Nurse-Patient Relationship Phases

1. Nurse-Patient Relationship Phases
a. Orientation (beginning)
i. Therapeutic Relationship
1. Develop trust
2. Establish goals
3. Therapeutic contract
4. Nursing diagnosis
b. Working (Middle)
i. Planning and Implementation
1. Communication skills to help client
2. Work on behavioral changes
3. Explore feelings and problems
c. Termination (End)
i. Evaluation
1. Inform client of other sources of help available
2. Evaluate therapeutic outcome
3. Evaluate nurse-patient relationship
4. Nurse may have mixed feelings (happy with result, sad to say bye)
2. Inappropriate Boundaries
a. Know and respect the boundaries
i. Nurses need to get own emotional needs met outside patient relationship ii. Under involvement vs. over involvement
iii. Attraction to patient or vice versa iv. Accepting or giving gifts
v. Giving out home address or phone # vi. Non-acceptance or avoidance vii. Encourage dependency
3. Characteristics of a Helping Relationship
a. Based on trust, respect, acceptance, and honesty
i. Listen carefully ii. Be aware of cultural differences iii. Know your role and limitations
i. Put yourself in their shoes ii. Confidentiality iii. Intellectual/emotional bond that focuses on the client iv. Maximize client’s decision making iv. Cultural competence
b. Be non-judgemental
i. Avoid stereotypes ii. Accept all patients as individuals
4. Levels of Communications
a. Verbal
i. All speech
b. Nonverbal – makes up 93% of communication
i. Facial expressions, posture, tone, actions
c. Congruent
i. Verbal and nonverbal communications match
d. Incongruent
i. Verbal and nonverbal do not match (confusing)
5. Communication Theory and Development
a. Begins in infancy
i. Sematic
1. Consists of crying, reddening of skin, fast breathing (decreases with maturatity) ii. Action Language
1. Reaching out, crawling, pointing (older infants)
6. Assertive Communication
a. Direct; respect self and others; encourages trust and teamwork
i. Takes practice, must take risks, strong self-esteem, must be persistent and determined
7. Becoming a Better Communicator
a. Active listening
i. Communicating interest and attentive ii. Eye contact, nodding, open posture, repeat what you hear, eye level
8. SBAR Recording
a. Prevents error; consistent
i. Situation ii. Background iii. Assessment iv. Recommendation
9. Collaboration skills
a. Working jointly and sharing knowledge and authority
i. Enhance positive patient outcome ii. Essential for teamwork iii. Need to know the limits and boundaries of others iv. Supportive environment
10. Factors Affecting Communication
a. Competition
i. Peer evaluations
b. Working Environment
i. Coping with difficult behavior
c. Stress
i. A destructive circle
11. Errors with Communication
a. Illegible writing
b. Dating errors
c. Inappropriate abbreviations
d. Cant understand terminology
e. Not giving enough info/ vice versa
12. Electronic communication
a. Email
i. Keep short ii. Be professional
iii.
Courteous tone
b. Cell phone
i. Avoid use around patient ii. Pay attention to other-disregard the phone iii. Be professional when texting
13. Principles of Leadership and Management
a. Leadership-inspire other to work towards a goal/ ability to influence the behaviors of others
i. Leaders emerge/evolve into role ii. Focused on the leader iii. Style Theory:
1. Laissez-faire
a. Non-direct or passive
b. Group determines goals
c. Lack of involvement by the leader
2. Democratic
a. All aspects to achieve a goal are shared by the group
b. Leader provides guidance to the group
c. Leader makes finial decision based on what’s best for the group
3. Authoritarian
a. Strong control over all aspects of group
b. Give orders
c. Final decision is made by leader
b. Management-influencing employees to be as productive as humanly possible
i. Managers are appointed ii. Focused on influencing employees to be as productive as possible iii. Not all managers are good leaders; not all leaders are good managers
14. Conflict Management
a. Conflict-nurses feel overworked and overwhelmed
b. Nurses are uncomfortable with conflict because
i. Fear of ridicule/ alienation ii. Think they don’t have the right to speak
up iii. Past negative experience iv. Lack of education or skill
15. Group Dynamics
a. Understanding the common goal- members feel valued when included in decision making
i. Support- achieve task with support ii. Reward Achievement-find accomplishment and celebrate iii. Indentity and trust- allows more open communication

