Regents College Nursing
Study Guide Expanded Notes
Commonalities in Nursing Care: Area A
Content Area
I. Health, Wellness, and Illness 10%
II. Comfort, Rest, and Sleep 10%
III. Activity/Mobility 15%
IV. Environmental Safety 25%
V. Biological Safety 20%
VI. Psychological Safety 20%
Content Outline
I. Health, Wellness, and Illness
A. Theoretical framework: basis for care
1. Concept of a continuum from wellness to illness
(health to illness), including variation on the health
continuum (e.g., high-level wellness, health belief
model, acute illness, chronic illness)
2. Concepts related to stress and adaptation
a. Nature of stress: Selye's theory
b. Types of stressors
1) Physiological
2) Psychological
c. Factors affecting adaptation to stress (e.g., age, life
experience, support systems, health status)
d. Defining characteristics of increased stress
1) Physiological (e.g., increased heart rate, increased
respiratory rate, diaphoresis, patient reports a nervous
stomach)
2) Psychological (e.g., inability to focus, decreased
perception, patient reports feelings of anxiety)
e. Adaptation to stress
1) Physiological adaptations (e.g., the general
adaptation syndrome)
2) Psychological adaptations (e.g., coping strategies,
defense mechanisms)
3) Stress management (e.g., relaxation techniques,
exercise, problem solving, humor, anticipatory
guidance)
3. Principles related to health assessment
a. Health history (e.g., interviewing skills, questioning
techniques)
b. Physical examination (e.g., vital signs, auscultation,
palpation, inspection, percussion)
4. Principles related to health maintenance and promotion
(e.g., health screening, principles of teaching and learning)
5. Factors affecting health, wellness and illness
a. Developing level: infancy through senescence
b. Individual preferences and patterns (e.g., lifestyle,
past experiences, educational level)
c. Physical condition (e.g., presence of chronic disease,
weight, height, fatigue, risk factors)
d. Ethnic and cultural considerations (e.g., values,
perception of health, spiritual and religious beliefs,
male-female roles, language, communication patterns)
e. Socioeconomic factors (e.g., availability of health
resources, health insurance, family structure, support
system, employment status, peer pressure)
f. Environmental factors (e.g., temperature, housing
conditions, occupational hazards, light and sound
levels)
g. Psychological factors (e.g., level of motivation;
orientation to time, place, and person; hopelessness;
helplessness)
B. Nursing Care Related to Theoretical Framework
1. Assessment: gather and synthesize data about the
patient's health status in relation to the patient's
functional health patterns
a. Obtain the patient's health history
b. Assess factors affecting adaptation to stress (see IA2c)
c. Assess factors affecting health, wellness and illness (see
IA5)
d. Obtain objective data (e.g., temperature, pulse,
respirations, blood pressure, breath sounds, heart rate and
rhythm, intake and output, daily weight)
e. Review laboratory and other diagnostic data (e.g., vital
signs, complete blood count [CBC]1, blood glucose)
2. Analysis: identify the nursing diagnoses (patient
problem) and determine the expected outcomes
(goals) of patient care
a. Identify nursing diagnoses (e.g., altered health
maintenance related to stress, fatigue related to excessive
role demands, health-seeking behavior [breast self-
examination] related to desire for highlevel wellness,
ineffective individual coping related to knowledge deficit
regarding stress management)
b. Set priorities and establish expected outcomes (patient-
centered goals) for care (e.g., patient will identify stressors
and effective health maintenance behaviors, patient will
report an increase in energy level, patient will correctly and
regularly perform breast self-examination, patient will use
adaptive coping methods to reduce anxiety)
3. Planning: formulate specific strategies to achieve
the expected outcomes
a. Plan nursing measures to help the patient achieve the
expected outcomes (e.g., encourage the patient to keep a log
of incidents that arouse anxiety and frustration, assist the
patient to set priorities and manage time effectively,
