1. Understanding the Resident
Chapter 6
Understanding the Resident
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2. Caring for the Person
For effective care, you must consider the whole person.
The whole person has physical, social, psychological, and spiritual parts.
These parts are woven together and cannot be separated.
Each part relates to and depends on the others.
Disability and illness affect the whole person.
The resident is the most important person in the center. Age, religion, and nationality make each person unique. So do culture, education, occupation, and life-style.
Each person is important and special. Each has value.
Each person has fears, needs, and rights. Each has suffered losses.
The person is treated as someone who thinks, acts, feels, and makes decisions.
Holism is a concept that considers the whole person (see Fig. 6-1 on p. 79).
The health team plans care to help the resident deal with all problems, not just physical ones.
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3. Address the Resident Properly
Addressing the person
Call residents by their titles.
Do not call residents by their first names unless they ask you to.
Do not call residents by any other name unless they ask you to.
Do not call residents Grandma, Papa, Sweetheart, Honey, or other names.
Addressing the person properly shows respect. It is a basic right of residents to be addressed properly.
Referring to a person as a room number strips the person of his or her identity.
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4. Basic Needs According to Abraham Maslow: 4
Basic needs must be met for a person to survive and function.
The needs are arranged in order of importance.
Lower-level needs must be met before higher-level needs.
A need is something necessary or desired for maintaining life and mental well-being.
See Figure 6-2 on p. 79, basic needs for life as described by Maslow.
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5. Maslow’s Basic Needs for Life
Basic needs, from the lowest level to the highest level, are:
Physiological or physical needs
Safety and security needs
Love and belonging needs
Self-esteem needs
The need for self-actualization
People normally meet their own needs.
When people cannot meet their own needs, it is usually because of disease, illness, injury, or advanced age.
Oxygen, food, water, elimination, rest, and shelter are needed for life.
Safety and security needs relate to feeling safe from harm, danger, and fear.
Love and belonging needs relate to closeness, affection, love, and meaningful relationships with others.
Esteem is the worth, value, or opinion one has of a person. Self-esteem means to think well of oneself and to see oneself as useful and having value.
Self-actualization means experiencing one’s potential. It involve learning, understanding, and creating to the limit of a person’s capacity.
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6. Culture and Religion
Culture is the characteristics of a group of people passed from one generation to the next.
The person’s culture:
Influences health beliefs and practices
Affects behavior during illness and when in a nursing center
People come from many cultures, races, and nationalities. Their family practices and food choices may differ from yours. So might their hygiene habits and clothing styles.
Some cultures have beliefs about what causes and cures illness.
In the textbook, review Caring About Culture: Health Care Beliefs and Caring About Culture: Sick Care Practices on p. 80.
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7. Religion Religion relates to spiritual beliefs, needs, and practices.
A person’s religion influences health and illness practices.
Many people find comfort and strength from religion during illness.
The nursing process reflects the person’s culture and religion.
Do not judge the person by your standards.
A person may want to see a spiritual leader or advisor. Report this to the nurse. Then make sure the room is neat and orderly. Provide privacy during the visit.
You will meet people from other cultures and religions. You must respect and accept the person’s culture and religion.
Learn about their beliefs and practices. This helps you understand the person and give better care. Tables 6-1 and 6-2 on p. 81 list some of the organized religious denominations in the United States.
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8. Effects of Illness and Disability
Sickness and injury have physical, psychological, and social effects.
Anger is a common response to illness and disability.
To help the person feel safe, secure, and loved:
Take an extra minute to “visit,” hold a hand, or give a hug.
Show that you are willing to help with personal needs.
Respond promptly.
Treat each person with respect and dignity.
A disability is any lost, absent, or impaired physical or mental function. It may be temporary or permanent.
Some people feel alone and isolated after outliving family and friends. Those who are disabled or have chronic illnesses may have many fears and concerns about nursing centers. They may feel lonely and abandoned by family and friends. They may fear depending on strangers. Many fear increasing loss of function.
Sick people fear death, disability, chronic illness, and loss of function.
You might have problems dealing with the person’s anger. If so, ask the nurse for help.
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9. Highest Potential Optimal level of function 9
Residents are helped to maintain their optimal level of function.
Encourage the person to be as independent as possible.
Always focus on the person’s abilities.
The optimal level of function is the person’s highest potential for mental and physical performance.
