Nursing process overview The LVN and the nursing process Communication techniques

Transcription

1 Nursing process overview The LVN and the nursing process Communication techniques Week 1, day 5 Lesa McArdle, MSN, RN FN 3 & 5 MSN 12 SPVN 8 & 9 Slide 1 1

2 Learning Objectives Define the nursing process Describe the components of the nursing process. Defining system of patient acuity and how it relates to the nursing process Explain the role of the LPN/LVN in the nursing process. Explain the relationship between the nursing process and critical thinking and why they are an important part of the LVN role. Slide 2 2

3 Assessment Involves collecting data about the health status of the patient A registered nurse must perform the initial admission assessment for each patient The LVN/LPN collects data through surveillance and monitoring and performs focused nursing assessments Slide 3 3

4 Assessment Subjective data Information reported by patient and family in a health history in response to direct questioning or in spontaneous statements Objective data Information that nurse or other members of health care team obtain through observation, physical examination, or diagnostic testing Slide 4 4

5 Physical Examination Inspection Purposeful observation of the person as a whole and then systematically from head to toe Slide 5 5

6 Physical Examination Palpation Uses touch to assess various parts of the body and helps to confirm findings that are noted on inspection Slide 6 6

7 Physical Examination Percussion Tapping on the skin to assess the underlying tissues Slide 7 7

8 Physical Examination Auscultation Listening to sounds produced by the body Slide 8 8

9 Nursing Diagnosis Derived from data gathered during the assessment Nursing diagnosis different from medical diagnosis Focuses on the patient s physical, psychological, and social responses to a health problem or potential health problem The RN formulates nursing diagnoses; the LVN/LPN is expected to assist with identifying patient needs and implementing plan of care Slide 9 9

10 Planning Develop a nursing care plan for the patient based on nursing diagnoses Nursing care plans a form of communication with other health care professionals to ensure continuity of care, prevent complications, and provide for health teaching and discharge planning Slide 10 10

11 Planning Steps in planning nursing care Determine priorities from the list of nursing diagnoses Set long-term and short-term goals to determine outcomes of care Develop objectives to reach the goals Write nursing orders to direct care to meet the goals Priorities established according to the most immediate needs of the patient Slide 11 11

12 Maslow s hierarchy of needs Slide 12 12

13 Intervention (Implementation) Actual performance of the nursing interventions in the plan of care Includes direct patient care, health teaching, or carrying out ordered medical treatments such as medications or dressing changes Nurses provide care to achieve established goals of care and then communicate the nursing interventions by documentation and report The care plan must be flexible and reflect changes in the patient s health care needs Slide 13 13

14 Evaluation Ongoing process that enables you to determine what progress the patient has made in meeting the goals for care The outcome criteria provide objective measures for determining the effects of care Outcomes compared with expected outcomes of patient care to determine whether the goals have been met, partially met, or not met Slide 14 14

15 Evaluation Important in individual care, but also provides data on quality of care in health care institution Quality assurance audits conducted by health care agencies as well as Joint Commission on Accreditation of Healthcare Organizations American Nurses Association Standards of Care used to determine if nurses have carried out the nursing process as documented in patient records Slide 15 15

16 Slide 16 16

17 Nursing Documentation Helps achieve continuity of care because it provides for communication among caregivers; a record of patient s progress Provides a legal record of care provided and a means to verify services rendered for insurance payments Slide 17 17

18 Nursing Documentation All treatments and care, including medications Procedures performed at the bedside, on the unit, or inside or outside the facility Patient s reaction to therapeutic and diagnostic procedures Observations of the patient Subjective and objective signs and symptoms experienced by the patient Evidence of changes in the patient s physical, psychosocial, and spiritual needs and status Any unusual incidents, such as falls or injuries, that occur during the patient s stay in the health care facility Slide 18 18

19 Nursing Documentation Should be factual, current, complete, organized, and accurate Writing should be legible, using proper grammar, punctuation, and spelling Observations stated objectively, describing only what was seen, heard, felt, or smelled Direct quotations from the patient regarding symptoms are appropriate Slide 19 19

20 Nursing Documentation Each time an entry is made, sign with your full name and title or login to an electronic system and remember to log out Use only permanent ink, and make no erasures If you make an error in charting, cross out the entry and write error or mistaken entry, followed by your initials Slide 20 20

