1. Medical Tech Prep 1 Lancaster High School Mrs. Carpenter Chapter 7: Understanding the Person Pages:81-96

2. Objectives  Define the key terms listed in this chapter  Identify the parts that make up the whole person  Explain Abraham Maslow’s theory of basic needs  Explain how culture and religion influence health and illness  Identify the emotional and social effects of illness  Describe the persons cared for in health care agencies  Explain the American Hospital Association’s The Patient Care Partnership:  Understanding Expectations, Rights, and Responsibilities  Identify the elements needed to communicate.  Describe how to use verbal and nonverbal communication.  Explain the methods and barriers to good communication.  Explain why family and visitors are important to the person.  Identify the courtesies given to the person and visitors.  Explain how to deal with behavior issues.

3. HOLISM  Holism is a concept that considers the whole person.  The physical, social, psychological, and spiritual parts are woven together and cannot be separated.  Patients and residents often complain that they are treated as things, not as people.  They are often treated as physical diseases or problems.  Each part relates to and depends on the other parts.

4. BASIC NEEDS  A need is something necessary or desired for maintaining life and mental well being.  basic needs must be met for a person to survive and function.  Maslow’s Heirarchy 1. The needs are arranged in order of importance. 2. Lower-level needs must be met before the higher- level needs.

5. Basic Needs lowest level to the highest level: Physiological or physical needs Safety and security needs Love and belonging needs Self-esteem needs The need for self-actualization

6. MASLOW’S HEIRARCHYSELFACTUALIZATION SELF ESTEEM LOVE AND BELONGING SAFETY AND SECURITY PHYSICAL

7. Focus on long-term care:  safety and security needs  Many persons do not feel safe and secure when admitted to a nursing center and become scared and confused. Be kind and understanding. Show them the new setting. Listen to their concerns. Explain all routines and procedures. Be patient.

8. CULTURE AND RELIGION  Culture the characteristics of a group of people passed from one generation to the next. Culture includes language, values, beliefs, habits, likes, dislikes, and customs.  Culture affects behavior during illness.  People come from many cultures, races, and nationalities. Family practices, food choices, hygiene habits, and clothing styles may differ from your own. speak a foreign language. beliefs about what causes and cures illness. beliefs and rituals about dying and death factor in communication.

9. CULTURE AND RELIGION  Religion relates to spiritual beliefs, needs, and practices  influences health and illness practices.  people find comfort and strength during illness.  Hospitals and nursing centers have chapels for prayer and religious services.

10. Religion  A person may want to see a spiritual leader or advisor. Report this to the nurse. Make sure the room is neat and orderly. Provide privacy during the visit. The nursing process reflects the person’s culture and religion

11. Focus on home care: Culture and Religion  Culture is reflected in the home.  Whether rich or poor, treat each person and family with respect, kindness, and dignity.  Do not judge the person’s lifestyle, habits, religion, or culture.

12. APPLICATION TERMINAL ILLNESS EXERCISE

13. ILLNESS  People do not choose sickness or injury.  The physical, psychological, and social effects of sickness and injury include Disabilities may occur.  may be temporary or permanent. Normal activities may be hard or impossible. People often feel angry, upset, and useless. Sick people fear death, disability, chronic illness, and loss of function.  You need to understand the effects of illness.  Sick people are expected to behave in a certain way.  Culture and religion affect how people think and behave when ill

14. PERSONS YOU WILL CARE FOR  People are grouped in health care agencies by their problems, needs, and age.  Mothers and newborns Obstetrics  the branch of medicine concerned with the care of women during pregnancy, labor, and childbirth and for the 6 to 8 weeks after birth.  Women are seen in clinics or doctors’ offices during pregnancy.  When labor begins, mothers usually go to a hospital’s obstetric (maternity) department.  Children Pediatrics  the branch of medicine concerned with the growth, development, and care of children.  range in age from newborns to adolescents.  nursing staff meets the child’s physical, safety, and emotional needs.

