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115 Cards in this Set
- Front
- Back
Definition of Nursing
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“The Act of utilizing the environment of the patient to assist him in his recovery.”
Nursing: The care of others Focus: The person receiving care Science: Knowledge based Art: Skilled application to help others reach maximum health |
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Nursing History
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18th-19th century: role changed
Originally: home and religion based Florence Nightingale: 1st training for nursing Made nursing an occupation |
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What did Nightingale say was essential for health
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clean environment
well ventilated quiet environment |
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Socialization of Nursing
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The process by which people learn to become members of a group and society unto itself. Socialization is following a set of norms for that group. Learning rules associated with the group. Becoming ‘like thinkers’ in a group situation
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What are the Aims of Nursing
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promote health
prevent illness (immunizations) restore health Facilitate coping during a crisis, whether ill or not |
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What is health?
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State of optimal functioning or well-being
Enhancing the quality of life |
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Preventing illness
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Optimal health is maintained by:
Educational programs such as prenatal care Good health habit information (diet exercise hygiene) Health assessments |
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Restoration of health
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Focuses on the sick patient from early detection of disease through the recovery period.
Providing care Performing diagnostic test and procedures Consultation with other health care professions Teaching Rehabilitation service |
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Nursing Roles
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Facilitate Coping: good listening & help gather resources
Provide Care: procedures, medication, teaching, etc Professional Membership: ANA (American Nurses Assoc) Manager of Care: Manage nursing care & delegate to other health providers Teacher: what needs to be done to get them to discharge. Help patient learn about meds, procedures. Communicator: communicates with patient, family, co-workers. Identifies clients problems and communicates it with other team members Advocate: Protect patient and help exercise their rights Critical thinker: act of metacognition |
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Health Care Settings Available
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Hospitals
Clinics Homes Community agencies LTC centers Rehab centers Schools |
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Providers of Care
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CNA
MA LPN RN MD OT PT SOCIAL WORKER |
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Maslow's Hierarchy
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Providing at all levels a human needs to thrive (in order)
1. Physiological Needs: Air, Water, Food, Shelter, Sleep 2. Safety & Security 3. Love and Belongingness 4. Self-Esteem 5. Self-Actualization, vitality, creativity, self-sufficiency, playfulness, meaningfulness |
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Definition of health
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A state of complete physical, emotional and social well-being, not merely the absence of disease of infirmity.
Defined by the Individual |
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Health Promotion
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Behavior motivated by the desire to increase well-being and actualize human health potential.
Not disease oriented Motivated by personal, positive approach to wellness Seeks to expand positive health Example: immunizations, weight control |
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Illness Prevention
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Injury or illness specific
Avoidance of illness **Diagnosed w/ diabetes starts exercise program |
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Disease
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Alteration in the biological process. Cause of disease is referred to as etiology.
Etiology means the identification of the cause factors that brought on the disease. Some diseases have no known etiology. (autism—continue to search) Diseases have specific symptoms Ex. Lung cancer-smoking |
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Cause of disease
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Inherited genetic defects
Developmental defects-i.e. Virus during pregnancy (ex. Measles) Biological agents Physical agents-temp, chemical radiation Tissue response to injury (vasculitis) Physiologic & emotional reactions to stress (can trigger different diseases—take advantage of stress) Excessive or insufficient production of body secretions(hormones-imbalance) thyroid |
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Illness
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Response to a disease
Level of functioning is changed Unique response for each person Influenced by Self-perception and others perception Affects of those changes on roles and relationships (things change when I don’t feel good) Culture and spiritual values |
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2 types of illness
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Acute illness: severe symptoms brought on quickly and hopefully will subside with treatment (flu, cold)
Chronic illness: Last longer than 6 months |
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Stages of Illness
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The person goes through stages
First, has early symptoms Then takes on the sick role (stays in bed, misses work) And then calls the physician and gets verification to be sick Take of dependent patient role Recovers and resumes wellness role |
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Effects of Illness
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Tend to regress to an earlier stage of development.
