Foundations exam 4
What is the nursing process?
A critical thinking model Foundation for clinical judgement - Structured way of thinking and planning care - Foundation of nurses' decision-making - Encompasses all significant actions taken by an RN - Client/patient centered- Outcome directed
lifelong professional growth
preservation of integrity and safety maintenance of competence commitment to continue personal and professional growth
Morals
private, personal, or group standards of right and wrong, good/bad.
Evidenced based practice
problem solving approach that involves the use of current best evidence, along with clinical expertise and client preferences and values in making decision about client care -best practice -clinician expertise -patient preference & values
values clarification
process by which people come to understand their own values and value system -distinguish between values/facts/opinions -What to you value and why
standard 3
promotes, advocates for and strives to protect by maintaining patient privacy and confidentiality, report illegal, incompetent or impaired practices, accountable for practice and delegation, lifelong professional growth, participate, collaboration and articulate values
confidentiality
protection of clients personal health information (HIPAA)
What is nursing process?
provides the framework in which nurses use their knowledge and skills to express human caring -critical thinking model -foundation for critical judgement -foundation for decisions making -client/patient centered process -outcome directed
Responsibility
respect obligations and follow through on promises
Which definition is correct to explain the nursing process?
sequence of steps used to meet the clients needs
illegal, incompetent or impaired practice examples
smell of alcohol on breath missing narcotics errors in drug counts sleeping on the job inaccurate/falsified documentation patient abandonment poor practice
Advocacy
support health, safety, rights of client
Duty of Care
the obligation people owe each other not to cause any unreasonable harm or risk of harm
veracity
truth telling
Feminist Ethics
type of ethical approach that aims to critique existing patterns of oppression and domination in society, especially as these affect women and the poor
Nursing Diagnosis
used to evaluate the response of the whole person to actual or potential health problems. May change day to day as patients response changes.
which describes Evidence informed nursing practice? EIP
using results from research to improve the outcome of nursing care
Utalitarianism
Greatest good for greatest amount of people, cost and benefit analysis
Intellectual standards of quality
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Characteristics of critical thinkers
-raise vital questions -gather relevant information -come to well reasoned conclusions -think open mindedly -effectively communicate with other to problem colve complex issues
Expected characteristics of entry level RN's
-application of knowledge to practice -critical thinking -ethical and moral standards -competent in clinical skills -effective communication skills
6 steps of ANA
-assessment -problems identification (diagnosis) -outcome identification -planning -implementation -evaluation
Benefits for using critical thinking
-detect problems early -prevent adverse occurrences -decrease mortality rate -decrease failure to rescue rate -improve patient outcomes
Cachetic nursing interventions/goals and outcome
-encourage proper nutrition -educate on importance of being active goals -return to a healthy weight -Improve in ADL's
value formation
-experiences in the family -religious beliefs -cultural traditions -schooling -governmental ideals -history -individual experience
Development of critical thinking
-knowing right from wrong -What are the alternatives? -Able to deal with complex issues and think outside of the box
Assessing stage of nursing process
-preparing for data collection -collecting data -identifying cues and making inferences -clustering related data and identifying patterns -reporting and recording data
Ethical frameworks
-utilitarianism -Deontology -feminist ethics -ethic of care/duty to care
Processing an Ethical Dilemma
1-presumption of good will on all parts 2- strict confidence 3- Client-centered decision making 4- Welcome family
Nursing process @ NNU
1. Assessment 2. Problem Identification/Diagnosis 3. Planning & Outcome Identification 4. Implementation 5. Evaluation
Elements of Reasoning
1. Has a purpose 2. An attempt to figure something out question, problem, issue at hand 3. Based on information, data, and evidence 4. Interpretation & Inference give meaning to the data 5. Expressed through and shaped by concepts, definitions, principles, models
development of critical thinking
1. Right from wrong - Patient Safety - Ergonomics - Policies, Best Practice Standards 2. What are the alternatives? - Developmental level - Gender, Culture, Religion - Diagnosis, Medications, Treatments, etc 3. Able to deal with complex issues/think outside the box (layered learning)
philosophy
A system of beliefs and values and assumptions
Types of Nursing diagnoses (NANDA)
Actual Risk (potential) Possible Syndrome Wellness
ANA professional standards
Advocacy responsibility accountability confidentiality
Order for nursing process
Assessing Diagnosis Outcome/planning Implementating Evaluating
The nurse is explaining the nursing process to a student. Which step of the nursing process would include interpretation of the data?