demonstrate the procedure for breast self-examination to
the patient, provide information about relaxation techniques
and problem-solving skills)
b. Consider factors affecting adaptation to stress (see IA2c)
c. Incorporate factors affecting health, wellness, and illness
in planning the patient's care (e.g., consider patient's
developmental level, occupation, exercise routine, smoking
habits, level of anxiety, support systems, and stage of
wellness-illness) (see IA5)
4. Implementation: carry out nursing plans designed
to move the patient toward the expected outcomes
a. Use nursing measures to structure an environment
conductive to health (e.g., eliminate annoying noise and
odors, control temperature)
b. Use nursing measures to maintain psychological comfort
(e.g., involve the patient in decision making, respect the
patient's needs, encourage the expression of feelings)
c. Provide information and instruction regarding health
maintenance and promotion (e.g., advise the patient
regarding the use of health care services, provide
information about self-examination for early detection of
disease, provide a list of community screening agencies)
5. Evaluation: appraise the effectiveness of the
nursing intervention relative to the nursing
diagnosis and the expected outcomes
a. Record and report the patient's response to nursing
actions (e.g., patient correctly performs relaxation
techniques, patient demonstrated ability to use the health
care system, patient reports less anxiety)
b. Reassess and revise the patient's plan of care as necessary
(e.g., need for further instruction, provide written
instruction to reinforce the nurse's demonstration)
II. Comfort, Rest, and Sleep
A. Theoretical framework: basis for care
1. Principles related to comfort, rest, and sleep (e.g.,
pain management, sleep cycles, circadian rhythms)
2. Common disturbances in comfort: general concept
and nature of pain (e.g., acute vs. chronic, types of
pain, gate control theory, pain threshold, pain
tolerance)
3. Factors affecting pain
a. Development level: infancy through senescence
b. Individual preferences and patterns (e.g., pain relief
practices)
c. Physical condition (e.g., debilitation, fatigue)
d. Ethnic and cultural considerations (e.g., stoicism)
e. Socioeconomic factors (e.g., lack of health insurance)
f. Environmental factors (e.g., isolation, time of day, heat and
cold)
g. Psychological factors (e.g., powerlessness, anxiety)
4. Common disturbances in rest and sleep (e.g.,
insomnia, sleep apnea, sensory deprivation, sleep
pattern disturbances)
5. Factors affecting rest and sleep
a. Developmental level: infancy through senescence
b. Individual preferences and patterns (e.g., sleep patterns,
lifestyle, shift changes, use of caffeine and alcohol)
c. Physical condition (e.g., health status, pain, activity level)
d. Socioeconomic factors (e.g., living conditions)
e. Environmental factors (e.g., temperature extremes,
ventilation)
f. Psychological factors (e.g., security, stress)
6. Theoretical basis for interventions to promote
comfort, rest, and sleep
a. Medications (e.g., narcotics, analgesics, sedatives,
hypnotics)
b. Environmental modifications (e.g., room temperature,
ventilation)
c. Physical modifications (e.g., positioning, backrubs, warm
milk, elevate head of bed, use of pillows, call light, time for
uninterrupted sleep, noise reduction)
d. Psychological modifications (e.g., distraction, imagery)
B. Nursing care related to theoretical framework
1. Assessment: gather and synthesize data about the
patient's needs for comfort, rest, and sleep in
relation to the patient's functional health patterns
a. Obtain information about the patient's comfort, rest, and
sleep patterns (e.g., verbalization of pain level, patient naps
daily, sleeps five hours a night, daytime drowsiness, pain
relief measures)
b. Assess factors affecting comfort, rest, and sleep (see IIA3
and IIA5)
c. Obtain objective data (e.g., alteration in vital signs; body
position; facial expressions; onset, intensity, frequency,
duration, and location of pain2)
2. Analysis: identify the nursing diagnosis (patient
problem) and determine the expected outcomes
(goals) of patient care
