PowerPoint - Chapter 13: Blended Competencies, Clinical Reasoning, and Processes of Person-Centered Care PDF

Chapter 13 Blended Competencies, Clinical Reasoning, and Processes of Person-Centered Care Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins ANA Definitions of Nursing #1  Provision of a caring relationship that facilitates health and healing  Attention to the...

Chapter 13 Blended Competencies, Clinical Reasoning, and Processes of Person-Centered Care Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins ANA Definitions of Nursing #1  Provision of a caring relationship that facilitates health and healing  Attention to the range of human experiences and responses to health and illness within the patient’s physical and social environments  Integration of assessment data with knowledge gained from an appreciation of the patient or group’s subjective experience  Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking Copyright © 2019 Wolters Kluwer All Rights Reserved 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 Copyright © 2019 Wolters Kluwer All Rights Reserved Thoughtful Person-Centered Practice  The person  The professional nurse  Reflective practice leading to personal learning  Clinical reasoning, judgment, and decision making  The nurse’s action in response to individual clinical need  Person-centered nursing process Copyright © 2019 Wolters Kluwer All Rights Reserved Components of Thoughtful Practice Copyright © 2019 Wolters Kluwer All Rights Reserved 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 between and among patients, care partners, physicians, and other caregivers.  Care is provided in a healing environment of comfort, peace, and support. Copyright © 2019 Wolters Kluwer All Rights Reserved 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. Copyright © 2019 Wolters Kluwer All Rights Reserved The Professional Nurse  Personal attributes o 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 o Ability to draw upon a body of nursing knowledge and evidence Copyright © 2019 Wolters Kluwer All Rights Reserved Blended Competencies #1  Cognitive Competencies o Critical Thinking o Purpose of thinking o Adequacy of knowledge o Potential problems o Helpful resources o Critique of judgment/decision Copyright © 2019 Wolters Kluwer All Rights Reserved Blended Competencies #2  Developing technical competencies  Developing interpersonal competencies o Promoting human dignity and respect o Establishing caring relationships o Enjoying the rewards of mutual exchange  Developing ethical/legal competencies o Understanding legal boundaries o Scope of practice o Owning personal strengths and weaknesses Copyright © 2019 Wolters Kluwer All Rights Reserved Question #1  A nurse’s moral code is to assist all patients to the best of one’s ability. What blended skill would the nurse use when seeking out special services for a homeless patient with a diabetic foot ulcer? A. Cognitive B. Technical C. Interpersonal D. Ethical/Legal Copyright © 2019 Wolters Kluwer All Rights Reserved Answer to Question #1 Answer: D. Ethical/Legal Rationale: Using ethical/legal skills is the best answer as it involves following a moral code and acting professionally. Cognitive skills involve thinking through a situation to achieve outcomes. Technical skills relate to the proper use of equipment. Interpersonal skills are used to develop caring relationships. Copyright © 2019 Wolters Kluwer All Rights Reserved QSEN Competencies  Patient-centered care  Teamwork and collaboration  Evidence-based practice  Quality improvement  Safety  Informatics Copyright © 2019 Wolters Kluwer All Rights Reserved  Clinical Judgment Concepts  Critical thinking  Clinical reasoning  Clinical judgment  Situational awareness Copyright © 2019 Wolters Kluwer All Rights Reserved  Critical Thinking  Critical thinking Copyright © 2019 Wolters Kluwer All Rights Reserved  Clinical Reasoning & Decision Making #1  Process used to think about patient problems in the clinical setting  Leads to clinical judgment—result (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 Copyright © 2019 Wolters Kluwer All Rights Reserved  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 or problems created by human nature Copyright © 2019 Wolters Kluwer All Rights Reserved Problem-Solving and the Nursing Process  Trial-and-error – Involves testing solutions until one is found that works  Scientific – Systematic, seven-step process  Intuitive – Direct understanding of a situation based on a background of experience, knowledge, and