t slim user guide

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t slim user guide

The 13-digit and 10-digit formats both work. Please try again.Please try again.Please try again. We think of Nurses as professional. That is, they have a knowledge base and skill set that is unique and valued - the quality of their work is important to them; we also think of Nurses as people who care about their patients they are concerned with our well-being when we are under their care. These considerations are the focal point for discussing how to best deal with difficult patients. This book provides a comprehensive perspective on how to work with difficult patients and difficult situations that is relevant to all health-care professionals. Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. Register a free business account Dr. Koob has two children and lives in Michigan with his lovely wife and their dog, Arwen.Full content visible, double tap to read brief content. Videos Help others learn more about this product by uploading a video. Upload video To calculate the overall star rating and percentage breakdown by star, we don’t use a simple average. Instead, our system considers things like how recent a review is and if the reviewer bought the item on Amazon. It also analyzes reviews to verify trustworthiness. Please try again later. Susan 4.0 out of 5 stars This provides a good formula for dealing with all patients. This book helped me re-focus on the whole patient, and was a good reminder of WHY some patients are difficult. To calculate the overall star rating and percentage breakdown by star, we don’t use a simple average. It also analyzes reviews to verify trustworthiness. See All Buying Options Add to Wish List Disabling it will result in some disabled or missing features. You can still see all customer reviews for the product. Please try again later. From the United StatesThis provides a good formula for dealing with all patients.

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This book helped me re-focus on the whole patient, and was a good reminder of WHY some patients are difficult.Please try again later. November 3, 2005RoutledgeNovember 3, 2005RoutledgeApril 11, 2007RoutledgeWhere the content of the eBook requires a specific layout, or contains maths or other special characters, the eBook will be available in PDF (PBK) format, which cannot be reflowed. For both formats the functionality available will depend on how you access the ebook (via Bookshelf Online in your browser or via the Bookshelf app on your PC or mobile device). Whether patient problems stem from mental distress and ill health, historic substance abuse, demanding family members or abusive behaviour, difficult patients place extra demands on nurses both professionally and personally. Caring for difficult patients requires both technical and interpersonal skills along with an ability to exercise power and set limits. Including learning points, further reading, case studies and dialogue examples to highlight good (and bad) practice, the book covers pertinent issues such as psychiatric diagnoses, setting limits and establishing authority, death and dying, stress and work. It is ideal for pre- and post-registration nurses, providing concrete direction on the management of difficult patients. The Nurse and the Dying Patient 12. Nurses and Stress 13. Getting Psychiatric Consultation. You can run into all reactions including defensiveness, anger, fear, demandingness, hysteria and a whole list of other things And that’s just the patients, not the families that you need to work with and work around. But there are useful strategies in handling the unrelenting, frustrated, unpleasant or uncooperative patients. You do things over and over again. But you need to really look at how you are interacting with those around you,” said Kathleen Bonvicini, executive director of the Institute for Healthcare Communication in New Haven, Conn.

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We all have those moments that the hair on the back of our neck goes up because of certain patients,” she says. “Or we might have come to work after having a fight with our spouse, or we haven’t had our morning coffee before we have to see a patient. It can be anything, and that leaks out sometimes in our body language.” Here are what the experts say to do with certain patients and situations: There might be a lot of things going on at work that create a perfect storm,” says Bonvicini. “It could be something about a patient that reminds you of someone you don’t care for in your personal life.” She suggests you excuse yourself for a moment. Take a deep breath, and think to yourself, “What am I bringing to the table?” Say something like -- “I feel like we are getting off on the wrong foot.” You have to remember that this is their experience that is the focus and not your own,” she says. “By having a conversation about their temperament and where it is coming from can help.”. If they are emotionally distraught, console them and give them the time and space to express their psychological and emotional needs. It’s about the patient,” says Berube. “This kind of thinking has helped me through many situations. Refrain from thinking about your feelings.” It can go a long way. It makes the patient feel as if you are really trying to understand them and that you care.”. Say something like, “There are certain things that we allow here, and in order to continue to talk to you, you cannot use that language. I will step out of the room for a while to give you time to calm down.”. If the patient is becoming demanding, and I’m getting frazzled, those energies need to be refocused. And when you do that, your body language realigns.”. This needs to be handled very gracefully and sensitively so they don’t feel abandoned by you, Bonvicini says. They have lives or lifestyles that you may not understand or even agree with. But none of that matters.

