Mission Medicine

Be Ready

 
 
TABLE OF CONTENTS
 
 
WORK  ETHICS .......................................................................................................................................................1  
VITAL  SIGNS ...........................................................................................................................................................3  
NURSING  PRACTICE.......................................................................................................................................... 15  
INFECTION........................................................................................................................................................... 23  
UNDERSTANDING  YOUR  PATIENT .............................................................................................................. 27  
 STUDY GUIDE 1
Work Ethics

Colossians 3:23, 24
And whatsoever ye do, do it heartily, as to the Lord, and not unto
men; Knowing that of the Lord ye shall receive the reward of the
inheritance: for ye serve the Lord Christ.

Fundamentals of Christian Education, page 316

It is the duty of every worker not merely to give his strength, but his
mind and intellect to that which he undertakes to do. . . .You can choose to
become stereotyped in a wrong course of action because you have not the
determination to take yourselves in hand and reform, or you may cultivate
your powers to do the very best kind of service, and then you will find
yourselves in demand anywhere and everywhere. You will be appreciated
for all that you are worth. “Whatsoever thine hand findeth to do, do it with
thy might.” “Not slothful in business; fervent in spirit; serving the Lord.”

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 QUALITIES OF GOOD WORK ETHICS

 Caring—Concern for the person. Help make person’s life happier, easier, less
painful.

 Dependability—Report to work on time and when scheduled. Perform delegated

tasks, keep obligations and promises, take responsibility.

 Consideration—Respect person’s physical and emotional feelings. Be gentle and

kind towards patients, families, co-workers.

 Empathy—See things from person’s point of view. Ask yourself how you would feel
if you had the person’s problem.

 Trustworthiness—Patients and staff have confidence in you. They believe you will
keep the persons information confidential (HIPAA).

 Respectfulness—Patients have rights, values, beliefs, and feelings. If theirs differ

from yours, do not criticize or condemn them. Treat them with respect and dignity at
all times. Show respect to supervisors/co-workers.

 Courtesy—Be polite and courteous to everyone you interact with. Address people
by title and last name (“Mr. Smith,” “Ms. Jones,” “Dr. Wilson”) until given permission
to do otherwise. Explain to the patient what you are going to do, say “please” and
“thank you,” don’t interrupt others.

 Conscientiousness—Be careful, alert, and exact in following instructions. Give

thorough care with knowledge and skill. Only do things that you are reasonably
comfortable with and that you can do safely. Always give your best possible effort.

 Honesty—Truthfully and accurately report the amount and type of care given, your
observations, and any errors.

 Cooperation—Willingly help and work with others. “Go the extra mile” during busy
and stressful times. Remember that you are part of a TEAM.

 Enthusiasm—Be eager, interested, and excited about your work. What you are
doing is IMPORTANT!

 Self-awareness—Know your own feelings, strengths, and weaknesses. You must

understand yourself before you can understand your patients.

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 STUDY GUIDE 2
Vital Signs

Genesis 2:7
And the LORD God formed man of the dust of the ground, and
breathed into his nostrils the breath of life; and man became a living soul.

Medical Ministry, page 9, paragraph 3

The physical organism of man is under the supervision of God, but it
is not like a clock, which is set in operation, and must go of itself. The heart
beats, pulse succeeds pulse, breath succeeds breath, but the entire being
is under the supervision of God. "Ye are God's husbandry; ye are God's
building." In God we live, and move, and have our being. Each heartbeat,
each breath, is the inspiration of Him who breathed into the nostrils of
Adam the breath of life—the inspiration of the ever-present God, the great I
AM.—R.H., Nov. 8, 1898.

