Described the essence of excellent nursing

practice as CARING after listening to staff

nurses’ stories and analyzing their meaning.

Transcultural Caring

 Caring is an essential human need.

Transpersonal Caring

caring becomes almost spiritual.

Theory of Caring

Striving to understand an event as it has meaning in the life of the

other

Being emotionally present to the other

Doing for the other as he or she would do for self if it were at all possible

Facilitating the other's passage through life transitions (e.g., birth, death) and unfamiliar events

Sustaining faith in the other's capacity to get through an event or transition and face a future with meaning

Entailed in caring as the human mode of being

is an inquiry into the being of something and into its range of possibilities. The ontological

question asks, what is the “being” of caring? What is caring as such?

Anthropology poses the question, what does it mean to be a caring person?

“Onticology” refers to the study of some entity in its actual relation with other entities (McQuarrie, 1955).

In this category, functional and ethical aspects of caring are included. What is a nurse doing when he or she is

caring? What obligations are entailed in caring?

concerned with ways of knowing. Questions in this category include, can one

know caring? How is caring known?

concerned with teaching and learning, and the strategies required to

further specific learning needs and goals. How is caring learned and taught?

to be with another in their suffering.

acquiring and using evidence-based scientific and humanistic knowledge and skill in the application of

therapeutic interventions in the current practice of nursing.

directs moral, ethical and legal decision-making.

trust in one’s ability to care for others.

maintaining and elevating the standards and obligations of the nursing profession and assuring the

delivery of excellence in nursing care.

the professional presentation of us as nurses to others in behavior, attitude, appearance, dress and

language that communicate a caring presence.

used when performing a task or procedure

expressed in the way you hold a patient’s hand, give a back massage, gently

position a patient, or participate in a conversation.

form of touch that protects the nurse and/or patient. The most obvious form

of protective touch is preventing an accident.

recognized the need to promote effective communication for patient- and family-

centered care, cultural competence, and improved patient safety.

When you consider a patient’s problems, it is important to apply critical thinking and critical

reasoning skills to improve communication in assessment and care of the patient.

Also helpful because they motivate a nurse to identify innovative solutions.

Patients respond more readily to a self-confident attitude.

An attitude of humility is necessary to recognize when you need to better communicate and

intervene with patients, especially related to their cultural needs.

powerful form of communication that you use as a professional nurse.

This level of communication is also called self-talk.

one-on-one interaction between a nurse and another person that often occurs face to

face. It is the level most frequently used in nursing situations and lies at the heart of nursing practice.

the interaction that occurs when a small number of people meet.

interaction with an audience.

the use of technology to create ongoing relationships with patients and health care team.

motivates one person to communicate with another. In health care setting sights, sounds,

sensations, perceptions, and ideas are examples of cues that initiate the communication process.

is the person who encodes and delivers a message,

the content of the communication.

means of sending and receiving messages through visual, auditory, and tactile

senses. Facial expressions send visual messages; spoken words travel through auditory channels.

is the person who receives and

decodes the message.

the message a receiver receives from the sender. It indicates whether the receiver understood the

meaning of the sender’s message.

factors within both the sender and receiver that influence communication. Perception

provides a uniquely personal view of reality formed by an individual’s culture, expectations, and experiences.

Each person senses, interprets, and understands events differently.

the setting for sender-receiver interaction. An effective communication setting provides

participants with physical and emotional comfort and safety.

Components of Verbal Communication:

Uses spoken or written words

Components of Verbal Communication:

Individuals who use a common language share the denotative meaning

o The connotative meaning is the shade or interpretation of the meaning of a word influenced by the

thoughts, feelings, or ideas that people have about the word.

Components of Verbal Communication:

Conversation is more successful at an appropriate speed or pace

Components of Verbal Communication:

Tone of voice dramatically affects the meaning of a message. Be aware of voice tone to avoid sending

unintended messages.

