Foundations Week 2 Chapters 15-20 PDF

Foundations Week 2 Chapters 15, 16, 17, 18,19, & 20 Next GEN THIN THINKING NEXT GEN THIN THINKING ❑ Top three (Needs, Concepts, Questions). What does the patient need now? ❑ Help quick! ACT NOW! What can I do RIGHT NOW? ❑ Identify greatest risk for safety. Where is the safety...

Foundations Week 2 Chapters 15, 16, 17, 18,19, & 20 Next GEN THIN THINKING NEXT GEN THIN THINKING ❑ Top three (Needs, Concepts, Questions). What does the patient need now? ❑ Help quick! ACT NOW! What can I do RIGHT NOW? ❑ Identify greatest risk for safety. Where is the safety concern? ❑ Nursing Process 2 most important are ASSESS and IMPLEMENT Why is this patient here, and what can we do to get them to the next level of care? Objectives 1. Describe the nature of clinical judgements in nursing practice. 2. Explain the importance of problem solving in n ursing practice. 3. Discuss the relationshi p of the nursing proces s to critical thinking. Nursing Process Tanner’s CJ Model NCJMM ADPIE/AAPIE Assessment Noticing Recognize Cues Diagnosis/Analysis Interpreting Analyze Cues Diagnosis/Analysis Interpreting Prioritize Hypotheses Planning Responding Generate Solutions Implementation Responding Take Action Evaluation Reflecting Evaluate Outcomes  Chapter 15 Clinical Decision Making Critical Thinking and The Nursing Process  Critical Thinking Nursing ❑ Recognition of a patient’s problems Judgement ❑ Diagnostic reasoning (page 213) ❑ Ability to assign meaning to signs and symptoms presented Critical Critical by patient. Thinking Thinking ❑ Expert nurse sees context of a patient situation, observes patterns and themes, and makes decisions quickly. ❑ Clinical decision making (page 214) Next Gen Nursing Process RAPGTE Nursing process as a competency Recognize Cues Analyze Cues Prioritize Hypotheses Generate Solutions Take Action Evaluate Outcomes  Chapter 16 Assessment/ Recognize Cues FIRST step in the Nursing Process  Assessment/cues Know your PATHOPHYSIOLOGY Know your SCOPE Examine your ATTITUDE Apply your EXPERIENCE Why is the patient here What am assessing? Assessment/cues Assessment/Cues involves collecting data from the patient and secondary sources (e.g., family members) Recognize Cues (WHAT MATTERS MOST) from the data you gathered? Assessment/cues HEALTH ASSESSMENT RETURNS Types include ❑ The patient-centered interview during a nursing health history. Figure 16-3, page 231 ❑ A physical examination. ❑ The periodic assessments you make during rounding or administering care. ❑ Lab/diagnostic data Assessment/cues Diagnostic and laboratory data ❑ Results provide further explanation of alterations or problems identified ❑ Interpreting and validating assessment data ❑ Ensures collection of complete database ❑ Leads to second step of nursing process USE YOUR “NURSE THINK” lab value resource - module 1  Diagnostic and laboratory data ❑ Results provide further explanation of alterations or problems identified ❑ Interpreting and validating assessment data ❑ Ensures collection of complete database ❑ Leads to second step of nursing process  Assessment/Cues Cultural Considerations ❑ To conduct an accurate assessment, you must consider a patient’s cultural background. ❑ When cultural differences exist between you & patient, respect the unfamiliar, be sensitive to a patient’s uniqueness. ❑ If you are unsure about what a patient is saying, ask for clarification to prevent making the wrong diagnostic conclusion. Humpty Dumpty ❑ Top three (Needs, Concepts, Questions). What does the patient need now? ❑ Help quick! ACT NOW! What can I do RIGHT NOW? ❑ Identify greatest risk for safety. Where is the safety concern? ❑ Nursing Process 2 most important are ASSESS and IMPLEMENT Why is this patient here, and what can we do to get them to the next level of care? Chapter 17 Analyze Cues/ Prioritize Hypothesis  Analyze Cues/Prioritize Hypothesis ❑ Review RELEVANT client data ❑ Recognize Cues (WHAT MATTERS MOST) from the data you gathered? ❑ Determine what the data MEANS (some data may be associated with common patient diagnosis or problems) ❑ Recognize ACTUAL complications ❑ Recognize POTENTIAL complications Chapter 18 Generate Solution/Goal  This will help with the nursing process ☺ Objectives ❑ Explain the relationship of planning to assessment and nursing diagnosis. ❑ Explain the SMART approach to writing goal and outcome statements. ❑ Develop a plan of care from a nursing assessment. Establishing Priorities ❑ Put problems in order based on urgency and/or importance. ❑Helps determine which interventions are needed first. ❑You will learn to do this in Simulation. ❑Per Hurst: “What will kill the patient first?” Establishing Priorities Classification of priorities: ❑High—Emergent - ABCs (airway, circulation, safe ty, pain) ❑Intermediate—non-life- threatening ❑Low—Affect patient’s future well-being Establishing Priorities ❑ Order of