Exam review

A group of nurses of the orthopedic floor of a hospital wish to improve their clinical performance. The nurse manager suggests a program in which the nurses will evaluate each other and provide feedback for improved performance. The nurses know that this program is termed which of the following?

Peer review Peer review is a process by which one nurse evaluates the performance of another in an effort to improve their professional performance. QSEN has as its goal the preparation of nurses with the knowledge, skills, and attitudes (KSAs) necessary to improve the quality and safety of healthcare systems. AACN strives to provide safe work environments and HCAHPS measures client satisfaction with health care. (less)

The nurse manager observes one of the unit nurses failing to was her hands upon entering a client room. Hospital protocol is washing hands before and after entering a client room. The nurse manager knows that this is an example of:

Quality by inspection Quality by inspection is obtained by nurses watching for deficient workers and removing them in an effort to prevent harm to clients.

Evaluation can be considered

Re-Assessment

Which action should the nurse take when client data indicate that the stated goals have not been achieved?

Review each preceding step of the nursing process. If a client's goal has not been achieved the nurse should review each of the preceding steps of the nursing process in order to try to identify the contributing factors causing problems with the plan of care. By conducting the evaluation this way, the nurse may find that more data must be collected or the plan of care needs revision. An individualized plan of care rather than a standardized plan of care is often warranted. (less)

Which client outcome is an example of a physiologic outcome?

The client's pulse oximetry reading is 97% on room air 30 minutes after removal of a nasal cannula. Physiologic outcomes are physical changes in the client, such as pulse oximetry. An affective outcome involves changes in the client's values, beliefs, and attitude, such as engaging in exercise. Cognitive outcomes demonstrate increases in client knowledge, such as administration of a vaginal cream. Psychomotor outcomes describe the client's achievement of new skills, such as performing active range of motion exercises. (less)

Nursing Process

The essence of critical thinking and clinical decisions in nursing

Which of the following nursing actions reflects evaluation?

The nurse assesses urine output following administration of a diuretic. Assessing the client's response to a diuretic medication is an example of evaluation. Recognition of a client health problem that can be prevented or resolved by independent nursing intervention, such as activity intolerance, is the focus of diagnosing. Auscultating the client's lungs and abdomen is an example of assessment. Setting a tolerable pain rating with the client is an example of planning. (less)

The nurse is conducting a peer review of a nursing colleague. Which action by the nurse is an example of peer review?

The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation. Peer review involves the evaluation of one staff member by another staff member on the same level in the hierarchy of the organization for the purpose of professional performance improvement. The nurse preceptor providing feedback to the new graduate nurse after 6 weeks of orientation is an example of peer review. (less)

Primary Purpose of the Nursing Process (Taylor p198)

The primary purpose of the nursing process is to help nurses manage each patient's care holistically, scientifically, and creatively.

A nurse is giving post-operative care to a client after knee arthroplasty. Which of the following is a possible short-term goal for this client?

To ambulate the client to a bedside chair

The health care team has convened to discuss the care of an end-of-life client who is not able to achieve an acceptable level of comfort. The physician asks for the nurse's perspective of the situation. Which standard for establishing and sustaining healthy work environments does this action represent?

True collaboration True collaboration involves skilled communication, mutual respect, shared responsibility, and decision making among nurses, and between nurses and other health team members. Skilled communication requires health team members to communicate in a non-intimidating manner with colleagues, allowing all voices to be heard regarding a matter. Effective decision making ensures nurses are valued and active partners in making policy, directing and evaluating clinical care, and leading organizational operations. (less)

Diagnosis

Why does this patient need a nurse?

Question: What are the primary purposes of the evaluation phase of the Nursing Process

a. Examine the need for adjstments and changes to the plan of care c. Measurement: the extent to which client goals have been met

For a client with self-care deficit, the long-term goal is that the client will be able to dress himself by the end of the 6-week therapy. For best results, when should the nurse evaluate the client's progress toward this goal?

as soon as possible Evaluating the progress of a long-term goal prior to the end date will encourage and motivate the client to continue working towards the goal. Waiting until the client is discharged or at the end of the 6 weeks does not provide the client the opportunity to feel a sense of accomplishment and motivation to continue working towards the goal. Only evaluating when the client shows progress may lead to the client becoming discouraged. (less)

5.Communicate- write the "plan of care"

client centered, step by step process Nursing Care Plan (slide) NANDA Nsg Dx: (Diagnostic label)_________________ R/T (etiology)_______________ AEB (defining characteristics)______________________ -------------------------------------------- Assmnt Goals/Otcmes Intvntns Ratnls Evals subj assmnt, for treatmnts, interventions education, objective etc.