Components of Verbal Communication:

Effective communication is simple, brief, and direct.

o Repeating important parts of a message also clarifies communication.

Components of Verbal Communication:

Timing is critical in communication.

o Even though a message is clear, poor timing prevents it from being effective.

Components of Nonverbal Communication:

Physical characteristics, facial expression, & manner of dress and grooming. These factors communicate

physical well-being, personality, social status, occupation, religion, culture, and self-concept.

Components of Nonverbal Communication:

(Manner or pattern of walking) are forms of self-expression.

o The way people sit, stand, and move reflects attitudes, emotions, self-concept, and health status.

Components of Nonverbal Communication:

Convey emotions such as surprise, fear, anger, happiness, and sadness. Patients closely observe nurses. Although it is hard to control all facial expressions, try to avoid showing shock, disgust, dismay, or other distressing reactions in a patient’s presence.

Components of Nonverbal Communication:

Maintaining eye contact during conversation shows respect and willingness to listen.

Components of Nonverbal Communication:

Emphasize, punctuate, and clarify the spoken word.

Components of Nonverbal Communication:

Sighs, moans, groans, or sobs also communicate feelings and thoughts. Combined with other nonverbal

communication, sounds help to send clear messages.

Components of Nonverbal Communication:

The needs to gain, maintain, and defend one’s right to space. Territory is important because it provides

people with a sense of identity, security, and control.

Zones of Personal Space:

 Holding a crying infant

 Performing physical assessment

 Bathing, grooming, dressing, feeding,

 and toileting a patient

 Changing a patient's surgical dressing

Zones of Personal Space:

 Sitting at a patient's bedside

 Taking a patient's nursing history

 Teaching an individual patient

Zones of Personal Space:

 Giving directions to visitors in the hallway

 Asking if families need assistance from the patient doorway

 Giving verbal report to a group of nurses

Zones of Personal Space:

 Speaking at a community forum

 Lecturing to a class of students

 Testifying at a legislative hearing

Special Zones of Touch:

hands, arms, shoulders, back

Special Zones of Touch:

mouth, wrists, feet

Special Zones of Touch:

face, neck, front of body

Special Zones of Touch:

genitalia, rectum

Four goal-directed phases:

before meeting a patient

Four goal-directed phases:

when the nurse and patient meet and get to know one another

Four goal-directed phases:

when the nurse and patient work together to solve problems and accomplish goals

Four goal-directed phases:

during the ending of the relationship

Factors Influencing Communication:

 Physiological status (e.g., pain, hunger, nausea, weakness, dyspnea)

 Emotional status (e.g., anxiety, anger, hopelessness, euphoria)

 Growth and development status (e.g., age, developmental tasks)

 Unmet needs (e.g., safety/security, love/belonging)

 Attitudes, values, and beliefs (e.g., meaning of illness experience)

 Perceptions and personality (e.g., optimist/pessimist, introvert/extrovert)

 Self-concept and self-esteem (e.g., positive or negative)

Factors Influencing Communication:

Social, helping, or working relationship

 Level of trust among participants

 Level of caring expressed

 Level of self-disclosure among participants

 Shared history of participants

 Balance of power and control

Factors Influencing Communication:

 Information exchange

 Goal achievement

 Problem resolution

 Expression of feelings

Factors Influencing Communication:

 Privacy level

 Noise level

 Comfort and safety level

 Distraction level

Factors Influencing Communication:

 Educational level of participants

 Language and self-expression patterns

 Customs and expectations

Therapeutic communication techniques:

means being attentive to what a patient is saying both verbally and nonverbally.

Therapeutic communication techniques:

Stating observations often helps a patient communicate without the need for extensive questioning,

focusing, or clarification.

Therapeutic communication techniques:

Empathy is the ability to understand and accept another person’s reality, accurately perceive feelings,

and communicate this understanding to the other.

Therapeutic communication techniques:

Appropriate encouragement and positive feedback are important in fostering hope and self-confidence

and for helping people achieve their potential and reach their goals.

