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NATIONAL AMERICAN

UNIVERSITY
BLOOMINGTON CAMPUS
BSN PROGRAM

Nursing 3331 Foundations of Holistic Nursing-Clinical


Winter: 2013-2014
Learning Plan 1
Clinical Day #1
Orientation to Clinical Class and Clinical Site
Therapeutic Communication/Holistic Assessment
Objective of the Course/Competency:
1. Establish therapeutic communication techniques during nurse client interactions to create and
maintain client relationships and professional boundaries.
Knowledge and skills leading to mastery of this competency:
a. Incorporate effective communication techniques to produce professional working relationships.
b. Adapt caring and healing techniques that promote a therapeutic nurse-client relationship.
c. Communicate effectively with the client and the clients support network.
d. Complete a professional communication critique to evaluate verbal and nonverbal communication.
e. Promote the phases of the helping relationship.
2. Enhance psychosocial well-being through effective assessment, interpretation, and intervention
regarding intellectual, emotional, social, spiritual and cultural development.
Knowledge and skills leading to mastery of this competency:
a. Develop an awareness of clients as well as healthcare professionals spiritual beliefs and values and
how those beliefs and values impact health care.
b. Implement holistic, client-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing management across
the health-illness continuum, across the lifespan, and in all healthcare settings.

3. Maximize self-esteem and a feeling of psychological safety and comfort.


Knowledge and skills leading to mastery of this competency:
a. Analyze theories and concepts from liberal education to build an understanding of the human
experience
b. Integrate theories and concepts from liberal education into nursing practice.
c. Choose behavioral change techniques to promote health and manage illness
4. Provide a safe client care environment to assist the client in meeting personal safety needs.
Knowledge and skills leading to mastery of this competency:
a. Create a safe care environment that results in high quality client outcomes.
b. Establish therapeutic communication, context, and relationship.
c. Demonstrate the application of psychomotor skills for the efficient, safe, and compassionate delivery
of client care.
d. Develop a caring presence.
e. Implement compassionate, client-centered, evidence-based care that respects client and family
preferences.
5. Explain the purposes, rationales, and indications for various nursing care activities.
Knowledge and skills leading to mastery of this competency:
a. Use an ethical decision making framework.
b. Provide for a clients need to know by giving, translating, or transmitting information.
c. Provide nursing care based on evidence that contributes to safe and high quality client outcomes.
d. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic
care of the client and their family to promote health across the lifespan.
6. Demonstrate accountability and responsibility for own professional behavior and development
to reflect professional standards and values.
Knowledge and skills leading to mastery of this competency:
a. Establish accountability for personal and professional behaviors.
b. Ensure professionalism, including attention to appearance, demeanor, respect for self and others, and
attention to professional boundaries with clients and families as well as among caregivers.
c. Examine the professional standards of moral, ethical, and legal conduct.
d. Maintain self-awareness.
Overview:

This clinical experience will build on the foundational concepts to provide holistic and culturally
congruent nursing care for adult clients in a sub-acute and long-term care setting. Students practice will
be guided by clinical practice guidelines and standard policy and procedures, while learning to provide
direct nursing care such as performing delegated medical treatments. Students will be required to collect
and interpret a variety of data to provide client and family centered care.
Learning Activities:
Work on communication critique with peer (See attached rubric) DUE by-Week 4 (P/NP)
Begin/Plan a holistic health assessment on an assigned patient (see attached) DUE by Week 4
(50 points)
Review:
Essential Elements of Therapeutic Communication
Holistic health assessment tool
Ackley (2014) Section 1
Review components of the nursing process
o Assessing:
o Diagnosing
o Planning
o Implementing care
o Evaluating the nursing care that has been given and making necessary revisions
Come to class prepared to discuss:
Nursing Process See Attachment 1 and Attachment 2
Post-class:
Review nursing process
Review therapeutic communication
Learning Objectives
1. Discuss the steps of the nursing process
2. Describe the relationship between data collection and data analysis
3. Explain the relationship between data interpretation, validation, and clustering
4. Differentiate between a nursing diagnosis, medical diagnosis, and collaborative problem
5. Discuss criteria used in priority setting
6. Discuss the process of selecting nursing interventions
7. Develop ability to analyze therapeutic communication in practice for self and another

