Nursing Theory: Guiding Professional Practice Nursing Theory

Nursing Theory: Guiding Professional Practice Nursing Theory ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Nursing Theory: Guiding Professional Practice Nursing Theory This assignment is a brief summary about the lesson this week (powerpoint attached). In other words, what did you learn from this week’s assignment. This should be no more than one full page, and have at least one cited reference. Review the grading rubric below to determine if you have met, partially met, or not met criteria for this assignment. Nursing Theory: Guiding Professional Practice Nursing Theory Submit in the Drop box by the due date Reflective Journal Guidelines Reflect uponthis week’s reading and lecture. Write a brief summary aboutthe lesson of the week. What did you learn from this week’s assignment? Explain how you could adapt and/or apply these tools to your career as a RN. No more than one page. Clearly written with correct spelling using APA format. Use at least one reference. attachment_1 Module 2 Chapters: 7, 12, 14, 15, 16 Chapter 7 Nursing Theory: Guiding Professional Practice Nursing Theory: Guiding Professional Practice • Philosophies – Express beliefs about nursing and nursing-related values – Broad, global explanations of phenomena of interest that contribute to nursing knowledge by giving directions to the profession and providing bases for theoretical understanding – Serve as guides for professional practice and influence professional behaviors – Nightingale, Watson, and Benner Nursing Theory: Guiding Professional Practice • Concepts – Are the building blocks of a nursing theory that is initiated, based on a personal philosophy or belief about nursing, and may be abstract or concrete – Allow the theorist to describe and classify a phenomenon of interest – A concept can be thought of as an idea, and must be clearly defined to reduce misunderstanding of the concept Nursing Theory: Guiding Professional Practice • Conceptual Models / Nursing Frameworks – Are structures that guide the development of a study – The term paradigm is often used interchangeably with the term conceptual model – Are interrelated definitions and concepts organized for viewing phenomena specific to nursing – A paradigm can be thought of as a detailed organizing framework – Levine, Orem, King, Newman, Roy, and Johnson Nursing Theory: Guiding Professional Practice • Theories – Are an integrated set of concepts and statements that can be used to explain, describe, predict, or control a phenomenon – May be developed using inductive or deductive reasoning Theories in Support of Nursing • Developmental or physiologic theories – Maslow’s Theory of the Hierarchy of Needs – Erikson’s Theory of Psychosocial Development • Systems theory • Role theory • Adaptation theory Nursing Philosophies • Florence Nightingale – Described the nurse’s function as one that puts the patient in the best condition for nature (God) to act upon him or her (Nightingale, 1955) – Focused on the environment, and described in detail the concepts of light, cleanliness, ventilation, warmth, diet, and noise Nursing Philosophies • Virginia Henderson – The Nature of Nursing: A Definition and Its Implications for Practice, Research, and Education (1966) – Fundamental needs are • • • • • • • • • • • • • • (1) breathing (2) eating and drinking (3) eliminating (4) moving (5) sleeping and resting (6) selecting clothing and dressing (7) regulating body temperature (8) maintaining adequate hygiene (9) remaining free of harm and avoiding harming others (10) communicating (11) learning and seeking general fulfillment (12) worshiping (13) working (14) playing Nursing Philosophies • Jean Watson – Philosophy of Science and Caring (originated 1979) • Organized around ten carative factors that attempted to honor the human dimensions of nursing’s work and the subjective experiences of the people nurses serve. 10 carative factors: • • • • • • • • • • Values faith and hope compassion for self and others Trusting Rapport encouraging and accepting emotional expression analytic decision making collaborative teaching and learning supportive environment meeting needs Nursing Philosophies • Patricia Benner – From Novice to Expert • Focuses on clinical nursing practice and her belief that nursing knowledge accrues over time • Five levels of skill acquisition: • (1) novice • (2) advanced beginner • (3) competent • (4) proficient • (5) expert Nursing TheoriesNursing Theory: Guiding Professional Practice Nursing Theory • Hildegard E. Peplau – Theory of Interpersonal Relations (1952) • Theory is grounded in practice, and based on the belief that the goal of nursing should be directed toward reducing dependence and encouraging autonomy • The concept of nurse, patient, health, and environment are interconnected and should be viewed within the context of the environment • Interpersonal relationship occurs in interlocking and overlapping phases known as pre-orientation, orientation, working, and termination Nursing Theories • Ida Jean Orlando – Nursing Process Theory • The goal of the nurse is to meet the immediate needs of the