Midterm #1 - Week 2

Question 1

Health Equity

Answer 1

o Elimination of systematic health disparities
o Associated with social advantage and disadvantage
an aspirational concept that reflects the values of social justice and is a fundamental part of achieving global health. It means that all people are able to achieve maximum health potential with any economic, social, or environmental disadvantages.

Question 2

Health disparities

Answer 2

a health difference that is linked with economic, social, or environmental disadvantages. It affects people who have systematically experienced greater hardships to their health due to racial or ethnic group; gender; age; socioeconomic status; mental health; religion; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics that have been historically discriminated against.

Question 3

Health inequities

Answer 3

inequalities in health that unfair or come from some kind of injustice

Question 4

intersectionality

Answer 4

a theoretical idea that looks at the influence of multiple social characteristics like race, gender, ethnicity, class, and socioeconomic factors affect a particular phenomenon such as the experience of health and its outcomes

Question 5

gender equality

Answer 5

o Equal treatment of all, regardless of gender.
o No discrimination.
the notion that people should be discriminated based on their gender and should be given equal treatment

Question 6

cultural safety

Answer 6

o Recognize power and resource distribution. Awareness of institutional discrimination.
creating is safe environment for all people

Question 7

cultural humility

Answer 7

o Lifelong learning. Interpersonal respect and reflection.
a personal commitment to evaluating yourself about other backgrounds

Question 8

cultural conflicts

Answer 8

when people of different cultural values, beliefs, or practices clash
(when people have biases and discrimination against other cultures)

Question 9

communication

Answer 9

the exchange of information between individuals, groups, or organizations

Question 10

Alzheimer’s

Answer 10

most common type of dementia. Fatal disease that overtime affects all aspects of a person’s life

Question 11

Trauma informed practice (definition)

Answer 11

• Trauma is often closely tied to substance use, mental illness, stigma, health care access barriers, and other challenges
• understanding the link between trauma with substance abuse, mental illness, stigma, barriers to health care, and other challenges. As well as making people feel safe and not re-traumatize them through their care

Question 12

Autonomy

Answer 12

the ability to be self directed and independent in accomplishing goals and advocating for other people

Question 13

Denotative meaning of a word

Answer 13

the meaning of the word that everyone knows

Question 14

Connotative meaning of a word

Answer 14

the meaning of a word that is influenced by peoples thoughts, feelings

Question 15

Aphasia

Answer 15

the inability to produce or understand language

Question 16

Prefix- hypo and hyper

Answer 16

hypo - below or under
hyper - excessive or high

Question 17

Implicit bias

Answer 17

unconscious biases that are thoughts and feelings outside our awareness and hard to acknowledge and control

Question 18

Explicit bias

Answer 18

the biases that people deliberately think about and make conscious reports about. Often stereotypes.

Question 19

Perceptual bias

Answer 19

perceptual biases are human tendencies that interfere with accurately perceiving and intercepting messages, attitudes, and values from other people

Question 20

verbal and nonverbal communication

Answer 20

verbal communication – uses spoken or written word
nonverbal communication – uses all five senses and refers to the transmission of messages that do involve the spoken or written word.
non-verbal supplements, reinforces, undermines verbal communication.

Question 20

Dementia

Answer 20

gradual and progressive decline in mental processing ability/cerebral dysfunction. It affects short term memory language, judgement, reasoning, and abstract thinking, and eventually long term memory and familiar task

Question 21

Delirium

Answer 21

A potentially reversable condition of cognitive impairment that often has a physiological cause

Question 22

Depression

Answer 22

described as the presence of a cluster of depressive symptoms that last for at least two weeks for most of the day and most of the time. With a high intensity compared to normal

Question 23

How does this knowledge about trauma informed practice improve our nursing communication?

Answer 23

Helps to build trust, by being mindful of how trauma affects people better relationships can be built

Question 23

Ethnocentrism

Answer 23

the idea that one’s own group, ethnicity, nationality, etc. is superior to others

Question 24

Cultural Safety (lack of and definition)

Answer 24

o Western medicine at the forefront. o Benefits do not often cover alternative medicine (or not as well) o This leads to fear of discrimination and lack of trust in the health care system. Necessary interventions are prolonged leaving the client and families to suffer consequences. o Do not make assumptions that all individuals from one group act the same way o “Awareness of social, political, and historical contexts of other groups of people and knowledge of the groups experiences”

Question 25

Discrimination

Answer 25

prejudice against other people, especially about ethnicity, age, etc.

Question 25

Stereotypes

Answer 25

oversimplified ideas about a person or thing that are widely held

Question 25

racism

Answer 25

discrimination based on race

Question 26

Different parts of Cultural Humility

Answer 26

o Ensuring culturally congruent and equitable care o Personal self-awarenesses o Profession self- awarenesses o Organizational awarenesses o Community awarenesses

Question 26

How do we make change?

Answer 26

o Education, equity guidelines, self-advocacy, research, equity policy, and accountability. o Understanding relationships; recognizing power imbalances; awareness of institutional discrimination; eliminate systemic disparities.

