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NSE 12 Weekly Objectives.docx

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Ryerson University
Juilet Thomas

Week 1 1. Discuss the course syllabus with a specific focus on content, accountability, attendance and evaluation process. 2. Discuss the use of Ryerson, Centennial, George Brown Collaborative Nursing Degree Program: Student Handbook 2012 – 2013. 3. Explore the College of Nurses (CNO) Standards of Practice and how they relate to your role as a student nurse. Professional Standards includes seven broad standard statements, a description of each statement and indicators that illustrate how the standard may be demonstrated. Standards: Accountability: Each nurse is accountable to the public and responsible for ensuring that her/his practice and conduct meets legislative requirements and the standards of the profession. Continuing Competence: Each nurse maintains and continually improves her/his competence by participating in the College of Nurses of Ontario’s Quality Assurance (QA) Program. Ethics: Each nurse understands, upholds and promotes the values and beliefs described in CNO’s Ethics practice standard. Knowledge: Each nurse possesses, through basic education and continuing learning, knowledge relevant to her/his professional practice. Knowledge Application: Each nurse continually improves the application of professional knowledge. Leadership: Each nurse demonstrates her/his leadership by providing, facilitating and promoting the best possible care/service to the public. Relationships: Each nurse establishes and maintains respectful, collaborative, therapeutic and professional relationships. 4. Discuss the CNO National Competencies in the context of entry-level Registered Nurse practice and how they relate to you as a student nurse. Professional Responsibility and Accountability: Demonstrates professional conduct; practises in accordance with legislation and the standards as determined by the regulatory body and the practice setting; and demonstrates that the primary duty is to the client to ensure consistently safe, competent, ethical nursing care. Specialized Body of Knowledge: Draws on nursing knowledge and ways of knowing, along with knowledge from the sciences, humanities, research, ethics, spirituality, relational practice and critical inquiry. Competent Application of Knowledge: Demonstrates competence in the provision of nursing care. The competency statements in this section are grouped into four areas and, while the presentation of these competency statements appears linear in nature, the actuality of providing nursing care reflects a critical inquiry process and an iterative process. Ethical Practice: Demonstrates competence in professional judgments and practice decisions by applying the principles implied in the code of ethics or ethical framework for registered nurses and by utilizing knowledge from many sources. Engages in critical inquiry to inform clinical decision‐making, which includes both a systematic and analytic process along with a reflective and critical process. Establishes therapeutic, caring, and culturally safe relationships with clients and health care team members based on appropriate relational boundaries and respect. Service to the Public: Demonstrates an understanding of the concept of public protection and the duty to practise nursing in collaboration with clients and other members of the health care team to provide and improve health care services in the best interests of the public. Week 2 1. Define self-concept and self-esteem.  Self-concept refers to an acquired set of thoughts, feelings, attitudes, and beliefs that individuals have about the nature and organization of their personality. Self-concepts help people experience who they are and what they are capable of becoming physically, emotionally, intellectually, socially, and spiritually in relationship or community with others. (Arnold & Boggs, 2011, pg. 62-63)  Self-esteem refers to the affective or emotional aspects of self. Representing an emotional appraisal of a person's worth or value, self-esteem is defined as the emotional value a person places on his or her personal self-worth in relation to others and the environment. Self-esteem affects a person's ability to weather stress without major changes in self-perception. Self-esteem mirrors a person's inner sense of self and adds an additional filter to perceptual and cognitive awareness of self. It also reflects cultural norms, genetic temperament, and supportive relationships. A key characteristic is the respect people have for themselves and their opinion of their conduct of life. (Arnold & Boggs, 2011, pg. 74) 2. Illustrate how self-concept and self-esteem affect communication. Self-concept: How a person interacts with others can be influenced by how they perceive the world around them and by the aspects of life that are important to them. It also is affected by the identity that they have acquired and by other beliefs that they have, i.e. spirituality. Check