NCM_103

• Primary prevention aims to prevent the occurrence of disease or injury and to promote health and well-being to prevent its spread to other people
• Tertiary prevention


  It begins early in the period of recovery from illness and consists of such activities as: consistent and appropriate administration of medications to optimize therapeutic effects, moving and positioning to prevent complications of immobility and active/passive exercises to prevent disability, minimizing residual disability and helping the client learn to live productively with limitations, intensive, periodic follow up and treatment
• Levels of Care


  • Health Promotion
  • Disease Prevention
  • Health Maintenance
  • Curative
  • Rehabilitative
• Illness


  Highly personal state in which the person feels unhealthy or ill
• Disease


  Alteration in body functions resulting in reduction of capacities or a shortening of the normal lifespan
• Sickness


  A status of social entity that is usually associated with disease or illness but can occur independently, determined by 3 distinct criteria: presence of symptoms, perception of how one feels, activity to carry out daily activities
• Classification of diseases according to etiologic factors

  • Hereditary defect in the genes of the parent which transmitted to the offspring
  • Congenital defect in the development
  • Metabolic disturbance in the intricate process of metabolism
  • Deficiency inadequate intake / absorption of essential dietary factors
• Acute illness


  Short duration & is severe, the signs & symptoms appear abruptly, are intense & often subside after a relatively short period
• Chronic illness


  Usually longer than six months, Client may fluctuate between maximal functioning & serious relapse that may be life threatening
• Types of Health Promotion Programs

  • Information Dissemination
  • Health Appraisal & wellness assessment Programs
  • Lifestyle & Behavior Change Programs
  • Worksites Wellness Programs
  • Environmental Control Programs
• Communication


  The act or reciprocal process of imparting or interchanging thoughts, attitudes, emotions, opinions, or information by speech, writing, or signs
• Effective communication


  • It is two way, it involves active listening, it reflects the accountability of speaker and listener, it utilizes feedback, it is free of stress, it is clear
• Therapeutic communication


  A process in which the nurse consciously influences or helps a client or helps the client to a better understanding through verbal or nonverbal communication, using specific strategies that encourage the patient to express feelings and ideas and that convey acceptance and respect
• Purposes of therapeutic communication

  • Establishing a therapeutic provider-client relationship
  • Identify client's concerns and problem
  • Assess client's perception of the problem
  • Recognize client's needs
  • Guide client towards a satisfying and socially acceptable solutions
• The "DOS" of effective therapeutic communication

  • Provide/select a private, quiet, safe environment
  • Listen twice as much as you speak
  • Think of the unique situation before responding
  • Acknowledge and build a positive self-regard
  • Use simple, clear and direct communication
  • Be appropriate in communication
  • Be alert and responsive to small changes
  • Observe all non-verbal cues
  • Be non-judgmental
  • Allow the client to proceed at his/her pace
  • Accept people as they present themselves
  • Provide an atmosphere for the exploration of thoughts and feelings
  • Remember the potential for growth and healthy living
• Techniques of therapeutic communication

  • Acknowledging
  • Being specific and tentative
  • Using touch
  • Using silence
  • Providing general leads
  • Presenting reality
  • Restating or paraphrasing
  • Using open-ended questions
  • Offering self
  • Clarifying time or sequence
  • Focusing
• Modes of communication


  • Verbal messages
  • Nonverbal messages
  • Paraverbal messages
• To communicate effectively, we must use all three modes of communication to send clear, concise messages and to hear and correctly understand messages someone is sending to us
• Nurses working with children must have knowledge of family dynamics, child development, and communication techniques appropriate for children
• Postures and Gestures


  Our body postures can create a feeling of warm openness or cold rejection
• Paraverbal Messages


  How we say the words refers to how we say what we say - the tone, pacing and volume of our voices
• To communicate effectively, we must use all three modes (verbal, nonverbal, paraverbal) to send clear, concise messages and hear and correctly understand messages someone is sending to us
• Communication evolves as


  • Cognition (knowledge)
  • Physical
  • Psychosocial development
  • Increase in experience
• Somatic language


  The primary language of infants communication which can continue throughout one's lifespan
• Action language begins later in infancy as the child learns to communicate wants and needs by

  • Reaching
  • Pointing
  • Crawling toward or away
  • Turning his or her head
  • Closing his or her lips
• Communication in cognitive development in children

