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Michelle Maroto

NSE 12 FALL EXAM REVIEW: WEEK 2- Exploration of Self 1. Define self-concept and self esteem -“SELF CONCEPT” an organized network of ideas, feelings, and actions that every person has a consequence of experiences and interactions with other people (parents being the most important in the development process) -how a person thinks about themselves, a subjective sense of self and a complex mixture of conscious and unconscious thought, attitudes, and perceptions. -“SELF ESTEEM” reflects the degree to which one feels valued, important, or satisfied with the concept of self. -self-esteem is an emotional process of self-judgment, an orientation to the self, ranging on a continuum from feelings of self-efficacy and respect to a feeling of being fatally flawed as a person - self-esteem is subjective and develops from individual’s perceptions of their personal being and achievements -self-esteem stems from self-concept, and self-esteem influences self-concept -self-concept is a descriptive term, whereas self-esteem is an evaluative term 2. Illustrate how self-concept and self-esteem affect communication -self-concept influences communication through perceptual and cognitive processes such as selective attention and self-fulfilling prophecy. -as nurses see themselves worthy of being cared for, they are more capable of giving to others. -becoming centered enhances the nurse’s ability for helping clients to develop their self-concept in developing to their highest potential. -health care professionals facilitate communication and ensure that the nursing care plan is individualized to meet each client’s needs 3. Explore concepts related to personal and professional self -“SELF AWARENESS” is the means by which a person gains knowledge and understanding of all aspects of self-concept. -nurses who are comfortable with themselves can help clients use a similar process of self- reflection in understanding themselves. -self-awareness provides an inner frame of reference for connecting emotionally with the experiences of another -self-awareness helps the nurse avoid using therapeutic interpersonal relationship with clients to meet personal rather than client needs -“SELF REFLECTION” is a mental process by which we are able to consciously examine the meaning of our motives and actions. -nurses learn more about themselves through self-reflection and feedback of others. -self-reflection increases the nurse’s capacity to be genuine. -knowing personal motivations, prejudices, strengths, and limitations helps the nurse connect with clients in a straightforward manner 4. Describe components and stressors of self-concept -components of self-concept include identity, body image, and role performance -“IDENTITY” involves the internal sense of individuality, wholeness, and consistency of a person over time and in various circumstances. It implies being distinct and separate from others. -“BODY IMAGE” involves attitudes related to the body, including physical appearance, structure, or function -“ROLE PERFORMANCE” is the way in which individuals perceive their ability to carry out significant roles. -a self-concept stressor is any real or perceived change that threatens identity, body image, or role performance -“IDENTITY STRESSORS” developmental markers such as puberty, menopause, retirement, and decreasing physical abilities may affect identity. It is most vulnerable during adolescence. -identity confusion results when people do not maintain a clear, consistent, and continuous consciousness of personal identity -“BODY IMAGE STRESSORS” changes in appearance, structure, or function of a body part requires an adjustment in body image. -“ROLE PERFORMANCE STRESSORS” -role conflict results when a person simultaneously assumes two or more roles that are inconsistent, contradictory, or mutually exclusive. -role ambiguity involves unclear role expectations. It is common in adolescence, where they are pressured by parents, peers, and media to assume adult like roles. -role strain is the stress or strain experienced by an individual when behaviours, expectations, or obligations associated with a single social role are incompatible. -role overload involves having more roles or responsibilities with a role than are manageable. -“SELF ESTEEM STRESSORS” children with low self-esteem are more likely to bully other children and be bullied. Low self-esteem in adolescence is one of the strongest predictors of depression and is related to suicide. Self-concept stressors in older adults include health problems, reduced functional abilities, spousal loss, etc. 5. Explain the nurse’s effect on a client’s self-concept -your acceptance of a client with an altered self-concept helps promote positive change -the client and family will likely observe your verbal and non-verbal responses and reactions -need to be aware of own feelings, ideas, values, expectations, and judgments -being self-aware of own identities allows you to be more readily able to accept and thus reinforce client’s identities -building a trusting nurse-client relationship and appropriately involving client and family in decision making can enhance their self-concept 