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
