Nursing 202 - Complete Study Guide (Final Exam)

Use of Nursing Diagnosis in Practice

*Concept Mapping* *Cultural Relevance in Diagnostics* - Consider your patients' cultural diversity, including ethnicity, values, beliefs, language, and health practices

Critical Thinking Attitudes

*Confidence*: Being able to speak with conviction and being confident in the actions you do *Thinking independently*: Being open-minded about different approaches *Fairness*: Listening to both sides of the discussion *Responsibility and Authority*: Ask for help if you are unsure about a specific task *Risktaking*: Be willing to recommend alternative approaches to nursing care when colleagues are having little success with patients *Discipline*: Be thorough in whatever you do. *Perseverance*: Find solutions for situations that may come up confusing *Creativity*: Look for different approaches if interventions are not working for a patient *Curiosity*: Always ask why. Be willing to challenge tradition *Integrity*: Recognize when your opinions conflict with those of a patient. Review your position and decide how best to proceed to reach outcomes *Humilty*: Recognize when you need more information to make a decision

Components of the Nursing History

- *Biographical data*: includes name, age, birth date, spouse, support person, children, address, phone number, occupation, financial status, insurance, etc. - *Reason for coming to facility*:addresses the primary reason, also described as the client's chief complaint or perception of the illness. what does the client expect to happen in the healthcare facility? - *Patient Expectations*:Assess a patient's expectations of health care providers. - *Present Illness or Health Concerns*: - P: Provokes: Precipitating and relieving factors - Q: Quality: Description of the pain - R: Radiate: Location of the pain - S: Severity: Pain scale from 1-10 - T: Time: Onset and duration of the pain - *Past Health History*: A holistic view of a patient's health care experiences and current health habits. - *Pertinent psychosocial information*:addresses family relationships, employment, living conditions, emotional stability, sexual relationships, substance use or abuse, medications, etc.

Types of Diagnoses

- *Nursing diagnosis*: Describes patient problems nurses can treat independently - *Medical diagnosis*: Describes problems for which the physician directs the primary treatment - *Collaborative problems*: Managed by using physician-prescribed and nursing-prescribed interventions

Types of Patient Data in Assessment

- *Subjective Data*: Are your patient's verbal descriptions of their health problems gathered during interviews (informal and formal). - *Objective Data*: Are the finding resulting from observation of patient behavior and clinical signs as well as direct

The History of Nursing Education

- 100 years ago, most American nurses received on-the-job training (little-to-no clinical supervision). - Around 1950, introduction of BSN program - Nursing shortage led to introduction of ADN program as a short-term solution. - Around 1980, introduction of PhD program, followed by formation of National Institute of Nursing Research (NINR)

Standard of Nursing Practice

- Assessment - Diagnosis - Outcome identification - Planning - Implementation - Evaluation

Critical thinking and clinical judgement

- Essential process for safe, efficient, and skillful nursing intervention - Involves knowing as much as possible about each patient - Need to sort out the information into patterns to clarify problems, recognize changes, and make appropriate care decisions under pressure - Improves patients' outcomes

Standards of Professional Performance

- Ethics: The registered nurse integrates ethics in all aspects of practice. - Advocacy: The RN demonstrates advocacy in all roles and settings. - Respectful and Equitable Practice: The RN practices with cultural humility and inclusiveness - Communication: The RN communicates effectively in all areas of professional practice. - Collaboration: The RN collaborates with healthcare consumers and other key stakeholders. - Leadership: The RN leads within the professional practice setting and the profession. - Education: The RN seeks knowledge and competence that reflects the current nursing practice and promotes futuristic thinking. - Scholarly Inquiry: The RN integrates scholarship, evidence, and research findings into practice. - Quality of Practice: The RN contributes to quality nursing practice. - Professional Practice Evaluation: The RN evaluates one's own and others' nursing practice - Resource Stewardship: The RN utilizes appropriate resources to plan, provide, and sustain evidence-based nursing that is safe, effective, and fiscally responsible and avoids waste. - Environmental Health: The RN practices in a manner that advances environmental safety and health.

