Chapter 4 - Competencies for Professional Nursing Practice

The statement, "The Nurse of the Future competency will minimize risk of harm to patients and providers through both system effectiveness and individual performance" best reflects which competency? A.) Safety B.) Evidence-based practice C.) Teamwork and collaboration D.) leadership E.) Professionalism

A.) Safety

The KSA in the QSEN Project and Nurse of the Future Model reflect which learning domains? A.) Cognitive B.) Psychomotor C.) Affective D.) All of these are correct

D.) All of these are correct

"The Nurse of the Future will function effectively within nursing and interdisciplinary teams, fostering open communication, mutual respect, shared decision making, team learning, and development"

Teamwork and collaboration

Essential knowledge, skills, and attitudes (KSAs) reflect:

cognitive, psychomotor, and affective learning domains that are specified for each competency.

Why are concept maps used in nursing?

to organize and link information about a patient's health problems. This allows the nurse to see relationships amount the patient's problems and helps to plan interventions that can address more than one problem.

Metaparadigm concept in the Nurse of the Future: Nursing Core Competencies:

-Human being/patients: "The recipient of nursing care or services...." -Environment: "The atmosphere, melieu, or conditions in which an individual lives, works or plays" -Health: "An experience that is often expressed in terms of wellness and illness..." -Nursing: "the protection, promotion, and optimization of health and abilities, prevention of illness and injury..."

What are some suggestions you should try to address when journaling your nursing experience?

-What happened? What are the facts? -What was my role in the event? -What feelings and senses surrounded the event? -What did I do? -How and what did I feel about what I did? Why? -What was the setting? -What were the important elements of the event? -What preceded the event, and what followed it? -What should I be aware of if the event recurs?

Six competences that were identified during the QSEN project:

1. Patient-centered care 2. Teamwork and collaboration 3. Evidence-based practice 4. Quality improvement 5. Informatics 6. Safety

10 essential competences included in the Nurse of the Future: Nursing Core Competencies:

1. patient-centered care 2. professionalism 3. informatics and technology 4. evidence-based practice 5. leadership 6. systems-based practice 7. safety 8. communication 9. teamwork and collaboration 10. quality improvement

3 following criteria to be considered a profession (Starr, 1982):

1. the knowledge of the group must be based on technical and scientific knowledge. 2. the knowledge and competence of members of the group must be evaluated by a community of peers. 3. the group must have a service orientation and a code of ethics.

3 pathways of impact on competency nursing practice:

1.) go to one hospital and obtain a diploma=3 years 2.) go to a community college and obtain an associate degree=2-3 years 3.) Go to a university and get BSN=4 years

Strong links between critical thinking and clinical judgment are (7):

1.) purposeful, informed, outcome-focused thinking 2.) carefully identify key problems, issues, and risks 3.) are based on principles of nursing process, problem solving, and the scientific method 4.) apply logic, intuition, and creativity 5.) are driven by patient, family, and community needs. 6.) call for strategies that make the most of human potential. 7.) require constant reevaluating

6 essential features of professional nursing according to ANA (2003):

1.Provision of a caring relationship that facilitates health and healing. 2.Attention to the range of human experiences and responses to health and illness within the physical and social environment. 3.Integration of objective data with knowledge gained from an appreciation of patient or group's subjective experiences. 4.Application of scientific knowledge to the processes of diagnostic and treatment through the use of judgment and critical thinking. 5.Advancement of professional knowledge through scholarly enquiry. 6.Influence of social and public policy to promote social justice.

The statement, "The Nurse of the Future will demonstrate accountability for the delivery of standard-based nursing care that is consistent with moral, altruistic, legal, ethical, regulatory, and humanistic principles" best reflects which competency? A.) Professionalism B.) Leadership C.) Communication D.) Patient-centered Care E.) teamwork and collaboration

A.) Professionalism

Who developed The Essentials of Baccalaureate Education for Professional Nursing Practice?

