1. Life Span Introduction Chapter 1&4

2. Life Expectancy “The average number of years a person is expected to live”

3. What is the life expectancy in the US as of 2011? A.68.3 B.71.5 C.78.4 D.81.7 E.89.7

4. Life expectancy 1850189019201950197019902011 38.342.556.366.367.972.778.4

5. Why? Why is life expectancy going up? Why is the US not number 1?

6. Antibiotics When was penicillin first available as a prescription drug? A.1782 B.1824 C.1868 D.1927 E.1942

7. Healthy Lifestyle Treatment should be based on the belief that nature has a strong healing component Hippocrates

8. Bacteriology – Louis Pasteur

9. Bacteriology – Louis Pasteur – Robert Koch

10. Bacteriology – Louis Pasteur – Robert Kock – Joseph Lister

11. What was the first vaccine available? A.Small pox B.Pertussis C.Diphtheria D.Tetanus E.Polio

12. What was the first vaccine available? A.Small pox (1796) B.Pertussis (1904) C.Diphtheria (1926) D.Tetanus (1938) E.Polio (1955) 1948 = DPT

13. Measles (1963) Mumps (1967) Rubella (1969) – MMR (1971) Hepatitis B (1981) Hib (1985) Chickenpox (1996)

14. What happened to the small pox vaccine? D/C 1971 – eradicated

15. Health “A state of complete physical, mental and social well-being, not merely the absence of disease or infirmity”

16. Holistic

17. Health Promotion “Health care directed toward the goal of increasing one’s optimal level of wellness.”

18. Empowerment “A form of self- responsibility that encourages people to take charge of their own decision making”

19. Disease prevention Primary – Before there is any disease Secondary – Begins with diagnosis Tertiary – Begins when a permanent disability occurs and is stabilized – Rehabilitation – Restoring the person to an optimal level of functioning

20. Healthy Lifestyle Nutrition Exercise Mental health

21. Mental Health Adjust to new situations Handles personal problems Contributes to society See themselves and others realistically Fluctuates – Continuity – Consistency

22. Stress “Anything that upsets our psychological or physiological equilibrium”

23. Responses to stress Physiological Emotional Intellectual

24. Emotions “feeling state” Autonomic System Limbic System

25. Emotional Maturity When individuals are able to control their responses and can express their emotions in socially appropriate ways.

26. 3 Stages of Stress Alarm stage State of resistance State of exhaustion

27. Anxiety “Response to a stressful situation”

28. Levels of Anxiety Mild Moderate Severe Panic

29. Stress  Health SRRS

30. Stress Reduction Techniques Relaxation Exercise Guided imagery

31. Chapter 4: Communication “An interaction between tow of more persons – an exchange of information, ideas, feelings or emotions.”

32. Communication Process 1.Message 2.Sender 3.Method 4.Receiver 5.Feedback

33. Types of communication Verbal Non-verbal

34. Modes of Non-verbal Communication Physical Appearance and dress

35. Modes of Non-verbal Communication Body movement and posture – Open – Closed

36. Modes of Non-verbal Communication Facial expressions

37. Modes of Non-verbal Communication Gestures

38. Modes of Non-verbal Communication Eye contact

39. Modes of Non-verbal Communication Tone and volume of voice

40. Modes of Non-verbal Communication Touch

41. Modes of Non-verbal Communication Silence

42. Personality Types Passive or Unassertive Allowing your own rights to be violated by failing to express honest feelings Goal: Avoid conflict no matter what Little risk involved – very safe Little eye contact, often defers to others opinions, usually quiet tone,

43. Examples of Passive communication “I don’t know.” “Whatever you think.” “you have more experience than I. You decide” “I’ll go with whatever the group decides.” “I don’t care. It doesn’t matter to me.”

44. Personality Types Aggressive Protecting ones own rights at the expense of other’s rights – no exceptions Goal: win at all costs Does not consider actions a risk because this person thinks they will always get their way. Eye contact is angry and intimidating; lots of energy; loud and belittling, never defers to others.

45. Examples of Aggressive communication “I don’t know why you can’t see that this is the right way to do it” “It’s going to be my way or not at all.” “You’re just stupid if you think that will work.” “That kid of logic will sink the company.” “Who cares what you feel. We’re talking about making things work here.”

46. Personality Types Passive - Aggressive Forfeiting your own rights initially, followed by manipulation and vengeance later. Goal: avoid conflict and then make the other party wish they had seen it your way Avoid risk initially, risks relationships later, then acts surprised when people are mad Behaves passively to people’s face, then aggressively when they are not around.

