Transcript of Define the term communication Explain why communication is an important concept in health care ...
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- Define the term communication Explain why communication is an
important concept in health care Describe what is meant by the
communication process Discuss four factors that affect
communication List five examples of therapeutic communication
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- List five examples of blocks to communications Explain why
multicultural health care is important List three components of a
cultural sensitivity assessment List two questions that would
elicit information about the clients spiritual issues.
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- Demonstrate the steps for beginning client interaction. Explain
why it is therapeutic to encourage the client to express feelings
and thoughts. Describe the phases of the health care
provider-patient relationship List three components for maintaining
a health care provider-patient relationship
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- Describe the rationale for discussing termination at the
beginning of the relationship
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- Communication is the process of sending and receiving messages
by means of symbols, words, signs, gestures, or other actions.
Messages sent and received define the relationship between people.
It is a vital element in health care and includes both verbal and
non-verbal expresions.
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- A person cannot not communicate. People have an inherent need
to communicate, whether it is verbal or non-verbal. Even silence is
a form of communication. There is a content, or informational value
to messages sent and received that explains what the message is
about and expresses how the sender regards the receiver.
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- The message sent is not necessarily the meaning received.
Messages contain overt and covert meanings. Communication becomes
dysfunctional when a person does not assume responsibility for his
or her communication. Dysfunctional communications results from
failing to learn to communicate properly and leaving the
responsibility for communicating to others.
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- Accept the patient as a valued and worthwhile individual, for
this acceptance is a prerequisite for a health care
provider-patient relationship. Be aware of the total patient, not
just his or her physical needs. The clients social, emotional, and
spiritual needs are also important.
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- Understand your own needs, feelings, and reactions so that they
do not interfere with the therapeutic process with the client Be
prepared to feel some degree of emotional involvement with your
patient, evidencing caring and concern for his her welfare. At same
time, however, it is necessary to remain objective.
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- Remember that the health care provider- patient interaction is
a professional one. As such you as the health care provider possess
the skills, abilities, and resources to relive the other persons
pain and discomfort and your patient seeks comfort and assistance
for alleviation of some existing problem.
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- A heath care provider-patient relationship does not require a
long term agreement or formal meetings between health care provider
and patient to be effective. Take an active role and guide the
conversation if the client is overly hesitant. Give broad opening
statements and ask open ended questions to help the patients
describe what is happening to him or her.
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- Use body language to convey empathy, interest, and
encouragement to facilitate communication. Use silence as a
therapeutic tools, as it allows the patient to pace and direct his
or her own communications. Long periods of silence, however, may
increase the patients anxiety level, so use this technique
wisely.
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- Therapeutic communication techniques assist the flow of
communication and always focus on the client.
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- Acknowledge the client without inserting your own values or
judgments. Acknowledgment may be simple and with or without
understanding, verbal or non-verbal.
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- Clarifying the patients message. Check out or make clear either
the intent or hidden meaning of what the message, or determine if
the message sent was the message received.
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- Using feedback to relay to the patient the effect of his or her
words. This method helps keep the client on course or alters the
course. It involves acknowledging, validating, clarifying,
extending, and altering.
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- Focusing or refocusing on the patients statement. Pick up on
central topics or cues given by the patient.
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- Encourage the client to continue.
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- Consciously receiving the patients message.
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- Keeping your own verbalization minimal and letting the client
lead the conversation.
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- Creating harmony of verbal and non- verbal messages.
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- Using body language to communicate interest, attention,
understanding, support, caring, and listening to promote data
gathering.
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- Asking questions that cannot be answered with a simple yes or
no or maybe/ Generally ask questions requiring an answer of several
words to broaden conversational opportunities and to help the
client communicate.
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- Identifying and sending back a message acknowledging the
feeling or repeating the last few words the patient said.
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- Repeating the patients statement as encouragement for him or
her to continue.
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- Verifying the accuracy of the senders message.
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- Introducing new topics inappropriately, a pattern that may
indicate anxiety.
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- Using clichs, cherry words, and advice, and comforting
statements in an attempt to reassure the patient. Most of what is
called reassurance is really false reassurance.
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- Telling the client what to do. Giving your opinion or making
decisions for the patient implies that he or she cannot handle his
or her own life decisions and that you are accepting responsibility
for him or her.
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- Sending verbal and nonverbal messages that contradict one
another; two or more messages, sent via different levels, seriously
contradicting one another. The contradiction may be between the
verbal/nonverbal content or time/space content.
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- Making an assumption about the meaning of someone elses
behavior that is not validated by the other person.
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- Ignoring or denying another persons presence, thoughts or
feelings.
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- Talking rapidly, changing subjects, and giving more information
than can be absorbed at one time.
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- Responding in a way that focuses attention on the nurse instead
of the patient.