Hospital patients are often treated as sick, dependent people. Promoting this “sick role” in a nursing center reduces quality of life.
The health team focuses on improving the person’s quality of life. You must help each person regain or maintain as much physical and mental function as possible.
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10. Nursing Center Residents
Alert, oriented residents
Confused and disoriented residents
Complete care residents
Short-term residents
Life-long residents
Mentally ill residents
Terminally ill residents
Alert and oriented residents know who they are and where they are. They may have problems adjusting to a nursing center. The care plan includes measures to help the person accept the nursing center as home (Fig 6-4 on p. 82).
Many residents are mildly to severely confused and disoriented. Sometimes confusion and disorientation are temporary. Sometimes confusion and disorientation are permanent and become worse.
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11. Behavior Issues
People who do not adjust well have some of the following behaviors:
Anger
Demanding behavior
Self-centered behavior
Aggressive behavior
Withdrawal
Inappropriate sexual behavior
A person’s behavior may be unpleasant.
You cannot avoid the person or lose control.
Good communication is needed.
Follow the care plan.
Anger is communicated verbally and nonverbally.
Residents with demanding behavior seem to never be pleased and can be critical of others.
With self-centered behavior, the person cares only about his or her own needs. The needs of others are ignored.
Aggressive behavior can include swearing, biting, hitting, pinching, scratching, or kicking. Protect the person, others and yourself from harm (see Chapter 10).
Withdrawal is when the person has little or no contact with family, friends, and staff, preferring to spend time alone and not taking part in social or group events.
Inappropriate sexual behavior can include inappropriate sexual remarks as well as touching others the wrong way or disrobing or masturbating in public.
Review Box 6-1 on p. 84 in the textbook.
See Teamwork and Time Management: Behavior Issues, p. 84.
See Focus on Communication: Behavior Issues, p. 84.
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12. For Effective Communication
Use words that have the same meaning for you and the person.
Avoid medical terms and words not familiar to the person.
Communicate in a logical and orderly manner.
Give facts and be specific.
Be brief and concise.
Understand and respect the resident as a person.
View the person as a physical, psychological, social, and spiritual human being.
You communicate with residents every time you give care.
The person and the family are aware of what you say and what you do.
Good work ethics and understanding the person are needed for good communication.
Review Residents with Dementia: Effective Communication on p. 85.
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13. For Effective Communication (Cont’d)
Appreciate the person’s problems and frustrations.
Respect the person’s rights.
Respect the person’s religion and culture.
Give the person time to process the information that you give.
Repeat information as often as needed.
Ask questions to see if the person understood you.
Be patient.
Include the person in conversations when others are present.
When repeating information, repeat exactly what the person said. Use the exact same words. If the person does not seem to understand, try re-phrasing the message.
People with memory problems may ask the same question many times. Accept the memory loss as a disability.
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14. Verbal Communication 14 Follow these rules for spoken communication:
Face the person.
Position yourself at the person’s eye level.
Control the volume and tone of your voice.
Speak clearly, slowly, and distinctly.
Do not use slang or vulgar words.
Repeat information as needed.
Ask one question at a time.
Do not shout, whisper, or mumble.
Be kind, courteous, and friendly.
The written word is used when the person cannot speak or hear but can read.
Words are used in verbal communication, which may be spoken or written.
Written words are used when the person cannot speak or hear but can read. Devices shown in Figure 6-5 on pp are often used. The person may also have poor vision.
When writing messages, keep them brief and concise, use a black felt pen on white paper, and print in large letters.
For persons who cannot speak or read, ask questions that have yes or no answers. Follow the care plan. A picture board may be helpful (Fig. 6-6 on p. 86).
Persons who are deaf may use sign language (Fig. 6-7 on p. 86; see Chapter 32).
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15. Nonverbal Communication
Messages are sent with gestures, facial expressions, posture, body movements, touch, and smell.
Touch means different things to different people.
People send messages through their body language:
Facial expressions and eye contact
Posture and gait
Gestures, hand and body movements
Appearance (dress, hygiene, and so on)
Nonverbal messages more accurately reflect a person’s feelings than do words.
Touch can convey caring, love, affection, and reassurance, but the meaning can differ based on age, gender, experience, and culture. See Caring about Culture: Touch Practices on p. 87.