patient and relieve distress or discomfort • Nursing practice should be autonomous • The nurses must explore the patient’s thoughts, feelings, and perceptions, and that assessment includes verbal and nonverbal behaviors • Using the nursing process in the provision of nursing care provides an overall framework for nursing and is effective in achieving a good outcome Nursing Theories • Nola J. Pender – Health Promotion Model • Based on the belief that the patient assumes an • • • • • • • • • • • • active role in managing his or her own health Focuses on wellness and clarifies the nurse’s role in health promotion Focuses on ten determinants of health promoting behavior, which are (1) prior related behavior (2) personal factors (3) perceived benefits to an action (4) perceived barriers to an action (5) perceived self-efficacy (6) activity-related affect (7) interpersonal influences (8) situational influences (9) commitment to a plan of action (10) intermediate competing demands and preferences Nursing Theories • Madeline Leininger – Culture Care Theory of Diversity and Universality • Is “to provide culturally congruent nursing care in order to improve or offer a different kind of nursing care service to people of diverse or similar cultures” (Leininger, 1996, p. 72) • Leininger (1996, p. 75) stated that: “Nurses need to realize that humans are complex beings who want their holistic views of life, care, culture, and health to remain together and do not want to be viewed as fragmented organs or body parts.” Nursing Theories • Margaret A. Newman – Theory of Health as Expanding Consciousness • Life process as a progression toward higher levels of consciousness health and believed that health and the evolving pattern of consciousness are the same • Interactions that occur between the environment and the person are key processes, and both health and illness can be seen as the manifestation of the pattern of the person-environment Nursing Models • Dorothy E. Johnson – Behavioral Systems Model • The goal of nursing is to assess the internal and external environments, and to help the patient select mutual goals and developing interventions • A person is composed of seven interrelated behavioral components (subsystems) that function together to form a whole • The seven subsystems of the behavioral system are (1) attachment, (2) dependency, (3) ingestive, (4) eliminative, (5) sexual, (6) aggressive and achievement behaviors, and (7) restorative behavior Nursing Models • Imogene M. King – Theory of Goal Attainment • King states that the theory “provides a process for human interactions that lead to transactions and to goal attainment for individuals, families and communities. The structure is human being transacting with their environment” (p. 62) • The goal of her theory is health for individuals, groups, and society (King, 1994)Nursing Theory: Guiding Professional Practice Nursing Theory Nursing Models • Myra E. Levine – Conservation Model • Based on three concepts: wholeness, adaptation, and conservation • Health or well-being of the patient (wholeness) is sustained through adaptation, a process of change in which conservation is the outcome Nursing Models • Betty Neuman – Health Care Systems Model • Theorizes that a person is a complex system that responds to stressors originating in both the internal and external environments • Guides nursing practice at three levels of prevention: primary, secondary, and tertiary • Nursing should treat the whole person, whereas systems (individuals, group, family, or community) are seen as being in constant change or motion, and interventions are aimed at maintaining stability Nursing Models • Dorothea E. Orem – Theory of Self-Care Deficit • A general theory comprised of three theories: theory of nursing systems, theory of self-care deficit, and theory of self-care • In this model for practice • (1) the outcome of all nursing actions should be to promote the capacity for self-care in all individuals • (2) defines activities of self-care as purposeful, ordered, and learned • (3) refers to the degree to which a person is able to participate in this as self-care agency • Self-care deficit is the degree to which the patient is unable to perform self-care Nursing Models • Sister Callista Roy – Roy Adaptation Model • The goal of nursing is to promote adaptive responses through a six-step nursing process • These steps are • • • • • • (1) assessing behaviors (2) assessing stimuli (3) formulating a nursing diagnosis (4) setting goals to promote adaptation (5) implementing interventions (6) evaluating whether the goals have been met • Roy viewed the person as a biopsychosocial adaptive system with physiologic, self-concept, role function, and interdependent modes Reference • Claywell, L. (2009). LPN to RN transitions (2nd ed.). St. Louis, MO: Mosby Elsevier. Disclaimer: This Microsoft PowerPoint Presentation was created by and is owned by Mosby Elsevier. This PowerPoint was edited to fit the needs of MPI. All content is to be credited to Lora Claywell, the author and Mosby Elsevier, the publishing company. Chapter 12 The RN as Communicator The RN as a Communicator • Foundation for communication • The RN is responsible for effectively gathering information from the patient regarding current health concerns The RN as a Communicator • This information will be shared with physicians and other health care team members – By law the RN must accurately record the patient’s responses to the condition as well as the treatment plan – This documentation becomes a legal record, is used to measure outcomes and determine costs, and may serve to defend the care given if case litigation occurs The RN as a Communicator • The RN needs to delegate duties, collaborate with many health care departments, and confer with other health care providers to carry out the plan of care • Communication can be either verbal (spoken or written) or nonverbal (body language) •Nursing Theory: Guiding Professional Practice Nursing Theory Nonverbal communication is considered to offer more “truth” than verbal communication Phases of Nurse/Patient Relationship • 1. Mutual definition: Together, nurse and patient define relationship • 2. Goal direction: purpose, time, and place are specific • 3. Specified boundaries: in time, space, content, and confidentiality • 4. Therapeutic communication: trust, honesty, comfort • 5. Assistance: Nursing helps patient toward resolution of patient problem Therapeutic Communication • When a nurse engages in a helping relationship with a patient and family, therapeutic communication is at the heart of the interaction • Requires empathy – Maintain compassionate insight into the feelings and beliefs of the individual – Accept with thoughtful consideration his or her point of view Communication Facilitators • Nurse projects warmth, acceptance, friendliness, openness, empathy, and respect in all interactions with the patient and family • Communication is patient focused to demonstrate that the nurse cares for the person and not the disease, the room number, or the bed number Communication Facilitators • Provide for the privacy, confidentiality, and comfort of the patient • The nurse must be mindful of the pace of his or her words and actions Communication Facilitators • Appropriate humor and touch can help foster a closer nurse-patient relationship • If the patient has an impaired ability to communicate, find alternate means to communicate Communication Blockers • Tends to stop conversation and build mistrust – Condescending language – Questioning a patient’s reasons rather than accepting them will block therapeutic communication – Task-oriented approach to nursing care – Failing to listen attentively – Offering unsolicited advice or false reassurances – Using clichés – Engaging in gossip Phases of Communication • Pre-orientation phase – Before beginning a conversation with a patient, the RN reviews available information • Initiation phase – Also known as the orientation phase, for the development of a trusting relationship with the patient – Factors influencing the initiation phase • Sensitive issues • Patient condition • Environment Phases of Communication • Exploration phase – The “working phase” and the longest phase, indeed the essence of the nurse-patient relationship – Listening skills – Orienting questions and explanations – Flexibility – Openness, honesty, and respectfulness – Providing clear explanations, with sound rationales, in advance of the action Phases of Communication • Termination phase – The final phase, the point where the nurse-patient relationship is completed – Needs sufficient planning, time to review goals, and allowance for the patient to recognize that he or she will be able to continue either alone or with the help of another nurse or health care professional Collaborative Communication • Delegation – Successful delegation requires sensitive but assertive communication – Fair but firm • Written communication – Transmit instructions, request equipment, record and explain incidences, pass on information in writing, nursing histories, nursing notes, memoranda, e-mail, letters, interdepartmental and inter-institutional forms Documentation as Communication • The patient’s record is documentation establishing that standards of practice, policies, and procedures were followed, and in a legal investigation it can validate that standards of care were met Nursing Theory: Guiding Professional Practice Nursing Theory • Nurse’s notes must be a complete, clear, and relevant record of the patient’s course of care Documentation as Communication • If you do not chart the nursing or collaborative intervention or the patient response to a treatment, then it did not happen Documentation Do’s & Don’ts • • • • Do make sure everything document is accurate Do make sure it is written clear and concisely Do NOT use white out or scribble out writing Do use a single strike-through and your initials when correcting your charting, ex., caucasian S.D., RN • Do NOT document for anyone else • Do NOT put incident reports involving patients and staff in the medical record Reference • Claywell, L. (2009). LPN to RN transitions (2nd ed.). St. Louis, MO: Mosby Elsevier. Disclaimer: This Microsoft PowerPoint Presentation was created by and is owned by Mosby Elsevier. This