Chapter 24 Communication Mosby items and derived items

Chapter 24 Communication Mosby items and derived items © 2005 by Mosby, Inc.

Communication and Interpersonal Relationships Vehicle for establishing a therapeutic relationship n Means of influencing the behavior of another to lead to successful outcomes n Mosby items and derived items © 2005 by Mosby, Inc.

Levels of Communication Intrapersonal n Interpersonal n Transpersonal n Small group n Public n Mosby items and derived items © 2005 by Mosby, Inc.

Basic Elements of Communication Referent n Sender and receiver n Messages n Channels n Feedback n Interpersonal variables n Environment n Mosby items and derived items © 2005 by Mosby, Inc.

Forms of Communication Verbal n Nonverbal n Symbolic n Metacommunication n Mosby items and derived items © 2005 by Mosby, Inc.

Verbal Communication Vocabulary n Denotative and connotative meaning n Pacing n Intonation n Clarity and brevity n Timing and relevance n Mosby items and derived items © 2005 by Mosby, Inc.

Nonverbal Communication Personal appearance n Posture and gait n Facial expression n Eye contact n Gestures n Sounds n Territoriality and personal space n Mosby items and derived items © 2005 by Mosby, Inc.

Zones of Personal Space Intimate zone: 0 to 18 inches n Personal zone: 18 inches to 4 feet n Social zone: 4 to 12 feet n Public zone: 12 feet and beyond n Mosby items and derived items © 2005 by Mosby, Inc.

Professional Helping Relationships Nurse—client n Nurse—family n Nurse—health team n Nurse—community n Mosby items and derived items © 2005 by Mosby, Inc.

Elements of Professional Communication Courtesy n Use of names n Privacy and confidentiality n Trustworthiness n Autonomy and responsibility n Assertiveness n Mosby items and derived items © 2005 by Mosby, Inc.

Communication in the Nursing Process n Assessment Physical and emotional factors l Developmental factors l Sociocultural factors l Gender l Mosby items and derived items © 2005 by Mosby, Inc.

Communication in the Nursing Process (cont’d) n Nursing diagnosis examples Impaired verbal communication l Anxiety l Social isolation l Ineffective coping l Impaired social interaction l Powerlessness l Mosby items and derived items © 2005 by Mosby, Inc.

Communication in the Nursing Process (cont’d) n Planning Goals and outcomes l Priorities l Continuity of care l Mosby items and derived items © 2005 by Mosby, Inc.

Communication in the Nursing Process (cont’d) n Implementation l Therapeutic communication techniques Mosby items and derived items © 2005 by Mosby, Inc.

Therapeutic Communication Techniques Active listening (SOLER) n Sharing observations n Sharing empathy n Sharing hope n Sharing humor n Sharing feelings n Mosby items and derived items © 2005 by Mosby, Inc.

Therapeutic Communication Techniques (cont’d) Using touch n Using silence n Providing information n Clarifying n Focusing n Paraphrasing n Mosby items and derived items © 2005 by Mosby, Inc.

Therapeutic Communication Techniques (cont’d) Asking relevant questions n Summarizing n Self-disclosure n Confrontation n Mosby items and derived items © 2005 by Mosby, Inc.

Nontherapeutic Communication Techniques Asking personal questions n Giving personal opinions n Changing the subject n Automatic responses n False reassurance n Sympathy n Mosby items and derived items © 2005 by Mosby, Inc.

Nontherapeutic Communication Techniques (cont’d) Asking for explanations n Approval or disapproval n Defensive responses n Passive or aggressive responses n Arguing n Mosby items and derived items © 2005 by Mosby, Inc.

Communication in the Nursing Process n Implementation l Adapting communication techniques for clients with special needs Mosby items and derived items © 2005 by Mosby, Inc.

Communication in the Nursing Process (cont’d) n Evaluation Analysis of communication patterns l Process recordings l Mosby items and derived items © 2005 by Mosby, Inc.

Chapter 25 Client Education Mosby items and derived items © 2005 by Mosby, Inc.

Standards n Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Mosby items and derived items © 2005 by Mosby, Inc.

Purposes Maintenance and promotion of health and illness prevention n Restoration of health n Coping with impaired functioning n Mosby items and derived items © 2005 by Mosby, Inc.

Teaching Interactive process n Conscious, deliberate set of actions n Assist individuals to gain knowledge, change attitudes, adopt new behaviors, perform skills n Mosby items and derived items © 2005 by Mosby, Inc.

Learning n Acquisition of new knowledge, attitudes, behaviors, and skills Mosby items and derived items © 2005 by Mosby, Inc.

Role of the Nurse Ethical responsibility n Response to client requests n Identification of client needs n Mosby items and derived items © 2005 by Mosby, Inc.

Teaching as Communication Referent n Sender n Message n Channels n Receiver n Feedback n Intrapersonal variables n Mosby items and derived items © 2005 by Mosby, Inc.

Domains of Learning n Cognitive learning Knowledge l Comprehension l Application l Analysis l Synthesis l Evaluation l Mosby items and derived items © 2005 by Mosby, Inc.

Domains of Learning (cont'd) n Affective learning Receiving l Responding l Valuing l Organizing l Characterizing l Mosby items and derived items © 2005 by Mosby, Inc.

Domains of Learning (cont'd) n Psychomotor learning Perception l Set l Guided response l Mechanism l Complex overt response l Adaptation l Origination l Mosby items and derived items © 2005 by Mosby, Inc.

Basic Learning Principles Motivation to learn n Ability to learn n Developmental l Physical l n Learning environment Mosby items and derived items © 2005 by Mosby, Inc.