Interview Techniques

- Interview techniques - *Observation*: Observe a patient's verbal and nonverbal behaviors, such as the use of eye contact, body language, positioning, or tone of voice. - *Open-ended questions*: Elicits a patient's unique story. This gives the patient the ability to decide how much information to disclose. - *Direct closed-ended questions*: Helps seek specific information about a problem. - *Leading questions*: Ex. "It seems to me this is bothering you quite a bit. Is it true?" - *Back channeling*: Reinforces your interest in what a patient has to say by using good eye contact and listening. - *Probing*: Encourages a full description without trying to control a story's direction.

Terminologies for Nursing Diagnoses

- NANDA International (NANDA-I) - International Classification for Nursing Practice (ICNP®)

Benner's Stages of Nursing Proficiency

- Novice: beginning nursing student or any nurse entering a situation in which there is no previous level of experience. For instance, an experienced home health nurse chooses to practice in behavioral health. The learner learns through a specific set of rules or procedures which are usually step wise and linear. - Advanced beginner: the nurse who has had some level of experience with the situation. May have experience in the field for a year or so - Competent: A who has been in the same clinical position for 2 to 3 years. The nurse understands the organization and specific care required by the type of patients. For example, surgical oncology or orthopedic patients - Proficient: A nurse with more than 2 to 3 years of experience in the same clinical position. Focuses on managing care as opposed to managing and performing skills. Is able to assess an entire situation and can readily transfer knowledge gained from multiple previous experiences to a situation. - Expert: A nurse with diverse experience who is intuitive of the existing or potential clinical problem. This nurse is able to zero in on the problem and focus on multiple dimensions of the situation. This nurse is skilled at identifying both patients centered problems and problems related to the healthcare system or perhaps the needs of a Novice nurse.

Prioritization

- Prioritization includes clinical care coordination such as clinical decision making, priority setting, organizational skills, use of resources, time management, and evaluation of care. - Clinical decisions are made by completing a thorough assessment which will help you make good judgments later when you see a changing clinical condition. A poor initial assessment can lead to missed findings later on. - Priority setting refers to addressing problems and prioritizing care. It is critical for efficient care. The RN uses his/her knowledge of pathophysiology when prioritizing interventions with multiple clients.

Critical Thinking

- The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process. - The aim of critical thinking is the ability to focus on the important issues in any clinical situation and make decisions that produce desired patient outcomes.

Levels of Critical Thinking

1. Basic: Task-oriented. They focus on performing skills and organizing nursing care activities rather than delivering skills within the context of their patient's specific clinical situation 2. Complex: Rely less on experts and instead trust their own decisions. Able to make critical thinking 3. Commitment: Complex, but you are able to accept (be accountable) fo one's own actions.

Critical Thinking and Clinical Judgement Skills

1. Interpretation: Be orderly in collecting data about patients. Apply reasoning while looking for patterns to emerge. Categorize the data. 2. Analysis: Be open-minded as you analyze information about a patient. Do not make assumptions. Do the data reveal a problem or trend that you believe is true, or are there other options? 3. Inference: Look at the meaning and significance of the findings. 4. Evaluation: Look at all situations objectively. 5. Explanation: Support your findings and conclusions. 6. Self-regulation: Reflect on your experiences.

ADN

2-year nursing degree

BSN

4-year nursing degree

Diagnostic Reasoning

A method of collecting and analyzing clinical information with the following components: (1) attending to initially available cues, (2) formulating diagnostic hypotheses, (3) gathering data relative to the tentative hypotheses, (4) evaluating each hypothesis with the new data collected, and (5) arriving at a final diagnosis.

