Nursing 325 Final Exam Guide: Key Concepts and Principles | Exams Nursing

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NURSING 325 FINAL EXAM GUIDE

Exam 1 - 20%

•Advanced Directives o Legislation that requires institutions to inform clients upon admission of their right to choose

whether to have life prolonging treatment should they become mentally ill or physically unable to make their own

decisions. Formal document executed by competent client/legal proxy identifying preferences for level of care at end

of life r/t treatment, medications, hydration, nutrition. Can be revoked/revised anytime by author.

oTypes of advanced directives:

 Living will – documents client’s preferences for medical treatment, artificial life support, nutrition,

antibiotic use, pain meds, etc if pt becomes incompetent or unable to state them

 Medical power of attorney for health care decisions – legal document with designation of proxy

who is authorized to make health care decisions for a person should the individual be unable to

express his/her wishes

 Durable power of attorney – legal document designating a proxy authorized decisions regarding

finances and to represent the pt’s interest should pt be unable to do so; durable power of attorney

can be revoked in writing at any time as long as pt is competent

 Do-not-resuscitate orders (DNR) – written direction about not resuscitating the client if client’s

breathing/heartbeat stops

 Durable mental health power of attorney – legal document with designation of a proxy who is

authorized to make mental health care decisions for a person should the individual be unable to

do so because of mental symptoms

•Barriers to the Relationship – anxiety, stereotyping, space violation, confidentiality violation, lack of respect, lack of

caring, failure to allow client to assume personal responsibility or failure to provide support and resources, mistrust,

lack of empathy, lack of time, communication conflicts, overinvolvement, culture/gender. Barriers limit nurse’s ability

to develop substantial rapport with client

•Benner's stages to clinical confidence o Novice stage (limited nursing experience, need textbook picture, lack of

practice)

oAdvanced beginner – partially grasp unique complexity of each client situation. Understand basic elements

of practice and can organize/prioritize clinical tasks.

oCompetence stage (1-2 years into practice) – manages contingencies of clinical nursing easily and begin to

practice “art” of nursing. Views are from broader perspective and is more confident about his/her role

oProficient – 3-5 years; self confident and perform tasks with competence speed and flexibility, sees clinical

situation as a whole and knows what needs to be modified in response to a given situation

oExpert – high level of clinical skill and capacity to respond authentically and creatively to client needs and

concerns. Can recognize unexpected and work with it creatively; master technology, sensitivity in

interpersonal relationships, and specialized nursing skills in all aspects of care giving

•Historical development of nursing

•Nurse Practice Acts

•Nursing metaparadigm o Worldview that distinguishes nursing profession from other disciplines and emphasizes its

unique functional characteristics. o Four key concepts:

 Person – individuals, family units, community; personal factors – their perceptions, values, beliefs,

preferences

 Environment – internal/external context of client as it shapes and is affected by client’s health care

situation; includes job, family, culture, climate, pollution, access to care, food choices

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NURSING 325 FINAL EXAM GUIDE

