Life Span Introduction Chapter 1&4. Life Expectancy “The average number of years a person is expected to live”

Life Span

IntroductionChapter 1&4

Life Expectancy

• “The average number of years a person is expected to live”

What is the life expectancy in the US as of 2011?

A.68.3B.71.5C. 78.4D.81.7E. 89.7

Life expectancy 1850 1890 1920 1950 1970 1990 2011

38.3 42.5 56.3 66.3 67.9 72.7 78.4

Why?

• Why is life expectancy going up? • Why is the US not number 1?

Antibiotics

• When was penicillin first available as a prescription drug?

A. 1782B. 1824C. 1868D. 1927E. 1942

Healthy Lifestyle

• Treatment should be based on the belief that nature has a strong healing component

Hippocrates

Bacteriology

– Louis Pasteur

Bacteriology

– Louis Pasteur– Robert Koch

Bacteriology

– Louis Pasteur– Robert Kock– Joseph Lister

What was the first vaccine available?

A. Small poxB. PertussisC. DiphtheriaD. TetanusE. Polio

What was the first vaccine available?

A. Small pox (1796)B. Pertussis (1904)C. Diphtheria (1926)D. Tetanus (1938)E. Polio (1955)

1948 = DPT

• Measles (1963)• Mumps (1967)• Rubella (1969)– MMR (1971)

• Hepatitis B (1981)• Hib (1985)• Chickenpox (1996)

• What happened to the small pox vaccine?

• D/C 1971– eradicated

Health“A state of complete physical, mental and social well-being, not merely the absence of disease or infirmity”

Holistic

Health Promotion

• “Health care directed toward the goal of increasing one’s optimal level of wellness.”

Empowerment

• “A form of self-responsibility that encourages people to take charge of their own decision making”

Disease prevention

• Primary– Before there is any disease

• Secondary– Begins with diagnosis

• Tertiary– Begins when a permanent

disability occurs and is stabilized

– Rehabilitation– Restoring the person to an

optimal level of functioning

Healthy Lifestyle

• Nutrition• Exercise• Mental health

Mental Health

• Adjust to new situations• Handles personal

problems• Contributes to society• See themselves and

others realistically• Fluctuates – Continuity – Consistency

Stress

• “Anything that upsets our psychological or physiological equilibrium”

Responses to stress

• Physiological• Emotional• Intellectual

Emotions

• “feeling state”• Autonomic System• Limbic System

Emotional Maturity

• When individuals are able to control their responses and can express their emotions in socially appropriate ways.

3 Stages of Stress

• Alarm stage• State of resistance• State of exhaustion

Anxiety

• “Response to a stressful situation”

Levels of Anxiety

• Mild• Moderate• Severe• Panic

Stress Health

• SRRS

Stress Reduction Techniques

• Relaxation Exercise• Guided imagery

Chapter 4: Communication

• “An interaction between tow of more persons – an exchange of information, ideas, feelings or emotions.”

Communication Process

1. Message2. Sender3. Method4. Receiver5. Feedback

Types of communication

• Verbal • Non-verbal

Modes of Non-verbal Communication

• Physical Appearance and dress


• Body movement and posture– Open– Closed


• Facial expressions


• Gestures


• Eye contact


• Tone and volume of voice


• Touch


• Silence

Personality Types

• Passive or Unassertive • Allowing your own rights to be violated by failing to express honest feelings

• Goal: Avoid conflict no matter what

• Little risk involved – very safe

• Little eye contact, often defers to others opinions, usually quiet tone,

Examples of Passive communication

• “I don’t know.”• “Whatever you think.”• “you have more

experience than I. You decide”

• “I’ll go with whatever the group decides.”

• “I don’t care. It doesn’t matter to me.”

Personality Types

• Aggressive • Protecting ones own rights at the expense of other’s rights – no exceptions

• Goal: win at all costs• Does not consider actions a

risk because this person thinks they will always get their way.

• Eye contact is angry and intimidating; lots of energy; loud and belittling, never defers to others.

Examples of Aggressive communication

• “I don’t know why you can’t see that this is the right way to do it”

• “It’s going to be my way or not at all.”• “You’re just stupid if you think that will work.”• “That kid of logic will sink the company.”• “Who cares what you feel. We’re talking

about making things work here.”