Patient Data in Assessment

A patient is a nurse's primary and best source of information. When a patient is not a reliable source, you may refer to the family. The individual identified as a family caregiver is preferred.

Clinician

A practitioner (of medicine or psychology) who does clinical work instead of laboratory experiments

Nursing Code of Ethics

A statement of philosophical ideals of right and wrong that define the principles you will use to provide care to your patients.

International Classification for Nursing Practice (ICNP)

A unified nursing language system to support standardized documentation at a patient's bedside or point of care. It is a wide-ranging, understandable reference terminology that can adapt to multiple purposes in different countries and that serves as a primary source to describe nursing practices.

Concept Mapping

A visual means of exploring connections between a subject and related ideas. It is also an instructional strategy that requires learners to identify, graphically display, and link key concepts.

Concept Mapping

A visual representation of patient problems and interventions that illustrates an interrelationship

ABCDE

Airway Breathing Circulation Disability Exposure

Clinical Nurse Specialist (CNS)

An APRN who has graduate preparation (master's degree or doctorate) in nursing and is an expert clinician in a specialized area of practice. The specialty may be identified by a population, setting, disease specialty, type of care, and type of problem.

Certified Nurse-Midwife (CNM)

An APRN who has graduate preparation (master's degree or doctorate) in nursing, is also educated in midwifery, and is certified by the American College of Nurse-Midwives.

Nurse Practitioner (NP)

An APRN who has graduate preparation (master's degree or doctorate) in nursing. NPs prove primary, acute, and specialty care to patients of all ages and in all types of health care settings.

Certified Registered Nurse Anesthetist (CRNA)

An APRN with advanced education from an accredited nurse anesthesia program.

Autonomy

An essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders (Personal Professional Accountability).

- Patient-centered interview (conduct nursing history.) - Periodic assessments (conducted during ongoing contact with patients)

Assessment requires accurate and thorough data collection. There are two types of assessment:

Orientation and Setting an Agenda

Begin by introducing yourself, your position, explaining the purpose of the interview. Explain why you are collecting data and assure patients that all of the information will be confidential. Ask the patient for his or her list of concerns or problems

The Future of Nursing 2020- 2030: Charting a Path to Achieve Health Equity

Committee vision: create a culture of health, reduce health disparities, and improve the health and well-being. Examine: Lessons from Future of Nursing Campaign for Action Current state of science and technology to meet the anticipated health and social demands until 2030. Future challenges in the profession as a result of the pandemic.

Nurse Researcher

Conducts evidence-based practice and research to improve nursing care and further define and expand the scope of nursing practice

you acquire and interpret scientific knowledge, integrate knowledge from clinical experiences, and become a lifelong learner.

Critical thinking applied with clinical judgement helps:

This step involves the collection of as much information as possible about a patient, family, or community. A thorough and comprehensive assessment allows you to sort the data (*cues*), recognize patterns, and make judgements that allows you to identify the type of health problems your patient is experiencing.

Define the assessment process:

Clinical Judgement

Defined by the National Council of State Boards of Nursing (NCSBN) as the observed outcome of critical thinking and decision-making. - Another definition is the conclusion about a patient's needs or health problems that leads to taking or avoiding actions.

Linda Burnes Bolton, DrPH, RN, FAAN

Demonstrated her ability to effect change on a national level through her role as vice chair of Initiative on the Future of Nursing Past president of the American Academy of Nursing and the National Black Nurses Association

Nurse's Experience

Experience provides a background for each clinical encounter with a patient. - Personal experience - Clinical experience - Experience with nursing skills

Components of Critical Thinking in Nursing

I. Critical thinking competencies: the ability to do specific skills II. Specific Knowledge Base III. Experience IV. Attitudes for critical thinking V. Standards for critical thinking - Intellectual standards - Professional standards

Scientific Method

Identify the problem Collect data Formulate a question or hypothesis Test the question or hypothesis Evaluate results of test or study.

