Topic 5 Flashcards
critical thinking is:
The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process
critical thinking is more than just problem solving…
It is a continuous attempt to improve how to apply yourself when faced with problems in patient care.
What are the levels of critical thinking
- Basic
- Complex
- Commitment
what are the components of critical thinking
specific knowledge base
experience
competencies
attitudes
standards
basic level of critical thinking
a learner trusts that experts have the right answers for every problem. Thinking is concrete and based on a set of rules or principles.
complex critical thinkers
begin to separate themselves from experts and analyze the clinical situation and examine choices more independently. In complex critical thinking, each solution has benefits and risks that you weigh before making a final decision
commitment level of critical thinking
nurses anticipate when to make choices without assistance from others and accept accountability for decisions made.
scientific method
a systematic, ordered approach to gathering data and solving problems.
five steps of the scientific method
identify the problem
collect data
formulate a question or hypothesis
test the question or hypothesis
evaluate results of the test or study
what are the two components of clinical decision making?
-a nurse’s understanding of a specific patient
-a nurse’s subsequent selection of interventions.
what are some important aspects of knowing your patient
-spend more time during initial patient assessment (determine what is important to them)
-PERSONAL CONVO rather than task-oriented convo
-listen to patients experience with illness
-check on patients consistently
-ask for the same patient over consecutive days
reflective journaling
Define and express clinical experiences in your own words
meeting with colleagues
Discuss and examine work experiences and validate decisions
concept mapping
Visual representation of patient problems and interventions that shows their relationships to one another
assess
Gather information about the patient’s condition
diagnosis
identify the patients problem
plan
set goals of care and desires outcomes and identify appropriate nursing actions
implement
perform the nursing actions identified in planning
evaluate
determine if goals and expected outcomes are achieved and were effective
Assessment involves collecting information from…
the patient
secondary sources
interpreting and validating information to form a complete database
when is a Patient-centered interview conducted
during a nursing history
when are periodic assessments conducted
during ongoing contact with patients
when are physical examinations conducted
during a nursing history and at any time a patient presents a symptom
cue
is information that you obtain through use of the senses
inference
is your judgment or interpretation of these cues
comprehensive assessment
moves from the general to the specific
-Typically certain aspects of a situation stand out as most important. You then ask more focused questions on the basis of the patient’s responses and physical signs.
problem oriented
You focus on a patient’s presenting situation and begin with problematic areas. You ask the patient follow-up questions to clarify and expand your assessment so you can understand the full nature of the problem.
what are the assessment data resources
-Patient
-Family, caregivers, and significant others
-Health care team
-Medical records
-Other records and the scientific literature
-Nurse’s experience
foundation for creating nurse-patient relationships
- tricot building (est. meaningful connection; goal: trust, comms, understanding)
- presence (physically, mentally, and emotionally present)
- rounding (consistent, purposeful check-ins)
patient centered interview
relationship based and is an organized conversation focused on learning about the well and the sick as they seek care.
motivational interviewing
a collaborative, person-centered form of guiding to elicit and strengthen motivation for change
what are the phases of an interview
orientation and setting an agenda
-working phase
-terminating the interview
Orientation and setting an agenda
-Begin by introducing yourself, your position, explaining the purpose of the interview.
-Explain why you are collecting data and assure patients that all of the information will be confidential.
-Ask the patient for his or her list of concerns or problems.
working phase
-ask open-ended questions.
-Use attentive listening and other therapeutic communication techniques that encourage a patient to tell his or her story.
-Gather information about a patient’s concerns and then complete all relevant sections of the nursing history.
termination phase
-Summarize your discussion with a patient and check for accuracy of the information collected.
-Give your patient a clue that the interview is coming to an end.
