UNIT 3 TEST Flashcards
problem solving approach to clincial practice that integrates the best evidence in combination with clincial expertise, and patient prefereence and values in making decisions about patient care
evidence based practice
ongoing curiosity about the best evidence to guide clinical decision making ; never be satisfied with the status quo, be motivated to learn, question why
spirit of inquiry
Ask a question ; collect the best evidence ; critique the evidence ; integrate the evidence ; evaluate practice decision or change
steps of evidence based practice
patient population of interest ; intervention of interest ; comparison of interest ; outcome of interest ; time
PICOT
when asking a clinical question we use ______
PICOT
could be categorized by age, gender, ethnicity, disease, or health problem
patient population of interest
ask yourself ‘which intervention is worthwhile to use?’
intervention of interest
usual standard of care vs. current intervention used
comparison of inerest
what you wish to achieve
outcome of interest
amount of time needed for intervention to acheive an outcome
Time portion of PICOT question
used reliable sources, peer reviewed research, and nursing reasearch databases
collect the best evidence
article is reviewed by a panel of experts familiar with the subject matter of the article before it was published
peer-reviewed research
determine value of evidence ; is it useful?
critique the evidence
apply the research in your plan of care for a patient ; put into practice
integrate the evidence
ask how well the intervention works? ; are the outcomes met? ; is it worthy of making the change?
Evaluate the evidence
tell others about the new findings
share outcomes
contiuous study and improvement of providing health care services
quality improvement (QI)
organization that analyzes and evaluates current performace to develop focused improvement actions
Performance improvement (PI)
anticipating ; continuous process characterized by open-mindedness, continual inquiry, and preseverance combined with a willingness to look at every situation and determine which assumtions are true /relevant
critical thinking
basic, complex, commitment
3 levels of Critical thinking
guided by rules and principles ; active process
basic critical thinking
more independent thinking ; lifelong process
complex critical thinking
innovative and creative thinking ; anitcipates without guidance
commitment critical thinking
systematic approach to gathering data and solving problems ; has 5 steps
scientific method
obtaining information plus using what you know to solve a problem ; can use trial and error method ; intuition
problem solving
product of critical thinking that focuses on problem resolution
decision-making
analytical process for determining a patients health problems ; determine meaning of a behavior
diagnostic reasoning
process of drawing conclusions from related pieces of evidence and previous experience with evidence ; formulation of a nursing diagnosis
inference
choosing the best option on basis of patients condition and priority or problem
clinical decision making
knowledge base, experience, nursing process competency, attitudes for critical thinking
critical thinking model
speaking with conviction and always being prepared to perform care safely ; helps build trust and increases experience
confidence
being open minded ; considering a wide range of ideas
independent thinker
listening to both sides in any discussion objectively, and analyzing view points
fairness
follow standards and be answerable to your performance
responisble and acountable
willing to recomend alternative approaches ; being an advocate for the patient
risk taker
take time to be throurough and manage time effectively
disciplined
be cautious of the easy answer ; look for a pattern and find a solution ; dont accept the staus quo
perseverance
look for a different approach if intervention is not working ; original thinking
creativity
explore and learn more about a patient to make appropriate clinical judgements
curious
dont compromise standards or honesty in delivering care
integrity
know when you need more information to make a decision ; admit to limitations in knowledge and skills
humility
guideline/pinciple for rational thought
intellectual
confidence, independent thinker, fairness, responsible/accountable, risk taker, disciplined, perseverance, creativity, curious, integrity, humility
attitudes for critical thinking
intellectual , professional
standards for critical thinking
reflective journals/logs ; concept mapping
ways to develop critical thinking in nursing students
organizing framework for professional nursing practice, a critical thinking process for the nurse to utilize to give the best care possible
nursing process
adhering to routine and bad habits ; fail to obtain critical facts ; lack of organizational skills ; over commitment ; fear of making mistakes ; inability to reflect ; using my way/highway option ; follow a leader
obstacles to critical thinking
assessment ; nursing diagnoses ; planning ; implement ; evaluate
components of the nursing process
foundation for appropriate diagnosis, planning and intervention ; includes biophysical , psychosocial , sociocultural, spiritual and environmental characteristics
assessment step of nursing process
identification ; gather information for health problems ; used for the nursing diagnosis
purpose of assessments
nursing admission assessment to the health care facility ; very comprehensive
initial assessment
limited assessment based on health care need
focused/problem focused assessment
reassessment of pt’s condition ; comparison of data to baseline data
ongoing assessment
data gathered in initial assessment
baseline data
start to determine cues ; validate the data
things to do as you gather data
information that is obtained through the use of senses
determining cues
confirm and verify ; helps determine gaps and keeps you free from errors
validate the data
collect and verify data ; organize and categorize the data ; make inferences ; analyze and interpret data ; document and report the data
assessment process
body systems models
organize and categorize the data
