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MODULE 2A NURSING AS AN ART

Fundamentals of Nursing Practice

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According to the article published by the College of St. Scholastica (2018), the art of nursing can appear in many forms. It can be a nurse’s ability to develop a relationship with a patient or their family and to build a mutual trust. It can be the ability to empathetically understand what a patient is going through and to explain conditions and treatments in a way they will comprehend. Through enough nurses must be equipped with the right tool on how to communicate with their patients and families may it be when giving beside care or teaching them regarding health care. In this module you will acquire knowledge regarding communication process, caring for the patient as well as health care. But before moving on to the main course, kindly answer this warm up activity.

A. COMMUNICATION PROCESS

RECEIVER

FEEDBACK MEDIUM/CHANNEL

MESSAGE SENDER

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B. MASLOW’S HIERARCHY OF HUMAN NEEDS Label the different human needs based on Maslow’s Hierachy.

1. As a nursing student assigned in the clinical area, how will you show your care to your patients? ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________

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2. As a nursing student, how will you deal and communicate with a tough and challenging patient in the clinical ward? ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ In this part is the discussion of caring for patient and yourself as the nurse and communication process

I. CARING  “the essence of excellent nursing practice”.  Through caring, nurses help patients recover in the face of illness, give meaning to their illness and maintain or reestablish connection. A. CARING PRACTICE MODELS 1. LEININGER’S TRANSCULTURAL CARING  By Madeliene Leininger  She describes the concept of care as the essence and central, unifying and dominant domin that distinguishes nursing from other health disciplines.  She stresses the importance for nurses to understand cultural caring behaviors, that even though human caring is a universal phenomenon, the expressions, processes and patterns vary among people of different cultures. Things to Consider for a Culturally Patient-Centered Care a. Know the patient’s beliefs and attitudes regarding health care and caring practices. b. Know the patient’s cultural practices regarding end-of-life care. c. Determine if a member of the patient’s family or cultural group is the best resource to guide the use of caring practices such as providing presence or touching. d. Know the patient’s cultural practices regarding removal of life support. 2. WATSON’S TRANSPERSONAL CARING  By Dr. Jean Watson  A holistic model for nursing that suggests that a conscious intention to care promotes healing and wholeness. Fundamentals of Nursing Practice

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  

This theory rejects the disease orientation to health care and places carebefore cure. When the nurse focuses on transpersonal caring, he or she looks for deeper sources of inner healing to protect, enhance, and preserve a person’s dignity, humanity, wholeness and inner harmony. In Watson’s model, the emphasis is on the nurse-patient relationship- the focus is on carative behaviors and the nurse-patient caring relationship.

WATSON’S 10 CARATIVE FACTORS a. Forming a human-altruistic value system- use loving kindness to extend yourself. b. instilling faith-hope c. cultivating a sensitivity to one’s self and to others d. developing a helping, trusting, human caring relationship e. promoting and expressing positive and negative feelings- support and accept your patient’s feelings f. Using creative problem-solving, caring processes g. promoting transpersonal teaching-learning h. providing for a supportive, protective, and/or corrective mental, physical, societal and spiritual environment. i. Meeting human needs j. Allowing for existential-phenomenological spiritual forces 3. SWANSON’S THEORY OF CARING  Developed by Kristen Swanson  This theory provides direction for how to develop useful and effective caring strategies appropriate for multiple age-group and health care settings.