a. Identify nursing diagnoses (e.g., pain related to physical
injury, sleep pattern disturbance related to change in
environment, fatigue related to altered sleep patterns)
b. Set priorities and establish expected outcomes (patient-
centered goals) for care (e.g., patient will state that pain has
been relieved, patient will demonstrate decreased signs of
sleep deprivation, patient will verbalize feeling refreshed
after awakening)
3. Planning: formulate specific strategies to achieve
the expected outcomes
a. Plan nursing measures to help the patient achieve the
expected outcomes (e.g., use measures to relieve pain such
as backrub, distraction, and repositioning; provide analgesics
as ordered; reduce environmental distractions such as noise
and lighting; position the patient to aid muscle relaxation)
b. Incorporate factors affecting comfort, rest, and sleep in
planning the patient's care (e.g., discourage the use of
caffeine prior to bedtime, adhere to a child's usual bedtime
routine, consider the patient's usual pain relief measures,
consider the patient's cultural response to pain) (seeIIA3
and IIA5)
4. Implementation: carry out nursing plans designed
to move the patient toward the expected outcomes
a. Use nursing measures to promote comfort, rest, and sleep
(e.g., promote bedtime rituals, encourage voiding before
bedtime, administer a backrub, use of heat and cold,
positioning, active listening)
b. Administer prescribed medications (e.g., administer pain
medication before the pain becomes severe, schedule
administration of medications to avoid nocturnal
awakenings, schedule pain medication prior to ambulation)
c. Use nursing measures to modify the environment (e.g.,
eliminate noises, provide soft music, decrease lighting)
d. Provide information and instruction regarding comfort,
rest, and sleep (e.g., instruct patient about relaxation
techniques, instruct patient regarding patient-controlled
analgesia [PCA], instruct patient in use of transcutaneous
electrical nerve stimulation [TEMS])
5. Evaluation: appraise the effectiveness of the
nursing intervention relative to the nursing
diagnosis and the expected outcomes
a. Record and report the patient's response to nursing
actions (e.g., changes in sleeping patterns, chart patient
reports of pain relief, note nonverbal behaviors)
b. Reassess and revise the patient's plan of care as necessary
(e.g., encourage the patient to request a change in pain
medication)
III. Activity/Mobility
A. Theoretical framework: basis for care
1. Principles related to mobility (e.g., normal body
alignment, body mechanics, range of motion,
positioning, transfer)
2. Common disturbances related to immobility
a. Physiological responses (e.g., decreased lung expansion,
orthostatic hypotension, pressure ulcer, constipation,
contractures, renal calculi, thrombophlebitis)
b. Psychological responses (e.g., hopelessness, sensory
deprivation, changes in sleep patterns, attention-seeking
behaviors, feelings of powerlessness)
c. Developmental responses (e.g., regression in children,
increased dependence in the older adult)
3. Factors affecting activity/mobility
a. Developmental level: infancy through senescence
b. Individual preferences and patterns ( e.g., sedentary
lifestyle, smoking, energy levels, leisure activities)
c. Physical condition (e.g., nutritional status, muscle atrophy,
presence of other illness or disability)
d. Ethnic and cultural considerations (e.g., value of physical
activity, compliance with treatment)
e. Socioeconomic factors (e.g., occupation)
f. Environmental factors (e.g., climate)
g. Psychological factors (e.g., hopelessness, helplessness)
4. Theoretical basis for interventions related to
activity/mobility
a. Interventions to promote activity/mobility
1) Exercise (e.g., quadriceps setting, active and passive
range-of-motion)
2) Positioning
3) Use of mechanical aids (e.g., walkers, canes,
crutches)
b. Interventions to prevent complications of immobility
1) Maintain fluid balance
2) Prevent stasis of pulmonary secretions
3) Maintain nutrition
4) Maintain skin integrity
5) Promote venous return
6) Maintain normal elimination patterns
7) Provide psychosocial stimulation
8) Maintain autonomy
B. Nursing care related to theoretical framework