-End the interview in a friendly manner, telling the patient when you will return to provide care.
cultural consideration is important to consider during an assessment so…
avoid making stereotypes and don’t make assumptions
nursing health history
Data collected about a patient’s level of wellness
biographical information
o age, address, occupations, marital status, health care insurance.
components of the nursing health history
biographic data
chief complaint/reason for seeking health care
patient expectation
history of present illness
health history
family history
environmental history
psychosocial history
spiritual health
ROS (review of systems)
Present illness or heath concerns
Determine when the problems began, how severe, intensity, quality, what makes them worse, and what makes them better
Concomitant symptoms
o Does the patient experience other symptoms along with the primary symptom?
data documentation
Use clear, concise appropriate terminology
Becomes baseline for care
record subjective data in quotes
what are 3 elements of the assessment process
data collection
interpretation
validation
data collection
capturing and gathering all data necessary for the patient
interpretation
o Critically interpret assessment data to determine whether abnormal findings are present.
o Cues and inferences
validation
Comparison of data with another source to determine data accuracy
problem-focused nursing diagnosis
Identify an undesirable human response to existing problems or concerns of a patient
defining characteristics
Related signs and symptoms or clusters of data that support the problem-focused diagnosis.
related factor
an etiological or causative factor for the diagnosis, and allows you to individualize a problem-focused nursing diagnosis for a specific patient need.
risk diagnosis
o Diagnoses that someone is at risk for developing, based on their risk factors
-Risk factors are the environmental, physiological, psychological, genetic, or chemical elements that place a person at risk for a health problem.
health promotion
the process of enabling people to increase control over, and to improve, their health
data cluster
is a set of cues, the signs or symptoms gathered during assessment
clinical criterion
an objective or subjective sign, symptom, or risk factor that, when analyzed with other criteria, leads to a diagnostic conclusion
NANDA-I classification of nursing
provides the standards for the patterns of data for each nursing diagnosis. These standards are the defining characteristics or risk factors
diagnostic label
the name of the nursing diagnosis as approved by NANDA International
-It describes the essence of a patient’s response to health conditions in as few words as possible.
related factor
is identified from the patient’s assessment data and is the REASON the patient is displaying the nursing diagnosis. (indicated the etiology)
what are the 4 categories of related factors for the NANDA-I?
-pathophysiological (biological or psychological)
-treatment-related
-situational (environmental or personal)
-maturational.
nursing diagnosis label includes..
o P (problem)
o E (etiology or related factor)
o S (symptoms or defining characteristics)
what should you do once you identify a patients nursing diagnosis
enter them either on the written plan of care or in the electronic health information record (EHR)
When initiating an original care plan, place the _____________ nursing diagnosis first.
highest-priority
what is one way to consider nursing diagnosis of high priority
with maslow’s hierarchy of needs (ABCs always first)
highest priority nursing diagnoses
if untreated, result in harm to a patient or others (e.g., those related to airway status, circulation, safety, and pain) (maslow’s)
intermediate priority nursing diagnoses
involve nonemergent, non-life-threatening needs of patients.
low-priority nursing diagnoses
not always directly related to a specific illness or prognosis but affect a patient’s future well-being.
when does priority setting begin?
when you identify and prioritize a patient’s main diagnoses or problems
what do you do after priority setting?
to prioritize the specific nursing interventions that you plan to use to help a patient achieve desired goals and outcomes.
goal
A broad statement that describes the desired change in a patient’s condition, perceptions, or behavior (Short-term & Long-term)
A patient-centered goal
reflects a patient’s specific behavior, not your own goals or interventions. It is important to select and measure patient outcomes that are influenced by nursing care.
when writing goals and expected outcomes they should be..
specific
measurable
attainable
realistic
time
short term goal
an objective behavior or response that you expect a patient to achieve in a short time, usually less than a week. In an acute care setting, you often set goals for over a course of just a few hours.
long term goal
an objective behavior or response that you expect a patient to achieve over a longer period, usually over several days, weeks, or months.
nurse-initiated intervention
Require no order and no supervision or direction from others. Nurse initiated interventions are autonomous actions based on scientific rationale.
o Independent—Actions that a nurse initiates
Health care provider initiated interventions
based on the health care provider’s response to treat or manage a medical diagnosis.
-Dependent—Require an order from a physician or other health care professional
collaborative interventions
Interdependent—Require combined knowledge, skill, and expertise of multiple health care professionals
consultation
a process by which you seek the expertise of a specialist such as your nursing instructor, a physician, or a clinical nurse educator to identify ways to handle problems in patient management or in planning and implementation of therapies.
