Nursing Arts: Module 5 & 6 Final Notes PDF

Nursing Arts: Module 5 → Enculturation: the gradual acquisition of the characteristics and norms of a culture or group by a person, another culture, etc. → Assimilation: Process by which a minority group or culture comes to resemble a society’s majority group or assimilates the values, behaviours...

Nursing Arts: Module 5 → Enculturation: the gradual acquisition of the characteristics and norms of a culture or group by a person, another culture, etc. → Assimilation: Process by which a minority group or culture comes to resemble a society’s majority group or assimilates the values, behaviours and beliefs of another group. → Racism: Involves specific actions and attitudes whereby one group exerts power over others on the basis of either skin color or racial heritage. → Discrimination: Treating people unfairly on the basis of their group membership. → Focused Charting: Data - Action - Response - Plan (specific, something that nurse can attain in a timely manner) // Area of focus for example: Wound Care → Value: strong personal belief // an ideal that a person or group believes has merit // acquired through culture, upbringing, family // values can change overtime → Ethics: the philosophical ideals of right and wrong // based on what one thinks one should or shouldn’t do // Nursing has documents of shared values: Code of ethics → How do our values form? Family experience, moral development, cultural values, and individual experiences → Physical restraints have certain guidelines that need to be followed The values in the CLPNA code of ethics: 1. Responsibility to the public 2. Responsibility to the clients 3. Responsibility to the profession 4. Responsibility to colleagues 5. Responsibility to oneself: commitment to career long education // ongoing learning → The Nursing Code of Ethics has allowed nurses to become confident in the care that they are providing. By giving nurses a set of ethical principles and standards to adhere to, they can easily make morally-sound decisions for their patients, ensuring that they get the best possible care. → Ethical Theory: There are branches // why do we believe certain things → Principles of Bioethics 1. Autonomy: Ability to make informed personal choices 2. Beneficence: Doing or promoting good for others 3. Nonmaleficence: Avoidance of harm or hurt “First, do no harm” 4. Justice: Fairness (ie: unbiased allocation of resources) → Relational Ethics - Ethical understanding are formed in, and emerge from a person’s relationship with others - Being able to understand our own values and ethics is what helps us build our relationship with others → Ethical Dilemma - Conflict between two sets of human values - Cause of distress and confusion for patients and caregivers - Given two sides that are both good → Ethicals issues in nursing practice - Issues of safety and ethics in the work environment Social networking and safety Working with a healthcare team to promote safe care - Moral integrity - Moral distress - Moral residue → The profession of Nursing 1. Regulator: Serve and protect the public 2. Professional: Advancing profession and improve health 3. Educational: Getting the education and knowledge to be able to practice 4. Union: Support the nurse → Legal limits of nursing Sources of law - Constitution of Canada - Civil law - Provincial, federal law - Public law, private law → Legal limits of nursing - Professional regulation (CLPNA outlines scope of practice) at the provincial or territorial level - Standards of care - Role and Scope → Professional Regulation: Look over slide → Standards of practice - Legal guidelines for nursing practice - Establish an expectation of nurses to provide safe and appropriate patient care - Nursing practice acts → Role and Scope: Look over slide → Tort: A civil wrong committed against a person or a property 1. Intentional tort: there is intent when harming another person // assault: physical or verbal // battery: intentional physical contact without consent (it’s important to get consent with patient when doing any physical contact) // Invasion of privacy: unwanted intrusion into private affairs, release of confidential information, computers and confidentiality, social media) // False imprisonment: loss of individual liberty and basic rights 2. Unintentional tort: Negligence and malpractice // there is no intent but due failure of standards of care, harm is done to the patient // medical errors that result in injury to patients How can we prevent negligence? Document and communicating Criminal liability: May involve civil suit and or criminal charge → Informed Consent: A signed form is required for all routine treatment, all hazardous procedures, and some other treatments // the person must have the legal and mental capacity to make a treatment decision // consent must be given voluntarily without coercion Module 6: Critical Thinking In Nursing Practice Critical Thinking: Critical thinking is a process acquired through learning and experience. Nurses who apply critical thinking in their work focus on options for solving problems and making decisions, rather than rapidly and carelessly adopting