Transcript: Attending ATTENDING Attention Focus on One Element Average person speaks at the rate of 150 words per minute Listeners can understand messages at the rate of 380 words per minute You have to learn to focus your attention to message Do You Know GET PHYSICALLY READY TO LISTEN Physical Environment Ready to Listen Eye Contact Use Of Voice TECHNIQUES OF ATTENDING Techniques of Attending Resist Mental Distractions Resist Mental Distraction Visual Auditory Physical Distraction Hear a person before you react Hear a Person Before You React Let the person end his conversation We Stop Listening person because of their mannerisms or words turn us off. Need to Learn the Value of Patience and Silence Resist Interrupting Others RESIST INTERRUPTING OTHERS Let the person finished his talk. Good Listners resist interrupting others. Non Verbal Cues Observe Non Verbal Cues Tone Of Voice Tone of Voice Body Actions Body Actions Facial Expression Facial Expression CONCLUSION CONCLUSION THANK YOU
Transcript: What is active listening? LISTENING Interrupt the person talking Cut the conversation short Invalidate someone's feelings Barriers of Attending/ Active Listening NON-VERBAL Attending/Active Listening Shows respect Facilitates disclosure Shows understanding Diffuses potential conflict Improves critical thinking Improves retention Combine eye contact with smiles and other non-verbal messages to encourage the speaker Refrain from fidgeting, looking at a clock or watch, doodling, playing with their hair or picking their fingernails Show empathy, comprehension and interest Know when to just be present and when words are not needed How Does Attending/Active Listening Relate to Nursing? The Do's and Don'ts of Active Listening https://www.playfactile.com/k2l4cowrrq/play Attending is defined as being present in the moment. Advantages of Attending/ Active Listening VERBAL DON'T: ACTIVE What is attending? Remembering Questioning Reflecting Clarifying Summarizing “Active listening is the process by which an individual secures information from another individual or group. The “active” element involves taking steps to draw out details that might not otherwise be shared.” Smiling Making eye contact Posture Mirroring Avoiding distractions ATTENDING/ Characteristics of Attending/ Active Listening Influences relationships with clients in a positive manner establishes therapeutic relationships and rapport with clients allows the nurse to be empathetic helps empower and motivate the client allows client to feel valued and understood DO: Nicole Travis, Stephanie Finlay, Rachelle Allen and Jesse Rivera. Language barriers Distractions (cell phones, sounds, etc.) Personal perspective Culture Jargon Interactive Activity
Transcript: 67 year old male weight 170 lbs height 5'5" Reason for Admission (4/02/2012) Resection of Gastro Esophageal junction carcinoma diabetes type II (12/05/2008)-present hyperlipidemia (12/05/2008)-present gout (12/05/2012)-present hypertension (12/05/2008)-present Parkinson's disease (12/05/2008)-present nuclear sclerosis (9/22/2010)-present prostate cancer (10/26/2010)-present GE junction carcinoma-(12/27/2011)-present Radiation started 1/17/2012 and completed 2/15/2012 dysphagia (12/27/2011-3/28/2012)-resolved dehydration (2/07/2012-3/28/2012)-resolved Hypocalcemia (4/03/2012)-present Vitals (4/02/2012) blood pressure 123/21 pulse 69 temperature 98.8 respirations 12 spO2 93% amantadine (parkinson's disease) carbidopa-levodopa (parkinson's disease) epinephrine (adrenaline) injection insulin levalbuterol (xopenex) methylnatrexone (treat constipation) nalbuphine (nubain) (relieves pain) pantoprazole (treat damage to esophagus) pramipexole (parkinson's disease) vancomycin (antibiotic) furosemide (diuretic) cefazolin (treat bacterial infection) Continous infusions during surgery norepinephrine naloxone (reverse effects of narcotic drugs during surgery) bupivacaine (anesthetic) lactated ringers (sterile irrigation of body cavities) dextrose (use when additional fluids are needed) epidural T-6 -7 (pain)-current Procedures during hospitalization Esophagogastrectomy (primary) CT chest (4/04/2012) pneumonia versus atelectasis moderate left pleural effusion two right chest tubes with tiny right anterior pneumothorax Sputum culture collection (04/04/2012) and resulted (04/06/2012) specimen source: Bronchial wash culture report: many Staphylococcus aureus Lab results (4/03/2012) creatine 0.9 BUN 16 NA 138 K 4.1 CO2 26 WBC 10.3 HGB 