Communication continued
What are the communication phases of a nurse-patient relationship?
· Preinteraction Phase
Before meeting a patient:
• Review available data, including the medical and nursing history.
• Talk to other caregivers who have information about the patient.
• Anticipate health concerns or issues that arise.
• Identify a location and setting that fosters comfortable, private interaction.
• Plan enough time for the initial interaction.
What events require an incident report?
· Examples include patient falls, needlestick injuries, medication administration errors, accidental omission of ordered therapies, a visitor losing consciousness, and any circumstances that lead to injury or pose a risk for patient injury such as a “near miss.”
· There are several definitions for “near miss”; however, there is consensus that this term should be used to indicate incidents in which a patient is exposed to a hazardous situation with the potential to cause harm but in which, for a variety of reasons (luck or early detection), no harm did occur
What considerations should you take into account when taking a patient’s respirations?
· Assess the depth of respirations by observing the degree of excursion or movement of the chest.
· Describe ventilatory movements as deep or shallow, normal or labored.
· A deep respiration involves a full expansion of the lungs with full exhalation.
What are physiologic responses to stress?
· Fight: Aggressiveness, Taughtness of body, stomp, kick, anger, rage, knot in stomach, nausea, vomiting
· Flight: restless legs and feet, fidgeting, feeling trapped, anxiety/adrenaline, wide eyes, tense
· Freeze: feeling numb, sense of dread, pale skin, holding breath/ restricted breathing
What are the reaction points to psychological stress?
· Primary appraisal: evaluating an event for its personal meaning
· Secondary appraisal: focuses on possible coping strategies
· Coping: the person’s effort to manage psychological stress
· Ego-defense mechanisms: regulate emotional distress and give a person protection from anxiety and stress
What are the communication phases of a nurse-patient relationship
Orientation Phase
When you and a and patient meet and get to know one another:
• Set the tone for the relationship by adopting a warm, empathetic, caring manner.
• Recognize that the initial relationship is often superficial, uncertain, and tentative.
• Expect the patient to test your competence and commitment.
• Closely observe the patient and expect to be closely observed by the patient.
• Begin to make inferences and form judgments about patient messages and behaviors.
• Assess the patient’s health status.
• Prioritize the patient’s problems and identify his or her goals.
• Clarify the patient’s and your roles.
• Form contracts with the patient that specify who will do what.
• Let the patient know when to expect the relationship to be terminated.
What is variance? What event require a variance report?
· occurs when the activities on the critical pathway are not completed as predicted or a patient does not meet the expected outcomes
· result from a change in a patient’s health or because of other health complications not associated with the primary reason for which a patient requires care. Once you identify a variance, you modify the patient’s care to meet the needs associated with the variance.
· A positive variance occurs when a patient makes progress faster than expected (e.g., an indwelling urethral catheter is discontinued a day earlier than anticipated according to the critical pathway).
· An example of a negative variance is when a patient develops pulmonary complications after surgery, requiring oxygen therapy and monitoring with pulse oximetry. Variances to expected outcomes are documented with a progress note
What other considerations should you take into account when taking a patient’s respirations?
Exercise
• Exercise increases rate and depth to meet the need of the body for additional oxygen and to rid the body of CO2.
· Acute Pain
• Pain alters rate and rhythm of respirations; breathing becomes shallow.
• Patient inhibits or splints chest wall movement when pain is in area of chest or abdomen.
· Anxiety
• Anxiety increases respiration rate and depth as a result of sympathetic stimulation.
· Smoking
• Chronic smoking changes pulmonary airways, resulting in increased rate of respirations at rest when not smoking.
· Body Position
• A straight, erect posture promotes full chest expansion.
• A stooped or slumped position impairs ventilatory movement.
• Lying flat prevents full chest expansion.
· Medications
• Opioid analgesics, general anesthetics, and sedative hypnotics depress rate and depth.
• Amphetamines and cocaine sometimes increase rate and depth.
• Bronchodilators slow rate by causing airway dilation.