6. Explore how culture affects values and beliefs X WEEK 3- GROUP COMMUNICATIONS 1. Describe the basic concepts related to groups and group communication in health care setting -“GROUP” defined as a) a gathering of two or more individuals b) who share a common purpose c) and meet over a substantial time period d) in face to face interaction e) to achieve an identifiable goal -“PRIMARY GROUPS” are more spontaneous and linked to the values of an individual -characterized by an informal structure and social process, group membership is either automatic (family) or is freely chosen because of a common interest (in scouting, religious, or civic groups) -informal structure and informal purpose -“SECONDARY GROUPS” are not spontaneous. They differ from primary in structure and purpose. -they have a planned, time limited association, a prescribed structure, a designated leader, and a specific identified purpose. -hen the goal is reached, the group disbands -ex: focus groups, therapy groups, discipline-specific work groups, educational groups… 2. Discuss professional and interdisciplinary team collaboration as an example of a secondary group X 3. Discuss factors that influence group dynamics -“GROUP DYNAMICS” a term used to describe communication processes and behaviours occurring during the life of the group 4. Describe the phases of group development -“FORMING PHASE” initial phase of group development. When the group has just formed, the members feel anxiety and building trust and developing commitment is important. -“STORMING PHASE” once people feel comfortable with each other, they cope with power and control issues. People use testing behaviours to elicit boundaries, communication styles, and personal reactions from other members. Such behaviours might include disagreements. This stage might be uncomfortable but it leads to development of group norms “NORMING PHASE” feedback becomes more spontaneous and group members begin to share more responsibility for leadership of the group. They exchange more personal information and begin to think about the task at hand. Common agreement develops about behavioural standards and individual goals align with group goals. Group holds members accountable and challenges those who fail to adhere to them -“PERFORMING PHASE” where most group work is accomplished. There is an esprit de corps and a possibility of affirmation, which is where people feel validated, respected, and cared about as a person -“ADJOURNING PHASE” final phase of group, which ideally occurs when group members have achieved desired outcomes. Group members express their feelings about one another as significant group members and their perception of personal contributions to attainment of identified objectives. 5. Define conflict and explore its impact in the group process -“CONFLICT” is tension from incompatible goals/needs, action of one frustrates the other, may be due to lack of communication and common cause. 6. Recognize and describe personal styles of response to conflict situations -PERSONAL STYLES: -“AVOIDANCE” lose-lose -“ACCOMODATION” win-lose -“COMPETITION” lose-lose -“COLLABORATION” win-win 7. Identify interventions that can be used to solve interpersonal conflict situations -CONFLICT INTERVENTIONS: -reflect -prevent -assess presence of conflict -resolving: prepare for encounter, organize info, manage own anxiety/anger, therapeutic communication -CARE: clarify, articulate, request a change, encourage change 8. List the objective and describe the requirements of Team Based Learning assignment X 9. Explain the purpose and method of Reflective Practice and use of LEARN in this process -“REFLECTIVE PRACTICE” • Associated with learning from experience – ‘Reflection is learning from everyday experiences with the intent of realizing desirable practice’ (Johns, 2004, p. 24) • Develop oneself as a reflective practitioner • Enables the student to be authentic and to make a unique contribution to the nursing profession -“REFLECTIVE ANALYSIS” • We all learn from experience • Reflective analyses formalize this learning • Supports the development of critical thinking skills -“LEARN PROCESS” • Increased emphasis on critical thinking • Change theory • Aesthetic expression -LOOKING BACK: Recalls and briefly outlines the event • A meaningful event presented • Event described concisely -ELABORATE: Objective Recall • Provides comprehensive description of event – What did you see, hear, taste, touch & smell? – Who was involved? – What happened? – What was said and/or done? – Are there ethical, cultural, spiritual, developmental, social or economic considerations to be taken into account? – Are there health/illness considerations to be taken into account? Subjective Recall • Explores the meaning of event – What did you think? Feel? – What were your intuitions? – How do you think others felt? – What are your values and/or beliefs in relation to this event? – Where do these values & beliefs arise and why? -ANALYZE: Incorporates knowledge and insights into the analysis of event • Identify the key issue – What was your sense of what was happening? – Formulate hypothesis about the key issue • Consider what is known from nursing & related courses, what you need to