The focus of a hospital's current quality assurance program is a comparison between the health status of clients upon admission and at the time of discharge. This form of quality assurance is characteristic of:

outcome evaluation. Outcome evaluation focuses on measurable changes in the health status of the client or the end results of nursing care. Whereas the proper environment for care and the right nursing actions are important aspects of quality care, the critical element in evaluating care is demonstrable changes in client health status. Process evaluation addresses performance expectations during the various stages of the nursing process. Structure evaluation addresses the environment of care. A nursing audit focuses on the review of records. (less)

diaphoretic

profuse sweating

A nurse is caring for a client in the immediate postoperative period and discovers there are factors that are affecting the attainment of client goals. Which of the following is true of factors that influence client responses and outcome achievement? Select all that apply.

• A client's strong motivation to learn appropriate health behaviors is an example of a positive factor. • The nurse should understand which factors are helpful to attaining outcome attainment and manipulate them to achieve goals. • The nurse will draw on positive factors to deal with other variables in the future. The nurse should reinforce positive behaviors to achieve the outcomes for the client. Positive and negative factors can be manipulated to improve client outcomes. The other choices are all true regarding positive factors. (less)

A new graduate nurse is working in a hospital that is utilizing a program to continuously improve every process in every department of the facility. The process is known as: (Select all that apply)

• Quality improvement • Continuous quality improvement • Total quality improvement Quality improvement, continuous quality improvement, and total quality improvement are all names that describe a facility program to continuously improve every process in every department in the facility. (less)

Which client outcome is a psychomotor outcome? Select all that apply.

• The client measures capillary blood sugar level. • The client catheterizes self, using clean technique. Psychomotor outcomes describe the client's achievement of new skills, such as measuring capillary blood sugar and self-catheterization. Cognitive outcomes demonstrate increases in client knowledge, such as identifying low sodium foods and describing how to empty a wound drain. An affective outcome involves changes in the client's values, beliefs, and attitude, such as using imagery to control anxiety. (less)

Benefits of the Nursing Process

For Patient: achieves for pt, scientifically based, holistic, individualized care; the opportunity to work collaboratively w/ nurse; & continuity of care. For the nurse: Achieve a clear, efficient, and cost effective plan of action by which the entire nursing team can achieve best results for pt; the satisfaction that they are making a difference in the lives of pts.; the opportunity to grow professionally as they evaluate the effectiveness of interventions and variables that contribute pos/neg to pt's achievement of valued outcomes.

Relationship of Evaluation to the Nursing Process

It is the last part of the circle, but it just goes back around to assessment->data analysis->planning -> implementation-> evaluation again! until health of pt established.

Problem List

Set of symptoms and observations about the patient that answer the question "why does he need a nurse?" but not in standard nursing language. Nursing Diagnosis has a standard language focused on altered states of health.

Data Types: Subjective and Objective

Subjective data: what pt/family says Symptoms Client's feelings Statement Objective data: what I see/observe as nurse Signs/ overt clues Observations Standard assessment Laboratory and diagnostic testing

2.Establish Goals and Expected Outcomes

-Provide guidelines for nursing interventions -establish evaluation criteria to measure the effectiveness of the nursing care plan -Goal: broad statement describing the desired change. Two types- long & short -Outcome: detailed, specific statement that describes the methods through which the goal will be achieved.

Case Study: Judy Jones

...

Assessment Types

-Initial assessment -Focused assessment -Time lapsed reassessment( maybe a yearly check or recheck after meds administered. ) -Emergency assessment: if someone is ABCs or heat attack, bleeding heavily for example.

Evaluation: how well did the interventions workout?

-the last phase of the nursing process. It follows implementation of the plan of care It's the judgement of the effectiveness of nursing care to meet client goals based on the client's behavioral responses

Nursing Process formalized

1950s-1970sThe nursing process was formalized and described. AssessPlanImplementEvaluate --> AssessDiagnosePlanImplementEvaluate

Examples of Nursing Diagnoses

3.Deficient Fluid volume related to vomiting/NG tube aspiration, medically restricted intake, altered coagulation and bleeding; AEB, changes in mentation, dizziness, syncope, cold clammy skin, decreased skin turgor, tachycardia, decreased Bp or hypotension, decreased pulse volume and pressure, decreased / concentrated urine, decreased Hemoglobin and Hematocrit, change in coagulation studies. 4. DEFICIENT KNOWLEDGE regarding patho-physiology, therapy choices, and self care needs may be related to insufficient familiarity with condition, lack of information, misinterpretation, AEB verbilization of concerns,questions, and recurrence of condition 5. INEFFECTIVE BREATHING PATTERN R/T decreased lung expansion decreased energy/fatigue, ineffective cough, secondary to pain and muscle weakness, AEB, fremitus, tachypnea, and decreased respiratory depth/vital capacity.

