Unit 8 study guide:



Unit 8: Client CareChapter 44: Therapeutic Communication SkillsChapter 45: Admission, Transfer & Discharge[This is a compilation of PowerPoints, notes and straight from the book. THIS IS NOT ALL INCLUSIVE!)(References: Rosdahl, C. B, Kowalksi, M. T. ( 2017). Textbook of Basic Nursing ( 11th ed.). Wolters Kluwer / Megan Wray / Andrew Carter / Summer McBride)Chapter 44: Therapeutic Communication SkillsCommunicationGiving, receiving, and interpreting information through any of the 5 senses by 2 or more interacting people.Therapeutic communication An interaction that is helpful and healing for one or more of the participantsThe client benefits from knowing that someone cares and understands, and the nurse derives satisfaction from knowing that he or she has been helpfulCommunication r/t to the nursing process in many ways:Problem solvingNurse must be able to collect client data accurately by paying attention to both verbal & nonverbal communicationThe nursing diagnosis and care plan must be clear and concisePlanning involves accurate communication among all members of the healthcare team, as well as the client and familyDuring implementation of the nursing care plan, the nurse communicates w/ the client and family and relates personal impressions and observations to other members of the healthcare teamOngoing evaluation of the effectiveness of nursing interventions depends on clear and coherent communication among all concerned.Client teaching and preparation for discharge depend on accurate and emphatic communication and client understanding.RapportSATA!Genuineness, caring, trust, empathy, and respect promote understanding among individuals Harmony and AgreementKey Concept***In some cases, the nurse has the right to request a different assignment if working with this client may cloud professional judgement. For example, a nurse whose religion forbids abortion may request not to assist with this procedure. The client has the right to his or her own beliefs and so does the nurse. In addition, it is not advisable to care for a family member or close friend. Communication requires several components:SenderMessageMedium/channelReceiver InteractionNCG 44-1 pg 542Verbal communicationUsing words – speech, sign lang., writing, slangNonverbal communicationFacial expressions, actions, and body positionCongruencyWhen words and actions are the same to convey the same messageCharacteristics of Speech:VolumeRate and rhythmAphasiaListeningAphasiaDefect in, or loss of, the ability to speak, write, or sign, or of the ability to comprehend speech and communicationExpressive aphasia (Broca’s area)Difficulty in speaking or finding the correct word, broken speechReceptive aphasia (Wernicke’s area)Brain disorder that interferes with comprehension of language, broken comprehensionKinesicsStudy of body languageProxemicsTerritoriality (space, in relationship to communication)Personal spaceAll people have an area around themselves, reserved for only close friends or intimatesPersonal space or communication zones:Intimate (within 6 in) – behavior w/ loved ones, sharing secrets, physical assessment in HCPersonal (6 in to 4 ft) – general conversation, interviews, teaching one on one, private conversationSocial (4 ft to 12 ft) – demonstrations, group interactions, partiesPublic (> 12 ft) – lectures, behavior w/ strangers Nursing Alert ***Be aware that some clients may react in an assaultive manner when touched, particularly those with psychiatric conditions or dementia. Always be alert to this possibilityIn addition, some clients may invade your personal space, it is important to set limits and to seek assistance if this behavior continues. Nonverbal communication:Eye contactFacial expressionsBody movements and postureGestures and ritualsPersonal appearance and groomingTherapeutic use of touchFactors influencing communicationAttentionAgeGenderKey Concept***Remember: A smile is part of the universal human language and is understood by allDifficult Client Behaviors: Inappropriate behavior on the part of clients creates barrier to communicationSexual harassment – defined as any unwanted sexual activity AggressivenessBox 44-2 pg 548CharacteristicsPassivity – this person does not seem to care what happens and may be forgetful and indifferentAggressiveness – This person seems angry and hostile, argues and disagrees w/ everything that is said, and displays angry body language.Passive Aggressive – This person seems passive and pleasant on the surface, but does things to undermine or sabotage care (or the work environment)Assertive behavior/ Assertiveness – can make statements without conveying either aggressiveness (overdominance) or passivity (submission)AssertivenessConfidence without aggression or passivityNursing Alert***Remember that any aggressive behavior toward clients by a nurse, whether physical or verbal, constitutes assault on the part of the nurse.Interview Goal directed conversation in which one person seeks information from another. Used to evaluate the client’s understanding of his or her health concerns and to acquire valuable information from and concerning the clientClosed ended questionsYes or no questionsOpen ended questionsUse of silenceGives the nurse and client an opportunity to collect their thoughts and prepare to continue the municating w/ the young childWhen working with small children, keep normal developmental stages in mind and communicate at an appropriate level for the child’s age. Children often regress (revert) to an earlier stage of development when ill. Role playing or drawing pictures may be helpful to determine what a child is feeling.Play is most effective means of communicatingCommunicating w/ the older adultImportant to respect and treat the older adult as you would expect to be treatedCommunicates w/ older adults at an appropriate level and is considered of personal dignityNot to “talk down to” any clients, whether younger or older. Show respect – address as Mr or Ms and adding clients last nameNO GRANDPA or municating w/ clients who has sensory problemsThe visually impaired or hearing impaired personThe unconscious clientThe person with aphasiaFacilitating communication in HCSkillfully interviewing clientsListening attentively Teaching clients and their familiesDocumenting infoReporting the condition of the client to other members of the HC teamParticipating in team conferencesMaintaining the confidentiality of infoTreating each pt individually, specificallyUsing both verbal