Exam 1 - 20%

Advanced Directives o Legislation that requires institutions to inform clients upon admission of their right to choose whether to have life prolonging treatment should they become mentally ill or physically unable to make their own decisions. Formal document executed by competent client/legal proxy identifying preferences for level of care at end of life r/t treatment, medications, hydration, nutrition. Can be revoked/revised anytime by author. o Types of advanced directives:  Living will – documents client’s preferences for medical treatment, artificial life support, nutrition, antibiotic use, pain meds, etc if pt becomes incompetent or unable to state them  Medical power of attorney for health care decisions – legal document with designation of proxy who is authorized to make health care decisions for a person should the individual be unable to express his/her wishes  Durable power of attorney – legal document designating a proxy authorized decisions regarding finances and to represent the pt’s interest should pt be unable to do so; durable power of attorney can be revoked in writing at any time as long as pt is competent  Do-not-resuscitate orders (DNR) – written direction about not resuscitating the client if client’s breathing/heartbeat stops  Durable mental health power of attorney – legal document with designation of a proxy who is authorized to make mental health care decisions for a person should the individual be unable to do so because of mental symptoms
Barriers to the Relationship – anxiety, stereotyping, space violation, confidentiality violation, lack of respect, lack of caring, failure to allow client to assume personal responsibility or failure to provide support and resources, mistrust, lack of empathy, lack of time, communication conflicts, overinvolvement, culture/gender. Barriers limit nurse’s ability to develop substantial rapport with client
Benner's stages to clinical confidence o Novice stage (limited nursing experience, need textbook picture, lack of practice) o Advanced beginner – partially grasp unique complexity of each client situation. Understand basic elements of practice and can organize/prioritize clinical tasks. o Competence stage (1-2 years into practice) – manages contingencies of clinical nursing easily and begin to practice “art” of nursing. Views are from broader perspective and is more confident about his/her role o Proficient – 3-5 years; self confident and perform tasks with competence speed and flexibility, sees clinical situation as a whole and knows what needs to be modified in response to a given situation o Expert – high level of clinical skill and capacity to respond authentically and creatively to client needs and concerns. Can recognize unexpected and work with it creatively; master technology, sensitivity in interpersonal relationships, and specialized nursing skills in all aspects of care giving
Historical development of nursing
Nurse Practice Acts
Nursing metaparadigm o Worldview that distinguishes nursing profession from other disciplines and emphasizes its unique functional characteristics. o Four key concepts:  Person – individuals, family units, community; personal factors – their perceptions, values, beliefs, preferences  Environment – internal/external context of client as it shapes and is affected by client’s health care situation; includes job, family, culture, climate, pollution, access to care, food choices

 Health – disease prevention and healthy lifestyle behaviors/well being promotion  Nursing – caring with overarching goal of empowering clients by providing them with support they need to achieve optimal health and well-being

Phases of Nurse-Client relationship o Preinteraction phase: only one in which client does not participate  Create physical environment – private space in which nurse and client will not be interrupted o Orientation phase: begins process of developing trust by providing client with basic info about the nurse and essential info about the purpose, nature, and time available for relationship and explain what data will be shared and what will be confidential  Clarifying purpose of relationship – r/t indentifying health needs, what info is needed, how it will be used, how client can participate, and what client can expect from outcome  Establish trust  Identify client needs  Participant observation – simultaneously participates in and observes progress of relationship from the nurse and client perspective  Defining problem – help clients describe their problems in concrete terms  Defining goals –should have meaning to the client o Working (exploitation/active intervention) phase: conversation turns to active problem r/t assessed health care needs; focus on self direction and self management to whatever extent is possible in promoting the client’s health and well- being  Tuning into client response pattern – recognize differences in the client response pattern  Defusing challenging behavior – before confronting client, nurse should anticipate possible outcomes  Self-disclosure – intentional revealing of personal experiences or feelings; used to deepn trust o Termination phase – nurse and client evaluate the client’s responses to treatment and explore the meaning of the relationship and what goals have been achieved; discuss client achievement, how both feel about ending relationship and plans for the future  Gift giving – delicate matter that does not lend itself to absolute dictums; invites reflection and professional judgment  Evaluation – was the diagnosis appropriate for the client? Were the interventions adequate? Is the client moving to maximum health and well being? Is follow up care needed?
Steps in the caring process
Therapeutic use of self o nurse achieves moral ideal whenever use of the whole self to form relationship with the whole person receiving care to explain the optimum involvement of self in the nurse/client relationship. Relationships that nurses establish with clients and their families and other practitioners in which the whole self is drawn into the process serves as primary means for putting into action health treatments and healing interventions needed for client support and self-care
Values of nursing o Values/Qualities: Altruism (concern for welfare/well being of others), autonomy (right to self determination/capacity to exercise choice), human dignity (respect for the inherent worth and uniqueness of individuals/populations), social justice (uses moral/legal principles to promote fair treatment), integrity (faithfulness to fact or reality)