The nurse participates in a quality assurance program and reviewing evaluation data from the previous year. Which of the following does the nurse recognize as an example of outcome evaluation?

A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery. Quality assurance programs focus on three types of evaluation: structure, process, and outcome. Outcome evaluation focuses on measurable changes in the health status of clients, such as a 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery. Structure evaluation focuses on the environment in which care is provided, such as the number of baccalaureate-prepared nurses employed in the facility and bed occupancy rates. Process evaluation focuses on the nature and sequence of activities carried out by nursing implementing the nursing process, such as 98% of all hospital admissions had a nursing history completed within 24 hours of admission. (less)

A nurse caring for a patient admitted with a deep vein thrombosis is individualizing a prepared plan of care that identifies nursing diagnoses, outcomes, and related nursing interventions common to this condition. What type of tool is the nurse using?

A standardized care plan

The nurse is collecting data on a client presenting to the medical short-stay unit for a colonoscopy. A client reports to the nurse that he quit smoking six months ago after being diagnosed with lung cancer. The nurse recognizes this change in behavior is which type of outcome?

Affective outcome Affective outcomes pertain to changes in client values, beliefs, and attitudes and are more complex to evaluate. Changes in behaviors, such as the cessation of smoking or nutritional changes that lead to weight loss, are examples of affective outcomes. Cognitive outcomes involve an increase in client knowledge and are evaluated by asking the client to repeat information or perform a skill. Psychomotor outcomes describe the client's achievement of a new skill. Physiologic outcomes result in physical changes and are evaluated through physical assessment. (less)

Nurses formulate different types of goals for clients when planning client care. What is considered a psychomotor client goal?

By 8/18/15, client will demonstrate improved motion in left arm. Psychomotor client goals refer to the client's achievement of new skills, such as demonstrating improved motion in the left arm. Valuing health by quitting smoking is an example of a quality of life goal/outcome. Listing three foods low in salt is a cognitive goal/outcome. Learning exercises to strengthen leg muscles is an affective goal/outcome. (less)

Provider carries out the plan of care

Carries out the plan of Nursing Care or Setting your plans in motion and delegating responsibilities for each step. Continues data collection and modifies The Plan of Care as needed. Documents the care given

Blended skills and critical thinking

Cognitive and technical skills equip nurses to manage the clinical problems stemming from the patient's changing health or illness state. Interpersonal and ethical skills are essential for nurses concerned about the patient's broader well-being.

The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of what type of outcome?

Cognitive outcome Cognitive outcomes demonstrate increases in client knowledge, such as strategies for minimizing leakage of an ileostomy bag. An affective outcome involves changes in the client's values, beliefs, and attitude. Physiologic outcomes are physical changes in the client. Psychomotor outcomes describe the client's achievement of new skills. (less)

Assessment Data Nursing Diagnoses

DATA: pain, nausea, vomiting, diaphoresis Fever, Jaundice URQ abdominal pain Elevated WBC, Liver funcs, & amylase Ultrasound/other diagnostics NURSING DIAGNOSIS: (diagnostic label portion) Acute pain Imbalanced nutrition Deficient knowledge Ineffective breathing pattern Deficient fluid volume

The nurse manager on an orthopedic unit has determined that the nurses are not keeping the nursing diagnoses up-to-date on client care plans and, in turn, are not using the plan of care. What is a feasible approach to correcting this problem?

Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses. Upon recognizing that the nursing diagnoses are not up-to-date, an effective approach by the nurse manager is to establish a process for periodic review of the plan of care. This review process will require deletion of nursing diagnoses that have been resolved and, conversely, adding new diagnoses as needed. Implementing concept mapping will not correct the problem of poorly updated nursing diagnoses, as concept mapping requires the identification of nursing diagnoses. Developing interviewing and assessment skills is an important component of the assessment phase of the nursing process. Also, one nurse should not be responsible for updating nursing diagnoses for all client care plans on the unit. (less)

A client is rehabilitating from a fractured right leg. She is learning to walk on crutches. Together, the client and the nurse have established a plan for the client to walk with a three-point gait for 20 feet by the next day. In outcome identification, what is this termed?

Establishing a client goal

Which purpose of the evaluation phase of the nursing process is a priority during client care?

Examine the client's behavioral response to the care received. Nurses continually assess responses of clients to particular nursing interventions, establish different priorities for nursing diagnoses, and alter plans of care as necessary.