Assignments: Holistic Nursing Assessment 50points


(See attached below)
Peer Therapeutic and Professional Communication Feedback Rubric pass/fail
(See attached below)

Student _____________________________
Instructor ___________________________

Holistic Nursing Assessment Tool


Initials: _______
Age: _____ Sex: _____
Significant other:
________________________________
Date of admission: ______ Date(s) cared for:
_______________________________________________
COMPLETE AT LEAST ONE OPTIONAL ASSESSMENT
Include Each Page of Assessment
Fill in all blanks: = no, N.A. = does not apply, use direct quotes whenever possible, NI = no information found,
deferred= not assessed at this time

1. Health Promotion
Health Awareness/Management:
Current health problems: _______________________________________________________________________________________________________________________________________
Allergies and reaction (food, medication, hives, asthma, eczema, hay fever)
_________________
______________________________________________________________________________
Past accidents/illnesses/hospitalizations/surgeries
______________________________________
______________________________________________________________________________
______________________________________________________________________________
Childhood Illnesses: measles, mumps, rubella, chicken pox, whooping cough,
rheumatic fever, scarlet fever, polio (circle)
Immunizations: Last flu shot ________ Pnuemovax ___________
Tetanus/Diphtheria_______
Last physical exam ___________________Blood transfusion history
______________________
Self and family history of the following conditions: (first entry: self, second
entry: designate mother, father, daughter, son, sister, brother, etc.)
Heart__________________________________________________________________________
Lung__________________________________________________________________________
Kidney______________________________Diabetes ___________________________________
Hypertension _________________________Stroke ____________________________________
Arthritis_____________________________TB________________________________________
Drug addiction________________________Alcoholism ________________________________
Cancer ______________________________COPD ____________________________________
Mental Illness ________________________Rheumatic fever ____________________________
Thyroid _____________________________ Liver _____________________________________

Current medications, prescription and OTC, herbs, herbal teas, vitamins. (List here,
also complete medication sheet and submit to instructor)
____________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Note current risk factors (e.g. smoking, hypertension, obesity,
immobility).__________________
What is your impression of the patients knowledge of their risk factors?
____________________
______________________________________________________________________________
Does the patient follow through with appropriate health plan? (Circle)
usually
sometimes
never
Reasons for unwillingness to follow through._________________________________________
Do you believe your medication helps you? What makes you believe this?
______________________________________________________________________________
What do you believe is the cause of this illness?
______________________________________
______________________________________________________________________________
Who is responsible for making decisions about your health? Explain.
_____________________
_______________________________________________________________________________
Is there anything special that makes you recover from an illness?
________________________
_______________________________________________________________________________
What do you think would help you to reach a higher level of health?
_____________________
_______________________________________________________________________________

2. Nutrition
Ingestion:
Teeth__________________________________ Gums__________________________________
Dentures, partials _______________________________________________________________
Difficulty chewing _____________________________ Difficulty Swallowing_______________
Nausea or Vomiting ________________________Where does client eat____________________
Number of meals per day ___________Special diet ____________________________________
Current therapy NPO ________ NG suction ______ Tube feeding ___________TPN
_______
Nutritional Supplements__________________________________________________________
Which foods does the patient recognize as healing foods? (Ex. yin/yang, hot/cold)
_______________
Food preferences/intolerances ______________________________________________________
How is your appetite?___________________________________________________________
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How does it compare to younger


years?_____________________________________________
Absorption/Metabolism:
Body type (circle) muscular
obese
thin
average
Ideal body weight (found in text) ___________ Height ____________ Weight
______________
Any changes in weight in last 3 - 6 months?
__________________________________________
Hydration:
Fluid preferences ________________________________________________________________
Use of caffeine/amount___________________________________________________________
Fluid Intake: (last 2 to 3 days) 24 hour totals
Date 11 pm 7
7 am 3
3pm24 hour total
am
pm
11pm