Exam 2 - 20%

Characteristics of a critical thinker o They approach problem solutions in a systematic, organized, and goal-directed way when making clinical decisions. They continually use past knowledge, communication skills, new information, and observations to make these clinical judgments o Attitude  Develops an analytical thinking ability

unconditional regard in a caring authentic relationship. Client centered care includes client’s individual preferences, values, beliefs, and needs as a fundamental consideration in all nursing interventions. CCC is core value in service delivery. Sit with pt and listen compassionately keeping in mind that each person’s experience is different despite similarities in diagnosis. o Respect pt’s values, preferences and expressed needs. o Coordinate/integrate care across boundaries of system o Provide information, communication and education that ppl need/want o Guarantee physical comfort, emotional support, and involvement of family/friends

New initiatives for safer care
Strategies to help nurses learn to communicate for safer care o Develop a safe priority attitude  Institute of medicine has urged organizations to create an environment in which safety is a top priority
Equipment is standardized and simplified
Assess individual safety needs, seek learning
Don't assume someone else has addressed the situation
Accident vs. error o Use practice simulations  Simulation lab  Poverty simulation  Practice in class  Journal entries o Develop evidence based practice o Use of SBAR
Interdisciplinary teams versus multidisciplinary teams o Multidisciplinary teams  “each work w/in their particular scope of practice & interact formally”  Share info w/ each other & work in tandem w/ other disciplines, Function independently, w/ each being responsible for different care needs  Each profession maintains own solo expertise w/out much interaction o Interdisciplinary teams  Characterized by greater overlapping of professional roles, formal and informal communication & shared prob solving for good of pt  Develop collective vision & common language to support collaborative unified working approach to clinical problems  Integrates services, using teamwork principles  Consist of core group of health professionals (common physician, nurse, social worker, pharmacist, and caseworker)  Integrated pt-centered care represents team’s core value  Decision making nonhierarchal , every profession willing & ready to assume responsibility for achieving positive tx outcomes  Team functions takes into account diverse standards & behaviors associated with each clinical discipline, & emphasizes common mission of working together to resolve complex clinical problems  Each member functions as both individual and healt care professional representing a distinct discipline

 Clear understanding of own’s discipline, pluse knowledge & mutual respect for each other’s discipline’s roles = fundamental effective participation

Interdisciplinary professional collaboration o Professional collaboration  Synthesis of information such that the outcomes are more than additive  Team leadership, situation monitoring, mutual support, communication  Team meetings, huddles, sharing critical info (SBAR, nursing comfort rounds, hospitalist
Nature and benefits of collaboration (OJIN article) o Collaboration involves an exchange of views and ideas that considers the perspective of all that are involved o Agreement does not have to be reached o Mutual respect o Necessitate trust and tenacity o Appreciation of the contributing disciplines and a clear understanding of nursing disciple.

o Use clear, congruent communication: clarify, choose direct, declarative sentences. Use objective words, and directly state the behavior that is the problem. Then proceed to articulate why their behavior is a problem by stating facts. Make sure verbal and nonverbal communication in congruent o Take one issue at a time: choose words that may lead to a positive outcome and focus only on the present issue, the past cannot be changed. Limiting your discussion to one topic issue at a time enhances the chance of success o Mutually generate some options for resolution: focus on ways to resolve the problem by listing possible options o Make a request for a behavior change: avoid blaming, this would only make your client feel defensive or angry. Request for a change, clearly as for the needed behavior change. His willingness to change needs to be considered. Rather than just stating your position, try to use some objective criteria to examine the situation. Client readiness is vital o Understand cultural implications o Evaluate the conflict resolution: encourage client to change by stating the outcomes, the positive consequences of changing or the negative implications for failing to change. Evaluation of conflict resolution, evaluate degree to which the interpersonal conflict has been resolved. Accepting small goals is useful when large goal attainment is not possible. Your goal is open communication with frequent feedback leading to successful problem solving o Identify client intrapersonal conflict situations: you convey acceptance of the individual's legitimate right to have feelings o Talk about it: talk emotion through with someone. Unlike complaining, the purpose of talking the emotion through is to help the person connect with all of his/her personal feelings surround the incident o Use tension-reducing actions: take action. Convey mutual respect and avoid any “put-down” type of comment about yourself or the client. Physical activity can reduce tension. Humor is frequently used by nurses to engage a client or to initiate an interaction, can also be used as a means of reducing tension. o Defuse intrapersonal conflict: may need to defuse destructive emotions before proceeding further  Identify the presence of an emotionally tense situations  Talk the situation through with someone  Provide a neutral, accepting environment  Take appropriate action to reduce tension Evaluate the effectiveness of the strategies  Generalize behavioral approaches to other situations o Evaluate: evaluate effectiveness of responses to emotions and to generalize the experience of confronting difficult emotions to other situations