SWANSON’S THEORY OF CARING Caring Process Definitions Subdimensions a. Knowing Striving to understand Avoiding assumptions an event as it has Centering on the one cared meaning in the life of for the other. Assessing thoroughly Seeking clues to clarify the event Engaging the self or both b. Being with Being emotionally Being there present to the other. Conveying ability Shared feelings Not burdening c. Doing for Doing for the other as Comforting he or she would do for Anticipating self if it were at all Performing skillfully Fundamentals of Nursing Practice

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possible. d. Enabling

Facilitating the other’s passage through life transitions and unfamiliar events

e. Maintaining belief

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

Protecting Preserving dignity Informing/explaining Supporting/allowing Focusing Generating alternatives Validating/Giving feedback Believing in/holding in esteem Maintaining a hope filled attitude Offering realistic optimism “Going the distance”

II. SIX (6) C’s OF CARING 1. CARE- is the core business of nursing, and the care nurses deliver helps the individual person and improves the health of the community. 2. COMPASSION- how care is given through relationships based on empathy, respect and dignity. 3. COMPETENCE- must have the ability to understand an individual’s health and social needs and the expertise, clinical and technical knowledge to deliver effective care and treatments based on research and evidence. 4. COMMUNICATION- is essential to successful caring relationship and to effective team working. 5. COURAGE- enables nurses to do the right thing for the people, to speak up for concerns and to have the personal strength and vision to innovate and to embrace new ways of working. 6. COMMITMENT- is needed to improve the care and experience of patients, to take action to make a vision and strategy a reality for all and meet the health, care and support challenges ahead. III. CARING FOR SELF AND OTHERS A. CARING FOR OTHERS 1. Providing Presence- person to person encounter conveying a closeness and sense of caring.  Involves “being there” and “being with” Fundamentals of Nursing Practice

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2. Touch- relational and leads to a connection between nurse and patient. a. Contact Touch- involves skin-to-skin contact. a.1 Caring Touch- connect with the patient physically and emotionally. a.2 Protective Touch- form of touch that protects a nurse and or patient. b. Noncontact- refers to eye contact. 3. Listening- it is a planned deliberate act in which the listener is present and engages the patient in a nonjudgmental and accepting manner.  It includes “taking in” what a patient says, interpreting and understanding what the patient is saying and then giving back that understanding to the patient.  Helps create a mutual relationship, through active listening the nurse begins to truly know his/her patients and what is important to them. 4. Knowing the Patient- comprises both a nurse’s understanding of a specific patient and his or her subsequent selection of interventions. Factors that Contribute to Knowing the Patient a. Time b. Continuity of care c. Teamwork of the nursing staff d. Trust e. Experience Barriers to Knowing the Patient a. organizational changes- often result in decreasing the amount of time that registered nurses are able to spend with their patients. b. Decrease length of stay- reduces the interactions between nurses and their patients 5. Spiritual Caring- in a caring relationship the patient and the nurse come to know one another so both Move toward by healing relationship by: a. Mobilizing hope for the patient b. Finding an interpretation or understanding of illness, symptoms, or emotions that is acceptable to the patient. c. Assisting the patient in using social, emotional, or spiritual resources. d. Recognizing that caring relationships connect us human to human, spirit to spirit. 6. Relieving Symptoms and Suffering- encompasses caring nursing actions that give a patient comfort, dignity, respect, and peace and provide necessary comfort and support measures to the family or significant others.  Ensuring that the patient care environment is clean and pleasant and includes personal items makes the physical environment a place that soothes and heals the mind, body and spirit. Fundamentals of Nursing Practice

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 Thru skillful, accurate assessment of a pits level of discomfort- nurses are able to design patient-centered care to improve patient’s level of comfort. 7. Family Care- as a nurse, it is important to know the family almost as thoroughly as you know a patient.  Success with nursing interventions often depends on their willingness to share information about the patient, their acceptance and understanding of therapies.  Family is an important resource. B. CARING FOR SELF  To be able to provider competent, quality and safe care, nurses need to take care of themselves to ensure they remain healthy.  Nurses are particularly susceptible to the development of COMPASSION FATIGUE  COMPASSION FATIGUE- is a combination of secondary traumatic stress (STS) and burnout.  Secondary traumatic stress- Develops as a result of the relationship that nurses develop with their patients and families.  Burn out- stems from conflicts or nurse job dissatisfaction within the work setting. Manifestations of Compassion Fatigue 1. Affection on the Nurse’s Health  Decline in health  Changes in sleep and eating patterns  Emotional exhaustion  Irritability  Restlessness  Impaired ability to focus  Feeling of hopelessness  Anxiety  Inability to take pleasure from activities 2. Affectation in the workplace  Diminished performance  Reduced ability to feel empathy  Depersonalization of the patient  Poor judgment  Chronic absenteeism  Conflict between nurses Management: 1. Personal strategies on health promoting behaviors and healthy lifestyle choices. a. Eat a nutritious diet b. Get adequate sleep regularly Fundamentals of Nursing Practice

