UNIT 2 Critical thinking; Nursing process Flashcards
Characteristics of Critical Thinkers:
Raise Questions
Show willingness to search for answers
Are inquisitive
Eager to acquire new knowledge
Consider multiple perspectives
Explore ideas/problems in new ways
Are open minded
Critical Thinking Equation:
Character + Knowledge + Skills = Critical Thinking
The Nursing Process
A systematic method of planning/providing Pt care. It is intertwined w critical thinking to help make informed, ethical decisions about Pt care (has 5 phases-> ADPIE)
Critical thinking:
A high-level cognitive process that is the means by which nurses learn to assess and modify, if indicated, before acting.
What is ADPIE?
The 5 phases of the nursing process
1) Assessment
2) Diagnosis
3) Planning
4) Intervention/Implementation
5) Evaluation
ADPIE: Assessment
To gather and analyze info about the Pt and their context from HIS/HER perspective (“Pt’s Story”) to establish a database:
- Includes subjective data + objective data.
ADPIE: Diagnosis
In the Diagnosis phase, nurse begins clustering subjective and objective data + formulating an evaluative judgement a/b Pts health status. (Uses clinical reasoning)
A working Nursing Diagnosis may have 2 or 3 parts.
Types of Data:
- Subjective data: What a Pt “says” = Symptoms
- Objective data: What you observe = Signs
Assessment: Sources of Data:
Subjective:
- Complete a thorough health and medical history via listening and observing Pt (Pt = primary source & Family/friends/Pt records = secondary sources)
- Info obtained verbally = subjective info
Objective:
- Perform a Physical assessment by taking vital signs and noting diagnostic test results
- info obtained physically = objective info
Diagnosis: 2 Part system
consists of the nursing diagnosis and the “related to” (r/t) statement.
- used when defining characteristics/signs and symptoms are obvious.
Problem–> Related To (r/t)–> Reason
Diagnosis: 3 Part System
consists of a nursing diagnosis, r/t statement, and the defining characteristics (“observable”). Also referred to as the PES system:
P (problem) - the nursing diagnosis label: a term or phrase that represents a bunch of related cues.
E (etiology) - r/t phrase: related cause/contributor to the problem.
S (symptoms) - defining characteristics phrase: symptoms that the nurse identified in the assessment.
Types of Nursing Diagnoses: Problem-focused Diagnosis
A clinical judgment concerning an undesirable human response to a health condition/life process in an individual, family, group, or community.
A.k.a. Describes an existing problem (e.g. Constipation)
Types of Nursing Diagnoses:
4 Different Types:
1) Problem-focused Diagnosis
2) Risk Diagnosis
3) Health-promotion Diagnosis
4) Syndrome Diagnosis
Types of Nursing Diagnoses: Health-promotion Diagnosis
A clinical judgment concerning the motivation and desire to increase wellbeing/actualize human potential.
A.k.a. Describes a Pt’s, family’s, or community’s desire to realize human health potential. the focus is on being as healthy as possible.
Types of Nursing Diagnoses: Risk Diagnosis
Is a clinical judgement concerning to the susceptibility of an individual, caregiver, family, group, or community for developing an undesirable human response to health conditions/life processes.
A.k.a. describes a potential problem that the Pt is vulnerable to.
Types of Nursing Diagnoses: Syndrome Diagnosis
Based on a group of signs and symptoms that occur together; they provide a distinct clinical picture
(e.g. Post-trauma Syndrome)
ADPIE: Planning
The planning phase includes the identification of priorities and the determination of appropriate Pt-specific outcome/interventions (determine urgency of problems and prioritize Pt needs)
- Occurs from 1st contact & continues till discharge (results in a “care plan”).
- Includes goals that are Pt-centered/desired outcome is SMART.
Classification of Priorities:
HIGH - ABC’s (airway, breathing, circulation), Emergencies, + immediate/life-threatening .
INTERMEDIATE - Non-emergent (acute pain, risk of infection, acute urinary elimination problems, etc.)
LOW - What affects future well-being.
When Writing Outcome Statements, Use SMART, which Means the outcome is…
S - specific
M - measurable
A - attainable
R - realistic
T - timed
(goals should always be either long-term or long-term)
How to write a goal (/w outcomes):
Combine a Verb with Condition and Criterion:
E.g. Patient will demonstrate minimal episodes of agitation as evidenced by a calm demeanor over 48hrs.
Independent goals:
Nurse can implement/achieve on own.
e.g. Give Pt prune juice to encourage bowel movement/
Dependent goals:
Requires Primary Physician (Dr.) to assist in implementing/achieving goal.
e.g. Dr. prescribes meds to help with pain.
