Applying MRM to the Nursing Process

Question 1

What are the steps of introducing yourself to the client?

Answer 1

Acknowledge
Introduce
Duration
Explain
Thank you

Question 2

How does the NCSBN Clinical Judgment Measurement Model relate to the Tanner Clinical Judgement Model and the nursing process?

Answer 2

Noticing : Assess : recognize cues

Interpreting : Analysis : Analyze cues, prioritize hypotheses

Interpreting : Plan : Generate solutions

Responding : Intervene: take actions

Reflecting : Evaluate : look at outcomes

In which recognizing and analyzing cues are part of forming hypotheses, prioritizing hypotheses and generations solutions are part of refining hypotheses, and taking action and evaluating outcomes are part of evaluation.

Question 3

What are important considerations in assessment/recognizing cues?

Answer 3

• Guided by the client’s EXPRESSED needs
• Structured (thorough and methodical) but continuous
• Holistic
• Deliberate

Question 4

What is the Golden Minute?

Answer 4

• Establish the therapeutic relationship
• Perform the general survey (cues/data)
• Perform the environmental scan (cues/data)

Question 5

What is subjective data?

Answer 5

• reported by the client (“I feel…”, “I am experiencing…”)
• reported by the client’s family

Question 6

What is objective data?

Answer 6

• Measurable
• Observable
• Example: respiratory rate 56, wheezing auscultated, gown soiled)

Question 7

What type of data should you NOT include in your assessment?

Answer 7

Interpretation or conclusions

Example: He’s irritable

She slept poorly

Developmentally appropriate

Question 8

How should you choose what to include in your assessment?

Answer 8

• What is the client’s primary concern
• Holistic: biophysical, psychosocial, mental, spiritual
• Choose comprehensive or focused based on nurse’s knowledge (don’t do a comprehensive assessment all the time just because you can -this is a waste of time if it is not necessary and doesn’t build trust)

Question 9

What is included in a comprehensive assessment?

Answer 9

• Health/illness history
• Home/family
• Personal info (learning style, literacy)

Question 10

What is included in a focused assessment?

Answer 10

• Situational or problem based: emergency/urgency
• Time-limited

Question 11

MRM Data Categories:

Description of the Situation

Answer 11

• Overview of the situation: what is the focus (expressed needs) and health concern?
• Etiology: are there stressors or distressors? Adaption or maladaption?
• Therapeutic needs: what does the client tell you they need?

Question 12

MRM Data Categories:

Expectations

Answer 12

• Immediate Expectations: “What is going to happen immediately?”
• Long-term Expectations: “What is going to happen in the future?”
• Look for whether the client can project themselves into the future - this helps to plan

Question 13

MRM Data Categories:

Resource Potential

Answer 13

External Resources: family and social support, sense of relationships from the client’s perspective (draining or filling), access to physical needs (food, shelter, healthcare)

Internal Resources: personal strengths, feeling and physiological states, ability to mobilize resources

Question 14

Why does the nurse ask about resources? What does this knowledge help with?

Answer 14

Resource potential helps the nurse with planning interventions tailored to the client

Question 15

What are important considerations in interpreting a client’s resources?

Answer 15

• Are they available at the moment?
• Do they restore or diminish health?
• Do they satisfy basic needs before growth needs?
• Do they promote affiliated-individuation?
• Is there value attached to each resource?
• Do they promote a holistic state of health?

Question 16

MRM Data Collection:

Goals and Life Tasks

Answer 16

• DIFFERENT FROM EXPECTATIONS
• Goals are not what the client expects to happen, but what they are reaching for
• Directed towards satisfying basic-need deficits and/or developmental task resolution

Question 17

Other than obtaining optimum holistic health, what are reasons a nurse should assess goals?

Answer 17

1. Collect data to identify need deficits
2. Determine where the client is in Erickson’s developmental process
3. Collect data on their perception of goals/tasks to help plan interventions
4. Info to predict where your client is headed

Question 18

How do you aggregate and synthesize all of this data? (what is the tldr of MRM data collection?)

Answer 18

• Requires reflection
• Consider sources (primary, secondary, tertiary)
• Context - what is the situation?
• Compare situation to what you know as a nurse: theory, evidence, experience
• Is this expected or unexpected? Does the client want to maintain, prevent, or change?
• Think early about interventions to achieve client’s goals

Question 19

Define aggregate

Answer 19

Compile or gather

Question 20

Define analyze

Answer 20

Examine critically to bring out essential elements (what is most important and it is what is expected?)

Question 21

Define synthesize

Answer 21

Integrate data into a holistic unit