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153 Cards in this Set
- Front
- Back
Phases of Nurse- Client Relationship
Initial /introductory phase |
introduce yourself
tell what you are there to do discuss the patient's problems/What brought you to the hospital? |
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Phases of Nurse- Client Relationship
Working/middle phase |
here you problem solve
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Phases of Nurse- Client Relationship
Termination phase |
at the end of shift or at discharge of patient
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Levels of Communication
Intrapersonal |
talking things through to yourself
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Levels of Communication
Interpersonal |
one to one communication with a patient or staff meneber.
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Levels of Communication
Small Group |
communicating with a small group
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Levels of Communication
Organizational |
delivering communication to a large group.
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Interpersonal Level of Communication
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Sender---Message---Channel---Receiver
Verbal Auditory Nonverbal Visual Written Kinesthetic arts |
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Group Level Communication
Task Group |
there's a specific purpose to the talk, a task to be accomplished is what is discussed.
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Group Level Communication
Therapeutic |
Alcoholics Anonymous
other support groups no group leader need be present |
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Group Level Communication
Therapy Group |
a healthcare professional leader is present with a specific topic to be discussed.
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Group Level Communication
Self Help Group |
no leader present,
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Communication Development
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infant --cries
toddler- limited language "No", "why?" Pre-school-child mimics language of others. School Age- learn to communicate with eachother-another language. Adolescent-may be a lack of communication with a lot of attitude. Adult-skills are honed and applied Older Adult-may withdraw due to sensory deprivation or be loud and demanding. |
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Factors Influencing Communication
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Developmental level-age
Gender differences affect communication. Sociocultural differences- personal space' touching. roles- your professional status in a group Space and territoriality-personal space, cultural differences Physical, emotional,mental state of person- pain may affect one's communication level. environment-a hospital unit may not be conducive to a patient's communication level. values-may be difficult to communicate with some one with differing values than your own. |
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Communication Methods
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it's not just verbal
non-verbal communication is extremely important-body language. art-colors, images may convey messages. music- singing,soothing music may relax. touch-holding a hand may convey a message, if culturally acceptable. |
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Non-verbal Communication
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Actions speak louder than words.
appearance-image of professionalism . facial expressions- you can say something but your face can tell another story. posture-leaning towards or away from the person. gestures-may have cultural meaning touch-cautious,aggressiveness,suspicious, can be interpreted in many ways. |
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Personal Space
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intimate- 0 to 18 inches
personal - 1.5 to 4 feet. social/public - 4 feet and beyond. |
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Effective Therapeutic Communication
Active Listening |
Stop talking- actively listen to patients
sit down- less threatening to patient, shows interest. allow time for communication give eye contact- shows interest,trust. think before you speak |
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Effective Therapeutic Communication
reflection/paraphrasing |
- "I don't like the food here" - don't say "why or how" this can intimidate, instead,
say"Tell me what you don't like about the food" - a problem can be fixed. |
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Effective Therapeutic Communication
Clarifying |
"I thought I heard you say you don't like the food here"
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Effective Therapeutic Communication
Stating observations/perception sharing |
"You seem displeased with your meal"
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Effective Therapeutic Communication
Focusing |
stay to the point
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Effective Therapeutic Communication
Open-ended questions |
"do you like to travel?" will probably elicit a yes or no answer.
instead, ask " where have you traveled?" |
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Effective Therapeutic Communication
Silence |
let people talk or cry, allow their form of communication. or maybe you are at a loss for words and it is best to stay silent.
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Effective Therapeutic Communication
Accepting |
do not convey your negative feelings on a topic even if you feel it is not an acceptable opinion they are expressing
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Effective Therapeutic Communication
Give recognition |
complement,
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Effective Therapeutic Communication
offering of self- |
"I'm hear to help you"
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Effective Therapeutic Communication
Sharing observations |
"I see you're looking better today"
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Effective Therapeutic Communication
Empathy |
imagine yourself in their situation.