OPTIONAL ASSESSMENT: Example: Mini Nutritional Assessment (include copy of


completed
assessment)
http://consultgerirn.org/uploads/File/trythis/try_this_9.pdf
Score:_______________
3. Elimination
Urinary System:
Usual urinary pattern (recent changes/how often during the day and
night/incontinence)
______________________________________________________________________________
Color _________________ Catheter size ______________ (last changed) __________________
Urine output: (last 2 to 3 days)
Date

11 pm 7
am

7 am 3
pm

3pm11pm

24 hour total

OPTIONAL ASSESSMENT: Example: Urinary Incontinence (include copy of completed


assessment)
http://consultgerirn.org/uploads/File/trythis/try_this_11_2.pdf
Gastrointestinal System:
Abdominal exam _________________ Bowel Sounds _________________Ostomy___________
Bowel: Usual bowel pattern (description/date last BM/constipation/diarrhea/special
measures to have bowel
movements)___________________________________________________________
______________________________________________________________________________
Pulmonary:
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Respiratory rate, rhythm __________ Difficulty breathing (circle) yes no


Note use of accessory muscles _________________________ Orthopnea
__________________
Breath sounds __________________________________________________________________
Complaints of dyspnea ________________________ Cause _____________________________
Cough (circle) nonproductive productive
Sputum: color __________consistency _____________ amount ____________
O2 amount and O2 delivery method________________ O2 saturation reading
_______________
4. Activity/Rest
Sleep/Rest:
Hours of sleep at night __________________________________ # Naps ___________________
What does patient do to aid sleep?___________________________________________________
OPTIONAL ASSESSMENT: Example: Sleep Quality (include copy of completed
assessment)
http://consultgerirn.org/uploads/File/trythis/try_this_6_1.pdf
score:_________________
Activity/Exercise:
Immobility of body parts, tremors___________________________________________________
ADLs. Note dependent areas.______________________________________________________
Special Assistive devices (ex. Walker,
w/c)____________________________________________
Daily exercise regimen____________________________________________________________
What is your impression of how safe the living area is to get around in?
_____________________
OPTIONAL ASSESSMENT: Example: ADL assessment (include copy of completed
assessment)
http://consultgerirn.org/uploads/File/trythis/try_this_2.pdf
Score:_________________
Energy Balance:
What is a typical day? ___________________________________________________________
______________________________________________________________________________
Describe what they do during their leisure time
________________________________________
What gives you energy? _________________________________________________________
______________________________________________________________________________
Cardiovascular Responses:
Apical rate/rhythm__________
Heart sounds S1 ____ S2____ S3____ S4____
Murmurs _________________Pacemaker_______
BP_______________ Position (circle)
sitting standing
lying
R or L (circle)
Peripheral Pulses +3 = bounding

+2 = palpable

+1= weak
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Carotid

Brachial

Radial

Femoral

Poplitea
l

Posterio
r tibial

Dorsalis
pedis

R __ L __

R __ L __

R__ L __

R __ L __

R __ L __

R __ L __

R __ L __

Skin temperature __________ Color ____________ Edema/level of pitting


_________________
Location of Edema______________________________________________________________
Capillary refill ________________Leg cramps/intermittent
claudication____________________
5. Perception/ Cognition
Attention:
Ability to concentrate (circle) focused
Memory problem (circle) yes
no
Insight (circle)
good
fair
poor

easily distracted
disoriented
Judgment realistic (circle) yes

no

Orientation:
Glasgow Coma Scale Total (see scale in medical/surgical text)

