Class 1-Evidence Based-Assessment Flashcards
Assessment: Data Collection
-the collection of data about an individual’s health state
-critical thinking is required for sound diagnostic reasoning and clinical judgement
-the PURPOSE of assessment is to make a judgement or diagnosis
Assessment: point of entry in an ongoing process
-subjective date + objective data + patient’s record, & laboratory studies form the database
-information from the database allows the nurse to make a clinical judgement or diagnosis about the patient’s health state
-key is organization of assessment based on complete factually based data
-subjective (what patient tells you)
-objective (what we’ll see)
Assessment: data collection
assessment is first step!
-history: subjective data
-physical exam: objective data
-what is the difference?
-what is the importance of data collection?
What are the 3 dimensions of critical thinking?
- theory and experiential knowledge to perform the nursing process
- commitment to learning to think critically
- psychomotor and manual skill development
-knowledge; compile knowledge; & perform
Assessment
-First step of the nursing process
-requires ability to gather data that is:
-accurate
-relevant
-differentiates normal and abnormal
-organized
-systematic
-complete
Nursing Process: Assessment
Collect data
-review of the clinical record
-interview
-health history
-physical exam
-functional assessment
-consultation
-review of the literature
So what are the steps in this assessment process?
-interpret data
-identify clusters of cues
-make inferences
-validate inferences
-compare clusters of cues with definitions and defining characteristics
-identify related factors
-establish a nursing diagnosis
Nursing process
-assessment, always the first step of the nursing process (collection of data; cues you take from pts)
-remaining steps of nursing process:
-diagnosis
-outcome identification
-planning
-implementation
-evaluation
Nursing Process
-assessment
-diagnosis
-outcome identification
-planning
-implementation
-evaluation
Data collection & first level priorities
-first level priority: emergent, life threatening, & immediate
-during assessment it is absolutely essential to have the ability to prioritize data
-these are always first level priorities, in this order:
-A-airway
-B-breathing
-C-circulation
Data collection & second level priorities
-next in urgency, requiring attention to avoid further deterioration
-these situations require prompt intervention to prevent further deterioration:
-acute pain
-change in mental status
-infection
^^urgent priority
Data collection & third level priorities
-these situations are important to the patient’s health but can be addressed after more urgent problems
-lack of knowledge
-family coping
-activity
-rest
^^preventative
How do we think critically about a situation?
Using case study…
-how does a person analyze health data and draw conclusions?
-what is a cue and how do I attend to it?
-what is a diagnostic hypothesis?
-how accurate are hunches?
-what cues are significant?
-what do I do with the cues once I have them?
-how do I validate that my hypothesis is correct?
-why is validation so important?
Diagnostic Reasoning
Components:
-attend to initially available cues (pieces of information)
-formulate diagnostic hypotheses (tentative explanation of cues)
-gather relevant data
-evaluate each hypothesis with ongoing data collection
-serve as basis for ongoing investigation
What do novices do?
slow process, lacks experience, may not see the whole picture, follow more of a defined pattern, and sets of rules
What would an expert do?
uses intuition, has learned to recognize patterns, able to draw conclusions from cues quickly and act on them
Critical thinking and the nursing process
Novice: starting out in an area of learning; uses rules to guide performance
Competency: building on 2 to 3 years of clinical experience; see actions in the context of patient goals or plans
proficient: 5-10 years, adding to time & experience; understands the patient situation as a whole rather than individual parts-apply long term goals
expert: attained mastery of an area of learning; performs clinical judgment using intuitive analysis
Types of data (4)
-complete (total health) database
-episodic or problem-centered database
-follow-up database
-emergency database
Complete total health database
describes current and past health state and forms baseline to measure all future changes
Episodic or problem-centered database
collect “mini” database, smaller scope and more focused than complete database
Follow-up database
status of all identified problems should be evaluated at regular and appropriate intervals
Emergency database
rapid collection of data often compiled concurrently with lifesaving measures
What is evidence based practice (EBP)?
-it is a systematic approach to practice that emphasizes the use of best evidence
-all patients deserve to be treated with the most current, and the best practice techniques to ensure the best patient outcomes
What is the role of the nurse (in EBP)?
-participating in research
-recognizing research that is relevant to practice
-implement changes in patient care that reflects EBP
Evidence-Based assessment
-1850s: historical evolution of the concept of “research” evidence began with Florence Nightingale
-1970s: “Evidence-based medicine” term defined
-Cochrane-systematic reviews of RCTs
-Evidence Based Practice (EBP)
-integration of research evidence, clinical expertise, clinical knowledge, and patient values and preferences
-clinical decision making=best evidence from literature review+patient’s own preference+clinician’s experience/expertise+physical exam
5 steps to evidence-based practice
- ask the clinical question
- acquire sources of evidence
- appraise and synthesize evidence
- apply relevant evidence in practice
- assess the outcomes