Table 4-1 Arnold and Boggs, pg. 66-67 Self-esteem: People with a high self-esteem tend to be more outgoing therefore communicating with others might be easier for them compared to people who have lower self-esteem. The ways they carry themselves and their confidence in their abilities are also influenced by their self-esteem. Check Table 4-2 Arnold and Boggs, pg. 76 3. Explore concepts related to the personal and professional self (i.e. self-awareness, self-reflection, personal and professional values) Self-awareness for nurses is just as critical as it is for clients. •Open self (arena): what is known to self and others •Blind self: what is known by others, but not by self •Hidden self (façade): what is known by self, but not by others •Unknown self: what is unknown to self and also unknown to others (Arnold & Boggs, pg. 64) The mental process through which we consciously examine our actions and motives to determine their meaning. Values clarification: process of appraising personal values  process of personal reflection  Result is greater self-awareness and personal insight. (Potter & Perry, pg. 90) Personal values: By understanding own personal values, we are able to understand our clients’ and colleagues’ values. (Potter & Perry, pg. 90) Professional values: When making a response to client, it should be brief and nonjudgemental. Respect client’s self-direction and avoid inappropriately introducing personal values into the conversation. (Potter & Perry, pg. 91)  Learned through nursing education ◦ Nursing lectures / labs ◦ Different clinical experiences ◦ Professional nursing practice 4. Describe the components and stressors of self-concept. Stressor: Any real or perceived change that Components: Identity, Body- image, Role threatens the components of self-concept. It Performance challenges a person’s adaptive capacities. (Potter & Perry, pg. 400) (Potter & Perry, pg. 402) 5. Explain the nurse’s effect on a client’s self-concept. o Your acceptance of a client with an altered self-concept helps promote positive change. o When a client's physical appearance has changed, likely both the client and the family will observe your verbal and nonverbal responses and reactions. o A positive and matter-of-fact approach to care can provide a model for the client and family to follow. o By building a trusting nurse–client relationship and appropriately involving the client and family in decision making, you can enhance self-concept. o A facial expression of shock or disgust can lead to development of a negative body image. It is important to monitor your responses toward clients. (Potter & Perry, pg. 406) 6. Explore how culture affects values and beliefs. Certain traditions and beliefs are exposed to a person since they were a child. Based on how they are raised, they form beliefs on certain topics, e.g. religion. Also, the social environment such as school or work can influence values and beliefs. Young adults can identify personal values within the context in the community. A person’s experience as well as lack of experience also influences his or her values. (Potter & Perry, pg. 90) Week 3 1. Describe the basic concepts related to groups and group communication in the health care setting. Primary Groups  Informal structure and social process  Automatic or voluntary membership  Closely related to self-concept Secondary Groups  Formal and planned structure  Specific purpose & time limited existence  Designated group leader 2. Discuss professional and interdisciplinary team collaboration as an example of a secondary group. 3. Discuss factors that influence group dynamics. Check Figure 12-2 Arnold & Boggs, pg. 224 4. Describe the phases of group development. Forming Phase: members come together to form a group. Getting to know each other, finding common threads in personal experience, and learning about group goals and tasks are emphasized. Storming Phase: conflict around interpersonal issues. Members focus on power and control issues. Norming Phase: individual goals become aligned with group goals. Group norms make the group safe and the members begin to experience the cohesiveness of the group as “their group.” Performing Stage: “work” is accomplished, which is characterized by interdependence and cohesion. Adjourning Phase: reviewing what has been accomplished, reflecting on the meaning of the group’s work together and making plans to move on to different directions. (Arnold & Boggs, pg. 228) 5. Define conflict and explore its impact in the group process. Conflict: defined as tension arising from incompatible goals or needs, in which the actions of one frustrate the ability of the other to achieve their goal, resulting in stress or tension. Impact: o Hampers productivity o Lowers morale o Causes more & continued conflicts o Causes inappropriate behaviors Causes of Conflict:  Lack of communication  Poor communication  Differences in personal values  Differences in opinions  Incompatible personalities  Stress 6. Recognize and describe personal styles of response to conflict situations.  