The nurse recognizes that identifying outcomes/goals must include which of the following?

Involvement of the patient and family

The nurse, in collaboration with the patient's family, is assigning priorities related to the care of the patient. The nurse explains that when setting priorities it is important to look at the urgency of specific problems. What provides the best framework for prioritizing patient problems?

Maslow's hierarchy of needs

The nurse is caring for Mr. H., a 35-year-old man who is hospitalized following a motorcycle accident. He has a traumatic brain injury. The nurse is working with Mr. H. on self-care behaviors. The following would help the nurse to assess the success of the nursing interventions except which of the following?

Model self-care behaviors for the client. This question asks specifically about evaluation. Modeling self-care behaviors is an intervention, not an evaluation or assessment technique. When considering the responses, first check for sentence structure. Only one of the choices contains the three elements of the nursing diagnosis: the diagnostic label, the related factors, and the defining characteristics. The question asks for an actual diagnosis; this eliminates any risk, wellness, or potential diagnoses. (less)

Nursing Diagnosis comes from (1) a problem list...using standard lang. (2) clinical judgement of altered pt's response to actual or potential health condition/need.

NSg Dx: (diagnostic label) ________ related to (R/T)[etiology]...______ as evidenced by (AEB) [defining characteristics]...

Differentiating Nursing Dx from Medical Dx

NURSING Dx focuses on unhealthy responses to health and illness Medical Dx focuses on Identifying disease. NURSING Dx describes problems treated by nurses w/in the scope of independent nursing practice. Medical Dx describes problems for which the physician directs the primary tx. NURSING Dx may change from day to day as pt responses change. Medical Dx remains the same for as long as the disease is present.

What are the essential skills necessary in assessment?

Observation Interviewing Physical exam techniques Intuition What you observe (data you collect) and the subjective data (what the pt says) Intuition comes from experience and knowledge

The quality assurance model of the ANA identifies three essential components of quality care. Which one of these components does the nurse use when determining whether a patient has met the goals stated on the care plan?

Outcome The ANA's three essential components of quality care are nursing-sensitive indicators that reflect the structure, process, and outcomes of nursing care. Outcomes are also referred to as goals in the nursing process. Retrospect is not a component of quality care. (less)

A nurse is evaluating the plan of care for the client under her care. Which of the following problems might the nurse note that is associated with the implementation phase of the plan of care?

Nurses are not aware of client priorities and the plan of care. During implementation of care, nurses should be aware of client priorities and adjust care accordingly. The other options are all rooted in the planning phase.

A nurse is caring for a client who is recovering from stroke. Which of the following would the nurse perform in the evaluation phase?

Revise the plan of care The nurse should revise the plan of care during the evaluation phase. It provides the feedback mechanism that starts the entire chain of events again. Setting priorities is part of the planning phase. Carrying out treatment procedures and recording interventions are activities in the implementation phase of the nursing process. (less)

A nurse is evaluating nursing care and patient outcomes by using a retrospective evaluation. Which action would the nurse perform in this approach?

The nurse devises a post-discharge questionnaire to evaluate patient satisfaction. Evaluations can be conducted concurrent with care (conducted by using direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met), or retrospective (postdischarge questionnaires, patient interviews by telephone or face to face, or chart review to collect data). (less)

The terms "criteria" and "standards" are often used interchangeably, but they actually have distinct definitions. "Measurable qualities, attributes, or characteristics that identify knowledge or health status" are known as:

criteria Criteria are "measurable qualities, attributes, or characteristics that identify skill, knowledge, or health status." Standards are the "levels of performance accepted by, and expected of, nursing staff or other health team members." Evidence-based practice incorporates delivering nursing care that evidence supports as likely to result in meeting the expected client outcomes. Evaluation involves measuring how well the client has achieved the outcomes that were set forth in the plan of care. (less)

The primary purpose for evaluating data about a client's care according to a functional health approach is to:

revise or modify the nursing care plan. Evaluation using the functional health approach provides a framework for organizing and evaluating data.

A client has returned to the clinic for a postoperative visit. The nurse reviews the plan of care and could choose to take which action based on the client's previous responses to the current plan of care? Select all that apply.

• Modify the plan of care if difficulty has been encountered with achieving outcomes. • Continue the plan of care if more time could result in achievement of outcomes. • Terminate the plan of care if outcomes have been achieved The plan of care should be discussed with the client and any significant others at the onset of care. The client should be informed that nurses will help along the way as the client strives to reach outcomes; the nurse should not demand that the client is on a set time frame. The other choices are appropriate when the plan of care is reevaluated. (less)

A nurse is documenting evaluation of the care provided for an infant born with Down syndrome. Which nursing actions exemplify the appropriate documentation process? Select all that apply.