judgement or interpretation of cues
inference
use critical thinking ; recognize patterns ; nursing diagnoses develop from this stage
analyze and interpret data
document objectively ; write legibly
document and report data
collect all data from one source ; do not realize that this is an ongoing process ; perform physical care before assessment ; make inferences without gathering data ; incorrectly cluster data
errors made by novices
statement of an actual or potential health problem that nurses can legally and independently treat
nursing diagnoses
provides a common language for understanding the clients needs ; provides a universal means of communicating with other nurses and HCP’s ; distinguishes the nurse from HCP’s ; provides a focus on the scope of nursing practice ; promotes the development of nursing knowledge
purposes of the nursing diagnoses
began in 1973 at St Louis university ; emphasis was on independent practice of the nurse ; client centered approach; allows nurse to be recognized as a professional ; reviewed every two years
North American Nursing Diagnosis Association (NANDA)
uses assessment data to logically explain a clinical judgement
diagnostic reasoning
each Ndx has its own set ; comes from pt ; clusters of sign / Sx that lead to a conclusion
defining characteristics
Ndx
nursing diagnosis
Sx
symptoms
Actual ; risk for ; health promotion ; wellness ; syndrome
types of nursing diagnoses
current problem identified by assessment
actual
aim is prevention ; may develop is a vulnerable individual, family or community
risk for
focuses on enhancing health ; readiness fro enhanced learning
health promotion
achieved optimal level of health ; strong spiritual belief
wellness
associated with cluster of other diagnoses
syndrome
diagnostic label ; related factors ; defining characteristics
components of a nursing diagnosis
use only NANDA approved nursing diagnoses
diagnostic label
the etiology, or the cause within the domain of nursing practice ; (R/T)
related factors (R/T)
abnormal or sustaining data that supports the diagnostic label ; obtained through assessment ; “as eveidenced by” or AEB ; not used in risk for diagnoses
defining characteristics
errors in data collection ; errors in interpretation of data ; errors in data clustering ; errors in diagnostic statement selection
common errors in the diagnostic phase of the nursing process
lack of knowledge or skills ; inaccurate data ; missing data ; disorganization
errors in data collection
inaccurate interpretation of cues ; failure to consider conflicting cues ; insufficient number of cues
errors in interpretation and analysis of data
insufficient cluster of cues ; early closure ; incorrect clustering
errors in data clustering
wrong label selected ; evidence of another diagnoses is more likely ; failure to seek guidance
errors in diagnostic statement selection
determines the appropriate client-specific outcomes and interventions
purpose of planning in the nursing process
ranking all health problems to determine which order the nurse should meet the clients needs
prioritizing nursing diagnoses for plan of care
life threatening problems ; loss of cardiac function or respiratory or any other threat to physiologic functioning
highest priority
health threatening problems ; not emergency problems nor life threatening ; may concern the safety of the patient ; acute physical or physiological impairment
medium priority
little potential to cause significant dysfunction of the client
low priority
desired change in pt behavior or condition
goal
specific and measurable behavior that reflects a pt’s highest possible level of wellness ; written to address NANDA Dx
client centered goal
expect pt will achieve in a short time
short term goal
expect the pt to achieve over a long period of a week longer
long term goal
measurable criterion to evaluate goal achievement ; mutually desired by nurse/ pt ;second part of goal statement
expected outcome
patient centered ; single goal statement ; list outcomes separately ; observable and measurable ; time limited ; realistic ; developed mutually with pt
guidelines for writing goals and expected outcomes
outcomes and goals reflect the pt behavior and responses expected as a result of nursing intervention
patient centered
making statements nurse-centered instead of patient centered
errors made by novices when developing goals
fails to individualize to pt need
error made by novices when developing goals
statements are written negatively instead of positively
error made by novices when developing goals
unrealistic statement for the pt
error made by novices when developing goals
unmeasurable, non specific, or vague statements
error made by novices when developing goals
statements are nursing orders instead of pt outcomes
error made by novices when developing goals
goal statement lacks a time frame
error made by novices when developing goals
A list of nursing actions for a goal ; Form of communication for what is to be done by the nurse for the client/family ; Help client achieve goals ;
Reflects standards of care
nursing interventions
minimum level of care accepted to ensure quality care to the pt
standard of care
independent nursing interventions ; dependent nursing interventions ; collaborative nursing interventions
nursing interventions
Observations, treatments, health promotion, prevention
categories of nursing interventions
include the date, use an action verb, good content , time element
guidelines for writing nursing orders
The nurse will…
using an action verb
detailed description of the action
content of nursing order
Omitting how often monitoring should be done ; Writing an order that cannot be done by a nurse ; Padding the list with assumed procedures for the patient
errors in making nursing orders
Informal plan ; standardized plan of care ; individualized plan of care ; critical or clinical pathway ; kardex care plan ; concept maps
types of nursing care plans
non specific or individualized ; developed for specific nursing diagnoses ; prepared by agency, text, or computer program
standardized plan of care
plan of care for your specific pt
individualized plan of care
collaborative plan of care ; plans the course of treatment over a hospital stay ; based on research