Environmental in Assessment

Includes details about living conditions, education level, and the ability of the person to purchase, transport, and cook food. The person's weekly budget for food purchases is also a key factor to consider. - Setting - Time Pressure - Task Complexity - Interruptions

Inductive and Deductive Reasoning

Inductive Reasoning: Moves from reviewing specific data elements to making inferences by forming conclusions about the relayed pieces of evidence Deductive Reasoning: in which a conclusion is reached by stating a general principle and then applying that principle to a specific case.

Data Interpretation

Involves placing a label on your data pattern or cluster to clearly identify a patient's response to health problems

Planning

Involves using critical thinking and decision making to form clinical judgements: reviewing a patient's nursing diagnoses and other collaborative problems, prioritizing nursing diagnoses, and problems, setting outcomes to guide the plan of care, and choosing relevant interventions for patient care.

Reflection

It involves purposefully visualizing a situation and taking the time to honestly review everything you remember about it.

Advanced Practice Registered Nurse (APRN)

Most independently functioning nurse; has advanced education in pathophysiology, pharmacology, and physical assessment and certification and expertise in a specialized area of practice.

- Collection of information from a primary source (a patient) and secondary sources. - The interpretation and validation of data to determine whether more data more data are needed or the database is complete.

Nursing assessment involves two steps. What are they?

art; science

Nursing is an ___ and a _______.

What is nursing?

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.

Cultural Considerations

Obtaining a nursing health history requires cultural competence. This involves self-awareness, reflective practice, and knowledge of a patient's core cultural background.

Handoff Report

Occurs when patients are transferred from one unit or area of care to another. Effective communication is key for better outcomes for the patient.

Intuition

One problem-solving approach that relies on one's inner sense.

Phases of the Assessment Interview

Orientation and Setting an Agenda Working Phase - Collecting Assessment Data Termination Phase

Changing Image of Nursing

Over time, nurses have had many images. Ranging from the angel of mercy to the sexual stereotype sometimes portrayed in works of fiction. - In 2001, the Center for Nursing Advocacy was founded to address the nursing shortage. After deciding to focus on improving the portrayal of nurses in the media, the Center began a series of annual Golden Lamp awards for the best and worst depictions of nurses.

Quality and Safety Education for Nurses (QSEN)

Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient's preference, values, and needs. Teamwork and Collaboration: Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve high quality patient care. Evidence-Based Practice: Integrate best current evidence expertise and patient/family preferences and values for delivery of optimal health care. Quality Improvement: Use data to monitor outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Safety: Minimize risk of harm to patients and providers through both system effectiveness and individual performance. Informatics: Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.

Redefining our Image

Professor L.D. Andrews of Rogers State University says that to create a new image for nursing, nurses must: value nursing and project that image daily take themselves seriously and dress the part recognize the value of what they do believe in themselves and their colleagues.

Nurse Administrator

Responsible for management of the nursing staff in a health care agency.

Interview Preparation

Review a patient's medical record when information is available. If your interview is performed at patient's admission, there may be little information in the record except for an admitting diagnosis and the patient's chief complain.

Scientific Data and Theory of Assessment

Reviewing the textbook and recent nursing, medical, and pharmacological literature about a patient's illness or treatment provides up-to-date information that helps you to identify and anticipate patient date information that helps you to identify and anticipate patient needs and to implement evidence-based interventions.

Clinical decision making

Separates professional nurses from technicians or other assistive personnel (AP)

nursing process

Specific critical thinking in nursing is the _______ _______ which incorporates the specific critical thinking competencies.