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c. Engage in regular exercise and relaxation activities d. Establish a good work-family balance e. Engage in regular non work activities f. Developing coping skills g. Focusing on one’s own spiritual health h. Find a mentor or experienced nurse who understand the stress of the job and is able to help you identify coping strategies. 2. Professional strategies a. Educational programs - To increase resiliency - These programs educate nurses about compassion fatigue & its negative effects, provide resources & tools for nurses to use to prevent or cope with STS & burn out. b. Participating in debriefing sessions or a compassion fatigue support group - allows nurses to identify stressors and work as a group to develop healthy coping strategies. COMMUNICATION PROCESS COMMUNICATION  Process in which people affect each other through exchange of information, ideas and feelings.  Health personnel communicate through discussion, reports and records.  It is a basic component of nurse-patient interaction.  A vehicle for establishing a therapeutic relationship with the patient. MODES OF CMMUNICATION 1. VERBAL COMMUNICATION  Uses spoken or written words. CRITERIA FOR EFFECTIVE VERBAL COMMUNICATION a. SIMPLICITY- includes use of commonly understood words, brevity and completeness b. CLARITY- involves saying exactly what is meant. o The nurse needs to speak slowly and enunciate words well. o Repeat the message as needed, reduce distraction c. TIMING AND RELEVANCE- needs to be appropriate to ensure that words are heard. o Ask one question at a time. o Wait for an answer before making another comment d. ADAPTABILITY- involves adjustment on what the nurse says and how it is said depending on the mood and behavior of the client. e. CREDIBILITY- an important criterion of effective communication o Nurses foster credibility by being consistent, dependable and honest. Fundamentals of Nursing Practice

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o Nurses need to convey confidence and certain in what they are saying (POSITIVISM). 2. NON VERBAL COMMUNICATION  Makes use of gestures, facial expressions, posture or gait, body movements, physical appearance, eye contact, tone of voice or body language. a. Posture and Gait- the way people walk and carry themselves are reliable indicators of self concept, current mood and health. b. Facial expression- the face is the most expressive part of the body. o Nurses must learn to control their feeling such as fear and disgust in certain situations. c. Hand movements and gestures o Hands communicate by touch- handshake, victory sign, wave goodbye o Culture specific- European women walk together holding hands (sign of friendship) o For people with special communication problems such as deaf- hands are invaluable in communication. COMMUNICATION PROCESS  Two way process involving the sending and the receiving of a message. COMPONENTS 1. SENDER/ SOURCE ENCODER- a person or group who wishes to communicate a message to another. o This term suggests that the person or group sending the message must have an idea or reason for communicating (source) and must put the idea or emotions into a form that can be transmitted. o ENCODING- involves the selection of specific signs or symbols (codes) to transmit the message on what language to use, how words are arranged, and what tone and gestures to be used. 2. MESSAGE- it is what is said and written, or the body language that accompanies the words, and how the message is transmitted. 3. RECEIVER- is the listener, who must listen, observe, and attend. o This person is the “decoder” who must perceive what the sender would like to convey. o DECODE- means to relate the message perceived to the receiver’s store house of knowledge and experience and to sort out the meaning of the message. 4. RESPONSE/FEEDBACK- it is the message that the receiver returns to the sender. o Can either be verbal or non verbal or a combination of both.