Have an increased interest in the environment. (little things bother us) Loss of autonomy. (need others to help) Change life style Role change |
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What is Culture?
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‘the values, beliefs, norms, and practices of a particular group that are learned and shared and that guide thinking, decisions and actions in a patterned way’
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Culture Determines
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Who is healthy & ill
What people think causes health & illness What healers are sought to prevent and treat disease What treatments are used Appropriate sick role behavior (some cultures allow you to get in bed and recover others believe tough it out How long a person is sick & when he/she has recovered |
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Cultural Competence
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Understanding cultural characteristics and application of cultural knowledge in healthcare setting
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Non-ethnic cultures
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Socioeconomic: Poverty, Homeless, Wealthy
Sexual Orientation: Gay, Transgender, Bisexual Disabled: Visually &/or Hearing Impaired Occupation: Nurses, Military Age: Adolescents, Elderly |
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Stereotyping
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We must not presume that all people of a certain culture adhere to all aspects of their culture.
The healthcare provider must identify which aspects are appropriate for each patient during the admission process. |
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3 Parts to Cultural Competence
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Cultural Awareness
Cultural Knowledge & skill Cultual Encounter |
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Cultural Assessment
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is a “systematic appraisal or examination of individuals, groups, and communities as to their cultural beliefs, values & practices to determine explicit needs & intervention practices within the cultural context of the people being evaluated.”
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Spirituality
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refers to a subjective experience of the sacred, whereas religion involves subscribing to a set of beliefs or doctrines that are institutionalized
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Religion & Spirituality in healing
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Prayer, Chants
Pilgrimages Fasting Amulets or talismans Healing rituals (Anointing with oil, sacraments, laying on of hands) |
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Religion, Health, & Culture
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Research demonstrates positive health outcomes for people with strong spiritual and religious beliefs
Congruent with holistic philosophical beliefs about human nature Dietary & lifestyle practices often promote health & prevent disease (e.g., lower incidence of heart disease among Mormons & Seventh-day Adventists) Guides moral & ethical decision making |
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Ethnoreligious Identity
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Shrines with Buddha, candles, incense, and various artifacts (Buddhist)
Presence of prayer beads (Muslim) Amulets and talismans (charms) to ward off illness or bring good health (Mexican, Puerto Rican, & many African groups) Rosaries, religious medals, statues, votive candles (Catholics) Presence of mezuzza (small case containing torah passages on parchment--usually hung in doorway) |
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Cross-cultural communication
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"By what name may I call you?"
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Unsafe Practices with Limited-English Speakers
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Using family members as interpreters
Recruiting ad hoc (or untrained) interpreters Writing instructions in English Untrained Interpreters cause medical errors |
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What is ethnicity?
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Identification with a cultural group
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What is race?