The Future of Nursing: Leading Change, Advancing Health (2010)

The 2010 report The Future of Nursing called, by 2020, for Increasing the number of BSN-prepared nurses to 80% Doubling the number of nurses with doctoral degrees. Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Nurses should be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the United States. Effective workforce planning and policymaking require better data collection and information infrastructure

NANDA International (NANDA-I)

The North American Nursing Diagnosis Association; organized in 1973, this organization formally identifies, develops, and classifies nursing diagnoses. Aims to: - Provide a precise definition of patient's human responses to health problems and life processes. - Develop, refine, and disseminate evidence-based terminology representing clinical judgements by professional nurses. - Allow nurses to communicate a plan of care among themselves and with other health care professionals and the public.

Recognizing a patient or a person selected by the patient as a full partner in providing compassionate and coordinated care based on respect for a patient's preferences, values and needs.

The Quality and Safety Education for Nurses (QSEN) defines patient-centered care as...

patient

The _______ is the center of your practice.

Emotional Intelligence

The ability to perceive, understand, manage, and use emotions.

Empathy

The ability to understand and share the feelings of another.

Validation

The comparison of data with another source determines data accuracy.

Diagnostic Validity

The extent to which a diagnosis measures what it purports to measure

Clinical Judgement Model

The identification and analysis of cues as the preliminary skill that builds clinical judgment. This analysis is then used to develop skill in generating hypotheses. These hypotheses are then prioritized, actions are taken, and outcomes are evaluated. This iterative process corresponds with the nursing process

Medical Records in Assessment

The medical record is a valuable resource for your patient assessment. It contains a patient's medical history, summaries of ongoing assessments and care activities, laboratory and diagnostic test results, current physical findings, and a health care provider' treatment plan.

The Nursing Health History Format

The nursing health history format method used to collect data about a patient.

Diagnostic Reasoning

The process of analyzing health data and drawing conclusions to identify diagnoses

Care Planning

The process of organizing and documenting the specific goals in the treatment of an individual patient, amending the goals as the patient's condition requires, and assessing the outcomes of care

Diagnostic Error

The result of a delay in diagnosis, failure to employ indicated tests, use of outmoded tests, or failure to act on results of monitoring or testing

- Assessment - Analysis and Diagnosis - Planning - Outcome Identification - Implementation - Evaluation

The steps of the nursing process, developed by the American Nurses Association (ANA) include (*Chapter 16: Nursing Assessment*):

Genomics

The study of all the genes in a person and interaction of these genes with one another and with that person's environment.

Formulating Diagnostic Statements

The way you phrase or word a nursing diagnosis statement affects how other HCP perceive it. Clarity and precision = essential; each type of diagnosis has a different format. Unless you use the correct format for a nursing diagnosis, the label for diagnosis is meaningless and can easily be misunderstood. - *Components*: - Diagnostic Label/Diagnosis - Related Factors - Major Assessment

Working Phase-Collecting Data

The working phase involves gathering accurate, relevant, and complete information about a patient's condition.

Diagnostic Plan

These data are valuable in confirming observational findings. The data can also direct nurses to explore a patient's condition more fully.

•Use critical thinking skills •Administer quality patient-centered care •Be responsible and accountable

To act professionally you must:

Professionalism in History Taking

To display professionalism and a caring approach during an interview, look at the patient and not the computer screen. Use the computer if you must but position it in a way that does not distract from your focus on the patient.

Knowledge of Planning

To plan for a patient, you must apply scientific knowledge of a patient's clinical condition, what you know about the patient from assessment, and nursing knowledge to improve your ability to recognize care priorities.

Family Caregivers and Significant Others

Who are the primary sources of information for infants, children, critically ill adults, and patients who have severe intellectual disabilities: - *Family Caregivers* - *Other Family Members* - *Significant Others*

Nurse Educator

Works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments

Termination Phase

You summarize your discussion with a patient and check for accuracy of the information you collected during the termination is coming to an end.

Health Care Team in Assessment

You will often communicate with other health care team members when gathering information about patients. Hand-off reports are necessary in acute care settings.

Data Clustering and Finding Patterns

Your review and analysis of assessment data involve critically organizing all data elements about a patient inot meaningful patterns, also called data clusters or set of assessment findings/defining characteristics.