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 VITAL SIGNS
Key Terms
 Apical pulse
Pulse taken by listening to the beat of the heart through the chest wall.
 Apnea
“A” = the lack or absence of, “pnea” = breathing
 Blood pressure (BP)
The amount of force exerted against the walls of an artery by the blood.
(normal = 120/80)
 Diastole
Period of heart muscle relaxation and filling.
 Diastolic pressure
Pressure in the arteries when the heart is at rest (bottom number when
documenting BP).
 Dyspnea
“Dys” = difficult/labored/painful, “pnea” = breathing
 Hypertension
Persistent blood pressure measurements above 140 systolic and 90
diastolic.
 Hyperventilation
Respirations that are rapid and deeper than normal.
 Hypotension
Low blood pressure.
 Hypoventilation
Respirations that are slow, shallow, and sometimes irregular.
 Pulse
Beat of the heart felt at an artery.
 Respiration
Act of breathing air into (inhalation) and out of (exhalation) the lungs.
 Sphygmomanometer
Instrument used to measure blood pressure.
 Stethoscope
Instrument used to listen to sounds produced
by the heart, lungs, and other body organs.
 Systole
Period of heart muscle contraction.
 Systolic pressure
Amount of force it takes to pump blood out of the heart into the arterial
circulation (top number when documenting BP).

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Vital signs (VS) include:
1. temperature
2. pulse abbreviated
3. respirations “TPR & BP”
4. blood pressure
5. pain
6. (oxygen saturation)

When to take vital signs:

 when pt first arrives—determine baseline (pt’s normal)
 routinely for monitoring—usually q4h (every 4 hours)
 after a treatment—determine response
 if any change in condition

Factors that affect vital signs:

 sleep
 activity (i.e. eating, exercise)
 weather
 noise
 medications
 illness
 age
 blood volume
 emotions (fear, anxiety, anger, excitement)
 pain
 body size
 position
 heat

Nursing Tip:
1. If possible, try to use the same equipment each time for more consistent
readings.
2. If a reading is unexpectedly high or low, RETAKE it!
3. Always have current VS BEFORE calling MD!

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 TEMPERATURE

Normal temperatures (± 1°F)

 oral (mouth)—98.6°F (37°C)
- most commonly used
 rectal (rectum/anus)—99.6°F (37.5°C)
- 1° higher than oral
 axillary (under arm)—97.6°F (36.5°C)
- 1° lower than oral

Glass thermometers
 use plastic cover
 must be shaken down before using (careful with mercury!)
 thermometer must be left in place:
- oral: 3 min
- rectal: 3 min
- axillary: 5-10 min

Nursing Tip:
Don’t take oral temp after pt has ingested hot/cold substance

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 PULSE

Pulse rate
 number of heartbeats/pulses felt in 1 minute
 normal = 60-100 bpm (beats per minute)
 may ↑ d/t (due to):
- age
- pain
- body temp (fever)
- exercise, position, sleep state
- fear, anger, anxiety, excitement

Sites for taking pulse:

 radial (wrist)
- used most often because most accessible
- thumb-side of wrist
 temporal (head)
 carotid (neck)
 brachial (arm)
 femoral (groin)
 popliteal (knee)
 pedal (foot)
- harder to feel in diabetics d/t poor circulation
- dorsalis pedis—top of foot (crease between big & 2nd toe)
- posterior tibial—inner ankle behind protruding bone

Apical pulse
 taken with stethoscope 2-3 inches to left of sternum
 “lub-dub” is one full heartbeat
 use for:
- infants/children under 3 years old
- adults with irregular pulse, on certain heart medication

Pulse descriptions
 rhythm—equal time intervals should occur between beats
 irregular—unevenly spaces or skipped beats
 force—strength described as:
- strong, full, or bounding
- weak, thready, or feeble

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Nursing Tip:
1. Don’t look at your watch while counting pulse (easy to start counting
seconds instead)!
2. Do not use your thumb to feel pulse (thumb has strong pulse which can be
mistaken for pt’s pulse).