1. Assessment: gather and synthesize data about the
patient's activity/mobility needs in relation to the
patient's functional health patterns
a. Obtain information about the patient's activity/mobility
patterns (e.g., activity tolerance, exercise patterns, ability to
perform activities of daily living [ADLs], endurance)
b. Assess factors affecting activity/mobility (see IIIA3)
c. Obtain objective data (e.g., range of motion, gait, body
alignment, muscle strength and symmetry, ambulation)
d. Review laboratory and other diagnostic data (e.g., serum
calcium levels, blood urea nitrogen [BUN], hematocrit)
2. Analysis: identify the nursing diagnosis (patient
problem) and determine the expected outcomes
(goals) of patient care
a. Identify nursing diagnosis (e.g., impaired physical
mobility related to bed rest, activity intolerance related to
sedentary lifestyle, impaired skin integrity related to
increased pressure over bony prominences, high risk for
injury related to unsteady gait)
b. Set priorities and establish expected outcomes (patient-
centered goals) for care (e.g., patient will demonstrate active
range of motion in all body joints; patient will verbalize the
need to incorporate exercise into daily activities; patient's
skin will be clean, intact, and well-hydrated; patient will not
experience injury)
3. Planning: formulate specific strategies to achieve
the expected outcomes
a. Plan nursing measures to help the patient achieve the
expected outcomes (e.g., instruct the patient to perform
range-of-motion exercises, explore the patient's activity
preferences, turn and position the patient q2h, provide a
safe environment for the patient)
b. Incorporate factors affecting activity/mobility in planning
the patient's care (e.g., establish an age-specific exercise
program, plan activities based on the patient's age and
physical findings, administer prn pain medication prior to
exercise)
4. Implementation: carry out nursing plans designed
to move the patient towards the expected outcomes
a. Use nursing measures to maintain the patient's
activity/mobility (e.g., turning, positioning, active and
passive range-of-motion exercises)
b. Promote the use of assistive devices (e.g., walkers, canes,
crutches)
c. Provide information and instruction regarding
activity/mobility (e.g., instruct the patient in crutch walking,
instruct the patient regarding transfer activities, instruct the
patient about body mechanics)
5. Evaluation: appraise the effectiveness of the
nursing intervention relative to the nursing
diagnosis and expected outcomes
a. Record and report the patient's response to nursing
actions (e.g., colour and condition of the skin, development
of pressure areas, ROM exercises performed, ambulates
independently, skin intact no areas of redness, intake and
output are normal)
b. Reassess and revise the patient's plan of care as necessary
(e.g., turn and reposition the patient more frequently, select
a device to minimize pressure for a patient who cannot keep
weight off pressure areas)
IV. Environmental Safety
(A safe environment is one in which physical hazards are
reduced. The skin is considered the body's first line of
defense against environmental hazards. Maintenance of the
integument through hygienic care promotes health.)
A. Theoretical framework: basis for care
1. Principles related to environmental safety and
maintenance of the integument (e.g., safe
administration of medications, basic physical
principles, anatomy and physiology of the
integument [this includes the skin and mucous
membranes, oral cavity, nails, hair, and sweat
glands])
2. Common safety hazards in the environment
a. Physical/mechanical (e.g., wet floors, loose cords, scatter
rugs, height of bed, friction, pressure)
b. Thermal (e.g., fire, electrical hazards, exposure to heat and
cold)
c. Chemical (e.g., alkaline soaps, commercial mouthwashes,
medications, poisons, pesticides)
d. Radiation (e.g., sunburn, heat lamps, X rays)
e. Ecological (e.g., air, noise, water pollution)
3. Common disturbances related to the integument
(e.g., changes in skin turgor; changes in secretions;
alterations in circulation; disruptions in skin
integrity; psoriasis, pustules, papules, etc.)