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Each patient deserves the best nursing care you can give them. Remember that you need to find the calm in yourself, be objective and be honest with them. Showing empathy and giving them your undivided attention and time could make a big difference in their attitude and soften those hard edges. Her work has recently appeared in Realtor.org, Nurse.org, Yahoo! Homes, ChicagoStyle Weddings, and a bi-weekly blog in Unigo.com. Check out our favorite free online CEU courses. Please enable scripts and reload this page. Pain and fear can lead to increased stress, anxiety, and frustration, which can result in anger and even loss of control. But do you know how to spot your patient's anger early and defuse it? These tips will help you get control of the situation and hopefully reduce the likelihood of legal action down the road. Look for changes in body language, including a tightened jaw, tense posture, clenched fists, fidgeting, and any other significant change from earlier behavior. A talkative person, for example, may suddenly become quiet. Is his voice raised. Is he demanding excessive attention? Start by spending extra time with the patient. Although you might be tempted to spend less time with him, doing so only increases your risk of liability. Ignoring his complaints or, say, rushing him may prove detrimental to his care. And if something goes wrong, dissatisfied patients are more likely to sue. Review the care he's received so far, the progress he's made, and how long his recovery should take. A patient who balks, for example, when a PT suggests replacing one exercise for low back pain with another may actually be anxious about an upcoming procedure or the results of tests. After you hear him out, reassure him that you take his concerns seriously.In this example, the PT would need to elaborate on the reason for the new exercise and explain that the patient's unwillingness to cooperate will delay his recovery.

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Keep some distance between you and the patient and do not respond until the verbal barrage is over. When it is, speak softly and call the patient by name. For instance, an EMT confronted by a patient screaming that he doesn't want to be touched should listen quietly until the patient is done.Use active listening instead: Paraphrase back to the patient what he's already told you, while at the same time identifying the real feelings behind the words--fear or helplessness, for instance. Keep your statements short and simple. Continue to treat the person with respect and show accepting body language by letting your arms hang loosely at your sides rather than standing with your hands on your hips or with your arms crossed. As in dealing with a child's temper tantrum, your reaction may determine exactly how long the fireworks last. Try to understand the event that triggered the angry outburst. Express regret about the situation, and let the person know you understand. Try to find some point of agreement, perhaps acknowledging that his complaint is a valid one. For more immediate assistance, consider establishing a code phrase that indicates when a staffer needs help. If applicable to your line of work, note administrative complaints in an incident report. Document clinical complaints in the patient's chart. But your finesse in defusing and managing anger will keep the focus on getting the patient healthy and protect you from unwarranted legal action.? This information is provided for general informational purposes only and is not intended to provide individualized guidance. All descriptions, summaries or highlights of coverage are for general informational purposes only and do not amend, alter or modify the actual terms or conditions of any insurance policy. Coverage is governed only by the terms and conditions of the relevant policy. This information is not intended to offer legal advice or to establish appropriate or acceptable standards of professional conduct.

Readers should consult with a lawyer if they have specific concerns. Neither Affinity Insurance Services, Inc., HPSO, nor CNA assumes any liability for how this information is applied in practice or for the accuracy of this information. Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Show details Hughes RG, editor. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr.Author Information Authors Susan C. Reinhard; 1 Barbara Given; 2 Nirvana Huhtala Petlick; 3 Ann Bemis. 4 Affiliations 1 Susan C. Reinhard, Ph.D., M.S.N., F.A.A.N. Professor and Co-Director, Center for State Health Policy, Rutgers, The State University of New Jersey. Research Project Assistant, Center for State Health Policy, Rutgers, The State University of New Jersey. In the case of older adults and people with chronic disabilities of all ages, this “informal care” can be substantial in scope, intensity, and duration. Family caregiving raises safety issues in two ways that should concern nurses in all settings. First, caregivers are sometimes referred to as “secondary patients,” who need and deserve protection and guidance. Research supporting this caregiver-as-client perspective focuses on ways to protect family caregivers’ health and safety, because their caregiving demands place them at high risk for injury and adverse events. Second, family caregivers are unpaid providers who often need help to learn how to become competent, safe volunteer workers who can better protect their family members (i.e., the care recipients) from harm. This chapter summarizes patient safetyand quality evidence from both of these perspectives. The focus is on the adult caregiver who provides care and support primarily for adults with chronic illnesses and chronic health problems.