-Consultation occurs at any step in the nursing process, most often during planning and implementation.
when and how to consult
HOW: begin with your understanding of the patients clinical problem.
-direct the consultation to the right professional.
-Provide the consultant with relevant information about the problem area: Summary, methods used to date and outcomes
-Do not influence consultants.
-Be available to discuss the consultants findings.
-Incorporate the suggestions.
Direct care interventions
Treatments nurses provide through interactions with patients or a group of patients
Indirect care interventions
o Treatments performed away from a patient but on behalf of the patient or group of patients
o Documentation
o Interprofessional collaboration
what does the American Nurses Association (ANA) do?
defines standards of professional nursing practice.
what are the Quality and Safety Education for Nurses (QSEN) skill competencies
authoritative statements of the duties that all registered nurses (RNs) are expected to perform competently, regardless of role, patient population they serve, or specialty. (Established standard competencies in knowledge, skills, and attitudes (KSAs) for the preparation of future nurses.)
Clinical practice guidelines and protocols
o A systematically developed set of statements that helps nurses, physicians, and other health care providers make decisions about appropriate health care for specific clinical situations
Standing orders
document that details the nursing care to be implemented in specific nursing situations, frequently when a physician is not present; may expand scope of nursing responsibilities, (give nurses legal protection to intervene appropriately in the best interests of patients with rapidly changing needs)
Preparing for implementation
Time management
Equipment
Personnel
Environment
Patient
what are the five preparatory activities
-reassessing the patient
-reviewing and revising the existing nursing care plan
-organizing resources and care delivery
-anticipating and preventing complications
-implementing nursing interventions.
Reassessment is not the ______ of care or determination of a patient’s response to an intervention, but it is the gathering of additional information to ensure that the plan of care is still appropriate.
evaluation of care
if a patients status has changed and the nursing interventions are no longer appropriate, what should be done?
modify the nursing care plan
what are the steps to modify an existing written care plan?
- Revise data in the assessment column to reflect the patient’s current status.
- Revise the nursing diagnoses and delete the old nursing diagnosis
- Revise specific interventions that correspond to the new nursing diagnoses and goals.
- Choose the method of evaluation for determining whether you achieved patient outcomes.
cognitive skills
Grasp each clinical situation at hand, interpret the information you observe, and anticipate a patient’s response so you individualize patient care appropriately.
interpersonal skills
Interpersonal communication is essential for effective nursing action. Develop a trusting relationship, express a level of caring, and communicate clearly with patients and their families. Good interpersonal communication keeps patients informed and engaged in decision making, provides individualized instruction, and supports patients who have challenging emotional needs.
psychomotor skills
require the integration of cognitive and motor activities.
what are the first steps in promoting a smooth transition for a patient from health care setting to home?
Adequate and timely discharge planning and education of the patient and family (patient adherence)
evaluation measures
are the same as assessment measures, but you perform them at the point of care when you make decisions about a patient’s status and progress.
what is the intent of evaluation
to determine if the known problems have remained the same, improved, worsened, or otherwise changed.
- Collect evaluative measures over a period of time; look for trends.
What is the aim of self-management?
to minimize the impact of chronic disease or sudden acute illness on physical health status and functioning and to enable people to cope with the psychological effects of an illness.
what are the purposes of the Nursing Outcome Classification (NOC)?
- to identify, label, validate, and classify nurse-sensitive patient outcomes;
- to field test and validate the classification; and
- to define and test measurement procedures for the outcomes and indicators using clinical data.
what are the steps to evaluate the degree of success in achieving outcomes of care?
- Examine the outcome criteria to identify the exact desired patient behavior or response.
- Evaluate a patient’s actual behavior or response.
- Compare the established outcome criteria with the actual behavior or response.
- Judge the degree of agreement between outcome criteria and the actual behavior or response.