Personality Types

• Passive - Aggressive

• Forfeiting your own rights initially, followed by manipulation and vengeance later.

• Goal: avoid conflict and then make the other party wish they had seen it your way

• Avoid risk initially, risks relationships later, then acts surprised when people are mad

• Behaves passively to people’s face, then aggressively when they are not around.

Examples of Passive-Aggressive communication

• “Sure doctor, I’d be happy to write that verbal order” but back on the unit the order is “forgotten”

• “I love your hair. Most people probably can’t even tell it’s a wig”

• “I hear what you’re saying, and I wouldn’t want to make waves, so I’ll do what you say even though someone will probably get sued.”

Personality Types

• Assertive • Protecting your own rights without violating the rights of others

• Goal: communicate with respect and find a solution to the problem

• Eye contact maintained, listens and validates others, confident and strong yet also flexible, objective and unemotional, presents wishes clearly and respectfully

Examples of assertive Communication

• “So what you’re saying is…”• I can see that this is important to you and it is

also important to me. Perhaps we can talk and try to solve the problem

• “I think… I feel… I believe that…”• “I would appreciate it is you…”

Assertiveness Skills

1. Persistence2. Objectivity3. Validation4. Owning5. Challenging False Information6. Pumping the negatives7. Humor

Okay in assertive Communication

• “I don’t know”• “No” or “I cannot do that”• It is OK to make mistakes as long as you take

responsibility• It is OK to disagree and to verbalize that• It is OK to challenge others opinions or actions• It is OK to not accept another opinion as fact• It is OK to ask for a change in behavior

Therapeutic Communication

• Purposeful• Goal oriented• Promotes trust

Components of Therapeutic Communication

• Listening and observing


• Warmth


• Genuineness


• Attentiveness


• Empathy


• Positive regard

3 phases of Therapeutic Communication

• Orientation phase– Build trust

• Working phase– Determine coping– Plan of care

implemented

• Termination phase– End of relationship

Factors affecting communication

• Congruence


• Time and setting


• Proxemics


• Biases


• Physical Handicaps

Blocks to Communication

• Belittling


• Disagreeing


• Agreeing


• Defending


• Stereotyping


• Giving false reassurances


• Giving advice


• Changing the subject


• Asking closed-ended questions


• Asking “Why” questions


• Probing

Techniques used to enhance communication

• Giving information

• Clarifying

• Reflecting

• Paraphrasing or restating

• Asking broad questions

• Using general leads

• Stating or making an observation

• Offering self

• Using humor


• “Tell me about a time you struggled caring for your family member.”

A. AppropriateB. Inappropriate


• “Describe the circumstance that led you to the crisis unit…”



• “Tell me about a time you felt confused about a decision.”



• “Tell me, what you do when you get upset.”



• “Why do you think your family does not care.”



• “Of all the concerns you mentioned which is the most troublesome?”



• “Tell me when you feel anxious…”A. AppropriateB. Inappropriate


• “Tell me your family problems.”A. AppropriateB. Inappropriate


• “The decision your family made is for your own good.”



• “Why do you feel like that. Your family seems to care.”



• “I would not worry about that…..”A. AppropriateB. Inappropriate


• “What you really mean is…”A. AppropriateB. Inappropriate


• “This hospital has a fine reputation.”A. AppropriateB. Inappropriate


• “Everyone gets down in the dumps.”A. AppropriateB. Inappropriate


• “I am not sure that I follow what you are saying.”


• Clarifying• Using broad opening

statements• Giving information• Reflecting• Validating• Acknowledging the patient’s

thoughts and feelings• Using general leads• Selective reflecting• Requesting an explanation

• Belittling the patient’s feelings• Making stereotyped

comments• giving approval• Defending• Using reassuring clichés• Expressing disapproval• Giving advice• Agreeing with the patient• Changing the subject• Disagreeing with the patient

• Patient: “I don’t know. I hate to have my boyfriend see me looking like this. Just thinking about him coming to visit makes me nervous.”Nurse: “You really should stop worrying. That may be what’s keeping you from getting the rest you need. And after all, no one expects you to look your best when you’re in the hospital.”