Problem-solving

requires you to obtain information that clarifies the nature of a problem, suggest possible solution over time to evaluate that it is effective.

Caregiver (Professional Responsibilities and Roles)

•As a caregiver, you help patients maintain and regain health and find their maximum level of independent function through the healing process. A patient's health care needs include the patient's emotional, spiritual, and social well-being.

Manager (Professional Responsibilities and Roles)

•As a manager, you will establish an environment for collaborative patient-centered care to provide safe, quality care with positive patient outcomes.

Patient Advocate (Professional Responsibilities and Roles)

•As a patient advocate you protect your patient's human and legal rights and help patients assert those rights when needed.

Nursing Today

•As a professional nurse you will learn to deliver care artfully with compassion, caring, and respect for each patient's dignity and personhood. •As a science, nursing practice is based on a body of knowledge that is continually changing with new discoveries and innovations. •When you integrate the art and science of nursing into your practice, the quality of care you provide to your patients is at a level of excellence that benefits patients and their families.

Educator (Professional Responsibilities and Roles)

•As an educator, your teaching can be formal or informal. Always use teaching methods that match your patient's capabilities and needs, and incorporate other resources, such as the family, in teaching plans.

Civil War to the Beginning of the Twentieth Century

•The Civil War, fought from 1860 to 1865, stimulated the growth of nursing in the United States. •Clara Barton, founder of the American Red Cross, tended soldiers on the battlefields. • Dorthea Lynde Dix and Mother Bickerdyke organized ambulance services and walked abandoned battlefields at night, looking for wounded soldiers. •Harriet Tubman was a prominent female in the Underground Railroad movement to free slaves. •Mary Mahoney was the first professionally trained African-American nurse. She was concerned with the relationship between cultures and races; and as a noted nursing leader she brought forth an awareness of cultural diversity and respect for the individual, regardless of background, race, color, or religion. •Isabel Hampton Robb: helped found the nurse's Associated Alumnae of the US and Canada. •Nursing in the community increased significantly in 1893, when Lillian Wald and Mary Brewster opened the Henry Street Settlement, which focused on the health needs of poor people who lived in tenements in New York City.

Nursing as a Profession

•The patient is the center of your practice. Your patient includes individuals, families, and/or communities. Patients have a wide variety of health care needs, knowledge, experiences, vulnerabilities, and expectations, but this is what makes nursing both challenging and rewarding. Making a difference in your patients' lives is fulfilling. Nursing offers personal and professional rewards every day. For example, helping a young mother learn parenting skills, assisting family caregivers with end-of-life care, offering shoulders to cry to the grieving family. •Nursing is not simple a collection of specific skills, and you are not simply a person trained to perform specific tasks. Nursing is a profession. No one factor absolutely differentiates a job from a profession, but the difference is important in terms of how you practice. To act professionally, you will use your critical thinking skills to administer quality patient-centered care in a safe, prudent, and knowledgeable manner. You are responsible and accountable to yourself, your patients, and your peers. •A variety of career opportunities are available in nursing, including clinical practice, education, research, management, administration, and even entrepreneurship. As a student it is important for you to understand the scope of professional nursing practice and how nursing influences the lives of your patients, their families, and their communities.

Robert Wood Johnson Foundation (RWJF) Future of Nursing: Campaign for Action

•This program is a multifaceted campaign to transform health care through nursing, and it is a response to the Institute of Medicine (IOM) publication on The Future of Nursing (IOM, 2010). •Together these initiatives prepare a professional workforce to meet health promotion, illness prevention, and complex care needs of the population in a changing health care system.

Communicator (Professional Responsibilities and Roles)

•Your effectiveness as a communicator is central to the nurse—patient relationship. It allows you to know your patients, including their strengths, weaknesses, and needs. You will routinely communicate with patients and families, other nurses and health care professionals, resource people, and the community.