patient care management and critical thinking

Patient Care Management & Critical Thinking

Justina Aguirre, RN, MSN351-3550 direct work line

351-3286 alternate work line

344-5005 home

[email protected]

Introduction Introduction Introduction Introduction

Course Expectations:• Gain knowledge in:

– patient care leadership and critical thinking processes

• Completion of ALL individual assignments

– journals, reports, presentations, attendance, and participation

• Completion of ALL group assignments

– reports, presentations, and participation

• Participation includes

– Class discussion – Exercises in class


Review Course Syllabus:Review Course Syllabus:• Journals

• Class participation & readiness

• Reading assignments

• Internet assignments

• Group assignments


Part I

• Send an email with the information requested to the instructor at [email protected]. Be sure to include your full name and your preferred name

Part II

1. Log onto the internet web site http://www.lib.berkeley.edu/TeachingLib/Guides/Internet/Evaluate.html. Read: Evaluating Web Pages: Techniques to Apply & Questions to Ask”

2. Log onto the internet web site http://www.aeb.org/

3. Evaluate ‘web site 2’ using the information you learned in ‘web site 1’

4. Email your evaluation to the instructor

Introduction Introduction Introduction Introduction Journal Assignment - Part I & II Journal 1Part I & II Journal 1Journal Assignment - Part I & II Journal 1Part I & II Journal 1

mailto:[email protected]

http://www.lib.berkeley.edu/TeachingLib/Guides/Internet/Evaluate.html

http://www.lib.berkeley.edu/TeachingLib/Guides/Internet/Evaluate.html

http://www.aeb.org/

http://www.aeb.org/

http://www.aeb.org/

Discussion: Why be a nurse?Discussion: Why be a nurse?• Job pays well

• Like people

• Illness loved-one

• Medicine too long

• Like science

• Work/volunteer in healthcare

• 1st step toward my final goal

• Counselor guided

• Relative guided

• “Professional"

• Set example for loved-ones

• Like to meet needs of others

• Like change and diversity


Small group exerciseDraw a ‘good’ nurse

• What is in your mind’s eye?

– What should a nurse look like?

– Do not use words in the drawing

• When finished, the group leader will present and explain the drawing


Review what the drawings show... Characteristics we expect of a nurse?

• Trustworthy & Commitment

• Communicates & Listens

• Knowledgeable & Prepared

• Smiles & Professional

• Other...


Briefly discuss: how each group selected their ‘Leader’

Briefly discuss: how each group selected their ‘Leader’


Nurses & leaders need – Time management

– Communication

Students need– Adjust to student life

– Know self as a person (chapter 2)


Time is FiniteTime is Finite• Effectiveness: Make situation better

• Efficiency: maximize time, resources, & effort

• Do you “work better under pressure”

• Do you “take all day, but get nothing done”

• Schedule should be realistic AND allow for

– Rest & recuperation

– Emergencies

Time Management Time Management Time Management Time Management

Time is MoneyTime is Money• Missed deadlines = money

• If time mgmt improved 10% for 7 people:

– 1 Mrg @ $34/hr would save $ 7,072/yr

– 4 RNs @ $22/hr would save $18,304/yr

– 2 LVN @ $16/hr would save $ 6,656/yr

– Total savings $32,032/yr

• You could hire another LVN!


3 Principles3 Principles3 Principles3 Principles• Allow time to plan

• Prioritize

• Re-prioritize based on new info

• Assert control over own time

• Plan

• Handle paperwork efficiently

• Identify common time wasters

4 Personal Steps 4 Personal Steps 4 Personal Steps 4 Personal Steps


Step 1 - Assert Control Over Time

Step 1 - Assert Control Over Time

• Learn when to say “NO” & when not to

• Know your high energy hours – are you a morning or nite person?

• When do you save or waste time? Time logs may help

• Document or chart as you go

• Clarify any requests for your time

Step 2. Planning & Prioritizing

Step 2. Planning & Prioritizing

• Time lines – for long range planning

• Make “To do” lists

– part of daily plan

– report sheet


Step 2. Planning & PrioritizingStep 2. Planning & Prioritizing

• Determine priorities or which tasks are:

– critical

– important

– time related

• What skills are needed for each task


Step 3. Paper or computer-work

Step 3. Paper or computer-work

• Limit length of “to do” lists

• Organize your work

– Develop a system for homework and for chart documentation

– Do Not Depend On Memory!