know & where you might find the information • Use literature to interpret the event & demonstrate how the readings expanded your understanding • Describe how your thinking about the key issues changed -REVISION: Revises thinking about the event based on new learning, *Focus on the event you are discussing and your role in it. • Identify which of your behaviors/actions you would preserve in the future & why • Identify how you would change your behaviors /actions in the future & why -NEW PERSPECTIVE: Formulates recommendations for professional growth related to the analysis of the event, * Focus on the future • Make recommendations for learning and actions/behaviors in similar situations for the future • Identify your priority learning needs and how you will achieve them -SELF ASSESSMENT • Based on CNO Professional Standards • Submitted at end of winter semester • Provide examples for standards – Things that you learned, things that you did – Focus on experiences from clinical practice • Identify strengths, areas/strategies for growth & development WEEK 4- NURSING INTERVENTIONS 1. Explain the relationship between CHAIN OF INFECTION and transmission of infection -the development of an infection occurs in a cycle that depends on presence of all following elements: • an infectious agent (pathogen) • a reservoir (source for pathogen growth) • a portal of exit from reservoir • a portal of entry to a host • a susceptible host -an infection develops if this chain remains intact, you can break the chain by following infection- prevention and control practices. -“INFECTIOUS AGENTS” microorganisms include bacteria, viruses, fungi, and protozoa -microorganisms on the skin are called RESIDENT or TRANSIENT FLORA -resident organisms are permanent on the skin, where they survive and multiply without causing harm -transient microorganisms attach to skin when a person comes in contact with another person or object, like a contaminated dressing or a bedpan -these organisms attach loosely to skin in dirt and grease and under fingernails and may be transmitted unless removed by handwashing -ANTIBIOTIC RESISTANT are organisms that are able to survive exposure to one or more antibiotics -the potential of microorganisms to cause disease depends on: a sufficient number of organisms, virulence (ability to produce disease), ability to enter and survive in host, susceptibility of host -“RESEVOIR” a place where a pathogen can survive but may or may not multiply -most common is the human body, where many microorganisms live on the skin and within body cavities, fluids, and discharges -when a pathogen is present but does not cause harm, it is “colonizing” the site -“carriers” are animals or persons who show no symptoms of illness but have pathogens that can be transferred to others -to thrive, pathogens require a reservoir that provides: Food, Oxygen (or absence of it), Water, Appropriate Temperature, pH, and Minimal Light -“PORTAL OF EXIT” the path by which the pathogen leaves the reservoir -after microorganisms find a reservoir, they must find a portal of exit if they are to enter another host and cause disease. -exits in human body include Body Openings: mouth, nose, rectal, vaginal, urethral; Breaks In The Skin: scrape, cut, wounds, and breaks in mucous membranes. -pathogens are carried through portals of exits by blood, body fluids, excretions, and secretions: urine, stool, vomitus, saliva, mucus, pus, vaginal discharge, semen, wound drainage, bile, sputum -“MODES OF TRANSMISSION” -CONTACT TRANSMISSION: transfer of microbes by physical touch • Direct Contact: physical skin-to-skin contact between infected/colonized individual and susceptible host • Indirect Contact: contact between susceptible host and contaminated intermediate object • Droplet Transmission: large droplets from respiratory system of infected source propelled up to 1m through the air and deposited onto susceptible host -AIRBORNE TRANSMISSION: small airborne particles containing microbes remain suspended in the air for long periods of time, air currents transmit these particles long distances >1m, and susceptible host inhales them -VEHICLE TRANSMISSION: a single contaminated source transmits infection to multiple host, possibly resulting in an outbreak -VECTORBORNE TRANSMISSION: insects or pests transmit microbes to humans -“PORALS OF ENTRY” route through which the organism can enter the host -organisms can enter the body through the same routes they use to exit -“SUSCEPTIBLE HOST” - whether a person acquires an infection is related to their susceptibility to an infectious agent -susceptibility depends on the individual’s degree of resistance to a pathogen -Who is the susceptible host? • Patient – Support defence – Promote healing • Other individuals also - health care workers, visitors 2. Give an example for preventing infections for each of the elements of chain of infection -“ASEPSIS” the absence of pathogenic microorganisms. Medical asepsis includes procedures used to reduce and prevent the spread of microorganisms -CONTROL OR ELIMINATION OF INFECTIOUS AGENTS: -reusable objects must be cleaned thoroughly before reuse and then either disinfected or sterilized -when cleaning equipment that is soiled by blood, fecal matter, mucus, or pus you should wear a mask and protective eyewear and waterproof gloves. 