The focus is not on those with developmental disabilities. In the first section, we discuss the evidence for protecting the caregiver from harm. The second section addresses research aimed at protecting the care recipient from an ill-prepared family caregiver. Caregivers as Clients For centuries, family members have provided care and support to each other during times of illness. What makes a family member a “family caregiver”. Who are these family caregivers, what do they do, and what harm do they face. What does the research tell us about ways to assess the needs of these hidden patients and evidence-based interventions to prevent or reduce potential injury and harm. This section answers these questions and highlights the need for nurses to proactively approach family caregivers as clients who need their support in their own right. Description of Caregiver Population The terms family caregiver and informal caregiver refer to an unpaid family member, friend, or neighbor who provides care to an individual who has an acute or chronic condition and needs assistance to manage a variety of tasks, from bathing, dressing, and taking medications to tube feeding and ventilator care. Those caring for someone 50 years or older are 47 years old—on average—and working at least part-time. 1 If they are providing care to an elder who is 65 years or older, they are, on average, 63 years old themselves and caring for a spouse; one-third of these caregivers are in fair to poor health themselves. 6 In many cases, they are alone in this work. About two out of three older care recipients get help from only one unpaid caregiver. 7 In the last decade, the proportion of older persons with disabilities who rely solely on family care has increased dramatically—nearly two-thirds of older adults who need help get no help from formal sources.

4 Caregiver Responsibilities Caregivers spend a substantial amount of time interacting with their care recipients, while providing care in a wide range of activities. Nurses have a limited view of this interaction. Caregiving can last for a short period of postacute care, especially after a hospitalization, to more than 40 years of ongoing care for a person with chronic care needs. On average, informal caregivers devote 4.3 years to this work. 8 Four out of 10 caregivers spend 5 or more years providing support, and 2 out of 10 have spent a decade or more of their lives caring for their family member. 9 This is a day-in, day-out responsibility. More than half of family caregivers provide 8 hours of care or more every week, and one in five provides more than 40 hours per week. 1 Most researchers in the caregiving field conceptualize the care that family members give as assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). But those concepts do not adequately capture the complexity and stressfulness of caregiving. 9 Assistance with bathing does not capture bathing a person who is resisting a bath. 10, 11 Helping with medications does not adequately capture the hassles of medication administration, 12 especially when the care recipient is receiving multiple medications several times a day, including injections, inhalers, eye drops, and crushed tablets. The need to make decisions on behalf of family members who are unable to do so is stressful, as this is contrary to the caregivers’ normal role, and they are concerned that the decisions are correct. Supervising people with dementia and observing for early signs of problems, such as medication side effects, are serious responsibilities as family members are often unable to interpret the meaning or the urgency. Due to inadequate knowledge and skill, family caregivers may be unfamiliar with the type of care they must provide or the amount of care needed.

Among the greatest challenges for family caregivers is interacting with nurses and other professionals in the hospital setting, and a rough crossing back home, as the patient is “discharged to family.” 22 Naylor’s review 23 of nearly 100 studies published between 1985 and 2001 confirms that breakdowns in care during the transition from hospital to home result in negative outcomes. Health professionals in emergency departments and inpatient hospital settings do not adequately determine the after-care needs of older patients when they are being discharged. Effective discharge planning is impeded by gaps in communication between the hospital and community interface, such as illegible discharge summaries and delays in sending information to the physician. 24 Focus groups of caregivers found that they experience their family member’s discharge from the hospital as an abrupt and upsetting event because the hospital staff did not prepare them for the technical and emotional challenges ahead of them. Many caregivers felt abandoned at a critical time, and none of the focus group participants had been referred by any health care professional in the hospital to community-based organizations for emotional support—or any other kind of support. 22 Hazards of Caregiving Health professionals’ lack of explicit attention to caregivers is a serious gap in health care in light of the more than two decades of research that documents the potential hazards of family caregiving. Caregivers are hidden patients themselves, with serious adverse physical and mental health consequences from their physically and emotionally demanding work as caregivers and reduced attention to their own health and health care. Declines in physical health and premature death among caregivers in general have been reported. 21, 25 Given and colleagues 18, 19 and Kurtz and colleagues 26 found that family caregivers experience significant negative physical consequences as the patient’s illness progresses.

