Standards for nursing practice:

1.  Responsibility and accountability (respnsblty & accntblty for own actions, within legal scope of practice & within legislation)
2.  Specialized body of knowledge (how & where find info; shares knowledge with client & others; decision based on knowl/theory)
3.  Competent application of knowledge (determines client status & responses to actual or potential health problems; plan/perform interventions and evaluates outcomes; search for info, uses skills of observation, communication and physical assessment)
4.  Code of ethics (Canadian charter of rights and freedoms; report unsafe practice; advocate to protect/promote cl. right to respect, privacy, dignity, and access to information; responsible that relationship with client are therapeutic and professional)
5.  Provision of service to the public (provide nursing services & collaborate with other health care team; delegated tasks/f-ns; QA)
6.  Self-regulation (responsible for maintaining competence, fitness to practice and evidence-based knowledge & skills for prof. practice; practice within own level of comptnce; maintain current registrtn & license; maintain own physical, mental & emotional well-being )

Health communication: Communication is the process of sharing information. Health communication (h.c.) – health-related transactions between individuals who are attempting to maintain health and avoid illness.  Comm. variables: empathy, control, trust, self-disclosure and confirmation- can enhance h.c.   Empathy – process of observing the world from another person point of view; it is a complex variable that involves cognitive, affective and communicative components.  Control – intrinsic part of human interaction. Two kinds – personal (when  person sense that they can influence circumstances surrounding their lives) and relational (when individuals share influence with others within relationship). 3 kinds of relationship: complementary, symmetrical, parallel.  Trust – in relationship when individ-s feel that they can rely on others.  Self-disclosure – process when person provide personal information , thoughts and feelings to others.  Confirmation – communication that enables others to value themselves more fully as unique human beings.

Types of relationship in h.care: pro-pro, pro-patient, pro-family, patient-family. Factors that affect quality of pro-patient relationship: role uncertainty(for patient & for pro), responsibility conflicts(4 models of helping & coping: moral, compensatory, medical, enlightenment models), power differences and unshared meanings. Factors that affect pro-pro relationship: role stress, lack of interpersonal understanding, autonomy struggles. In pro-family relationship problem is that family members has little contact with health professionals and prof-s have not attuned to special needs of family members, or importance of collaborative relationship with family members. Family members often receive “filtered” communication (information management) or have limited access to information. Patient-family – coping with disruption of family roles is a problem for both patient and family members. => too much role ambiguity lead to confusion , while too much role rigidity may inhibit appropriate adaptation to circumstances of illness. Closed communication (due to family rules or something else)

Nonverbal communication: to express feelings, to regulate interactions, to validate messages, to maintain self-image, maintain relationship. 5 categories: 1) kinetics (gestures, facial expression, gaze(eye contact)  2) proxemics (personal space, territory, distance)  3)paralinguistic (vocal sounds and cues)  4) touch (handshake, touch; personal receptivity to touch-gender, type and location of touch, age, nature of relationship)  5)environmental/physical factors (formality, warmth, privacy, constraint, distance, familiarity; sound, furniture and structural design)-i.e. formal, private, relaxing

Interviewing: is a special type of interpersonal communication that is purposeful and serious, usually involving questions and answers, with the goal of sharing information or facilitating therapeutic outcomes. In health care-2 general types of interviews: information-sharing interviews & therapeutic interviews. Information-sharing interviews - requesting or providing information, the focus of the interaction is on purposeful content in a specific area of interest. Therapeutic interviews - help clients identify and work through personal issues and concerns. Emphasis is placed on building a supportive relationship in this type of interview. Therapeutic interviews can be conducted by health professionals using directive as well as nondirective approaches.  The four phases of the interview process are preparation, initiation, exploration, and termination. The preparation phase occurs prior to the actual interview dialogue, & it involves anticipating & planning for the interview. In this phase, the major tasks of the health professional are to engage in self-assessment and to plan for the first meeting with the client. In the second phase, initiation, the stage is set for the rest of the interview. In this phase, the clinician's responsibilities focus on establishing a therapeutic climate, clarifying the purpose of the interview, formulating a contract with the client, and establishing mutual goals. The third phase, exploration, is often called the working phase. In this phase, the clinician and client confront, analyze, and struggle with the client's concerns. The clinician tries to assist the client in analyzing problems, managing feelings, and in developing coping skills. The termination phase signals to the client that the end of the interview relationship is near. In this phase, the clinician's responsibilities include planning for closure, summarizing major issues, and assisting the client in expressing feelings about termination.      Special communication techniques directly related to interviewing include closed and open questions, silence, restatement, reflection, clarification, and interpretation. Closed questions are questions that elicit yes or no answers. They take less time but only provide a restricted amount of information. Open questions elicit in-depth answers from clients and require more time. Silence may be used to encourage further response from the client. It can be positive or negative depending on how much empathy or tension exists between the participants. Restatement is used to repeat or paraphrase the content of a client's message, whereas reflection is used to focus on the feelings that the client is expressing beneath the words. Clarification moves the interaction from generalities to specifics, and interpretation offers the client a tentative new way of looking at his or her situation

