Patient Care Management and Critical Thinking

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  • Patient Care Management and Critical Thinking

    1. 1. Patient Care Management & Critical Thinking Justina Aguirre, RN, MSN 351-3550 direct work line 351-3286 alternate work line 344-5005 home aguirres@adelphia.net IntroductionIntroductionIntroductionIntroduction
    2. 2. 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 IntroductionIntroductionIntroductionIntroduction
    3. 3. Review Course Syllabus: • Journals • Class participation & readiness • Reading assignments • Internet assignments • Group assignments IntroductionIntroductionIntroductionIntroduction
    4. 4. Part I • Send an email with the information requested to the instructor at aguirres@adelphia.net. 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/E . 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 IntroductionIntroductionIntroductionIntroduction Journal Assignment - Part I & IIPart I & II Journal 1Journal 1
    5. 5. 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 IntroductionIntroductionIntroductionIntroduction
    6. 6. Small group exercise Draw 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 IntroductionIntroductionIntroductionIntroduction
    7. 7. Review what the drawings show... Characteristics we expect of a nurse? • Trustworthy & Commitment • Communicates & Listens • Knowledgeable & Prepared • Smiles & Professional • Other... IntroductionIntroductionIntroductionIntroduction
    8. 8. Briefly discuss: how each group selected their ‘Leader’ IntroductionIntroductionIntroductionIntroduction
    9. 9. Nurses & leaders need – Time management – Communication Students need – Adjust to student life – Know self as a person (chapter 2) IntroductionIntroductionIntroductionIntroduction
    10. 10. Time 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 ManagementTime ManagementTime ManagementTime Management
    11. 11. Time 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! Time ManagementTime ManagementTime ManagementTime Management
    12. 12. 3 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 Personal4 Personal StepsSteps Time ManagementTime ManagementTime ManagementTime Management
    13. 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. 14. Step 2. Planning & Prioritizing • Time lines – for long range planning • Make “To do” lists – part of daily plan – report sheet Time ManagementTime ManagementTime ManagementTime Management
    15. 15. Step 2. Planning & Prioritizing • Determine priorities or which tasks are: – critical – important – time related • What skills are needed for each task Time ManagementTime ManagementTime ManagementTime Management
    16. 16. 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! Time ManagementTime ManagementTime ManagementTime Management
    17. 17. Step 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) Time ManagementTime ManagementTime ManagementTime Management
    18. 18. Step 4. Identify Time Wasters • Poor communicationPoor communication – ““straight forward” without offendingstraight forward” without offending – aware of people who drain energyaware of people who drain energy – learn to negotiatelearn to negotiate • Lack information aboutLack information about duty/roleduty/role • ProcrastinationProcrastination – Time ManagementTime ManagementTime ManagementTime Management
    19. 19. Book – page 278 • 26 questions to answer for self26 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 workTotal scores on page 282 will let you know areas to work onon Time ManagementTime ManagementTime ManagementTime Management
    20. 20. Journal Assignment - Part III ofPart III of Journal 1Journal 1 • Log of everything you do forLog of everything you do for 22 daysdays • Record how you felt (emotionally) for each activityRecord how you felt (emotionally) for each activity • At the end ofAt the end of 22 days, review what you wrote in their logdays, review what you wrote in their log • Evaluate your use of time based on what was discussed inEvaluate your use of time based on what was discussed in classclass • Email to your instructor with your real thoughts on thisEmail to your instructor with your real thoughts on this exerciseexercise Time ManagementTime ManagementTime ManagementTime Management
    21. 21. CommunicationCommunicationCommunicationCommunication
    22. 22. 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 CommunicationCommunicationCommunicationCommunication
    23. 23. 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
    24. 24. Variables 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 CommunicationCommunicationCommunicationCommunication
    25. 25. Social / 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 CommunicationCommunicationCommunicationCommunication
    26. 26. Social / Psychological Barriers 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 CommunicationCommunicationCommunicationCommunication
    27. 27. 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? ClinicalClinical CommunicationCommunication ClinicalClinical CommunicationCommunication
    28. 28. •listening –actively vs passively •written –no white out –requires reading with meaning •verbal –face to face –formal and informal –rounds and patient conferences ClinicalClinical CommunicationCommunication ClinicalClinical CommunicationCommunication
    29. 29. With Patients • Avoid frivolous conversation. • Avoid joking. • Show respect. • Be honest in relationships. ClinicalClinical CommunicationCommunication ClinicalClinical CommunicationCommunication
    30. 30. With Patients – Ask questions. – Restate. – Clarify phrases. – Have a clear purpose. – Ensure confidentiality. ClinicalClinical CommunicationCommunication ClinicalClinical CommunicationCommunication
    31. 31. •You need empathy and sympathy •Empathy includes an intellectual understanding of the experience. •Sympathy includes an emotional component of the experience. ClinicalClinical CommunicationCommunication ClinicalClinical CommunicationCommunication
    32. 32. Special Situations •Non-English speaking •Hearing impaired •Vision impaired •Speech impaired Remember Communication Process (next slide) ClinicalClinical CommunicationCommunication ClinicalClinical CommunicationCommunication
    33. 33. CommunicationCommunication ProcessProcess CommunicationCommunication ProcessProcess
    34. 34. 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 CommunicationCommunicationCommunicationCommunication
    35. 35. 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 CommunicationCommunicationCommunicationCommunication
    36. 36. •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 CommunicationCommunicationCommunicationCommunication To be effective...
    37. 37. Effective Communication • Page 61 -62 • Take test CommunicationCommunicationCommunicationCommunication
    38. 38. 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?” CommunicationCommunication ExerciseExercise CommunicationCommunication ExerciseExercise
    39. 39. 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 CommunicationCommunication ExerciseExercise CommunicationCommunication ExerciseExercise
    40. 40. Think 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? CommunicationCommunication ExerciseExercise CommunicationCommunication ExerciseExercise
    41. 41. 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. CommunicationCommunication ExerciseExercise CommunicationCommunication ExerciseExercise
    42. 42. Think 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? CommunicationCommunicationCommunicationCommunication
    43. 43. • 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 CommunicationCommunicationCommunicationCommunication
    44. 44. Think 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? CommunicationCommunicationCommunicationCommunication
    45. 45. • 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 CommunicationCommunicationCommunicationCommunication
    46. 46. Maslow’s Hierarchy of Needs (work) Physiological or Basic Needs Safe Environment / Climate control / Base Wage Security and Safety Needs Job security / Competency Social, Love, and Belonging Team work / Trust co-workers Self Esteem Position / Recognition Self Actualization Challenging role
    47. 47. Your Physical Health •Diet •Rest and exercise •Personal hygiene •Smoking •Chemical dependence •Personal illness Student as a Person
    48. 48. Your Emotional Health – Understanding yourself – Personality – Personal values and beliefs – Prejudice – Stress – see page 49 for another exercise Student as a Person
    49. 49. Your Career •Continuing education •Career plans •Future .... More in later classes •Thank you for substituting! Student as a Person

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