Pupils (circle)
Left 2 3 4 5 6 mm
Right 2 3 4 5 6 mm

Reaction: Brisk
Reaction: Brisk

Sluggish
Sluggish

____________

Nonreactive
Nonreactive

Change in level of consciousness per patient or family report__________


___________________
______________________________________________________________________________
________________________________________________________________
Sensation/Perception:
Note any deficits.
Visual Disorders____________________
Glasses __________________________________
Can patient read a newspaper/menu _______________________________________________
Hearing ____________________ Hearing aid _____________________________________
Can patient hear a ticking watch by ear? ___________________________________________
Balance____________________
Gait (circle) steady
unsteady
Sensation __________________ Able to distinguish sharp from dull? ___________________
Olfactory ____________________ Able to smell breakfast foods?________________________
Is your sense of smell as keen as it was in younger
years_______________________________
Is your sense of taste as keen as it was in younger
years?_______________________________
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Have you noticed any change in your ability to feel pain, pressure, or different
temps?_______
Cognition:
Last grade completed ____________________________________________________________
What is your impression of the patients ability to learn at this time?
______________________
How happy are you with how you read? ____________________________________________
OPTIONAL ASSESSMENT: Executive Dysfunction/Cognitive impairment assessment
(include copy of completed assessment and result of tests) found at:
http://consultgerirn.org/uploads/File/trythis/try_this_d3.pdf
Communication:
Primary language ____________________________
English (circle) read write understand

Translator needed (circle) yes

no
Speech (circle) appropriate /

loud / soft / pressured / disconnected

clear
slurred
aphasic (receptive/expressive)
Non-speech communication (e.g. word board, bell, signaling)
___________________________
If patient needs an interpreter: Would you be comfortable with someone you did not
know?
______________________________________________________________________________
______________________________________________________________________________

6. Self Perception
Self Concept/Self Esteem:
What is your impression of the patients feelings about their state of health and self?
__________
______________________________________________________________________________
______________________________________________________________________________
Appearance (circle) neat
clean / disheveled / erect position /
good eye
contact
General mood:
quiet / withdrawn / irritable / pleasant / cooperative
Thoughts about self (circle) appropriate / low self-esteem / grandiosity
paranoia / phobias / depression / isolation
Observations of visitors, cards, gifts, phone calls, living space
____________________________
Are you lonely? Explain. _______________________________________________________
Body Image:
Are you comfortable having someone assist you with hygiene needs? (Is modesty
an issue, does client mind if someone touched their head when shampooing their
hair?) _______________________
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MANDATORY ASSESSMENT: Geriatric depression assessment (include copy of


completed
assessment) found at:
http://consultgerirn.org/uploads/File/trythis/try_this_4.pdf
Total Score: ______________
7. Role Relationship
Caregiver Roles/Family Relationships:
Does patient live alone? __________________If not, with whom does patient live?
___________
Relationship status ______________________________________________________________
How long has patient been in this relationship? (Married, widowed, separated or
divorced)______
Which members of family or friends provide patient with the most support?
_________________
______________________________________________________________________________
Children and ages _______________________________________________________________
Who is considered to be your family?_______________________________________________
Would you say one person has more authority in your family? Explain.
__________________
How is your familys respectfulness for each others point of view?
______________________
______________________________________________________________________________
Do certain members of your family help you when you are ill? Explain.
__________________
Role Performance:
Occupation (former or current) _____________________________________________________
What are your feelings about your (past) job?
________________________________________
Are finances an issue? Explain___________________________________________________

8. Sexuality
Sexual Function:
Problems with sexual activities: ____________________________________________________
Effect of illness on sexuality:_______________________________________________________
What are your sexual concerns? _________________________________________________
Reproduction:
Breasts SBE ___________frequency ______________ lymph nodes _______________
Symmetry ______________ nipple discharge _________ masses ____________
Date of last mammogram ____________ frequency _______________
Female: Gravida __________ Para _______________
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Date of last Pap Smear _________ frequency _________ recommended