11.1 PLT 125 ABG ( 4/04/2012) ph 7.39 po2 60.1 pCO2 47.5 HCO3 28.3 Base 2.7 Lab results (4/04/2012) creatinine 0.9 BUN 14 NA 136 K 4.2 CL 101 CO2 30 WBC 8.1 HGB 10.3 PLT 122 CBC 4/05/2012 WBC 8.5 RBC 3.45 Hgb 10.5 PLT 124 Neutrophils 7.61 lymphocites 0.18 monocytes 0.70 basophils 0.01 Rt involvement (4/06/2012) Patient was on 1 l/min NC SpO2 pre 91% post 98% Pulse pre 104 post 94 Levalbuterol (xopenex) nebulizer solution 0.63mg q4h order for chest physioterapy Qid, discontinued that day and started Acapella Diagnosis Cancer of esophagus 2 chest tubes on R lung LLL and RLL collapsed Any questions besides Shawn Medical History Patient Presentation allergies lisinopril (treats high blood pressure) Medications By Karla Arias Admission patient was admitted to ICCU on (04/02/2012) Resection of gastroesophageal carcinoma
Transcript: Life History Born in Manti, UT 3 brothers and 3 sisters Married at one time, currently single Raised 2 sons and a daughter on her own worked multiple jobs low income (Medicaid) Support System Son- working 2 jobs and wife not willing to help with JH Son- house not adaptable to wheelchair Daughter- little contact History of Present Illness Admitted from Mt. View Hospital Having trouble living on her own- wasn't managing diabetes well, having pain with prosthesis, paranoid, poor health (shortness of breath, dysuria, cellulitis of right leg) PCP recommended a short term nursing home stay a couple weeks turned into over a year Tried to discharge twice. 1st time- home overnight, couldn't get up to go to the bathroom, in chair for 12-15 hours 2nd time- got home, could not bear her weight and collapsed getting out of car...son helped her up and she asked if he could take her back to nursing home. Acute & Chronic Conditions Type II Diabetes Hypertension Congestive Heart Failure Liver Cirrhosis Neuropathy Arthritis Umbilical Hernia Sleep apnea Left above knee amputation Glaucoma Insomnia GERD Time with Client Challenging Spent: administering meds, physical assessment, talking with her, the "Dirty Work" Pressure Ulcer Goals- Improved skin integrity and patient more compliant with care plan Interventions- turn q 2 hours, pressure-reducing mattress, monitoring site for any changes in size/color, patient education, assessing why patient is not compliant Outcomes Improved skin integrity Increasing patient compliance Did NOT turn q 2 hrs Uses pressure reducing mattress Able to examine ulcer during brief changes Assessed why patient isn't compliant (doesn't feel ulcer, tiring to turn in bed) Patient Education (importance of turning and keeping site clean/moist) Spiritual Assessment LDS entire life Doesn't get out of bed for church Bring sacrament to her Evidence Based Issue Pressure Ulcers and the Effectiveness of the Pressure- Redistributing Mattresses Knowledge Pressure Ulcer Care Medications (antihypertensives such as Zaroxolyn and Zestril and analgesics such as Methadone and Percocet) Skills Insulin injections Brief changes Bed linen change Heart/Lung Assessment Sample of 60 high-risk patients 65% had existing wounds 5-month period using PRM Although 1.6% developed erythema in sacral area, 69% had improved or healed wounds Journal of Tissue Viability "The Value of Systematic Evaluation in Determining the Effectiveness and Practical Utility of a Pressure- Redistributing Support Surface" Caring/Personal Growth I've learned... Patience Optimism Gratitude Love Knowledge Pressure Ulcer Care Initial Diagnoses Imbalanced Nutrition Impaired Skin Integrity Conclusions Of the 1,959 persons, 83.62% had a Braden scale rating of 6-12 and 43.62% had ulcers 54.62% ulcers improved 7.6% ulcers progressed Compare/Contrast The use of pressure relieving mattresses is a current evidence-based practice and can be seen in the nursin home in the case of JH. Caring Moments Sitting and talking with her about her family (but not in great detail) Watching "Price is Right" with her Demographics 56-year-old Caucasian Female My Care What I Learned Professioni Infermieristiche "Prevention of Pressure Ulcers: Retrospective Study Regarding the Effectiveness of an Alternate Pressure Device" Patient Presentation Evaluated use of APM's in terms of: 1) Risk Factors (Braden Scale) 2) Duration of Mattress usage 3) Description of lesions at beginning 4) Changes in lesions by the end Caring Strategies Keeping her company (talking, watching TV) Bringing her milk and ice Irritated when treated "like a baby" Being gentle (complains that the nurses are rough with her)