15. PERSONS YOU WILL CARE FOR  Adults with medical problems  Medical problems are illnesses, diseases, or injuries that do not need surgery. Acute, chronic, and terminal illnesses can occur.  Persons having surgery Surgical patients need care before and after surgery. Surgeries range from simple to very complex.

16. PERSONS YOU WILL CARE FOR  Persons with mental health problems  Psychiatry concerned with mental health problems. vary from mild to severe mental and emotional disorders Some persons are dangerous to themselves or others.  Persons in special care units  Special care units designed and equipped to treat and prevent life-threatening problems. Special care units include  intensive care units  Coronary care units  kidney dialysis units  burn units  Emergency rooms.

17. PERSONS YOU WILL CARE FOR  Persons needing subacute care or rehabilitation  Subacute and rehabilitation unit meet the needs of persons who:  Need more time to recover than hospital care allows  Need rehabilitation

18. PERSONS YOU WILL CARE FOR  Older persons  Geriatrics concerned with the problems and diseases of old age and older persons. Aging is a normal process Body changes normally occur with aging. Social and psychological changes also occur.

19. FOCUS ON LONG-TERM CARE  older persons need long-term care.  Alert and oriented persons (1) These residents have physical problems. (2) The amount and care required depends on the disability.  Confused and disoriented persons (1) mildly to severely confused and disoriented. (2) Some have Alzheimer’s disease or other dementias  Persons needing complete care. (1) These persons are severely disabled, confused, or disoriented. (2) They cannot meet their own needs.

20.  Short-term residents recover from fractures, acute illness, or surgery. They usually return home.  Life-long residents (1) Some disabilities occur before age 22 (2)Impairments may be physical, intellectual, or both. The person needs lifelong assistance, support, and special services. FOCUS ON LONG-TERM CARE

21. PERSONS YOU WILL CARE FOR  Mentally ill persons Mental illness affects behavior and function. Self-care and independent living may be impaired.  Terminally ill persons The person is dying. The goal is a peaceful, dignified death.

22. THE PERSON’S RIGHTS  The American Hospital Association (AHA) has adopted The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities.

23. Focus on Long-Term Care: The Person’s Rights  Residents have: Rights as United States citizens Rights under OBRA  Centers must protect and promote resident rights.  Residents must be free to exercise their rights without interference.  Some residents are incompetent, Legal representatives exercise rights for these residents.  Residents are informed of their rights: Orally and in writing Before or during admission In the language the person uses and understands

24. COMMUNICATION RECEIVER SENDER

25. COMMUNICATING WITH THE PERSON  Rules of Communication Use words that have the same meaning for you and the person. Avoid medical terms and words that are unfamiliar to the person. Communicate in a logical and orderly manner. Give facts, and be specific. Be brief and concise.

26. Rules of Communication  Understand and respect the patient or resident as a person.  View the person as a physical, psychological, social, and spiritual human being.  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 information.  Repeat information as often as needed.  Repeat exactly what you said.  Ask questions to see if the person understood you.  Be patient.

27. TYPES OF COMMUNICATION  Verbal communication Words are used in verbal communication. Words are spoken or written.  Face the person.  Control the loudness 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. Wait for the answer.  Do not shout, whisper, or mumble.  Be kind, courteous, and friendly.

28. TYPES OF COMMUNICATION  Nonverbal communication Words are not used. Messages are sent with gestures, facial expressions, posture, body movements, touch, and smell. Nonverbal messages more accurately reflect a person’s feelings than words do. Watch the person’s eyes, hand movements, gestures, posture, and other actions. Touch is a form of nonverbal that means different things to different people.  depends on age, gender, experiences, and culture.  Cultural groups have rules or practices about touch.  See the “Caring About Culture (Touch Practices)” page 90 in the textbook.  follow the person’s care plan.

29. COMMUNICATION WITH A PATIENT WHO HAS A DISABILITY  Hearing Problems The written word is used when a person cannot speak or hear. The nurse and care plan tell you how to communicate with the person Persons who are deaf may use sign language  Poor vision. Rules for written messages (1) Keep them brief and concise. (2) Use a black felt pen on white paper. (3) Print in large letters.  Mute Ask questions that have “yes” or “no” answers. Follow the care plan.

