1. Communication Styles
1.1. Assertive Communication
1.1.1. Definition: Expressing thoughts, feelings, and needs directly and respectfully. Characteristics: Use of “I” statements. Clear, firm, but respectful language. Example: “I need more information before I can make a decision on this.”
1.2. Aggressive Communication
1.2.1. Definition: Expressing thoughts and feelings in a way that is forceful and often disregards the rights of others. Characteristics: Blaming or accusing language, interrupting others, controlling conversations. Example: “You never get this right!”
1.3. Passive Communication
1.3.1. Definition: Failing to express one’s thoughts or feelings, often to avoid conflict. Characteristics: Avoidance of eye contact. Agreeing with others despite personal disagreement. Example: “It doesn’t matter to me, whatever you think is best.”
2. ISBARR
2.1. Introduction, Situation, Background, Assessment and Recommendation, Read Back (ISBARR) communication tool
2.1.1. Introduction Definition: Identify yourself and your role in the care of the patient.
2.1.2. Situation Definition: Clearly and briefly explain the current situation or the reason for the communication. Example: "Mr. Jones has developed a sudden onset of chest pain and shortness of breath."
2.1.3. Background Definition: Provide relevant background information that contextualizes the situation. Example: "Mr. Jones is a 67-year-old male with a history of coronary artery disease and hypertension. He had a stent placed two years ago."
2.1.4. Assessment Definition: Share your assessment of the situation based on your observations and clinical judgment. Example: "His current vitals are BP 160/90, HR 110, RR 24, and he is diaphoretic. I’m concerned that this may be a myocardial infarction."
2.1.5. Recommendation Definition: State your recommendation for action, or ask for guidance if unsure. Example: "I recommend starting him on oxygen at 4L via nasal cannula and obtaining an ECG immediately. Would you like to order any other tests or medications?"
2.1.6. Readback Definition: Repeat back any orders or instructions to confirm accuracy and ensure clear understanding. Example: "So just to confirm, you’re ordering an ECG, a stat troponin level, and 2 mg of morphine IV for pain management?"
3. Conflict
3.1. Latent Conflict Definition: The potential for conflict exists, but it has not yet surfaced. Example: A nurse is aware of a colleague’s differing opinion on patient care but has not yet addressed it.
3.2. Perceived Conflict Definition: Individuals recognize that a conflict exists, though it may not be openly acknowledged or discussed. Example: A nurse senses tension with a colleague over how to handle a patient’s discharge but avoids bringing it up.
3.3. Felt Conflict Definition: The conflict is felt emotionally, leading to stress or anxiety, even if it is not openly expressed. Example: A nurse feels frustrated and stressed because of ongoing disagreements with a team member about patient assignments.
3.4. Manifest Conflict Definition: The conflict becomes visible and is expressed openly, often through arguments or other forms of confrontation. Example: A disagreement between a nurse and a physician about a treatment plan escalates into a heated discussion in front of the patient.
3.5. Conflict Aftermath Definition: The outcome of the conflict, which may result in resolution or ongoing issues that affect relationships and work dynamics. Example: After the argument, the nurse and physician agree to communicate more effectively in the future, but there may still be lingering tension.
4. Electronic Health Records (EHR)
4.1. Benefits of Using EHR
4.1.1. Improved Accessibility
4.1.2. Enhanced Communication
4.1.3. Increased Efficiency
4.1.4. Better Clinical Decision Support
4.1.5. Improved Patient Safety
4.1.5.1. HIPAA
4.1.6. Client documentation and optimal client care
5. Incivility
5.1. Bullying
5.1.1. Horizontal or lateral violence: Peer to Peer (nurse to nurse)
5.1.2. Vertical violence is incivility between supervisor to employee or vice versa.
6. Leadership Styles
6.1. Example for Leadership Styles:
6.1.1. Autocratic Leadership Democratic Leadership Laissez-faire Leadership Transformational Leadership Transactional Leadership Bureaucratic Leadership
6.1.1.1. How does the autocratic leadership style benefit patient outcomes in high-pressure situations? What are the potential downsides of using this style too frequently?
6.1.1.2. What are the advantages of using a democratic leadership style when implementing new procedures or technology? How might this style affect team morale?
6.1.1.3. When is a laissez-faire leadership style appropriate? What are the risks, particularly when new or less experienced staff are involved?
6.1.1.4. What are the advantages of a bureaucratic leadership style in ensuring compliance and standardization?
6.1.1.5. How does transactional leadership ensure that tasks are completed efficiently? What might be the limitations of relying solely on this leadership style in a healthcare setting?
6.1.1.6. How does transformational leadership foster long-term improvements in staff engagement and patient care quality?
7. Delegation
7.1. Five Rights of Delegation
7.1.1. Right Task Right Circumstance Right Person Right Direction and Communication Right Supervision and Evaluation
7.1.1.1. Right Task
7.1.1.1.1. Delegable Tasks: Taking vital signs, assisting with ADLs, collecting urine samples. Non-Delegable Tasks: Initial assessments, care plan development, patient education.
7.1.1.2. Right Circumstance
7.1.1.2.1. Considerations: Client Stability: Is the client’s condition stable and predictable? Environment: Are there sufficient resources and support available?
7.1.1.3. Right Person
7.1.1.3.1. Competence Assessment: Training: Does the delegatee have the necessary training and experience? Skill Level: Can they perform the task independently without requiring extensive supervision?
7.1.1.4. Right Direction and Communication
7.1.1.4.1. Components: Specific Instructions: Detailed steps for performing the task. Expectations: Clear expectations for when and how the task should be completed. Reporting: Instructions on what information needs to be reported back to the nurse.