solutions. A process and a set of skills Requires PURPOSEFUL and REFLECTIVE reasoning Recognition that an issue exists, analyzing information, evaluating information, and drawing conclusions Use of evidence-informed knowledge and the clinical decision-making process Critical Thinking Requirements Ability to ask questions, being curious Being well informed Being honest in facing personal biases Being willing to reconsider and think differently about issues → Without these dispositions, sound critical thinking is unlikely to occur. Ask yourself these questions: → What do I know about the patient's situation? → How do I know? → What is the patient's situation now? → How might it change? → What is the patient's perspective on the situation? → What else do I need to know to understand this situation better or improve it? → How can I obtain that information? → In what way will a specific therapy affect the patient? → Are other options available? → What health outcomes are important to the patient? → How can I work with the patient to attain those outcomes? Critical Thinking: Critical thinking requires purposeful and reflective reasoning to examine ideas, assumptions and beliefs, principles, conclusions, and actions within the context of the situation. When you care for a patient, you begin to think critically by asking the above stated questions. By answering these questions, you are able to identify alternative solutions to address the patient's health-related concerns and to involve the patient in making decisions about the care provided. Reflection and Critical Thinking: Their Relationship 1. What is Reflection? Reflection is the process of thinking deeply about an experience, action, or situation, often with the goal of learning from it.  In nursing, reflection involves looking back at interactions with patients, clinical decisions, or daily tasks to evaluate what went well, what didn’t, and how it can be improved for the future. 2. What is Critical Thinking? Critical thinking refers to the ability to analyze, evaluate, and synthesize information to make informed decisions or solve problems. In nursing, critical thinking is crucial for assessing patient conditions, making clinical judgments, and applying evidence-based practices. 3. How are Reflection and Critical Thinking Related? Reflection and critical thinking complement each other and often work together in clinical practice. Reflection allows a nurse to look back on their actions and evaluate their own decisions. This evaluation process encourages critical thinking, as it requires the nurse to analyze their reasoning, consider alternatives, and think about what could have been done differently. Critical thinking helps nurses think logically and systematically about situations, while reflection encourages deeper insight and a more personal understanding of the situation. Together, they foster improvement and learning. 4. Examples of Their Relationship in Nursing: Reflection Leading to Critical Thinking: After a patient’s treatment, a nurse might reflect on their approach to managing the patient’s care. This reflection could lead the nurse to critically assess whether the interventions used were the most effective or if alternative treatments could have been better. The reflection process stimulates critical thinking, helping the nurse make more informed decisions in the future. Critical Thinking Promoting Reflection: A nurse might use critical thinking to evaluate a clinical scenario, such as a sudden change in a patient’s condition. By thinking critically about the facts, the nurse then reflects on their actions (e.g., assessment, intervention) and determines if something was missed or could be improved in their future approach. 5. Benefits of Reflection and Critical Thinking Working Together: Enhanced Problem-Solving: By reflecting on past actions and using critical thinking, nurses can make better decisions and find innovative solutions to challenges. Improved Patient Care: Reflection and critical thinking enable nurses to learn from experiences, leading to better judgment and more effective care for patients. Personal and Professional Growth: Reflection on clinical practice combined with critical thinking allows nurses to continuously improve their knowledge, skills, and ability to provide high-quality care. Conclusion: Reflection and critical thinking are interrelated and essential for continuous learning in nursing practice. Reflection allows nurses to assess their actions and experiences, while critical thinking enables them to analyze these experiences deeply to make informed decisions. Together, they support the development of effective, thoughtful, and evidence-based nursing care. Critical thinking: Critical thinking requires not only cognitive skills, such as interpretation, analysis, inference, evaluation, explanation, and self-regulation, but also a nurse's habit (disposition) to ask questions, to be well informed, to be honest in facing personal biases, and to always be willing to reconsider and think differently about issues. Without these dispositions, sound critical thinking is unlikely to occur Critical Thinking and Nursing