Competing/ Confronting: lose-lose situation  Collaborating: win-win situation  Avoiding: lose-lose situation; distance yourself from client or provide them less support.  Accommodating: lose-win situation  Compromising: finding a solution that both parties could agree on 8. List the objectives and describe the requirements of the Team-Based Learning: Safety Across the Lifespan Assignment. 9. Explain the purpose and the method of Reflective Practice and the use of the LEARN in this process. Reflective Practice  Life-long learning  Receiving and giving peer feedback  Identifying learning needs  Setting and meeting learning goals  CNO requirement Completed using the LEARN format: ◦ Look back ◦ Elaborate ◦ Analyze ◦ Revision ◦ New Perspective Week 4 Routine Practices and Hand Hygiene 1. Explain the relationship between the chain of infection and the transmission of infection. Health care workers can protect themselves from contact with infectious materials or exposure to communicable diseases by having the knowledge of the infectious process and appropriate barrier protections. (Potter & Perry, pg. 636) Infectious agents:  Resident organisms – permanent residents on the skin, they survive without causing any harm; may not be removed by hand washing unless considerable friction is applied.  Transient organisms – attach to the skin when a person has contact with another person or object; can be removed by hand washing Reservoir:  A place where a pathogen may or may not survive  Most common reservoir: human body  A pathogen is colonizing the site when it does not cause harm  Carriers – animals or persons who show no symptoms of illness but who have pathogens on or in their bodies that can be transferred to others.  In order for a pathogen to survive, a reservoir provides: food, oxygen, water, temperature (35*C), pH (5-8) and minimal light. Portal of Exit:  Path which the pathogen leaves the reservoir  Exits in the human body: body openings and breaks in the mucous membranes  Pathogens are carried to portals of exit by: blood, body fluids, excretions and secretions. Modes of Transmission:  A microorganism may be transmitted by more than one mode.  Indirect contact – major mode of transmission in health care facilities  Follow practices to minimize the spread of infection: proper hand washing and ensuring the equipment has been adequately disinfected or sterilized. Portal of Entry:  Pathogens can entry the body through the same routes they use to exit Susceptible Host:  Susceptibility – depends on the individual’s degree of resistance to a pathogen. (Potter & Perry, pg. 636-639) 2. Give an example for preventing infection for each of the elements of the chain of infection. Infectious agent:  Proper cleaning, disinfection and sterilization of contaminated objects.  Cleaning – physical removal of foreign material from objects and surfaces; involves use of water and mechanical action with detergents and enzymatic products.  Disinfection – elimination of all pathogens except bacterial spores; disinfectants are used in inanimate objects; antiseptics are used on living tissues  Sterilization – destruction of all microorganisms, including spores. Items must be cleaned thoroughly before they can be sterilized. Reservoir:  Eliminate or control sources of body fluids, drainage, or solutions that might harbour microorganisms Portals of Exit:  Wear a mask as needed, avoid talking directly into clients' faces, and never talk, sneeze, or cough directly over surgical wounds or sterile dressing fields.  Cover your mouth or nose when sneezing or coughing.  Teach clients to protect others when they sneeze or cough and for providing clients with disposable wipes or tissues to control the spread of microorganisms.  Always wear disposable gloves when handling blood, body fluids, secretions, or excretions.  Appropriate disposal of disposable soiled items in impervious plastic bags. Modes of Transmission:  Remain aware of the modes of transmission and ways to control them.  A client should have personal set of care items.  Hand hygiene – most important and most effective; use of instant alcohol hand antiseptic before and after providing client care, hand washing with soap and water when hands are visibly soiled, and performing a surgical scrub when necessary.  Teaching hand hygiene is particularly important if health care is to continue at home. Portal of Entry  Maintaining the integrity of skin and mucous membranes reduces the chances of microorganisms reaching a host  The client's skin should be kept well lubricated by using lotion as appropriate. Immobilized and debilitated clients are particularly susceptible to skin breakdown.  Engage any safety device and carefully dispose of needles in a puncture-resistant box  To prevent the entrance of microorganisms into the wound, you should clean outward from a wound site. Susceptible Host:  First tier: care for all clients in any setting  routine practices  Standard precautions or routine practices apply when a health care worker is or potentially may be exposed to (1) blood; (2) all body fluids, secretions, and excretions except sweat; (3) non- intact skin; or (4) mucous membranes.  