and nonverbal communicationUsing touch as a therapeutic modalityRead Table 44-1Barrier - ExampleChapter 45: Admission, Transfer & DischargeAdmission:Admission to the healthcare facilityActivities surrounding a client’s arrival at the facility for the purpose of receiving healthcare One admission Each continuous period of time a client spends in a facility is considered one admissionAdmitting departmentProper identification of each client is vitalThe Client’s Arrival on the Nursing Unit:Assist in changing to hospital gown or robe. Inspect for skin integrity.Assist the client into bed.Orient the client to the facility.Care for the client’s personal belongings.Check for client identification, allergies, fall precautions, seizure precautions, resuscitation statusPrevent dehumanization.Assess for anxiety/apprehension.Client Identification Checklist:Proper ID bands with correct informationAllergiesFall precautionsSeizure precautionsResuscitation statusCare plan board or communicationCaring for Client Valuables and Personal Items:Encourage clients to keep only essential items in hospitalCompetent clients may keep personal items at the bedsideValuables should not be brought to the facility; if they are they should be kept in the facility vaultIn memory care or mental health unit, facility does assume some responsibility for client belongingsCareful listing and description of client property is even more importantMeasures to Prevent Dehumanization:Develop rapport and trust with the client before delving into personal matters or embarrassing procedures.Ask the client for input in their care and allow client to maintain personal dignity.Handle questions and procedures with utmost tact and respect for the individual.Think of client as person whose needs for physical and emotion support are greater because of illness.Emphasize client strengths rather than weaknesses.Assessing Client Anxiety Level:Calm: Not anxious+1 anxiety: Increasing uneasiness and apprehension+2 anxiety : Increasing uneasiness, apprehension, dread+3 anxiety : Increasing apprehension, dread, paranoiaPanic: Symptoms may include a feeling of choking, difficulty breathing, inability to sit still, chest tightness or pain, trembling, sweating, increased pulse rate and blood pressure, or headacheNursing Interventions to Alleviate Client Anxiety and Fear:Assessment of level of discomfortClear explanations and clear answers to questionsOffering the client an opportunity to express feelingsProviding more helpful coping mechanismsAllowing the client to make decisions relating to his or her careAssessment, Reporting, and Documentation:WeightHeightVital signsPulse oximetryCollecting specimensRadiology and laboratory examinationsReporting the Admission:The Joint CommissionAn RN performs formal admission assessments and formulates nursing diagnosesLV/LPN Client orientation and admission proceduresClient’s vital signs, weight, and client-reported symptomsNeed for Transfer to Another Unit:Assignment to a certain unit is temporaryA change in client acuity necessitates placing the client in another departmentThe client’s condition requires transfer to the ICU or specialized carePostpartum areaPostsurgical unitPsychiatric unitPreparation for the Transfer:Explain the need for transfer to the client and family. Assemble client’s personal belongings and medications and take these to the new unit.Transfer the client’s information to the computer in the new location. Determine how the client will be moved. Provide for client safety.Review the health record and check for completeness. Record the transfer in a transfer note. Make sure the receiving unit is ready. Transporting the Client:Keep the client safe during the move.Introduce the client to the staff at the new nurses’ station.Give a report to the staff on the new unit, make sure the transfer is completed in the computer. Take the client to the room and assist the client into bed. When returning to the nursing unit, notify all necessary departments of the transfer. Request assistance from security personnel if necessary.Observe procedures for isolation as required.The Client’s Discharge (D/C) and Nursing Actions involved:Plans begin at admission.Involves the total nursing care team, client, and family.Nursing students and LVs/LPNs assist with teaching the client and family before discharge.Client and family should verbalize information and perform return demonstrations of procedures.Carefully document all discharge teaching.Educating the Client:Explain the safe change of dressings.Describe the amount of rest and suggested exercises.Detail dietary restrictions.Show how to perform personal care.Demonstrate the operation of equipment. Emphasize the importance of self-care and building the client’s independence and self-esteem.Describe medication administration.Identify situations that require the client to be seen by the primary care provider.Write down the phone number of the hospital municate the date, time, and location of the next scheduled examination, if known.Discuss with the physician the need for a public health nursing referral.Make sure the client has all personal property.Discharge Planning and Teaching Begin on AdmissionAgainst Medical Advice (AMA):AMA: Client leaves the facility without permission. Report to the team leader. The client is asked to sign a dated release form.A licensed nurse witnesses the client’s signature. The primary provider documents the AMA discharge.Client refusal to sign must be noted on the form. The form is signed by at least two witnesses. AWOL:AWOL (absent without leave)The client walks off the unit to go home or to leave the facility without being discharged The client usually needs to be readmitted on returnThis is considered a new admission for the clientLong-term facilities usually identify vulnerable clients who are likely to leave without permission WanderGuard or other special transmitter alert Important for safety if the client is confused or otherwise vulnerableThe HIPAA Legislation:Health Insurance Portability and Accountability Act (HIPAA) Guidelines must be followed to protect client privacy Client or responsible person signs a document confirming that agencies policies were discussedProtect the client’s privacyConfirm Advance directives or living willDonor statusCommunication Among Healthcare Team Members:Primary healthcare providers’ ordersVerbal ordersTelephone communicationComputer use ................
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