priorities changes as a patient’s condition changes. ❑ Patient-centered care - know a patient’s preferences, values, and expressed needs. ❑ What was top priority for: ❑ New surgical patient ❑ Fresh trauma ❑ Chest pain What are potential complications? ❑ Look at assessment data ❑ Current priorities ❑ Lab trending (remember normal can still be relevant data) ❑ Medication adverse effects ❑ Pathophysiology, medical diagnosis and procedures ❑ What can go wrong? Common Complications ❑ Chest pain ❑ Increased respiratory distress ❑ Hypotension ❑ Change in level of consciousness (LOC) or neurologic status ❑ Falls (Rischer & Pence, 2018) Creating Goals and Outcomes ❑ Must be patient-centered PATIENT WILL.. ❑Use SMART acronym – give examples – Specific – Measurable – Attainable – Realistic – Timed Goal/Outcome language ❑ Patient will demonstrate understanding ❑ Patient will verbalize understanding ❑ Patient will teach back with accurate return demonstration ❑ Patient will demonstrate use of ❑ Patient will identify ❑ Patient will report ❑ Patient will ambulate ❑ Patient will drink/eat ❑ Patient will void ❑ Patient will complete ❑ *All of these are a START: Remember a good goal will be SMART and patient-centered. Chapter 19 Take Action  Standard Nursing Interventions ❑Set level of clinical excellence for care ❑Must be within scope of practice ❑American Nurses Association (ANA) standards ❑Quality and Safety Education for Nurses (QSEN) skill competencies Types of Interventions KNOW! Nurse-initiated – Independent – Actions that a nurse initiates Health care provider initiated – Dependent – Require an order from a physician Collaborative – Interdependent – Combined knowledge, skill, and expertise of multiple health care professionals TAKE ACTION ❑ Do we automatically implement physician-initiated or collaborative interventions? ❑ Ability to recognize incorrect therapies is extr emely important - administering medications or implementing procedures ❑ Legally responsible Consider the Following! Desired patient outcomes Research-based knowledge for the intervention Feasibility of the interventions Acceptability to the patient Nurse’s competency  Take Action/Interventions Standing orders – Preprinted document containing orders for the conduct of routine therapies, monitoring guidelines, and/or diagnostic procedures for specific patients with identified clinical problem Examples: Labs, meds, diet, PT/OT, wound care  Standard Nursing Interventions Nursing interventions classification ❑ Differentiates nursing practice from other health care disciplines – nurses’ language ❑ Standardization to enhance communication of nursing care across settings and to compare outcomes.  Clinical Judgement ❑ Review all possible nursing interventions ❑ Review all possible consequences associated with each nursing action ❑ Determine the probability of all possible consequences ❑ As a beginning nursing student, seek out supervision from instructors or experienced nurses  Take Action Reassessing a patient – Continuous process with each patient interaction – Not evaluation of care or determining response Reviewing and revising the existing nursing care plan.  Take Action ❑ Time management – don’t rush! ❑ Equipment – gather before ❑ Personnel – more about delegation later ❑ Environment – safety, privacy & ↓ distractio ns ❑ Patient at center of care Direct Care Indirect Care Treatments performed through Treatments performed away from t interactions with patients he patient but on behalf of patients Medication administration Managing the patient’s environmen Insertion of an intravenous (IV) t (e.g., safety and infection control) infusion Documentation Counseling during a time of gri Interdisciplinary collaboration ef Delegation Delegation Delegation 5 RIGHTS ❑ The "right" person ❑ The "right" task ❑ The "right" circumstances ❑ The "right" directions and communication ❑ The "right" supervision and evaluation Delegation RAPGTE Nursing process as a competency Recognize Cues Analyze Cues Prioritize Hypotheses Generate Solutions Take Action Evaluate Outcomes Chapter 20 Evaluation/ Evaluate Outcomes  Objectives ❑ Explain process of evaluating outcomes of care for a patient ❑ Describe how evaluation leads to discontinuation, revision or modification of a plan of care. ❑ Explain the relationship among goals, outcomes and evaluative measures. Evaluation ❑ Examine the results according to clinical data collected ❑ Compare achieved effect with goals and expected outcomes ❑ Observe, teach back, demonstrate and recognize errors and use self-reflection Evaluation Discontinuing a care plan Modifying a care plan – Reassessment – Redefining diagnoses – Goals and expected outcomes – Interventions Examples! Standards of Evaluation Resolve actual health problems – problem focused Prevent potential problems – risk diagnosis Maintain a healthy state – health promotion or wellness Thank you