Nursing Definitions and Thoughtful Practice

ANA Definitions of Nursing

• Provision of a caring relationship facilitating health and healing
• Attention to the range of human experiences and responses to health and illness
• Integration of assessment data with knowledge of patient's subjective experience
• Application of scientific knowledge to diagnosis and treatment through critical thinking and judgment

ANA Definitions of Nursing #2

• Advancement of professional nursing knowledge through scholarly inquiry
• Influence on social and public policy to promote social justice
• Assurance of safe, quality, and evidence-based practice

Thoughtful Person-Centered Practice

• The person
• The professional nurse leading to personal learning
• Reflective practice
• Clinical reasoning, judgment, and decision-making
• The nurse's action in response to individual clinical needs
• Person-centered nursing process

Components of Thoughtful Practice

• Thoughtful Person-Centered Practice
• Reflective Practice leading to personal learning
• The Nurse's personal attributes, knowledge base, clinical experiences, blended competencies, and QSEN competencies
• Patient-centered Nursing Process (assessing, diagnosing, planning, implementing, evaluating)
• Person/Patient
• Clinical reasoning, judgment, and decision making

10 Guiding Principles of Person-Centered Care #1

• All team members are considered caregivers
• Care is based on continuous healing relationships
• Care is customized and reflects patient needs, values, and choices
• Knowledge and information are freely shared among patients, care partners, physicians, and other caregivers
• Care is provided in a healing environment of comfort, peace, and support

10 Guiding Principles of Person-Centered Care #2

• Families and friends of the patient are considered an essential part of the care team
• Patient safety is a visible priority
• Transparency is the rule in the care of the patient
• All caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient
• The patient is the source of control for their care

The Professional Nurse

• Personal attributes: Open-mindedness, sense of the value of the person, self-awareness, sense of personal responsibility, motivation to do the best, leadership skills, bravery to question the system
• Knowledge base: Ability to draw upon a body of nursing knowledge and evidence

Blended Competencies #1

• Cognitive Competencies
  • Critical Thinking
  • Purpose of thinking
  • Adequacy of knowledge
  • Potential problems
  • Helpful resources
  • Critique of judgment/decision

Blended Competencies #2

• Developing technical competencies
• Developing interpersonal competencies
  • Promoting human dignity and respect
  • Establishing caring relationships
  • Enjoying the rewards of mutual exchange
• Developing ethical/legal competencies
  • Understanding legal boundaries
  • Scope of practice
  • Owning personal strengths and weaknesses

Question #1

• A nurse's moral code is assisting all patients to the best of their ability. What blended skill should a nurse use when seeking services for a homeless patient with a diabetic foot ulcer?
• Answer: D. Ethical/Legal

Answer to Question #1

• Rationale: Ethical/legal skills are best as they involve following a moral code and acting professionally. Cognitive skills involve thinking through a situation for outcomes. Technical skills relate to proper use of equipment. Interpersonal skills are used to develop caring relationships.

QSEN Competencies

• Patient-centered care
• Teamwork and collaboration
• Evidence-based practice
• Quality improvement
• Safety
• Informatics

Clinical Judgment Concepts

• Critical thinking
• Clinical reasoning
• Clinical judgment
• Situational awareness

Critical Thinking

• Critical thinking

Clinical Reasoning & Decision Making #1

• Process used to think about patient problems in a clinical setting
• Leads to clinical judgment (outcome of critical thinking, clinical reasoning, and decision making)
• Purposeful, informed, outcome-focused thinking
• Guided by standards, policies, ethics codes, and laws
• Driven by patient, family, and community needs
• Based on principles of the nursing process, problem solving, and the scientific method
• Focuses on safety, quality, reevaluating, and self-correcting

Clinical Reasoning & Decision Making #2

• Identifies key problems, issues, and risks
• Includes patients, families, and key stakeholders in decision-making early in the process
• Uses logic, intuition, and creativity
• Grounded in specific knowledge, skills, and experiences
• Calls for strategies that make the most of human potential and compensate for problems created by human nature

Problem-Solving and the Nursing Process

• Trial-and-error: Involves testing solutions until one works
• Scientific: Systematic, seven-step process
• Intuitive: Direct understanding of a situation based on experience, knowledge, and skill
• Creative thinking

Clinical Judgment Models #1

• Tanner Model
  • Noticing: Perceptual grasp of the situation
  • Interpreting: Developing sufficient understanding to respond
  • Responding: Deciding on a course of action
  • Reflecting: Attending to patient responses

Clinical Judgment Models #2

• Nursing Process: Systematically collecting patient data, identifying strengths and problems, developing a plan of care, executing the plan, evaluating the plan

Characteristics of the Nursing Process

• Systematic: Part of an ordered sequence of activities
• Dynamic: Great interaction and overlapping among steps
• Interpersonal: Human being is always at the heart of nursing
• Outcome-oriented: Nurses and patients work together to identify outcomes
• Universally applicable: Framework for all nursing activities

Five Steps of the Nursing Process

• Assessing: Collecting, validating, and communicating patient data
• Diagnosing: Analyzing patient data to identify patient strengths and problems
• Planning: Specifying patient outcomes and related nursing interventions
• Implementing: Carrying out the care plan
• Evaluating: Measuring extent to which patient achieved outcomes

Question #2

• Which step of the nursing process is a nurse using when analyzing patient data to determine a patient's strengths following a CVA?
• Answer: B. Diagnosing

Answer to Question #2

• Rationale: Diagnosing involves analyzing data to determine strengths and weaknesses. Assessing involves collecting, validating, and communicating data. Planning involves determining patient outcomes and interventions. Implementing involves carrying out the plan. Evaluating involves measuring patient outcomes.

The Steps of the Nursing Process are Dynamic and Interrelated

Question #3

• Which characteristic of the nursing process describes the interaction and overlapping of steps within the process itself?
• Answer: B. Dynamic

Answer to Question #3

• Rationale: The nursing process is dynamic, having interaction and overlapping steps. It is systematic, an ordered sequence of activities. Interpersonal refers to the human element in nursing. The nursing process is universally applicable, a framework for all nursing activities.

Benefits of the Nursing Process

• Patient: Scientifically based, holistic individualized patient care, continuity of care, clear, efficient, cost-effective plan of action
• Nurse: Opportunity to work collaboratively with other health care workers, satisfaction of making a difference in the lives of patients, opportunity to grow professionally

Steps in Concept Mapping

• Collect patient problems and concerns in a list
• Connect and analyze relationships
• Create a diagram
• Keep key concepts in mind: the nursing process, holism, safety, and advocacy

Question #4

• Is concept mapping an instructional strategy requiring learners to identify, graphically display, and link key concepts?
• Answer: A. True

Answer to Question #4

• Rationale: Concept mapping is an instructional strategy needing learners to identify, graphically display, and link key concepts.

Reflective Practice

• Reflection in action: Happens in the present activity, "thinking on your feet"
• Reflection on action: Occurs after the activity, involves thinking through a past situation
• Reflection for action: Helps think about how future actions might change

PICMONIC ADPIE Video

• Video link provided

Explore the essential definitions of nursing according to the ANA and the components of thoughtful person-centered practice. This quiz will challenge your understanding of the relationships, assessments, and reflective practices that define effective nursing care. Enhance your professional knowledge through both theory and practical inquiry.