Location of pulse points in the body

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 RESPIRATIONS

Respiratory rate
 number of inhalations (breathing in) and exhalations (breathing
out) in 1 minute
 each respiration includes 1 inspiration and 1 exhalation
 normal = 12-20

Respiratory terms
 tachypnea
“tachy” = rapid, “pnea” = breathing, rate > 24
 bradypnea
“brady” = slow, rate < 10
 apnea
“a” = lack/absence
 dyspnea
difficult, labored, painful
 hyperventilation
rapid and deeper than normal
 hypoventilation
slow, shallow, irregular
 Cheyne-Stokes
pattern of breathing deeply for short time then breathing slowly
or stopping breathing periodically

Nursing Tip:
1. People change their breathing patterns when they know their
respirations are being counted. Count respirations right after taking
pulse without moving fingers from wrist so that person is unaware
respirations are being counted.
2. Count by watching rise and fall of chest. If unable to discern chest
movement, watch abdomen for movement (usually more in children) or
put hand on back to feel breath movements.

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 BLOOD PRESSURE

Blood pressure (BP)

 amount of force exerted against the walls of an artery by the blood
 normal = 120/80
 measured in millimeters (mm) mercury (Hg)
 record systolic pressure over diastolic pressure

Physiology
 controlled by:
- force of heart contraction
- amount of blood pumped with each heartbeat (stroke
volume)
- how easily blood flows through blood vessels (peripheral
resistance)
 systole = period of heart muscle contraction (higher pressure and
number)
 diastole = period of heart muscle relaxation (lower pressure and
number)

BP measurement
 taken with a sphygmomanometer (BP cuff)
 cuff width should be 40% of mid-arm circumference (too narrow =
false high reading)
 1st sound heard = systolic, disappearance of sound = diastolic

Blood pressure terms

 hypertension
BP > 140/90
 hypotension
low BP
 orthostatic BP
BP taken with pt lying/sitting and then standing

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 COMMON MISTAKES IN
BLOOD PRESSURE MEASUREMENT

Error Effect
Cuff too wide False low reading
Cuff too narrow False high reading
Cuff wrapped too loosely False high reading
Deflating cuff too slowly False high diastolic reading
Deflating cuff too quickly False low systolic and false high
diastolic reading
Stethoscope that fits poorly or False low systolic and false high
impairment of the examiner's diastolic reading
hearing, causing sounds to be
muffled
Inaccurate inflation level False low systolic reading

Sounds heard during auscultation of blood pressure

Nursing Tip:
1. DO NOT take BP in an arm if pt:
- has had a mastectomy (breast removal) on that side
- has a dialysis shunt/graft in that arm

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 - has a PICC (peripherally inserted central catheter) in that arm
AVOID if has running IV in that arm (especially if at high rate)
2. Ask the pt what their normal BP is before taking it so you have an idea of how
high to pump the cuff.
3. If a pt is flaccid (weak) on one side, use the other side (flaccid side BP is
usually lower than pt’s true baseline).
4. If a BP is abnormal, try the other arm (up to 10mm Hg difference is normal).

PAIN

Importance
 JCAHO (Joint Commission on Accreditation of Healthcare
Organizations) required
 importance to pts
 reflection of body response to problem
 affects other VS

Assessment
 quantity
- nonverbal—posture, facial expressions,
rubbing affected area
- scales—0-10, FACES (esp. children)
 place
- radiate/referred pain
 quality
- description—sharp, dull, achy, throbbing, etc.
 time
- length of time having pain (may be chronic)
 remedies/aggravants
- what makes it better/worse—pressure, breathing, etc.
 previous experiences
- history of pain
- treatments used
Reassessment
 within 30 min – 1 hour after intervention
 document relief using pain scale

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 OXYGEN SATURATION

Oxygen saturation (O2 sat) measurement

 amount of oxygen bound to hemoglobin in the blood expressed as
a percentage of the maximum capacity
 measured with digital pulse oximeter
- probe on finger (sometimes toe, ear, bridge
of nose)
- remove red fingernail polish (false high
reading)
 usually want > 92%
 pt response
- after O2 applied, wait 2-3 min before rechecking sat
- after O2 removed/decreased
check pt for signs/symptoms of respiratory distress
recheck sat within 1 min for significant decrease
if stable, wait 15-20 min before rechecking again