PowerPoint was edited to fit the needs of MPI. All content is to be credited to Lora Claywell, the author and Mosby Elsevier, the publishing company. Chapter 14 The RN as Manager of Care The RN as Manager of Care Role • Leadership characteristics – An important aspect of leadership is empowerment of all the team members to do the jobs of which they are most capable The RN as Manager of Care Role • Defining the leadership role – To manage is directing or supervising others as a means to control a situation – Managing patient care means overseeing the plan of care and directing others to implement the plan toward achievement of the desired outcomes – A manager has leadership qualities, acts as an advisor, and influences the beliefs of others The RN as Manager of Care Role Defining the leadership role • The leadership role is both an expectation as well as an earned role – Self-knowledge, respect, trust, integrity, vision, participation, learning, communication, and catalyzing change – Decisive, practices sound judgment, and is able to articulate fluently Leadership Styles • Democratic – Bases decisions on consensus – Delegates duties according to the strengths within the team • Authoritarian – Use power to influence others and effect outcomes – Can be beneficial in acute crisis to effectively manage situation • Laissez-faire – Deliberately intervenes as little as possible Leadership Styles • Transactional – Leads through cost-benefit or some economic reward exchange with a subordinate • Transformational – Uses characteristics such as inspiration, charisma, intellectual stimulation, and idealized influence to effect a change in the subordinate Choosing a Style • The RN’s style of leadership should reflect the personalities of the group members as well as respond to the situation • The RN as a manager of care incorporates one or more styles of leadership to meet the needs of the patient Collaborator in Providing Care • Delegation of care – Delegation is the process of assigning tasks or duties to an entrusted individual – Must always maintain patient safety by understanding the scopes of practice and the skills and abilities of the other health care team members – Delegating fairly does not mean delegating equally Delegation • Involves: – Responsibility: an obligation to accomplish a task – Accountability: accepting ownership of the task and the consequences (positive, negative, expected, unexpected) – Authority: right to act or empower Principles of Delegation • The delegator (RN) remains accountable for the task • The responsibility and authority of the task is transferred to the delegatee (CNA, LPN, other RN) Nursing Theory: Guiding Professional Practice Nursing Theory • Delegation is a contractual agreement that is entered into voluntarily • The task must match the delegatee’s abilities – Must be within their scope of practice Five Rights of Delegation • • • • • 1. Right task 2. Right Circumstances 3. Right Person 4. Right Direction/ Communication 5. Right Supervision Inappropriate Delegation • Under-Delegation: RN does not think UAP can perform of complete task or does not transfer full authority • Reverse Delegation: Team members request RN to complete task because of inability or unwillingness to perform task • Over-Delegation: RN delegates too many tasks or delegates tasks that are not appropriate for UAP to perform (not in scope) Conflict Management • Sacrifice resolution – Compromise to resolve conflict, both parties give up their positions • Competition resolution – One or both of the parties work competitively, instead of cooperatively, toward resolution – One side wins and the other loses Conflict Management • Win-win resolution – Two opposing parties come together to decide on mutual goals, design interventions to meet these goals, and work together to evaluate the outcomes Accountability for Care • The RN as coordinator of care is accountable for patient outcomes as they apply to the plans of care for the patients • When delegating responsibilities to the team members or collaborating with other departments to extend care, the RN must evaluate the effectiveness of the plan of care Advocate for Care • Advocacy occurs when one individual promotes someone else or someone’s idea • As a patient advocate, the RN promotes the patient’s decisions in a nonjudgmental manner Advocate for Care • The RN is responsible for assessing the patient’s understanding of the plan of care and ensuring that the patient has all the information needed to make informed decisions • The RN must understand the complexities of patient care management in order to advocate for the patient Responsibilities of Advocates • Beneficence: preventing/ removing harm, promoting good – If a patient is at risk for harm, the nurse must intervene – If a nurse believes a patient is being neglected or abused in or outside of the healthcare the nurse must intervene • Veracity: telling the truth • Confidentiality: protecting private information • Justice: Fairness • Role fidelity: practice faithfully within scope Legal … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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Nursing Theory: Guiding Professional Practice Nursing Theory