· Neurological Injury
• Injury to brainstem impairs respiratory center and inhibits respiratory rate and rhythm.
· Hemoglobin Function
• Decreased hemoglobin levels (anemia) reduce oxygen-carrying capacity of the blood, which increases respiratory rate.
• Increased altitude lowers amount of saturated hemoglobin, which increases respiratory rate and depth.
• Abnormal blood cell function (e.g., sickle cell disease) reduces ability of hemoglobin to carry oxygen, which increases respiratory rate and depth.
What is General Adaptation Syndrome (GAS)?
· An immediate physiological response of the whole body to stress; involves several body systems, especially the autonomic nervous and endocrine systems, and includes immunological changes (Selye)
· a three-stage set of physiological processes that prepare, or adapt, the body for danger so that an individual is more likely to survive when faced with a threat
· GAS is triggered either directly by a physical event or indirectly by a psychological event
What is PTSD
· An acute stress disorder that begins when a person experiences, witnesses, or is confronted with a traumatic event
· May include flashbacks = Recurrent and intrusive recollections of the event
What are the communication phases of a nurse-patient relationship?
Working Phase
When you and a patient work together to solve problems and accomplish goals:
• Encourage and help the patient express feelings about his or her health.
• Encourage and help the patient with self-exploration.
• Provide information needed to understand and change behavior.
• Encourage and help the patient set goals.
• Take action to meet the goals set with the patient.
• Use therapeutic communication skills to facilitate successful interactions.
• Use appropriate self-disclosure and confrontation.
What is a SOAP note and what belongs in each section?
· S (subjective data) - chief complaint or other information the patient or family members tell you.
o EX: Patient states, “My leg is so swollen. I’m worried about this blood clot. Do you know how they are going to treat it?”
· O (objective data) - factual, measurable data, signs and symptoms, vital signs, or test values.
o EX: Patient asking question about medications and how DVT will be treated. Alert and oriented; responds appropriately to instruction.
· A (assessment data) - conclusions formulated as patient problems or nursing diagnoses
o EX: Patient lacks knowledge regarding anticoagulation therapy, seeking information about therapy.
· P (plan) - strategy for relieving the patient's problems, including short- and long-term actions
o EX: Discussed importance of bed rest and the reason for treatment with heparin infusion. Provided brochure on anticoagulation therapy for DVT. Explained rationale for bed rest and daily blood tests to check anticoagulation levels.
What are factors affecting vital signs of older adults?
• Aging causes ossification of costal cartilage and downward slant of ribs, resulting in a more rigid rib cage, which reduces chest wall expansion. Kyphosis and scoliosis that occur in older adults also restrict chest expansion and decrease tidal volume.
• Older adults depend more on accessory abdominal muscles during respiration than on weaker thoracic muscles.
• The respiratory system matures by the time a person reaches 20 years of age and begins to decline in healthy people after the age of 25. Despite this decline older adults are able to breathe effortlessly as long as they are healthy. However, sudden events that require an increased demand for oxygen (e.g., exercise, stress, illness) create shortness of breath in the older adult.
• Identifying an acceptable pulse oximeter probe site is difficult with older adults because of the likelihood of peripheral vascular disease, decreased cardiac output, cold-induced vasoconstriction, and anemia.
What is the alarm stage reaction? Example?
· A stressor is perceived. Slight drop in homeostasis occurs as the mind and body temporarily lose balance
· CNS is aroused, body defenses are mobilized; this is the “Fight or Flight” response
· During this stage rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and norepinephrine, heart rate, blood flow to muscles, oxygen intake, and mental alertness. In addition, the pupils of the eyes dilate to produce a greater visual field.
· If the stressor poses an extreme threat to life or remains for a long time, the person progresses to the second stage, resistance
What is compassion fatigue
· a term used to describe a state of burnout and secondary traumatic stress.
· Secondary traumatic stress is the stress that health care providers experience when witnessing and caring for others who are suffering.
· The feelings of hopelessness and anxiety from compassion fatigue usually result in feelings of inadequacy and lower self-esteem.
