Unit 2: Introduction to the Patient

1. Unit 2: Introduction to the Patient Competent Healthcare Basic Nurse Assistant Training Program

2. Understanding the Person

3. Key Terms • Obesity • Obstetrics • Optimal level of function • Paraphrasing • Pediatrics • Psychiatry • Religion • Self-actualization • Self-esteem • Verbal communication • Bariatrics • Body language • Comatose • Culture • Disability • Esteem • Geriatrics • Holism • Morbid obesity • Need • Nonverbal communication

4. Caring for the Person • The patient or resident is the most important person in the agency. • For effective care, you must consider the whole person. • Holism is a concept that considers the whole person. The whole person has physical, social, psychological, and spiritual parts. These parts are woven together and cannot be separated. • Each part relates and depends on the others • Disability and illness affect the whole person

5. Example • Mrs. Beal had a stroke. She needs help with physical needs. She had to leave her home. Relationships with her husband and children are changed. She is angry with God for letting this happen to her. The health team plans care to help her deal with her problems.

6. Addressing the Person • Call the patients and residents by name and not room number • Call patients and residents by their titles, Mr. or Mrs. etc. • Do not call patients and residents by their first names unless they ask you to. • Do not call patients and residents by any other name unless they ask you to • Do not call patients and residents Grandma, Papa, Sweetheart, Honey or other names

7. Basic Needs • A need is something necessary or desired for maintaining life and mental well-being. • According to Abraham Maslow, a famous psychologist, basic human needs must be met for a person to survive and function. In this theory, needs are arranged in order of importance. Lower-level needs must be met before the higher-level needs. • People normally meet their own needs. When they cannot, it is usually because of disease, illness, injury, or advanced age.

8. Maslow’s Hierarchy of needs

9. Physical Needs • Oxygen, food, water, elimination, rest, and shelter are needed for life and to survive. • A person dies within minutes without oxygen. • Without food or water, a person feels weak and ill within a few hours. The kidneys and intestines must function. Otherwise, poisonous wastes build up in the blood and can cause death. • Without enough rest and sleep, a person becomes very tired. • Without shelter, the person is exposed to extremes of heat and cold.

10. Safety and Security Needs • Safety and security needs relate to feeling safe from harm, danger and fear. • People feel safer and more secure if they know what will happen. • For every task the person should know: • Why it is needed? • Who will do it? • How it will be done? • What sensations to feel or expect?

11. Love and Belonging Needs • Love and belonging needs relate to love, closeness, and affection. They also involve meaningful relationships with others. • There are cases in which people become weaker or died from the lack of love and belonging.

12. Self-Esteem Needs • Esteem is the worth, value, or opinion one has of a person. • Self esteem means to think well of oneself and to see oneself as useful and having value. • People often lack self-esteem when ill, injured, older, or disabled. • Example: an older man once built his own home and worked a farm. He supported and raised a family. Now he cannot dress or feed himself.

13. The Need for Self-Actualization • Self-actualization means experiencing one’s potential. It involves learning, understanding, and creating to the limit of a person’s capacity. • This is the highest need • Rarely, if ever, is it totally met. • Most people constantly try to learn and understand more. • This need can be postponed, and life will continue.

14. Culture and Religion • Religion relates to spiritual beliefs, needs and practices • Consists of beliefs about: • Daily living • Behaviors • Relationships • Diet • Healing • Days of worship • Birth and birth control • Death and drugs • Culture is the characteristics of a group of people. • Passed from one generation to the next • Consists of: • Language • Value • Beliefs • Habits • Likes • Dislikes • Customs

15. Religion • Many people find comfort and strength from religion during illness. They may want to pray and observe religious practices. • Assist the person to attend services as needed. • If a person wants to see a spiritual advisor, tell the nurse. • You must respect and accept the person’s culture and religion. This helps you give better care.

16. Effects of Illness and Disability • A disability is any lost, absent or impaired physical or mental function. • Can be temporary or permanent • Normal activities such as work, driving, fixing meals, hobbies may be hard or impossible. People often feel angry, upset, and useless when unable to perform them. These feelings may increase if the person needs help with routine functions.

17. Effects of illness and disability • Fears of death, disability, chronic illness, and loss of function are common. Some people explain why they are afraid, others do not. • Anger is a common response to illness and disability. Persons who need nursing center care are often angry. The person may direct anger at you. However, the person is usually angry at the situation. You might have problems dealing with the person’s anger. If so, ask the nurse for help

18. What you can do • You can help the person feel safe, secure, and loved. • Take an extra minute to “visit”, to hold a hand, or to give a hug. (remembering professional boundaries) • Show that you are willing to help with personal needs. Respond promptly. Treat each person with respect and dignity.

