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.