Therapeutic communication techniques:

It is a coping strategy that can reduce anxiety and promote positive feelings.

Therapeutic communication techniques:

Emotions are subjective feelings that result from one’s thoughts and perceptions. Feelings are not right,

wrong, good, or bad, although they are pleasant or unpleasant. If individuals do not express feelings,

stress and illness may worsen.

Therapeutic communication techniques:

Touch is one of the most potent and personal forms of communication.

o It expresses concern or caring to establish a feeling of connection and promote healing.

o Comfort touch such as holding a hand is especially important for vulnerable patients who are

experiencing severe illness with its accompanying physical and emotional losses.

o Nurses need to be aware of patients’ nonverbal cues and ask permission before touching them to ensure

that touch is an acceptable way to provide comfort.

Therapeutic communication techniques:

Providing relevant information tells other people what they need or want to know so they are able to make

decisions, experience less anxiety, and feels safe and secure.

o It is also an integral aspect of health teaching.

Therapeutic communication techniques:

To check whether you understand a message accurately, restate an unclear or ambiguous message to

clarify the sender’s meaning. In addition, ask the other person to rephrase it, explain further, or give an

example of what the person means.

Therapeutic Communication Techniques:

it involves centering a conversation on key elements or concepts of a message. If conversation is

vague or rambling or patients begin to repeat themselves, focusing is a useful technique.

Therapeutic Communication Techniques:

restating another’s message more briefly using one’s own words.

o Through paraphrasing you send feedback that lets a patient know that he or she is actively involved in the

search for understanding.

Therapeutic Communication Techniques:

This is a technique that nurses use to recognize and acknowledge a patient’s thoughts, feelings, & needs.

o Patients and families know they are being heard and taken seriously when the caregiver addresses their

issues.

Therapeutic Communication Techniques:

Nurses ask relevant questions to seek information needed for decision making. Ask only one question at

a time and fully explore one topic before moving to another area.

o Use both open-ended and closed-ended questions. Asking too many questions is sometimes

dehumanizing.

Therapeutic Communication Techniques:

a concise review of key aspects of an interaction. It brings a sense of satisfaction and

closure to an individual conversation and is especially helpful during the termination phase of a nurse-

patient relationship.

Therapeutic Communication Techniques:

subjectively true personal experiences about the self that are intentionally revealed to

another person.

o This is not therapy for a nurse; rather it shows a patient that the nurse understands his experiences and

those they are not unique.

Therapeutic Communication Techniques:

When you confront someone in a therapeutic way, you help the other person become more aware of

inconsistencies in his or her feelings, attitudes, beliefs, and behaviors.

Nontherapeutic communication techniques:

Asking personal questions that are not relevant to a situation simply to satisfy your curiosity is not

appropriate professional communication.

Nontherapeutic communication techniques:

When a nurse gives a personal opinion, it takes decision making away from the other person. It inhibits

spontaneity, stalls problem solving, and creates doubt.

Nontherapeutic communication techniques:

Changing the subject when another person is trying to communicate his or her story is rude and shows a

lack of empathy.

o It blocks further communication, and the sender then withholds important messages or fails to openly

express feelings.

Nontherapeutic communication techniques:

Stereotypes are generalized beliefs held about people. Making stereotyped remarks about others reflects

poor nursing judgment and threatens nurse-patient or team relationships.

Nontherapeutic communication techniques:

When a patient is reaching for understanding, false reassurance discourages open communication.

Offering reassurance not supported by facts or based in reality does more harm than good.

Nontherapeutic communication techniques:

This is concern, sorrow, or pity felt for another person. A nurse often takes on a patient’s problems as if

they were his or her own.

Nontherapeutic communication techniques:

Some nurses are tempted to ask patients why they believe, feel, or act in a certain way. Regardless of a

patient’s perception of your motivation, asking “why” questions causes resentment, insecurity, and

mistrust.