4. Factors affecting environmental safety and
maintenance of the integument
a. Developmental level: infancy through senescence
b. Individual preferences and patterns (e.g., previous
accidents, lifestyle, safety knowledge, hygiene practices, use
of medications)
c. Physical condition (e.g., level of awareness, sensory
perception, hydration, activity patterns, nutritional status)
d. Ethnic and cultural considerations (e.g., familial hygienic
practices, genetic differences in skin and hair)
e. Socioeconomic factors (e.g., crowded housing,
unemployment, income level)
f. Environmental factors (e.g., proximity to nuclear plants,
climate, occupation hazards)
g. Psychological factors (e.g., anxiety, cognition, stress)
5. Theoretical basis for interventions related to
environmental safety and maintenance of the
integument
a. Environmental modifications (e.g., lighting, furniture
arrangement, heat and cold)
b. Safety instructions (e.g., need for appropriate footwear,
regulatory guidelines)
c. Medications/topical agents (e.g., syrup of ipecac, powders,
lotions, sunscreens)
d. Safety devices (e.g., restraints, siderails)
B. Nursing care related to theoretical framework
1. Assessment: gather and synthesize data about the
patient's environmental safety needs in relation to
the patient's functional health patterns
a. Determine the presence of environmental hazards (e.g.,
fire radiation, pollution, safety hazards)
b. Identify patient at risk for physical injury (e.g., confused
mental state, sensory deficit, weakened physical state)
c. Determine the condition of the patient's integument (e.g.,
turgor, elasticity, colour, temperature)
d. Assess factors affecting environmental safety and
maintenance of the integument (see IVA4)
2. Analysis: identify the nursing diagnosis (patient
problem) and determine the expected outcomes
(goals) of patient care
a. Identify nursing diagnoses (e.g., high risk for impaired
skin integrity related to knowledge deficit, impaired skin
integrity related to urinary or fecal incontinence, self-care
deficit [bathing and hygiene] related to inability to use the
hands, high risk for injury related to cluttered environment,
high risk for injury related to sensory deficit)
b. Set priorities and establish expected outcomes (patient-
centered goals) for care (e.g., patient will verbalize factors
that increase potential for skin injury; patient's skin will be
clean, dry, and intact; patient will not sustain injury; patient
will use safety measures when ambulating)
3. Planning: formulate specific strategies to achieve
the expected outcomes
a. Plan nursing measures to help the patient achieve the
expected outcomes (e.g., teach the patient about risk factors
such as overexposure to the sum, check the patient for
incontinence q2h, provide total hygiene care for the patient
daily, identify potential hazards in the patient's
environment, encourage the patient to use a hearing aid)
b. Incorporate factors affecting environmental safety in
planning the patient's care (e.g., establish a safe
environment for a toddler, provide safety bars in the
shower for an older adult, plan to apply moisturizer to the
skin of a patient who lives in a dry climate, consider cultural
factors when planning hygiene care) (see IVA4)
4. Implementation: carry out nursing plans designed
to move the patient toward the expected outcomes
a. Use nursing measures to structure an environment
conducive to safety (e.g., place furniture in an uncluttered
arrangement, remove safety hazards)
b. use nursing measures to promote the integrity of the
patient's integument (e.g., provide oral hygiene; provide care
of the skin, hair, eyes, nails, and perineum; use an air
mattress to prevent pressure ulcer formation; use
appropriate topical agents)
c. Use nursing measures appropriate to particular safety
needs (e.g., use heat and cold appropriately, shield
appropriately from radiation, provide a large-print
thermometer to measure bathwater temperature for an
older adult)
d. Use safety devices properly (e.g., use mobilizing devices
correctly, siderails)
e. Use measures to safely administer medications (e.g., use
the "five rights" in drug administration, use established
protocol, perform calculations accurately)
f. Provide information and instruction regarding
environmental safety and maintenance of the integument
(e.g., orient patient to the environment, explain use of
mobilizing devices, provide instructions regarding skin care
and the use of sunscreens)
5. Evaluation: appraise the effectiveness of the
nursing interventions relative to the nursing
diagnosis and the expected outcomes
a. Record and report the patient's response to nursing
actions (e.g., administration of medications, condition of the
integument, correct use of safety devices)
b. Reassess and revise the patient's plan of care as necessary
(e.g., discontinue the use of soap fro hygienic care)
V. Biological Safety
(A safe biological environment is one in which the
transmission of pathogens is reduced. The inflammatory
process is considered a common body response to invasion
by pathogens.)
