within the Standards of practice • Maintains professional behavior • Focuses on patient (pt) goal • Respect individual differences/characteristics (everyone is different) • **Recognize when you need help • Some patient behavior can appear abusive o Some patient conditions we will try to understand ▪ Alzheimer, Dementia, Strong Pain Killers, Confusion, Major Loss, Withdrawal Effective Communication is an essential factor in creating & maintaining a successful relationship Clarify Boundaries • Health Unit type Clinic, make sure the teenagers know that their parents wont find out why they are there • Hospital, if you get assigned to someone you know you can ask to get a change o Shouldn't’t be a family members nurse • Clinic, probably going to know a lot of your patients o Clarify that it is a patient-professional relationship How Does the Nurse Manage the Relationship? • Nurse engages in reflective practice • Nurse follows an established and comprehensive PLAN OF CARE o Each patient has a plan of care that is given to them by their health care team • Nurse meets own needs outside this relationship. • The nurse understands & communicates expectations for confidentiality • The nurse is sensitive to the context in which care is provided • The nurse understands & communicates expectations for confidentiality • The nurse is sensitive to the context in which care is provided o Community and home visits are tricky ▪ You’re allowed to have tea Boundaries • Know them • Respect them Psychotherapeutic Relationship • A psychotherapeutic relationship involves planned and structured psychological, psychosocial and/or interpersonal interventions aimed at influencing a behavior, mood and/or the emotional reactions to a different stimuli. o Definition from CNO (2006). Therapeutic Nurse-client Relationship. (From WHO 2001) • One year after the therapeutic relationship • Can’t take care of them if they are readmitted • Cant date while giving care • If they aren't frequent to your care Acceptable or Unacceptable • Self disclosure o Sometimes, if it helps them and you turn it right back to the patient again, don’t upstage the person, if it helps their understanding • Accepting gifts from patients o Not personally, unless it will devastate them, tell your manager, acceptable for a team of nurses • Giving gifts to patients o Don’t give gifts to the patients unless it is from a group of nurses, its kind of frowned upon • Attending patient funerals o One nurse per funeral usually, not about liking or disliking the patient Boundaries are blurring or crossed: Warning Signs • Extra time with client beyond therapeutic needs • You understand the patient the best? • Disclosing personal problems • Dressing differently • Thinking about the client… • Off-duty time with client • Ignoring policies of the agency • Keeping secrets • Giving a home number unless it is part of required nursing role • Being defensive when questioned about your interactions Abuse • The misuse of power • Betraying trust • Violating respect • Many forms—all unacceptable. • Neglect • Financial (don’t borrow money or silicate gifts) CNO • Responsibility of nurse to report instances of abuse o If you know of abuse and don’t report it you are in trouble o It is professional misconduct if you do not report unsafe or unethical conduct. Communication Learning Outcomes • By the end of this lecture, the learner will be able to: • Differentiate between active and passive listening • Explain when technology should and should not be used in the therapeutic relationship • Consider factors that define own culture Communication • Communication is just as important for the healthcare professional delivering care, as it is for the patient receiving care • Purpose is to share information. • Many reasons in healthcare why we must be able to communicate effectively…. Importance • Can result in both harm and good. • Hurt or heal • VERY powerful Forms of Communication • Verbal o Use of words • Active Listening o Listening attentively with one’s whole being o Don’t be concerned about what to say next o Listen without judgment o Minimal cues and leads – smiling, nodding, leaning forward o Clarification o Paraphrasing o Summarizing • Goal: to understand your patient How do we Communication Other than the Spoken Word? • Body Language • Facial Expressions • Eye Contact • Tone of Voice • Listen • Everything we do (basically) Communication is Done Through: • Words = 20% • Tone = 20-30% • Non-verbal = 50% Assertiveness • The ability to express your thoughts, your ideas, your feelings without undue anxiety & not at the expense of others  VERSUS non-assertive or aggressive Interprofessional Communication • Focus on accomplishing mutual health goals for patients • Build positive relationships • Good communication can improve patient outcomes • Teamwork Silence • Silence is golden • Gives time to think • Doesn’t make a situation feel rushed Non-Verbal Communication • Personal appearance • Posture & gait • Facial expression • Eye-contact • Gestures Other Forms of Communication • Short forms • Written words • Social media and technology CNO Professional Standards • Ethics o Maintaining Commitments – to clients, to the nursing profession and to oneself o Be accountable • Privacy and Confidentiality o Not discussing client information with colleagues or others in public places o Not using standard e-mail to send personal health information o Don’t discuss patient information • Accountability o Reporting to the appropriate authority any health care team member or colleague whose actions or behaviours toward clients are unsafe or unprofessional • Leadership o Each nurse demonstrates his/her leadership by providing, facilitating and promoting the best possible care/service to the public Summary: Technology and your Nursing Role • Many practice standards can be applied to the use of technology in the healthcare setting • Determine an appropriate level of use for technology in your practice • Determine the positive and/or negative impacts it can have on the public, your career and the profession • New and innovative technology is here and more is still to come, we need to embrace it and adapt it to our profession Bridges: Respect • Maintain professionalism • Accept differences in values or opinions • Respect cultural differences • Acknowledge mutual health goals • Ask patients how they would like to be addressed; avoid casual names: dear, hun • Respect privacy and confidentiality Bridges: Caring • “An intentional human action characterized by commitment and a sufficient level of knowledge and skill to allow you to support the basic integrity of your client.” • (Arnold & Boggs, 2011) • Family-centered care • Ethical responsibility • Be a positive patient advocate • Understand your patients perspective Bridges: Empowerment • Assist patients to assume responsibility for their own health • Nurse’s role: Provide the patient with the necessary resources and tools to help them obtain independence in managing their own health • Makes patients feel valued, improves coping mechanisms and positive thinking • Key concept in many nursing theories Bridges: Communicating Important Information • Engage patients in their own care • Help patients understand and take control over their own health (avoid medical jargon, use unique approaches) • People have capacity to understand their own health information • Self-management, this is particularly important for patients who have a chronic disease • Provide patient with necessary resources or inform them of resources that exist Bridges: Trust • Crucial towards: o obtaining an accurate assessment o establishing a positive relationship • Maintain an open exchange of information • Be honest • Maintain confidentiality • Follow through on commitments Blocking Behaviors, Communication Styles (Don’t) • Asking personal questions o If its relevant to the care then you can ask if it isn’t than don’t ask • Giving personal opinions • Change the subject • Automatic responses • False reassurance o “It will be okay, everything will work out” Barriers: Blocking Behaviors • Sympathy • Approval or disapproval • Defensive responses • Passive or aggressive responses • Arguing • Failure to listen • Failure to probe • Parroting • Patronizing • Environmental distractions • Amount of space between you and the patient (will depend on the individual) • Arrangement of furniture • Space violation Barriers: Health Conditions • May pose as a barrier to communication o Hard of hearing o Stroke o Embarrassment o Visually Impaired Reducing Anxiety • Be calm and unhurried • Teach breathing and relaxation techniques • Initiate recreational activities • Explore reasons for anxiety • Provide clear explanation of procedures • Be honest • Note: really talk to people about why they are anxious Barriers: Therapeutic Relationships • Stereotyping and bias • Over involvement • Cultural barriers Perception • Are influenced by many factors: o Individuals own experience o Educational background o Individuals own culture • All of us see things in a certain way Perceptual Biases • Human tendencies that interfere with accurately perceiving and interpreting messages from others Stereotyping • Process of attributing characteristics to a group of people as though all persons in the identified group possess them (Arnold & Boggs, 2011) • Ethnic origin, culture, religion, social class, occupation, age, health issues Culture • Refers to the learned beliefs, values, norms, and way of life that influence an individuals thinking, decisions, and actions in a certain way. o Adapted from Leininger, 1991, in CNO document. Cultural Competence • Assume that everyone has a culture • Meaning of illness • Understand client’s beliefs and values • Avoid stereotyping • Assess each patient as an individual Language Barrier: Interpreters • Used when language barriers exist • Obtain consent from patient • Ensure that interpreter is appropriate for the situation • Ensure that information translated is understood by patient • Interpreter is the “voice of the client” • Talk to client Nurse’s Role: Culturally Sensitive Care • Accountability • Seek ways to broaden your understanding of cultural concepts and issues • Be non-judgemen
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