frequency_____
Labia _____________ urethral opening ______________ discharge _______________
Vaginal opening ______________________ lesions ____________________________
Male: Testicular exam ___________ frequency _________ masses _________ swelling
______
Penile exam _______ masses _____ growths _____ lesions _______ discharge
_______
foreskin retraction _________ urethral opening _______ inguinal masses ________
Male & Female:
History of STDs _____________ Pain ___________ Burning _______________
9. Coping/Stress Tolerance
Post Trauma Responses/Coping Responses:
What does the patient do to solve problems? Does this pattern meet the patients
needs in a healthy manner?
________________________________________________________________
______________________________________________________________________________
What has been a recent stress in your
life?__________________________________________
______________________________________________________________________________
Are you grieving a loss? Explain _________________________________________________
What are your anxiety and/or fears? ______ ________________________________________
What are your feelings about your current living situation
______________________________
Do you feel like you have unfinished business? (Things you need to say to
someone? Forgiveness you would like to seek or
offer?)__________________________________________________________
10. Life Principles
Values/Beliefs:
Ethnic Origin:__________________________________________________________________
What cultural attitudes or preferences does the patient express toward health,
Western health care, surgery, and medicines?
______________________________________________________
______________________________________________________________________________
Cultural practices________________________________________________________________
Cultural meaning of eye contact or lack of eye contact __________________________________
What (if any) alternative or complementary healing practices does the patient usually
use (e.g. herbs, folk-healers, medicine man, shaman, ancestral influence,
acupuncturists, massage therapists)
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Cultural view of time and place (possible influence on appointments, plans of care)
__________
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______________________________________________________________________________
Belief System/ Faith/ Religion______________________________________________________
What is the source of your hope, strength, and daily comfort?
___________________________
______________________________________________________________________________
What are your religious practices? _______________________________________________
Do you read the Bible or other religious
texts?_______________________________________
If so, are you able to do this reading
now?___________________________________________
What does your belief mean to you?_______________________________________________

Value/Belief/Action Congruence:
Is there anything about your faith or spiritual beliefs that is causing you distress,
discomfort or
conflict?______________________________________________________________________
What role do you think your faith has had in your illness and
healing?____________________
How do you feel about death?____________________________________________________
What would you say has been the most meaningful experience of your
life?________________
______________________________________________________________________________

11. Safety/Protection
Infection/Defensive Processes//Thermoregulation:
Temperate _________ Route ___________ Moisture____________
(For each of the following, indicate size and draw location on the figure below)
Any sores, pain, white or red patches in mouth
________________________________________
Rashes ____________________ Lesions ___________________Petechiae __________________
Surgical incisions/scars _______________________Bruising ____________________________
Abrasions _____________
MANDATORY ASSESSMENT: Braden Score _______ (include copy of completed
assessment)
Found at:
http://www.ruralfamilymedicine.org/educationalstrategies/braden_scale_for_predicting_pres.
htm

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(Use above diagram to indicate size of lesion)

Physical Injury/Environmental Hazards:


Environmental hazards: __________________________________________________________
MANDATORY ASSESSMENT: Fall Risk Assessment (include copy of completed
assessment)
Found at; http://consultgerirn.org/uploads/File/trythis/try_this_8.pdf
Violence:
Suicidal or self injury?
_____________________

___________

Abuse or neglect evident?

OPTIONAL ASSESSMENT: Elder Abuse and Neglect (include copy of completed


assessment). Found at http://consultgerirn.org/uploads/File/trythis/try_this_15.pdf

12. Comfort
Physical:
Pain (draw location and radiation of pain on figures below)
Onset _____________________________
Duration ___________________________________
Intensity (0-10, 10 is worst) ____________ Quality (e.g. sharp, dull)
______________________
What increases pain _____________________________________________________________
What decreases pain _____________________________________________________________

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13. Growth/Development
Growth/Development:
Developmental Summary: (Ericksons Psychosocial Stage, what stage are they in and
what is the resolution to this stage what data helped you to determine the
resolution?)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Adapted from:Dossey, B., Keegan, L., & Guzzetta, C. (2005) Holistic Nursing: A handbook for practice 4th Ed.. Massachusetts:
Jones and Bartlett Publishers.

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Peer Therapeutic and Professional Communication Feedback


1. What contextual factors influenced your peers interaction with this patient? (see box
24-6 in Potter and Perry) Identify one in each of these five categories specific to this
interaction.

2. What elements of verbal or nonverbal cue did your peer use in order to communicate
effectively? As a reminder, again Potter and Perry are helpful. See pages 313-314 for
review.

3. How did your peer show respect for his/her client through this interaction? Was
AIDET (either precisely or in other words) incorporated into the interaction?

4. Were there ways in which your peer needed to adapt communication in order to
improve the patients understanding of the information? Did the patient have special
needs for effectively communicating with him/her?

5. Do you have any general comments or suggestions for your peer concerning this
interaction?

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