• The nurse writes a 2-part evaluative statement that includes a decision about how well the outcome was met, along with client data that support the decision. • The nurse has three decision options for how goals have been met. • After the data have been collected to determine client outcome achievement, the nurse writes an evaluative statement to summarize the findings. After the data have been collected and interpreted to determine client outcome achievement, the nurse makes and documents a judgment summarizing the findings. The 2-part evaluative statement includes a decision about how well the outcome was met, along with client data or behaviors that support this decision. Outcomes may have been met, partially met, or not met. The goal is not discontinued if not met; it can be modified. The complexity of a goal may be increased in complexity if it will benefit the client. The client, nurse, or other health care variables may affect correctly written goals. (less)

A nurse is evaluating the plan of care for a client and determines that the achievement of goals is difficult to evaluate. Which of the following might the nurse do in evaluating the plan to see that the outcomes are correctly written? Select all that apply.

• Be sure that the criteria for appropriate response are clearly specified. • Be certain that the subject is the client or some part of the client. • See if the client's expected behavior is written in observable, measurable terms, • Specify time limits in the plan. The nurse would not rewrite the plan of care just so the client meets the outcomes. It should be ascertained that the plan of care leads to a better state of health not just modify it so the client achieves the outcomes. The other choices are appropriate to evaluate the plan of care. (less)

Nurses formulate physiologic goals for patients when providing patient care. What are examples of physiologic goals? (Select all that apply.)

• By 4/6/15, the baby will demonstrate adequate sleep-wakefulness patterns. • By 4/6/15, the baby will show an adequate comfort level indicating satisfactory parenting. • Before discharge, the baby will have reached a target weight gain of 8 lb (birth weight: 7 lb, 6 oz). Physiologic goals meet the need of normal, healthy body functioning. An infant's sleep-wake patterns, comfort level, and weight are all examples of physiologic goals/outcomes. Decreased anxiety of the parents and demonstration of confidence in bathing their baby is an affective outcome. Listing appropriate resources demonstrates cognitive goals. (less)

A hospital is revising its quality improvement program. The goal of the program is to improve quality in the facility. Which of the following are major premises of the program? (Select all that apply)

• Leadership commitment • Empowerment • Customer orientation • Focus on the organizational mission Focus is not on unit nurses in a quality improvement program. It is focused on client care and the other choices noted above.

Which of the following would a nurse know is a part of an evaluative statement? Select all that apply.

• Patient data that supports how the outcome was met • Description of how the patient outcome was met An evaluative statement includes a description of how the patient's outcome was met and the data that supports that decision. The name of the physician and the health history would only be included if it contributed to the patient's outcome. (less)

Which expected client outcome is an example of a psychomotor outcome? Select all that apply.

• Safely ambulating using a walker. • Accurately drawing up insulin Examples of psychomotor outcomes include accurately drawing up insulin and ambulating safely using a walker. Identifying signs and symptoms of infection is an example of a cognitive outcome. Rating pain as a 2 on a 10-point scale is a physiologic outcome. An example of an affective outcome is reporting increased confidence in testing blood sugar. (less)

5 Steps in Nursing Process Today

1. Assessment 2. Diagnosis 3. Outcome Indentification & Planning 4. Implementation 5. Evaluation

Necessary/appropriate parts of nursing diagnosis

1. Diagnostic label 2. Etiology (patho...) 3. Defining Characteristics (uses subj & object data as evidence... need at least on kind of evidence)

Name 5 categories of nursing interventions of the NIC Iowa Intervention Project

1. Physiologic 2. psychosocial 3. illness treatment 4. illness prevention 5. health promotion

What are the unique characteristic of the Nursing Process?

1. Systematic- ordered sequence with each activity dependent on the accuracy of the activity that preceded it. 2.Dynamic- ever changing, steps overlap and flow 3. Interpersonal- Human interaction is at the heart of nursing. interact w/ pt & family 4. Outcome oriented/Goal-directed: Together the nurse and patient set goals, short & long-term for the health plan. 5. Universally applicable to any nursing situation

EXAMPLES OF NURSING DIAGNOSES

1.ACUTE PAIN related to inflammation and distortion of tissuesm ductal spasm; AEB, verbal reports, guarding/distraction behaviors and autonomic responses (specify changes in vital signs.) 2. IMBALANCED NUTRITION: less than body requirements related to inability to ingest/absorb adequate nutrients secondary to food intolerance/pain/nausea/vomiting,anorexia AEB, possibly evidenced by aversion to food/decreased intake and weight loss.