Small group communication - verbal and nonverbal communication that occurs among a collection of individuals whose relationships make them to some degree interdependent. Various types of h. care groups can be distinguished according to degree to which they are content oriented or process oriented.       Components of small groups that affect the groups' functioning: First, goals provide the reason and motivation for people to form a group. It is important that goals be clear, realistic, & shared to considerable extent among group members. Norms are the rules established by group members that indicate what types of behaviors are appropriate within group. Norms can be overt or covert, and they can facilitate or restrict the group's activity. Cohesiveness is the sense of "we-ness" shared by group members that stimulates members to stay in a group. Leader behavior plays an important role in guiding the group, developing norms, and facilitating communication. Specific leader behaviors such as emotional stimulation, caring, meaning-attribution, and executive functioning are linked to effective group functioning. Member behavior, often overlooked, is also important component. Member behavior can be described in terms of the roles occupied by group members (task roles, group-building & maintenance roles, and individual roles, communication network (star, Y, 2-step, chain, all-channel, circle)) or in terms of the interaction patterns used by group members.    Therapeutic factors, often referred to as curative factors, are also an important component in group functioning. Eleven therapeutic factors that can have a positive influence on group members have been identified as operating in groups at one time or another (hope, universality, altruism, imparting (advice, suggestions), socializing, imitation, cohesiveness(сплоченность) other) .

Five phases of groups’ progress: orientation, conflict, cohesion, working, and termination. Orientation phase occurs at the beginning as members try to determine how they are related to each other and to the group goal. Communication usually stays on safe topics with limited amounts of self-disclosure during this phase. Conflict phase centers around issues of authority and control as members try to determine how much influence they have in the group; communication is frequently marked by disagreements & dissent. In cohesion phase, group members draw closer together & develop greater sense of unity. Members often suppress negative communication & become more supportive of one another. In working phase - greater disclosure and more profound discussion of group issues. Termination phase occurs at the end of process as group completes its tasks or goals; issues are summarized and members' feelings toward one another and the group are expressed.

Conflict – struggle between 2 or more people over perceived incompatible differences in beliefs, values and goals, or over differences in desires for control, status, and affection. If it is manages appropriately, conflict need not be destructive, but can be constructive and used to positive ends. Communication plays a central role in conflict and in resolution.      Conflict occurs between people on 2 levels: content and relationship. Conflict on content level involves differences in beliefs, values, or goal orientation. Conflicts regarding goal orientation can be further divided into procedural and substantive conflicts. Procedural conflicts involve differences regarding the best way of approaching a goal, whereas substantive conflicts occur over struggles about the nature of the goal itself. Conflict on relational level refers to differences between individuals with regard to their desires for esteem, control, and affiliation in their relationships. Relational conflicts are seldom obvious, which makes them difficult for people to recognize and resolve.

