The Nursing Process
Critical Thinking model for clinical decision making
- Kataoka-Yahiro and Saylor's (1994) model of critical thinking for nursing judgement defines the outcome of critical thinking: nursing judgement that is relevant to nursing problems in a variety of settings. Aims of nursing practice - think critically - improve clinical practice -decrease errors
2. NURSING DIAGNOSIS
- a clinical judgement about individual, family or community responses to actual or potential health problems -a health issue that can be prevented, reduced, resolved, or enhanced through independent nursing measures
Introduction to Nursing process
- allows nurses to communicate plans and activities to clients, other HCPS, families -encourages orderly thought, analysis, planning -encompasses all steps taken by the nurse in caring for clients
Critical Thinking
- an essential component of professional accountability and quality nursing care. - ability to "think in a systematic and logical manner with openness to question and reflect on the reasoning process." - different levels of critical thinking in nursing - RN's ability grows as knowledge and experience in practice is gained
2. NURSING DIAGNOSIS Problem identification
- analyze the data (information) - identify actual and potential health problems - identify and list strengths -identify and list risk factors -formulate a clear statement of the problem in terms of a NANDA diagnosis
1. ASSESSMENT nursing health history
- biographical information -reason for seeking health care -present illness or health concerns ( history of present illness) - expectations -health history -environmental history -spiritual history (diet/blood transfusions) - family history - social history review of systems (full body head to toe or a certain system)
2. NURSING DIAGNOSIS (application to care planning)
- by learning to make correct nursing diagnoses, your plan will help communicate the patient's health care problems - a nursing diagnosis will ensure that you select relevant and appropriate nursing intervention ( the next step in the nursing process)
Objectives
- define critical thinking and clinical decision making. Relate these concepts of use of the nursing process - explain the nursing process and discuss the importance and benefits of its use with clients - list of the first two steps of the nursing process and explain what each one includes
2. NURSING DIAGNOSIS
- determine immediate priorities + which diagnoses need immediate attention? + which ones can wait? - this will guide your planning phase - make sure you and the patient have same goals
2. NURSING DIAGNOSTIC PROCESS
- formulated from your assessment data - some will have related to ("r/t") factors pertinent to the problem + condition, historical factor, or causative agent that gives context for the defining characteristics and shows a relationship with the diagnosis + individualizes diagnosis - some will have defining characteristics "AEB" which are signs and symptoms + individualizes diagnosis
Components of critical thinking in nursing
- knowledge -experience -the nursing process competency -attitudes for critical thinking -standards for critical thinking + intellectual + professional - ethical criteria for nursing judgement - criteria for evaluation - professional responsibility
Remember to be culturally sensitive
- nurses must provide care congruent with a client's expectations - this is not about you (the nurse) - respect client differences -what is the significance of the problem or illness to him/her? -what does it mean to the client's family/community
benefits of the Nursing process
- organized -accuracy - thoroughness -cost-effective -increase client participation - discover what the patient wants out of their careplan
1. ASSESSMENT data clustering
-a set of signs or symptoms gathered during assessment a nurse groups together in a logical way -patterns of data that contain defining characteristics- clinical criteria that are observable and verifiable - each clinical criterion is an objective or subjective sign, symptom , or risk factor that, when analyzed with other criteria, leads to a diagnostic conclusion foundation of their care plan
Introduction to the Nursing process
-a systematic, critical thinking method of providing evidence-based, patient-centered care to clients -an organizational framework for the practice of nursing -central to all nursing care -provide personalized healthcare - you have to think about what is best for the client consider the client's livelihood-
1. ASSESSMENT
-assessment involves + collection of information + interpretation and validation of data -bases on the client, a nurse will do either a comprehensive or problem focused assessment -establish a good database
critical thinking attitudes and application in nursing practice
-confidence -thinking independently -fairness -responsibility and authority - risk taking - discipline - perseverance - creativity - curiosity -integrity -humility
Error
-data collection -interpretation and analysis of data - labeling the diagnosis/diagnostic statement -documentation and informatics
Medical diagnoses vs. nursing problem ID