Standard precautions or routine practices include the appropriate use of gowns, gloves, masks, eyewear, and other protective devices or clothing. Barrier protection is indicated for use with all clients because every client has the potential to transmit infection via blood and body fluids and the risk for infection transmission can be unknown.  Standard precautions or routine practices also include rules on appropriate hand washing, cleaning of equipment, and disposal of contaminated linen and sharps.  Second tier: contain pathogens in one area  isolation precautions  The precautions used depend on how the pathogen is spread. (Potter & Perry, pg. 649-657) 3. Identify the body’s normal defenses against infection.  Our body’s immune system produces necessary immunoglobulins and WBCs to adequately fight some infections.  The immune response is a protective reaction that neutralizes pathogens and repairs body cells.  The immune system is composed of cells and molecules that help the body resist disease; certain responses of the immune system are nonspecific and protect against microorganisms regardless of prior exposure (e.g., normal flora, body system defences, and inflammation), whereas others are specific defences against particular pathogens. If any of the body's defences fail, an infection can quickly progress to a serious health problem.  The mass of normal flora maintains a sensitive balance with other microorganisms to prevent infection.  Each organ system has defence mechanisms physiologically suited to its structure and function.  Inflammation is the body’s cellular response to injury or infection. (Potter & Perry, pg. 639-640) 4. Identify clients most at risk for infection.  Infants who are bottle-fed because they did not receive the mother’s antibodies to fight off infections which is important because at this age, the infant’s immune system is immature against infection.  Older adults since defence against infection change with aging. The immune response, particularly cell-mediated immunity, declines.  Clients who are not getting the right amount of protein and have trouble swallowing. Reduction in protein intake and other nutrients reduces body’s defences against infection and impairs wound healing.  Clients who are stressed. Cortisone levels increase which decreases defences against infection.  Clients with chronic diseases.  Client who takes medications that may increase infection susceptibility. (Potter & Perry, pg. 643-645) 5. Define the term “healthcare acquired infection.” Also known as, nosocomial infection or iatrogenic infection is an infection acquired after admission to a health care facility that was not present or incubating at the time of admission. May be:  Exogenous infection: microorganism external to the individual that do not exist as normal flora  Endogenous infection: when some of the client’s flora become altered and overgrowth results. (Potter & Perry, pg. 641) 6. Describe and explain the rationale for Standard Precautions. Avoid the transmission of a pathogen from one patient to another via the nurse or healthcare professionals. 7. Perform proper procedure for hand hygiene. 8. Perform proper procedure for donning and removing gloves. Safety 9. Discuss the specific risks to safety related to developmental stages. Infants and Children:  Unintentional injuries (1-14yrs)  Poisoning in infancy and toddlerhood  Drowning (toddlers and preschoolers)  Incorrect use of vehicle restraints for children aged 5-14 Adolescents:  May begin to act impulsively and engage in risk-taking behaviours such as smoking and other substances.  increases the incidence such as drowning and motor vehicle accidents Adults:  Lifestyle habits: drinking excessive alcohol, smoking, etc.  High levels of stress may cause more accidents or illnesses Older Adults:  Falls due to the changes in vision, hearing, mobility, reflexes, circulation and the ability to make quick judgments.  Causes of falls: transferring from beds, chairs and toilets, while getting into or out of a tub, by tripping over carpet edges or doorway thresholds, by slipping on wet surfaces and while descending the stairs. Icy sidewalks and obstacles.  Diseases that are common to older adults: arthritis, cerebrovascular accidents, etc. increases the chances of injury (Potter & Perry, pg. 799-800) 10. Describe nursing interventions specific to a client’s age for reducing risk for injury. Infants, Toddlers and Preschoolers:  Educate parents (about accidental poisoning)  Also ensure that parents or guardians are aware that poisoning can result from swallowing miniature button or disk batteries  commonly found in games, camera, calculators, etc.  Poison control centre phone number should be visible on the telephone in homes with young children  Educate parents that children under 5 yrs are more susceptible to diseases  Immunization given before 2 yrs can protect child from life-threatening diseases. School-Aged Children:  Parents, teachers, and nurses must instruct children in safe practices to follow at school and play.  