Oxygen therapy
 safety!—no smoking/flammables (Vaseline)
 measured in liter/minute (2 L/min delivers 24% O2)
 usually via nasal cannula
- nasal probes curve down
 humidification to keep airways moist
- bubbling in chamber indicates O2 flow
 pts with history of COPD (chronic obstructive
pulmonary disease) do NOT use > 2 L/min
(may stop breathing)

Incentive spirometry (ICS)

 device which encourages voluntary deep breathing
 pt EDUCATION on how to use device is key!
 usually ordered 10 times/hour WA (while awake)
 procedure:
- pt sit up straight in bed
- blow all air OUT
- seal lips around mouthpiece
- inhale through spirometer until ball reaches goal height
- hold breath 2-3 seconds to keep ball floating
- slowly exhale and repeat

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Nursing Tip:
1. If O2 sat:
- not reading—fingers may be cold, warm them up or try a different
extremity; may need to remove red nail polish
- low—sometimes pt is not getting good air exchange, have pt sit up
high in bed and cough
2. Turn on O2 and set flow rate BEFORE applying to pt.

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 STUDY GUIDE 3
Nursing Practice

Matthew 25:35-40
For I was an hungered, and ye gave Me meat: I was thirsty, and ye
gave Me drink: I was a stranger, and ye took Me in: Naked, and ye clothed
Me: I was sick, and ye visited Me: I was in prison, and ye came unto Me.
Then shall the righteous answer Him, saying, Lord, when saw we Thee an
hungered, and fed Thee? or thirsty, and gave Thee drink? When saw we
Thee a stranger, and took Thee in? or naked, and clothed Thee? Or when
saw we Thee sick, or in prison, and came unto Thee? And the King shall
answer and say unto them, Verily I say unto you, Inasmuch as ye have
done it unto one of the least of these my brethren, ye have done it unto Me.

A Call to Medical Evangelism and Health Education, page 18,

paragraph 2&3
Earnest, devoted young people are needed to enter the work of God
as nurses. As these young men and women use conscientiously the
knowledge they gain, they will increase in capability and become better and
better qualified to be the Lord's helping hand. They may become
successful missionaries, pointing souls to the Lamb of God, who taketh
away the sin of the world, and who can save both soul and body.
The Lord wants wise men and women, acting in the capacity of
nurses, to comfort and help the sick and suffering.
Oh, that all who are afflicted could be ministered to
by Christlike physicians and nurses who could help
them to place their weary, pain-racked bodies in the
care of the great Healer, in faith looking to Him for
restoration.—Review and Herald, May 9, 1912.

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 ABBREVIATIONS & SYMBOLS
Abd abdomen p after
ac before meals pc after meals
ADL activities of daily living per by/through
ad lib as much as desired PM afternoon
AM morning po by mouth
amt amount prn as needed
approx approximately pt patient
as tol as tolerated
ATC around the clock q every
qd every day
bid twice a day qh every hour
BM bowel movement q3h every 3 hours
BP blood pressure qid 4 times daily
BR bedrest/bathroom qod every other day
BRP bathroom privileges qs quantity sufficient

C centigrade (Celsius) R, rt, R right

c with RBC red blood cells
CBC complete blood count (test) ROM range of motion
c/o complaint of r/o rule out
rx prescription
EKG/ECG electrocardiogram (test)
s without
F Fahrenheit sm small
fx fracture SOB short of breath
spec specimen
GI gastrointestinal stat immediately
GU genitourinary SC, SQ subcutaneous

hr hour tid three times daily

Hct hematocrit TLC tender loving care
Hgb hemoglobin T.O. telephone order
H2 O water TPR temperature, pulse, respirations
HS hour of sleep (bedtime) tx treatment
ht height
hx history UA urinalysis

I&O intake and output V.O. verbal order

IM intramuscular VS vital signs
IV intravenous
WA while awake
L, L left WBC white blood cells
lg large WNL within normal limits
lt light wt weight

meds medications y/o years old

mod moderate yr year
- - - - - - - - - - - - - - - - - - - - - - - - - - -
neg negative > greater than
NKDA no known drug allergies < less than
noc night = equal to
NPO nothing by mouth O none/no/nothing
N/V nausea/vomiting ↑ increased
↓ decreased
O2 oxygen ♀ female
OD right eye ♂ male
OOB out of bed @ at
OS left eye x times
OU both eyes # number

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 DOCUMENTATION OOPS!