Lecture 12: Healthcare Systems

16. Major Categories of Healthcare Services
a. Health Promotion
i. Help maintain and promote
b. Illness Prevention
i. Addressed problem after risk factor is identified
c. Diagnosis & Treatment
i. Diagnosis of illness
d. Rehabilitation Services
i. Restore to fullest level of functioning
1. Disease management
a. Proactively helping patients manage chronic conditions
b. Attempts to prevent hospitalizations/increase health care costs
2. Long Term Care
a. Provided in assisted-living, intermediate and skilled care nursing homes
b. Growing at rapid rate due to aging population
17. Levels of Health Care Services
a. Primary
i. Initial care rendered when entering health care systems ii. Health promotion/preventive care (campaign, health education)
b. Secondary
i. Involves prevention of complications from disease, typically in hospitals ii. Emergency and acute care (hospitals, diagnosis/treatment)
c. Tertiary
i. Provided to acutely ill and those requiring long term care and rehabilitation ii. Rehabilitative service/ long term care/ care of the dying
d. Subacute
i. Inpatient care between hospital and long term care ii. Impatient care between hospital and long-term care
18. Healthcare Members
a. Physicians- responsible for diagnosis and interventions
b. Nurses- preform functions of the physician under supervision
c. Pharmacists-prepares/ dispense medication and monitors use of controlled substance
d. Dietitians-focus on therapeutic values of food
e. Therapist
i. Physical- regain maximum physical activity/strength ii. Occupational-helps patient resume ADL’s
f. Counselor- therapeutic communication to encourage patients/family to discuss feeling, opinions, and solutions
g. Respiratory Therapy- preforms diagnostic procedures/treatments
h. Technologists
i. Lab- handles patients specimens (blood/urine) ii. Radiology-preforms x-rays
i. Social Workers- assist family in crisis and connect them with resources
j. Administrative Support
19. Nursing Care Delivery System
a. Functional Nursing
i. Focuses on organizing/dividing the tasks of nursing care ii. One function for one nurse for every patient iii. Assigned according to skill level
b. Team Nursing
i. Work groups consisting of nurses and ancillary workers (RN- team leader) ii. Responsible for care of group of patients, typically during 8-12hr shift iii. Leader delegates task and oversees care
c. Primary Nursing
i. One nurse has responsibility for the planning, implementations, and evaluation for one or more patients 24hrs/day ii. Admission-discharge iii. Assisted by others
d. Case Management
i. Do not provide direct care, but actively collaborate with primary nurses assigned to patients ii. Attempts to improve cost-effectiveness while providing quality of care
20. Managing Quality in Health Care
a. CQI: Continuous Quality Improvement
i. Involves use of quality improvement concepts by groups of employees from different departments with a goal of deciding how care will be provided. Underlying belief is that quality is everyone’s responsibility.
b. PI: Performance Improvement
i. Focuses efforts in increasing individual and group competence and productivity. Efficiency equals job satisfaction.
21. Methods of Payment for Health Care
a. Medicare
i. Caring for people 65 year or older, certain disability, dialysis/kidney transplant
b. Medicaid
i. Available to low income, elderly, blind, and disabled individuals
c. Private
i. Paid by insured individual or by their employer ii. Entails insured to certain healthcare benefits
22. Health Care Facilities
a. Voluntary Agencies
i. Private donations ii. Government grants iii. Addresses problems iv. Not covered by governmental agencies
v. Large volunteer pool
b. Government Agencies
i. Federal-all citizen ii. State-within state iii. Local- in community
23. Health Care Settings
a. Public Health
i. Treats and prevents contagions disease ii. Child health iii. Pregnancy care iv. Detection/treatment of terrorist acts
b. School-based service
i. Screening ii. Health promotion/illness prevention programs iii. Treat minor health care problems iv. Stress management
v. Drug abuse vi. Adolescent pregnancy

Lecture 13: The Politically Active Nurse

24. Professional Organizations
a. Why Join:
i. Networking, continuing education, leadership skills, influence health policy, certification
b. Issues:
i. Less than 10% of RNs are members of ANA; high cost dues, lack of time, lack of interest, generational challenges
25. Roles of nurses involvement in politics
a. Nursing citizen
i. Brings perspective to HC by: voting in elections, keeping informed about HC issues, know elected officials, join nursing organizations
b. Nursing Activist
i. Brings expertise of professional life by: joining politically active nursing organization, working in a campaign, inciting legislator to visit workplace
c. Nurse Politician- bring desire to develop legislation to political office by: running for office, use nursing expertise as a front-line policy maker who can enhance healthcare

26. Voter Turnout
a. Percentage of eligible voters who cast a ballot in the election

Lecture 14: Science of Nursing
1. Research
a. NOT: information gathering and transportation of facts
b. IS: systematic process of collecting and analyzing information to increase understanding
i. Quantitative Research
1. Measurable variables and outcomes
2. Systematic collection of numeric information
3. Considered to be objective ii. Qualitative Research
1. Systematic collection and analysis of subjective narrative
2. Unstructured interviews and participant observation
2. Pure and Applied science
a. Pure (basic science)
i. Summarizes and explains ii. New knowledge and information for the sake of obtaining
b. Applied science (applied research) NURSING
i. Uses info in practical, beneficial way ii. Nursing conducts applied research to improve patient outcomes through nursing care
3. Reasoning: Inductive and Deductive
a. Inductive
i. Proceeds from specific to general ii. Generalizations from particular experiences (observations) seen over and over- lead to logical probabilities
b. Deductive
i. Proceeds from general to specific ii. Conclusions made from logical progressions with valid (soundly founded) end result
4. Sources of research problems
a. Clinical situations
i. Clinical issues that effect every day nursing
b. Literature review
i. Replication of existing study or design of similar study
c. Theory
i. Use existing nursing theory as a basis