Children should be warned repeatedly not to accept candy, food, gifts, or rides from strangers.  Children need to know what to do if a stranger approaches.  “block parent” program  Parents and health care professionals can reinforce these safety tips by insisting that children wear protective gear during sports  Children should be taught the rules of the road and cautioned not to engage in dangerous stunts or activities while bike riding.  A properly fitted helmet should be worn. Adolescents:  Adults serve as role models for adolescents and, through providing examples, setting expectations, and providing education, can help adolescents minimize risks to their safety.  Nurse should be aware of the risks posed at this time and be prepared to teach adolescents and their parents measures to prevent accidents and injury  The young driver must be taught to comply with rules and regulations when using a car.  They need prompt, accurate instruction about abstinence, safer sexual practices, and birth control. Adults:  Useful resources are stress-management centres, employee-assistance programs, and health- promotion activities, which can be found in many communities and hospitals.  Neighbourhood centres, community clinics, and outpatient clinics are equipped to assist adults in modifying lifestyle habits that present risks to their health Older Adults:  Reduce the risk of falls and other accidents and to compensate for the physiological changes of aging.  Recommend the use of medication organizers that are filled once a week by the client or family.  Educate clients regarding safe driving.  Counselling may be necessary to help a client make the decision of when to stop driving.  Help locate resources in the community that provide transportation. (Potter & Perry, pg. 808-809, 812) Also check Table 37-2, Potter & Perry, pg. 810--811 11. Discuss ways to maintain a safe environment for clients. Fires: Home  Smoke detectors should be placed strategically throughout the home and checked regularly.  Multipurpose fire extinguishers should be installed near the kitchen and any workshop areas.  Have a plan of action in the event of fire  fire drill once or twice a year  Ensure that the phone number for reporting fires appears on the telephone and is visible at all times. Health Care Agency  Know your agency's mnemonic (if any), fire drill, and evacuation plan.  Know the location of all fire alarms, exits, extinguishers, and the oxygen shut-off.  Use the mnemonic RACE to set priorities in case of fire: Rescue and remove all clients in immediate danger. Activate the alarm. Always do this before attempting to extinguish even a minor fire. Confine the fire by closing doors and windows and turning off oxygen and electrical equipment. Extinguish the fire using an extinguisher. Other environmental Interventions:  Help your clients meet basic needs related to oxygen, humidity, nutrition, and temperature.  Carbon monoxide detectors should be available in homes  Teach basic techniques for proper food handling and preparation.  Client education for older adults and clients who enjoy outdoor activities to prevent heatstroke, hypothermia, frostbite, etc.  Adequate lighting and security measures in and around the home  Clients should be encouraged to join block associations and work closely with law enforcement personnel to reduce crime in their neighbourhoods. (Potter & Perry, pg. 813-814) 12. Describe the four categories of risk to client safety within the healthcare environment.  Lifestyle  Impaired mobility  Sensory or communication impairment  Lack of safety awareness (Potter & Perry, pg. 800) 13. Define the acronym WHMIS and describe the three main elements of WHMIS. Workplace Hazardous Materials Information System – sets the standards for the 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 labeling of products  Provision of Material Safety Data Sheets (MSDSs)  are available to provide detailed information about the substance, any health hazards imposed, precautions for safe handling and use, and steps to take if the substance is released or spilled. (Potter & Perry, pg. 800) Week 5 1. Identify and describe the components of the therapeutic nurse-client relationship. Client Centered  Based on the belief that each person has within him or herself the capacity to heal, given support from a helping person who treats the client with the utmost respect and unconditional regard in a caring, authentic relationship.  Client-centered care includes the client's individual preferences, values, beliefs, and needs as a fundamental consideration in all nursing interventions.  Keeping in mind that each person's experience is different, despite similarities in diagnosis. From Mutuality to Partnership  Empower clients and families to assume as much responsibility as possible in self-management of chronic illness.  