1. Rinse object with cold running water to remove organic material. Hot water causes it to stick to objects 2. After rinsing, wash with soap and warm water. Soap reduces surface tension of water and emulsifies the dirt. Rinse the object to remove the emulsified dirt. 3. Use a brush to remove the dirt or material in grooves or seams. 4. Rinse object in warm water 5. Dry object and prepare it for disinfection if indicated 6. Brush, gloves, and sink in which equipment was cleaned should be considered contaminated and should be cleaned and dried -“Disinfection” is the elimination of all pathogens EXCEPT for spores and are used on inanimate objects, antiseptics are used on living tissue (chemicals, heat, ultraviolet light, alcohols, chlorines) -“Sterilization” is the destruction of all microorganisms INCLUDING spores (steam under pressure, hydrogen peroxide plasma, chemicals) -CONTROL OR ELMINATION OF RESEVOIRS: -you must eliminate or control sources of body fluids, drainage, or solutions that might harbour microorganisms. -you must also discard articles that become contaminated with infectious material -CONTROL PORTALS OF EXIT: -to control exits via respiratory tract, you should wear a mask, avoid talking directly into client’s face, and never talk, sneeze, or cough directly over surgical wounds or sterile dressing fields. -cover your mouth or nose when sneezing or coughing -teach you clients to protect others when they sneeze or cough and provide them with disposable wipes or tissues -if you have an upper respiratory tract infection, consider not working, if you do continue working, wear a mask when working closely with a client and pay special attention to hand hygiene, you should not be caring for clients who are highly susceptible to infections. -always wear disposable gloves when handling blood, body fluids, secretions, or excretions -masks, gowns, and protective eyewear should be worn if splashing or contact with any fluids is possible. -lab specimens are handled as if they were infectious -CONTROL OF TRANSMISSION: -in hospital, home, or long term care facility, a client should have personal set of care items -soiled items and equipment should not touch your clothing -fluid resistant linen bags should be used, or soiled linen should be carried with hands held out from the body -laundry hampers should be replaced before they are overflowing HAND HYGIENE -most basic and important -includes using an instant alcohol hand antiseptic before and after providing client care, handwashing with soap and water when hands are visibly soiled, and performing surgical scrub when necessary -good hand washing: use of adequate soap, rubbing hands together and create friction, and rinsing under a stream of water -type of hand hygiene depends on: intensity of contact, degree of contamination, susceptibility of client, and procedure or activity performed -wash hands at least 15 seconds, if visibly soiled, may need more -plain soap with water can physically remove a certain level of microbes, but antiseptic agents are necessary to kill or inhibit microorganisms -alcohol based water less antiseptics is recommended because it is more effective -wash hands if visibly soiled, use alcohol antiseptic if not -use alcohol antiseptic: before direct contact with client, after direct contact, before donning gloves, and after removing gloves, after contact with fluids, when moving from contaminated body site to a clean body site, after contact with inanimate objects -CONTROL OF PORTALS OF ENTRY: -maintaining the integrity of skin and mucous membranes reduces chances of microorganisms reaching a host -client’s skin should be kept well lubricated and should not be positioned on tubes or objects that cause breaks in skin. -dry wrinkle free linen reduces chance of skin breakdown as well as frequent turning and positioning. -cleansing in a direction from least to most contaminated area helps reduce genitourinary infections -after administering an injection or inserting an intravenous catheter, you should engage any safety device and carefully dispose of needles in a puncture resistant box -the point of connection between a catheter and drainage tube should remain closed and intact -movement of catheter at the urethra should be minimized by stabilizing it with tape. -first you must perform hand hygiene then disinfect tubes and ports by wiping surface outward with alcohol, and temporarily placing gauze around edges of open drainage tubes adds further protection, but remember that keeping drainage tubes closed and secure is the best practice -to prevent entrance of microorganisms into a wound, you should clean outward from a wound, apply antiseptic around the wound edge first and then cleaning outward away from the wound -PROTECTION OF THE SUSCEPTIBLE HOST: -client’s resistance to infection improves as you protect their normal body defenses against infections -you can intervene to maintain the body’s normal reparative processes -you must also protect yourself and others by following your agency’s isolation guidelines 3. Identify the body’s normal defenses against infection -normal