47. Examples of Passive-Aggressive communication “Sure doctor, I’d be happy to write that verbal order” but back on the unit the order is “forgotten” “I love your hair. Most people probably can’t even tell it’s a wig” “I hear what you’re saying, and I wouldn’t want to make waves, so I’ll do what you say even though someone will probably get sued.”

48. Personality Types Assertive Protecting your own rights without violating the rights of others Goal: communicate with respect and find a solution to the problem Eye contact maintained, listens and validates others, confident and strong yet also flexible, objective and unemotional, presents wishes clearly and respectfully

49. Examples of assertive Communication “So what you’re saying is…” I can see that this is important to you and it is also important to me. Perhaps we can talk and try to solve the problem “I think… I feel… I believe that…” “I would appreciate it is you…”

50. Assertiveness Skills 1.Persistence 2.Objectivity 3.Validation 4.Owning 5.Challenging False Information 6.Pumping the negatives 7.Humor

51. Okay in assertive Communication “I don’t know” “No” or “I cannot do that” It is OK to make mistakes as long as you take responsibility It is OK to disagree and to verbalize that It is OK to challenge others opinions or actions It is OK to not accept another opinion as fact It is OK to ask for a change in behavior

52. Therapeutic Communication Purposeful Goal oriented Promotes trust

53. Components of Therapeutic Communication Listening and observing

54. Components of Therapeutic Communication Warmth

55. Components of Therapeutic Communication Genuineness

56. Components of Therapeutic Communication Attentiveness

57. Components of Therapeutic Communication Empathy

58. Components of Therapeutic Communication Positive regard

59. 3 phases of Therapeutic Communication Orientation phase – Build trust Working phase – Determine coping – Plan of care implemented Termination phase – End of relationship

60. Factors affecting communication Congruence

61. Factors affecting communication Time and setting

62. Factors affecting communication Proxemics

63. Factors affecting communication Biases

64. Factors affecting communication Physical Handicaps

65. Blocks to Communication Belittling

66. Blocks to Communication Disagreeing

67. Blocks to Communication Agreeing

68. Blocks to Communication Defending

69. Blocks to Communication Stereotyping

70. Blocks to Communication Giving false reassurances

71. Blocks to Communication Giving advice

72. Blocks to Communication Changing the subject

73. Blocks to Communication Asking closed-ended questions

74. Blocks to Communication Asking “Why” questions

75. Blocks to Communication Probing

76. Techniques used to enhance communication Giving information

77. Clarifying

78. Reflecting

79. Paraphrasing or restating

80. Asking broad questions

81. Using general leads

82. Stating or making an observation

83. Offering self

84. Using humor

85. Therapeutic Communication “Tell me about a time you struggled caring for your family member.” A.Appropriate B.Inappropriate

86. Therapeutic Communication “Describe the circumstance that led you to the crisis unit…” A.Appropriate B.Inappropriate

87. Therapeutic Communication “Tell me about a time you felt confused about a decision.” A.Appropriate B.Inappropriate

88. Therapeutic Communication “Tell me, what you do when you get upset.” A.Appropriate B.Inappropriate

89. Therapeutic Communication “Why do you think your family does not care.” A.Appropriate B.Inappropriate

90. Therapeutic Communication “Of all the concerns you mentioned which is the most troublesome?” A.Appropriate B.Inappropriate

91. Therapeutic Communication “Tell me when you feel anxious…” A.Appropriate B.Inappropriate

92. Therapeutic Communication “Tell me your family problems.” A.Appropriate B.Inappropriate

93. Therapeutic Communication “The decision your family made is for your own good.” A.Appropriate B.Inappropriate

94. Therapeutic Communication “Why do you feel like that. Your family seems to care.” A.Appropriate B.Inappropriate

95. Therapeutic Communication “I would not worry about that…..” A.Appropriate B.Inappropriate

96. Therapeutic Communication “What you really mean is…” A.Appropriate B.Inappropriate

97. Therapeutic Communication “This hospital has a fine reputation.” A.Appropriate B.Inappropriate

98. Therapeutic Communication “Everyone gets down in the dumps.” A.Appropriate B.Inappropriate

99. Therapeutic Communication “I am not sure that I follow what you are saying.” A.Appropriate B.Inappropriate

100. Clarifying Using broad opening statements Giving information Reflecting Validating Acknowledging the patient’s thoughts and feelings Using general leads Selective reflecting Requesting an explanation Belittling the patient’s feelings Making stereotyped comments giving approval Defending Using reassuring clichés Expressing disapproval Giving advice Agreeing with the patient Changing the subject Disagreeing with the patient

101. Patient: “I don’t know. I hate to have my boyfriend see me looking like this. Just thinking about him coming to visit makes me nervous.” Nurse: “You really should stop worrying. That may be what’s keeping you from getting the rest you need. And after all, no one expects you to look your best when you’re in the hospital.”