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categories based on specific physical characteristics
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Stereotyping
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assumption all member of a culture, ethnic group, or race act alike
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Cultural imposition
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Everyone should conform to YOUR own belief system
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Cultural Blindness
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Ignores differences and proceeds as though they do not exist
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Cultural Conflict
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Responds by ridiculing the beliefs and traditions of others
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White Middle Class
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Family: is valued (elderly may live in LTC)
Healthcare: Self-diagnois, use OTC meds Beliefs: Youth is valued over age, attractiveness, achievements, cleanliness Common health problems: Breast cancer, heart disease, hypertension, diabetes mellitus, obesity Nursing assessment: patients use of OTC and dietary habits |
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African Americans
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Family: Close/supportive extended-family, strong ties with non-blood relatives from church social groups, matriarchal
Healthcare: varies can include spiritualits, herb dr, voodoo, faith healing Beliefs: Clergy are highly respected, highly religious present oriented Common Heath issues: Hypertension, stroke, Sickle cell, lactose intolerance, keloids Nursing Assessment: special care for hair and skin, lots of visitors |
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Asian
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Family: Welfare of family valued above person, extended families, ancestors respected, sharing among family members
Healthcare: Taoism (balance in all things), balance of dark/cold & light/warm, loss of balance due to diet or strong emotions. Treatment is energy based Beliefs: Self-respect and self-control, respect for age and authority, praise is considered poor manners, conflict avoidance Common Health issues: Hypertension, cancer of liver, lactose intolerance, thalassemia Nursing assessment: Some asian culture do not like blood drawn, will not complain, may tell you what they think you want to hear |
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Hispanic
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Family: Familial role is important, compadrazgo (bond between child's parents and grandparents), family is primary unit of society
Healthcare: Curanderas (folk healers)-body functions based of 4 body fluids (blood-hot/wet, yellow bile-hot/dry, black bile-cold/dry, phlegm-cold/wet) secret is to balance hot and cold. Cold disease cured with hot treatments Beliefs: Respect is given to age (older) and males, Roman Catholic influential, God gives health and allows illness for reason Common Health issues: Diabetes mellitus, lactose intolerance Nursing Assessment: Difficult to convince asymptomatic patient he/she is ill, special diet if patient believes in hot/cold |
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Cultural Personal Space
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Arabic-stand close
African-stand close Asian-like distance European-like distance South Asian cultures-being late is respectful |
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Food Preferences
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Vietnamese may eat soup at every meal
Mexican people-beans are a staple Middle Eastern-eat cheese and olives for breakfast Native Americans & Latino-eat 2 meals a day Holy days influence food choices |
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What is ethnocentrism?
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Belief that one's own ideas, beliefs, and practices are best and superior.
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Non-verbal Communication
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Facial expressions, body language, & tone of voice play a much greater role in cultures where people prefer indirect communication & talking around the issue.
Examples: Koreans are taught laughter & frequent smiling is a sign of intelligence Americans widen eyes to show anger Chinese narrow their eyes to show anger Vietnamese consider anger personal and not to be shown in public Chinese-smiling & laughing may be signs of embarrassment and confusion Southern Europeans commonly talk with hands African American & Arabs stare directly (not a challenge) Latino/Asian may drop eyes as sign of respect |
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Gestures
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Use gestures with care, as they can have negative meanings in other cultures.
Thumbs-up and the OK sign are obscene gestures in parts of South America & the Mediterranean. Pointing with the index finger and beckoning with the hand as a “come here” sign are seen as rude in some cultures much as snapping one’s fingers at someone would be viewed in the United States. |
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Touch
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Different rules about who can be touched & where.
A handshake is generally accepted as a standard greeting in business, yet the kind of handshake differs. North America = hearty grasp Mexico = softer hold Asia = soft handshake with the second hand brought up under the first is a sign of friendship & warmth |
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Religious Rules to Touch
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Religious rules may apply to appropriate touch.
Touching between men & women in public is not permitted by some orthodox religions, so a handshake would not be appropriate. Ideas about respect are conveyed through touch Touching the head, even tousling a child’s hair as an affectionate gesture, would be considered offensive by many Asians. If you need to touch someone for purposes of an examination, explain the purpose & procedure before you begin. |
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Appropriate Discussion
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Many Asian groups regard feelings as too private to be shared.
Latinos generally appreciate inquiries about family members, while most Arabs & Asians regard feelings as too personal to discuss in business situations. In social conversations, Filipinos, Arabs, & Vietnamese might find it completely acceptable to ask the price you have paid for something or how much you earn, while most Americans would consider that behavior rude. |
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Inappropriate Discussion
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Even a seemingly innocuous comment on the weather is off limits in the Muslim world, where natural phenomena are viewed as Allah’s will, not to be judged by humans.
This points to another aspect that relates to privacy. To many newcomers, Americans seem naively open. Discretion and purposeful communication help us judge when to converse and when to be silent. |
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Privacy
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Discussing personal matters outside the family is seen as embarrassing by many cultures.
