Test 3 Flashcards
(111 cards)
1
Q
NCSBN Psychosocial Integrity
A
Nurse provides and directs care that promotes and supports emotion, mental, and social well-being of clients w/ acute or chronic mental illness
2
Q
WHO, 2006 Sexual Health
A
- a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity
- requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence
- to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled
3
Q
Development of self-concept
A
- Lifelong process
- Erikson’s psychosocial theory:
- each stage builds tasks of the previous stage
- successful mastery leads to a sense of self
4
Q
Components of Self- Concept
A
- Identity
-Body image
-Role performance
-Self esteem
5
Q
What is identity self concept?
A
Happens alot during adolescence
-one’s sense of self
-according to Erikson, the adolescent’s task is to solidify a sense of self by testing and integrating various roles
6
Q
What is body image concept?
A
-attitudes related to physical appearance, structure, and function
7
Q
What is the role performance concept?
A
Relationship or situational transitions and illness
-how individuals carry out their significant roles
8
Q
What is self-esteem concept?
A
Vary by developmental stage
-an individual’s general feeling of self-worth
9
Q
What are sexuality stressors?
A
Occur across the lifespan
10
Q
How can the nurse influence the patient’s self-concept and sexuality?
A
-Use a positive and matter of fact approach
- Build a trusting relationship
-Be aware of facial and body expressions
11
Q
During the nursing assessment, what behaviors suggests altered self-concept and sexuality?
A
-Avoids eye contact
-Slump posture
-Unkept appearance
-Overly apologetic
-Hesitant/withdrawn
-Critical or angry
-Frequent/inappropriate crying
-Negative self evaluation
-Excessively dependent
-Lack interest in what is happening
-Passive attitude
-Difficulty in making decision
12
Q
Other considerations during assessment of self concept?
A
Older adults:
-ask about past sexual experiences
-consider coping behaviors
-explore resources and strength
Patient expectations:
-discuss the patient’s goals
13
Q
Example of Nursing Diagnosis for Self-Concept
A
-Disturbed Body Image
-Disturbed Personal Identity
-Ineffective Role Performance
-Readiness for Enhanced Self-Concept
-Chronic Low Self-esteem
-Situational Low Self-esteem
-Sexual Dysfunction
-Ineffective Sexuality Pattern
14
Q
What is role conflict?
A
-the tension caused by competing demands between two or more roles pertaining to different statuses
15
Q
What is role overload?
A
-having more work to accomplish than time permits
16
Q
What is role ambiguity?
A
-uncertainty about what behaviors are expected of a person in a particular role
17
Q
What is role strain?
A
the incompatibility among roles corresponding to a single status
18
Q
What can we implement for patient’s struggling with stress?
A
Health promotion: healthy lifestyle behaviors that support adaptation to stress
- Education topics based on patient’s age
Acute Care: Address patient stressors to promote health
Restorative and continuing care: Teach patients to develop effective coping mechanisms
-Make appropriate referrals
19
Q
Factors Influencing Response to Stressors
A
-Intensity
-Scope
-Duration
-Number/nature of other stressors
-Predictability
20
Q
What is the Fight or Flight Response?
A
-Arousal of the SNS
-Prepares a person for action
-Diverts blood from the intestines to the brain and straited muscles
-Increases BP, HR, RR, and blood glucose
21
Q
What is the General Adaptation Syndrome (GAS)?
A
- An immediate physiological response of the whole body to stress; involves the autonomic nervous and endocrine systems, and includes immunological changes
A three-stage reaction to stress:
Alarm reaction
Resistance stage
Exhaustion stage
22
Q
What is stress?
A
- when an event is viewed as a threat and exceeds our ability to deal with it
23
Q
What happens during the ALARM stage of (GAS)?
A
organism recognizes stress, begins to respond: prepares body to fight or flight; senses are heightened
24
Q
What happens during the RESISTANCE stage of (GAS)?
A
second stage;
body functions normalize while responding to the stressor. The body begins to repair damage
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What happens during the EXHAUSTION stage of (GAS)?
third stage; only occurs if resistance stage does not work
if the client reaches this stage, body functions are no longer able to maintain an adaptive response to the stressor
26
What are indicators of stress?
Physical: cardio, neuro, reproductive etc.
Psychological: Cognitive, emotional, behavioral/lifestyle
27
What is the PRIMARY APPRAISAL reaction to psychological stress?