Nursing Theory: Guiding Professional Practice Nursing Theory ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Nursing Theory: Guiding Professional Practice Nursing Theory This assignment is a brief summary about the lesson this week (powerpoint attached). In other words, what did you learn from this week’s assignment. This should be no more than one full page, and have at least one cited reference. Review the grading rubric below to determine if you have met, partially met, or not met criteria for this assignment. Nursing Theory: Guiding Professional Practice Nursing Theory Submit in the Drop box by the due date Reflective Journal Guidelines Reflect uponthis week’s reading and lecture. Write a brief summary aboutthe lesson of the week. What did you learn from this week’s assignment? Explain how you could adapt and/or apply these tools to your career as a RN. No more than one page. Clearly written with correct spelling using APA format. Use at least one reference. attachment_1 Module 2 Chapters: 7, 12, 14, 15, 16 Chapter 7 Nursing Theory: Guiding Professional Practice Nursing Theory: Guiding Professional Practice • Philosophies – Express beliefs about nursing and nursing-related values – Broad, global explanations of phenomena of interest that contribute to nursing knowledge by giving directions to the profession and providing bases for theoretical understanding – Serve as guides for professional practice and influence professional behaviors – Nightingale, Watson, and Benner Nursing Theory: Guiding Professional Practice • Concepts – Are the building blocks of a nursing theory that is initiated, based on a personal philosophy or belief about nursing, and may be abstract or concrete – Allow the theorist to describe and classify a phenomenon of interest – A concept can be thought of as an idea, and must be clearly defined to reduce misunderstanding of the concept Nursing Theory: Guiding Professional Practice • Conceptual Models / Nursing Frameworks – Are structures that guide the development of a study – The term paradigm is often used interchangeably with the term conceptual model – Are interrelated definitions and concepts organized for viewing phenomena specific to nursing – A paradigm can be thought of as a detailed organizing framework – Levine, Orem, King, Newman, Roy, and Johnson Nursing Theory: Guiding Professional Practice • Theories – Are an integrated set of concepts and statements that can be used to explain, describe, predict, or control a phenomenon – May be developed using inductive or deductive reasoning Theories in Support of Nursing • Developmental or physiologic theories – Maslow’s Theory of the Hierarchy of Needs – Erikson’s Theory of Psychosocial Development • Systems theory • Role theory • Adaptation theory Nursing Philosophies • Florence Nightingale – Described the nurse’s function as one that puts the patient in the best condition for nature (God) to act upon him or her (Nightingale, 1955) – Focused on the environment, and described in detail the concepts of light, cleanliness, ventilation, warmth, diet, and noise Nursing Philosophies • Virginia Henderson – The Nature of Nursing: A Definition and Its Implications for Practice, Research, and Education (1966) – Fundamental needs are • • • • • • • • • • • • • • (1) breathing (2) eating and drinking (3) eliminating (4) moving (5) sleeping and resting (6) selecting clothing and dressing (7) regulating body temperature (8) maintaining adequate hygiene (9) remaining free of harm and avoiding harming others (10) communicating (11) learning and seeking general fulfillment (12) worshiping (13) working (14) playing Nursing Philosophies • Jean Watson – Philosophy of Science and Caring (originated 1979) • Organized around ten carative factors that attempted to honor the human dimensions of nursing’s work and the subjective experiences of the people nurses serve. 10 carative factors: • • • • • • • • • • Values faith and hope compassion for self and others Trusting Rapport encouraging and accepting emotional expression analytic decision making collaborative teaching and learning supportive environment meeting needs Nursing Philosophies • Patricia Benner – From Novice to Expert • Focuses on clinical nursing practice and her belief that nursing knowledge accrues over time • Five levels of skill acquisition: • (1) novice • (2) advanced beginner • (3) competent • (4) proficient • (5) expert Nursing TheoriesNursing Theory: Guiding Professional Practice Nursing Theory • Hildegard E. Peplau – Theory of Interpersonal Relations (1952) • Theory is grounded in practice, and based on the belief that the goal of nursing should be directed toward reducing dependence and encouraging autonomy • The concept of nurse, patient, health, and environment are interconnected and should be viewed within the context of the environment • Interpersonal relationship occurs in interlocking and overlapping phases known as pre-orientation, orientation, working, and termination Nursing Theories • Ida Jean Orlando – Nursing Process Theory • The goal of the nurse is to meet the immediate needs of the