Turning conflict into collaboration o Prepare for the encounter: purpose, organization, content, and word choice o (^) Organize information: organize and validate information with another knowledgeable person who is not directly involved in the process is useful; avoid bringing up the past Manage your own anxiety or anger: recognizing and controlling your own natural emotional response to your client’s upsetting behavior may be one key factor in managing conflict. Cool off, take a few deep breaths, fortify yourself with positive statements, defuse you own anger before confronting the patient,

o o Time the encounter: select a time when both can discuss the matter privately and use neutral ground; select time when patient is most receptive o Put situation into perspective: do not play the blame game o Use therapeutic communication skills: active listening, really try to understand what the client is upset about o Use clear, congruent communication: clarify, choose direct, declarative sentences, objective words and directly state the behavior that is the problem. Articulate why their behavior is a problem by stating facts. Make verbal and nonverbal communication is congruent o Take one issue at a time: limit discussion to one topic issue at a time o Mutually generate some options for resolution: listing possible options o o Understand cultural implications o o o o Use tension-reducing actions: listen, physical activity, humor o o

Strategies to remove barriers to communication with other professionals o Convey respect: nurses need to be appreciated, recognized, and respected as professionals for the work they do o Clarify communications: communication problems lead to a large percentage of disruptive behaviors, especially telephone communication (SBAR) o Use conflict resolution strategies and respond to putdown and destructive criticisms o Use peer negotiation: once it is determined that conflict is present, look for the basis of the conflict and label is as personal or professional. Sharing feelings about a conflict with others helps to reduce its intensity. Self-awareness is beneficial in assessing the meaning of a professional conflict focus on one issue Make a request for a behavior change: clearly ask client for needed behavior change, willingness needs to be considered Evaluate the conflict resolution: encourage client to change and evaluate degree to which interpersonal conflict has been resolved Identify client intrapersonal conflict situations: convey acceptance of individual’s legitimate right to have feelings Talk about it: talk emotion through with someone, purpose is to help person connect with all of his/her personal feelings surrounding the incident Defuse intrapersonal conflict: recognize their presence and assess the appropriateness of expressing emotion in the situation Evaluate: evaluate effectiveness of responses to emotions and to generalize experience of confronting difficult emotions to other situations

Exam 4- 40%

Advantages of computerized client electronic health records o Interagency accessibility: electronic

records are more durable than paper charting and easily transferable

o Cost savings – in addition to actual paper/printing costs, there are costs involved with record

transcription, filing, storage, and retrieval of information

o Increased access to client information: information is instantly available to variety of users; clients

can carry their information on a flashdrive

o Efficiency and ease of use: computer assisted charting can reduce time you spend charting >

allows more time to spend w/ client > increases client satisfaction; efficiency is increased because

providers across all agencies have immediate access to client info

o Enhanced quality of care and communication: info is more rapid; quality of care can be

maximized with clinical decision-making electronic “prompts” that remind you to do complete

care or to chart comprehensively

o Safety – errors are prevented because assistance is given w/ drug calculations, and in assisting w/

decision support such as checking drug incompatibility allergies, and so on

o Aggregated data: ease of combining together information from many clients for reports, disease

surveillance, and to research best practice nursing care

Assessing teaching/learning needs at discharge
Children and death o Developmental level is key factor in the child’s attitude toward death such that a

child younger than 5 has no clear concept of what death means. As a child matures, the finality of death

becomes more real. Death is difficult for children because they don’t have the cognitive development

and life experiences to process them completely. They do not express their grief in the same way as

adults: acting out, anger, fear, crying are common responses, which appear spontaneously.