5. Roses of nurse in research
a. Baccalaureate
i. Read, interpret, and evaluate research for application to practice
b. Master’s
i. Replicate studies previously conducted
c. Doctoral
i. Favorable to receive research funding
6. Limitations of Scientific Method in Nursing
a. Health care settings are not laboratories. Can not control all variables
b. Human beings are complex organisms with interrelated parts and systems
c. Objectivity of scientific method (subjective vs objective data), fails to consider meaning of patients own experiences- their subjective view
d.
Ethical implications
7. What is Nursing Research?
a. A scientific process
b. Validates and refines existing knowledge
c. Generates new knowledge
d. Directly and indirectly influences practice
8. Review of the literature
a. absolutely necessary to see what has been done, and the results of any previous research. Replication of studies is a validation of a need. When there is limited or no data found, there is also a need
9. Problem Solving
a. Research is different than problem solving
b. Problem solving is specific to a given situation and is designed for immediate action
c. Research is generalizable (transferable) to other situations and deals with long term
10. What is Evidenced Based Practice?
a. Provides empirical evidence to support nursing interventions
b. Incorporates health care research evidence from a variety of disciplines
c. Goals
i. Include cost effective practice based on data produced by research and implement best practice interventions into nursing practice
d. Evaluates scientific evidence

9. Based Practice (EBP)
Formalized Process Steps:
1. Definition of a patient problem
2. Identification of information necessary to solve the
problem
3. Efficient and thorough literature search
4. Critical appraisal of evidence
5. Extraction of clinical answer as it applies to the patient problem
6. Clinical guideline or protocol development/implementation
7. Evaluation
10. Research Process
Steps in Process:
1. Identification of a research problem
2. Review of literature
3. Formulation of the research question or hypothesis
4. Design of the study
5. Implementation
6. Drawing conclusions based on findings
7. Discussion of implications
8. Dissemination of findings
11. Research Replication
a. Confirms original findings
12. Barriers to Research in Practice
a. Nurses lack of knowledge of research and the findings
b. Nurses negative attitudes toward nursing research
c.
13. Ethical Issues In Research
a. Confidentiality:
1. Make certain no participants are identified
2. Name of agency where study took place should never be mentioned b. Consent 1. IRB approval---child vs. adult 2. Informed- clear understanding, risk/benefits are known, option to refuse or withdrawal

Lecture 15: Development in Current Nursing Practice and Nursing’s Future Challenges

1. Societal Challenges
a. Aging population
i. People are living longer; baby-boomers; Centenarians are the fastest growing group- those persons more than 100 years of age ii. Ethical Issues
1. Euthanasia and assisted suicide
2. End of life and palliative care will increase
b. Poverty
i. Working poor can not provide for families ii. Medically indigent do not qualify for Medicaid and hesitate to seek help due to cost iii. Disenfranchised have no power in political system and limited access to care
c. Cultural diversity
i. People from different racial, ethnic, religious, social, and geographic backgrounds ii. Nurses
d. Urbanization
i. Movement of people from rural areas to cities ii. Violence is major driver
e. Environment
f. Disasters and Bioterrorism
i. Disaster
1. A situation that is greater than an emergency; disrupts essential services, and requires the response of people outside the community affected. Can be natural or man-made ii. Bioterrorism
1. Refers to the use of a biological or chemical agent as a weapon
2. Early recognition is key to treatment
3. Look for: increased number of clients with same symptoms
g. Unhealthy lifestyles
i. Obesity, tobacco use, lack of exercise, eating disorders, stress-related disorders, drug abuse, HIV/AIDS
h. Cost containment
i. Regulation of health care
2. Future Trends in Nursing Education
a. Nursing informatics
i. Rapid curriculum change to reflect rapidly changing needs will be common
b. Outcome-based education
c. Diversity
i. Cultural competence will become mandatory
d. Collaboration models
e. Reform in health care
f. Faculty/student shortage
3. Challenges Nursing Must Resolve to Ensure Control of its Destiny
a. Professional associations
i. Gives nursing a voice ii. Less than 10% of nurses involved iii. Find a common ground and come together iv. Working in a united manner through nursing professional associations
4. New Roles for Nurses
a. Forensic nursing
i. SANE nurse ii. Medical examiner nurse death investigator iii. Forensic correctional nurse iv. Legal nurse consultant
v. Forensic psychiatric nurse
b. Nurse entrepreneur
i. Nurse staffing business ii. Clinic iii. Clothing
c. Case management
i. Advocate for patient, make sure they get the right treatment in a respectable manner, and are discharged on time