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- Giving ones own opinion, moralizing or implying ones own values
by using words such as nice, good, bad, right, wrong, should, and
ought.
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- As we move into the 21 st Century thee are demographics shifts
occurring that will change the direction of health care.
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- 70.4%Caucasian 11.8%African American 0.7% American Indian or
Alaskan native 3.8% Asian 0.1% Pacific Islander or native Hawaiian
10.5% Other race 37.6% Hispanic or Latino
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- 72.4%Caucasian 12.6%African American 0.9% American Indian or
Alaskan native 4.8% Asian 0.2% Pacific Islander or native Hawaiian
6.2% Other race 16.3% Hispanic or Latino
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- Because of the change in the US, and more specific Texas
population demographics, there are emerging barriers to health
care. The greatest barrier is language. Approximately 20% of the US
population cannot speak English at all. It is estimated that over
half a million people in the state of Texas do not speak
English.
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- Living in urban, poor neighborhoods Poor health care prevention
Poverty Beliefs that affect how certain cultural groups understand
illness and respond to treatment Reduced access to health care
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- As more and more people are migrating to the US, health care
providers will be faced with cultural diversity problems in
administering health care. Cultural Diversity implies the range of
differences in values, beliefs, customs, folklore, traditions,
language, and patterns of behavior for the various culture
groups.
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- The health provider needs to be aware that personal space is
related to culture, gender, and group behavior. Because all of
these aspects potentially affect how an individual experiences,
copes with, and responds to illness, health care providers must be
aware of these cultural differences.
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- Health care providers must become sensitive to people from
cultures other than their own. People from different cultures may
have different beliefs and values about illness and treatment, and
different health practices and patterns of behavior. In order to
treat the patient holistically, the health care provider should be
aware of these differences and be able to incorporate them into the
patients plan of care.
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- When completing a total assessment on a client, the individual
cultural components that would be important to include are:
Cultural background and orientation Communication patterns (based
on culture) Nutritional practices
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- Family relationships Beliefs and perceptions relating to
health, illness, and treatment modalities. Values relating to
health practices Education Issues affecting the delivery of health
care.
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- This need not be invasive or intrusive. The purpose of such an
assessment is to open the channels of communication so that the
patient will feel comfortable in discussing spiritual issues. If
the patient does not experience an opening from the nurse, he or
she may conclude that the health care provider does not wish to
discuss spirituality.
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- Health care providers are given the unique opportunity to share
part of who they are with others who have asked directly or
indirectly for assistance. It is within this interpersonal
relationship that the patient care relationship begins to develop
and take on its individual characteristics.
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- Both individuals bring into the relationship their thoughts,
feelings, sense of self or self- worth, behavior patterns,
abilities to adapt and cope, belief systems, and points of view
about life and how they interact with it. Characteristics of the
relationship include acceptance, honesty, understanding, and
empathy of the nurse towards the patient who is willing or
unwillingly seeking help.
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- The goal of relationship therapy is to assist the patient to
identify and meet his or her own needs. The health care provider
may assist the patient in reaching the goals by demonstrating
acceptance so that the client may experience the feeling of being
accepted as an individual; by developing mutual trust through
consistent, congruent nursing behaviors; by providing corrective
emotional experiences to increase self- esteem; and finally by
creating a safe, supportive environment.
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- Principles underlying a helping relationship include: Awareness
of the total client, including emotional and physical needs,
cultural and spiritual needs. Some degree of emotional involvement
while maintaining objectivity. The setting of appropriate limits
and consistency in behavior while caring for the client.
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- Open, honest, clear communication Encouragement of the
expression of feelings Focus on the here and now
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- There are three phases in a traditional health care
provider-patient relationship. 1. Initiation or Orientation phase
2. Continuation or Active Working phase 3. Termination Phase
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- In this phase, you introduce yourself to the client and
establish boundaries of the relationship. Identify problems,
expectations, and relevant issues that need to be addressed during
the relationship. Identify any impairments such as hearing,
speaking, developmental, or psychological that must be taken into
account so that adjustments in the relationship may be made.
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- This is the phase in which you would develop a working
relationship, and in conjunction with meeting the patients needs,
begin resolving the patients problems.
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- At this final phase, when the patient is soon to be discharged;
you would follow the plan that you began when the patient was
admitted, that includes anticipating any problems or concerns the
patient may have when they go home; complete discharge planning and
teaching; deal with the patients fears about being on their own
after leaving the hospital or clinic.
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- Obtain the patient assignment. Read the chart and review the
patients chief complaint, past medical history, and history of
present illness. Clarify any questions about patient assignment
Proceed to patients room and check room number Introduce yourself
to the patient.
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- Rationale: Blind clients become anxious when they hear someone
enter the room who does not speak. If the patient is blind,
introduce yourself as you come into the room: tell exactly what you
are doing and when you are leaving. Rationale: Blind clients become
anxious when they hear someone enter the room who does not speak.