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Effective Therapeutic Communication
Validation |
agree with the patient
'it must be difficult to be in the hospital" |
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Effective Therapeutic Communication
Sharing hope |
terminal patient says"I'm going to my daughter's wedding next year" - you can't take away their hope.
Say "that's going to be wonderful" |
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Effective Therapeutic Communication
Humor |
breaks the ice
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Effective Therapeutic Communication
Sharing emotions |
it's ok to laugh and cry with your patient. it makes you "human"
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Effective Therapeutic Communication
Trust |
if you say you'll be back in an hour you need to make sure you will.
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Effective Therapeutic Communication
Providing information |
your role is to help and provide/teach.
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Effective Therapeutic Communication
Encourage spontaneity and expression of feelings. |
you must seize the moment- if patient wants to express feelings, even if you are pressed for time, stay and listen-that moment may never be recreated.
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Effective Therapeutic Communication
Confrontation |
"If you do that, this is going to happen to you.."
used often with a patient in substance abuse who is in denial."you've been drinking heavily and that's what brought you to the hospital" |
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Effective Therapeutic Communication
Clarity and brevity |
make sure your communication is clear and brief.
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Effective Therapeutic Communication
Rate and tone of your speech |
patient can sense if you are in a hurry.
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Effective Therapeutic Communication
Self disclosing your own feelings |
sometimes.
it's not your purpose to pour your heart out to patient. you can say "I'm feeling badly about that" |
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Barriers to Communication
Age |
differing values
and mode of speaking. you don't speak to a young child the same way you would speak to an adult. |
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Barriers to Communication
Gender |
can pose problems to some.
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Barriers to Communication
Physical and health status |
pain and illness can block you out.
they may not want to communicate. |
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Barriers to Communication
intellectual factors |
levels of education
vocabulary may intimidate slang/jargon may not be understood. |
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Barriers to Communication
Emotional factors |
patient may be too upset to communicate with you.
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Barriers to Communication
Language differences |
if the patient speaks a different language, a lack of comprehension may hinder communication.
a translator may be needed. depending on a family member or friend may not get your message across, and you'll never know it. |
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Barriers to Communication
Cultural factors |
meanings may be misconstrued.
An islamic person may not allow a man to discuss topics with his wife. |
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Barriers to Communication
Environmental factors |
a noisy room may not be conducive to a conversation.
lack of privacy clutter. |
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Barriers to Communication
Asking personal questions/probing |
you are not there to find out about there love life, for instance.
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Barriers to Communication
Automatic responses |
don't "yes" someone to death.
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Barriers to Communication
Sympathy |
differs from empathy. don't condescend or pity them.
be sincere. |
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Barriers to Communication
asking for explanations or probe |
cues that they are becoming anxious from your questions
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Barriers to Communication
Arguing |
don't argue.
it creates a stalemate, no-win situation. |
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Barriers to Communication
Changing the subject |
you may not feel comfortable and try to change the subject, thus losing that period of communication.
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Barriers to Communication
False reassurance |
don't promise things you know are not true, even if you mean well.
Say "we'll be there for you" You can't say "you're not going to die" |
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Barriers to Communication
Giving personal opinions |
" if I were you..."
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Barriers to Communication
Inattentive listening |
pay attention to patient
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Barriers to Communication
not showing approval |
"you should not do that"
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Barriers to Communication
Being defensive |
patient says " I hate this place"
Do not respond with "why? this is a beautiful place!" |
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Barriers to Communication
Belittleing feelings |
don't say "you shouldn't feel that way" to a patient.
you are negating their feelings. |
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Barriers to Communication
Cliches |
avoid these.
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Barriers to Communication
Topping it off |
patient tells you his back hurts and you respond "you, my back hurts all the time!"