Nontherapeutic communication techniques:

Becoming defensive in the face of criticism implies that the other person has no right to an opinion.

o The sender’s concerns are ignored when the nurse focuses on the need for self-defense, defense of the

health care team, or defense of others.

Nontherapeutic communication techniques:

serve to avoid conflict or sidestep issues. They reflect feelings of sadness,

depression, anxiety, powerlessness, and hopelessness.

o Aggressive responses provoke confrontation at the other person’s expense. They reflect feelings of

anger, frustration, resentment, and stress.

Nontherapeutic communication techniques:

Challenging or arguing against perceptions denies that they are real and valid.

Domains of Learning:

includes all intellectual behaviors and requires thinking

Domains of Learning:

deals with expression of feelings and development of attitudes, opinions, or values

Domains of Learning:

involves acquiring skills that require coordination & integration of mental & physical movements

Basic Learning Principles:

addresses the patient’s desire or willingness to learn

Basic Learning Principles:

depends on physical and cognitive abilities, developmental level, physical wellness, thought

processes

Basic Learning Principles:

allows a person to attend to instruction

Health Care Delivery System:

prenatal and well-baby care

 nutrition counselling

 family planning

 exercise, yoga, and mediation classes

Health Care Delivery System:

blood pressure and cancer screenings

 immunizations

 mental health counselling and crisis prevention

Health Care Delivery System:

emergency care

 acute medical-surgical care

 radiological procedures for acute problems

Health Care Delivery System:

intensive care

 subacute care

Health Care Delivery System:

cardiovascular and pulmonary rehabilitation

 orthopedic rehabilitation and home care

 sports medicine and spinal cord injury programs

Health Care Delivery System:

assisted living

 psychiatric and older adult day care

Levels of Preventive Care:

True prevention that lowers the chances that a disease will develop

 Aimed at health promotion includes health education programs, immunizations, nutritional programs, and physical

fitness activities.

Levels of Preventive Care:

Focuses on those who have health problems or illnesses and are at risk for developing complications or

worsening conditions

 Delivered in homes, hospitals, or skilled nursing facilities.

Levels of Preventive Care:

Occurs when a defect or disability is permanent or irreversible

 Aims to help patients achieve as high a level of functioning as possible. This level of care is called preventive care

because it involves preventing further disability or reduced functioning.

Levels of Preventive Care:

is any situation, habit, or other variable such as social, environmental, physiological, psychological,

developmental, intellectual, or spiritual that increases the vulnerability of an individual or group to an illness or

accident.

 Variables that increase the vulnerability of an individual or a group to an illness or accident

Types of Illness:

Short duration and severe

Types of Illness:

Persists longer than 6 months

a nursing action that produces a written account of pertinent patient data, nursing clinical

decisions and interventions, and patient responses in a health record.

Subjective, objective, assessment, plan

Subjective, objective, assessment, plan, intervention, evaluation

Problem, intervention, evaluation

Data, action, response

Commitment to include patients in decisions

Taking positive actions to help others

Avoidance of harm or hurt

Being fair

Agreement to keep promises

Defines actions as right or wrong

Proposes that the value of something is determined by its usefulness

Focuses on the inequality between people

Emphasizes the importance of understanding relationships, especially as they are

revealed in personal narratives

Case-based reasoning

a civil wrong made against a person or property.

an intentional threat toward another person that places the person in reasonable fear

of harmful, imminent, or unwelcome contact. No actual contact is required for an assault to occur.

any intentional offensive touching without consent or lawful justification. The contact

can be harmful to the patient and cause an injury, or it merely can be offensive to the patient’s

personal dignity.

occurs with unjustified restraint of a person without a legal

reason.

the release of a patient’s medical information to an unauthorized person

such as a member of the press, the patient’s employer, and the patient’s family, or online.

conduct that falls below the generally accepted standard of care of a reasonably

prudent person

one type of negligence and often referred to as professional negligence

occurs when one speaks falsely about another

the written defamation of character