Thoughts, feelings, & problems are kept to oneself in most groups outside the dominant American culture. Privacy boundaries may have implications when medical problems are exacerbated by personal or family problems. |
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Dignity preserved at all costs
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In Asia, the Middle East, & to some extent Latin America, one’s dignity must be preserved at all costs.
Death is preferred to loss of face in traditional Japanese culture, hence the suicide ritual, hara-kiri, as a final way to restore honor. Any embarrassment can lead to loss of face, even in the dominant American culture. To be criticized in front of others, publicly snubbed, or fired, would be humiliating in most any culture. Seemingly harmless behaviors can be demeaning to some patients. |
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Culturally Competent (Attitudes)
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Understanding: Acknowledging that there can be differences between our Western and other cultures’ healthcare values and practices.
Empathy: Being sensitive to the feeling of being different. Patience: Understanding the potential differences between our Western and other cultures’ concept of time and immediacy. Ability: To laugh with oneself and others. Trust: Investment in building a relationship with patients, which conveys a commitment to safeguard their well-being. |
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Non-verbal Communication
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65% of all communication
All cultures have rules, often unspoken, about who touches whom, when & where. Includes: Touch Facial expressions Eye movements Body posture |
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Modesty
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Patients may prefer clinicians of the same gender
May be taboo for males to examine or treat females (e.g., Middle Eastern groups) In some Asian & Hispanic cultures, older adults may believe that hospital gowns cause disease by exposing them to cold drafts (related to yin/yang & hot/cold theories of disease) |
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What is pain?
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Pain is an abstract concept which can be referred to as:
A personal private sensation A stimulus that signals harm A pattern of behavior to protect from harm Pain is a universal human experience, but pain reactions are unique to the individual and includes thoughts, feelings, reactions, expectations and past experiences associated with pain. The experience of pain can also be described in physiologic, psychosocial, economic and spiritual contexts. |
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Pain Assessment (cross-culturally)
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Pain Expression: Verbal and non-verbal behaviors, including gestures and tone of voice.
Pain Language: Word(s) used to describe pain. Language or other communication techniques such as pointing to site of pain. Religious Beliefs: Meaning of pain or suffering. Rituals and taboos associated with pain or pain treatment. |
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Pain Assessment (culturally)
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Social Roles:
Ethnic identity and degree of acculturation: such as primary language used, identification of social support networks. Family relationships, consider the role(s) the individual has within the family, extended family presence and role in community (such as employment). Gender and Age Influences. Perception of the healthcare system: Trust vs. suspicion. Use of traditional/lay remedies. Past experience with the healthcare system. |
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Pain Treatment Culturally
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Attitudes and fears about pain medications or other interventions may impact the patient and/or family compliance with a pain treatment plan.
Physiologic response to medications has race and age variations. For example, body composition of fat and serum protein in the elderly may alter distribution and absorption of medications. Also elicit patient beliefs about: Meaning of pain or illness. Expectations of healthcare providers. Therapeutic goals. |
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Barriers to pain assessment
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Stereotyping.
Lack of empathy. Ethnocentrism. (You think your better) Language. Experience or expertise of practitioner and time constraints. |
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Complementary medicine
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A therapy is called complementary when it is used in addition to conventional biomedical/scientific treatments
Goal: Gain the patient’s trust so he/she will tell you the truth about alternative and complementary practices used to treat pain or other symptoms |
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Alternative Therapy
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An alternative therapy is used instead of conventional biomedical/scientific treatments.
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What does a clinician do with a patient using complementary therapies?