Question 27

TIP

Answer 27

o Understanding and responding to the impact of trauma. Ensure physical, psychological, and emotional safety o Prevention: prevent more harm and triggers o Safety: take down barriers and reduce stigma

Question 28

reflexivity

Answer 28

the ability of someone to examine their own feelings, reactions, and motives

Question 29

perception

Answer 29

based on information from the five senses

Question 29

Trauma Informed Practice – How to

Answer 29

o Safety – doing point of care risk assessments to make sure patient is okay and not in distress o Trust and transparency – gain the patients trust, if you said you were going to do something go through with it o Peer support – peer support groups for patients for more support o Empowerment, voice, and choice – advocacy o Collaboration and mutuality – working with the patient and with the healthcare team o Cultural, historical, and gender issue – try to understand and learn about other peoples/perspectives

Question 30

Why is communication important in nursing practice?

Answer 30

o Therapeutic relationships: Individualized care; Safety, trust, caring; Good nursing care o Have uncomfortable conversations o The basis for the nursing process o Client autonomy o Better client outcomes o Increases professional credibility

Question 31

5 Levels of Communication

Answer 31

o Intrapersonal – with yourself o Transpersonal – spiritual o Interpersonal – between people o Small-group – small group of people o Public – having an audience

Question 32

contextual knowledge

Answer 32

the skill of knowing when it is relevant to apply specific rules or concepts in a specific context

Question 33

The Communication Process

Answer 33

o Sender – is the person who encodes and delivers the message, the senders messages acts as a referent for the receiver o message – the content of the communication, two nurses can provide the same information yet deliver 2 different messages, to send effective messages express yourself clearly, directly, and in a manner familiar to the receiver o channel – ways to conveying and receiving messages through visual, auditory, and tactile senses o receiver is the person who receives and decodes the message, they are responsible for attending to decoding, and responding to the senders message o Feedback – the message sent by to the sender by the receiver which indicates if the receiver got the intended message and understood it o noise – noises in the environment?? a o Environment – the place where the communication takes place o interpersonal variables – anything that can affect the message/communication o Referent (motivates one person to communicate with another)

Question 34

Strategies for communicating with the older adult

Answer 34

- Try to find a quiet room with little outside noises - Sit facing the patient so they can see your lip and facial movements - If masks must be worn consider other ways to creating a warm, inviting environment - Make sure glasses or hearing aids are worn if needed - Speak slowly and clearly (do not speak loudly) - Keep the tone of your voice low (older persons can her lower tones better) - Periodically summarize what has been said to clarify and repeat important points - Ask the older person what they understood and invite questions to clarify - Emphasize and integrate emotional and personal values in the acquisition of skills and ideas

Question 35

What are three possible outcomes when nurses communicate ineffectively?

Answer 35

- Poor patient outcomes - Increases in adverse incidents - decreases in professional credibility

Question 36

The 4R's

Answer 36

- The 4 Rs: realize, recognize, respond, resist o Realization: an organization wide realization of how trauma affects people o Recognize: the ability to recognize the signs of trauma o Response: a system wide response to trauma that informs all behaviours, language, programs, and polices o Resistance: resisting re-traumatization of patients, clients, and staff. Organization can unintentionally create conditions that will re-traumatize people

Question 37

How can Verbal communication impact a message?

Answer 37

the message can be impacted by vocabulary – word choice, denotative and connotative meaning – the different meanings of a single word, pacing – the speed of the message, intonation – the tone of voice, clarity and brevity – effective communication through simple, brief, and direct messages, timing and relevance – timing is critical

Question 38

How does Nonverbal communication impact a message?

Answer 38

the message can be impacted by general appearance – physical characteristics, facial expression, manner of dress, etc., posture and gait – the way people move, sit, stand, etc., facial expression – the face is the most expressive part of the body, eye contact – shows the readiness to communicate, gestures – emphasize and clarify spoken word, sounds – communicate feelings and thoughts, personal space – the right of someone to need and defend their own space, if it becomes threatened communicate is harder. It provides people with a sense of security, identity, and control

Question 38

Therapeutic communication strategies

Answer 38

o Active listening o Sharing observations o Sharing empathy o Sharing hope o Sharing humor o Sharing feelings o Using touch o Using silence o Providing information o Clarifying o Focusing o Paraphrasing o Asking relevant questions o Summarizing o Self-disclosure o Confrontation

Question 39

What are therapeutic communication techniques?

Answer 39

- Therapeutic communication involves using specific response that encourage the expression of feelings and ideas and convey acceptance and respect

Question 40

What is nontherapeutic communication?