Developmentally, they do not understand the permanence of death. Children should be encouraged to

talk about changes in the health of a parent or impending death of a central person in their lives,

questions should be answered directly and honestly at the child’s developmental level of

comprehension. They need physical contact, reassurance, and relevant discussions about the person

who has died. Goal is to provide physical comfort

(medication/physical therapy to improve function and relieve pain), emotional support (arranging

art, music, or other expressive therapies), normal life (informing the child and involving him/her

in decisions), family functioning (helping parents make special time for siblings_,

cultural/spiritual values (accommodating religious rituals and traditional customs), and preparing

for death (palling for parents, siblings, and others to be with the child at and after death)

Concepts of grief and grieving o Acute grief: occurs as “somatic distress” that occurs in waves w/

feelings of tightness sin the throat, shortness of breath, empty feeling in the abdomen, sense of

heaviness and lack of muscular power, and intense mental pain. Sudden traumatic deaths are more

likely to stimulate

o Anticipatory grief: emotional response that occurs before the actual death around a family

member with a degenerative or terminal disorder

o Chronic sorrow – ill-defined form of grief, occurring while a person is still alive, in relation to a

limiting disease, or as an ongoing loss of potential in a loved one. Has been identified in parents

of disabled or mentally ill children, spouses of dementia victims, permanent disabilities. Is an

intermittent grief process, there are periods of emotional neutrality and positive emotions

o Complicated grieving: represents a form of grief, distinguished by being unusually intense,

significantly longer in duration, or incapacitating. A history of depression, substance abuse, death

of a parent of sibling during childhood can predispose. Can result in clinical symptoms such as

depression/anxiety disorders that require professional help

Cultural assessment o Information you need include client’s” identified cultural affiliation, health

beliefs and values, customary health practices, spiritual beliefs and practices, culturally specific social

structures related to health care

 Personal heritage (country of origin, politics, education, etc), communication (dominant

language/dialects, personal space, body language), family roles/organization(gender

roles, extended family roles, head of household), workforce issues

(acculturation/assimilation, gender roles, current/previous jobs), bioecology (genetics,

hereditary factors), high risk health behaviors (drugs, sexual behavior), nutrition

(meaning of food, availability/food preferences, use of food in illness),

pregnancy/childbearing (rituals/constraints during pregnancy, labor/delivery practices),

death rituals (how death is viewed, rituals, body preperation), spirituality (religious

practices, spiritual meanings, prayers), health care practices(traditional practices, pain is

expressed, individual/collective responsibility for health), health care practitioners

(traditional/folk practitioners)

Cultural competence o Set of cultural behaviors and attitudes integrated into the practice methods of a

system, agency, or its professionals, that enables them to work effectively in cross cultural situations;

begins w/ selfawareness of you own cultural values, attitudes, and perspectives, followed by developing

knowledge and acceptance of cultural differences in others; is expressed through cultural sensitivity

(ability to be appropriately responsive to the attitudes, feelings, or circumstances of groups of people

that share a common and distinctive racial, national, religious, linguistic, or cultural heritage)

Cultural diversity o Variations among cultural groups, people notice differences related to language,

mannerisms, and behaviors in people of different cultures; lack of exposure to an understanding of

people from other cultures reinforces stereotypes and creates prejudices

Documentation suggestions o Content:

 Chart promptly but never ahead of time, don’t wait to end of shift

 Document complete care reflecting nursing processing

 Document all non cooperative/bizarre behaviors

 Document refusals of ordered treatment

 Document teaching (info you gave to the client/family)

 When care or medicine is omitted, document action/rationale (who was notified and what

was said)

 Document all significant changes in client’s condition and who was notified as well as

your nursing intervention

o Mistakes to avoid

 Failure to record complete, pertinent health information

 Making “untimely” entries

 Failing to record drug admin, route, outcome

 Recording on wrong chart

 Failing to document a discontinued medication

o Appropriate to complete when an even occurst hat harms or potentially harms an individual, or

evidence of serious dissatisfaction by patient, visitors, or staff, and for any concern you feel needs

to be looked at by risk management

o Designed to promptly document all circumstances surrounding an event to alert quality assurance

and risk management, involved administrators and clinicians of a potential liability

o An information base to monitor/evaluate the number and types of incidents that take place in a

facility

Interpreters in healthcare o Federal law mandates the use of trained interpreter for any client

experiencing communication difficulties in health care settings because of language; in general, family

members, particularly children, should not be used as interpreters

o Guidelines for using interpreters

 Whenever possible, translator shouldn’t be a family member

 Orient translator to goals of clinical interview and expected confidentiality

 Look directly at the client when either you or a client is speaking

 Ask the translator to clarify anything that isn’t understood by either the nurse or the client