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Barriers to Communication
Asking questions containing why or how |
always a wrong approach.
makes patient feel he has to defend their reasoning. "I hate this place" don't ask "Why do you hate it" instead ask "Tell me why you hate this place" |
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Barriers to Communication
Transference |
between patient & nurse-
patient says " you look just like my son" they'll treat you like their son. |
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Barriers to Communication
Counter transference |
between nurse & patient-
nurse says "oh my goodness, she looks just like my grandmother" so, will nurse treat her like she treats her grandmother? |
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Barriers to Communication
Gift giving |
patient may insist on giving you a gift.
we are not allowed to accept. how do you handle this situation without insulting patient? cannot impart the idea that if gift isn't accepted they will not be treated well. |
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Barriers to Communication
difficult client |
may be in pain, lonely
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Communicating with Clients with Special needs
Hearing impaired |
face patient directly
do not raise voice. |
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Communicating with Clients with Special needs
Visually impaired |
touch
point provide ample lighting do not raise voice, they are not hearing impaired. |
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Communicating with Clients with Special needs
Aphasic |
if patient cannot speak back,use writing.
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Communicating with Clients with Special needs
Confused client |
you need to get into their world
If they insist it's Monday and it's actually Wednesday, go along. |
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Communicating with Clients with Special needs
Unconscious patient |
you need to tell them everything that is going on because they still can here you.
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Communicating with Clients with Special needs
Angry clients |
be calm
do not create a shouting match. silence |
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Communicating with Clients with Special needs
Non English speaking clients |
provide a translator.
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Client Education
definition |
explain what you are doing and teach them to take care of themselves.
This applies to a family member or caretaker, as well. |
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Client Education
health promotion |
- DARE Program
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Client Education
Prevent illness |
teach hand washing
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Client Education
restoration of health |
teaching a diabetic how to give himself insulin or stay on a diet
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Client Education
coping with impaired functions |
teaching skills to deal with an impairment.
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the Role of the Nurse in Client Education
The essential function of every nurse |
a doctor's order is not needed to teach a patient.
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the Role of the Nurse in Client Education
Legally bound |
nurse must teach how to do essential skills to patient, and it must be thoroughly documented.
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the Role of the Nurse in Client Education
ANA |
ANA considers patient education one of our Standards of Nursing.
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the Role of the Nurse in Client Education
JCAHO |
JCAHO will not certify an institution unless there is evidence that patient education is being done.
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the Role of the Nurse in Client Education
Documentation |
all teaching must be documented, making it part of the legal record.
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Factors Affecting Client Learning
Age/Developmental level |
in the case of a dementia patient, the nurse needs to teach the caregiver.
children and adults are not taught the same way |
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Factors Affecting Client Learning
Family support |
very often there are families that are willing to help with client education. this is good family support.
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Factors Affecting Client Learning
Financial resources |
this is very important.you can teach a diet, but the family may not be able to afford it.
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Factors Affecting Client Learning
Cultural influences |
does the client believe or agree with the treatment being taught?
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Factors Affecting Client Learning
Literacy |
can the client read and comprehend any reading material provided to them?
do not assume that they can. |
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Domains of Learning
Cognitive |
thinking - what is the disease and how does the client control it.
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Factors Affecting Client Learning
Affective |
emotional- how to emotionally deal with the implications of the disease.
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Factors Affecting Client Learning
Psychomotor |
actually doing - how to physically handle the tasks required to handle their treatment.
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Factors Affecting Client Learning
Teaching Strategies for all Domains |
each client is different and their strengths and weaknesses must be identified.
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Preparing to Teach Use of the Nursing Process
Assessment-identification of learning needs |
determine what client knows and what needs to be taught.
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Preparing to Teach Use of the Nursing Process
Planning |
need to set goals for the client
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Preparing to Teach Use of the Nursing Process
Implementing of teaching Strategies |
interventions-how are we actually going to do this teaching?
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Preparing to Teach Use of the Nursing Process
Evaluation of the Goals |
are the interventions effective?