Practice: Nurses who apply critical thinking in their work focus on options for solving problems and making decisions, rather than rapidly and carelessly adopting solutions. Thinking critically is becoming the benchmark or standard for professional nursing competence. Critical thinking is more than just problem solving; it is an attempt to continually improve how you apply knowledge when faced with problems in patient care. → Recall that models serve to explain concepts and help nurses make decisions and evaluate patients (Remember the Nursing Theory Module) → Kataoka-Yahiro and Saylor (1994) devised the critical thinking model. ­Defines the outcome of critical thinking as a nursing decision / action that is relevant to solving nursing problems in a variety of settings The model helps explain what is involved as you make clinical decisions about your patients. It also defines the outcome of critical thinking: nursing decisions and actions that are relevant to nursing problems in a variety of settings. Throughout this text, this model is used for applying critical thinking during the nursing process (see Chapter 5). Each clinical chapter of the text (Chapters 31 to 48) is organized by the steps of the nursing process and includes both scientific (empiric) and nursing knowledge (personal, ethical, aesthetic, and emancipatory ways of knowing). It is your knowledge base (the first critical thinking component) that prepares you to make clinical decisions as a nurse. Figure 12-1 demonstrates how to apply elements of critical thinking in assessing patients, in planning the interventions you provide, and in evaluating the outcomes. ​The critical thinking model combines a nurse’s knowledge base, experience, competence in nursing process, qualities, and standards to explain how nurses make clinical judgments that are necessary for safe, effective nursing care. Your ability to think critically grows as you gain new knowledge and experience in nursing practice. Three levels of critical thinking in nursing—basic, complex, and commitment—are incorporated in the critical thinking model developed by Kataoka-Yahiro and Saylor (1994). As a beginning nursing student, you will apply the  critical thinking model at the basic level. As you advance in practice, you will adopt complex critical thinking and commitment. Basic: Following a procedure step by step without adjusting to a patient’s unique needs is an example of basic critical thinking. In complex critical thinking, a nurse learns that alternative and perhaps conflicting solutions to problems exist. At the commitment level, a nurse chooses an action or belief on the basis of the alternative solutions available and stands by that choice. Levels of Critical Thinking ​→ Basic critical thinking Learner trusts that experts have the right answers for every problem Thinking is concrete, based on a set of rules or principles Following the policy and procedures step by step and not necessarily adapting skill to patient comfort or unique needs Complex problems may be seen as right or wrong → Complex critical thinking Separately thinking from authorities (ie. Policies) and look at them independently You can see alternative and sometimes conflicting solutions exist Thinking can become more creative and innovative → Commitment You make independent choices without consultation with other professionals Take accountability and responsibility for those decisions With independent choices you evaluate to ensure that they were the correct choice. Components of Critical Thinking in Nursing: Critical thinking consists of five components: These elements explain how nurses make clinical judgements that are necessary for safe, competent, and ethical nursing care 1. knowledge base → Specific Base of knowledge from theory and nursing Use their knowledge to think holistically about patient problems and health related matters Enables you to think critically about nursing issues Nurses use their knowledge base in a different way than other health care providers and think holistically about patient problems and health-related matters (Canadian Nurses Association [CNA], 2015). For example, a nurse's broad  knowledge base offers a physical, psychological, social, moral, ethical, legal, and cultural view of patients and their health concerns. The breadth and depth of your knowledge influence your ability to integrate and apply different kinds of knowledge and to think critically about nursing problems in a range of practice settings. Building a sound knowledge base demands that you develop strong information literacy skills, which includes proficiency in knowing when information is needed and how to effectively find, retrieve, evaluate, and apply research findings (LoBiondo-Wood, Haber, Cameron, et al., 2017). Critical thinking dispositions, such as truth-seeking, being systematic, analytical, open-minded, and inquisitive, will allow you to become an informed consumer of information found in print, through social media, and on the Internet. 