Agency for Healthcare Research and Quality and Robert Wood Johnson Foundation

AACN stands for:

American Association of Colleges of Nursing

Type of cognitive skills critical thinkers practice in nursing:

Analyzing, applying standards, discriminating, seeking information, reasoning logically, predicting and transformed knowledge.

What part of the nursing process answers the questions of what is happening or what could happen?

Assessment - It involves systematically collecting, organizing and analyzing information about the client patient.

Developing a visual representation of the relationships amount concepts and ideas is known as which of the following? A.) Journaling B.) Concept mapping C.) Reflection D.) All of these are correct E.) None of these are correct

B.) Concept mapping

Which of the following is true of Tanner's conclusions about thinking like a nurse? A.) It should occur as a detached objective exercise B.) It is a form of engaged moral reasoning C.) It is most influenced by objective data about the situation D.) All of these are correct E.) None of these is correct

B.) It is a form of engaged moral reasoning

Abraham Flexner (1916):

Based the body of knowledge, that can be learned; intellectual (opposite of physical); Practical rather than theoretical; Can be taught through a process of professional education; Has a string internal organization of members; Has practitioner

The statement, "The Nurse of the Future will interact effectively with patients, families, and colleagues, fostering mutual respect and shared decision making to enhance patient satisfaction and health outcomes" best reflects which competency? A.) Evidence-based practice B.) Leadership C.) Communication D.) Professionalism E.) Safety

C.) Communication

Which of the following is characteristic of critical thinkers? A.) Critical thinkers are inflexible. B.) Critical thinkers oversimplify. C.) Critical thinkers empathize. D.) Critical thinkers based judgments on personal feelings. E.) All of these are correct.

C.) Critical thinkers empathize.

An interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient's response or the use of the clinician's experience and knowledge in assessment, diagnosis, planning, intervention, and evaluation.

Clinical judgment

The processes by which nurses and other clinicians make their judgments, including both the deliberative process of generating alternatives, weighing them against the evidence, and choosing the most appropriate, and those patterns that might be characterized as engaged, practical reasoning.

Clinical reasoning

"The Nurse of the Future will interact effectively with patients, families, and colleagues, fostering mutual respect and shared decision making, to enhance patient satisfaction and health outcomes"

Communication

The ability to demonstrate an integration of knowledge, attitudes, and skills necessary to function in a specific roll and work setting

Competence

Method used to organize and link information about a patient's health problems so that the nurse can see relationships among a patient's problems and plan interventions that can address more than one problem.

Concept mapping

What tool is useful for summarizing information, consolidating information from different sources, thinking through complex problems, and presenting information in a format that shows the overall structure of your subject?

Concept maps

The ability to understand a situation by identifying patterns or connections, focusing on key underlying issues, and integrating them into a conceptual framework:

Conceptual thinking

Critical thinkers exhibit the following habits of mind:

Confidence, contextual, perspective, creativity, flexibility, inquisitive-ness, intellectual integrity, intuiting, open-mindedness, perseverance, and reflection

The ability to think in a systematic and logical manner, solve problems, make decisions, and establish priorities in the clinical setting. It is the competent use of thinking skills and abilities to make sound clinical judgments and safe decisions.

Critical thinking

What is an outcome for quality nursing care and for the development of clinical judgment?

Critical thinking competence

Which of the following describes reflective thinking? A.) Deliberate thinking and careful consideration B.) Creating an understanding through one's experiences. C.) Exploring potential alternatives D.) All of these are correct

D.) All of these are correct

The statement, "The Nurse of the Future will provide holistic care that recognizes an individual's preferences, values, and needs and respects the patient or designee as a full partners in providing compassionate, coordinated, age and culturally appropriate, safe and effective care" best reflects which competency? A.) Evidence-based practice B.) Quality improvement C.) Teamwork and collaboration D.) Patient-centered care E.) Professionalism

D.) Patient-centered care

What part of the nursing process analyze and derives meaning from the assessment information?

Diagnosis - the identification of a problem. This is a statement that describes a specific response to an actual or potential health problem.