patient and relieve distress or discomfort • Nursing practice should be autonomous • The nurses must explore the patient’s thoughts, feelings, and perceptions, and that assessment includes verbal and nonverbal behaviors • Using the nursing process in the provision of nursing care provides an overall framework for nursing and is effective in achieving a good outcome Nursing Theories • Nola J. Pender – Health Promotion Model • Based on the belief that the patient assumes an • • • • • • • • • • • • active role in managing his or her own health Focuses on wellness and clarifies the nurse’s role in health promotion Focuses on ten determinants of health promoting behavior, which are (1) prior related behavior (2) personal factors (3) perceived benefits to an action (4) perceived barriers to an action (5) perceived self-efficacy (6) activity-related affect (7) interpersonal influences (8) situational influences (9) commitment to a plan of action (10) intermediate competing demands and preferences Nursing Theories • Madeline Leininger – Culture Care Theory of Diversity and Universality • Is “to provide culturally congruent nursing care in order to improve or offer a different kind of nursing care service to people of diverse or similar cultures” (Leininger, 1996, p. 72) • Leininger (1996, p. 75) stated that: “Nurses need to realize that humans are complex beings who want their holistic views of life, care, culture, and health to remain together and do not want to be viewed as fragmented organs or body parts.” Nursing Theories • Margaret A. Newman – Theory of Health as Expanding Consciousness • Life process as a progression toward higher levels of consciousness health and believed that health and the evolving pattern of consciousness are the same • Interactions that occur between the environment and the person are key processes, and both health and illness can be seen as the manifestation of the pattern of the person-environment Nursing Models • Dorothy E. Johnson – Behavioral Systems Model • The goal of nursing is to assess the internal and external environments, and to help the patient select mutual goals and developing interventions • A person is composed of seven interrelated behavioral components (subsystems) that function together to form a whole • The seven subsystems of the behavioral system are (1) attachment, (2) dependency, (3) ingestive, (4) eliminative, (5) sexual, (6) aggressive and achievement behaviors, and (7) restorative behavior Nursing Models • Imogene M. King – Theory of Goal Attainment • King states that the theory “provides a process for human interactions that lead to transactions and to goal attainment for individuals, families and communities. The structure is human being transacting with their environment” (p. 62) • The goal of her theory is health for individuals, groups, and society (King, 1994)Nursing Theory: Guiding Professional Practice Nursing Theory Nursing Models • Myra E. Levine – Conservation Model • Based on three concepts: wholeness, adaptation, and conservation • Health or well-being of the patient (wholeness) is sustained through adaptation, a process of change in which conservation is the outcome Nursing Models • Betty Neuman – Health Care Systems Model • Theorizes that a person is a complex system that responds to stressors originating in both the internal and external environments • Guides nursing practice at three levels of prevention: primary, secondary, and tertiary • Nursing should treat the whole person, whereas systems (individuals, group, family, or community) are seen as being in constant change or motion, and interventions are aimed at maintaining stability Nursing Models • Dorothea E. Orem – Theory of Self-Care Deficit • A general theory comprised of three theories: theory of nursing systems, theory of self-care deficit, and theory of self-care • In this model for practice • (1) the outcome of all nursing actions should be to promote the capacity for self-care in all individuals • (2) defines activities of self-care as purposeful, ordered, and learned • (3) refers to the degree to which a person is able to participate in this as self-care agency • Self-care deficit is the degree to which the patient is unable to perform self-care Nursing Models • Sister Callista Roy – Roy Adaptation Model • The goal of nursing is to promote adaptive responses through a six-step nursing process • These steps are • • • • • • (1) assessing behaviors (2) assessing stimuli (3) formulating a nursing diagnosis (4) setting goals to promote adaptation (5) implementing interventions (6) evaluating whether the goals have been met • Roy viewed the person as a biopsychosocial adaptive system with physiologic, self-concept, role function, and interdependent modes Reference • Claywell, L. (2009). LPN to RN transitions (2nd ed.). St. Louis, MO: Mosby Elsevier. Disclaimer: This Microsoft PowerPoint Presentation was created by and is owned by Mosby Elsevier. This PowerPoint was edited to fit the needs of MPI. All content is to be credited to Lora Claywell, the author and Mosby Elsevier, the publishing company. Chapter 12 The RN as Communicator The RN as a Communicator • Foundation for communication • The RN is responsible for effectively gathering information from the patient regarding current health concerns The RN as a Communicator • This information will be shared with physicians and other health care team members – By law the RN must accurately record the patient’s responses to the condition as well as the treatment plan – This documentation becomes a legal record, is used to measure outcomes and determine costs, and may serve to defend the care given if case litigation occurs The RN as a Communicator • The RN needs to delegate duties, collaborate with many health care departments, and confer with other health care providers to carry out the plan of care • Communication can be either verbal (spoken or written) or nonverbal (body language) •Nursing Theory: Guiding Professional Practice Nursing Theory Nonverbal communication is considered to offer more “truth” than verbal communication Phases of Nurse/Patient Relationship • 1. Mutual definition: Together, nurse and patient define relationship • 2. Goal direction: purpose, time, and place are specific • 3. Specified boundaries: in time, space, content, and confidentiality • 4. Therapeutic communication: trust, honesty, comfort • 5. Assistance: Nursing helps patient toward resolution of patient problem Therapeutic Communication • When a nurse engages in a helping relationship with a patient and family, therapeutic communication is at the heart of the interaction • Requires empathy – Maintain compassionate insight into the feelings and beliefs of the individual – Accept with thoughtful consideration his or her point of view Communication Facilitators • Nurse projects warmth, acceptance, friendliness, openness, empathy, and respect in all interactions with the patient and family • Communication is patient focused to demonstrate that the nurse cares for the person and not the disease, the room number, or the bed number Communication Facilitators • Provide for the privacy, confidentiality, and comfort of the patient • The nurse must be mindful of the pace of his or her words and actions Communication Facilitators • Appropriate humor and touch can help foster a closer nurse-patient relationship • If the patient has an impaired ability to communicate, find alternate means to communicate Communication Blockers • Tends to stop conversation and build mistrust – Condescending language – Questioning a patient’s reasons rather than accepting them will block therapeutic communication – Task-oriented approach to nursing care – Failing to listen attentively – Offering unsolicited advice or false reassurances – Using clichés – Engaging in gossip Phases of Communication • Pre-orientation phase – Before beginning a conversation with a patient, the RN reviews available information • Initiation phase – Also known as the orientation phase, for the development of a trusting relationship with the patient – Factors influencing the initiation phase • Sensitive issues • Patient condition • Environment Phases of Communication • Exploration phase – The “working phase” and the longest phase, indeed the essence of the nurse-patient relationship – Listening skills – Orienting questions and explanations – Flexibility – Openness, honesty, and respectfulness – Providing clear explanations, with sound rationales, in advance of the action Phases of Communication • Termination phase – The final phase, the point where the nurse-patient relationship is completed – Needs sufficient planning, time to review goals, and allowance for the patient to recognize that he or she will be able to continue either alone or with the help of another nurse or health care professional Collaborative Communication • Delegation – Successful delegation requires sensitive but assertive communication – Fair but firm • Written communication – Transmit instructions, request equipment, record and explain incidences, pass on information in writing, nursing histories, nursing notes, memoranda, e-mail, letters, interdepartmental and inter-institutional forms Documentation as Communication • The patient’s record is documentation establishing that standards of practice, policies, and procedures were followed, and in a legal investigation it can validate that standards of care were met Nursing Theory: Guiding Professional Practice Nursing Theory • Nurse’s notes must be a complete, clear, and relevant record of the patient’s course of care Documentation as Communication • If you do not chart the nursing or collaborative intervention or the patient response to a treatment, then it did not happen Documentation Do’s & Don’ts • • • • Do make sure everything document is accurate Do make sure it is written clear and concisely Do NOT use white out or scribble out writing Do use a single strike-through and your initials when correcting your charting, ex., caucasian S.D., RN • Do NOT document for anyone else • Do NOT put incident reports involving patients and staff in the medical record Reference • Claywell, L. (2009). LPN to RN transitions (2nd ed.). St. Louis, MO: Mosby Elsevier. Disclaimer: This Microsoft PowerPoint Presentation was created by and is owned by Mosby Elsevier. This