2. Experience: You need experiences to develop clinical decision making skills // You learn from each experience // Clinical is the “laboratory” for evaluating nursing knowledge // Value all of your experiences - each will teach you something different // REFLECT - OFTEN Experience - Nursing is a practice discipline and clinical nursing experiences are necessary for you to acquire clinical decision-making skills. In clinical situations, you learn from observing, sensing, talking with patients and families, and reflecting actively on your experiences Reflection is key as it allows you to review the experience, identify if it was correct and what you need to learn or adapt You learn that “textbook” approaches form the basis for nursing practice, but you make safe adaptations or revisions in approaches to accommodate the setting, unique characteristics and desires of the patient, and the experience you gained from caring for previous patients 3. Competencies: → General critical thinking competencies: ­Scientific method, ­Problem solving, ­Decision making. Critical thinking competencies are the cognitive processes that a nurse uses to make judgements about the clinical care of patients. They include general critical thinking, specific critical thinking in clinical situations, and specific critical thinking in nursing. → General Critical Thinking Competencies: General critical thinking competencies are not unique to nursing. They include the scientific method, problem solving, and decision making. 1. Scientific method – WHAT ARE THE 5 STEPS? Systematic approach to gathering data and solving problems - he scientific method has five steps: 1.1. Identification of the problem  2.2. Collection of data 3.3. Formulation of a research question or hypothesis 4.4. Testing of the question or hypothesis 5.5. Evaluation of the results of the test or study 2. Problem solving Involves evaluating the solution over time to be sure that it is still effective - It becomes necessary to try different options if a problem recurs 3. Decision making is a product of critical thinking that focuses on problem resolution. Following a set of criteria helps you make a well-reasoned decision. Product of critical thinking that focuses on a problem resolution Leads to informed decision → Specific Critical Thinking Competencies Specific critical thinking competencies in clinical situations include diagnostic reasoning, clinical inference, and clinical decision making. As soon as you receive information about a patient in a clinical situation, you begin diagnostic reasoning, a process of determining a patient's health status after you make physical and behavioural observations and after you assign meaning to the behaviours, physical signs, and symptoms exhibited by the patient. The information that you collect and analyze leads to a diagnosis of the patient's condition. Part of diagnostic reasoning is clinical inference: the process of drawing conclusions from related pieces of evidence. An inference involves forming patterns of information from data before making a diagnosis Engaging in clinical reasoning involves collecting cues, processing information, coming to understand the patient problem or situation, planning and implementing interventions, evaluating outcomes, and reflecting on and learning from the process. As you gain experience in nursing, your ability to identify the salient aspects of patient situations and to differentiate between clinical problems that require immediate attention (difficulty breathing due to an adverse medication reaction) and those that are less acute (shortness of breath related to chronic pulmonary disease) will increase. Use of clinical decision making distinguishes professional nurses from technical personnel. It is the professional nurse, for example, who takes immediate action when a patient's clinical condition deteriorates, decides whether a patient is experiencing complications that call for notification of a physician, or decides whether a teaching plan for a patient is ineffective and needs revision. Each patient's problems are unique and products of many factors, including the patient's physical health, lifestyle, culture, relationship with family and friends, living environment, and experiences. Clinical decision making requires careful reasoning so that you choose the options for the best patient outcomes on the basis of the patient's condition, the priority of the problem, or health concern.  4. Attitudes: Requires the nurse to be curious, dig deeper, persevere and take responsibility for understanding the patient situation. The fourth component of the critical thinking model incorporates the attitudes needed to think critically Knowing when you need more information, knowing when information is misleading, and recognizing your own knowledge limits and personal biases are examples of how critical thinking attitudes play a key role in decision making. 