– Avoid clutter in the work area.

•“A clean desk is a sign of boring person” is wrong!


Step 4. Identify Time WastersStep 4. Identify Time Wasters• Management by crisis.

Respond by doing hardest task first if possible

• Telephone or visitor interruptions. Learn to say, I do not have the time now

• Conflicting duties. Respond by setting goals & work toward your goal

• Attempting too much. Learn to say no (See step 1)


Step 4. Identify Time Wasters Step 4. Identify Time Wasters

• Poor communicationPoor communication– ““straight forward” without offending straight forward” without offending

– aware of people who drain energyaware of people who drain energy

– learn to negotiatelearn to negotiate

•Lack information about duty/roleLack information about duty/role

•ProcrastinationProcrastination– just change the behavior, don’t try to explain it away just change the behavior, don’t try to explain it away


Book – page 278 Book – page 278

• 26 questions to answer for self 26 questions to answer for self

• Add your scores as per page 281Add your scores as per page 281

• Total scores on page 282 will let you know areas to work Total scores on page 282 will let you know areas to work onon


Journal Assignment - Part III of Journal 1Part III of Journal 1Journal Assignment - Part III of Journal 1Part III of Journal 1

• Log of everything you do for Log of everything you do for 22 days days

• Record how you felt (emotionally) for each activityRecord how you felt (emotionally) for each activity

• At the end of At the end of 22 days, review what you wrote in their log days, review what you wrote in their log

• Evaluate your use of time based on what was discussed in Evaluate your use of time based on what was discussed in classclass

• Email to your instructor with your real thoughts on this Email to your instructor with your real thoughts on this exerciseexercise


Communication Communication Communication Communication

Definitions

Exchange of information

Exchange of words or meaning

Message is passed from

•sender to a receiver,

•hopefully with intended message understood

Verbal, non-verbal, & write


Sender – Message – Receiver

• Encode

– Putting the sender’s intended message into words, gestures, expressions, culture’s effects....

– Variables and barriers can effect (more later)

• Decode

– Meaning dependent on receiver’s interpretations, perceptions, and values

– Variables and barriers can effect (more later)

Communication ModelCommunication ModelCommunication ModelCommunication Model

Variables and BarriersVariables and Barriers

Physical

• distance, equipment, wall, computer...

• space and territory

Environmental

• noise = disturbing, static on phone, crowds

• e-mail = glitches

Work Structures

• authority & reporting structures

• roles or relationships

• time constraints

• grapevine


Social / Psychological BarriersSocial / Psychological Barriers

Personal bias

• Past experiences

• Culture

• Spiritual values

• Gender

• Stereotyped responses

Control issues

• Rules, regulations...

• Too many demands (overload!)

• Too many messages

• Expressed disapproval


Social / Psychological BarriersSocial / Psychological BarriersNonverbal barriers

• Expressions, body language

• Emotions & attitudes

• Lack of trust

• Roles insincerity

• Belittling feelings

Asking

• Yes or no questions

• Personal questions

• Or just changing the subject without asking


Distances

– Intimate 18 inches

– Personal – up to 4 ft

– Social up to 12 ft

– Public > 12 ft

Dress

– Traditional nurse

– Cute little girl

– I don’t care

– Sexy

– Career nurse

Who would your grandma, mom, dad want for a nurse?

Clinical Communication Clinical Communication Clinical Communication Clinical Communication

•listening

–actively vs passively

•written

–no white out

–requires reading with meaning

•verbal

–face to face

–formal and informal

–rounds and patient conferences


With Patients

•Avoid frivolous conversation.

•Avoid joking.

•Show respect.

•Be honest in relationships.


With Patients

– Ask questions.

– Restate.

– Clarify phrases.

– Have a clear purpose.

– Ensure confidentiality.


•You need empathy and sympathy

•Empathy includes an intellectual understanding of the experience.

•Sympathy includes an emotional component of the experience.


