NUR1118 Unit 2 Notes

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Mississippi Gulf Coast Community College *

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1118

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Health Science

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Feb 20, 2024

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docx

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Unit 2 Fundamentals August 29, 2023 Communication Process of info being transferred from one person to another – patient, patient family, provider Verbal, written, body language The sender, the receiver, the message Feedback – allows sender and receiver to know the message was clearly understood SBAR – communication tool, used for shift report. Needed for client safety to know what is going on, what needs to be done, updates on client Feedback and client education – knowing the client understood the information Have them demonstrate how to properly administer their medication to themselves. SBAR EXAMPLE Situation – client has nausea after surgery Background – history of nausea following surgery Assessment – patient vomiting 100ml of green bile, bowel sounds present Recommendation – antiemetic given, recommend keeping the client NPO (nothing by mouth) Verbal communication – what is said Nonverbal communication – gestures, body language Auditorial communication – what the receiver hears; are there any deficits? If there is, are there any tools that are needed? Energetic communication – how a person projects themselves 4 modes of communication Verbal, nonverbal, electronic, written Verbal Things to include: making sure we are always speaking clearly so the receiver can hear, making sure the receiver understands what is said

(feedback), adjusting distractions, facing the receiver when speaking promotes active listening Written communication – educational material Electronic communication – video conferencing: ensuring privacy Nonverbal Body language: facial grimace Demonstrate an open posture towards client Communication styles Passive – avoid conflict; individual says nothing or simple agrees Ex. “I’ll do whatever you want” Assertive – honest and clear communication that does not violate the right of others Ex. “I express my ideas clearly, and the others in the meeting chose a different option” Aggressive – verbally and sometimes physically abusive Ex. “its your fault the client fell, you never listen to me” Passive – passive on surface while demonstrating anger in a subtle or indirect way Ex. A nurse ignoring a call light several times, or saying they will do something and not following through Nontherapeutic communiation – results in misunderstanding, poor patient care, decrease patient satisfaction; not listening, being critical, rejecting what they are saying, dismissing client concerns “so many people have it worse than you” “don’t worry, it could be worse” -Active listening to the clients and their concerns and working through what we can do for them Therapeutic communication – silence, active listening, open ended questions “what would you do” requires more than a yes or no answer “and how did that make you feel?” giving the client an opportunity to give more information Restating, paraphrasing and summarize – repeat the question back to the client to ensure the client understands and identify any needs for clarification Reflection – used when clients are asking for advice or nurse opinion “what do you think you should?”

Instead of repeating the clients message back to them, the nurse attempts to reveal the clients feelings behind he message. Motivational interviewing – known by OARS: • Open ended questions: “tell me more” • Affirmations: statemtents that encourage clients o Ex. “you did very well with your food diary this week” • Reflective listening – restate what the client said encouraging clarification of feelings o Ex. “so youre worried you will get diabetes like your mother?” • Summarizing: paraphrasing what your client said o Ex. “so does your mother also have diabetes?” Communication barriers Language Cultural diversities Cognitive and developmental impairments – speaking in a language they will understand, speaking clearly in a slow pace, being aware of clients body language Safety Identify clients correctly - Name - DOB Utilize an open ended question: “Can you tell me your name and DOB?” - Barcode scanning: used at time of med admin; scanning ID bracelet Communication Reporting critical results such as lab results (blood work and potassium came back high) that are life threatening if not immediately improved Written documentation of the notification of results to the provider (who received the results and who communicated them) Use Medication Safely - Labeling all meds - Reconcile client medications: what they are taking, what they will continue to take, before discharge

Use of alarms safely – intention is to warn providers of a serious event Ex. IV pumps Preventing Hospital-Acquired infections Central line – pathogens enter the bloodstream via central line; UTIs with catheters Surgical site – where the surgery occurred Ventilator associated pneumonia – while a client is on a ventilator Hand hygiene is the single most important step that healthcare workers can do to prevent the spread of infection Adverse events in surgery - A series of safety checks before beginning an invasive surgery Using two client identifiers - Marking of surgical site if possible - Time out in operation in procedure room to ensure correct client and procedure being performed Near miss – potiential error or event or circumstance that could have caused harm but was cauht and avoided  A client safety event is an unexpected event or circumstance that occurred with or without injury to the client, but that had the potential to cause harm to the client.  An adverse event is a situation or circumstance that caused unexpected harm to the client.  A sentinel event (never event) is a critical, unexpected adverse event that caused severe physical or psychological harm to a client, including death, dismemberment, permanent injury, and severe or temporary injury.

Creating a culture of safety – safe environment Transporting care at bedside – nurses spend 70% of time at bedside performing direct client care Strengthening management through leadership Implement rapid response – designated team that a nurse can notify if a client starts to deteriorate or have changes; interdisciplinary team Ex. Sudden change in vitals, change in mental status Hourly rounding – checking on the clients every hour and documenting Occurrence reporting Not intended to punish individuals but to learn from the incident Used to track those incidents Action plans must be created to prevent future occurrences Safety assessments 1) Preventing infections 2) Simplifying discharge instructions 3) Protocol to prevent venous thromboembolism (VTE) 4) Education regarding medications Electrical, chemical, radiation safety Electrical - Following safe practices when working with electrical appliances Chemical – Radiation safety – Hospital Acquired Injury (HAIs) Pressure injuries Reposition the client, turning the client Identifying High Risk Injury - Fall risk Screening tools - MORSE fall scale and braden scale Fall risk preventions - nonskid footwear and socks - bed at lowest position - locking bed wheels - basic orientation to the room; free of clutter, call light easily accessible

Fire Safety & Rescue RACE: Race Alarm Contain Extinguish PASS: Use of restraints Restraints should be used as a LAST resort Other interventions – deescalating the situation, remind and reorient client to not get out of bed and not pull on their tubing Physical restraints Mechanical Chemical Barrier Seclusion Seizure precautions Padding on side rails, suctions, oxygen ****Review precautions on particular disease processes**** Prevent of Work related injuries Work related musculoskeletal disorders (MSDs) Turn sheets, lifting devices, sit to stand lift device Types of Movements ****Need to Know**** Types of Movement  Flexion: bend; reduce the angle between the bones  Extension: straighten the limb  Abduction: move away from baseline  Adduction: bring closer to baseline  Pronation: turning to face backward

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