Begin to establish a health care provider-patient relationship
using clear, open communication.
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- State your purpose. Following introduction, relate purpose of
interaction. State your purpose. Tell the patient specifically what
you will be doing in terms of his or her care. Ask if the patient
understands or has any questions. Encourage the patient to describe
how he or she is feeling at the time. Encourage the patient to
participate in his or her care-both verbally and non-verbally.
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- Rationale: Often, your best information is drawn from
observation. Pay attention to communication as well as the
procedure you are administering. Rationale: Often, your best
information is drawn from observation. Assess non-verbal behavior
and determine if it fits with verbal communication, especially when
you are evaluating pain level. Complete communication by asking
patient for feedback.
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- Complete interaction by telling patient when you will return,
and what you will be doing in relation to their care. Follow
through on agreed upon meeting time to build patient trust.
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- Rationale: A complete history will detail cultural diversity
patterns; a. Ethnic heritage and language; b. Family orientation
and role of members; c. Dietary practices and knowledge about
nutrition; d. Education, formal and informal; e. Health care
practices and beliefs. Review patient medical history related to
cultural orientation to determine if adequate information
pertaining to cultural preferences is included. Rationale: A
complete history will detail cultural diversity patterns; a. Ethnic
heritage and language; b. Family orientation and role of members;
c. Dietary practices and knowledge about nutrition; d. Education,
formal and informal; e. Health care practices and beliefs.
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- Determine patients perception of illness based on cultural
beliefs Rationale: When the patients cultural background is
different from the health care providers, communication problems
may occur. Validate verbal and non-verbal communication from
patient based on cultural understanding. Rationale: When the
patients cultural background is different from the health care
providers, communication problems may occur.
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- Rationale: An interpreter will facilitate communication and
reduce stress on the patient. Consider using an interpreter if
communication seems unclear. Rationale: An interpreter will
facilitate communication and reduce stress on the patient.
Rationale: Health care should be congruent with the patients
expectations or a positive outcome of treatment can be in jeopardy.
Examine expectations of health care based on the patients cultural
influences. Rationale: Health care should be congruent with the
patients expectations or a positive outcome of treatment can be in
jeopardy.
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- Rationale: If the health care provider never opens this
subject, the patient will not feel free to discuss spiritual
issues. Ask the patient relevant questions concerning spiritual
issues. Rationale: If the health care provider never opens this
subject, the patient will not feel free to discuss spiritual
issues. Rationale: This approach will open communication and notify
the client that you are willing to discuss these issues. Are there
any spiritual issues that you would like to discuss? If so, lets
arrange a time to talk about these issues. Rationale: This approach
will open communication and notify the client that you are willing
to discuss these issues.
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- Encourage the patient to describe his or her perceptions and
feelings. Focus on communication as well as body reactions.
Rationale: The less you, the more you encourage spontaneity and
verbalization from the patient. DO NOT dominate the conversation.
Rationale: The less you, the more you encourage spontaneity and
verbalization from the patient.
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- Assist the patient to clarify feelings. Rationale: Making value
judgments, even non-verbal ones, negatively affects the health care
provider-patient relationship. Maintain an accepting,
non-judgmental attitude. Rationale: Making value judgments, even
non-verbal ones, negatively affects the health care
provider-patient relationship. Rationale: This open approach
enables the patient to describe what is happening. Give broad
opening statements, and ask open-ended questions. Rationale: This
open approach enables the patient to describe what is
happening.
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- Focus on feelings rather than superficial topics during
interactions. Assist patient to identify thoughts and feelings.
Pick up on verbal cues, leads, and signals from the patient.
Rationale: Being aware of your own feelings and attitudes and
separating them from the patients contributes to acceptance. Convey
attitude of acceptance and empathy toward the patient. Rationale:
Being aware of your own feelings and attitudes and separating them
from the patients contributes to acceptance.
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- Note what is said as well as what is not said. Assist the
patient to become aware of differences between behavior, feelings,
and thoughts. Give honest, non-judgmental feedback to the
patient.
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- Rationale: Sitting down at the patients bedside or not acting
as if you are in a hurry encourages communication. Use body
language as well as verbal communication to convey empathy.
Rationale: Sitting down at the patients bedside or not acting as if
you are in a hurry encourages communication. Respect the patients
need for emotional privacy, but be available to the patient.
Encourage the patient to apply the problem solving approach to
different situations.
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- Be non-judgmental. Mutually identify goals to meet the patients
individual needs. Keep all agreements with the patient. Become the
patients advocate. Give patient positive feedback when
appropriate.