102. Patient: “You’d think my doctor would have prevented me from getting phlebitis, but he’s too busy to care about what’s happening to me.” Nurse: “You’re wrong, Mr. Iverson. Of course he cares.”

103. Nurse: “You seem to be kind of restless tonight.” Patient: “Nobody cares. My doctor wants me to go—just go on home. He doesn’t care?” Nurse: “Go home?”

104. Patient: “Maybe I should find a hobby or something. I try not to get discouraged; I know I shouldn’t let it get me down.” Nurse: “That’s the right attitude. It really doesn’t help to worry about it.”

105. Nurse: “How are you feeling this morning, Mr. Patterson?” Patient: “Oh, fine, thanks.” (unenthusiastic) Nurse: That’s good.

106. Patient: “I can’t go home with this…AIDS. If they want me out of here so bad, why don’t they just let me die?” Nurse: “You can’t go home because you have AIDS?”

107. Patient: “Well, I haven’t been able to work for quite a while now, and the doctor says I might not ever work as a carpenter again.” Nurse: “It must be difficult for you right now, but I’m sure everything will be all right.”

108. Patient: "I'm just jumpy-I get like this sometimes. I guess it's because I didn't get too much sleep last night." Nurse: "Yes, when you don't get a good night's sleep it does make you edgy."

109. Patient: "What's there to talk about? First they say they have to operate, and then when I'm beginning to feel better, I get this infection. I don't think I'm ever going to get out of here!" Nurse: "I know just how you feel. You know, everyone gets frustrated when things aren't going right."

110. Listening Exercise Pair up with another student. Person A will tell person B her/his most memorable recent experience. Person B should try to think about a problem they have or an assignment coming up while person A is speaking. Discuss how you felt about both roles and experiences, with person A speaking first.

111. Person A then tells the same story again, taking about the same amount of time. This time person B will concentrate as much as possible on person A and on what he/she is saying. Share the differences between these two experiences and discuss the relevance this may have when person A is a client and person B is a nurse.

112. Therapeutic Communication Techniques (6) Initial Communication “What should the nurse say initially?” Goal of initial communication is to open communication. Empathy Restatement Reflection

113. An elderly woman is admitted to the hospital with a subdural hematoma. There are also numerous ecchymotic areas and cigarette burns. Elder abuse is suspected. The nurse’s aide says to the nurse, “Every time I see her family, I get so angry. How could anyone deliberately hurt such a sweet old lady?” Which initial response by the nurse would be most helpful to the aide? “It is not appropriate for nursing personnel to make judgments about people.” “It is very upsetting isn’t it.” “There is no proof yet as to who abused her.” “You should try to understand how frustrating it is to care for the elderly 24 hours a day.”

114. Who is client? Nurse’s aide. What is the problem/behavior? Nurse’s aid is angry with family of client. What are the details? Suspects elder abuse. What does question ask? Initial response to aide Answer: 2. Initially should encourage aide to express feelings.

115. The nurse is caring for an 18 yo male who is comatose following a head injury. The parents ask whether they should visit their son since he is comatose. Which of the following is the best initial response for the nurse to make? Advise the parents thay should visit their son as often as possible. Suggest to the parents that their presence is important even though their son does not seem to be aware. Tell them that they should arrange for his teenage friends to visit in small groups. Explain that he is unaware of their presence and tell them

116. Who is client? Parents of 18 y/o What is the problem/behavior? Ask if they can visit son. What are the details? 18 y/0 comatose after head injury. What does question ask? Initial response Answer: 2. Look at the verbs. Suggest is only collaborative verb. Advise, tell and explain are authoritarian verbs.

117. Think about the most fulfilling relationship that you have experienced with a client, one in which you felt you made a difference. 1.What were some of the aspects of this relationship that made it fulfilling? 2.How did you make a difference? 3.What communication skills did you use?

118. Now think about a relationship with a client that was the least fulfilling; one in which you think that you did not help. 1.What are some of the aspects of this relationship? 2.What happened and why?