What are the communication phases of a nurse-patient relationship?
Termination Phase
During the ending of the relationship:
• Remind the patient that termination is near.
• Evaluate goal achievement with the patient.
• Reminisce about the relationship with the patient.
• Separate from the patient by relinquishing responsibility for his or her care.
• Achieve a smooth transition for the patient to other caregivers as needed.
How can medical documentation be used?
· facilitating interprofessional communication among health care providers, providing a legal record of care provided, justification for financial billing and reimbursement of care
· Data are also used to audit, monitor, and evaluate care provided to support the process needed for quality and performance improvement
· a clear description of individualized and goal-directed nursing care you provide based on your nursing assessment. Always document patient care in a timely manner following agency standards.
· Documenting all aspects of the nursing process is a critical nursing responsibility that limits nursing liability by providing evidence that you maintained or exceeded practice standards while taking care of patients
If vital signs are delegated what is your responsibility as the RN?
• You may delegate these measurements in selected situations (e.g., in stable patients). However, it is your responsibility to review vital sign data, interpret their significance, and critically think through decisions about interventions.
• Use vital sign measurements to determine indications for medication administration.
• Analyze the results of vital sign measurements on the basis of patient’s condition and past health history.
• Verify and communicate significant changes in vital signs.
• Educate the patient or family caregiver in vital sign assessment and the significance of findings.
What is the resistance stage of GAS? Example?
· This stage contributes to the fight-or-flight response, and the body stabilizes and responds to compensate for the changes induced by the alarm stage
· Hormone levels, heart rate, blood pressure, and cardiac output return to normal, and the body begins to repair damage.
· These compensation attempts consume energy and other bodily resources
What is second victim syndrome?
· Second victim syndrome affects health care providers when a medical error that results in significant harm to a patient and the patient’s family occurs (Hartley, 2018).
· Often overlooked, nurses who have been involved in such a medical error can sustain complex psychological harm that can lead to detrimental outcomes such as suicide.
· These fatal errors can haunt nurses throughout their lives, leading to symptoms that are similar to post-traumatic stress disorder.
· One potential outcome is that nurses “move on” and work on gaining additional knowledge and skills to prevent errors in the future. But in many cases, nurses are reluctant to return to work because of fear of isolation from the organization, loss of confidence, remorse, depression, humiliation, and guilt
Is it ever okay to become facebook, Instagram, tiktok friends with patients or to give the your personal cell number or email?
Absolutely NOT! Just don't do it.
What do you want to document at the time of occurrence?
• Vital signs
• Pain assessment
• Administration of medications and treatments
• Preparation for diagnostic tests or surgery, including preoperative checklist
• Change in patient’s status, treatment provided, and who was notified (e.g., health care provider, manager, patient’s family)
• Admission, transfer, discharge, or death of a patient
• Patient’s response to treatment or intervention
What patients are at high risk of tachycardia/bradycardia?
• The older adult has a decreased heart rate at rest.
• It takes longer for the heart rate to rise in the older adult to meet sudden increased demands that result from stress, illness, or excitement. Once elevated, the pulse rate takes longer to return to normal resting rate.
• Heart sounds are sometimes muffled or difficult to hear in older adults because of an increase in air space in the lungs.
• Pedal pulses are often difficult to palpate in older adults.
• If it is difficult to palpate the pulse of an obese older adult, a Doppler device provides a more accurate reading.
What is the exhaustion stage of GAS? Example?
continuous stress causes progressive breakdown of compensatory mechanisms.
· This occurs when the body is no longer able to resist the effects of the stressor and has depleted the energy necessary to maintain adaptation. The physiological response has intensified, but the person’s ability to adapt to the stressor diminishes.
· Replenish them, and the body will return to homeostatic state.
· If not, this may cause long-term physiological problems such as chronic HTN, depression, sleep deprivation, chronic fatigue syndrome, and autoimmune disorders
· May be a temporary “rally” or increase in bodily response before death
True or False
Free