Initial Survey of Event: " how stressful is this event?"
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What is the SECONDARY APPRAISAL reaction to psychological stress?
Focus on resources and coping strategies to overcome stressful event
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What is problem focused coping?
Attempting to alleviate stress directly by changing the stressor or the way we interact with that stressor
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What is emotional focused coping?
Attempting to reduce stress by avoiding or ignoring a stressor and attending to emotional needs related to our stress reaction
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What are ego-defense mechanisms?
Regular emotional distress
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What are some stress management techniques?
-Cope w/ general stress
-Relax and soothe body/mind
-breathing exercise
-massage
-imagery
-humor laughter
-yoga meditation
33
What is the Neuman Systems Model?
Based on the concepts of stress and reaction to stress
34
What is the Pender's health promotional model?
Focuses on promoting health and managing stress
35
Factors that Influences Stress & Coping
-Situation
-Maturation
-Sociocultural
-Compassion Fatigue
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What should we understand when doing an assessment on a patient with stress/coping?
Subjective Findings: Patient's POV
Objective Findings: Patient's appearance and nonverbal behaviors
Patient's expectations: Ensure the patient's needs are addressed
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What should we look for when doing a nursing diagnosis on the patient?
Coping Specific Diagnoses: Compromised family coping, ineffective coping, and readiness for enhanced coping
Stress-Specific Diagnoses: Stress overload
Potential Consequences of Ineffective Coping or Overwhelming Stress: Anxiety, Fear, Hopelessness
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What should be addressed during planning of care of a patient with stress/coping?
Goals & Outcomes: Coping w/ stressors, family coping, psychosocial adjustment: life change
Primary, Secondary, & Tertiary Prevention
Setting Priorities
Collaborative Care
39
What are some ways to implement health promotion?
-Regular exercise
-Progressive muscle relaxation
-Support system
-Cognitive therapy
-Assertiveness training
-Workplace stress management
40
What are some examples of acute, restorative, and continuing care examples?
Acute care:
-Crisis intervention: defining the problem, ensuring patient safety, and providing support
Restorative and continuing care:
- The effects of a crisis may last for years
- When people successfully cope with a crisis, they become more mature and healthy.
- Teach stress management skills to reduce the stress response in future situations.
41
How do you evaluate a patient with stress/coping?
-Has stress been reduced?
-Revise plan of care as needed
-Maintain communication
-Collaborate w/ pt & family
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Basic Elements of the Communication Process:
"Sender"
-Person who delivers the message
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Basic Elements of the Communication Process:
"Receiver"
-Person who receives the message
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Basic Elements of the Communication Process:
"Message"
-The content of the conversation, verbal and nonverbal
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Basic Elements of the Communication Process:
"Feedback"
-The message that the receiver returns to the sender
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Basic Elements of the Communication Process:
"Channel"
-Means of conveying and receiving messages through senses
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Basic Elements of the Communication Process:
"Interpersonal Variables"
- Influence communication because the sender and receiver continually influence one another
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Basic Elements of the Communication Process:
"Enviroment"
-The physical and emotional climate in which an interaction takes place
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Levels of Communication: Intrapersonal
Self-talk; mental rehearsal; reflection
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Levels of Communication: Interpersonal
Communication that occurs between two people or within a small group; nonverbal, verbal, social context, symbols, and cues
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Levels of Communication: Public
Interaction of one individual with large groups of people; make use of eye contact, posture, gestures, voice inflection, media materials
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Forms of Communication: Verbal
-Vocab
-Meaning
-Pacing
-Intonation & Volume
-Clarity & Brevity
-Timing
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Forms of Communication: Nonverbal
-Personal appearance
-Posture & Gait
-Facial expressions
-Eye Contact
-Gestures
-Territoriality & Personal Space
54
Factors Influencing Communication
-Metacommunication: a broad term that refers to all factors that influence communication; send messages that often create incongruence between the word and body language
-Context: influence the nature of communication and interpersonal relationships; awareness of these factors helps you to make sound decisions during the communication process
55
What is self awareness?
