255 Exam 2 Flashcards
What 3 things does nursing involve?
- Thinking
- Doing
- Caring
What is clinical judgement?
Utilization of processes that promote safe client care
What does clinical judgement require of nurses?
- Requires nurses to recognize and interpret client problems, prioritize a response, take action, evaluate outcomes, and modify actions as needed.
What are the 4 types of nursing knowledge?
- Theoretical
- Practical
- Self
- Ethical
What 4 aspects does the Tanner model of clinical judgement contain?
- Noticing
- Interpreting
- Responding
- Reflections
What are the 4 layers of the NCSBN CJM model of nursing (0-2)
Layer 0: clinical decisions
Layer 1: Comprises the outcome
Layer 2: Form, refine hypothesis, evaluate
What are the 4 layers of the NCSBN CJM model of nursing (3-4)
layer 3: Contains the clinical judgement tasks (Recognizing cues, analyze cues, prioritize hypotheses, general solutions, take action, evaluate outcomes)
Layer 4: Context (individual and environmental factors)
Clinical reasoning Definition
- The process of synthesizing knowledge and information from numerous sources and incorporating experience to develop a plan of care for a particular scenario
Clinical reasoning (What does it require)
It requires a reliance on your knowledge and experience to develop a plan of care for a particular client or case scenario.
Why is Clinical reasoning important?
- Essential part of clinical judgement
- Healthcare is ever-changing and complex
- When ineffective, it is a major factor why nurses fail to respond to deteriorating client conditions.
What is critical thinking (Composed of)
- Reasoned thinking
- Openness to alternatives
- Ability to reflect
- A desire to seek truth
Why is critical thinking important to nurses?
- Handling complex situations
- Each client is unique
- Needed for holistic care
- Nursing is an applied discipline
- Nursing is fast paced
- Nursing changes rapidly
- Critical thinking is needed for evidence based practice
Critical thinking model (What are the 5 steps)
- Contextual awareness
- Inquiry
- Considering alternatives
- Analyzing assumptions
- Reflecting skeptically and deciding what to do
What is caring?
- Caring is always specific and relational for each nurse person encounter
- caring is not an abstraction
- Caring involves thinking and acting in ways that preserve human dignity and humanity
Components of caring (What are they?)
- Knowing
- Being with
- Doing for
- Enabling
- Maintaining belief
What is full spectrum nursing (Definition)
A unique blend of thinking, doing, and caring for the purpose of effecting good outcomes from a client situation
Socratic reasoning (3 components)
- Thinking (knowledge, problem solving)
- Doing (Skills)
- Caring (Self knowledge, ethical knowledge, effective and interpersonal skills)
What does assessment include?
- Collecting data
- Using a systematic approach and ongoing process
- Categorizing data
- Recording data
How does delegating assessment tasks work?
- A professional nurse must perform the assessment portion of nursing assessment.
- UAP and LPNs can collect vital signs, pain reports and glucose levels but it is the nurses responsibility to assign the tasks and validate the data collected.
What are the 5 Delegatee factors to consider?
- predictability of outcome
- Potential for harm
- Complexity of care
- Need for problem solving
- Level of interaction wth the client
What Bodies contain information on delegation rules?
- State nurse practice acts
- Agency policies/procedures
- accrediting agencies
- American Nurses Association
5 types of assessments (What are they?)
- Initial: at the beginning of
- Ongoing: conducted over time
- Comprehensive: of the full body systems
- Focused: focused on a specific body system
- Special needs: a more holistic assessment
Special needs assessments consist of
- Nutrition
- Pain
- Culture
- Spiritual health
- Psychosocial
- Wellness
- Family
- Community
- Functional ability
What is the purpose of a nursing interview?
To gather subjective data for the nursing health history
What to do to prepare for interviews?
- Know the purpose of the interview and how the data will be used
- read the clients chart
- Form some goals and opening questions
- schedule uninterrupted time
- have your forms and equipment ready
- Compose yourself before entering the room
When should data be validated?
- When subjective and objective data do not align
- Clients statements differ at times in an interview
- Data are far outside normal range
- Factors are present that interfere with accurate measurement
What are the 5 models of organizing data?
- Gordons functional health patterns
- The NANDA-international nursing diagnosis taxonomy
- International classification for nursing practice
- Roy adaptation model
- Orem’s self care model
Nursing diagnosis definition
A clinical judgement about individual, family, or community experiences/responses to an actual or potential health problem/life processes
Collaborative problems (What are they?)
- Physiological complications of disease medical treatments or diagnostic studies
- Clients with certain diseases or treatments are at risk for developing the same complications
- Always a potential problem
Taxonomy Definition
Classifies ideas or objects based on common characteristics
What does writing quality statements involve?
- Do not rely on the label alone
- Include both problem and etiology
- Make sure etiology does not restate problem
- Avoid using medical diagnosis as treatment
- Write statement clearly
- Be descriptive and specific
- State the problem as a patient response
- Avoid legally questionable language
Why is the patient care plan important?
- Ensures care is complete,
- Provides continuity of care
- Makes things more efficient
- Guides charting and assessment
- Meets requirements of accrediting agencies
What are the three types of care plans?
- Preprinted standardized plans
- Computerized plans
- Student care plans
What 5 things does a nursing order contain?
- Date
- Subject
- Action verb
- Times and limits
- Signature
What are the 5 rights of delegation?
- Right task
- Right circumstance
- Right person
- Right direction/communication
- Right supervision
What needs to be evaluated in evaluation stage?
- Clients progress towards goals
- Effectiveness of nursing care
- Quality of care in the healthcare setting
What are the 3 types of evaluation?
- Structure: Focus on setting, time and policies
- Process: manner in which care was given
- Outcomes: Changes in health of patient
Types of evaluation related to time?
- Ongoing
- Intermitent
- Terminal
PES (What does it stand for?)
- Problem (Label from the NANDA-l list)
- Etiology (r/t Statement what factors are contributing to the diagnosis)
- Symptoms (Signs and symptoms described by NANDA-l)
What must client outcomes be?
Measurable
What does ADPIE stand for?
Assessment
Diagnosis
Planning
Implementation
Evaluate
What are the three types of nursing diagnosis?
- Problem focused
- Risk diagnosis
- Health promotion diagnosis
SMART (What does it stand for?)
- Specific
- Measurable
- Attainable
- Realistic
- Timely
What are the 8 attitudes of a critical thinker?
- Intellectual autonomy
- Intellectual Curiosity
- Intellectual humility
- Intellectual empathy
- Intellectual courage
- Intellectual perseverance
- Fair mindedness
- Confidence in reasoning
5 things to evaluate an effective care plan.
- Review outcomes
- Collect reassessment data
- Judge goal achievement
- Record the evaluative statement
- Evaluate collaborative problems
Outcomes evaluation (What to focus on)
- Observable measurable progress
- Evaluate the quality of care given
How is clinical reasoning related to clinical judgement?
- Clinical reasoning is the use of knowledge in different areas that allows us to make informed decisions which is needed for effective clinical judgement.