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Assessment of Learning
Source of information |
interview patient, doctor and family as well as other healthcare professionals
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Assessment of Learning
Learning needs |
what information does patient need to know now?
what is the information that is nice that the patient knows-complications,additional care information that may not be able to be taught in a short stay in the hospital. what does the patient already know about his condition? is there misinformation? |
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Assessment of Learning
Motivation |
does patient want to learn?
look at behavior being exhibited. is patient eager, inquisitive? |
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Assessment of Learning
Health beliefs and lifestyles |
is patient's lifestyle conducive to his achieving wellness?
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Assessment of Patient's Ability to Learn
physical |
does patient have the physical dexterity to perform tasks, manipulate equipment?
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Assessment of Patient's Ability to Learn
Sensory |
can patient hear, see, feel?
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Assessment of Patient's Ability to Learn
Reading level |
is material provided at patient's reading level?
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Assessment of Patient's Ability to Learn
Developmental level |
attention span may vary
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Assessment of Patient's Ability to Learn
Cognitive function |
not everyone can be taught.may have to teach a caregiver for the dementia patient, for instance.
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Assessment of Patient's Ability to Learn
Learning style |
does patient prefer visual, auditory or doing?
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Assessment of Patient's Ability to Learn
Compliance |
does client want to learn?
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Assessment of Patient's Ability to Learn
interference |
financial limitations
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Assessment of Patient's Ability to Learn
pyschosocial issues |
is there undue stress in the home making learning difficult?
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Assessment of Patient's Ability to Learn
Client's strengths and weaknesses |
physical weakness hampering their willingness to learn?
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Assessment of Patient's Ability to Learn
Assessment of Teacher |
does teacher know subject matter?
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Nursing Diagnosis
knowledge deficit - of what? |
why is there a knowledge deficit?
is it related to a lack of knowledge? is this a new experience? |
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Planning
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take this information gathered from the assessment:
need to know what to know already knows what to teach who will teach when where strategies and create a plan.. |
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Planning
Short term goals Long term goals |
what do we want the patient to accomplish?
in the hospital? at home? |
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Setting Goals
Single behavior |
set goal for a single behavior:
"Patient will be able to inject himself with insulin", for instance. |
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Setting Goals
observable or measurable |
must see that patient knows how to perform task.
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Setting Goals
Time measured |
by when?
mutually set by nurse and client. patient will be able to inject himself with insulin by discharge" |
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Setting Goals
set priorities |
what goals should be prioritized first?
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Learner's Ability to Retain Information
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retaining rates for learning:
reading retains 10% hearing " " 26% Sight " " 30% Seeing and hearing retains 50% talking retains 70% teaching retains 90% |
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Teaching Tools
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printed material must be at the correct literacy level.
programed instruction involves class,bedside instruction. computers visual aids allow seeing and hearing of material for good retention. audiovisuals - CD's Contracts-agreements binding client to promise to learn. |
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Interventions - Teaching Strategies.
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set priorities- teaching the need to know material first.
where will it be taught? timing depends on patient graduated regime- information needs to build in steps. practice makes perfect. sometimes the support system(caregiver) learns along with patient. teacher/learner relationship needs to develop and flourish. |
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Teaching Strategies.
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what worked before?
provide models for teaching. sequential steps explain in terms the client understands. adjust to clients needs- is he tired/ doesn't want to do any for at this time- must postpone till a later time. |
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Teaching Strategies.
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types of teaching models:
discussion is most common. role play - role model group/ individual setting independent study with a CD. Demonstration/return demonstration -I show you now you show me. Use of games. positive Reinforcement. incorporate teaching while giving actual nursing care - talk them through the procedures. |
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Theory of Adult Learners
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Androgogy-teaching the adult learner..
Pedagogy- teaching children Geragogy-teaching the older adult. |
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Andragogy
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adults are independent in self concept-they are going to learn only what they want to learn.