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Check for drug interactions with prescription or over-the-counter medications
Assess for harmful side effects Discourage over-reliance on traditional healing if it delays necessary biomedical treatment (for example, conditions for which an antibiotic is needed) |
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Meta-Communicative Cultural Communication
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Pay attention to body language, facial expressions & behavioral cues; information is found in what is not said
Ask open ended questions or ones that give choices; remember a nod or yes may mean: “Yes, I heard” rather than “Yes, I understand” or “Yes, I agree” Consider that smiles & laughter may indicate discomfort or embarrassment; investigate to identify what is causing the difficulty or confusion |
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Meta-Communicative Cultural Communication
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Make formal introductions using titles (Mr., Mrs., Ms., Dr.) & surnames; let the individual take the lead in getting more familiar
Greet patients with “Good Morning” or “Good Afternoon” and when possible, in their language If there is a language barrier, assume confusion; watch for tangible signs of understanding, such as taking out a driver’s license to get a required number |
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Meta-Communicative Cultural Communication
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Take cue from patient about formality, distance, & touch
Question your assumptions about the other person’s behavior; expressions & gestures may not mean what you think; consider what a particular behavior may mean from the other person’s point of view Explain the reasons for all information you request or directions you give. |
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Meta-Communicative Cultural Communication
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Use a soft, gentle tone and maintain an even temperament
Spend time cultivating relationships by getting to know patients & coworkers Be open to including patients’ family members in discussions & meetings with patients Consider the best way to show respect, perhaps by addressing the ”head’ of the family or group first Use pictures & diagrams where appropriate; Pay attention to subtle cues that may tell you an individual’s dignity has been wounded Recognize that differences in time consciousness may be cultural & not a sign of laziness or resistance |
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Main Cultural Points Review
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By being open-minded and respectful toward their beliefs, values, & practices, you can help patients feel more comfortable.
Factors that may differ from patient to patient include ethnic, religious, and occupational factors. Some people belong to more than one ethnic group, as well as cultural groups, and other people have fewer group identities. |
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Main Cultural Points Review
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Importance of religion can vary from person to person. For example, some people keep many daily traditions, such as eating certain foods.
Others keep traditions only on special occasions, or not at all. For many different reasons, religious, ethnic, health, personal preference, etc., a person may eat or avoid certain foods at certain times, or not eat some foods at all |
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Main Cultural Points Review
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Different cultures have different ideas about how to express & respond to pain.
Some cultures value bearing pain silently, while others expect expressiveness. Different cultures have different views about when to seek professional medical help, treat oneself, or be treated by a family member or traditional healer. |
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What is communication?
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Process of exchanging and transmitting meanings between two or more individuals.
It is the foundation of society and the most primary aspect of a nurse patient interaction. Communication also assists in meeting our psychosocial needs of love, belonging and self esteem |
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Stimulus
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need that must be addressed
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Sender or Source
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person or group who initiates communication process
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Message
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actual physiologic product of the source (interview, conversations, gesture)
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Channel
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the medium the sender selects
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3 types of communication
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auditory-spoken words and cues
visual-sight observations and perceptions kinesthetic-touch |
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receiver
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interprets the message sent
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What is verbal communication?
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An exchange of information using works, including both the spoken and written word.
Depends on language, or a prescribed way of using words so that people can share information effectively. Language includes a common definition of words and a method of arranging the words in a certain order. |
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Examples of verbal communication
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Verbal interactions with patients and family, giving oral reports to other nurses, writing care plans, and recording progress in the chart. Other examples include public speaking, writing for publication and composing signs and posters.
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What is non-verbal communication
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The transmission of information without the use of words. Also known as body language.
It often helps nurses to understand subtle and hidden meaning in what is being said verbally. Example: The nurse asks the patient “how do you feel today?” The patient responds “I feel all right”. However the nurse notes the patient does not maintain eye contact and his facial expression is tense. This would indicate that the nurse should investigate further because of the incongruence of the patient verbal and nonverbal communication. |
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Non-verbal communication
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Information is exchanged through nonverbal communication in various ways. It is generally accepted that it expresses more of the true meaning of a message than verbal communication.