30. TYPES OF COMMUNICATION  Body language People send messages through body language.  Facial expressions Gestures Posture Hand and body movements Gait Eye contact Appearance  Some situations require control of body language.

31. Communication methods  Listening Active passive  Paraphrasing Summarizing what the person has said  Direct question Obtain information

32. Communication methods  Open-ended question Invites sharing of thoughts, feelings, or ideas Requires more than yes or no  Clarifying To be sure the message is understood  Focusing Directing the conversation to the topic  Silence Not always necessary to talk

33. Communication barriers  prevent sending and receiving messages.  Using unfamiliar language  Cultural differences  Changing the subject  Giving your opinion Opinions involve judging values, behavior, or feelings. Talking a lot when others are silent  Failing to listen Do not pretend to listen this shows lack of interest and caring. Pat answers the person feel that you do not care about his or her concerns, feelings, and fears.  Illness and disability

34. COMMUNICATION BARRIERS  The person who is comatose is unconscious. Cannot respond to others. can often hear and feel touch and pain. *****Assume that the person hears and understands you.  RULES TO FOLLOW Knock before entering the person’s room. Tell your name, the time, and the place every time you enter Give care on the same schedule every day. Explain what you are going to do. 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 Tell the person when you are leaving the room.

35. THE FAMILY AND VISITORS  BENEFITS help meet safety and security, love and belonging, and self-esteem needs. offer support and comfort. They lessen loneliness. Some help with the person’s care. right to visit with family and friends in private and without unnecessary interruptions.  CAREGIVING WHEN THE FAMILY IS PRESENT Do not expose the person’s body in front of visitors. Treat family and visitors with courtesy and respect. Do not discuss the person’s condition with visitors. Refer questions from visitors to the nurse.

36. BEHAVIOR ISSUES  New as a result of illness  Life-long personality traits  Do not avoid the person  Keep control of your emotions

37. BEHAVIOR ISSUES  Anger Causes Fear  Pain  Dying and death  Loss of function  Loss of control over health and life May be shown verbally or non-verbally Violent behavior can occur

38. BEHAVIOR ISSUES  Demanding behavior Nothing seems to please the person. critical of others. Causes of demanding behavior  Loss of independence  loss of health  loss of control of life  Unmet needs

39. BEHAVIOR ISSUES  Self centered behavior cares only about his or her own needs. demands the time and attention of others

40. BEHAVIOR ISSUES  Aggressive behavior Includes  Swearing  Biting  Hitting  Pinching  Scratching  kicking Causes  Fear  Anger  Pain  dementia Protect the person, others, and yourself from harm

41. BEHAVIOR ISSUES  Withdrawal little or no contact with others may signal  physical illness  depression.

42. BEHAVIOR ISSUES  Inappropriate sexual behavior Make inappropriate sexual remarks Touch others Disrobe or masturbate in public  behaviors may be on purpose  May be a result of  Disease  Confusion  dementia  drug side effects.

44. Care Planning Considerations Mrs. Sarah Stein was admitted to Pine Crest Nursing Center today. She is an 80-year-old widow of the Jewish religion. She came to America from Germany with her parents when she was 12 years of age. She speaks German and English fluently. She was a college professor and taught at the local university for 20 years. She was married for 55 years. Her husband died 2 years ago. Mrs. Stein is hard of hearing and has poor vision. She walks with a cane. Before coming to Pine Crest Nursing Center, she lived with her married daughter for 2 years. Her daughter believed it was no longer safe for her mother to live with her because she was alone most of the day while the daughter and her husband were at work. Mrs. Stein had fallen twice during the last month. Answer the following questions: 1. How might Mrs. Stein’s culture affect her care plan? 2. How might Mrs. Stein’s religion affect her care plan? 3. How might the RN meet the following needs of Mrs. Stein:  Physical needs?  Safety and security needs?  Love and belonging needs?  Self-esteem needs?  Self-actualization needs? 4. What feelings might Mrs. Stein have about moving to Pine Crest? 5. What needs might Mrs. Stein’s daughter have?