-medical diagnosis identifies conditions the phyisican is licensed & qualified to treat + focus on illness, injury or disease processes + remains constant until a cure is effected -nursing diagnosis identifies situations the RNs licensed & qualified to treat + focuses on the clients responses to actual or potential health/ life problems + changes as the client's response and/ or the health problem changes
1. ASSESSMENT next steps
-observation of patient behavior -physical examination - diagnostic and laboratory data -interpreting and validating assessment data (DOCUMENT THROUGHOUT)
1. ASSESSMENT source of data
-primary source + patient + exam you perform - secondary sources + family +lab +past chart
2. NURSING DIAGNOSIS
-provides a precise statement of the client's problem that gives RNs a common language and understanding of the client's needs
characteristics of the Nursing Process
-require creativity in its application +steps remain the same +application and results are different +remember it must be within the legal scope of nursing -uses + throughout the lifespan +any care setting - know about the patient culture, past medical history
1. ASSESSMENT types of assessment data
-subjective data: symptoms + data from the client's point of view; what does he/she tell you? +information that only the client feels and describes (beliefs, feelings, perceptions, concerns) +main way to collect subjective data is by interview -objective data: signs +observable & measureable data + main way to collect objective data is through observation, physical assessment, lab and diagnostic testing
A 35-year-old male is admitted to the unit for abdominal pain. He has been intermittently vomiting for two days. His wife is with him. He has never been hospitalized before and is otherwise a healthy police officer: The RN goes in to the patient's room, introduces herself, and explains that she will be collecting information needed for his admission. The patient is agreeable. The RN starts her data collection. What should she want to accomplish during the interview? select all that apply. a. establish a caring, therapeutic relationship with the patient b. determine that patient's goals and expectations regarding his care. c. gain insight about the patient's concerns and worries d. determine the patient's medical diagnosis e. obtain cues about which part of the interview may require further investigation f. conduct a review of systems
A, B, C, E, F
Types of Diangoses
ACTUAL - describes human responses to health conditions or life processes that exist (problem-focused diagnosis...) RISK - describe human responses to health conditions/life processes that may develop 4 (Risk for...) HEALTH PROMOTION (readiness for...)
Crystal, a student nurse, is caring for Mr. chuck Rhodes, a 37-year-old fireman who was admitted to the medical-surgical unit for unrelenting abdominal pain. He has been intermittently vomiting for the last 2 days and has been unable to eat any solid food. His wife has accompanied him. Mr. Rhodes has never been hospitalized. During her assessment. Mr. Rhodes rated his pain as a 9 on a scale of 0 to 10. Crystal is developing the nursing diagnosis. She reviews her assessment. Which of the following statements are true about nursing diagnosis? Select all that apply a. nursing diagnosis are always based on a physiological problem b. nursing diagnoses have two parts, which include the diagnostic label and the related factor c. errors in nursing diagnosing can occur from inadequate assessment d. nursing diagnoses are focused on the scope of nursing practice
B, C, and D are all true
Differences between nursing problem vs. medical diagnosis
NURSING PROBLEM - ineffective breathing -activity intolerance - pain -disturbed body image -risk for altered body temperature MEDICAL DIAGNOSIS - chronic obstructive pulmonary disease - CVA (stroke) - appendectomy -left lower leg amputation -strep throat
Health promotion diagnoses
Readiness for... - enhanced coping -enhanced nutrition -enhanced comfort -enhanced communication -enhanced decision making -enhanced hope -enhanced immunization status -enhanced knowledge -enhanced self-care -enhanced self-concept -enhanced self-health management -enhanced sleep -enhanced spiritual well-being
which of the following are objective data and which are subjective data? a. nausea b. vomiting c. unsteady gait d. anxiety e. bruises on the right arms and face f. temperature 101 degrees Fahrenheit
SUBJECTIVE - nausea -anxiety (could be both) -vomiting (could be both) OBJECTIVE - unsteady gait (could be both) - bruises on the right arms and face -temperature 101 degrees
A 57-year old female patient developed an infection after surgery and needs an IV for antibiotics. The RN receives an order to put in a PIV. The RN has not inserted a PIV into a patient before. The RN reviews the procedure manual before carrying out the procedure. What level of critical thinking is the RN using? a. basic critical thinking b. complex critical thinking c. nursing process d. scientific method
a. basic critical thinking
John is completing an assessment of the patient and notices that she has a rash that he has never seen before. He reports the rash to the nurse and asks her to access it with him. What type of critical thinking attitude is John applying? a. humility b. thinking independently c. curiosity d. responsibility and authority
d. responsibility and authority