Theoretical approaches by researchers to explain human conflict are game theory & conflict resolution theory. Game theory focuses on payoffs and losses that people encounter in trying to resolve conflict in game situation. Game theory is most useful in understanding conflict in laboratory settings. Conflict resolution theory, based on Filley's model, is helpful in describing conflict in real-life situations. This model identifies six steps that occur in conflict resolution: antecedent conditions,→ ( perceived conflict ⇄. felt conflict), → manifest behavior, → conflict resolution or suppression, →  resolution aftermath.      To resolve interpersonal conflict, there are three strategies: win-lose, lose-lose, or win-win. Individuals attempt to dominate or control one another in the less effective win-lose and lose-lose conflict strategies. Win-win strategies are constructive because they emphasize mutual satisfaction of needs and relationship development, with no attempt by one party to control another. Win-win strategies are facilitated by the process of creative problem solving, which includes 1) mutually defining a problem, 2) identifying solutions, 3) assessing the merits of each solution, 4) select­ing the best solution, 5) evaluating the fit between solution and problem.     Five styles of approaching conflict: avoidance, competition, accommodation, compromise, and collaboration. Each of these styles characterizes individuals in terms of the degree of assertiveness and cooperativeness they show when confronting conflict. The most constructive approach to conflict is collaboration, which requires that individuals recognize, confront, and resolve conflict by attending fully to others' concerns without sacrificing their own. Managing conflicts effectively leads to stronger relationships among participants and more creative solutions to problems.         Three practical approaches to conflict resolution: differentiation, fractionation, and face-saving. Differentiation is a process that helps participants to define the nature of the conflict and to clarify their positions with one another. Fractionation refers to the technique of sizing down large conflicts into smaller, more manageable conflicts. Face-saving consists of relational messages that individuals express to each other in order to maintain their self-image during conflict. Together or singly, these approaches can assist health professionals in making the conflict resolution process more productive.

Biomedical ethics is one of fastest growing areas of h. care and an area in which communication plays a pivotal role. Ethics is concerned with applying principles of "right'' and "wrong" to the complex problems that occur in a highly sophisticated h. care system in which resources are sometimes scarce or limited.    Major dimensions of biomedical ethics include beneficence, autonomy, and justice. Beneficence - professionals' making h. care choices that benefit patients and family members. When actions are taken on behalf of patients without determining whether patients indeed want help, those actions are described as paternalistic. Autonomy emphasizes self-determination for patients and underscores that individuals should be in charge of matters related to their own health. The principle of justice refers to fairness in health care, to giving each individual what s/he rightfully deserves, and to distributing society's resources equitably.       A cornerstone of bioethics is legal doctrine of informed consent. It requires that health professionals communicate certain kinds and amounts of information to patients so patients can determine what, if anything, will be done to them. For consent to be truly informed, it is essential that patients understand information they receive from health professionals. Effective interpersonal relationships will also facilitate patients' understanding and willingness to give consent. The opportunity to obtain full informed consent is enhanced when health professionals pay attention to who provides information to the patient, to readability of consent forms, to opportunity to allow patients to ask questions, and to supplemental audiovisual and written materials that accompany consent information.

Honesty and truth telling refer to the honest disclosure of information to patients. Respect for autonomy requires that providers attend closely to patients' needs regarding the amount of information they want and how they want it expressed.

Bioethics committees provide structure for discussing & making decisions about complex ethical dilemmas in h. care. The primary functions of these committees are education, policy, and consultation. Bioethics committees do their work by applying principles to cases, principle-based approach, or by starting with case and comparing it to previous cases, case-based approach.

Intercultural communication is influenced by ethnocentrism & prejudice. Ethnocentrism – universal tendency for people to place their own group at the center of their observations of others and, in so doing, to give priority and greater value to their own perspective. It is an obstacle to effective h. communication because ethnocentrism distorts one's view of others and limits one's ability to be fully empathic with others' circumstances. Prejudice is the individual's tendency to make judgments of other individuals or groups which are faulty or not fully substantiated. Prejudice is an obstacle that gets in the way of our ability to be other-oriented and to fully understand others and communicate effectively.    Individualistic cultures place individual's interests, needs, & values above those of group. In collectivistic cultures, social norms and group concerns supersede the interests of the individual.  Cultures also distinguished by how they incorporate contexts in communication. High-context cultures interpret messages based on a broad set of culturally based rules, which reside in the individual and the environment. Low-context cultures rely primarily on specific content of messages, paying far less attention to culturally based rules. When compared to people from low-context cultures, people from high-context cultures are more effective at reading nonverbal cues, talk less, and place less emphasis on verbal messages.   Culture is related to three aspects of communication: perception, verbal communication, and nonverbal communication. Perception has a profound influence on how health professionals and patients view symptoms, causes of illness, and types of treatment. For h. pros the challenge is to develop alliance with patients, while acknowledging and giving respect to the patient's different frame of reference.  Greatest barrier to effective intercultural communication is language differences and in nonverbal communication