Nurses must be aware of both the nonverbal messages they send and the nonverbal messages they receive from patient. |
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What are different types of non-verbal communication?
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Touch, Eye Contact, Facial Expressions, Posture,
Gait, Gestures, General Physical Appearance, Sounds, Silence |
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4 levels of communication
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Intrapersonal communication
Interpersonal communication Small group communication Organizational communication |
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Intrapersonal communication
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Intrapersonal, or self-talk: Communication that happens within the individual.
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Interpersonal communication
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Occurs between two or more people with the goal to exchange messages.
Most of the nurses day is spent communicating with patients, family members, and members of the healthcare team. |
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Small Group Communication
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Occurs when nurses interact with two or more individuals.
To be functional, members of the small group must communicate to achieve their goal. Examples of small groups include staff meetings, patient care conferences, teaching sessions or support groups. |
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Organizational Communication
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Occurs when individuals and groups within an organization communicate to achieve established goals.
Nurses on a practice council meeting to review unit policies, or nurses working with interdisciplinary groups on strategic planning or quality assurance will use organizational communication to achieve their aims. |
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Group Dynamics
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How individual group members relate to one another during the process of working toward group goals.
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Factors that influence communication
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Developmental Level: ie. Working with children
Gender: Be sensitive to differences. Sociocultural Differences: Healthcare system has its own culture as well. Roles and Responsibilities: Occupation, take charge person, healthcare worker. Space and territoriality: Most comfortable in area that is their own. Remember personal space. Physical, Mental and Emotional State: Need to develop sensitivity to the physical, mental and emotional barriers to effective communication. |
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Factors that influence communication
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Values
Communication is influenced by the way people value themselves, one another, and the purpose of any human interaction. Example: Nurses who believe that teaching is an important aspect of nursing and who value empowering will communicate this to the patient. Conversely, a nurse who believes teaching is an unimportant chore is unlikely to be an effective teacher. |
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Factors that influence communication
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Environment
Communication happens best when the environment facilitates an easy exchange of needed information. The environment most conducive to communication is one that is calm and non-threatening. The goal is to minimize distractions and ensure privacy. |
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Therapeutic communication
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A helping relationship exists among people who provide and receive assistance in meeting human needs. It sets the climate for the participants to move towards common goals.
When a nurse and patient are involved in a helping relationship, the nurse is the helper, and the patient is the one being helped. |
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Therapeutic communication
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The quality of the relationship between these individuals is the most significant element in determining helping effectiveness.
Nursing theorist Jean Watson states that “Of all the problems that can arise in nursing care, perhaps the most common is failure to establish rapport and a helping-trust relationship with the other person. |
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Helping Relationship
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A helping relationship does not occur spontaneously. It occurs for a specific purpose with a specific person.
Characterized by an unequal sharing of information. The patient shares information related to personal health problems, whereas the nurse share information in terms of a professional role. Built on the patient’s needs, not on those of the helping person. A friendship might grow out of a helping relationship, but this is separate from the purposeful, time limited interaction that is usually considered a helping relationship. |
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Characteristics of a helping relationship
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Dynamic
Purposeful and time limited The person providing the assistance is professionally accountable for the outcomes of the relationship and the means used to attain them. The helping person should present his or her helping abilities as honestly as possible and not promise to provide more assistance than he or she can offer. |
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Goals of a helping relationship
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Goals of a helping relationship between a nurse and a patient are determined cooperatively and are defined in terms of the patients needs.
Common goals might include increased independence for the patient, greater feelings of worth, and improved health and well-being. |
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Promoting effective helping relationship
Dispositional Traits |
Warmth and Friendliness
Openness and Respect Empathy: identifying with the way another person feels. Is sensitive to the patients feelings and problems. Honesty, Authenticity, and Trust Caring: not just a “not just a task to be performed” Competence |
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Promoting effective helping relationship
Rapport |
Rapport: a feeling of mutual trust experienced by people in a satisfactory relationship. It facilitates open communication.
