TEST 2 - UNIT B - EF - CLINICAL JUDGEMENT Flashcards
The nursing process for PNs includes four steps:
data collection, planning, implementation,/evaluation. PNs should always work under the supervision of an RN.
Assessment of the client is holistic, including the
client’s physical, spiritual, mental,/social needs.
Analysis of the client’s assessment data is needed to identify the
client’s problem.
Planning may require the nurse to refer to
textbooks, the internet,/facility resources/to collaborate with other nurses/interprofessional team members.
Planning involves developing
clear client-centered, time-oriented goals.
Implementation is a
client-centered step that involves using the plan of care to provide care for clients to help meet the identified goals.
Evaluation determines
the effectiveness of the interventions provided,/documents the client’s response.
Initially, the steps of the nursing process go in order. However, the steps may be
repeated after the initial use, or the process may go back/forth between steps, such as planning, implementation,/evaluation, to provide optimal results.
Nurses must remember that _________cannot be delegated.
clinical reasoning/judgment
Licensed nurses—both RNs/PNs—are responsible for the portions of client care that involve
clinical reasoning.
The nurse uses a client s assessment data to develop
§ measureable client goals/outcomes/identify nursing interventions. The nurse uses evidenced based practice to set client goals, establish priorities of care,/identify nursing interventions to assist the client to achieve their goals.
· analysis
oanalysis of assessment data to identify health problems/risks/a client s needs for health intervention. The nurse identifies patterns or trends, compares the data with expected standards or reference ranges/draws conclusions to direct nursing care.
· assessment
o The application of nursing knowledge to the collection, organization, validation/documentation of data about a client’s health status. The nurse thinks critically to perform a comprehensive assessment of subjective/objective information.
· critical thinking
o Thought process that is systematic/logical in reviewing information/data, that is open to reflection, inquiry/exploration in order to make informed decisions.
· delegation
o Assigning a nursing task or procedure to another person who has the training appropriate for that task or procedure.
· evaluation
o The evaluation of a client s response to nursing interventions/to reach a nursing judgment regarding the extent to which the client has met the goals/outcomes. During this step the nurse will also assess client/staff understanding of instruction, the effectiveness of interventions,/identify the need for further intervention or the need to alter the plan.
· implementation
o The application of nursing knowledge to implement interventions to assist a client to promote, maintain, or restore their health. The nurse uses problem-solving skills, clinical judgment,/critical thinking when using interpersonal/technical skills to provide client care. During this step the nurse will also delegate/supervise care/document the care/the client s response.
· interprofessional health care team
o A group including members from different disciplines who work collaboratively with the client to make decisions/set goals.
· nursing process
o A framework that guides nurses in delivering client-focused care that takes the entire person into consideration.
A five-step sequential process that guides nurses in assessing/prioritizing care for clients.
o The five steps are
assessment,
analysis,
planning,
implementation,/
evaluation.
· objective data
o Data that can be observed by the nurse through the senses.
· plan of care
o A plan including the client problem (analysis), plans/goals, implementation,/responses; it is used by the interprofessional health care team.
o A plan including the ____, __________, ______,is used by the interprofessional health care team.
client problem (analysis), plans/goals, implementation,/responses; it
· planning
o The planning step of the nursing process involves the nurse s ability to make decisions/problem solve.
· subjective data
o Data that is based upon the client’s feelings, perception/assumptions.
- A charge nurse is preparing to discuss critical thinking skills with a group of newly licensed nurses. Which of the following skills should the nurse plan to include in the discussion?
Inference, creativity, inductive reasoning
- A nurse is caring for a client who has been wheezing. The nurse asked an assistive personnel do use a stethoscope/listen to the clients lung sounds to determine if their wheezing has improved. This is an example of which of the following concepts?
Delegation of the wrong task
- A charge nurse is planning to discuss factors that can influence the clinical decision making process in client care with a newly licensed nurse. Which of the following factors should the charge nurse include?
Available resources, awareness of client status, support from other staff
- A nurse is reviewing the concept of critical thinking with a newly licensed nurse. Which of the following statements should the nurse make?
Critical thinking is the foundation for clinical decision making
- In what order should an RN perform the steps of the nursing process?
Assessment, analysis, planning, implementation, evaluation
- A nurse is reviewing methods created to assist nurses in using evidence-based practice. Which of the following is a NCSBN model that can assist the nurse is critical thinking/decision making?
Clinical judgment
- A nurse is developing a goal for a client to ambulate with assistance at least once by the end of the shift. The nurse should identify that this is an example of which of the following steps of the nursing process?
Planning
- A nurse asked the client to write the current level of pain using a scale of 0 to 10 after administering a pain medication 30 minutes ago. Which of the following steps of the nursing process is the nurse performing?
Evaluation
- A nurse/urgent care clinic is auscultating the lungs of a client who reports a cough/shortness of breath. Which of the following steps of the nursing process is the nurse using?
Assessment
10.A nurse is caring for a client who is in an acute care facility. The nurse should recognize that the clients care requires clinical reason when it is complicated by which of the following factors?
Complex clinical situations, ongoing client/family concerns
Using a stethoscope and listening to lung sounds (wheen wheezing) is not within the range of function of an
AP. The circumstances of this assignment involves assessment or data collection, which require clinical reasoning and should be delegated to a nurse.
Delegating an AP to use a stethoscope and listen to lung sounds is inappropriate as it is not
within the range of function of an AP. This action involves clinical reasoning and should be delegated to a nurse.
Inspection is part of the________step of the RN nursing process
assessment
assessment step of the nursing process is where the nurse does what
in which the nurse observes the client for expected and unexpected findings.