body flora that reside inside and outside the body protect a person from several pathogens -each organ system has defence mechanisms that fight infectious microorganisms -immune response is a protective reaction that neutralizes pathogens and repairs body cells. -immune system is composed of cells and molecules that help body resist disease -certain responses of the immune system are nonspecific and protect against microorganisms regardless of prior exposure (normal flora, body system defences, and inflammation) -whereas others are specific defenses against particular pathogens NORMAL FLORA -do not typically cause disease when residing in their usual area of the body but, instead, participate in maintaining health -normal flora in large intestine secrete antibacterial substances within intestine walls -skin’s normal flora exert protective action by inhibiting multiplication of organisms landing on skin -mouth and pharynx are also protected by flora that impair growth of invading microbes -mass of normal flora maintains a sensitive balance with other microorganisms to prevent infection -any factor that disrupts this balance places a person at increased risk for acquiring an infectious disease -use of broad-spectrum antibiotics can lead to superinfection, which is where normal bacteria flora are also eliminated, reducing body’s defences and therefore allowing disease-producing microorganisms to multiply BODY SYSTEM DEFENCES -skin, respiratory tract, and gastrointestinal tract are easily accessible to microorganisms -pathogenic organisms easily adhere to the skin’s surface, are inhaled into the lung, or are ingested with food -each organ system has defense mechanisms suited to its structure and function -ex: lungs’ airways are lined with hairlike projections cilia that rhythmically beat to move a blanket of mucus and adherent or trapped organisms up to the pharynx to be removed INFLAMMATION -body’s cellular response to injury or infection -it is a protective vascular reaction that delivers fluid, blood products, and nutrients to interstitial tissues in an area of injury -the process neutralizes and eliminated pathogens or necrotic/dead tissues and establishes a means of repairing body cells and tissues -signs of localized inflammation are swelling, redness, heat, pain or tenderness, and a loss of function in the affected body part -with systematic infections, you will notice fever, leukocytosis, malaise, anorexia, nausea, vomiting, and lymph node enlargement -after tissues are injured, inflammatory response occurs: vascular and cellular responses, formation of inflammatory exudates, and tissue repair. 4. Identify the clients most at risk for infection -Who is the susceptible host? • Patient -Support defence -Promote healing • Other individuals also - health care workers, visitors -Patients with increased risk • Immunocompromised • Elderly • Young • Other factors: – Nutrition – Stress – Medical therapy – Disease 5. Define the term “healthcare acquired infection” -also known as nosocomial infection or iatrogenic infection -it is an infection acquired after admission to a health care facility that was not present or incubating at the time of admission -can result from a diagnostic or therapeutic procedure, like a urinary tract infection after catheter insertion -HAIS may be exogenous or endogenous -exogenous: arises from microorganisms external to the individual that do not exist as normal flora -endogenous: can occur when some of client’s flora become altered and overgrowth results 6. Describe and explain the rationale for Standard Precautions -Tier 1 -used with ALL patients -apply to blood, all body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes -hands are washed between client contacts, after contact with blood, body fluids, secretions, and excretions and after contact with equipment or articles contaminated by them, and immediately after gloves are removed -gloves are worn when touching blood, body fluids, secretions, excretions, nonintact skin, mucous membranes, or contaminated items. Gloves should be removed and hand hygiene performed between care of clients. Gloves should also be changed between procedures on the same client and after contact with material that may be highly contaminated -masks, eye protection, or face shields are worn if client care activities may generate splashes or sprays of blood or body fluid -gowns are worn if soiling of clothing is likely from blood or body fluid. Remove used gowns as soon as possible. Perform hand hygiene after removing your gown. -client care equipment is properly cleaned and reprocessed, and single-use items are discarded -contaminated linen is placed in a leak proof bag and handled in a manner that prevents skin and mucous membrane exposure -all sharp instruments and needles are discarded in a puncture resistant container. Safety devices must be enabled after use to prevent injury. Never recap a used needle -a private room is unnecessary unless a client’s hygiene is unacceptable. Check with an infection-control professional 7. Perform proper procedure for hand hygiene -inspect surface of hands for breaks, cuts in skin or cuticles. Report and cover lesions before providing client care -inspect hands for visible soiling -inspect nails for length and presence of artificial acrylics or chipped nail polish -asses client’s risk for infection -push wristwatch and long uniform sleeves above wrist, avoid wearing rings and remove during procedure. -if hands are visibly dirty, use water and plain soap or antimicrobial soap for handwashing: -stand in front of sink, keeping hands and uniform away from sink surface, if hands touch sink, repeat procedure again -turn on water, turn faucet on or push knee pedals laterally or press pedals with foot to regulate temperature -avoid splashing water against uniform -regulate flow of water so temperature is warm -wet hands and wrists thoroughly under running water. Keep hands and forearms lower than elbows during washing -apply a small amount of soap, lathering thoroughly. Soap granules and leaflet preparations may be used. -wash hands using plenty of lather and friction for at least 10 to 15 seconds. Interlace fingers and rub palms and back of hands with circular motion at least five times each. Keep fingertips down to facilitate removal of microorganisms. Rub knuckles of one hand into the palm of the other, repeat with other hand -rub thumb on one hand with the palm of the other hand, repeat with the other hand -work the fingertips on one hand into the palm of the other. Massage soap into nail spaces, repeat with other hand -areas under fingernails are often soiled. Clean them with orangewood stick or fingernail of other hand and additional soap -rinse hands and wrists thoroughly, keeping hands down and elbows up -dry hands thoroughly from fingers to wrists and forearms with a paper towel, single use cloth, or warm air drier -if paper towel is used, discard it in proper receptacle -turn off water with foot or knee pedals. To turn off hand faucet, use clean, dry paper towel, avoid touching handles with hands -if hands are dry or chapped, apply lotion or barrier cream -inspect surfaces of hands for obvious signs of soil or other contaminants -inspect hands for dermatitis or cracked skin -if hands are not visibly soiled, use an alcohol based waterless antiseptic for routine decontamination of hands in all clinical situations -apply ample amount of product to palm of one hand -rub hands together, covering all surfaces of hands and fingers with antiseptic -rub hands together for several seconds until alcohol is dry. Allow hands to dry before putting on gloves -if hands are dry or chapped, a small amount of lotion or barrier cream may be applied 8. Perform proper procedure for donning and removing gloves -perform thorough hand hygiene -remove outer glove package wrapper by carefully separating and peeling apart sides -grasp inner package and lay it on clean, dry flat surface just above waist level. Open package, keeping gloves on wrapper’s inside surface -if gloves are not prepowdered, take packet of powder and apply lightly to hands over sink or wastebasket -identify right and left gloves. Glove dominant hand first -with thumb and first two fingers of nondominant hand, grasp edge of cuff of glove for dominant hand. Touch only glove’s inside surface. -carefully pull glove over dominant hand, being sure cuff does not roll up wrist. Be sure thumb and fingers are in proper spaces -with gloved dominant hand, slip fingers underneath second glove’s cuff -carefully pull second glove over nondominant hand. Do not allow fingers and thumb of gloved dominant hand to touch any part of exposed nondominant hand. Keep thumb of dominant hand abducted back -after second glove is on, interlock hands. The cuffs usually fall down after application. Be sure to touch only sterile sides GLOVE DISPOSAL -grasp outside of one cuff with other gloved hand; avoid touching wrist. -pull glove off, turning it inside out. Discard in receptacle -take fingers of bare hand and tuck inside remaining glove cuff. Peel glove off, inside out. Discard in receptacle. Perform hand hygiene. 9. Discuss the specific risks to safety related to developmental stages INFANTS AND CHILDREN -small children are curious and trusting of their environment and do not perceive themselves to be in danger -incidence of poisoning is highest in late infancy and toddlerhood because of children’s increased level of oral activity and growing ability to explore their environment -toddlers and preschoolers, who are attracted to water but do not perceive its dangers, are at a greater risk for drowning -childhood injuries are also reflective of adult’s perceptions of that causes of accidents and their ability to prevent them ADOLESCENTS -adolescents start to separate emotionally from their families and their peers have a stronger influence on them -they may begin to act impulsively and engage in risk-taking behaviours such as smoking and substance use. -the ingestion of such substances increases incidence of accidents such as drowning or motor vehicle accidents ADULTS -threats to an adult’s safety are frequently related to lifestyle habits OLDER ADULTS -physiological changes that occur during the aging process increase a client’s risk for injury -changes in vision, hearing, mobility, reflexes, circulation, and ability to make quick judgments predispose older adults to falls -clients most often fall when transferring from beds, chairs, and toilets; while getting out of the bathtub, by tripping over carpet edges or doorway thresholds; by slipping on wet surfaces; and while descending stairs 10. Describe nursing interventions specific to a client’s age for reducing risk for injury X 11. Discuss the ways to maintain a safe environment for clients X 12. Describe four categories of risk to client safety within the healthcare environment X 13. Define WHMIS and describe three main elements WORKPLACE HAZARDOUS MATERIALS INFORMATION SYSTEM -sets standards for control of hazardous substances in workplaces across Canada -a hazardous substance is any product or material that could cause physical or medical problems -Three main elements: worker education programs, cautionary labelling of products, and the provision of Material Safety Data Sheets. WEEK 5- THERAPEUTIC COMMUNICATION 1. Identify and describe the components of the therapeutic nurse-client relationship. -therapeutic communication is used to support, educate, and empower people to effectively cope with difficult health related issues -it is a purposeful form of conversation designed to help a client achieve identified health-related goals through participation in a focused relationship -Established & maintained by the nurse -Developed through nursing knowledge, skill, and behaviour -Contribute to the client’s health and well-being -The relationship is based on trust, respect, empathy and professional intimacy and requires the appropriate use of the power inherent in the care provider’s role. COMPONENTS -Professional -Necessity -Purpose: Health related goal -Time-limited -Interpersonal & interdependent -Client centred -Professional boundaries: violation & crossings -Different than social 2. Identify concepts to enhance therapeutic relationships • Respect • Caring • Empowerment • Trust • Empathy • Mutuality • Veracity • Professional intimacy • Therapeutic use of self (authenticity, presence, self awareness) 3. Identify barriers to the therapeutic nurse-client relationship • Lack of: – Respect, Caring, Empowerment, Trust, Empathy, Mutuality, Veracity • Anxiety • Stereotyping & bias • Overinvolvement • Violation personal space • Level of involvement 4. Describe the phases of therapeutic relationship PREINTERACTION PHASE: before meeting the client -before meeting the client, the nurse: -reviews available data, including medical and nursing history -talks to other caregivers who may have information about the client -anticipates health care concerns or issues that may arise -identifies a location and setting that will foster comfortable, private interaction with the client -plans enough time for initial interaction ORIENTATION PHASE: getting to know the client -when the nurse and client meet and get to know one another, the nurse accomplishes: -sets the tone for the relationship by adopting a warm, empathetic, caring manner -recognizes that the initial relationship may be superficial, uncertain, and tentative -expects the client to test the nurse’s competence and commitment -closely observes the client and expects to be closely observed by the client -begins to make inferences and form judgements about client messages and behaviours -assesses the client’s health status -prioritizes the client’s problems and identifies the client’s goals -clarifies the client’s and nurse’s roles -negotiates a contract with the client that specifies who will do what -lets the client know when to expect the relationship to be terminated WORKING PHASE: moving forwards, making process -when the nurse and client work together to solve problems and achieve goals, the nurse accomplishes the following tasks: -encourages and helps the client to express feelings about his or her health -encourages and helps the client to explore own feelings and thoughts -provides info that the client needs to understand and change behaviour -encourages and helps the client to set goals -takes actions to meet the goals set with the client -uses therapeutic communication skills to facilitate successful interactions -uses appropriate self-disclosure and confrontation TERMINATION PHASE: moving on -during the ending of the relationship, the nurse accomplishes the following tasks: -reminds the client that the relationship termination is near -evaluates goal achievement with the client -reminisces about the relationship with the client -separates from the client by relinquishing responsibility for his or her care -facilitates a smooth transition for the client to other caregivers as needed 5. Identify professional boundaries of the therapeutic nurse-client therapeutic relationship • Level of involvement • Therapeutic use of self • Therapeutic relationship not social 6. Explore how culture affects the therapeutic nurse-client relationship • Practice Standard: Cultural competence • Client’s beliefs • Gender differences • Therapeutic = willingness to understand and respond • CARE = ConnectAppreciateRespondEmpower • CNO Practice Standards – TNCR – Client-centered care – Protecting from Abuse – Culture Competence WEEK 6- THERAPEUTIC COMMUNICATION 1. Describe the basic elemen
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