Vocab
Aggressive communication
Every time an interaction occurs between a healthcare provider and a patient the tone is set for the relationship. The style of _________ demonstrated is often what makes the difference between a positive or a negative interaction.
Communication
This has never been more important in the healthcare system than it is today, it is a legal record that is used to meet the many demands of the health, accreditation, medical insurance and legal systems.
____ are written on paper forms or electronically with computers or other electronic devices.
Medical Records ( chart, clinical record )
11:00pm is what time?
2300
People appointed to examine patients charts and health records to assess quality of care.
Auditors
The two ways of communication are what?
One way and two way
Good documentation reflects the _____ of the person doing the documenting.
Character
As a PCT the nursing process is followed through _____ of a nurse?
Delegation
2100
Some systems permits computer input only at the main station some facilites have bedside systems also referred to as _____. _____. _____
Point of Care
What are the five ways of non-verbal communication?
tone, rate of voice, volume of speech, eye contact, physical appearance and use of touch.
EHR's are used in various settings what are these settings?
healthcare providers offices, clinics and home care agencies
The nursing process may be known as the care plan. The nursing process has five categories. What are these five categories?
Assessment, diagnosis, planning, implementation, and evaluation.
0700 is what time?
7:00am
A communication style in which one does not stand up for what he or she feels or believes is right.
Unassertive communication
The world telephone means essentially the same thing to anyone who is familiar with the English language
This refers to the commonly accepted definition of a particular word.
Denotative Meaning
If the patient begins to show signs of a complication the _____ is the document that will reflect what led up to this complication.
Chart
This part of the medical record is used for frequent care measures?
Flow sheets or graphic sheets
0959 is what time?
9:59am
This is type delivery can send messages to a person, specifically with tone, volume of speech, eye contact, physical appearance, and use of touch.
Voice
An absence of eye contact communicates many things what are the five things it can communicate?
lack of confidence, disinterest, embarrassment, hirt, deference and respect
Documenting more than was done is also an issue of integrity and shoes that one is ____.
Dishonest
This part of the medical record tells you the patients name, date of birth, age and any personal information.
Admission record
What time is 12:00 Midnight?
0000 or 2400