Rapport can be achieved by paying attention to the following variables. Specific objectives Comfortable environment Privacy Confidentiality Patient focus, not task focus Using Nursing Observations Optimal pacing: don’t rush Respecting personal space |
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Conversation skills
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Control the tone of your voice so that you are conveying exactly what you mean to say and not a hidden message. Tone should show interest not boredom, patience rather than anger, acceptance rather than hostility.
Be knowledgeable about the topic of conversation and have information, and ahead of time if possible. If unfamiliar, it is best to tell the patient and family and to direct them to other resources. Convey confidence and honesty to the patient. |
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Conversation skills
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Be flexible. Follow the patients lead if possible.
Be clear and concise and make statements as simple as possible. Avoid words that might have different interpretations. Be truthful. A patient who is given false information sill soon distrust the nurse. If you’re not sure about something, admit you don’t know and seek an answer rather than make a comment that is likely to be an error. You don’t say it’s going to be alright because you don’t really know that. Don’t say you may get discharged tomorrow—you don’t know that |
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Conversation skills
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Keep an open mind. An attitude of “I know better than the patient” is quickly discerned by the patient.
Take advantage of available opportunities. You can make even the most routine task meaningful by talking with your patients and family while you are with them. |
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Developing Therapeutic skills
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Listening is a skill that involves both hearing and interpreting what the other says.
It requires attention and concentration to sort out, evaluate, and validate clues to better understand the true meaning of what is being said. |
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Listening Skills
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When possible, sit when communicating with a patient. Do not cross your arms or legs because that conveys a message of being closed to the patient’s comments.
Be alert and relaxed and take sufficient time so that the patient feels at ease during the conversation. Keep the conversation as natural as possible and avoid sounding overly eager. If culturally appropriate, maintain eye contact with the patient, without staring, in a face to face pose. This conveys interest in the conversation and willingness to listen. |
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Listening Skills
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Indicate that you are paying attention to what the patient is saying by using appropriate facial expressions and body gestures. Be attentive to both your own and the patient’s verbal communication.
Think before responding to the patient. Responding impulsively tends to disrupt communication and listening. Do not pretend to listen. Most patients are sensitive to an attitude of feigned attention or to boredom and apathy. |
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Listening Skills
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Listen to themes in the patients comments. What are the repeated themes in the persons speech and behavior? What topics does the patient tend to avoid? Do they shift the conversation to another subject to avoid a certain subject? Are there inconsistencies and gaps in their conversation?
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Developing Therapeutic Skills
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Silence-wait for the patient to initiate or continue speaking. Reflect on what has been shared watch non-verbal clues
Touch-can provide connection, affirmation, reassurance. It can communicate frustration. Use wisely Humor-used effectively can maintain a balanced perspective in work and encourage patients to do the same. Laughter releases excess energy and reduces stress |
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Interviewing techniques
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open-ended questions
paraphrasing-Restating in fewer words using simple and precise language Validation-validate what you believe you heard/observed Clarifying questions-gain understanding of a comment Reflective questions-repeating what is said or describing the person's feelings Sequencing-place events in chronological order Directing question Focus-refocus-Helping the client expand on and develop a topic of importance |
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Why questions
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Requesting an explanation can be:
intimidating implied disapproval parental Better to ask: “what, where, who, when, how………” is occurring than WHY it is occurring |
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Alternatives to Why
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“I notice that……”
making an observation “Tell me about what happened…...” open-ended question “When did you first notice……” “What happened then……” placing an event in time and place seeking clarification |
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Assertive communication
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Good
Assertive response 1. have empathy 2. describing one's feelings or situation 3. clarifying one's expectations 4. anticipating consequences |
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Aggressive communication
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BAD
harsh injurious or destructive |
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4 phases of helping relationship
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1. Dispositional traits
2. Rapport Builders 3. Communication skills 4. Listening skills |