  1. 1 to 6 months - uses primarily non-verbal communication, responds to adults through tactile stimulation and by the sound and tone of adults voice, uses vocalization through crying and cooing

  2. 6 to 12 months - builds on what has been learned previously, the infant is starting to become egocentric, beginning to build a vocabulary, with the first words spoken at 6 to 7 months of age, begins to experience "stranger anxiety"

  3. 1 to 6 years old (toddler/preschool years) - remains egocentric and focus on communication for and about themselves how they feel and what they can do, communicate with their hands when the words are not there, are rapidly acquiring language skills, growth in vocabulary and the ability to use it in sentences, interpret words literally

  4. 6 to 12 years old (school age) - wants explanation and reasons for everything (step by step and why), enthusiastic participant in communication, use logic and often misinterprets adult conversation

  5. 12 to 18 years (adolescent) - child fluctuates between child-like and adult thinking behavior, participates in decision making process, has attitudes and feelings that need to be communicated about a wide range of topics
• Communication strategies with children

  • Get to know a child's developmental level
  • Learn the child's interest based on your observations of his or her activities
  • Talk at the child's level and with vocabulary he or she will understand
  • "Level the playing field" by sharing your thoughts and/or observations about what is happening to the child
  • Maintain a calm, unhurried, caring, gentle approach
  • Use concrete examples and/or link information to activities of daily living vs. abstractions
  • Allow opinions to be expressed
  • Be an active, attentive listener
• Do not when communicating with children

  • Make a child self-conscious by drawing attention to him or herself
  • Use abstractions with a child who is concrete thinker
  • Jump to conclusions
  • Get "in the middle" between a child and a parent, especially in front of the child
• Child-specific communication strategies


  • Word Games
  • Storytelling
  • Drawing
  • Story Writing
  • Play
• Word Games


  An effective means of communicating, focus on the words the child uses, are the words positive or negative in tone, word association are use to neutral words to more anxiety-provoking words
• Storytelling


  Allows reality and imagination, can be guided and or directed
• Drawing


  Another means of encouraging a child to express without words, allows externalization of internal mental images and emotions, the emphasis is not on how well the picture is drawn, but the ability to get in touch with feelings and healing through the drawing
• Story Writing


  Similar to storytelling but is used by an older child or adolescent, can take many forms, from actual event-driven stories, to journal writing, or writing letters
• Play


  Is children's work, it is what they know, what they understand, and it is how they communicate
• Those with severe physical disabilities may not be able to communicate effectively using speech. As an alternative, besides sign language and communication boards, there are many high tech computer generated speech output devices
• Tips on how to effectively communicate with those of different abilities

  • Acknowledgment - avoid staring but don't avoid eye contact, look at the person as a person
  • Give it some time - familiarize oneself to patterns like asking questions that require more than a "yes" or "no" answer or have him or her read aloud
  • Patience - allow extra response time from someone who has a speech impairment
  • Be encouraging - create an encouraging atmosphere by having an accepting attitude, use eye contact, smile, lean forward, and nod to show that you are interested
  • Alternative communication - if a communication device or other speech method is used, get acquainted with how the system works, respect and use whatever form is most functional to that person
  • Space bubble - always respect the personal space of someone with a physical disability, equipment used is their personal space
  • Be accessible - sit with the same eye level, do not stand and talk down
  • Sensitivity - keep in mind that certain touches, even a hug or pat on the back could be irritating or startling to someone with neurological damage
• Communicating with cognitively impaired patients

  Respect is an important part of communication, they may need help understand, but they have feelings and deserves to be treated with respect, also requires patience and skills that take time to develop
• Aggressive communication


  A style in which individuals express their feelings and opinions and advocate for their needs in a way that violates the rights of others, is born of low self-esteem, unhealed emotional wounds, and feelings of powerlessness
• Characteristics of aggressive communicators


  • Try to dominate others
  • Use humiliation to control others
  • Criticize, blame, or attack others
  • Be very impulsive
  • Have low frustration tolerance
  • Speak in a loud, demanding, and overbearing voice
  • Act threateningly and rudely
  • Not listen well
• Health care professionals must be able to communicate with clients who speak different languages, and come from distinct cultural backgrounds, they must be able to understand and show compassion for the different cultures, lifestyles, traditions, and expectations they will encounter