 After each completed statement, pause for translation

Legal aspects of charting o Legal assumption is that the care was not given unless it is documented in

client’s record > if not charted not done because the purpose of med records is to list care given and

client outcomes, any info that is clinically significant must be included; legally, all care must be

documented. Any method of documentation that provides comprehensive, factual info is legally

acceptable

Patterns of grieving o Denial – “no, not me” stage – be sensitive to those in denial o Anger – “why

me?” stage; associated w/ feelings about unfairness of life or anger w/ God.

Feelings get projected on those closest to client o Bargaining – “yes, me but I need a little more

time” stage; involves pleading for time extension or special consideration; support hope and avoid

challenges to client’s reality

o Depression: “yes me” stage; accompanied by depressive feelings. Help clients to accept

depression as being normal response and being present to clients and families as an empathetic

listening witness to their experiences

o Acceptance: characterized by acknowledgement of inevitable EOL; gradual detachment from

world as client approaches death, person is almost “void of feeling”

Strategies to assist the client with speech and language difficulties o Avoid prolonged, continuous

convos; instead use frequent short talks. Present small amounts of info at a time

o When clients falter in written or oral expression, supply needed compensatory support o Praise

efforts to communicate

o Provide regular mental stimulation in a non taxing way o Allow extra time for delays in

cognitive processing of information o For print materials, use short, bulleted lists

Suggestions for helping the client with sensory loss o Always maximize use of sensory aids (hearing

aid, pics, sign language) o Pick means of available communication best suited to your client

o Help elderly clients adjust hearing aids (lacking fine motor dexterity, elderly client may not be

able to insert aids to amplify hearing) o Hearing impairment

 Stand/sit face to face, communicate in well lighted room

 Facial expressions/gestures that reinforce verbal content

 Speak distinctly w/o exaggerating words

 Write important ideas and allow the client the same option to increase the chances of

communication, always have writing pad available

 Always face client when communicating (see lips move)

 Tap on floor or table to get attention via vibration

 Arrange for TTY for client with partial hearing loss

 If unable to hear rely on visual materials

 Arrange for closed caption TV

 Use text messaging on client cell phone/email on computer

 Encourage client w/ hearing loss to verbalize speech, even if the person uses only a few

words or the words are difficult to understand at first

 Use intermediary, such as family member who knows sign language, to facilitate

communication w/ deaf clients who sign

o Vision impaired

 Let person know when you approach by simple touch, always indicate when you are

leaving

 Adapt teaching for low vision by using large print, audiotaped info, Braille

 Don’t lead or hold client’s arm when walking, instead, allow person to take your arm

 Use touch/close physical proximity while you are w/ client; give person something

substantial to touch in your absence

 Develop and use signals to indicate changes in pace or direction while walking

Treatment related communication disabilities o Environment – communication is particularly

Nursing 325 Final Exam Guide: Key Concepts and Principles, Exams of Nursing

Related documents

Partial preview of the text

Download Nursing 325 Final Exam Guide: Key Concepts and Principles and more Exams Nursing in PDF only on Docsity!

