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Introduction to N1037

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Introduction to N1037 Course Outline Topic Outline – PowerPoint PPT presentation

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Title: Introduction to N1037


1
Introduction to N1037
  • Course Outline
  • Topic Outline

2
Intro to N1037
  • Handouts
  • Schedule
  • Assignment
  • Marking scheme

3
Schedule for Lab Groups
  • Group 1 Mondays 1630-1930
  • Group 2 Thursdays 1430-1730
  • Group 3 Thursdays 1730-1930
  • Group 4 Friday 1630-1930

4
Definitions
  • Assessment
  • Critical Thinking
  • Critical Reasoning

5
Assessment definition
  • Assessment is the hallmark of the health
    profession. It is the ability to distinguish
    normal functioning of the human organism from the
    abnormal, and if the latter is discovered to
    determine the gravity of the abnormality. It does
    not mean pinpointing the precise pathological
    process underlying the findings garnered at the
    examination the ultimate expertise for this
    function belongs to the physician. Assessment ,
    however belongs to all the healing professions.
    Sorting out the healthy from the unhealthy and
    grading the significance of any threat to the
    human person is an activity common to the health
    professional of whatever type. Furthermore it is
    the prime characteristic that sets us apart from
    the nonprofessional.

6
Critical Thinking - definition
  • - is purposeful, goal-directed thinking process
    that strives to problem solve patient care issues
    through the use of clinical reasoning. It
    combines logic, intuition, and creativity.

7
Critical Reasoning - definition
  • - is a disciplined, creative and reflective
    approach used together with critical thinking, is
    purpose is to establish potential strategies to
    assist patients in reaching their desired health
    goals.

8
Nursing Process and Critical Thinking Components
of Critical thinking
  • Interpretation
  • Analysis
  • Inference
  • Explanation
  • Evaluation
  • Self-regulation

9
Assessment
  • Whats the problem?
  • Collect data
  • Review of the clinical record
  • Interview
  • Health history
  • Physical examination
  • Functional assessment
  • Consultation
  • Review of the literature

10
Diagnosis
  • Interpret data
  • Identify clusters of cues
  • Compare clusters of cues with definition and
    defining characteristics
  • Identify related factors
  • Document the diagnosis

11
Outcomes/Goals
  • Identify expected outcomes
  • Individualize to the person
  • Realistic and measurable
  • Include a time frame

12
Planning
  • What are we going to do about it?
  • Establish priorities
  • Develop outcomes
  • Set time frames for outcomes
  • Identify interventions
  • Document plan of care

13
Implementation
  • Move into action!
  • Do it!
  • Review the planned interventions
  • Schedule and coordinate the person's total health
    care
  • Collaborate with other team members

14
Evaluation
  • Did it work?
  • How did it go?
  • Refer to established outcomes
  • Evaluate the individual's condition and compare
    actual outcomes with expected outcomes
  • Summarize the results of the evaluation

15
Evaluation
  • Identify reasons for the person's failure, if
    indicated, to achieve expected outcomes stated in
    the plan of care
  • Take corrective action to modify the plan of care
    as necessary
  • Document the evaluation of the person's
    achievement of outcomes and the modifications, if
    any, in the plan of care

16
Interviewing
  • Purpose
  • How to begin
  • Environment
  • Confidentiality
  • Note taking

17
Stages in Interview Process
  • Stage 1 - Joining stage
  • Stage 2 Working stage
  • Stage 3 Termination stage

18
Communication
  • PROCESS OF COMMUNICATION
  • SENDING RECEIVING
  • The sender needs to be aware of verbal
    nonverbal communication
  • Receiver will interpret your V NV
  • Communication is a basic skill (tool) which can
    be learned and must be practiced/re-evaluated on
    a regular basis.

19
Factors affecting Communication
  • Listening
  • Non verbal cues
  • Distance
  • Personal space

20
Communication
  • INTERNAL FACTORS
  • Liking others (optimistic view of the person)
  • Empathy
  • The ability to listen actively to the client

21
Communication
  • EXTERNAL FACTORS
  • Ensure privacy
  • Refuse interruptions
  • Physical environment comfortable temperature,
    good lighting, reduced noise, no distractions,
    comfortable distance (4 to 5 feet), eye
    level-face to face seating, do not stand.
  • Dress professionally

22
Techniques of Communication
  • Listening techniques
  • Questioning techniques
  • Sending messages techniques

23
INTRODUCING THE INTERVIEW
  • Use clients last name.
  • Introduce yourself and your role.
  • Give the reason for the interview.