• Patient: “You’d think my doctor would have prevented me from getting phlebitis, but he’s too busy to care about what’s happening to me.”

• Nurse: “You’re wrong, Mr. Iverson. Of course he cares.”

• Nurse: “You seem to be kind of restless tonight.”Patient: “Nobody cares. My doctor wants me to go—just go on home. He doesn’t care?”Nurse: “Go home?”

• Patient: “Maybe I should find a hobby or something. I try not to get discouraged; I know I shouldn’t let it get me down.”Nurse: “That’s the right attitude. It really doesn’t help to worry about it.”

• Nurse: “How are you feeling this morning, Mr. Patterson?”Patient: “Oh, fine, thanks.” (unenthusiastic)Nurse: That’s good.

• Patient: “I can’t go home with this…AIDS. If they want me out of here so bad, why don’t they just let me die?”Nurse: “You can’t go home because you have AIDS?”

• Patient: “Well, I haven’t been able to work for quite a while now, and the doctor says I might not ever work as a carpenter again.”Nurse: “It must be difficult for you right now, but I’m sure everything will be all right.”

• Patient: "I'm just jumpy-I get like this sometimes. I guess it's because I didn't get too much sleep last night." Nurse: "Yes, when you don't get a good night's sleep it does make you edgy."

• Patient: "What's there to talk about? First they say they have to operate, and then when I'm beginning to feel better, I get this infection. I don't think I'm ever going to get out of here!" Nurse: "I know just how you feel. You know, everyone gets frustrated when things aren't going right."

Listening Exercise

• Pair up with another student.• Person A will tell person B her/his most

memorable recent experience. Person B should try to think about a problem they have or an assignment coming up while person A is speaking.

• Discuss how you felt about both roles and experiences, with person A speaking first.

• Person A then tells the same story again, taking about the same amount of time. This time person B will concentrate as much as possible on person A and on what he/she is saying.

• Share the differences between these two experiences and discuss the relevance this may have when person A is a client and person B is a nurse.

• Therapeutic Communication Techniques (6)• Initial Communication • “What should the nurse say initially?” • Goal of initial communication • is to open communication. • Empathy • Restatement • Reflection

• An elderly woman is admitted to the hospital with a subdural hematoma. There are also numerous ecchymotic areas and cigarette burns. Elder abuse is suspected. The nurse’s aide says to the nurse , “Every time I see her family, I get so angry. How could anyone deliberately hurt such a sweet old lady?” Which initial response by the nurse would be most helpful to the aide?

• “It is not appropriate for nursing personnel to make judgments about people.”

• “It is very upsetting isn’t it.” • “There is no proof yet as to who abused her.” • “You should try to understand how frustrating it is to care

for the elderly 24 hours a day.”

• Who is client? • Nurse’s aide. • •What is the problem/behavior? • Nurse’s aid is angry with family of client. • •What are the details? • Suspects elder abuse. • •What does question ask? • Initial response to aide • •Answer: 2. Initially should encourage aide to

express feelings.

• The nurse is caring for an 18 yo male who is comatose following a head injury. The parents ask whether they should visit their son since he is comatose. Which of the following is the best initial response for the nurse to make?

• •Advise the parents thay should visit their son as often as possible. •Suggest to the parents that their presence is important even though their son does not seem to be aware. •Tell them that they should arrange for his teenage friends to visit in small groups. •Explain that he is unaware of their presence and tell them

• Who is client? • Parents of 18 y/o • What is the problem/behavior? • Ask if they can visit son. • What are the details? • 18 y/0 comatose after head injury. • What does question ask? • Initial response • Answer: 2. Look at the verbs. Suggest is only collaborative

verb. Advise, tell and explain are authoritarian verbs.

• Think about the most fulfilling relationship that you have experienced with a client, one in which you felt you made a difference.

1. What were some of the aspects of this relationship that made it fulfilling?

2. How did you make a difference?3. What communication skills did you use?

• Now think about a relationship with a client that was the least fulfilling; one in which you think that you did not help.

1. What are some of the aspects of this relationship?

2. What happened and why?

Life Span Introduction Chapter 1&4. Life Expectancy “The average number of years a person is expected to live”

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