Implementation is the_______ step of the nursing process that
fourth
implementation
involves taking action to provide nursing care as outlined in the client’s plan of care.
Inference is a skill that is associated with
critical thinking that the nurse can use as part of higher-level thinking.
Creativity is a skill that is associated w/
critical thinking.
The nurse can use _______ as a part of higher-level thinking to critically analyze problems and develop solutions.
creativity
Inductive reasoning is a skill that is associated w/
critical thinking that the nurse can use as a part of higher-level thinking.
The nurse is using the evaluation step of the nursing process is
collecting subjective data from the client using an established pain scale to compare the client’s current pain level to their original level of pain.
In the implementation step of the nursing process, the nurse
carries out interventions that were planned for the client.
An example of the implementation step would be
the administration of pain medication to the client.
In the analysis step of the nursing process, the nurse
reviews client findings and determines the client’s problems in order to develop the client’s plan of care.
In the planning step of the nursing process, the nurse develops
interventions to treat or manage the client’s identified problems.
The Clinical Judgment Model was developed to assist nurses in
using evidence-based practice to think critically and make decisions.
Critical thinking is the skill of
learning to analyze and interpret data and is an element of the NCSBN’s Clinical Judgment Model for nurses.
Clinical reasoning is a
constant and repeated action that nurses use in practice.
Clinical reasoning influences the
NCSBN’s (>?? WHAT IS THIS)Clinical Judgment Model for nurses.
The acronym SMART represents a goal-setting framework
(specific, measurable, attainable, relevant, time-based).
While SMART t is helpful in goal setting, it is not specific to using e
vidence-based practice to make clinical judgments used in the NCSBN’s Clinical Judgment Model for nurses.
The evaluation step of the nursing process occurs when the
nurse assesses the effectiveness of interventions used to help the client achieve a goal, such as ambulating.
an example of the evaluation step of the nursing process.
Reviewing if the client ambulated with assistance is
The implementation step of the nursing process occurs when
the nurse carries out the interventions planned for the client. Assisting the client to ambulate is an example of implementation.
an example of implementation.
Assisting the client to ambulate is
In the analysis step of the nursing process, the nurse
uses objective and subjective data to determine what problems the client is experiencing. ( could use nonverbal cues (such as shaking of the head), verbal reports)
In the planning step of the nursing process, the nurse
develops interventions to treat or manage the client’s identified problems.
The plan of care guides the
treatment of the client and should be modified as the client’s condition changes. In this scenario, the nurse is making goals for the client regarding ambulation.
Although appropriate delegation is a necessary part of daily nursing practice, it is not a factor that can influence the
clinical decision-making process, which is used as the framework for developing the plan of care.
Cost of client care not considered a factor that can influence the
decision-making process, which is used as the framework for developing the plan of care.
Available resources is a factors that can influence the
decision-making process, which is used as the framework for developing the plan of care.
Awareness of client status is a factor that can influence the
decision-making process, which is used as the framework for developing the plan of care.
The availability of support from other staff is a factor that can influence the
decision-making process, which is used as the framework for developing the plan of care.
Critical thinking is considered a
higher order of thinking that is the foundation for clinical decision making.
critical thinking - critical component of
nursing care and is used in each step of the nursing process to enhance client care.
each step of the nursing process to enhance client care.
critical thinking
Clinical reasoning, rather than critical thinking, takes into consideration
nursing, scientific, and technological knowledge in client situations.
Clinical judgment is defined by the NCSBN® as the
visible or observed outcome of the elements of critical thinking and decision making that considers nursing knowledge, client situations, prioritization of client problems and concerns, while using evidence-based practice.
Objective client data is
data that can be observed by the nurses through the senses (sight, hearing, smelling, touching). It does not involve the element of critical thinking to collect this type of data.
In the evaluation step of the nursing process, the nurse
evaluates the effectiveness of interventions provided for the client.
In the implementation step of the nursing process, the nurse
carries out the interventions in the client’s plan of care.
In the analysis step of the nursing process, the nurse
reviews the client’s assessment findings to determine what problems the client might have in order to formulate a plan of care.
The nurse should identify auscultating a client’s lungs as being part of
the assessment step of the nursing process because the nurse is collecting data from the client.
Auscultating the client’s lung sounds is part of a
physical assessment.
physical assessment.
ASSESSMENT
ANALYSIS
PLANNING
IMPLEMENTATION
EVALUATION
Clinical reasoning is necessary when determining the
prioritization of important clinical issues over issues that can wait.
EX of Complex clinical situations
For example, clients who have broken bones as well as a compromised airway need their airway to be stabilized prior to setting broken bones.
This is a key part of clinical reasoning in complex care settings.
Correct prioritization
Client and family concerns
complicate the clinical situation of the client’s care, making clinical reasoning a necessity.
Clients and family members can reveal important pieces of information as they
express their concerns.
The nurse needs to carefully listen to everything that clients and
their families say to collect information that might be useful in providing optimal care to the client.
In some cases, the benefits of the health care interventions can be
much less than the cost of those interventions.
Ex of benefits of health care costs < than the cost of the intervention
For example, a client who has terminal cancer might not benefit from medication or surgery and, by receiving either form of care, the client would incur further costs without receiving a benefit.
A decreased need for advanced health care practitioner intervention would
not complicate the client’s care and could help to simplify it.
The need for fewer interventions would
not require clinical reasoning because the health care decisions would be less complex.
Computerized medical records can assist nurses b
y providing quick access to client information and clinical resources which can streamline, rather than complicate, clinical reasoning.