Collaborative goals:
Requires working w other professions to implement/achieve goal.
e.g. helping a Pt with mobility which requires physical therapist, and maybe a pharmacist or Doctor.
ADPIE: Implementation
“Acting on nursing interventions”
This phase includes the carrying out of specific, individualized, and jointly agreed-on interventions in the care plan.
Initiate appropriate nursing interventions AFTER:
- Reassessing the Pt
- Organizing resources/assistance
- Anticipate/prevent complications
T/F Rationale is required when applying and documenting the implementation/intervention phase?
True
you have to state the significance of WHY you chose a particular intervention and provide a scholarly resource.
ADPIE: Evaluation
Occurs throughout the Nursing Process. The nurse reassess the client, taking into consideration the Pt before the intervention, + after the intervention.
you will consider if the care was effective, if change has occurred in the Pt, & if not revise the plan.
ALWAYS Document
Evidence-Informed Practice (EIP):
A more inclusive view of what “counts” as evidence. There are many forms of evidence that inform clinical decision-making and the delivery of care (6 different forms)
It can also be defined as a paradigm + lifelong problem-solving approach that uses the best evidence along w ones own clinical expertise to improve Pt outcomes.
What are the 3 possible statements you could write for the evaluation on if the goal was achieved?
1) Goal met
2) Goal partially met
3) Goal not met
*You can only write ONE statement.
6 main forms that influence evidence-informed practice:
intervention studies
clinical trials
ethnographic research
systematic reviews
policy analyses
evaluation studies
The Biomedical Model:
The predominant model of the Canadian healthcare system.
Health is defined as the absence of disease and are viewed in 2 ways:
- Disease is caused by specific agents/pathogens
- Heath is when the symptoms that the pathogen caused have been eliminated.
The Behaviour Model:
Believes that healthcare extends beyond treating disease to include secondary and primary preventions (changing behaviours & lifestyles)
The Socioenvironmental Model:
Incorporates sociological + environmental aspects in addition to the biomedical and behavioural ones.
Defines health as a resource to realize goals/aspirations, meet personal needs, and cope w everyday life.
(includes the prerequisites of health and the social determinants of health)
The Prerequisites to/for health:
Peace
Shelter
Education
Food
Income
A sustainable ecosystem
Sustainable resources
Social justice
Equality
Social Determinants of Health:
The social, economic, and political conditions that shape the health of individuals, families, and communities.
Health Promotion:
Defined as a comprehensive social and political process of enabling people to increase their control over the determinants of health, thereby improving their health.
- Directed towards changing social, economical, + environmental conditions to improve health.
What is the Relational Approach to Nursing Practice?
Used to describe the complex, interrelated nature of health, people, society, and the nursing practice.
It is a relational approach that aids you in all nursing situations and requires you to consider:
- the experience of others
- how people understand their health
- how they manage their current/evolving states of health
- the intra/interpersonal + contextual dimension (looking at all that are involved)
Reflexivity:
Central to the relational approach to nursing. it involves a combination of observation, critical scrutiny, and conscious participation.
4 Types of Databases:
1) Complete (total-health) Database
2) Episodic/Problem-centred Database
3) Follow-up Database
4) Emergency Database
Complete (total-health) Database:
- consists of a complete health history, the results of a full physical exam, current/past health statements and records.
- it forms a baseline.
- mainly used in primary care and acute hospital care.
Episodic/Problem-centred Database:
- mainly used for a limited or short-term problem (“mini database”) and concerns mainly 1 problem/cue complex/body system
- it is used in all settings (hospital, primary, + long-term care)
Follow-up Database:
- states the status of any identified problems, and should be evaluated at regular + appropriate intervals
- used in all settings to monitor short-term or chronic health problems
6 Competencies for Nursing:
Pt-centered care
Teamwork/collaboration
Evidence-based practice (EBP)
Quality improvement
Safety
Informatics
Emergency Database:
- calls for rapid collection of the data (diagnosis must be swift and sure)
- Pt is questioned simultaneously while their ABC’s , level of consciousness, + disability are being assessed.
EBN:
Abbreviation used when interventions have a scientific rationale supported by nursing research.
Person-Centred Care:
The ability to recognize the Pt as the source of control and a full partner in providing compassionate/coordinated care
- Based on Pt preferences, values, and needs
CEB:
Abbreviation for research that has not been replicated or is older (commonly seminal studies)
EB:
Abbreviation used when interventions have scientific rationales supported by research obtained by disciplines other than nursing.
Safety
Defined as minimizing risk of harm to clients and providers through both system effectiveness/individual performance. (Client safety is a priority)