Shared knowledge, mutual decision-making power, and respect for the capacities of client to actively contribute to his or her health care to whatever extent is possible are active components of the partnership required of client centered care. Professional Boundaries  Represent invisible structures imposed by legal, ethical, and professional standards of nursing that respect nurse and client rights, and protect the functional integrity of the alliance between nurse and client.  Define how nurses should relate to clients as a helping person, that is, not as a friend, not as a judge, but as a skilled professional companion committed to helping the client achieve mutually defined health care goals. (Arnold & Boggs, pg. 84-86) 2. Identify concepts to enhance therapeutic relationships. Respect  Convey respect for client’s values and opinions. 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.  “Patient-centred care” – involves understanding of client’s perceived needs and expectations for health.  Ethical responsibility that guides a health care provider to advocate for the client.  Clients can focus on accomplishing the goals of health care instead of worrying about whether care is forthcoming.  Caring for the client’s family where they could express emotions and talk with ethics and palliative care experts decrease their anxiety and depression. Empowerment  Assisting the client to take charge of his own life.  The more involved a client is in his own care, the better the health outcome.  In helping our clients take control of their lives, we identify and build on their existing strengths. Trust  Foundation in all relationships.  Nurse is perceived as dependable  For the client, trust implies a willingness to place oneself in a position of vulnerability, relying on health provider as expected. Empathy  Ability to be sensitive to and communicate understanding of the client’s feelings.  An empathetic nurse perceives and understands the client's emotions accurately. Mutuality  Nurse and the client agree on the client's health problems and the means for resolving them, and that both parties are committed to enhancing the client's well-being.  Mutual respect for the autonomy and value system of the other. Veracity  Legal and ethical standards mandate specific nursing behaviors, such as confidentiality, beneficence, and respect for client autonomy. (Arnold & Boggs, pg. 104-108) 3. Identify barriers to the therapeutic nurse-client relationship. Lack of respect  Nurse to client – clients feel devalued when staff are avoiding talking to them or are unfriendly  Between members of the healthcare team – cause of adverse client outcomes  Physician to client – lead to communication failures resulting in harm to the client Lack of caring  Nurse tries to meet her own needs rather than the client’s needs.  Nurse develops detachment that interferes with expressions of caring behaviours  Nurses can be rushed to meet multiple demands that she seems unable to focus on the client Mistrust  Client: Having confidence in the nurse's skills, commitment, and caring allows the client to place full attention on the situation requiring resolution.  Nurse: Recognize testing behaviors and set clear limits on their roles and the client's role. Lack of empathy  Failure to understand the needs of clients may lead you to fail to provide essential client education or to provide needed emotional support.  Major to barriers to empathy - lack of time, lack of trust, lack of privacy, or lack of support. Anxiety  Lower satisfaction with communication is associated with increased client anxiety.  Moderate-to-severe anxiety on the part of either nurse or client hinders the development of the therapeutic relationship.  Can cloud your perceptions and interfere with relationships. Stereotyping and Bias  Stereotypes negate empathy and erode the nurse-client relationship.  In the extreme, this can result in discrimination.  If nurses bring their biases with them to the clinical situation, they will distort their perception, prevent client change, and disrupt the provider-client relationship. Overinvolvement  Sharing too much information about yourself, your job problems, or about your other clients can become a barrier if your client becomes unclear about his role in your relationship. Violation of Personal Space  Many nursing care procedures are a direct intrusion into your client's personal space.  Maintain a social physical body distance of 4 feet when not actually giving care.  When invasions of personal space are necessary while performing a procedure, you can minimize impact by explaining why a procedure is needed. Cultural Barriers  Cultural background and level of health literacy may have a powerful influence on communication practices.  No medical jargon Gender Differences  Male nurses' touching of clients is problematic. This is because although our culture equates female touch with caring, being touched by a male individual is perceived as sexual.  