Ch. 13 Patient Centered Care Flashcards
A female patient who is receiving chemotherapy for breast cancer tells the nurse, “The treatment for this cancer is worse than the disease itself. I’m not going to come for my therapy anymore.” The nurse responds by using critical thinking skills to address this patient problem. Which action is the first step the nurse would take in this process?
The nurse judges whether the patient database is adequate to address the problem. The nurse considers whether or not to suggest a counseling session for the patient. The nurse reassesses the patient and decides how best to intervene in her care. The nurse identifies several options for intervening in the patient’s care and critiques the merit of each option.
c. The first step when thinking critically about a situation is to identify the purpose or goal of your thinking. Reassessing the patient helps to discipline thinking by directing all thoughts toward the goal. Once the problem is addressed, it is important for the nurse to judge the adequacy of the knowledge, identify potential problems, use helpful resources, and critique the decision.
The nursing process ensures that nurses are person centered rather than task centered. Rather than simply approaching a patient to take vital signs, the nurse thinks, “How is Mrs. Barclay today? Are our nursing actions helping her to achieve her goals? How can we better help her?” This demonstrates which characteristic of the nursing process?
Systematic Interpersonal Dynamic Universally applicable in nursing situations
b. Interpersonal. All of the other options are characteristics of the nursing process, but the conversation and thinking quoted best illustrates the interpersonal dimension of the nursing process.
An experienced nurse tells a beginning nurse not to bother studying too hard, since most clinical reasoning becomes “second nature” and “intuitive” once you start practicing. What thinking below should underlie the beginning nurse’s response?
Intuitive problem solving comes with years of practice and observation, and novice nurses should base their care on scientific problem solving. For nursing to remain a science, nurses must continue to be vigilant about stamping out intuitive reasoning. The emphasis on logical, scientific, evidence-based reasoning has held nursing back for years; it is time to champion intuitive, creative thinking! It is simply a matter of preference; some nurses are logical, scientific thinkers, and some are intuitive, creative thinkers.
a. Beginning nurses must use nursing knowledge and scientific problem solving as the basis of care they give; intuitive problem solving comes with years of practice and observation. If the beginning nurse has an intuition about a patient, that information should be discussed with the faculty member, preceptor, or supervisor. Answer b is incorrect because there is a place for intuitive reasoning in nursing, but it will never replace logical, scientific reasoning. Critical thinking is contextual and changes depending on the circumstances, not on personal preference.
The nurse uses blended competencies when caring for patients in a rehabilitation facility. Which examples of interventions involve cognitive skills? Select all that apply.
The nurse uses critical thinking skills to plan care for a patient. The nurse correctly administers IV saline to a patient who is dehydrated. The nurse assists a patient to fill out an informed consent form. The nurse learns the correct dosages for patient pain medications. The nurse comforts a mother whose baby was born with Down syndrome. The nurse uses the proper procedure to catheterize a female patient.
a, d. Using critical thinking and learning medication dosages are cognitive competencies. Performing procedures correctly is a technical skill, helping a patient with an informed consent form is a legal/ethical issue, and comforting a patient is an interpersonal skill.
A nurse uses critical thinking skills to focus on the care plan of an older adult who has dementia and needs placement in a long-term care facility. Which statements describe characteristics of this type of critical thinking applied to clinical reasoning? Select all that apply.
It functions independently of nursing standards, ethics, and state practice acts. It is based on the principles of the nursing process, problem solving, and the scientific method. It is driven by patient, family, and community needs as well as nurses’ needs to give competent, efficient care. It is not designed to compensate for problems created by human nature, such as medication errors. It is constantly re-evaluating, self-correcting, and striving for improvement. It focuses on the big picture rather than identifying the key problems, issues, and risks involved with patient care.
b, c, e. Critical thinking applied to clinical reasoning and judgment in nursing practice is guided by standards, policies and procedures, and ethics codes. It is based on principles of nursing process, problem solving, and the scientific method. It carefully identifies the key problems, issues, and risks involved, and is driven by patient, family, and community needs, as well as nurses’ needs to give competent, efficient care. It also calls for strategies that make the most of human potential and compensate for problems created by human nature. It is constantly re-evaluating, self-correcting, and striving to improve
A nurse is caring for a patient who has complications related to type 2 diabetes mellitus. The nurse researches new procedures to care for foot ulcers when developing a care plan for this patient. Which QSEN competency does this action represent?
Patient-centered care Evidence-based practice Quality improvement Informatics
c. Quality improvement involves routinely updating nursing policies and procedures. Providing patient-centered care involves listening to the patient and demonstrating respect and compassion. Evidence-based practice is used when adhering to internal policies and standardized skills. The nurse is employing informatics by using information and technology to communicate, manage knowledge, and support decision making.
A nurse is assessing a patient who is diagnosed with anorexia. Following the assessment, the nurse recommends that the patient meet with a nutritionist. This action best exemplifies the use of:
Clinical judgment Clinical reasoning Critical thinking Blended competencies
a. Although all the options refer to the skills used by nurses in practice, the best choice is clinical judgment as it refers to the result or outcome of critical thinking or clinical reasoning—in this case, the recommendation to meet with a nutritionist. Clinical reasoning usually refers to ways of thinking about patient care issues (determining, preventing, and managing patient problems). Critical thinking is a broad term that includes reasoning both outside and inside of the clinical setting. Blended competencies are the cognitive, technical, interpersonal, and ethical and legal skills combined with the willingness to use them creatively and critically when working with patients.