21 Documentation Formats Paper Many organizations still use paper documentation for most if not all of the patient care activities. Electronic About 13% of hospitals across the nation have completely moved to an electronic medical record This percentage is constantly increasing due to federal mandates and financial incentives Slide 21 21

22 Critical Thinking Defined as reflective and reasonable thinking that is focused on deciding what to believe or do Tools to seek and apply knowledge Slide 22 22

23 Relationship of Critical Thinking to the Nursing Process The nursing process is a framework for developing, implementing, and evaluating a plan of care It spells out the patient s needs and problems, the goals for care, interventions to achieve goals, and how goal achievement will be assessed Slide 23 23

24 Relationship of Critical Thinking to the Nursing Process The nursing process does not flow smoothly from one step to the next, but often moves back and forth between steps The nursing process is a sequence of steps that should be based on critical thinking Slide 24 24

25 Characteristics of a Critical Thinker Curiosity The desire, not just to know, but to understand how and why, to apply knowledge Systematic thinking Uses an organized approach to problem solving, rather than knee-jerk responses Analytic Applies knowledge from various disciplines, approaches a problem by examining the parts and seeing how they fit together Slide 25 25

26 Characteristics of a Critical Thinker Open-minded Willing to consider various alternatives Self-confident Sense of assurance that the problem-solving process produces a good conclusion/plan Maturity Recognition that many variables are at work in patient situations, and sometimes the best plans do not work Truth-seeking Eager to know, asking questions, seeking answers, reevaluates common knowledge Slide 26 26

27 Critical Thinking Tools Interpretation Clarifying meaning of events, data Analysis Examining ideas, breaking down into components Evaluation Assessing possibilities, opinions, usual practices Inference Deriving alternatives, drawing conclusions Explanation Presenting arguments for views, decisions; justifying Self-regulation Reconsidering conclusions, recognizing need to make changes Slide 27 27

28 Week 1 - Objectives for communication Discuss therapeutic nursing communication techniques Identify therapeutic and non-therapeutic responses Discuss basics of good communication Discuss responsibility of the LVN in communicating with patients, instructors, staff members and physicians Identify barriers to effective communication Discuss emotional needs of patients Describe two types of communication Differentiate between sympathy and empathy Discuss the use of verbal and nonverbal communication Define humor List ways in which humor may be used by patients or staff therapeutically Slide 28 28

29 Slide 29 29

30 Overview Requirements for Communication Sender Receiver message One-way communication Two-way communication Slide 30 30

31 Overview Verbal Communication Involves the use of spoken words or symbols Connotative meaning Denotative meaning Jargon Nonverbal Communication Transmission of messages without the use of words Voice Slide 31 31

32 Overview Nonverbal Communication Eye Contact Eye contact: intention to interact Extended eye contact: aggression or induce anxiety Absence of eye contact: shyness, lack of confidence, disinterest, embarrassment, or hurt Eye contact for 2 to 6 seconds during interaction helps involve the other person. Culture significantly affects how eye contact is interpreted. Slide 32 32

33 Overview Physical Appearance Attributes Size Color of skin Dress Grooming Posture Facial expression A professional appearance conveys pride and competence. Slide 33 33

34 Overview Physical Appearance Gestures Movements used to emphasize the idea being communicated Posture The way a person sits, stands, and moves Open posture Relaxed stance Closed posture Formal, distant stance Slide 34 34

35 Overview Consistency of verbal and nonverbal communication Nonverbal communication is very powerful. If nonverbal cues are not consistent with the verbal message, it will most likely be the nonverbal message that is received. Slide 35 35

36 Styles of Communication Manner in which a message is communicated will greatly affect the mood and the overall outcome of an interaction Assertive Communication Aggressive Communication Unassertive Communication Slide 36 36

37 CLASS ACTIVITY Slide 37 37

38 Establishing a Therapeutic Relationship Interaction in which the nurse demonstrates caring, sincerity, empathy, and trustworthiness. Trust is essential to effective nurse-patient interaction. The nurse must be careful to maintain professional boundaries in nurse-patient relationship. Slide 38 38

39 Establishing a Therapeutic Relationship Tips for Building Rapport with Your Patient Become visible. Anticipate needs. Be reliable. Listen. Stay in control. Use self-disclosure. Treat each patient as an individual. Use humor when appropriate. Educate. Give the patient some control. Show support with small gestures. Slide 39 39