A. Theoretical framework: basis for care
1. Principles related to biological safety
a. Medical asepsis
b. Surgical asepsis
c. The infectious process: agent, reservoir, portal of exit,
mode of transmission, portal of entry, host
2. The inflammatory process
a. Localized defining characteristics (e.g., edema, pain,
erythema, increased local temperature)
b. Systemic defining characteristics (e.g., altered vital signs,
fatigue, anorexia, increased WBC)
3. Factors affecting biological safety
a. Developmental level: infancy through senescence
b. Individual factors (e.g., lifestyle, health habits, risk-taking
behavior, educational level)
c. Physical condition (e.g., nutritional status, presence of
other illness, immunosuppressive therapy)
d. Ethnic and cultural considerations (e.g., beliefs about
health and illness)
e. Socioeconomic factors (e.g., income level, access to health
care)
f. Environmental factors (e.g., overcrowding, unsanitary
conditions, pollution, reservoirs of infection)
g. Psychological factors (e.g., stress)
4. Theoretical basis for interventions to promote
biological safety
a. Medications (e.g., antibiotics, antiinflammatory agents,
antipyretics)
b. Maintenance of asepsis (e.g., handwashing, barriers,
protective asepsis)
c. Application of heat and cold (e.g., compresses,
aquathermia pads, ice packs)
d. Dietary modifications (e.g., increased fluid intake,
increased protein intake)
B. Nursing care related to theoretical framework
1. Assessment: gather and synthesize data about the
patient's biological safety in relation to the patient's
functional health patterns
a. Determine the patient's susceptibility to infection (e.g.,
presence of chronic illness, invasive lines, over age 85)
b. Determine the patient's response to the infectious process
(e.g., increased temperature, increased pulse rate, increased
WBC)
c. Assess factors affecting biological safety (see VA3)
d. Review laboratory and other diagnostic data (e.g., vital
signs, white blood count [WBC] and differential,
sedimentation rates, serum albumin, culture and sensitivity
reports)
2. Analysis: identify the nursing diagnosis (patient
problem) and determine the expected outcomes
(goals) of patient care
a. Identify nursing diagnosis (e.g., high risk for infection
related to presence of invasive lines, high risk for infection
related to altered immunity, altered tissue perfusion related
to inflammation)
b. Set priorities and establish expected outcomes (patient-
centered goals) for care (e.g., patient's temperature, pulse,
and WBC will remain within normal limits; patient will show
no signs of infection; patient will show signs of increased
tissue perfusion)
3. Planning: formulate specific strategies to achieve
the expected outcomes
a. Plan nursing measures to help the patient achieve the
expected outcomes (e.g., monitor the patient's vital signs
q4h, teach the patient appropriate aseptic practices, apply a
warm soak to the site of inflammation, wash the hands
before and after direct patient contact, use universal
precautions)
b. Incorporate factors affecting biological safety in planning
the patient's care (e.g., consider the patient's hygienic
practices, explore the patient;s previous strategies for coping
with stress, adapt teaching materials to the patient's
developmental level) (see VA3)
4. Implementation: carry out nursing plans designed
to move the patient toward the expected outcomes
a. Maintain aseptic technique (e.g., maintain sterile
technique during dressing changes, use handwashing
technique prior to dressing changes)
b. Use nursing measures to aid in the resolution of the
inflammatory process (e.g., elevate extremities, apply heat
and cold, encourage fluid intake)
c. Administer medications (e.g., antibiotics, antipyretics)
d. Provide information and instruction regarding biological
safety (e.g., instruct patient regarding antibiotic therapy,
instruct patient regarding mode of transmission of
pathogens, emphasize preventive measures, discuss the
spread of infection, refer to neighborhood health care
centers)
5. Evaluation: appraise the effectiveness of the
nursing intervention relative to the nursing
diagnosis and the expected outcomes
a. Record and report the patient's response to nursing
actions (e.g., changes in vital signs, condition of the wound,
decrease in level of discomfort, characteristics of drainage)
b. Reassess and revise the patient's plan of care as necessary
(e.g., increase fluid intake based on the patient's
preferences)
VI. Psychological Safety
(A safe psychological environment is one in which the patient
understands what to expect from others. Communication and
the therapeutic relationship are considered the means by
which the nurse and patient exchange information and
feelings.)