Other types of nursing diagnoses

1.Actual Nursing Diagnosis- (diagnostic label & etiology) 2.Risk for: Nursing Diagnosis- (diagnostic label & etiology ...where you expect that risk to come from)" risk for pain, risk for poor airway clearance, etc. 3.Wellness Nursing Diagnosis- different, one part statement "readiness for enhanced spiritual well-being. 4.Possible Nursing Diagnosis- it raises awareness to keep eye on.Includes diagnostic label but not sure where it is coming from. 5.Collaborative Health Problems- Diagnosis where you aer working with the Dr. ex: electrolyte imbalance need a medical order so collaborative.

Implementation: what will the nurse do for this patient?

1.Consists of Doing & Documenting the activities that are the specific nursing actions needed to carry out the interventions or nursing orders. 2.The first three nursing process phases(assessing, diagnosing, and planning) provide the basis for nursing action performed during implementing step. 3.In turn, the implementing phase, provide the actual nursing activities and client responses that are examined in the final phase, the evaluating phase.

Planning: What can or should be done for this Patient?

1.Est. client goal/outcomes 2.Work w/ client to prevent, reduce, resolve problem 3.Determine related nursing interventions (actions) that are most likely to assist client in achieving goal. This is about improving quality of life for your pt. This is about what your pt needs to do to improve their health status or better cope with illness.

What are the elements of planning in the nursing process?

1.Establish priorities 2.Write client goals/outcomes 3.Develop an evaluative strategy 4.Select nursing interventions 5.Communicate the plan

1.Prioritizing Nursing Diagnoses

1.HighPriority: Dx- Ineffective breathing pattern --> Nursing Implications: assess breathing sounds, monitor vital signs, reposition client, encourage IS/TCDB 2.MediumPriority: Dx- risk of impaired skin integrity--->Comprehensive skin assess, keep skin clean/dry, turn reposition client on specified schedule 3.LowPriority: Dx- Ineffective Coping--> assist to identify problems, encourage keeping daily journal, teach client strategies for expressing feelings. *ABCs are always first!

4.Specify- Nursing Interventions

1.Once the goals have been mutually agreed on by the nurse and client, the nurse should use a decision-making process to select the appropriate nursing interventions. 2. Nursing interventions are treatment, based upon clinical judgement and knowledge that a nurse performs to enhance patient/client outcomes.

3.Guidelines for Writing Outcomes

1.Outcomes are derived from only one nursing diagnosis 2.Show a direct resolution of the problem statement in the nursing diagnosis 3.Identify long-term and short-term outcomes

Problem solving and the Nursing Process

1.Trial and error problem solving- testing several solns until one is found that works for that particular problem. Not efficient for nursing. 2.Scientific problem solving- systematic, 7-step process, used most correctly in a scientific controlled research setting, but is closely related to problem solving in healthcare. 3.Intuitive problem solving- a direct understanding of a situation based on a background of experience, knowledge and skill that makes expert decision making possible. Critical thinking in nursing has several facets: logical, scientific & evidence-based & clinical reasoning that is both creative and intuitive.

Nursing Process: Activity

Collect Data Validate Data Organize Data Documenting Data: saves time for others and gives you a frame of reference.

Which statement related to the evaluation of outcome attainment for a client is correct?

Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria. In addition to knowing what type of data to collect to determine outcome achievement, it is important to know when to collect the data based upon established time criteria. It is important for the nurse to evaluate client outcome achievement as early as possible and not wait until discharge, when the plan of care cannot be modified. Evaluation of the client's attainment of outcome goals is determined by the nurse, client, and the client's family. Celebrating outcome attainment with the client usually helps encourage the client and leads to further outcome achievement. (less)

A nurse caring for an older adult client who has dementia observes another nurse putting restraints on the client without a physician's order. The client is agitated and not cooperating. What would be the best initial action of the first nurse in this situation?

Confront the nurse and explain how this could be dangerous for the client. Confronting the nurse and explaining the danger for the client is a form of peer evaluation. Peer evaluation involves evaluation of one staff member by another staff member on the same level in the hierarchy of the organization. This is an important mechanism nurses can use to improve their professional performance; it can be done formally or informally. Reporting the nurse does not enhance a good working relationship and does not follow the chain of command. An incident report is not warranted at this point in time. The physician should not be contacted for an order unless it is decided that the restraint is going to be left on the client. (less)

A client comes into the clinic for a routine postoperative visit. While the nurse is assessing the level of pain, the client states that there is occasional discomfort but that pain levels have improved daily since returning home from the hospital. What should the nurse's response be regarding the client's plan of care?