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FACTORS INFLUENCING COMMUNICATION PROCESS 1. DEVELOPMENT- knowledge of a client’s developmental stages will allow the nurse to modify the message accordingly. 2. GENDER  Girls- tend to use language to seek confirmation, minimize differences and establish intimacy.  Boys- use language to establish independence and negotiate status within the group. 3. VALUES AND PERCEPTION  VALUES- are standards that influence behavior.  PERCEPTIONS- are the personal view of an event. 4. PERSONAL SPACE- the distance people prefer in interaction with others.  PROXEMICS- the study of distance between people in their interactions. FOUR DISTANCES THAT AFFECT COMMUNICATION a. INTIMATE DISTANCE- touching to 1.5 feet o Characterized by body contact heightened sensations of body heat and smell with vocalizations that are low. b. PERSONAL DISTANCE- 1.5 to 4 feet. o Less overwhelming than intimate contact o Voice tones are moderate, body heat and smell are less noticeable o Physical contact such as handshake or touching a shoulder is possible. c. SOCIAL DISTANCE- 4 to 12 feet o Characterized by clear visual perception of the whole person o Body heat and odor are imperceptible, eye contact is increased and vocalizations are loud enough to be overheard by others. o Communication is more formal and is limited to seeing and hearing. d. PUBLIC DISTANCE- 12 to 15 feet o Requires a loud, clear vocalization with careful enunciation. 5. TERRITORIALITY- a concept of space and things that an individual considers as belonging to himself. o Examples: clients in the hospital often consider their territory as bounded by the curtains around the bed units, nurses need to obtain permission from clients to remove, rearrange, or borrow objects in their hospital area. 6. ROLES AND RELATIONSHIPS  Roles such as nursing student and instructor, client and primary care provider, or parent and child affect the content and responses in the communication process.  Choice of words, sentence structure and tone of voice vary considerably from role to role. 7. ENVIRONMENT  People usually communicate most effectively in a comfortable environment.  Temperature extremes, excessive noise, poorly ventilated environment and lack of privacy may interfere with communication. Fundamentals of Nursing Practice

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8. INTERPERSONAL ATTITUDES  Attitudes such as caring, warmth, respect and acceptance facilitate communication, whereas condenscension, lack of interest, and coldness inhibit communication. 9. BOUNDARIES  Limits of individuals, objects or relationships.  To keep clear boundaries, the nurse keeps the focus on the client and avoids sharing personal information or meeting his or her own needs through the nurse-client relationship.  Some of the boundary issues: gift-giving by the nurse or client, spending more time than necessary with a client.

THERAPEUTIC COMMUNICATION  Promotes understanding and can help establish a constructive relationship between the nurse and the client. o Attentive Listening- listening attentively and with mindfulness, using all the senses and paying attention to what the client says, does and feels o Visibly Tuning In- an expression of empathy that tells clients that you are with them, and it puts you in a position to listen carefully to their concerns.

HELPING RELATIONSHIP  Nurse-client relationship KEYS TO THE HELPING RELATIONSHIP 1. The development of trust and acceptance between the nurse and the client. 2. An underlying belief that the nurse cares about and wants to help the client. PHASES OF THE HELPING RELATIONSHIP 1. PREINTERACTION PHASE  Is similar to the planning stage before an interview  The nurse obtains information about the client before going into the initial face to face meeting.  Eg: Client’s name, age, address, medical and social history 2. INTRODUCTORY PHASE  Also referred to as the ORIENTATION or the PREHELPING PHASE  It is important s it sets the tone for the rest of the relationship.  The goal of the nurse in this phase is to develop trust and security within the nurse-client relationship  After introductions, the nurse may initially engage in some social interaction to put the client at ease. Fundamentals of Nursing Practice

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By the end of the introductory phase, clients should begin to: o Develop trust in the nurse o View the nurse as a competent professional capable of helping o View the nurse as honest, open and concerned about their welfare o Believe the nurse will try to understand and respect their cultural values and beliefs o Be...