Your actions, movements, and facial expressions send messages. See Caring About Culture: Facial Expressions, on p. 87.
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16. Communication Methods
Listening means to focus on verbal and nonverbal communication.
Paraphrasing is restating the person’s message in your own words.
Direct questions focus on certain information.
Open-ended questions invite the person to share thoughts, feelings, or ideas.
Clarifying lets you make sure you understand the message.
Certain methods help you communicate with others and result in better relationships.
See Caring About Culture: Eye Contact Practices on p. 88.
Paraphrasing shows you are listening and lets the person see if you understand the message.
Open-ended questions allow the person to choose what to talk about, the topic. The information given and answers require more than a yes or no response.
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17. Communication Methods (Cont’d)
Focusing is dealing with a certain topic.
Silence is a very powerful way to communicate.
Focusing is useful when a person rambles or wanders in thought.
Silence is useful when making decisions. It is also helpful when the person is upset and needs to gain control.
See Caring About Culture: The Meaning of Silence on p. 89.
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18. Communication Barriers
Communication barriers include:
Using unfamiliar language
Cultural differences
Changing the subject
Giving your opinion
Talking a lot when others are silent
Failure to listen
Pat answers
Illness and disability
Age
To communicate with persons from other cultures, ask the nurse about the beliefs and values of the person’s culture. Learn as much as you can about the person’s culture.
In the textbook, review Caring About Culture: Communicating with Persons From Other Cultures on p. 89.
Let others express feelings and concerns without adding your opinion. Pretending to listen shows lack of interest and caring. Pat answers make the person feel that you do not care about his or her concerns, feelings, and fears.
Verbal and nonverbal communications are affected by illness and disability.
Values and communication styles vary among age groups.
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19. Residents with Disabilities
A person may acquire a disability any time from birth through old age.
People with disabilities have the:
Same basic needs as you and everyone else
Right to dignity and respect just like you and everyone else
Your attitude is important for effective communication.
People do not choose illness, injury, or disability.
The person has to adjust to the disability. For many people, this can be long and hard (see Chapter 41).
People with disabilities have the same basic needs as you and everyone else. They feel joy, sorrow, happiness, sadness, and other emotions just like you and everyone else.
They have the right to dignity and respect just like you and everyone else (see Box 6-2 on p. 90).
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20. Care of the Comatose Person
The person who is comatose is unconscious.
The comatose person cannot respond to others.
The person often can hear and can feel touch and pain.
Knock before entering the person’s room.
Tell the person your name, the time, and the place every time you enter the room.
Give care on the same schedule every day.
Comatose means being unable to respond to verbal stimuli.
Assume that the person hears and understands you.
Use touch and give care gently.
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21. Care of the Comatose Person (Cont’d)
Explain what you are going to do. Explain care measures step-by-step as you do them.
Tell the person when you are finishing care.
Use touch to communicate care, concern, and comfort.
Tell the person what time you will be back to check on him or her.
Tell the person when you are leaving the room.
Often the person can hear and can feel touch and pain. Pain may be shown by grimacing or groaning.
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22. Family and Friends
Help meet safety and security, love and belonging, and self-esteem needs
Offer support and comfort
Lessen loneliness
Often help with the person’s care
The presence or absence of family or friends affects the person’s quality of life.
The person has the right to visit with family and friends in private and without unnecessary interruptions (Fig. 6-9 on p. 90).
If you need to give care when visitors are there, protect the right to privacy. Do not expose the person’s body in front of them. Politely ask them to leave the room. Show them where to wait. Promptly tell them when they can return. A partner or family member may want to help you. If the resident consents, you may allow the person to stay.
Family and friends may have concerns about the person’s condition and care. They need support and understanding. However, do not discuss the person’s condition with them. Refer their questions to the nurse.
Know your center’s visiting policies and what is allowed for the person.
See Caring About Culture: Family Roles in Sick Care on p. 90.
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23. Quality of Life Always focus on the person’s abilities.
The resident is the most important person in the nursing center.
Learn as much as you can about a person’s religious and cultural beliefs and practices.
Illness and disability affect quality of life.
Always focus on the person’s abilities.
Always treat family and visitors with respect.
Each person has physical, psychological, social, and spiritual needs.
You must know and respect the whole person to provide quality care. This includes promoting physical, mental, spiritual, and social well-being.
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