Special Situations

•Non-English speaking

•Hearing impaired

•Vision impaired

•Speech impaired

Remember Communication Process

(next slide)


Communication Process Communication Process Communication Process Communication Process

Informal Communication “The Grapevine”

• Will not go away

• Occurs on all levels & is ~ 75% accurate

• Natural motivation to exchange information

• Influences others & source affects the strength

• If staff have enough information, it may satisfy their need and may be no need to start rumor


To be effective...•Take time to listen & clarify before speaking

•Teach yourself to concentrate & to listen

•to what is being said – real message

•not just how it is said

•consider physical and human setting

•listen with your eyes

•Suspend judgment

•Keep staff informed & keep lines of communication open


•Make desired impact through tone of voice & choice of words

•Learn from the grapevine

•Give positive feedback frequently

•Give negative feedback •privately in timely, accurate, & objective manner

•based on observed behavior

•give suggestions for alternative behaviors

•avoid put downs or blaming


To be effective...

Effective Communication Effective Communication • Page 61 -62

• Take test


Eric worked the night shift, and received report from Mary. Mary would talk of the difficult day, patients that were a “pain”, and excuses why things were not done. Eric often began his shift by picking up after Mary.

Eric did not discuss this with anyone, but was becoming very frustrated.

One day he snapped... “Mary , what is your problem? Everything is left for me to do, and all you give me are excuses. Besides complaining, what else do you do all day?”

Communication ExerciseCommunication ExerciseCommunication ExerciseCommunication Exercise

What type of communicator is Eric

Identify the behavior Eric exhibited that enabled Mary to continue hers

If you were Eric, what other approach would be more constructive

If you were a team member how would you respond


Think About It – pg 43Think About It – pg 43

• One of your very close friends, who knows you are in nursing school, called and said he thinks he might have AIDS.

• He said he doesn’t know what to do or whom to trust. He wants to meet you after school tomorrow because he said he needs to talk to someone.

• You want to be there for your friend, but you realize how little you really know about AIDS. What are you going to do?


Think About It Think About It

• “Be there for him.”

• Your friend “thinks” he has AIDS. How does this affect what the friend should do?

• How can you learn more about AIDS in a short period of time? What are reliable sources of information?

• How can you identifying facts and avoiding jumping to conclusions.

Communication Exercise Communication Exercise Communication Exercise Communication Exercise

Think About It – pg 63Think About It – pg 63

• As you enter Mr. Callahan’s room, you ask him how he is feeling. He replies in a pinched voice, “I am fine, thank you.”

• You notice that his hand is clutching his side, he has a grimace on his face, and his skin is flushed.

• What responses would be appropriate in this situation?


• Using the critical thinking skills in Box 1-2...

• Suggestions to distinguish between fact and fallacy.

• The facts—clutching his side, grimace on his face, flushed skin—do not match what Mr. Callahan is saying. So, what would you ask?

• “You are saying that you are fine but you are clutching your side. Your face looks like you are in pain, and your skin is flushed. What does that mean?”

• Could have just taken niacin or washed face?

• Could have a grimace because the coffee tasted awful?

• Could he be clutching side because of hospital gown?

Think About It discussion Think About It discussion


Think About It page 74Think About It page 74

• You are a female nurse and you have a patient who has refused to allow you to bathe him for 3 days. He has had a high fever, is unable to get out of bed, and his skin condition is deteriorating.

• You know that in his culture, most people bathe no more than once a week. You also think that he might have a cultural code that forbids him to be alone with a woman.

• What might resolve this situation?


• See situation from many perspectives.

• Patient should have a daily bath and skin care.

• Family can get the patient to agree to a bath?

• Male nurse can give the bath

• Maybe the patient can bathe himself.

• Other possible solutions to this problem.

Think About It discussion Think About It discussion


Maslow’s Hierarchy of Needs (work)

Physiological or Basic NeedsSafe Environment / Climate control / Base Wage

Security and Safety NeedsJob security / Competency

Social, Love, and BelongingTeam work / Trust co-workers

Self EsteemPosition / Recognition

Self ActualizationChallenging role

Your Physical Health

•Diet

•Rest and exercise

•Personal hygiene

•Smoking

•Chemical dependence

•Personal illness

Student as a Person

Your Emotional Health

– Understanding yourself

– Personality

– Personal values and beliefs

– Prejudice

– Stress – see page 49 for another exercise

Student as a Person

Your Career•Continuing education

•Career plans

•Future .... More in later classes

•Thank you for substituting!

Student as a Person

patient care management and critical thinking

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