PowerPoint was edited to fit the needs of MPI. All content is to be credited to Lora Claywell, the author and Mosby Elsevier, the publishing company. Chapter 14 The RN as Manager of Care The RN as Manager of Care Role • Leadership characteristics – An important aspect of leadership is empowerment of all the team members to do the jobs of which they are most capable The RN as Manager of Care Role • Defining the leadership role – To manage is directing or supervising others as a means to control a situation – Managing patient care means overseeing the plan of care and directing others to implement the plan toward achievement of the desired outcomes – A manager has leadership qualities, acts as an advisor, and influences the beliefs of others The RN as Manager of Care Role Defining the leadership role • The leadership role is both an expectation as well as an earned role – Self-knowledge, respect, trust, integrity, vision, participation, learning, communication, and catalyzing change – Decisive, practices sound judgment, and is able to articulate fluently Leadership Styles • Democratic – Bases decisions on consensus – Delegates duties according to the strengths within the team • Authoritarian – Use power to influence others and effect outcomes – Can be beneficial in acute crisis to effectively manage situation • Laissez-faire – Deliberately intervenes as little as possible Leadership Styles • Transactional – Leads through cost-benefit or some economic reward exchange with a subordinate • Transformational – Uses characteristics such as inspiration, charisma, intellectual stimulation, and idealized influence to effect a change in the subordinate Choosing a Style • The RN’s style of leadership should reflect the personalities of the group members as well as respond to the situation • The RN as a manager of care incorporates one or more styles of leadership to meet the needs of the patient Collaborator in Providing Care • Delegation of care – Delegation is the process of assigning tasks or duties to an entrusted individual – Must always maintain patient safety by understanding the scopes of practice and the skills and abilities of the other health care team members – Delegating fairly does not mean delegating equally Delegation • Involves: – Responsibility: an obligation to accomplish a task – Accountability: accepting ownership of the task and the consequences (positive, negative, expected, unexpected) – Authority: right to act or empower Principles of Delegation • The delegator (RN) remains accountable for the task • The responsibility and authority of the task is transferred to the delegatee (CNA, LPN, other RN) Nursing Theory: Guiding Professional Practice Nursing Theory • Delegation is a contractual agreement that is entered into voluntarily • The task must match the delegatee’s abilities – Must be within their scope of practice Five Rights of Delegation • • • • • 1. Right task 2. Right Circumstances 3. Right Person 4. Right Direction/ Communication 5. Right Supervision Inappropriate Delegation • Under-Delegation: RN does not think UAP can perform of complete task or does not transfer full authority • Reverse Delegation: Team members request RN to complete task because of inability or unwillingness to perform task • Over-Delegation: RN delegates too many tasks or delegates tasks that are not appropriate for UAP to perform (not in scope) Conflict Management • Sacrifice resolution – Compromise to resolve conflict, both parties give up their positions • Competition resolution – One or both of the parties work competitively, instead of cooperatively, toward resolution – One side wins and the other loses Conflict Management • Win-win resolution – Two opposing parties come together to decide on mutual goals, design interventions to meet these goals, and work together to evaluate the outcomes Accountability for Care • The RN as coordinator of care is accountable for patient outcomes as they apply to the plans of care for the patients • When delegating responsibilities to the team members or collaborating with other departments to extend care, the RN must evaluate the effectiveness of the plan of care Advocate for Care • Advocacy occurs when one individual promotes someone else or someone’s idea • As a patient advocate, the RN promotes the patient’s decisions in a nonjudgmental manner Advocate for Care • The RN is responsible for assessing the patient’s understanding of the plan of care and ensuring that the patient has all the information needed to make informed decisions • The RN must understand the complexities of patient care management in order to advocate for the patient Responsibilities of Advocates • Beneficence: preventing/ removing harm, promoting good – If a patient is at risk for harm, the nurse must intervene – If a nurse believes a patient is being neglected or abused in or outside of the healthcare the nurse must intervene • Veracity: telling the truth • Confidentiality: protecting private information • Justice: Fairness • Role fidelity: practice faithfully within scope Legal … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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