Their life's experiences can be related to what they need to learn. their orientation to learning is the present. their readiness to learn will be shown by their questions, eagerness. |
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Geragogy strategies
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teach when alert and rested.
use appropriate sensory aids when needed. control the environment-noise/temperature. face the client use a slow pace attention span is about 20 minutes/give small amounts of information at one time. cover 1 topic at a time. |
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Geragogy strategies
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audiovisual material works well.
allow time for expression. how do they feel about the material? set realistic goals. focus on their strengths. base teaching on previous knowledge. use analogies. summarize important points. have family/caregiver present as their backup. |
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Strategies fo, r Teaching Children
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infants are taught to trust by consistent routine.
pre-schoolers- role play, pictures, demonstration. school age- psychomotor skills discussion. adolescent- self expression, problem solving, allow them to make decisions, being a role model. |
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Evaluation
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most important step.
was outcome met? post-test. return demonstration- show me you know how to do it. observation- changes in behavior-did diabetic patient pick the right foods? VERY IMPORTANT. get feedback from patient-what does he think/feel? Does Plan Need Revision? are goals realistic? |
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Documentation
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Document assessment of learning needs.-What does patient need to know?
What information did you teach? what method did you use? Who was taught? Patient and Family? What was response/outcome to teaching? Is there a need for more teaching? Is there the ability to manage needs after discharge? |
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T.E.A.C.H
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T-tune into the client
E-edit client information A- act on every teaching moment C- clarify often H- honor client as a partner in the education process. |
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non verbal communication ia also known as
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body language
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touch is viewed as
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one of the most effective non verbal ways to express feelings of:
love affection security anger frustration aggression excitement |
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the most expressive part of the body is the
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face
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posture can express
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positive attitude-held in good alignment
depression-slouched rigid- pain |
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intrapersonal communication
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self talk
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interpersonal communication
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between two or more people with a goal to exchange messages.
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hand off communication involves
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the accurate presentation of all patient related information to another caregiver.
TJC recommends the use of SBAR S -situation B- background A - assessment R- recommendations |
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SBAR
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Situation & Background provide objective data
Assessment & Recommendation provide subjective data. |
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Helping Relationship
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occurs between the nurse and patient
is not spontaneous characterized by an unequal sharing of information, based on the patient's needs.-unlike a social relationship which information shared is usually equal and spontaneous, |
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The Helping relationship is described as having three phases:
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ORIENTATION-
patient calls nurse by name and describes the roles of the participants in the relationship patient and nurse will agree upon the goals, frequency of contacts and duration of the relationship WORKING PHASE- patient expresses feelings and concern to nurse patient actively participates in achieving mutually accepted goals TERMINATION patient identifies the goals accomplished patient verbalizes feelings about the termination of the relationship |
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empathy
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identifying with the way another person feels
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rapport
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a feeling of mutual trust experienced by people in a satisfactory relationship.
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semantics
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the study of the meaning of words-their interpretations.
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Using "why" or "how" in a question
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do not use- can be intimidating to the patient.
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dysarthria
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impaired control of speech
may be slurred or otherwise difficult to understand. |
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aphasia
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a reduced ability to understand what others are saying, express oneself, or be understood with an impaired ability to speak.
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Health Literacy
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the ability to read, understand and act on health information.
the average American reads at the 8-9th grade level. meanwhile, most healthcare literature and directions are written at a 10th. grade level. |
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the COPE model
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a method of helping family members to become effective problem solvers and supporters of your nurse-patient teaching effort.
C - CREATIVITY-help family overcome healthcare management and overcome obstacle. O-OPTIMISM-help family view the situation with confidence. P- PLANNING_help family plan for future problems and develop a contingency plan. E-EXPERT INFORMATION-help family learn how to obtain expert information and how to handle specific situations. |
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Patients learn in three domains
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cognitive
psychomotor affective |
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Cognitive learning
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storing of information that includes:
acquisition of knowledge comprehension application of knowledge analysis of knowledge |
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psychomotor learning
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learning a physical skill
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