7.1.1.5. Right Supervision and Evaluation
7.1.1.5.1. Supervision Level: Direct Supervision: For tasks that are new to the delegatee or complex. Indirect Supervision: For routine tasks that the delegatee is competent in performing. Evaluation: Assess Outcomes: Did the delegatee complete the task correctly and safely? Provide Feedback: Offer constructive feedback to improve future performance.
7.2. Examples of Tasks for Delegation
7.2.1. Tasks appropriate for Assistive Personnel (AP) Tasks appropriate for LPN Tasks requiring an RN
8. Priority Setting
8.1. Maslow’s Hierarchy of Needs
8.1.1. Physiological Needs: Basic needs like air, water, food, and shelter that are essential for survival. Example: A patient experiencing respiratory distress should receive care before addressing less urgent needs.
8.1.1.1. Safety Needs: Protection from harm, stability, and security. Example: A patient with a fall risk due to unsteady gait should have fall precautions implemented before focusing on social needs.
8.1.1.1.1. Love/Belonging Needs: Social relationships, emotional support, and a sense of connection. Example: Reuniting a confused elderly patient with family can help address their emotional and social needs after physiological and safety needs are met.
8.2. ABCDE Priority Framework
8.2.1. A - Airway: Ensuring that the patient’s airway is open and clear. Example: Prioritizing care for a patient who is choking or has an obstructed airway.
8.2.2. B - Breathing: Assessing respiratory rate, depth, and effort; providing interventions like oxygen if needed. Example: Administering oxygen to a patient with pneumonia who is experiencing shortness of breath.
8.2.3. C - Circulation: Monitoring blood pressure, heart rate, and perfusion; addressing any issues promptly. Example: Starting IV fluids for a patient with hypotension after surgery.
8.2.4. D - Disability: Evaluating neurological status and consciousness level. Example: Performing a neurological assessment on a patient who suddenly becomes confused or unresponsive.
8.2.5. E - Exposure: Protecting the patient from environmental hazards or assessing the entire body for injuries. Example: Removing wet clothing from a patient with hypothermia to prevent further heat loss.
8.3. Acute vs. Chronic Conditions
8.3.1. Acute Conditions: Conditions with a sudden onset that can rapidly worsen; typically prioritized higher. Example: Treating a patient with sudden chest pain and shortness of breath before a patient with chronic back pain.
8.3.2. Chronic Conditions: Long-standing, stable conditions that require ongoing management; typically prioritized lower unless there is an acute exacerbation. Example: Continuing to monitor a patient with controlled diabetes, but prioritizing intervention for a new onset of acute symptoms like diabetic ketoacidosis.
8.4. Urgent vs. Non-Urgent
8.4.1. Urgent: Administering insulin to a diabetic patient whose blood glucose level is dangerously high before addressing a non-urgent issue like routine medication administration.
8.4.2. Non-Urgent: Providing education on lifestyle changes to a stable hypertensive patient, which can be done after urgent needs are addressed.
9. Interdisciplinary Teams
9.1. Case Manager
9.1.1. Role: Coordinates care, ensuring that the patient’s needs are met efficiently across different services. Responsibilities: Planning Discharge: Arranging for home health services or follow-up care. Resource Management: Ensuring the patient receives necessary resources without unnecessary costs. Example: A case manager arranges for physical therapy sessions at home for a patient post-discharge.
9.2. RN
9.2.1. Care Coordinator: communicates with the interprofessional team to ensure the needs of the client are met.
9.3. Social Worker
9.3.1. Role: Addresses the psychosocial needs of patients, providing support and connecting them with resources. Responsibilities: Counseling: Offering emotional support and helping patients cope with illness. Resource Referral: Connecting patients with financial assistance, housing, or support groups. Example: A social worker helps a patient with cancer apply for financial aid and find a support group.
9.4. PT
9.4.1. Responsibilities: Rehabilitation: Creating and guiding exercise programs to improve strength and mobility. Patient Education: Teaching patients exercises they can do at home to continue progress. Example: A physical therapist works with a patient post-knee surgery to regain strength and mobility.
9.5. OT
9.5.1. Role: Assists patients in achieving independence in daily activities. Responsibilities: ADL Training: Helping patients with activities of daily living (e.g., dressing, bathing). Adaptive Equipment: Recommending and training patients on the use of assistive devices. Example: An occupational therapist teaches a stroke patient how to use adaptive utensils for eating.
10. Client Advocacy
10.1. Key Principles
10.1.1. Patient-Centered Care: Ensuring that the patient’s needs, preferences, and values are respected. Empowerment: Helping patients make informed decisions about their care. Protection of Rights: Safeguarding patients’ legal and ethical rights, including the right to informed consent and the right to refuse treatment. Example: A nurse advocating for a patient’s right to refuse a medication after the patient expresses concerns about side effects.
10.2. Examples of Advocacy in Action
10.2.1. Protecting Patient Autonomy Scenario: A patient decides to refuse chemotherapy after learning about the side effects. The nurse respects the patient’s decision and communicates it to the healthcare team, ensuring that no pressure is applied to change the patient’s mind. Discussion: How does the nurse’s role as an advocate support patient autonomy in this situation?
10.2.2. Ensuring Informed Consent Scenario: Before a surgical procedure, a nurse notices that a patient seems unsure about the details of the surgery. The nurse takes the time to explain the procedure again and answers all of the patient’s questions, ensuring they fully understand and can give informed consent. Discussion: Why is ensuring informed consent a critical aspect of patient advocacy?
10.2.3. Advocating for Vulnerable Populations Scenario: An elderly patient with no family is hesitant about being transferred to a nursing home. The nurse advocates for a social worker to be involved, helping the patient explore all available options and find a solution that respects their wishes. Discussion: How does advocacy play a role in protecting vulnerable populations in healthcare?