Elderly spouses who experience stressful caregiving demands have a 63 percent higher mortality rate than their noncaregiver age-peers. 21 Most recently, research documents that elderly husbands and wives caring for spouses who have been hospitalized for serious illnesses face an increased risk of dying prematurely themselves. 27 Declines in caregiver health have been particularly associated with caregivers who perceive themselves as burdened. 21 Caregiver burden and strain have been related to the caregiver’s own poor health status, increased health-risk behaviors (such as smoking), and higher use of prescription drugs. 28 Researchers have reported that caregivers are at risk for fatigue and sleep disturbances, 29 lower immune functioning, 30, 31 altered response to influenza shots, 32 slower wound healing, 33 increased insulin levels and blood pressure, 34, 35 altered lipid profiles, 36 and higher risks for cardiovascular disease. 37 Burton and colleagues 38 examined the relationships between provision of care by family members and their health behaviors and health maintenance. These researchers found that, with a high level of caregiving activities, the odds of the caregiver not getting rest, not having time to exercise, and actually not recuperating from illness were also high. In addition, caregivers were more likely to forget to take their prescriptions for their own chronic illnesses. Providing care poses a threat to the overall health of caregivers, which can compromise their ability to continue to be caregivers. If caregivers are to continue to be able to provide care, relief from the distress and demands of maintaining the required care must be considered. Both highly negative and highly positive consequences of providing care may exist simultaneously. 39 It is plausible that positive consequences, such as rewards and satisfaction, may buffer the negative effects of caregiving.

Picot and colleagues 41, 42 worked primarily with African American caregivers and found that the rewards perceived by caregivers were more important than coping. A specific Picot Caregiver Reward Scale of 25 items exists and has been widely used to show that both rewards and costs can exist in the same care situation. Overall, financial concerns cause particular distress for caregivers during long treatment periods, 52, 53 as resources become depleted. Higher-income families, with greater financial resources to purchase needed care, might not become as distressed or burdened as those with limited resources. 54 Caregiver burden and depressive symptoms are the most common negative outcomes of providing care for the elderly and chronically ill. 20, 55, 56 Caregiver burden is defined as the negative reaction to the impact of providing care on the caregiver’s social, occupational, and personal roles 57 and appears to be a precursor to depressive symptoms. 58 Whether the caregiver develops negative outcomes seems to be directly related to the care recipient’s inability to perform ADLs, either due to physical limitations or cognitive status. 51 If the care recipient wanders (associated with Alzheimer’s disease) or displays unsafe behavior, the caregiver has to be alert and on call for supervision 24 hours per day. The constant concern for managing disruptive behaviors (such as turning on stoves, walking into the street, taking too many pills, yelling, screaming, or cursing) also affects the caregivers negatively. Interventions directed to the family caregiver should serve two purposes (see Evidence Table ). First, interventions can support the caregiver as client, directly reducing caregiver distress and the overall impact on their health and well-being. In this intervention approach, the caregiver is the recipient of the direct benefit and the patient benefits only secondarily.

Second, interventions can be aimed to help make the caregiver become more competent and confident, providing safe and effective care to the patient, which can indirectly reduce caregiver distress by reducing their load or increasing their sense of certainty and control. In this section, we focus on the research evidence supporting caregivers as clients. Evidence Table Supporting Family Caregivers in Providing Care Despite the importance of information and support to help family caregivers, studies on interventions to increase support for family caregivers have lagged far behind those provided for patients. A focus on the family as a part of the patient’s therapeutic plan of care is largely absent from interventional research and from general clinical practice as well. Few randomized clinical trials of educational interventions directed toward family caregivers have been conducted or published, and there is limited research to inform us about skills training for caregivers to prevent back injuries, infection, and other potential risks inherent in the caregiver situation. Interventions To Reduce Burden and Distress Recent meta-analyses of caregiver interventions found mixed results, which are important to note. Multicomponent interventions, rather than single interventions like support groups or education, significantly reduced burden. 69, 70 Other interventions found no reductions in burden, but significant improvements in caregiver knowledge and delayed nursing home admission for care recipients. 71 Sorenson and colleagues 72 found that interventions aimed at individual caregivers were more effective in improving caregiver well-being than group interventions, although group interventions were more effective in improving care-recipient symptoms. Reasons for this are unclear. The effectiveness of caregiver interventions lasts approximately 7 months. Few studies are funded for long-term followup.