Continue the plan of care. The nurse should continue the plan of care, as the client is progressing toward the ultimate outcome—the healing of the surgical site. There is no need to modify the plan, as the client is responding. The client is still having some pain so it would not be appropriate to discontinue the plan of care. With the improvement in the client's pain, there is no need to increase pain medication; the nurse should just remind the client to take it when pain is uncomfortable. (less)

Once a nurse has collected and interpreted the data on a client's outcome achievement, the nurse will then make a judgment and document a statement summarizing those findings. This is called which of the following?

Evaluative statement An evaluative statement is a statement summarizing the client's outcome achievement. Criteria are "measurable qualities, attribute, or characteristics that identify skill, knowledge, or health status." Standards are the "levels of performance accepted by and expected of nursing staff or other health team members." Evidence-based practice incorporates delivering nursing care that evidence supports as likely to result in meeting the expected patient outcomes. (less)

Identifying the kind and amount of nursing services required is a possible solution for:

Inadequate staffing. A possible solution for inadequate staffing is to identify the kind and amount of nursing services required. Using a team conference to develop a consistent plan of care is a possible solution for the client who refused to cooperate with the therapeutic regimen, while educating the client to become an assertive healthcare consumer is a possible solution for the client who quietly accepts whatever care is delivered or not delivered. A possible solution for the nurse who is a candidate for burnout is to learn to give quality care during the designated work period. (less)

The nurse recognizes that encouraging the parents to sleep in the room with a toddler admitted with acute glomerulonephritis meets which of Maslow's human needs?

Love and belonging needs

Nursing Process is Holistic

Physical Emotional Psychosocial Developmental Spiritual Being This is a personalized holistic approach involving the patient as a whole, individually. Inso doing you look also at the environment of the individual...their family interactions and other aspects of their environment.

The nurse participates in a quality assurance program and reviews evaluation data for the previous month. The data indicates a nursing plan was developed within 8 hours of admission for 97% of all admissions. The nurse recognizes this as which type of evaluation?

Process evaluation Quality assurance programs focus on three types of evaluation: structure, process, and outcome. Process evaluation focuses on the nature and sequence of activities carried out by nurses implementing the nursing process, such as the timing of nursing care plan creation. Outcome evaluation focuses on measurable changes in the health status of clients. Structure evaluation focuses on the environment in which care is provided. There is no "design evaluation." (less)

Implement safe care

Provide teaching, support and comfort to enhance the effectiveness of nursing care plans. Be holistic, view the client as a whole Respect the dignity of the client and enhance the client's self-esteem Encourage client to participate actively in implementing the nursing intervention

A nurse is evaluating the outcome of the plan of care after teaching a client how to prepare and administer an insulin pen. Which of the following types of outcome is the nurse addressing?

Psychomotor Preparing and administering an insulin pen is a psychomotor outcome. Psychomotor is performing a physical activity. Cognitive is the ability to think. Affective is an emotional or mental state. Physiological is concerning body functioning. (less)

Before discharge the client will demonstrate aseptic dressing changes. This is an example of which type of evaluative statement?

Psychomotor Psychomotor outcomes are those that are related to new skill attainment , cognitive outcomes are related to achieving greater knowledge, affective outcomes are related to feelings and attitudes and physical changes are related to actual body changes in the individual. (less)

The nurse is caring for a client who has a fractured left femur. He will be discharged home this afternoon. The outcome on the plan of care state "Client will demonstrate appropriate cast care prior to discharge" This is an example of what type of evaluative statement?

Psychomotor This is an example of a psychomotor evaluative statement. ??Psychomotor outcomes are those that are related to new skill attainment , cognitive outcomes are related to achieving greater knowledge, affective outcomes are related to feelings and attitudes and physical changes are related to actual body changes in the individual. (less)

Nursing Assessment Purpose & Activity assoc.

Purpose: Make a judgement about the patient's health status, ability to manage his or her own healthcare, and need for nursing. Activities of Assessment: 1.Establishes a Data Base (DB): Nursing hx Physical assessment Review of pt record & nursing Lit. Consult w/ pt's support ppl & health care professionals 2.Continuously update DB 3.Validate DB checking accuracy, dbl checking 4.Communicate Data: Documenting Data

The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?