24
WORKING PHASE (data gathering phase)
  • OPEN ENDED QUESTIONS to request narrative
    information, to begin the interview, introduce a
    new area of questioning or topic.
  • CLOSED OR DIRECT QUESTIONS to illicit a yes or
    no answer, to request specific information.
  • USING RESPONSES facilitation (go on, uh-huh),
    silence, reflection, summary.

25
10 TRAPS OF INTERVIEWING
  • OFFERING FALSE ASSURANCES OR REASSURANCES
  • ADVISING
  • USING AUTHORITY
  • USING PROBLEMATIC QUESTIONING
  • ENGAGING IN DISTANCING
  • USING PROFESSIONAL JARGON
  • USING LEADING OR BIASED QUESTIONS
  • TAKING TOO MUCH TIME
  • INTERRUPTING
  • DEFENDING

26
NONVERBAL SKILLS/BEHAVIOURS OF THE INTERVIEWER
  • POSITIVE
  • Eye contact
  • Open posture, relaxed
  • Leaning forward
  • Tone of voice moderate
  • Appropriate touch
  • Professional appearance
  • NEGATIVE
  • Standing
  • Bland expression
  • High pitch tone
  • Speech slow or fast
  • Sitting far away, behind a desk
  • Inappropriate dress

27
DEVELOPMENTAL CONSIDERATIONS
  • Parent/infant greet both by name,interview
    together, allow toys for the child, ask about toy
    to make contact.
  • School-age child parent/child together, child
    will have valuable information at times, ask
    child about symptoms first then parent later.
  • Adolescent be respectful, dont judge, give
    truth with rationale, keep it short and simple.
  • Older adult greet by last name, allow more time
    for interview, shorter segments may be necessary.
  • You must be able to develop a rapport with people
    at different stages of life.

28
INTERVIEWING PEOPLE WITH SPECIAL NEEDS
  1. Hearing-impaired
  2. Acutely ill people
  3. Crying
  4. Anger
  5. Threat of violence

29
CROSS CULTURAL COMMUNICATION
  1. Etiquette formal/respectful/polite, name and
    title.
  2. Space and distance 2-4 feet with all.

30
OVERCOMING COMMUNICATION BARRIERS
  • Language
  • Divers backgrounds
  • Behaviours
  • Eye contact

31
The Complete Health History
  • What is the purpose of the complete health hx?
  • Subjective data what the person says about
    himself/herself.
  • Objective data physical examination and lab
    studies.
  • Both form the data base which is used to make a
    diagnosis about the health status of the
    individual.

32
The health history
  • complete picture of the person's past and present
    health
  • describes the individual as a whole how the
    person interacts with the environment
  • records health strengths coping skills
  • for the well person - hx used to assess lifestyle
    e.g. exercise, diet, risk
    reduction, health promotion behaviour
  • for the ill person - hx includes a detailed
    chronological record of the health problem

33
Health History Forms
  • biographical data
  • reason for seeking care (previously chief
    complaint)
  • present health or history of present illness
  • past history
  • family history
  • review of systems
  • functional assessment or activities of daily
    living (ADLs)

34
Health History (Adult)
35
A-Health Hx
  • Biographical data
  • Name
  • Age
  • Address
  • Phone number
  • Birth date
  • Sex
  • Marital status
  • Source of history
  • Who provided the information?
  • Are they a reliable source?
  • Was there an interpreter present?

36
Health Hx
  • Reason for seeking
  • care
  • Brief statement of why the client is seeking
    health care.
  • It states one or two symptoms and their duration.
  • Use quotation marks.
  • Present health/history
  • of present illness
  • Chronological record of the reason for seeking
    health care.
  • Tell me aboutfrom the time it started
  • Should include the 8 critical characteristics.

37
Health Hx Symptoms- 8 Critical Characteristics
  • location
  • character or quality (burning, sharp, dull, etc.)
  • quantity or severity (scale, how many?)
  • Timing (onset, duration, frequency)
  • Setting
  • aggravating or relieving factors (better, worse)
  • associated factors
  • patient's perception (what do you think it means?)