“The patient refused an autopsy.”

“The patient had waffles for breakfast and anorexia for lunch.”

“She is numb from her toes down.”

“I saw your pt today who is still under our car for physical therapy.”

“The left leg became numb at times, but she was able to walk it off.”

“Patient has chest pain if she lies on her left side for over a year.”

“Skin: somewhat pale, but present.”

“On the 2nd day the knee was better, and on the 3rd day it had completely
disappeared.”

“Discharge status: alive but without permission.”

“The client has been depressed ever since she began seeing me in 1983.”

“The patient has no past history of suicides.”

17

Guidelines
 Do not erase, apply
correction fluid, or scratch
out errors made while
recording.
 Do not write retaliatory or
critical comments about
client or care by other health
care professionals.
 Correct all errors promptly.
 Record all facts.
 Do not leave blank spaces in
nurse’s notes.
 Record all entries legibly and
in ink.
 If order is questioned, record
that clarification was sought.
 Chart only for yourself.
 Avoid using generalized,
empty phrases such as
“status unchanged” or “had
good day.”
 Begin each entry with time,
and end with your signature
and title.
Potter, P. A., & Perry, A. G. (1997). Fundamentals of nursing: Concepts, process, and practice (4 ed.). St. Louis: Mosby.
DOCUMENTATION
Rationale
 Charting becomes illegible: it
may appear as if you were
attempting to hide
information or deface record.
 Statements can be used as
evidence for nonprofessional
behavior or poor quality of
care.
 Errors in recording can lead
to errors in treatment.
 Record must be accurate
and reliable.
 Another person can add
incorrect information in
space.
 Illegible entries can be
misinterpreted, causing
errors and lawsuits; ink
cannot be erased; records
are photocopied & stored.
 If you perform order known to
be incorrect, you are just as
liable for prosecution as the
physician is.
 You are accountable for
information you enter into
chart.
 Specific information about
client’s condition or case can
be accidentally left out if
information is too
generalized.
 This guideline ensures that
correct sequence of events is
recorded; signature
documents who is
accountable for care
delivered.
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Correct Action
 Draw single line through
error, write word “error”
above it; then record note
correctly.
 Enter only objective
descriptions of client’s
behavior; client comments
should be quoted.
 Avoid rushing to complete
charting; be sure information
is accurate.
 Be certain entry is factual; do
not speculate or guess.
 Chart consecutively, line by
line; if space is left, draw line
horizontally through it and
sign your name at end.
 Never erase entries or use
correction fluid, and never
use pencil.
 Do not record “physician
made error.” Instead, chart
that “Dr. Smith was called to
clarify order for___.”
 Never chart for someone
else (exception: if care giver
has left unit for day and calls
with information).
 Use complete, concise
descriptions of care.
 Do not wait until end of shift
to record important changes
that occurred several hours
earlier; be sure to sign each
entry.
th
 DOCUMENTATION, cont.