19. Optimal Level of function • Patients and residents are helped to maintain the highest potential for mental and physical performance. • Encourage the person to be as independent as possible. Always focus on the person’s abilities • Do not focus on disabilities. This reduces quality of life • You must help each person regain or maintain as much physical and mental function as possible.

20. Persons You Will Care For • Obstetrics is the branch of medicine concerned with the care of women during pregnancy, labor, and childbirth and for 6 to 8 week after birth. • Pediatrics is the branch of medicine concerned with the growth, development, and care of children. They range in age form newborns to teenagers. • Medical-adults with medical problems are illnesses, diseases and injuries that could be acute, chronic, or terminal and do not need surgery.

21. Persons you will care for • Surgical-these patients need care before and after surgery. • Psychiatric- person with mental health problems vary from mild to severe mental and emotional disorders. • Special care units are designed and equipped to treat and prevent life-threatening problems.

22. Persons you will care for • Persons needing sub-acute care or rehabilitation need more time to recover then hospital care allows. • Geriatrics is the branch of medicine concerned with the problems and diseases of old age and older persons. Aging is a normal process. It is not an illness or disease.

23. Persons you will care for • Bariatrics is the field of medicine focused on the treatment and control of obesity. • Obesityis having an excess amount of total body fat. A person is said to be obese when his or her weight is 20% or more above what is considered normal for that person’s height and age. • Morbid obesity means that the person weights 100 pounds or more over his or her normal weight. • Bariatric patients are at risk for many serious health problems.

24. Communicating with the Person • For effective communication • Follow the rules • 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 the information • Repeat as often as needed • Ask questions • Be patient • Include the person

25. Verbal Communication • Face the person • Position yourself at the person’s eye level • 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 • Do not shout, whisper or mumble • Be kind, courteous and friendly

26. Written Communication • Use written word when the person cannot speak or hear but can read. • When writing messages: • Keep them brief and concise • Use black felt pen on white paper • Print in large letters Some persons cannot speak or read. Ask questions that have “yes” or “no”. Persons who are deaf may use sign language.

27. Nonverbal Communication • Does not use words. 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. • Sometimes they tell you more than words.

28. Touch • Touch is a very important form of nonverbal communication. It conveys comfort, caring, love, affection, interest, trust, concern and reassurance. • Some people do not like to be touched. However, touch can show caring and warmth. • Remember to maintain professional boundaries.

29. Body Language • People send messages through their body language; • Facial expressions • Gestures • Posture • Hand and body movements • Gait • Eye contact • Appearance

30. Control you reaction! Your body language should show interest and enthusiasm. It should show caring and respect for the person. Often you will have to control your body language. Control reactions to odors from body fluids, secretions, excretions, or the person’s body. • Many odors are beyond the person’s control. • Embarrassment and humiliation increase if you react to odors.

31. Communication Methods • Means to focus on verbal and non verbal communication. • You use sight, hearing, touch, and smell. • You focus on what the person is saying, observe nonverbal cues. • Mrs. Hays says, “I want to stay here. That way my son won’t have to care for me.” • You see tears, and she looks away from you. • Her verbal says happy. Her nonverbal say sadness. Listening Example

32. Show interest • Face the person • Have good eye contact • Lean toward the person. Do not sit back with your arms crossed. • Respond to the person. Nod your head. Say “uh huh,” “mmm,” and “I see.” • Avoid communication barriers

33. Communication methods • Restating the person’s message in your own words. • You use fewer words then the person did. • It shows you are listening, lets the person know you understand, and promotes further communication. • Mrs. Hays: My son was crying after he spoke with the doctor. I don’t know what they talked about. • You: you don’t know why your son was crying? • Mrs. Hays: the doctor must have said that I have a tumor. Paraphrasing Example

34. Communication Methods • Focus on certain information. You ask the person something you need to know. • Some direct questions have “yes” or “no” answers. • Others require more information • You: Mrs. Hays, do you want a shower this morning? • Mrs. Hays: yes • You: when would you like to do that? • Mrs. Hays: could we start in 15 minutes? Direct questions Example

35. Communication methods • Lead or invite the person to share thoughts, feelings, or ideas. • The person chooses what to talk about • He or she controls the topic and the information given • Require more than a “yes” or “no” • “What do you like about living with your son?” • “What was your husband like?” • “What do you like about being retired?” Open-ended question Example