5. Standards Standards of critical thinking Intellectual – standard that guides a principle or thought Professional = ethical criteria for nursing judgements, highest level of quality of nursing care for types of clients (instructional and community) The fifth component of the critical thinking model includes intellectual and professional standards (Kataoka-Yahiro & Saylor, 1994). → Intellectual Standards: An intellectual standard is a guideline or principle for rational thought. You apply such standards when you conduct the nursing process. When you consider a patient problem, apply intellectual standards such as thoroughness, precision, accuracy, and consistency to make sure that all clinical decisions are sound. Efficacious use of the intellectual standards in clinical practice ensures that you do not perform critical thinking haphazardly. → Professional Standards: Professional standards for critical thinking refer to ethical criteria for nursing judgements, evidence-informed criteria for evaluation, and criteria for professional responsibility. Professional standards promote the highest level of quality nursing care for individuals and groups in institutional and community-based settings. Nursing Process: Assessment → Diagnosis → Planning → Implementation → Evaluation The nursing process is often called a blueprint or plan for care. When you use the nursing process, you identify a patient's health-related concerns, clearly define a nursing diagnosis or collaborative problem, determine priorities of care, and set goals and expected outcomes of care. Then you develop and communicate a plan of care, perform nursing interventions, and evaluate the effects of your care. Involving your patient in each step of the nursing process helps ensure that care is patient-centred. As you become more competent in using the nursing process, you will be able to focus on multiple problems or diagnoses and move back and forth between steps when considering all the information available to you about a patient's concerns. Developing Critical Thinking Skills: → To develop critical thinking skills, it is important to learn how to connect knowledge and theory in practice. Using strategies such as case-based learning, reflective writing, and concept mapping will help you develop and refine your critical thinking skills. Case based learning - Simulation and virtual reality can be used to practise psychomotor skills to enhance your knowledge base, respond to unanticipated events in a controlled environment, and receive immediate feedback on your performance. Using these technologies you can identify knowledge gaps, learn from your mistakes in a safe environment, and enhance your ability to solve problems and make clinical judgements in increasingly complex scenario Reflective writing - Reflective writing is a tool for developing critical thought that uses the process of reflection to purposefully recall a situation in order to discover its purpose or meaning. Reflective writing gives you the opportunity to describe a clinical experience in your own words, explore your perceptions and understanding of the experience, and become more aware of how you use clinical decision-making skills. Similarly, reflecting on visual images, narratives, poetry, music, or drama offers you opportunities to examine multiple perspectives, challenge your assumptions, and develop self-awareness and empathy Concept maps - As a nurse, you care for patients who have multiple nursing diagnoses. A concept map is a visual representation of patient problems and interventions that depicts their relationships to one another. Drawing a concept map can help you synthesize relevant data about a patient, including assessment data, health needs, nursing diagnoses, nursing interventions, and evaluation measures Critical thinking: is a reasoning process by which you use knowledge, reflect on previous experience, and integrate professional practice standards to provide competent and ethical nursing care to patients (Figure 12-3). Thinking critically requires dedication and a desire to grow intellectually. Synthesis of Critical Thinking Clinical Decision Making in Nursing Practice → Critical thinking skills + Nursing practice = Clinical decision making → Clinical decision making separates professional nurses from technical personnel. → Patients have problems for which no textbook answers exist. → Nurses need to seek knowledge, act quickly, and make sound clinical decisions. → The use of evidence-informed knowledge; knowledge based on research or clinical expertise; makes you an informed critical thinker and improves patient outcomes. Side note: Always question, never get stuck in routines. // Your critical thinking skills can always improve throughout your career. Reflection is essential in nursing practice → Decide if your ideas about reflection are modified depending on whether you reflect before, during or after an event. Does reflection at a specific point require more effort or offer greater possibilities? → Reflection before action – involves thinking about what you aim to achieve and understanding the means by which this will be accomplished by drawing on previous experience. → Reflection in action – relates to your conduct while undertaking the task and allows you to modify what you are doing while you are doing it. This is commonly described as “thinking on your feet.” → Reflection on action – involves looking retrospectively at how practice was executed and analyzing the information gathered in terms of knowledge, new learning and professional development