A. Theoretical framework: basis for care
1. Communication
a. Definition and goals
b. Types of communication
1) Verbal
2) Nonverbal: silence, body language, facial expression
c. Principles of therapeutic communication
d. Components necessary for effective communications
1) Stimuli
2) Sender
3) Message
4) Receiver
5) Feedback
e. Factors affecting communication
1) Developmental level: Infancy through senescence
2) Individual preferences and patterns (e.g., body
language, territoriality, privacy, personal experiences
and needs, self-awareness)
3) Physical condition (e.g., pain, level of
consciousness, sensory deficits, cognitive level)
4) Socioeconomic factors (e.g., differences in values)
5) Ethnic and cultural considerations (e.g., language
barriers, attitudes, personal space, values related to
touching and expression of feelings)
6) Environmental factors (e.g., light, noise, physical
space, furniture arrangement)
7) Psychological factors (e.g., stress, anxiety, readiness
to learn)
f. Communication techniques
1) Techniques that facilitate communication (e.g.,
clarifying, reflection, use of open-ended statements,
listening, tough, silence)
2) Blocks to communication (e.g., use of judgmental
responses, offering false reassurance, stereotyped
responses, probing, changing the subject, advising)
2. The therapeutic nurse-patient relationship
a. Definition and goals of the relationship
b. Components of the relationship (e.g., empathy, trust and
security, dependency, autonomy, acceptance, genuineness)
c. Phases of the relationship (i.e., initiation, working, and
termination)
d. Factors influencing the relationship (see VIA1e)
e. Roles in the relationship
1) Roles of the nurse (e.g., as a person, as a caregiver,
as an advocate)
2) Roles of the patient (e.g., as a person, as a health
care consumer)
B. Nursing care related to theoretical framework
1. Assessment: gather and synthesize data about the
patient's ability to communicate and interact with
others
a. Identify the patient's perceptions of communication
patterns and mood (e.g., patient states that he feels sad,
patient feels intimidated communicating with authority
figures)
b. Assess factors affecting communication (see VIA1e)
c. Obtain objective data (e.g., nonverbal behavior, energy
and activity levels, affect, language development,
communication style, body language)
2. Analysis: identify the nursing diagnosis (patient
problem) and determine the expected outcomes
(goals) of patient care
a. Identify nursing diagnoses (e.g., impaired verbal
communication related to language barrier, impaired verbal
communication related to developmental level, impaired
social interaction related to cultural differences)
b. Set priorities and establish expected outcomes (patient-
centered goals) for care (e.g., patient will express basic
needs with minimal frustration, patient will participate in
one group activity daily)
3. Planning: formulate specific strategies to achieve
the expected outcomes
a. Plan nursing measures to help the patient achieve the
expected outcomes (e.g., teach the patient simple phrases to
communicate needs, establish an age appropriate method of
communication for expressing needs, encourage the patient
to express feelings)
b. Incorporate factors affecting communication in planning
the patient's care (e.g., locate a private environment for a
patient interview, plan to use closed-ended questions with a
patient who has impaired verbal communications, ensure
that the patient's hearing aid is functioning, use active
listening with an adolescent patient) (see VIA 1e)
4. Implementation: carry out nursing plans designed
to move the patient toward the excepted outcomes
a. Use facilitative communication techniques (e.g., listen
attentively to a patient who is anxious; reassure a frightened
child; use therapeutic communication; paraphrasing, tough,
focusing, etc.)
b. promote a therapeutic nurse-patient relationship
c. Structure the environment to promote communication
(e.g., use a communication board, use an interpreter, provide
privacy, reduce noise level, maintain eye contact)
d. Provide information and instruction regarding
communication (e.g., instruct the patient in the use of a
hearing aid; instruct the family of a patient with a memory
loss regarding orientation methods)
5. Evaluation: appraise the effectiveness of the
nursing intervention relative to the nursing
diagnosis and the expected outcomes
a. Record and report the patient's responses to nursing
actions (e.g., increased verbalization, refuses to use a hearing
aid, participated in group activities, expresses feelings about
illness)
b. Use a process recording to evaluate the nurse's
communication style and technique
c. Reassess and revise the patient's plan of care as necessary
(e.g., encourage the patient and family to teach staff some
words and phrases in the patient's native language)