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- Assess the patients symptoms and problems, and communicate a
willingness to help alleviate these discomforts. Rationale: Open,
honest, congruent communication and consistent behavior help lay
the groundwork for trust in a relationship. Establish a beginning
relationship. Rationale: Open, honest, congruent communication and
consistent behavior help lay the groundwork for trust in a
relationship.
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- Rationale: Goals mutually set and agreed on are more easily
accepted by both parties in the relationship. Establish mutual
goals as a basis for the relationship. Rationale: Goals mutually
set and agreed on are more easily accepted by both parties in the
relationship. Rationale: The MOST IMPORTANT element is the
beginning of trust. Without trust the health care provider-patient
relationship is ineffective. Be consistent in your behavior; do
what you say you will do, and only make promises that you are
willing to keep. Rationale: The MOST IMPORTANT element is the
beginning of trust. Without trust the health care provider-patient
relationship is ineffective.
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- Rationale: This focus enhances compliance to treatment.
Encourage the patients participation in his or her care. Rationale:
This focus enhances compliance to treatment. Rationale: The patient
may interpret a cool, aloof manner as a lack of interest. Approach
the patient in a warm, accepting manner. Rationale: The patient may
interpret a cool, aloof manner as a lack of interest.
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- Assume the role of facilitator in the relationship. Rationale:
Basic acceptance is a fundamental prerequisite of a relationship.
Accept the patient ass having value and worth as an individual.
Rationale: Basic acceptance is a fundamental prerequisite of a
relationship. Provide a safe environment conducive to patients
willingness to share.
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- Rationale: Responding on a professional rather than a social
level defines the relationship. Maintain the relationship on a
professional level. Rationale: Responding on a professional rather
than a social level defines the relationship. Rationale: Discussion
of past or future experiences does not contribute to a change in
behavior now. Keep interaction reality oriented, that is, in the
here and now. Rationale: Discussion of past or future experiences
does not contribute to a change in behavior now.
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- Listen actively, that is, responding to the patients cues. Use
non-verbal communication to support and encourage patient.
Recognize meaning and purpose of nonverbal communication,
especially in assessing pain. Keep verbal and nonverbal
communication congruent.
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- Focus on content and direction of conversation on patients
cues, not on social or superficial topics. Interact on patients
intellectual, developmental, and emotional level. Rationale: Asking
why places the patient on the defensive because it requires
justification of behavior. Focus on how, what, when, where, and who
rather than why. Rationale: Asking why places the patient on the
defensive because it requires justification of behavior.
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- Teach patient problem solving to correct maladaptive patterns.
Assist patient to identify, express, and cope with feelings. Help
patient develop alternative coping mechanisms that are more
adaptive. Recognize a high level of anxiety, and assist patient to
deal with it.
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- Rationale: This approach promotes the patients independence and
increases his or her sense of self-esteem. Work closely with the
patient in discharge planning and in planning the termination of
the relationship from its beginning. Rationale: This approach
promotes the patients independence and increases his or her sense
of self-esteem. Rationale: Saying goodbye is often uncomfortable
and difficult for both the patient and the health care provider.
Anticipate problems of termination and plan for their resolution.
Rationale: Saying goodbye is often uncomfortable and difficult for
both the patient and the health care provider.
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- Rationale: Allowing this behavior to be expressed helps the
patient to work through it. Be aware that the patients behavior may
reflect fear that he or she cant cope at home, overdependence,
depression and withdrawal. Rationale: Allowing this behavior to be
expressed helps the patient to work through it. Do not terminate
the relationship too abruptly or allow it to persist beyond the
patients needs.
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- Rationale: This enables the patient to move on. Complete a
satisfactory termination of the relationship. Rationale: This
enables the patient to move on.
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- Primary goals of health care provider- patient relationship and
identified patient needs. Ongoing process of relationship therapy,
including patients expressed feelings, thoughts, and so forth.
Patients behavior and changes in behavior, both positive and
negative. Cues to other team members on how best to relate to this
particular patient. Elements of discharge planning.
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- A 25-year old male comes to the emergency department. He has a
bleeding wound on his arm and he refuses surgical intervention when
told he must remove his clothes and jewelry.
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- 1. What effect would this patient response have on the initial
health care provider plan of care? 2. What is your understanding of
this patient response? What are some questions you might ask the
patient? 3. Describe the strategies and goals you would devise to
solve this problem. 4. Describe the measures you would implement to
resolve this situation.
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- A client has just been admitted with a diagnosis of rectal
cancer. He is scheduled for surgery the next day. When you are
completing an assessment and you ask about spiritual beliefs, the
patient says, Im a washed out Catholic and I dont think Im going to
live, so whats the sense in talking about it?
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- What would be the consequence of not responding to the patients
comments about spiritual beliefs? How would the goals of
establishing a health care provider-patient relationship and
assessing spiritual beliefs overlap in this situation? Describe the
actions you would take to engage this patient in a discussion about
these issues.