Comprehensive counseling sessions for spouses caring for a person with dementia help reduce depression. 73 Counseling appeared to be effective in improving the quality of life for caregivers of stroke survivors. 74 However, even a simple one-to-one telephone call may be effective in helping the caregiver as client. An automated, interactive voice-response telephone support system for caregivers reduced burden for those caregivers with a lower sense of control over their situation. 75 Davis and colleagues 76 found an unexpected reduction in burden and distress for caregivers receiving friendly, socially supportive phone calls that provided some respite from caregiving, even without in-home caregiver skills training. Home visits and enhanced social support also can help reduce caregiver depression. 77, 78 Zarit and colleagues 79 used a quasi-experimental design to demonstrate that caregivers who used adult day care services for their relatives with dementia had significantly lower levels of caregiver stress, anger, and depression after 3 months of this respite care than a control group of similar caregivers who did not obtain this intervention. Interventions To Improve Competence and Confidence Smeenk and colleagues 80 investigated the quality of life of family caregivers who received a home care intervention that consisted of a specialist nurse coordinator, a 24-hour nurse telephone service with access to a home care team, a collaborative home care dossier and case file, and care protocols. The care dossier was used to assist with communication and coordination between caregivers and health professionals. The dossier included the lists of the patient’s caregivers, discharge reports, nursing home case transfer reports, medication lists, and multidisciplinary reports. From these reports, specific patient intervention approaches were developed. The intervention significantly improved caregiver quality of life at 1 week and 4 weeks after discharge from the hospital.

Houts and colleagues 81 describe a prescriptive program that is based on research on problem-solving training and therapy. Designed to empower family members to moderate caregiver stress, the Prepared Family Caregiver model is summarized in the acronym COPE (Creativity, Optimism, Planning, and Expert information). COPE teaches caregivers how to design and carry out plans that focus on medical and psychosocial problems that are coordinated with care plans of health professionals. Although proponents of this program assert it has positive outcomes for caregivers, a formal evaluation of COPE was not found. Teaching caregivers how to manage specific patient problems can improve the caregiver’s well-being. For example, not being able to sleep at night is a serious problem for caregivers of people with Alzheimer’s disease, as the caregivers become fatigued and exhausted, which can have an adverse effect on both the physical and emotional health of the caregiver. Teaching them how to improve their family members’ nighttime insomnia through daily walks and exposure to light can improve sleep time for both the caregiver and care recipient. 82 Even caregivers providing end-of-life care can benefit from structured interventions. McMillan and colleagues 83 found that a skills and coping training intervention with family caregivers of hospice patients improved the caregivers’ quality of life. Caregivers as Providers Twenty-five years of research have documented that the work of family caregiving can be stressful. That stress can adversely harm both the caregiver and the care recipient. This section addresses research aimed at protecting the care recipient from an ill-prepared or emotionally stressed family caregiver. It describes the link between the work of caregiving and patient harm, and examines interventions that aim to make the caregiver a better worker and less likely to harm the patient.

The Potential for Harm Caregivers can place their family members at risk in two ways, and both situations are preventable. First, despite their good intentions and hard work, if caregivers do not have the knowledge and skills to perform their work, they may unintentionally harm their loved one. This risk for injury is directly related to lack of knowledge and competence, which can be improved through caregiver education and support. For example, a recent study confirmed that patients had many negative outcomes when untrained informal caregivers managed their home enteral nutrition or tube feeding. 84 Problems included tube displacement, tube clogging, infection, and dehydration—all of which can lead to a stressful caregiving situation and hospital readmission. A second concern is that the demanding work of caregiving can put caregivers at risk of engaging in harmful behaviors toward their care recipients, particularly among caregivers of persons with cognitive impairments. 85 Depressed caregivers are more likely to harm their spouses. Caregivers who are at risk of depression while caring for spouses with significant cognitive or physical impairments are more likely to engage in neglect or abusive behaviors, such as screaming and yelling, threatening to abandon or use physical force, withholding food, hitting, or handling roughly. 63 In general, family members may be challenged to find the capacity or ability to provide care, but Fulmer 86 found that caregivers who were in poor health or from low-income or dysfunctional situations might have the most limited capacity to provide needed care. They also might not understand the standard for quality and might not provide the level of care that is needed. The risk of elder abuse The presence of dementia and cognitive behavioral problems put the care recipient at risk for abusive behaviors by the caregiver.