The Nurse of the Future Core Competencies include with of the following? A.) Professionalism B.) Patient-centered care C.) Systems-based practice D.) Teamwork and collaboration E.) All of these are correct

E. All of these are correct

Which of the following competencies was identified during the Quality and Safety Education for Nurses (QSEN) project? A.) Patient-centered care B.) Teamwork and collaboration C.) Evidence-based practice D.) Quality improvement E.) All of these are correct

E.) All of these are correct

Which of the following is an example of approach to developing critical thinking skills? A.) Nursing process B.) Journaling C.) Concept mapping D.) Group discussions E.) All of these are correct

E.) All of these are correct

Which of the following is included in clinical judgment? A.) Critical thinking B.) Problem solving C.) Ethical reasoning D.) Decision making E.) All of these are correct

E.) All of these are correct

Which of the following is a characteristic of critical thinking? A.) Critical thinking is rational and reasonable. B.) Critical thinking is based on preferences. C.) Critical thinking requires reflection D.) Critical thinking is based on preferences and requires reflection. E.) Critical thinking is rational and reasonable and requires reflection.

E.) Critical thinking is rational and reasonable and requires reflection

What part of the nursing process has the nurse compare the patient's current status to the patients goals?

Evaluation - the nurse will analyze outcomes to determine if the interventions worked, and if not, why?

"The Nurse of the Future will identify, evaluate, and use the best current evidence coupled with clinical expertise and consideration of patients' preferences, experience and values to make practice decisions"

Evidence-based practice

Characteristics of a critical thinker:

Flexible, bases judgments off of facts and reasoning, doesnt oversimplify, examines available evidence before drawing conclusions, thinks for themselves, remains open to the need for adjustment and adaptation, accepts change, empathizes, welcomes different views....

The Essentials of Baccalaureate Education for Professional Nursing Practice

Handbook for nurses on patient safety and quality. Provided a wealth of information for nursing, icluding background research and tools for improving the quality of care.

The level of profession described as: initially, tasks were very simple; now even simple nursing tasks require high levels of intellectual functioning, such as assessment skills and knowledge

High Intellectual Level

Common targets for malpractice suits ; legal, ethical, professional implications of accountability

High Level of Individual Responsibility and Accountability

What part of the nursing process carries out the plan of care and depends on the first three steps of the nursing process?

Implementation

"The Nurse of the Future will be able to use advanced technology and to analyze as well as synthesize information and collaborate in order to make critical decisions that optimize patient outcomes"

Informatics and technology

The process by which one sits down quietly on a daily or regular basis to think and record one's thoughts and ideas in writing. Recording clinical experiences that were meaningful or troubling to you is a recommended way to help enhance and develop reasoning skills.

Journaling

"The Nurse of the Future will influence the behavior of individuals or groups of individuals within their environment in a way that will facilitate the establishment and acquisition/achievement of shared goals"

Leadership

What are some examples of individualized interventions that a nurse could implement on a patient with decreased cardiac output?

Look at skin color and temperature, monitor for fatigue and activity tolerance, monitor lab and x-rays, monitor chest pain

Keeping attention focused in the present, resulting in the ability to see salient aspects of the clinical situation and to take decisive action to prevent harm.

Mindfullness

Why are making sound clinical judgements essential for nurses?

Must provide safe, competent, and high-quality care.

NOF stands for:

Nurse of the Future (Nursing Core Competencies)

The tool by which all nurses can become equally proficient at critical thinking. The nursing process contains the following criteria: (1) assessment, (2) diagnosis, (3) planning, (4) implementation. and (5) evaluation.

Nursing process

Approaches to developing critical thinking skills:

Nursing process; concept mapping; journaling; group discussions

How can you ensure that you maintain and continue clinically competent practice as a RN?

Obtain additional formal education in your area of clinical practice ; obtain/maintain formal certification ; attend continuing education programs/courses/conferences ; consider membership on your facility's quality committee

"The Nurse of the Future will provide holistic care that recognizes an individual's preferences, values, and needs and respects the patient or designee as a full partners in providing compassionate, coordinated, age and culturally appropriate, safe and effective care"

Patient-centered care

What part of the nursing process develops a plan to provide consistent, continuous care that meets the clients unique needs?