Reflection on your interactions increases your understanding of the communication process and improves your ability to communicate with your patients
56
Tips for clear communication
-lead with most important info
-break complex info down into understandable chunks
-use simple language, avoid jargon
-use the active voice
57
Nurse-Patient Relationship: Pre-interaction Phase
-Before the nurse meets the patient
58
Nurse-Patient Relationship: Orientation Phase
-Nurse and patient meet and get to know each other
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Nurse-Patient Relationship: Working Phase
-Nurse and patient work together to solve problems and accomplish goals
60
Nurse-Patient Relationship: Termination Phase
Occurs at the end of year
61
Nurse-Health Team Member Relationships
-Handoff communication
-Common language (SBAR)
-Teamwork
-Conflict resolution
-Compassion fatigue
-Lateral Violence
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Establishing a Therapeutic Relationship
-Professionalism
-Courtesy
-Confidentiality
-Trust
-Acceptance
-Respect
-Presence
63
Components of therapeutic communication
-open-ended questions
-empathy
-active listening (SOLER)
-sharing observations
-conveying empathy
-using silence
-providing info
-clarifying
-focusing
-paraphrasing
-summarizing
-self disclosure
-instilling hope
64
Components of nontherapeutic communication
-inattentive listening
-overusing medical vocab
-prying or asking personal questions
-giving approval or disapproval
-changing the subject
-automatic responses
-false reassurances
-asking for explanations
-arguing
-being defensive
-sympathy
65
Confrontation
“Being able to identify and to respond – communicate – provide feedback –regarding those discrepancies in another person’s behavior in such a manner that the other person can grow.”
66
What are two parts to confrontation?
-Making others aware of the destructiveness or lack of productiveness of their behavior
-Making a suggestion about how they can behave in a more productive way
67
Two situations warranting confrontation
-Behavior is unproductive or destructive
-Behavior invades our rights or the rights of others
68
CARE Confrontation
Clarify
Articulate
Request
Encourage
69
Conflicts in Health Care
1. Many different people with many different backgrounds
2. Different perceptions, roles, and obligations
3. Different or opposing ideological views about a situation.
4. Some conflict is to be expected and it is healthy for the group.
70
Confrontation=Empowerment
-Make self improvement a priority
-Pay attention to feelings of anger and fear
-Speak up respectfully before an angry blow up
-Commit to treating others respectfully
-Be honest
-Practice self care skills
71
How to say "NO" assertively
-stay calm
-refuse in a polite, matter-of-fact manner
-be direct and clear
-Communicate understanding of their situation
-right to set our own priorities
-show respect for yourself
-indicate reason but don't give excuses
-state refusal at the beginning of your response
-suggest alternate if applicable
-Speak in forthright, calm, and polite manner
Maintain consistent refusal
72
Nonassertive Communication: Submissive Communication
-Allow rights to be violated by others
-Meet the demands and requests of others without regard to own feelings and needs
-Believe own feelings not important
-May be insecure and try to maintain self-esteem by avoiding conflict
73
Nonassertive Communication: Aggressive Communication
-Screaming
-Sarcasm
-Rudeness
-Belittling jokes
-Direct personal insults
74
How to communicate w/ Aggressive Individuals
-General tips
-Get to the source of the problem
-Increase your aggressor’s awareness of abusive behavior and its negative effects
-Limit the aggressive behavior
75
How to improve communication skills w/ aggressive individuals
-Assess the other person’s thoughts, feelings, and requests
-Remain calm, relaxed, and focused
Avoid hostility
Use empathetic acknowledgement of the other person’s feelings
Convey response in a direct, confident, and calm manner
Implementation and evaluation of your communication strategies
76
4 Categories of Conflict
-Facts
-Methods
-Goals
-Values
77
Conflict Resolution Approaches: Win-win
results in a solution in which you and your colleague are happy; the preferable approach; requires you to be assertive and responsible; requires creativity with unique and innovative resolution
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Conflict Resolution Approaches: Lose-Win
you allow a colleague to resolve conflict at your expense; you are not happy with the outcome or you permit your colleague to walk all over you; this approach is nonassertive and irresponsible
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Conflict Resolution Approaches: Win-Lose
you resolve conflict in a way that satisfies you but you bulldoze over the rights of your colleagues; this approach is aggressive and irresponsible
80
Components of win-win strategy
1. view the problem in terms of need
2. stay focused on the data
3. identify the differences
4. see conflict from another view
5. brain-storm a solution
6. develop a plan
7. implement the plan
8. evaluate the problem-solving process and review how well the solution turned out
81
Conflict Resolution:
When conflict arises on the unit:
-discuss issue first with the person with whom you're having a problem
-if no response, follow the chain of command: team leader, manager, dept head, nursing admin
82
What is civility?