NURSING 325 FINAL EXAM GUIDE

Exam 1 - 20%

Exam 2 - 20%

Exam 4- 40%

records are more durable than paper charting and easily transferable

o Cost savings – in addition to actual paper/printing costs, there are costs involved with record

transcription, filing, storage, and retrieval of information

o Increased access to client information: information is instantly available to variety of users; clients

can carry their information on a flashdrive

o Efficiency and ease of use: computer assisted charting can reduce time you spend charting >

allows more time to spend w/ client > increases client satisfaction; efficiency is increased because

providers across all agencies have immediate access to client info

o Enhanced quality of care and communication: info is more rapid; quality of care can be

maximized with clinical decision-making electronic “prompts” that remind you to do complete

care or to chart comprehensively

o Safety – errors are prevented because assistance is given w/ drug calculations, and in assisting w/

decision support such as checking drug incompatibility allergies, and so on

o Aggregated data: ease of combining together information from many clients for reports, disease

surveillance, and to research best practice nursing care

child younger than 5 has no clear concept of what death means. As a child matures, the finality of death

becomes more real. Death is difficult for children because they don’t have the cognitive development

and life experiences to process them completely. They do not express their grief in the same way as

adults: acting out, anger, fear, crying are common responses, which appear spontaneously.

Developmentally, they do not understand the permanence of death. Children should be encouraged to

talk about changes in the health of a parent or impending death of a central person in their lives,

questions should be answered directly and honestly at the child’s developmental level of

comprehension. They need physical contact, reassurance, and relevant discussions about the person

who has died. Goal is to provide physical comfort

(medication/physical therapy to improve function and relieve pain), emotional support (arranging

art, music, or other expressive therapies), normal life (informing the child and involving him/her

in decisions), family functioning (helping parents make special time for siblings_,

cultural/spiritual values (accommodating religious rituals and traditional customs), and preparing

for death (palling for parents, siblings, and others to be with the child at and after death)

feelings of tightness sin the throat, shortness of breath, empty feeling in the abdomen, sense of

heaviness and lack of muscular power, and intense mental pain. Sudden traumatic deaths are more

likely to stimulate

o Anticipatory grief: emotional response that occurs before the actual death around a family

member with a degenerative or terminal disorder

o Chronic sorrow – ill-defined form of grief, occurring while a person is still alive, in relation to a

limiting disease, or as an ongoing loss of potential in a loved one. Has been identified in parents

of disabled or mentally ill children, spouses of dementia victims, permanent disabilities. Is an

intermittent grief process, there are periods of emotional neutrality and positive emotions

o Complicated grieving: represents a form of grief, distinguished by being unusually intense,

significantly longer in duration, or incapacitating. A history of depression, substance abuse, death

of a parent of sibling during childhood can predispose. Can result in clinical symptoms such as

depression/anxiety disorders that require professional help

beliefs and values, customary health practices, spiritual beliefs and practices, culturally specific social

structures related to health care

 Personal heritage (country of origin, politics, education, etc), communication (dominant

language/dialects, personal space, body language), family roles/organization(gender

roles, extended family roles, head of household), workforce issues

(acculturation/assimilation, gender roles, current/previous jobs), bioecology (genetics,

hereditary factors), high risk health behaviors (drugs, sexual behavior), nutrition

(meaning of food, availability/food preferences, use of food in illness),

pregnancy/childbearing (rituals/constraints during pregnancy, labor/delivery practices),

death rituals (how death is viewed, rituals, body preperation), spirituality (religious

practices, spiritual meanings, prayers), health care practices(traditional practices, pain is

expressed, individual/collective responsibility for health), health care practitioners

(traditional/folk practitioners)

system, agency, or its professionals, that enables them to work effectively in cross cultural situations;

begins w/ selfawareness of you own cultural values, attitudes, and perspectives, followed by developing

knowledge and acceptance of cultural differences in others; is expressed through cultural sensitivity

(ability to be appropriately responsive to the attitudes, feelings, or circumstances of groups of people

that share a common and distinctive racial, national, religious, linguistic, or cultural heritage)

mannerisms, and behaviors in people of different cultures; lack of exposure to an understanding of

people from other cultures reinforces stereotypes and creates prejudices

 Chart promptly but never ahead of time, don’t wait to end of shift

 Document complete care reflecting nursing processing

 Document all non cooperative/bizarre behaviors

 Document refusals of ordered treatment

 Document teaching (info you gave to the client/family)

 When care or medicine is omitted, document action/rationale (who was notified and what

was said)

 Document all significant changes in client’s condition and who was notified as well as

your nursing intervention

o Mistakes to avoid