skill that makes expert decision making possible  Creative thinking Copyright © 2019 Wolters Kluwer All Rights Reserved Clinical Judgment Models #1  Tanner Model o Noticing, a perceptual grasp of the situation at hand o Interpreting, developing a sufficient understanding of the situation to respond o Responding, deciding on a course of action deemed appropriate for the situation o Reflecting, attending to patients’ responses to the nursing action while in the process of acting Copyright © 2019 Wolters Kluwer All Rights Reserved Clinical Judgment Models #2  Nursing Process – Systematically collect patient data (assessing) – Identify patient strengths and actual and potential health problems and needs (diagnosing) – Develop a plan of individualized care that specifies the desired patient goals and related outcomes and the nursing interventions most likely to assist the patient to meet those expected outcomes (planning) – Execute the plan of care (implementing) – Evaluate the effectiveness of the plan of care in terms of patient goal achievement (evaluating) Copyright © 2019 Wolters Kluwer All Rights Reserved Copyright © 2019 Wolters Kluwer All Rights Reserved Characteristics of the Nursing Process  Systematic: part of an ordered sequence of activities  Dynamic: great interaction and overlapping among the five steps  Interpersonal: human being is always at the heart of nursing  Outcome oriented: nurses and patients work together to identify outcomes  Universally applicable: a framework for all nursing activities Copyright © 2019 Wolters Kluwer All Rights Reserved 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 Copyright © 2019 Wolters Kluwer All Rights Reserved 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 (cerebrovascular accident or stroke)? A. Assessing B. Diagnosing C. Planning D. Implementing E. Evaluating Copyright © 2019 Wolters Kluwer All Rights Reserved Answer to Question #2 Answer: B. Diagnosing Rationale: The diagnosing step involves analyzing patient data to determine strengths and weaknesses. The assessing step refers to the collection, validation, and communication of patient data. In the planning step, the nurse determines patient outcomes and related nursing interventions, and in the implementing step, the nurse carries out the plan. When evaluating, the nurse measures the extent to which the patient achieved outcomes. Copyright © 2019 Wolters Kluwer All Rights Reserved The Steps of the Nursing Process are Dynamic and Interrelated Copyright © 2019 Wolters Kluwer All Rights Reserved Question #3 Which of the following characteristics of the nursing process describes the interaction and overlapping of steps within the process itself? A. Systematic B. Dynamic C. Interpersonal D. Universally Applicable Copyright © 2019 Wolters Kluwer All Rights Reserved Answer to Question #3 Answer: B. Dynamic Rationale: The nursing process is dynamic in that there is much interaction and overlapping of the steps. It is systematic since it is an ordered sequence of activities. Interpersonal refers to the human being at the heart of nursing. The nursing process is universally applicable in that it is a framework for all nursing activites. Copyright © 2019 Wolters Kluwer All Rights Reserved 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 lives of patients – Opportunity to grow professionally Copyright © 2019 Wolters Kluwer All Rights Reserved Steps in Concept Mapping 1. Collect patient problems and concerns on a list. 2. Connect and analyze the relationships. 3. Create a diagram. 4. Keep in mind key concepts: the nursing process, holism, safety, and advocacy Copyright © 2019 Wolters Kluwer All Rights Reserved Question #4 Tell whether the following statement is true or false. Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts. A. True B. False Copyright © 2019 Wolters Kluwer All Rights Reserved Answer to Question #4 Answer: A. True Rationale: Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts. Copyright © 2019 Wolters Kluwer All Rights Reserved Reflective Practice  Reflection in action o Happens in the here and now of the activity and is also known as “thinking on your feet.”  Reflection on action o Occurs after the fact and involves thinking through a situation that has occurred in the past.  Reflection for action o Helps the person to think about how future actions might change as a result of the reflection. Copyright © 2019 Wolters Kluwer All Rights Reserved PICMONIC ADPIE Video  https://youtu.be/cIGiSRE3u1o Copyright © 2019 Wolters Kluwer All Rights Reserved