A nurse working in a long-term care facility bases patient care on five caring processes: knowing, being with, doing for, enabling, and maintaining belief. This approach to patient care best describes whose theory?
Travelbee’s Watson’s Benner’s Swanson’s
d. Swanson (1991) identifies five caring processes and defines caring as “a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility.” Travelbee (1971), an early nurse theorist, developed the Human-to-Human Relationship Model, and defined nursing as an interpersonal process whereby the professional nurse practitioner assists an individual, family, or community to prevent or cope with the experience of illness and suffering, and if necessary to find meaning in these experiences. Benner and Wrubel (1989) wrote that caring is a basic way of being in the world, and that caring is central to human expertise, curing, and healing. Watson’s theory is based on the belief that all humans are to be valued, cared for, respected, nurtured, understood, and assisted.
The nurse practices using critical thinking indicators (CTIs) when caring for patients in the hospital setting. The best description of CTIs is:
Evidence-based descriptions of behaviors that demonstrate the knowledge that promotes critical thinking in clinical practice Evidence-based descriptions of behaviors that demonstrate the knowledge and skills that promote critical thinking in clinical practice Evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, and skills that promote critical thinking in clinical practice Evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, standards, and skills that promote critical thinking in clinical practice
c. Evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, and skills that promote critical thinking in clinical practice.
A nurse caring for patients in the intensive care unit develops values from experience to form a personal code of ethics. Which statements best describe this process? Select all that apply.
People are born with values. Values act as standards to guide behavior. Values are ranked on a continuum of importance. Values influence beliefs about health and illness. Value systems are not related to personal codes of conduct. Nurses should not let their values influence patient care.
b, c, d. A value is a belief about the worth of something, about what matters, which acts as a standard to guide one’s behavior. A value system is an organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. A person’s values influence beliefs about human needs, health, and illness; the practice of health behaviors; and human responses to illness. Values guide the practice of nursing care. An individual is not born with values; rather, values are formed during a lifetime from information from the environment, family, and culture.
A pediatric nurse is assessing a 5-year-old boy who has dietary modifications related to his diabetes. His parents tell the nurse that they want him to value good nutritional habits, so they decide to deprive him of a favorite TV program when he becomes angry after they deny him foods not on his diet. This is an example of what mode of value transmission?
Modeling Moralizing Laissez-faire Rewarding and punishing
d. When rewarding and punishing are used to transmit values, children are rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values. Through modeling, children learn what is of high or low value by observing parents, peers, and significant others. Children whose caregivers use the moralizing mode of value transmission are taught a complete value system by parents or an institution (e.g., church or school) that allows little opportunity for them to weigh different values. Those who use the laissez-faire approach to value transmission leave children to explore values on their own (no single set of values is presented as best for all) and to develop a personal value system.
A nurse who is working in a hospital setting uses value clarification to help understand the values that motivate patient behavior. Which examples denote “prizing” in the process of values clarification? Select all that apply.
A patient decides to quit smoking following a diagnosis of lung cancer. A patient shows off a new outfit that she is wearing after losing 20 pounds. A patient chooses to work fewer hours following a stress-related myocardial infarction. A patient incorporates a new low-cholesterol diet into his daily routine. A patient joins a gym and schedules classes throughout the year. A patient proudly displays his certificate for completing a marathon.
b, f. Prizing something one values involves pride, happiness, and public affirmation, such as losing weight or running a marathon. When choosing, one chooses freely from alternatives after careful consideration of the consequences of each alternative, such as quitting smoking and working fewer hours. Finally, the person who values something acts on the value by combining choice and behavior with consistency and regularity, such as joining a gym for the year and following a low-cholesterol diet faithfully.
A nurse incorporates the “five values that epitomize the caring professional nurse” (identified by the American Association of Colleges of Nursing) into a home health care nursing practice. Which attribute is best described as acting in accordance with an appropriate code of ethics and accepted standards of practice?
Altruism Autonomy Human dignity Integrity
d. The American Association of Colleges of Nursing defines integrity as acting in accordance with an appropriate code of ethics and accepted standards of practice. Altruism is a concern for the welfare and well-being of others. Autonomy is the right to self-determination, and human dignity is respect for the inherent worth and uniqueness of individuals and populations.
A nurse caring for patients in an institutional setting expresses a commitment to social justice. What action best exemplifies this attribute?
Providing honest information to patients and the public Promoting universal access to health care Planning care in partnership with patients Documenting care accurately and honestly
b. The American Association of Colleges of Nursing lists promoting universal access to health care as an example of social justice. Providing honest information and documenting care accurately and honestly are examples of integrity, and planning care in partnership with patients is an example of autonomy.
An older nurse asks a younger coworker why the new generation of nurses just aren’t ethical anymore. Which reply reflects the BEST understanding of moral development?
“Behaving ethically develops gradually from childhood; maybe my generation doesn’t value this enough to develop an ethical code.” “I don’t agree that nurses were more ethical in the past. It’s a new age and the ethics are new!” “Ethics is genetically determined…it’s like having blue or brown eyes. Maybe we’re evolving out of the ethical sense your generation had.” “I agree! It’s impossible to be ethical when working in a practice setting like this!”
a. The ability to be ethical, to make decisions, and to act in an ethically justified manner begins in childhood and develops gradually.