Transcript: Patient Portal Utilization Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities Engage patients and family Improve care coordination, and population and public health Maintain privacy and security of patient health information Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs. Two metrics: Patient Electronic Access 1: 50% target Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely access to view online, download, and transmit to a third party their health information subject to the EP's discretion to withhold certain information. Patient Electronic Access 2: 5% target For an EHR reporting period in 2017, more than 5 percent of unique patients seen by the EP during the EHR reporting period (or his or her authorized representatives) view, download or transmit to a third party their health information during the EHR reporting period. “When patients interact with their test results, they need to know the purpose of the test, the interpretation of the result, and next steps. Addressing these issues may help improve patient-centered care” (Baldwin, Singh, Sittig, & Giardina, 2016). References 2016 Program Requirements. Retrieved September 25, 2016, from https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2016ProgramRequirements.html Baldwin, J. L., Singh, H., Sittig, D. F., & Giardina, T. D. (2016, October). Patient portals and health apps: Pitfalls, promises, and what one might learn from the other. In Healthcare. Elsevier. Eschler, J., Liu, L. S., Vizer, L. M., McClure, J. B., Lozano, P., Pratt, W., & Ralston, J. D. (2015). Designing Asynchronous Communication Tools for Optimization of Patient-Clinician Coordination. In AMIA Annual Symposium Proceedings (Vol. 2015, p. 543). American Medical Informatics Association. Heyworth, L., Paquin, A. M., Clark, J., Kamenker, V., Stewart, M., Martin, T., & Simon, S. R. (2014). Engaging patients in medication reconciliation via a patient portal following hospital discharge. Journal of the American Medical Informatics Association, 21(e1), e157-e162. Snyder, E., & Oliver, J. (2014). Evidence based strategies for attesting to Meaningful Use of electronic health records: An integrative review. Available in the. Online Journal of Nursing Informatics (OJNI), 18(3). Wade-Vuturo, A. E., Mayberry, L. S., & Osborn, C. Y. (2013). Secure messaging and diabetes management: experiences and perspectives of patient portal users. Journal of the American Medical Informatics Association, 20(3), 519-525. Wilcox, L., Patel, R., Back, A., Czerwinski, M., Gorman, P., Horvitz, E., & Pratt, W. (2013, April). Patient-clinician communication: the roadmap for HCI. In CHI'13 Extended Abstracts on Human Factors in Computing Systems (pp. 3291-3294). ACM. Stage 3 and MACRA Meaningful Use and the Patient Portal Literature “regular internet use and having a personal computer partially accounted for differences in use of the portal to send messages to health care providers by age, race, and income, whereas education and sex-related differences remained statistically significant even after controlling for internet access and care preference” (Graetz, Gordon, Fung, Hamity, & Reed, 2016). Meaningful Use Usability and Functionality Wanjiku Kariuki Viola B. Leal Mohammad Tabatabai Ana Ibarra Noriega MyUofMHealth.org Secure Messaging “over two-thirds had at least one medication discrepancy at discharge, and nearly one-third had at least one potential ADE” (Heyworth et al., 2014). The authors found that “virtual medication reconciliation following hospital discharge has the potential to improve medication safety in the transition from inpatient to outpatient care” “more effort on the part of the provider is needed to encourage patients to use a portal system. If providers take a more active role in educating patients as to the benefit of the portal, provide a positive view of the system, provide consistent standardized information, and remind the patients in multiple ways and times, patients are more likely to enroll in the portal system” (Snyder & Oliver, 2014). Objective 8: Patient Electronic Access (VDT) Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP. Patient Portal Metric Provider Buy-in Portal on Newer Internet Browser Lab Test Results DMC Patient Portal “patient and provider attitudes toward patient portal use found that the most negatively-perceived feature was user-friendliness, making the portal difficult to navigate” (Baldwin, Singh, Sittig, & Giardina, 2016). “When patients interact with their test results, they need to know the purpose of the test, the interpretation of the