40 Communication Techniques Therapeutic An exchange of information that facilitates the formation of a positive nurse-patient relationship and actively involves the patient in all areas of the nursing process Nontherapeutic Prevents the patient from becoming a mutual partner in the relationship and may place the patient in a passive role Slide 40 40

41 Communication Techniques Nonverbal Therapeutic Communication Listening Most effective methods but also most difficult Conveys interest and caring Active listening Passive listening Slide 41 41

42 Communication Techniques Nonverbal Therapeutic Communication Silence Most underused Requires skill and timing Can convey respect, understanding, caring, support; often used with touch Gives you time to look at nonverbal responses Slide 42 42

43 Communication Techniques Nonverbal Therapeutic Communication Touch Must be used with great discretion to fit into sociocultural norms and guidelines Can convey warmth, caring, support, and understanding Nature of the touch must be sincere and genuine If the nurse is hesitant or reluctant to touch, it may be interpreted as rejection Slide 43 43

44 Figure 3-1 (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.) Touch can communicate caring comfort. Slide 44 44

45 Communication Techniques Nonverbal Therapeutic Communication Conveying Acceptance Patient may be reluctant to share information because he or she feels the nurse may disapprove of the patient s values, beliefs, or practices or may even fear rejection. Acceptance is the willingness to listen and respond to what a patient is saying without passing judgment. The nurse must be careful not to nonverbally communicate disapproval through gestures or facial expressions. Slide 45 45

46 Communication Techniques Verbal Therapeutic Communication Closed questioning Open-ended question Restating Paraphrasing Clarifying Focusing Reflecting Stating observation Offering information Summarizing Slide 46 46

47 CLASS ACTIVITY Slide 47 47

48 Factors Affecting Communication Posturing and Positioning Where and how the nurse sits or stands conveys a message to the patient. The most therapeutic posture and positioning is for the nurse to assume the same position and level as the patient. Slide 48 48

49 Factors Affecting Communication Space and Territoriality Comfort zone Distance between two or more individuals that must be maintained to guard against personal threat or intimidation. Four personal space zones Intimate zone: 0 18 inches Personal zone: 18 inches 4 feet Social zone: 4 12 feet Public zone: 12 feet or more Slide 49 49

50 Slide 50 50

51 Factors Affecting Communication Environment Should provide a calm, relaxed atmosphere Level of Trust Trusting relationship essential for effective nursepatient interaction Language Barriers Interpreter if available; messages must be kept simple Culture Significant component of a patient s psychosocial well-being Slide 51 51

52 Factors Affecting Communication Age and Gender A significant age difference between the nurse and the patient may be a barrier to communication. Male and female patterns of communication are often related to cultural, familial, and lifestyle patterns. Slide 52 52

53 Factors Affecting Communication Physiologic Factors Patients may experience physiologic factors that can interfere with effective communication. Pain Altered cognition Impaired hearing Psychosocial Factors Stress Grieving Slide 53 53

54 Blocks to Communication False reassurance Giving advice False assumptions Value judgments Clichés Defensiveness Asking for explanations Changing the subject Slide 54 54

55 Communication in Special Situations Ventilator-Dependent Patients Assess the patient s ability to use a particular alternative method of communication Aphasic Patients Expressive aphasia Receptive aphasia Slide 55 55

56 Communication in Special Situations Alternative Methods of Communication Lip reading Sign language Paper and pencil/magic slate Word or picture cards Magnetic boards with plastic letters Eye blinks Computer-assisted communication Clock face communicator Slide 56 56

57 Communication in Special Situations Unresponsive Patients Anyone interacting with the unresponsive patient should assume that all sound and verbal stimuli may be heard. Speak to the patient as if he or she were awake. Always explain to the patient any procedure or activity that is to take place involving the patient. Slide 57 57

58 Use of Humor Laughter is the best medicine. Laughter is a psychological and physical release. It can enhance feelings of well-being, reduce anxiety, and increase pain threshold. The use of humor can be effective and helpful, but it must be used with caution and discretion. Never appropriate to laugh at only with a person. Slide 58 58

59 Figure 3-2 (From Leahy, J.M., Kizilay, P.E. [1998]. Foundations of nursing practice: a nursing process approach. Philadelphia: Saunders.) Sharing a joke with patients can assist in supporting a therapeutic relationship. Slide 59 59

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