critical or clinical pathway
trade name ; paper or computerized ; contains basic nursing care information as well as formal care plan
kardex care plan
visual representation of problems, and interventions to show their relationships ; holistic view of needs
concept mapping
carrying out specific individualized jointly agreed on interventions in the care plan ; outcome directed
implementation
reassessment ; reviewing ; organizing ; anticipating and preventing complications ; implementing nursing interventions
activities of implementation
occurs each time we see the pt
reassessment
use of delegation
organizing resources and care delivery
risks of treatment/ procedures ; directs us to prevent thing from happening
anticipating and preventing complications
teaching, emotional support, physical activities
implementing nursing interventions
interactions with pt
direct care
working on the pt’s behalf
indirect care
used to determine progress, and if outcomes are met
why evaluation is necessary
Identify the evaluative criteria & standards ; Data Collection ; Interpretation & Summary; Documentation ; revision
process of evaluation
Discontinue Plan of Care ; Modify Plan of Care ; Continue Plan of Care
care plan revisions
use if goals have been met ; prevents unnecessary nursing care
discontinue plan of care
identify factors that interfere with goal achievement
modify plan of care
reevaluate time frame
continue plan of care
interactive process that promotes learning
teaching
acquisition of knew knowledge , behaviors, skills, and attitudes
learning
maintain and promote health and illness prevention ; restore health ; facilitating coping ; prevention
purpose of patient education
provide info and skills that enable pt to assume healthier behaviors
maintaining/ promoting health and illness prevention
need more info to regain health
restore health
learning to cope with permanent health alterations
facilitate coping
Describes what the learner will be able to do after successful instruction
learning objective
cognitive ; affective ; psycho-motor
domains of learning
requires thinking ; includes knowledge, comprehension, application, analysis, synthesis, and evaluation
cognitive learning
deals with expression of feelings ; difficult to measure
affective learning
involves acquiring skills that require the integration of mental and muscular activity
psychomotor learning
occurs inside the learner ; discovery of personal meaning and relevance of ideas ; consequences of experience ; collaborative and cooperative process ; builds on past learning and experiences ; intellectual and emotional
attributes of learning
Seeing and Hearing
Reflecting and Acting
Reasoning logically and Intuitively
Analyzing and Visualizing
How we learn
Allows learner to focus and comprehend
Attentional Set
Internal force that can be influenced by external factors (social, tasks, physical motives
Motivation
Personal belief on ability
Self-Efficacy
Related to stages of grieving
Learning is best at the acceptance level
Readiness to learn
Implies eagerness to acquire new skills
Active involvement
Visual, Kinesthetic, Auditory
learning styles
Value of information; Must be useful and purposeful
Relevance
Meaningful and timely ; non judgmental
feedback
Logical organization ; step by step order
simple to complex
use different methods with same content
repetition
Short time between teaching and application
timing
has a negative or positive influence on learning
learning environment
Often reflects real-life need and application ; sometimes need help to see problem and change perspectives
adult learner
Based on developmental level
learning in children
based on level of physical development and physical health ; shows strength and coordination
physical capacity
what do patients expect from us
expectations of learning
changes depending on a pt’s current health status
learning needs
ask questions to determine pt’s motivation
motivation to learn
physical and cognitive ability
ability to learn
needs to be conducive to learning ; assess for distractions, comfort, and available equipment
teaching environment
assess family/caregivers readiness and ability to learn the information
resources for learning
cognitive and social skills that determine the motivation and ability of individuals to gain access to understand and use info in ways that promote good health
health literacy and learning disabilities
set the minimum criteria for success
goals and outcomes
based on immediate needs, nursing diagnoses and the goals/outcomes established
priority setting
choose appropriate teaching methods, encourage the pt to offer suggestions and make referrals
collaborative approach
Active participation is essential! ; Build on existing knowledge ; Use effective teaching approaches ; Integrate teaching with nursing care ; Match instructional method with learning needs
implementation
learned better when more than one sense is used
active participation
present info on a learners existing knowledge
building on existing knowledge
use when teaching limited information
telling
become involved in learning process together
participating
provide the pt the opportunity to manage self care
entrusting
increase the probability fro response
reinforcement
makes you gain confidence in your clinical skills
integrate teaching with nursing care
Disabilities; Cultural considerations
Developmental consideration ; Teaching tools
special considerations
most common method of teaching ; informal
one on one
economical way to teach a number of pt’s at one time ; lecture and discussion
group
when teaching psychomotor skills
demonstrations
when teacher translates complex language into words the pt understands
analogies
method in which pt learns to feel more comfortable
role play
for teaching problem solving, application and independent thinking
simulation
knowledgeable of pt’s cultural background and beliefs
cultural diversity
depends on teaching methods learning needs and ability to learn
teaching tools
determine if teaching was effective
evaluation
Be specific
Identify any barriers
Identify need for reinforcement, future teaching, or revision
documentation of learning