Teaching Process and Assessment Expectations of learning n Learning needs n Motivation to learn n Ability to learn n Teaching environment n Resources for learning n Mosby items and derived items © 2005 by Mosby, Inc.

Teaching Process and Nursing Diagnosis n Examples Deficient knowledge l Ineffective health maintenance l Impaired home maintenance l Ineffective therapeutic regimen management l Mosby items and derived items © 2005 by Mosby, Inc.

Teaching Process and Planning Learning objectives n Setting priorities n Timing n Organizing teaching material n Maintaining attention and participation n Building on existing knowledge n Mosby items and derived items © 2005 by Mosby, Inc.

Teaching Process and Planning Selection of teaching methods n Availability of teaching resources n Writing teaching plans n Mosby items and derived items © 2005 by Mosby, Inc.

Teaching Tools Printed material n Programmed instruction n Computer instruction n Non-print materials n l Diagrams, charts, pictures, objects, audiovisuals Mosby items and derived items © 2005 by Mosby, Inc.

Teaching Process and Implementation n Teaching approaches Telling l Selling l Participating l Entrusting l Reinforcing l Mosby items and derived items © 2005 by Mosby, Inc.

Teaching Process and Implementation (cont’d) Incorporating teaching with nursing care n Instructional methods n One-on-one discussion l Group instruction l Preparatory instruction l Demonstrations l Mosby items and derived items © 2005 by Mosby, Inc.

Teaching Process and Implementation (cont’d) n Instructional methods Analogies l Role playing l Simulation l Mosby items and derived items © 2005 by Mosby, Inc.

Teaching Process and Implementation (cont’d) n Particular client needs Illiteracy and disabilities l Cultural background and language l Developmental stage l Mosby items and derived items © 2005 by Mosby, Inc.

Teaching Process and Evaluation Measurement methods n Client expectations n Documentation n Mosby items and derived items © 2005 by Mosby, Inc.

Chapter 26 Documentation and Informatics Mosby items and derived items © 2005 by Mosby, Inc.

Confidentiality Nurses are legally and ethically obligated to keep client information confidential. n Nurses are responsible for protecting records from all unauthorized readers. n HIPAA act requires disclosure or requests regarding health information. n Mosby items and derived items © 2005 by Mosby, Inc.

Standards n The Joint Commission requires each client have an assessment: l n Physical, psychosocial, environment, self-care, client education, and discharge planning needs Federal and state regulations, state statutes, standards of care, and accreditation agencies set nursing documentation standards. Mosby items and derived items © 2005 by Mosby, Inc.

Multidisciplinary Communication Within the Health Care Team n Records or chart: l n Confidential permanent legal document Reports: l Oral, written, audiotaped exchange of information Mosby items and derived items © 2005 by Mosby, Inc.

Multidisciplinary Communication Within the Health Care Team n Consultations: l n A professional caregiver providing formal advice to another caregiver Referrals: l Arrangement for services by another care provider Mosby items and derived items © 2005 by Mosby, Inc.

Purposes of Records Communication Legal documentation Financial billing Education Research Auditing/monitori ng Mosby items and derived items © 2005 by Mosby, Inc.

Guidelines for Quality Documentation and Reporting Factual n Accurate n Complete n Current n Organized n Mosby items and derived items © 2005 by Mosby, Inc.

Methods of Recording n Narrative: l n The traditional method Problem-Oriented Medical Record (POMR): Database l Problem list l Nursing care plan l Progress note l Mosby items and derived items © 2005 by Mosby, Inc.

Methods of Recording: Progress Notes n SOAP: l n SOAPIE: l n Subjective, objective, assessment, plan, intervention, evaluation PIE: l n Subjective, objective, assessment, plan Problem, intervention, evaluation Focus Charting (DAR): l Data, action, response Mosby items and derived items © 2005 by Mosby, Inc.

Methods of Reporting n Source records: l n Charting by exception (CBE): l n A separate section for each discipline Focuses on documenting deviations Case management plan and critical pathways: l Incorporates a multidisciplinary approach to care Mosby items and derived items © 2005 by Mosby, Inc.

Common Record-Keeping Forms Admission nursing history form Flow sheets and graphic records Client care summary or Kardex Acuity records Standardized care plans Discharge summary form Mosby items and derived items © 2005 by Mosby, Inc.

Home Care Documentation Medicare has specific guidelines for establishing eligibility for home care. n Documentation is the quality control and justification for reimbursement from Medicare, Medicaid, or private insurance. n Mosby items and derived items © 2005 by Mosby, Inc.

Home Care Documentation n Nurses need to document all their services for payment. Mosby items and derived items © 2005 by Mosby, Inc.

Long-Term Health Care Documentation n n Governmental agencies are instrumental in determining the standards and policies for documentation. The Omnibus Budget Reconciliation Act of 1987 includes Medicare and Medicaid legislation for long-term care documentation. Mosby items and derived items © 2005 by Mosby, Inc.

Long-Term Health Care Documentation n The department of health in states governs the frequency of written nursing records. Mosby items and derived items © 2005 by Mosby, Inc.

Computerized Documentation Software programs allow nurses to enter assessment data. n Computers generate nursing care plans and document care. n A complete computer-based patient care record (CPCR) is not without legal risks. n Mosby items and derived items © 2005 by Mosby, Inc.

Reporting Change of shift n Telephone reports n Verbal or telephone orders n Transfer reports n Incident reports n Mosby items and derived items © 2005 by Mosby, Inc.