Planning - this includes developing expected outcomes and working with the client to identify goals and to determine appropriate nursing actions and interventions that will reduce the identified problem.

"The Nurse of the Future will demonstrate accountability for the delivery of standard-based nursing care that is consistent with moral, altruistic, legal, ethical, regulatory, and humanistic principles."

Professionalism

Help clients adapt to illness, achieve maximal function ; All members of the public receive key focus; Nurses are altruistic

Public Service and Altruistic Activities

QSEN stands for:

Quality and Safety Education for Nurses

"The Nurse of the Future uses data to monitor the outcomes of care processes, and uses improvement methods to design and test changes to continuously improve the quality and safety of health care systems"

Quality improvement

The process of analyzing, making judgments, and drawing conclusions to create an understanding through one's experiences and knowledge and exploring potential alternatives.

Reflective thinking

Who funded the Quality and Safety Education for Nurses (QSEN)?

Robert Wood Johnson Foundation (2005)

"The Nurse of the Future will minimize risk of harm to patients and providers through both system effectiveness and individual performance"

Safety

Research created nursing science; best practices have a theoretical basis; hallmarks for web-based information include peer review, author credentials, prejudice/bias, timeliness, and presentation

Specialized Body of Knowledge

"The Nurse of the Future will demonstrate an awareness of and responsiveness to the larger context of the health care system and will demonstrate the ability to effectively call on work unit resources to provide care that is of optimal quality and value"

Systems-based practice

TIGER stands for:

Technology Informatics Guiding Education Reform

What abilities does critical thinking give nurses for clinical decision making?

To think in a systematic and logical manner, with openness to question and reflect on the reasoning process used to ensure safe nursing practice and high-quality care.

Defined profession as "a vocation requiring advanced training and usually involving training and usually involving mental rather than manual work, as teaching, engineering, especially medicine, law"

Webster 1989

Some of the ethical principles are:

autonomy, justice, nonmaleficence

What type of characteristics are involved with critical thinking?

conceptualization, cognitive (thinking) skills and attitude (feelings), creative thinking

The nurse uses _________ ___________ to develop goals and nursing interventions for problems that require an individualized appoach.

critical thinking

Why are group discussions a way to enhance critical thinking skills?

explore alternatives and arrive at conclusions. Group discussions amount nursing students and teachers can take place in the classroom or following clinical experiences. During discussions, students are encouraged to formulate alternatives to clinical or ethical decisions

Purpose of the Nurse of the Future: Nursing Core Competences:

intended to guide nursing curricula and practice emanate from the central core of the model that represents nursing knowledge.

What is a recommended way to help enhance and develop reasoning skills?

keeping a journal of clinical experiences that were meaningful or troubling to you.

During implementation, the nurses carries out:

nursing interventions individualized to the patient, reassesses the client, and validates that the plan of care is accurate and successful

What type of characteristics are required in critical thinking?

reflection and knowledge

Keeping a journal of clinical experience is a form of:

reflection. This allows you to view your own thinking, reasoning, and action. It helps create and clarify meaning and new understandings of a particular experience.

How do you begin a concept map?

start in the center of the page with a main idea or central theme and work outward in all directions, producing a growing organized structure composed of key words or pictures.

A Code of Ethics document may outline:

the mission and values of the business or organization, how professional are supposed to approach problems, the ethical principles based on the organization's core values and the standards to which the professional is held

The Nurse of the Future: Nursing Core Competencies graphic illustrates:

the use of broken lines the reciprocal and continuous relationship between each of the competencies and nursing knowledge, that the competencies can overlap and are not mutually exclusive, and that all competencies are of equal importance. In addition, nursing knowledge is placed as the core in the graphic to illustration that nursing knowledge reflects the overarching art and science of professional nursing practice.