- If there is no agreement (or only partial agreement) between the outcome criteria and the actual behavior or response, what is/are the barrier(s)? Why did they not agree?
when do you discontinue a care plan
if the patient has met all goals and outcomes
when goals and outcomes of a patient are not met, what needs to be done?
identify the factors that interfere with their achievement. Usually a change in a patient’s condition, needs, or abilities makes alteration of the care plan necessary.
what is a nurse executive
a clinical and business leader who is concerned with maximizing quality of care and cost-effectiveness while maintaining relationships and professional satisfaction of the staff.
what is a nurse manager
uses transformational leadership is focused on change and innovation through team development, motivates and empowers staff to function at a high level of performance, and serves as a role model for the nurses on the unit.
TEEAMS
Time, Empowerment, Enthusiasm, Appreciation, Management, and Support
TEEAMS (Time, Empowerment, Enthusiasm, Appreciation, Management, and Support) approach
the nurse manager spends TIME on the unit with the staff sharing ideas, EMPOWERS the staff, is ENTHUSIASTIC about seeking opportunities to enhance the team, shows APPRECIATION and recognizes team members for a job well done, MANAGES the team and holds team members accountable, and provides SUPPORT in the stressful health care environment.
What is the Magnet Recognition Program?
A hospital that is Magnet certified has a transformed culture with a practice environment that is dynamic, autonomous, collaborative, and positive for nurses.
team nursing
the registered nurse (RN) is the leader who leads a team of other RNs, practical nurses, and nursing assistive personnel (NAP) who provide direct patient care.
primary nursing
supports a philosophy regarding nurse and patient relationships
Patient- and family-centered care
a model of nursing care in which mutual partnerships among the patient, family, and health care team are formed to plan, implement, and evaluate the nursing and health care delivered.
Respect and dignity
Ensuring that the care provided is given on the basis of the patient’s and family’s knowledge, values, beliefs, and cultural backgrounds.
Information sharing
Meaning that health care providers communicate and share information so patients and families receive timely, complete, and accurate information to effectively participate in care and decision making.
Participation
Whereby the patients and families are encouraged and supported in participating in care and decision making.
Collaboration
Demonstrated by the health care leaders collaborating with patients and families in policy and program development, implementation, and evaluation, and patients who are fully engaged in their health care.
Total patient care
Emphasizes a high degree of collaboration with other health care professionals.
Case management
Approach that coordinates and links health care services to patients and their families while streamlining costs and maintaining quality.
Decentralized management
decision making occurs at the level of the staff creating an environment in which managers and staff become more actively involved in shaping the identity and determining the success of a health care organization
responsibility
duties and activities an individual is employed to perform
autonomy
independent decisions about patient care
authority
legitimate power to give commands and make final decisions specific to a given position
accountability
answerable for the actions
Competencies needed for effective interpersonal collaboration include…
· Work with individuals of other professions to maintain a climate of mutual respect and shared values.
· Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and populations served.
· Communicate with patients, families, communities, and other health care professionals in a responsive and responsible manner that supports patient-centered care and a team approach to the maintenance of health and treatment of disease.
Interprofessional rounding
members of the team meet and share patient information, answer questions asked by other team members, discuss patients’ clinical progress and plans for discharge, and focus all team members on the same patient goals
delegation
Transfers responsibility while remaining accountable for outcomes, requires nurses to know the Nurse Practice Act for their state to know what skills are transferrable
what are the 5 rights of delegation?
Right Task
Right Circumstances
Right Person
Right Direction/communication
Right Supervision/Evaluation
right task
one that can be delegated for a specific patient, such as tasks that are repetitive, require little supervision, are relatively noninvasive, have results that are predictable, and have potential minimal risk.
right circumstance
Appropriate patient setting, available resources, and other relevant factors are considered in determining the right circumstance.
right person
delegating the right tasks to the right person to be performed on the right person.
right direction/communication
indicates that a clear, concise description of the task, including its objective, limits, and expectations, is given.
right supervision/evaluation
appropriate monitoring, evaluation, intervention as needed, and feedback are provided.
Steps to Effective Delegation
o Assess the knowledge and skills of the delegatee.
o Match tasks to the delegatee’s skills.
o Communicate clearly:
-Task, outcome, time
o Listen attentively.
o Provide feedback.
