1. Solving Problems Together

2. OBJECTIVES At the end of this Lecture the student will be able to 1. Discuss the use of face work and politeness theory in approaching client. 2. Discuss mutual problem solving to involve the client in implementation of nursing process. 3. Complete exercises to practice a mutual problem-solving approach to the nursing process. 4. Examine the steps in making contracts with clients. 5. Participate in exercises to build skills in solving problems with clients.

3. Face Work and Politeness T heory The out come of the client-nurse interaction depends on nurses ability to engage the client in decision making and share the control and power in the relationship. Nurses build their communication skills by study and practice of techniques, trial and error, observation of role models, experience, and achievement of comfort with the use of their own intuition.

4. Defining the Difference Between Problem Solving and Mutual Problem Solving in Nursing A.Problem Solving: The Nursing Process. 1.Assessment. 2.Diagnosis. 3.Planning. 4.Implementation. 5.Evaluation.

5. The Mutual Problem-Solving Process in Nursing VALIDATION ● Validation makes the difference between problem solving for client and mutual problem solving with client. ● Incorporating validation keeps us focused on the right and obligation of clients to make their own decision about their health.

6. A mutual problem-solving process in nursing looks like this I. Assessment. A. Collection data regarding the clients, clients family system, or community. B. Identifying needs, problems, concerns, or human responses. II. Diagnosis A. Analyzing data. B. Validating interpretation of data with clients. C. Identifying nursing diagnosis. D. Validating the nursing diagnosis with the clients.

7. III. Planning A. Setting priorities for resolution of identified problems with clients. B. Determining expected and desired out-comes of nursing action in collaboration with the clients. C. Writing nursing intervention to achieve these out comes in collaboration with the clients. IV. Implementation.. A. Implementing nursing action with assistance from the clients. B. Encouraging clients participation in carrying out nursing action to achieve the outcomes. C. Continuing to collect data about the clients condition and interaction with the environment. V. Evaluation.. A. Evaluating the outcomes of nursing care in consultation with the clients. B. Ongoing evaluation to revise the nursing care plan.

8. Incorporation of Validation into the Nursing Process The example given in the following subsections illustrated suggested methods for ensuring maximal client participation in the mutual problem solving approach. 1-Validating interpretation of collected data. 2-Identifying actual or potential problems with the client. 3-Validating the nursing diagnoses with client. 4-Setting priorities with the client for resolution of identified problems.

9. Incorporation of Validation into the Nursing Process 5-Determining expected and desired out-comes of nursing actions in collaboration with client. 6-Deciding on the nursing strategies to achieve these outcomes in collaboration with the client. 7-Implementing nursing action with assistance from the client and encouraging client participation in carrying out nursing actions to meet the outcomes. 8-Evaluating the outcomes of nursing care in consultation with client.

10. BENEFITS OF MUTUALITY THAT GO BEYOND THE CLIENT-NURSE DYAD -Nurses and clients gain trust in each other as human being and their own ability to relate effectively in the helping relationship. -The clients who more active role in their treatment recover faster.

11. WAYS TO MAKE CLINICAL PROBLEM SOLVING A MUTUAL AFFAIR 1.Explore what you believe about the issue of clients having an active part in their health care. 2. Practice revealing your opinions to clients. 3. Avoid giving nursing care without checking with your clients to see where they would like to start. 4. Do not negotiate nursing strategy if there is in fact no choice for your client.

12. 5) Before you do something for your clients, ask yourself: - Could my clients be doing this (turning, transferring, making a telephone call. -Speaking to a relative, making a bed, changing a dressing) for themselves? -By doing for our clients we rob them of the opportunity to dis-cover their own power to take care of themselves. 6. Remember to evaluate with your clients. 7. Keep in mind that validating is an assertive act.

13. Elements of a Client-Nurse Contract Once you have mastered the skills of validation and mutual problem solving, you have the basic ingredients for making a contract with your client. The following is a list of components of a client nurse contract for you to adapt to your workplace: 1. Names of client and nurse. 2. Purpose of the client-nurse relationship. 3. Roles of client and nurse. 4. Responsibilities of client and nurse. 5. Expectations of client and nurse. 6. Specific details such as meeting times and structure for confidentiality. 7. Conditions for termination.