Transcript: Attendant Career Research Flight Educational Requirements 01 High School degree or equivalent Some airlines prefer applicants who have taken college courses (tourism and hospitality) Must be certified by the Federal Aviation Administration Required Skills 02 Organized Attentive Communication skills Decision making skills Airlines set height, weight and age requirements Certain physical abilities are required Salary 03 Salary is affected by experience level, location and airline company. Average salary: $56,000 yearly Entry level salary: $18,000 to $20,000 yearly Average maximum salary: $86,000 yearly Most airlines offer a standard raise for every year of service. Job Duties 04 Responsible for ensuring passenger's safety and comfort at all times Ensure that emergency equipment is working, cabin is clean and that there is enough food and beverages for the passengers. Average amount of hours a flight attendant works is 80 to 90 hours a month Maximum amount of hours is 100 hours a month. Work Time This profession is available in most countries. Job Benefits 05 Flexible work schedules Free accommodations while on the job Per diem and daily food allowance Health insurance Retirement savings plan(401K) Free/reduced travel discounts(tickets, hotels, etc.) Low salary Being away from home Long flights Working on holidays Being on call until having enough seniority Downsides of being a flight attendant
Transcript: Attending behavior in counseling Angel Shrestha Introduction ATTENDING Attending is the behavioural aspects of building rapport. When counsellor first meets with a client, they must indicate to the client that they are interested in listening to them and helping them. Through attending, the counsellor is able to encorage the client to talk and open about their issues. Service Several components of good attending behavior Solution POSTURE This is natural response of interest. It's best to lean slightly towards the person in a relaxed manner. relaxation is important,to focus from yourself so that you are better able to listen to the person you are talking with. looking at the person is one way of showing interest in that person. If you stare at them they may feel uncomfortable and forget the things what he/she wants to say or may not tell you the whole story. The best way of showing that you are listening to someone is by looking at them naturally. Eye Contact Solution Gesture Strategy Competitive Advantages A movement of part of body, especially a hand or the head, to express an idea and meaning. If you flail widly with your hands or if you cross your arm over your chest and lunch your shoulders with your head bent downwards, you are very likely communicate some uniteneded messages. Facial expression Case Study Facial expression is one or more motions or position of the muscle beneath the skin of the face. A good listener facial expression indicate responsiveness. example: smiling, eye-brow raising, frowning, when appropriate Q&A Verbal behavior A good listener comments relate to what the other person is saying.
Transcript: Thinking points Decreased albumin production Increased a-1-AGP Possible p-450 reduction Increased liver/renal flow 49 yo female admitted with 86% TBSA burn (80% 3rd degree). > 5 month ICU stay. Multiple infections and antibiotic courses PMH Hypothyroidism Adrenal insufficiency SH 1/2 pack/d smoker FH Negative Allergies None Phases of Thermal Injury Phases of Thermal Injury Clinical Presentation Blood culture results 10/30 P. aeruginosa Tobramycin 400 mg Iv q24h Antibiotics in burn patients : Pharmacokinetic considerations Clinical Presentation Clinical Presentation Phases of Burn Injuries Increased blood flow Antibiotics (11/9) Fluconazole 800 mg IV q24h Tobramycin 400 mg Iv q24h Phase 2 cont. Increased blood flow and reduced albumin production results in an increase is elimination of highly protein bound antibiotics. Ertapenem Daptomycin Ceftriaxone Nafcillin Phase 1 (<48-72 hr) Hypovolemia Vascular Hyperpermeability Negative interstitial pressure Low CO/GFR Phase 2 (>48-72 hr) Hypermetabolic Increased contractility/CO Low vascular resistance Increased liver/renal flow Clinical Presentation Phase 2 (>48-72 hr) Hypermetabolic Increased contractility/CO Low vascular resistance Increased liver/renal flow
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