Quality assurance Accreditation by the Joint Commission evaluates quality assurance. Quality assurance is an externally driven process, demonstrating nursing excellence by meeting professional standards of care. Quality improvement is an internally driven, continuous process focusing on the processes of client care. Peer review is a process whereby individual nurses improve their professional performance through the evaluation of one staff member by another staff member on the same level of the hierarchy. Magnet status is awarded by the American Nurses Credentialing Center, recognizing health care organizations for their excellence in nursing. (less)

A nurse incorrectly administers digoxin to her client. The nurse admits her actions to the nurse manager and to her peers in an effort to prevent them making the same mistake. This is an example of:

Quality by opportunity In this example the nurse is attempting to improve quality through the opportunity of sharing her experience to help other nurses.

Nurse Mayweather is auscultating lung sounds. She notes crackles in the LLL which were not present at the start of the shift. Nurse Mayweather is engaged in which type of nursing intervention?

Surveillance interventions include detecting changes from baseline data and recognizing abnormal response. Nurses rely on the senses to detect changes: observing the appearance and characteristics of clients; hearing by auscultation, pitch, and tone. Nurses use these surveillance activities to determine the current status of clients and changes from previous states. (less)

The nurse completes the implementation phase of the nursing process by recording the interventions and the client's responses in the nursing process notes.

TRUE

A client who was admitted to the acute care unit with angina pectoris is no longer having chest pain. Based on this assessment, which of the following does the nurse decide to do with the plan of care for chest pain?

Terminate the plan of care Terminate the plan of care for chest pain as the expected outcome has been achieved. The plan of care for chest pain does not need to be continued or modified. A new plan of care is not indicated at this time. (less)

Which nursing action reflects evaluation?

The nurse assesses the client's response to pain medication. Examples of evaluation include assessing the client's response to pain medication. The focus of diagnosing is recognition of a client health problem that can be prevented or resolved by independent nursing intervention, such as a wound infection. Setting an anxiety rating with the client is an example of is an example of planning. Performing colostomy irrigation is an example of implementation. (less)

A nurse evaluates clients prior to discharge from a hospital setting. Which action is the most important act of evaluation performed by the nurse?

The nurse evaluates the client's goal/outcome achievement. The priority is to evaluate the client's goal/outcome achievement. This determines if the nursing diagnosis has been resolved. If the client's goal/outcome had not been met the nurse should then begin evaluating all aspects of the plan of care. It is not the responsibility of the nurse to evaluate the competence of nurse practitioners. The nurse can evaluate services available to the client but this is not the purpose of the evaluation phase of the nursing process. (less)

Which of the following does a nurse recognize is among the rules suggested by the Institute of Medicine's (IOM) Committee on Quality of Health Care in America to improve health care?

• The patient as the source of control • Safety as a system priority • Anticipation of clients' needs • Cooperation among clinicians Each client should have his or her own customized plan of care. The other choices are all suggestions made by the IOM Committee on Quality of Health Care in America.

A nurse is evaluating the plan of care for a client in the clinic. Which actions will she perform as a classic element of evaluation? Select all that apply.

• identifying evaluative criteria and standards • collecting data to determine if criteria or standards are being met • interpreting and summarizing findings • terminating, continuing, or modifying the plan of care The nurse must document findings as they relate to the plan of care but should also include the nurse's judgement as to whether the outcomes are being met. All of the other choices are criteria for evaluation. (less)

Which scenario represents a nurse demonstrating the critical thinking process?

assessing whether physician help is needed Critical thinking involves consistency, relevancy, and logical thinking. It enables the nurse to make decisions. Therefore, assessing whether physician help is needed is an example of the critical thinking process. The other actions support other nursing soft skills. (less)

When the nurse prepares to discharge a client, and subsequently evaluate the effectiveness of the nursing care, the nurse should determine whether the:

client's goals have been achieved. Evaluation is defined as the judgment of the effectiveness of nursing care to meet client goals based on the client's behavioral responses. This phase involves a thorough, systematic review of the effectiveness of nursing interventions and a determination of client goal achievement. (less)

Objectives of Nursing Process

Compare 3 approaches to problem solving: Classical, Technology (counter clockwise), Scientific Method- starts with a THEORY developed by observation (Use the theory to make a prediction) -->This leads to PREDICTION (design an experiment to test prediction)-> perform EXPERIMENT --> OBSERVATION (create new of modify the theory)

Which action is appropriate when evaluating a client's responses to a plan of care?

Continue the plan of care if more time is needed to achieve the goals/outcomes. The client's goals/outcomes sometimes are not met or partially met only because more time is needed for the plan of care to be effective. It is not necessary to reinforce the plan of care when each expected outcome is achieved because as goals are met, the plan can simply continue to the next goal. Termination of the plan is not warranted due to difficulties in achieving goals/outcomes; modifications to the plan of care may only be required. The plan of care may continue past discharge if necessary. (less)