83
How does civility affect PATIENT SAFETY?
Incivility can result in life-threatening mistakes, preventable complications and harm, or even the death of a patient
84
How does civility affect a patient's VULNERABILITY?
Most vulnerable groups experience incivility and bullying in nursing.
Ex. Nursing students, new grads or inexperienced, new to diff positions, per diem, traveler, floaters
85
How does civility affect NURSE ATTRITION?
Incivility causes 1 in 5 nurses to leave their first job within 1 yr
86
What is nursing incivility?
-Rude, disrespectful actions towards colleague , that may or may not have negative intent
-Ex. eye roll, sarcasm, blaming, violence, rumors, and gossip
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Incivility related to education
-Any form of negative behavior such as rudeness, inappropriateness, or bullying that is directed at peers, faculty, or any clinical partners in class, online, or clinical
-ex. academic dishonesty or plagiarism, disruptive behavior, stops the learning process
88
What cause nursing students to be uncivil?
-High stress/competitiveness
-Academic workload
-balancing family, jobs, relaxing
-pressure for exams/nclex
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What causes nurses to be uncivil?
-Time
-Staff ratio
-Critical nature of patients
-Patients demands
90
Effects of incivility on STUDENTS
Many leave field prior to graduation or between graduation and placement
-Generally happens during first 5 years in profession
-More stress, attrition
-Poor performance, communication (shut down)
-Absenteeism
-Lower confidence, decrease commitment
-Depression
91
Impact of incivility on PATIENTS
- Uncivil behaviors by healthcare workers have direct impact on patient care/safety
-Increase med errors
-Poor communication among health care team
- Failed communication also cause of adverse events or near misses
-Worse patient care- poor patient outcomes
92
Impact of incivility on NURSES
-" Nurses eat their young"
-Bad behavior as student can result in the same as professional
-Increase burnout and lower job satisfaction leads to high turnover
-Higher calls out/increased sick time
93
Impact of incivility on NEW GRADS
-Hard to complete tasks and focus on the patient
-Scared to ask questions or help
94
Ways to combat incivility
-Speak up- be assertive
-Look out for peers
-Conflict management/communication skills
-Create unit norms
95
Essential Components for Interprofessional Collaboration
-care
-cure
-coordination
96
What is care?
Understanding pt needs so you can individualize nursing therapies
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What is cure?
Help pt's regarding illness and helping them cope
-admin. of meds, use of clinical judgment to determine outcomes
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What is coordination?
-organizing and timing medical and other professional/technical services to meet holistic needs of pt
-Supervising, teaching, and directs all involved w/ nursing care
99
ANA: Scope and standards of practice
-Nursing standard that provide guidelines for implementing and evaluating nursing care.
100
Nurse Practice Act
-Each state has their own
-Most are similar
-Reflect the growing autonomy and expanded roles and scopes of practice
101
Licensure
-RN candidates must pass NCLEX
-Standardized minimum knowledge base for nurses
102
Certification
- Specific area of nursing practice
-Maintain through ongoing CEU
103
Responsibilities and Roles of the Nurse
-Caregiver
-Advocate
-Educator
-Communicator
-Provider of Care
-Manager
104
What is the role of the CAREGIVER?
Helps pt regain health and heal
105
What is the role of the ADVOCATE?
Protect human and legal rights of pt and help pt assert those rights
106
What is the role of the EDUCATOR?
Explain concepts/facts about health
-reinforces learning by demonstrating and teach pt about maintaining care
107
What is the role of the COMMUNICATOR?
Speaking to pt and families about their needs.
Includes strengths and weaknesses/ plan of care communicated
108
What is the role of the PROVIDER OF CARE?
Most nurses provide direct pt care in an acute care setting
-Takes care of pt
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What is the role of the MANAGER?
Establish an environment for collaborative, patient centered care
- Coordinates staff to deliver nursing care, and maintains policy, budget, and specific unit responsibility
110
QSEN- Quality and Safety Education for Nurses
Patient-Centered Care
Teamwork and Collaboration
Evidence-Based Practice
Quality Improvement
Safety
Informatics-techy stuff
111
5 Right of Delegation
Right Task
Right Circumstances
Right Person
Right Direction and Communication
Right Supervision and Evaluation
The nurse is responsible for all care given to the client.