Assessment
intellectual standards of quality thinking
Clarity Accuracy Precision Relevance Depth Breadth Logic Fairness
outcomes for using critical thinking
Detect patient problems early Prevent adverse occurrences Decrease mortality rate Decrease failure to rescue rate Improve patient outcomes
Beneficence
Do good for others best interests of the patient
Ethics of Care
Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives
Cachetic nursing diagnosis
Failure to thrive
HELP pneumonic
Help observe the first signs patient may need help. Look for signs of distress Environmental equipment- look for safety hazards. Ensure all equipment is working Look and examine patient thoroughly People. Who are the people in the room? What are they doing?
Which step in the nursing process is similar to the assessment step of The nursing process?
Identifying the problem
The nurse is performing care therapies and including the client as an active participant in the care. Which step in the nursing process is involved in this situation?
Implementation
standard one nursing ethics
In all professional relationships, practices with compassions and respect for the inherent dignity, worth, and uniqueness of every individual. unrestricted by considerations of social or economic status, personal attributes, or the nature of the health problems.
medical diagnoses
Medical • Describes a disease, illness, or injury • Identifies a pathology so that appropriate treatment can be given. • More narrowly focused than a nursing diagnosis .• Can have any number of nursing diagnoses associated with it.
Nursing diagnoses process
Organizing & validating data (Cluster) - What info is pertinent at this time for this patient? - Is this "normal" for this patient? Analyze the data - What is the patients present status? - What is contributing to it? - Nursing focused Identify actual and potential problems - Hypothesize about their health status - Validate with patient Prioritize the problems
Sources of ethical standards in nursing
Patient self-determination act (Danforth amendment) Patient bill of rights ANA code of ethics
Values
Personal belief about the worth of a given idea, attitude, custom or object that sets standards that influence behavior
Can I Delegate Assessments?
The ANA's Code of Ethics for Nurses, Provision 4 (2001), states: "The nurse . . . determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care."
standard 2
Primary commitments is to the patient, whether an individual, family, group or community.
Autonomy
Respect for the patients ideas and beliefs Include them in all care decisions self-determination
SMART goals
Specific, Measurable, Attainable, Realistic, Timely
Outcome, identifying and planning
The nurse works in partner with patient and family to establish priorities, identify and write expected patient out comes
accountability
answer for your own actions follow agency and community standards of best practice
Ethics
The study of conduct and character (what should I do in this situation)
bioethics
The study of ethics related to issues that arise in health care.
Which features distinguish a nursing diagnosis from a medical diagnoses?
They involve the patient when possible They involve the sorting of problems within the nursing domain They involve clinical judgement about the patients response to health problems
collaboration
collaborate with other health professionals and the public in promoting community, national and international efforts to meet health needs -world hunger -environmental pollution -health disparities -equitable access to care -social reform -local and regional threats to health
Five Rights of Delegation
a) Right Task b) Right Circumstance c) Right Person d) Right Direction/Communication e) Right Supervision
ethical values/principles
autonomy beneficence nonmaleficence justice fidelity veracity
justice
be fair
ethics committee
committee made up of individuals who are involved in a patient's care, including health care practitioners, family members, clergy, and others, with the purpose of reviewing ethical issues in difficult cases -focus to educate, change policy and to provide direction for specific cases -focus on strengthening relationships
Deontology
defines actions as right or wrong
nonmaleficence
do no harm
fidelity
keep your promises be trustworthy
Nursing diagnoses
• A statement of client health status that nurses can identify, prevent, or treat independently •You cannot predict a patient's nursing diagnoses just by knowing his or her medical diagnosis or pathology. •Clients with the same medical diagnosis may have different nursing diagnoses.
NANDA-I
• Diagnostic label • Definition • Defining characteristics • Related factors • Risk factors
collaborative problems
• Physiological complications of diseases, medical treatments, or diagnostic studies • Clients with certain diseases or treatments are at risk for developing the same complications. • Always a potential problem
Nursing diagnoses- outcomes and diagnoses
• The problem (Label & Definition) suggest the goal .• The etiology (Characteristics, related factors, risk factors) suggest interventions.
standardized plans
• Unit standards of care are general guides; describe the care that nurses are expected to provide for all clients in defined situations • Standardized Plans provide detailed nursing care for a particular nursing diagnosis; for all nursing diagnoses that commonly occur with a certain medical condition • Critical pathways are outcome-based, interdisciplinary plans that sequence client care based on case type • Concept Maps are care plans developed using colors, shapes, that show relationship between the sections