Time systems
 military time = 24-hr system

Military Civilian
0100 1:00AM
0200 2:00AM
0215 2:15AM
1200 Noon
1420 2:20PM
1800 6:00PM
2400 Midnight
0001 12:01AM

Positioning

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 MEDICATIONS

5 Rights
1. Right DRUG
 only give what YOU have prepared
 listen to pt
2. Right DOSE
 check and re-check
 some meds verify quantity with another nurse
3. Right CLIENT
 check ID band
4. Right ROUTE
 oral
- oral
- sublingual (under tongue)
 parenteral
- SQ (subcutaneous)
- ID (intradermal)
- IM (intramuscular)
- IV (intravenous)
 topical
- skin
- mucous membranes
 inhalation
- nasal
- oral
 intraocular
- apply onto conjunctiva, not directly onto cornea
5. Right TIME
 chart immediately
 if refused, chart reason

Injections
 NEVER recap needles!!!!
 all needles disposed of in “sharps” container
- never force needle into full container

20
 BODY MECHANICS

General guidelines for lifting

 position of weight—as close to the lifter as
possible
 height of object—slightly above level of middle finger with arm
hanging at side
 body position—trunk erect so multiple muscle groups work
synchronously; alignment of head, neck and vertebrae
 maximum weight—too heavy if 35% or more of person’s body
weight

General guidelines for transferring

 always make sure wheelchair or bed wheels
are LOCKED!
 raise rail on opposite side
 raise bed to comfortable height
 explain to pt what you are about to do
 call for assistance, if needed
 close door/curtain for privacy
 before moving pt, make sure all tubing/lines
are free/untangled
 if pt is elderly and/or has been bed-bound, let pt dangle legs on
edge of bed before standing (reduces risk of orthostatic
hypotension)

BED BATH

General guidelines
 provide privacy—close door/pull curtains, expose only areas being
bathed
 maintain safety—side rails up while away, call light in reach if must
leave room temporarily
 maintain warmth—no drafts, bath blanket to conserve heat
 have all supplies at bedside, promote pt independence
 wash from cleanest to dirtiest—vagina (front to back), eyes (inner
to outer)
 stroke extremities from distal to central—promotes venous return

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 BED MAKING

General guidelines
 usually done while pt is bathing,
showering, or out of room for tests
 straightened throughout day
 changed if becomes wet/soiled
 hold dirty linens away from body
 discard clean linens if touch floor
 raise bed to comfortable height—ALWAYS return to lowest
position when finished!

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 STUDY GUIDE 4
Infection

Psalms 51:7
Purge me with hyssop, and I shall be clean: wash me, and I shall be
whiter than snow.

Ministry of Healing, p. 234

Disease never comes without a cause. The way is prepared, and
disease invited, by disregard of the laws of health.

PREVENTION

Levels
 primary
- client—those who are healthy
(precedes dysfunction)
- focus—decrease probability of
illness
- examples—health education
programs, immunizations, physical fitness programs,
NEWSTART
 secondary
- client—those who have health problems and are at risk for
developing complications
- focus—diagnosing and intervening
- examples—screening, treatment in hospital or home
 tertiary
- client—those who have disabilities that are
permanent/irreversible
- focus—rehabilitation, minimizing effects of disease
- examples—retraining, education to maximize remaining
capabilities

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 CHAIN OF INFECTION

1. infectious agent
 microorganisms = bacteria, viruses, fungi, protozoa
- normal flora—reside on skin and in GI tract without causing
disease (impair growth of other microorganisms)
2. reservoir
 where pathogens can survive
- may not multiply—carriers =
pathogens present and can be
transferred to others but host has no
symptoms
 like warm, dark environment

3. portal of exit
 pathogen leaves reservoir to enter another
host
 examples—break in skin, respiratory tract
4. mode of transmission
 person-to-person, object-to-person
 droplets
 vectors—mosquitoes, fleas
 #1 mode of transmission = hands
- so……WASH YOUR HANDS!!!!!!!
5. portal of entry
 can enter body through same routes used for exiting
6. susceptible host
 acquisition of infection depends on individual’s resistance
- immune response
- inflammation
- body system defenses (i.e. skin)
- normal flora

INFECTIOUS PROCESS

Stages of infection
1. incubation period
- entrance of pathogen into body until appearance of first
symptoms
- examples—chickenpox: 2-3 wks, common cold: 1-2 days