Appears that gender need not be a factor in developing therapeutic communication with clients. (Arnold & Boggs, 104-113) 4. Describe the phases of the therapeutic relationship. Phase Stage Purpose Skills Orientation Phase Gathering information, To determine how the Basic listening and Engagement, defining the problem, client views the problem attending; open-ended assessment identifying strengths and what client questions, verbal cues, strengths might be used and leads in their resolution Working Determining outcomes: To find out how the Attending and basic (Implementation) What needs to happen to client would like to be; listening; influencing; Phase reduce the self-care how things would be if feedback Planning (identification demand? Where does the problems were component) the client want to go? solved Implementation Explaining alternatives To work toward Influencing; feedback (exploitation and options resolution of the client'sbalanced by attending component) self-care needs and listening Termination Phase Generalization and To enable changes in Influencing; feedback; Evaluation transfer of learning thoughts, feelings, and validation behaviors; to evaluate the effectiveness of the changes in modifying the self-care need (Arnold & Boggs, pg. 90) 5. Identify professional boundaries of the therapeutic nurse-client therapeutic relationship.  Examples of relationship boundaries involve the setting, time, purpose, and length of contact, maintaining confidentiality, and use of appropriate professional behaviors.  The National Council of State Boards of Nursing (NCSBN, 2007) describes professional boundaries as the spaces between the nurse's position power and client vulnerability.  The nurse, not the client, is responsible for maintaining professional boundaries.  Nurses need to carefully examine their behaviors, look for possible misinterpretations or unintended consequences, and seek supervision when boundary crossings occur. (Arnold & Boggs, pg. 86) 6. Explore how culture affects the therapeutic nurse-client relationship. Check obj. # 3, cultural barriers.  There are language barriers that could be confronted and this might affect the communication between nurse and client.  Nurse should be aware of his/her own culture, beliefs and biases in order to avoid stereotyping the clients of different culture.  Knowledge of the client’s cultural preferences helps you avoid stereotyping and allows you to adapt your communication. (Arnold & Boggs, pg. 112) Week 6 Therapeutic Communications 1. Describe the basic elements and forms of the communication process. Basic Elements Referent  motivates one person to communicate with another Sender and Receiver  sender is the person who encodes and delivers the message  sender puts ideas or feelings into a form that can be transmitted and is responsible for accuracy and emotional tone  receiver is the person who receives and decodes the message.  sender's message acts as a referent for the receiver, who is responsible for attending to, decoding, and responding to the sender's message Messages  content of the communication  contains verbal, nonverbal, and symbolic expressions of thoughts or feelings that are transmitted from the sender to the receiver  Personal perceptions sometimes distort the receiver's interpretation of the message. Channels  Means of conveying and receiving messages through visual, auditory, and tactile senses.  Facial expressions send visual messages, spoken words travel through auditory channels, and touch traverses tactile channels.  More channels the sender uses to convey a message, the more clearly the message is usually understood. Feedback  message returned by the receiver  indicates whether the meaning of the sender's message was understood by the receiver  social relationship, both participants assume equal responsibility for seeking openness and clarification, but in the nurse–client relationship, this responsibility is primarily the nurse's Interpersonal Variables  characteristics within both the sender and receiver that influence communication Environment  setting for sender–receiver interaction  the environment should meet participants' needs for physical and emotional comfort and safety (Potter & Perry, pg. 248-249) Forms of Communication Verbal Communication  use of spoken or written words  Most important aspects of verbal communication ◦ Vocabulary ◦ Denotative and Connotative Meaning (single word can have several meanings) ◦ Pacing (speak slowly and enunciate clearly) ◦ Intonation (tone dramatically affects message’s meaning) ◦ Clarity and Brevity (simple, brief, direct) ◦ Timing and Relevance Nonverbal Communication  makes use of all five senses and refers to transmission of messages that do not involve the spoken or written word.  interpretation of nonverbal behaviour is subjective ◦ Personal Appearance ◦ Posture and Gait ◦ Facial expression ◦ Eye contact (differences in maintaining eye contact between different cultures) ◦ Gestures (emphasize, punctuate, and clarify the spoken word) ◦ Sounds (help send clear messages) ◦ Territoriality and Personal Space (provides people with a sense of identity, security, and control)
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