36. Lets you make sure that you understand the message. You can ask the person to repeat the message, say you do not understand, or restate the message. • “Could you say that again? • “I’m sorry, Mrs. Hays. I don’t understand what you mean.” • “Are you saying that you want to go home?” Clarifying Example

37. Communication methods • Dealing with a certain topic. It is useful when a person rambles or wanders in thought. • Example: Mrs. Hays talks at length about food and places to eat. You need to know why she did not eat much breakfast. To focus, say: “lets talk about breakfast, you said you don’t feel like eating.” • A very powerful way to communicate. Just being there shows you care. • Gives time to think, organize thoughts or choose words. • Dealing with silence gets easier as you gain experience in your role. Focusing Silence

38. Communication Barriers • Using unfamiliar language • Cultural differences • Changing the subject • Giving your opinion • Talking a lot when others are silent • Failure to listen • Pat answers (“don’t worry” “everything will be okay”, “Your doctor knows best”) • Illness and disability • Age

39. Persons with disabilities • You will care for many people with disabilities. Your attitude is important for effective communication. • People with disabilities have the same basic needs as you and everyone else. They have the right to dignity and respect just like you and everyone else.

40. The Person who is Comatose • Comatose means being unable to respond to verbal stimuli • This person is unconscious, cannot respond. • Often can hear and feel touch and pain • Assume that the person hears and understands you • Knock before entering the room • Introduce yourself • Give care at the same time each day • Explain what you are going to do • Tell them you are leaving the room and what time you will be back to check on them • Use touch to communicate care, concern, and comfort

41. Family and friends • Help meet safety and security, love and belonging, and self-esteem needs. They offer support and comfort. • Some help with the person’s care • The person has the right to visit with family and friends in private and without unnecessary interruptions. • Ask visitors to leave the room and tell them when they can return. • If the resident consents a family member can stay and may assist with care. • Do not discuss the person’s condition with them, refer questions to the nurse.

42. Behavior Issues • Aggressive behavior: the person may swear, bite, hit, pinch, scratch, or kick. Fear, anger, pain and dementia are causes. • Protect the person, others and yourself from harm. • Withdrawal is when the person has little or no contact with family, friends, and staff. Spends time alone and does not take part in social or group events. • Inappropriate sexual behavior. Some people make inappropriate sexual remarks. Or they touch others in the wrong way. • Some disrobe or masturbate in public. Some behaviors are not pleasant. You cannot avoid the person or lose control.

43. Behavior Issues • Anger is a common emotion. Causes include fear, pain, and dying and death. • Loss of function and loss of control over health and life are causes. • Verbal outburst, shouting, violence can occur. • Demanding behavior is when nothing seems to please the person. He or she wants care given at a certain time and in a certain way. • Self-centered behavior is when the person cares only about his or her own needs. The needs of others are ignored. The person demands the time and attention of others and becomes impatient if unmet.

44. Growth and Development

45. Key Terms • Menopause • Peer • Primary caregiver • Puberty • Reflex • Sexual orientation • Adolescence • Development • Developmental task • Ejaculation • Growth • Infancy • Menarche

46. Bodies grow, Brains develop • It is hard to see the start and end of each stage. • The rate of growth and development varies with each person. • The primary caregiver is the person mainly responsible for providing or assisting with the child’s basic needs. • You will care for people of all ages that are in different stages of growth and development. • Growth and development are presented in stages. The stages overlap.

47. Principles • Growth is the physical changes that are measured and that occur in a steady and orderly manner. • Measured in height, weight and changes in appearance and body function. • Development relates to changes in mental, emotional, and social function. • A person behaves and thinks in certain ways in each stage of development

48. Growth and development • Overlap • Depend on each other • Occur at the same time

49. Principles • The process starts at fertilization and continues until death. • The process proceeds from the simple to the complex: Sit Stand Walking Running • The process occurs in certain directions • From head to foot and from center of body outward • The process occurs in a sequence, order and pattern. • A developmental task is a skill that must be completed during a stage of development. • A stage cannot be skipped. Each stage is the basis for the next stage. • The rate of the process is uneven. It is not at a set pace. • Each stage has its own characteristics and development

50. Infancy (Birth to 1 year) • The first year of life • Growth and development are rapid during this time. • Developmental tasks are: • Learning to walk • Learning to eat solid foods • Beginning to talk and communicate with others • Beginning to have emotional relationships with parents, brothers, and sisters • Developing stable sleep and feeding patterns