Patient Care Management

1
Patient Care Management Critical Thinking
Introduction

• Justina Aguirre, RN, MSN
• 351-3550 direct work line
• 351-3286 alternate work line
• 344-5005 home
• aguirres_at_adelphia.net

2
Course Expectations
Introduction

• 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

3
Review Course Syllabus
Introduction

• Journals
• Class participation readiness
• Reading assignments
• Internet assignments
• Group assignments

4
Introduction
Journal Assignment - Part I II Journal 1

• Part I
• Send an email with the information requested to
  the instructor at aguirres_at_adelphia.net. Be sure
  to include your full name and your preferred name
• Part II
• Log onto the internet web site http//www.lib.berk
  eley.edu/TeachingLib/Guides/Internet/Evaluate.html
  . Read Evaluating Web Pages Techniques to Apply
  Questions to Ask
• Log onto the internet web site http//www.aeb.org/
  
• Evaluate web site 2 using the information you
  learned in web site 1
• Email your evaluation to the instructor

5
Discussion Why be a nurse?
Introduction

• 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

6
Small group exerciseDraw a good nurse
Introduction

• What is in your minds 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

7
Review what the drawings show... Characteristics
we expect of a nurse?
Introduction

• Trustworthy Commitment
• Communicates Listens
• Knowledgeable Prepared
• Smiles Professional
• Other...

8
Briefly discuss how each group selected their
Leader
Introduction
9
Introduction

• Nurses leaders need
• Time management
• Communication
• Students need
• Adjust to student life
• Know self as a person (chapter 2)

10
Time is Finite
Time Management

• 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

11
Time is Money
Time Management

• Missed deadlines money
• If time mgmt improved 10 for 7 people
• 1 Mrg _at_ 34/hr would save 7,072/yr
• 4 RNs _at_ 22/hr would save 18,304/yr
• 2 LVN _at_ 16/hr would save 6,656/yr
• Total savings 32,032/yr
• You could hire another LVN!

12
3 Principles
Time Management
4 Personal Steps

• Allow time to plan
• Prioritize
• Re-prioritize based on new info

• Assert control over own time
• Plan
• Handle paperwork efficiently
• Identify common time wasters

13
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

14
Step 2. Planning Prioritizing
Time Management

• Time lines for long range planning
• Make To do lists
• part of daily plan
• report sheet

15
Step 2. Planning Prioritizing
Time Management

• Determine priorities or which tasks are
• critical
• important
• time related
• What skills are needed for each task

16
Step 3. Paper or computer-work
Time Management

• 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!

17
Step 4. Identify Time Wasters
Time Management

• 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)

18
Step 4. Identify Time Wasters
Time Management

• Poor communication
• straight forward without offending
• aware of people who drain energy
• learn to negotiate
• Lack information about duty/role
• Procrastination
• just change the behavior, dont try to explain it
  away

19
Book page 278
Time Management

• 26 questions to answer for self
• Add your scores as per page 281
• Total scores on page 282 will let you know areas
  to work on

20
Journal Assignment - Part III of Journal 1
Time Management

• Log of everything you do for 2 days
• Record how you felt (emotionally) for each
  activity
• At the end of 2 days, review what you wrote in
  their log
• Evaluate your use of time based on what was
  discussed in class
• Email to your instructor with your real thoughts
  on this exercise

21
Communication
22
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

23
Communication Model

• Sender Message Receiver
• Encode
• Putting the senders intended message into words,
  gestures, expressions, cultures effects....
• Variables and barriers can effect (more later)
• Decode
• Meaning dependent on receivers interpretations,
  perceptions, and values
• Variables and barriers can effect (more later)

24
Variables and Barriers
Communication

• 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

25
Social / Psychological Barriers
Communication

• Personal bias
• Past experiences
• Culture
• Spiritual values
• Gender
• Stereotyped responses

• Control issues
• Rules, regulations...
• Too many demands (overload!)
• Too many messages
• Expressed disapproval

26
Social / Psychological Barriers
Communication

• Nonverbal 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

27
Clinical Communication

• Distances
• Intimate 18 inches
• Personal up to 4 ft
• Social up to 12 ft
• Public 12 ft
• Dress
• Traditional nurse
• Cute little girl
• I dont care
• Sexy
• Career nurse

Who would your grandma, mom, dad want for a
nurse?
28
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

29
Clinical Communication

• With Patients
• Avoid frivolous conversation.
• Avoid joking.
• Show respect.
• Be honest in relationships.

30
Clinical Communication

• With Patients
• Ask questions.
• Restate.
• Clarify phrases.
• Have a clear purpose.
• Ensure confidentiality.

31
Clinical Communication

• You need empathy and sympathy
• Empathy includes an intellectual understanding of
  the experience.
• Sympathy includes an emotional component of the
  experience.

32
Clinical Communication

• Special Situations
• Non-English speaking
• Hearing impaired
• Vision impaired
• Speech impaired
• Remember Communication Process
• (next slide)

33
Communication Process
34
Informal Communication The Grapevine
Communication

• 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

35
To be effective...
Communication

• 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

36
Communication
To be effective...

• 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

37
Effective Communication
Communication

• Page 61 -62
• Take test

38
Communication Exercise

• 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?

39
Communication 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

40
Think About It pg 43
Communication Exercise

• 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 doesnt 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?

41
Think About It
Communication Exercise

• 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.

42
Think About It pg 63
Communication

• As you enter Mr. Callahans 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?

43
Think About It discussion
Communication

• Using the critical thinking skills in Box 1-2...
• Suggestions to distinguish between fact and
  fallacy.
• The factsclutching his side, grimace on his
  face, flushed skindo 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?

44
Think About It page 74
Communication

• 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?

45
Think About It discussion
Communication

• 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.

46
Maslows Hierarchy of Needs (work)
Self Actualization Challenging role
Self Esteem Position / Recognition
Social, Love, and Belonging Team work / Trust
co-workers
Security and Safety Needs Job security /
Competency
Physiological or Basic Needs Safe Environment /
Climate control / Base Wage
47
Student as a Person

• Your Physical Health
• Diet
• Rest and exercise
• Personal hygiene
• Smoking
• Chemical dependence
• Personal illness

48
Student as a Person

• Your Emotional Health
• Understanding yourself
• Personality
• Personal values and beliefs
• Prejudice
• Stress see page 49 for another exercise

49
Student as a Person

• Your Career
• Continuing education
• Career plans
• Future .... More in later classes
• Thank you for substituting!