Answer 40

- Non-therapeutic communication techniques damage or hinder professional relationships and often cause recipients to active their defenses to avoid being hurt or negatively affected

Question 40

Non-therapeutic communication techniques

Answer 40

o Asking personal questions o Giving personal opinions o Changing the subject o Automatic responses – such as stereotypes and clichés o False reassurance o Sympathy – it is a feeling of concern, sadness, pity for the patient that generated by personal identification with the patient’s needs. It is not as therapeutic or responsive as empathy o Asking for explaination – why questions can feel like accusations or make the patient feel like you are testing them. o Approval or disapproval o Defensive responses o Passive or aggressive responses o Arguing

Question 41

Different parts of verbal communication

Answer 41

o Vocabulary o Pacing o Tone o Brevity o Timing o Relevance

Question 41

What are the principals of TIP

Answer 41

- Safety - Trust and transparency - Peer support - Collaboration and mutuality - Empowerment, voice, and choice - The importance of cultural, historical, and gender issue

Question 41

Different parts of nonverbal communication

Answer 41

o Personal appearance o Facial expression o Posture and gait o Eye contact o Touch, gestures, and sound o Personal space

Question 42

Personal Space (other spaces)

Answer 42

o Intimate 0 – 1.5ft (consent privacy) o Personal 1.5 – 4ft (it is okay for the nurse to enter this space) o Social 4 – 12ft o Public 12+ ft

Question 43

Elements of Professional Communication

Answer 43

o Courtesy o Use of names o Trustworthiness o Autonomy and responsibility o Assertiveness (“I” language/ “I feel _ about _ because _”)

Question 44

Strategies for active listening

Answer 44

o S – Sit facing the pt o O – Open posture o L – Lean forward o E – Eye contact o R – Relax

Question 45

Older Adult Client Needs: Age specific approach

Answer 45

o Physical and psychosocial o Function impacted by disease and disability o Decreased homeostasis o Lack of standard norms o Altered manifestations and response

Question 46

Cognitive Changes in aging truths

Answer 46

Symptoms such as disorientation, loss of language skills, loss of the ability to calculate, and poor judgement are not normal changes with aging – can indicate something is wrong.

Question 47

Delirium symptoms

Answer 47

o Confused/disorientated o Visual hallucinations (auditory hallucinations – less common) o Difficulty thinking/focusing attention o Behavior or personality different than usual o Day/nights are mixed up o Drift between asleep and awake o More alert or more tired o Older persons tend to experience hypoactive delirium – making it harder to recognize – it might seem like depression

Question 48

Delirium

Answer 48

o “out of the track” o Delirium is an acute, reversible state of disorientation, inattention, and confusion o Rapid onset (hrs. – days) o Increased prevalence with age & more likely to occur in acute care settings o MEDICAL EMERGENCY

Question 49

why does delirium happen?

Answer 49

o Infection: causes inflammation- confusion in the older adult, o Low Na+ (sodium): cell swelling- confusion, o Impaction: dehydration, nausea, irritation, constipation can lead to bowel perforation

Question 50

why is it a medical emergency?

Answer 50

o Poor outcomes (can lead to falls, injury etc.), o Increase L.O.S. (Length of stay), o Death.

Question 51

Delirium Management

Answer 51

o Find and treat the underlying cause o Include family and friends o Keep the clients routine as simple as possible o Keep the environment calm – reduce distractions o Encourage healthy eating and promote drinking fluids o Keep sentences short and simple o Make sure the pt has their glasses, hearing aids etc. o Do not argue with the pt re: hallucinations

Question 52

What is dementia

Answer 52

o Broad term for a set of symptoms that affect the brain o Generalized impairment of intellectual functioning, gradual deterioration

Question 53

what are the warning signs of dementia

Answer 53

o Memory loss affecting day-to-day abilities o Difficulty performing familiar tasks (ADL’s) o Problems with language o Disorientation in time and space o Impaired judgment o Problems with abstract thinking o Misplacing things o Changes in mood/behavior o Changes in personality o Mini-mental (MMSE) score of 23 or less= cognitive impairment

Question 54

Communicating with people living with Dementia

Answer 54

o 1. Identify yourself, e.g. ”My name is… o I’m here to help you get into your wheelchair.” o 2. Approach the person from the front. o 3. Move slowly; maintain eye contact. o 4. Address the person by name; speak slowly and clearly. o 5. Present one idea at a time. o 6. Repeat/rephrase responses to clarify what the client is trying to tell you. o 7. Ask “yes” or “no” questions & allow time for a response. o 8. Back up your words with actions using gestures. o 9. Listen actively/ acknowledge the person’s emotional state. o 10. Touching too roughly quickly could cause increased stress.

Question 55

What is depression

Answer 55

o A mood disorder characterized by feelings of sadness and despair o 2 or more weeks o Not a normal part of aging

Question 56

what are depression risk factors

Answer 56

o Health challenges o Chronic disease o Chronic pain o Loss o Social isolation o Changes in independence

Question 57

Signs and Symptoms of Depression

Answer 57

o ADLs o Loses interest o Feelings of worthlessness and sadness o Sleep changes o Nutritional changes o Physical symptoms o Lethargy o Difficulty concentrating o Spends more time alone o Suicide o GDS – geriatric depression scale

Question 58

Depression Management

Answer 58

o Diet o Exercise o Manage Stress o Avoid drugs/alcohol o Medications (anti-depressants) o Suicide risk? - report to your instructor/RN, - refer to resources.