38
B-Past Health
  • Childhood illnesses MMR, chickenpox, pertussis,
    strep throat, polio.
  • Accidents/injuries auto, fractures, head
    injuries, burns.
  • Serious/chronic illnesses diabetes, BP, heart
    disease, cancer, seizures.
  • Hospitalizations cause, name of.., how was it
    treated, how long, physician.

39
B-Past Health
  • Operations type, date, surgeon, name of
    hospital, how they recovered.
  • Obstetric hx Grav___Term___Preterm___Ab___Living
    __
  • Immunizations MMR, polio, DpT, Hep B, Tb
    immunization and skin test, last flu shot.
  • Last examination date MD, dental, vision,
    hearing, ECG, chest x-ray.

40
B-Past Health
  • Allergies allergen and reaction.
  • Current medication Rx OTC. Note name dose
    and schedule. How often do they take it? What
    is it for? How long have they been taking it?

41
C-Family History
  • Include a Genogram
  • Include age and health of the parents,
    grand-parents and siblings.
  • or age and cause of death.

42
D-Review of Systems
  • The purpose of this review is to evaluate
    past/present health states, to evaluate health
    promotion strategies and to identify if any
    information was missed.
  • Review each system in the lab as well as
    corresponding health promotion(HP) strategies.

43
D-Review of Systems (listed only)
  • Skin
  • Hair
  • Head
  • Eyes
  • Ears
  • Nose and Sinuses
  • Mouth and Throat

44
Review of Systems
  • Neck
  • Breast
  • Axilla
  • Respiratory
  • Cardiovascular
  • Peripheral Vascular
  • Gastrointestinal

45
Review of Systems
  • Urinary
  • Male Genital
  • Female Genital
  • Sexual Health
  • Musculoskeletal
  • Neurological
  • Hematological

46
E-Functional Assessment
  • This is a measure of the persons self-care
    abilities with respect to
  • ADLs bathing, dressing, toileting, eating,
    walking.
  • IADLs housekeeping, shopping, cooking, doing
    laundry, using phone, managing finances,
    nutrition, social relationships/resources,
    self-concept/coping, home environment.

47
E-Functional Assessment
  • Self-esteem/Self-concept education,
    financial status, value-belief system.
  • Activity/Exercise
  • Sleep/Rest
  • Nutrition/Elimination
  • Interpersonal Relationships/Resources social
    roles and support persons.
  • Coping/Stress Management

48
Functional Assessment Including ADLS
  • Personal habits
  • Tobacco
  • Alcohol
  • Street drugs
  • Environmental hazards
  • Occupational health

49
F-Perception of Health
  • How do you define health?
  • What are your health goals?
  • What do you expect from your health care
    providers?

50
Developmental Considerations
  • Children include prenatal/perinatal hx, parent
    description of problem, developmental overview
    nutritional hx.
  • Older adults ADLs and IADLs very important.
    Explore changes to ADLs caused by aging process
    or chronic illnesses. Note if the impact of
    disease is more important than the disease
    itself. Note the reason for the person seeking
    health care not the HCPs assumption of the
    problem.

51
THE GENERAL SURVEY
  • Follows the health history
  • This is subjective not objective
  • Study of the whole person

52
THE GENERAL SURVEY
  • The GENERAL SURVEY is split up into 4 different
    components
  • Physical appearance
  • Body structure
  • Mobility
  • Behaviour

53
1. Physical Appearance
  • Age
  • Sex
  • Level of Consciousness
  • Skin Colour
  • Facial Features

54
2. Body Structure
  • Stature
  • Nutrition
  • Symmetry
  • Posture
  • Position
  • Body build, Contour

55
3. Mobility
  • Gait
  • Range of Motion

56
4. Behaviour
  • Facial expression
  • Mood and affect
  • Speech
  • Dress
  • Personal Hygiene

57
Developmental Considerations
  • Infants/children
  • Physical appearance, body structure, mobility
    note same but with consideration to age and
    development.
  • Behaviour note response to stimuli according to
    developmental age
  • Parental bonding
  • Aging Adult
  • physical appearance 8th to 9th decade contour is
    sharper and facial features more angular and a
    change to body proportions.
  • Posturegeneral flexion by 8th to 9th decade.
  • Gait wider base due to poor balance, arms out,
    smaller steps.
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