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 2. prodromal stage
- onset of nonspecific s/s to more specific
symptoms (fatigue, low-grade fever)
- microorganisms multiplying, more
contagious
3. acute stage
- manifests s/s specific to type of infection
(common cold: sore throat, rhinitis;
mumps: high fever, salivary
gland swelling)
4. convalescence
- when acute symptoms of infection disappear
Sign and symptoms
 local (confined to one specific body part)
- redness
- swelling
- drainage—note color
- pain/tenderness
- restricted movement
 systemic (involves whole body—s/s usually more generalized)
- fever
- fatigue
- lymph enlargement/tenderness
- anorexia
- N/V

INFECTION CONTROL

Universal precautions
 general principles
- apply to blood, all body fluids, secretions,
excretions (except sweat), non-intact
skin, and mucous membranes
- apply to ALL pts
 handwashing
- washed between client contacts, after
contact with body fluids or articles
contaminated by them, and immediately
after gloves removed
- at least 10-15 seconds
 gloves
- when touching body fluids or items contaminated by them

25
 - removed and hands washed between client care
 face equipment
- masks, eye protection, or face shields worn if care may
generate splashes or sprays of body fluid

 gowns
- worn if soiling of clothing is likely from body fluids
 equipment
- cleaned and reprocessed
- singe-use items discarded
Sterile technique
 sterile = absence of all microorganisms
 principles
- sterile object becomes contaminated if touched by dirty,
clean, or questionable object (i.e. discard if sterile package
has tear)
- sterile surface becomes
contaminated if in contact with wet,
contaminated surface (i.e. moisture
seeping through sterile packaging)
- 1 inch border of sterile drape is
contaminated (edge touches
contaminated surface)
- any object held below waist level is
considered contaminated (cannot be
viewed at all times)

26
 STUDY GUIDE 5
Understanding Your Patient

Matthew 14:14
And Jesus went forth, and saw a great multitude, and was moved
with compassion toward them, and He healed their sick.

Medical Ministry, p. 251

True sympathy between man and his fellow men is to be the sign
distinguishing those who love and fear God from those who are unmindful
of His law. How great the sympathy that Christ expressed in coming to this
world to give His life a sacrifice for a dying world! His religion led to the
doing of genuine medical missionary work. He was a healing power. "I will
have mercy, and not sacrifice," He said. This is the test that the great
Author of truth used to distinguish between true religion and false. God
wants His medical missionaries to act with the tenderness and compassion
that Christ would show were He in our world.

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 COMMUNICATION TECHNIQUES

Hard of hearing
 lower voice pitch, slow pace, speak normally, use simple sentences
 face person, use pictures/gestures

Visual impairment
 speak when near and before touching
 explain what you will do beforehand
 orient to environment and sounds
 tell when you are leaving and returning

Speech impairment
 be patient, let them answer
 ask “yes” and “no” questions
 don’t shout or treat them like they can’t
understand
 use alternative methods—pictures, paper and pen, etc.

Cognitive impairment
 quiet environment, get attention before you speak
 simple explanations, don’t talk down to them
 listen patiently, involve family

STAGES OF GRIEF (DYING)

From Dr. Kubler-Ross’ book, “On Death and Dying”

1. denial—“No, not me!”

 when person learns that he is terminally ill
 cushions impact of patient’s awareness that death
inevitable
2. rage and anger—“Why me?”
 resents that others will remain healthy while he
must die
 God is special target for anger because He is
regarded as imposing death sentence
3. bargaining—“Yes me, but…”
 accepts fact of death but strikes bargains for more time
 mostly bargains with God
4. depression—“Yes, me.”
 first mourns past losses, things not done, wrongs committed
 then enters “preparatory grief,” getting ready for death
 grows quiet, doesn’t want visitors
5. acceptance—“My time is very close and it’s all right.”
 described by Dr. Ross as “not a happy stage, but neither is it unhappy. It’s
devoid of feelings, but it’s not resignation, it’s really a victory.”

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