Notre Dame Australia NURS1040 Professional Practice 1 Lecture 1 Week 3 PDF

NURS1040 Professional Practice 1 (Nursing Practice 1) Lecture 1 Week 3 ACKNOWLEDGEMENT OF COUNTRY The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodians of this land upon which our University sits. The University acknowledges that the Freman...

NURS1040 Professional Practice 1 (Nursing Practice 1) Lecture 1 Week 3 ACKNOWLEDGEMENT OF COUNTRY The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodians of this land upon which our University sits. The University acknowledges that the Fremantle Campus is located on Wadjuk Country, the Broome Campus on Yawuru Country and the Sydney Campus on Cadigal Country. Housekeeping Face to Face appointments with UNDA start this week Please book a time to meet with someone prior to assessment 1 due in week 4! https://koalendar.com/e/face-to-face-verification-documents- vetting-by-unda  Learning Outcomes At the end of this week, you will be able to: 1. Explore communication within a therapeutic relationship 2. Examine how nurses use clinical reasoning during the provision of nursing care. 3. Discuss the nursing process with a focus on nursing assessment. 4. Demonstrate the fundamental numeracy concepts associated with fluid balance. 5. Explain basic medical terminology used in nursing practice.  Thinking Critically The Nursing Process Registered Nurse Standards for Practice Nursing and Midwifery Board. (2016, June 1). Registered nurse standards for practice. Nursing and Midwifery Board. https://www.nursingmidwiferyboard.gov.au/News/2016-02-01-revised-standards.aspx Registered Nurse Standards for Practice 1. Thinks critically and analyses nursing practice. 2. Engages in therapeutic and professional relationships. 3. Maintains the capability for practice. 4. Comprehensively conducts assessments. 5. Develops a plan for nursing practice. 6. Provides safe, appropriate and responsive quality nursing practice. 7. Evaluates outcomes to inform nursing practice. Nursing and Midwifery Board. (2016, June 1). Registered nurse standards for practice. Nursing and Midwifery Board. https://www.nursingmidwiferyboard.gov.au/News/2016-02-01-revised-standards.aspx Critical Thinking “is a complex collection of cognitive skills and affective habits of the mind and can be described as the process of analysing and assessing thinking with a view to improving it” (Berman et al., 2021, p. 191). Why is Critical Thinking important? Constant change in health care environment Increased complexity, co-morbidities Increased consumer involvement Increased technology Evidence-base practice New problems need new thinking Autonomy and responsibility require professional level of thinking Critical Thinking involves the ongoing commitment of the individual to examine any belief or knowledge in the light of the evidence that supports it. Nurses use Critical Thinking primarily when solving problems and making decisions. leads to Clinical Reasoning to make decisions and act upon them to achieve positive patient outcomes.  Critical thinking and the Nursing Process Note Reprinted from Kozier & Erb’s Fundamentals of Nursing (p. 208) by A. Berman et al., 2021, Pearson Australia. Copyright 2021 by Pearson Australia. Nursing Process Characteristics: o Cyclic & dynamic o Evidence-based o Goal directed & person-centred (holistic) o Focused on problem solving & decision making o Interpersonal & collaborative o Systematic – uses critical thinking Nursing Process Assessing  Collect, organise, validate & document data Purpose  To establish a database of the patient’s responses to healthcare concerns or illness & their ability to manage health care needs Purpose of nursing assessment o To find out about the client’s needs, health problems & responses to these problems, related experiences, health practices, goals, values, lifestyle & expectations of the healthcare system. o To identify (& work with) patient strengths. o To identify health risks, such as falling, pressure injury. o To inform an individualised plan of care. o To compare to previous data & evaluate the effectiveness of nursing care. Gathering data How? Observing Interviewing Examining Primary source Patient Sources of data? Secondary source Family Subjective Health professionals Records / reports Objective Laboratory / Diagnostic tests Types of data? Types of data Subjective data – are data from the person’s point of view and include feelings, perceptions and concerns. Objective data – are measurable data that are obtained through observation, physical examination and laboratory or diagnostic testing. (Berman et al., 2018, p. 210). Understanding the difference Subjective data Objective data o Apparent only to the person o Detectable by an observer… can be affected measured or tested against a o Symptoms … described by the standard patient … includes feelings, o Signs … seen, felt, heard, smelled, beliefs, perceptions, stress measured o Example … o Example… On palpation the “I have a pain in my stomach & abdomen is firm & slightly distended. it’s making me feel sick” Pulse & blood pressure elevated compared to baseline data. Sources of data Primary – from the person Secondary – family members, support persons, health care professionals, records, laboratory and diagnostic tests and relevant literature (Berman et al., 2018, p. 210). Gathering data – How? Observation Vision: Overall appearance, skin colour & lesions, signs of distress Smell: Body or breath odours Hearing: Lung & heart sounds, bowel sounds, ability to communicate, language spoken Touch: Skin temperature & moisture, muscle strength, pulse rate, lesions felt Gathering data – How? Interviewing Planned communication or a conversation with a purpose o Identify problems & concerns o Evaluate progress Approach o Environment, seating, timing, language o Combination of directive & non-directive approaches o Questioning techniques – open, closed, probing, clarifying o Listening The purpose of interviewing patients/clients Often is the first To inform part of a decision making comprehensive assessment Crucial in Foundation of a establishing therapeutic rapport relationship Gathering data - How? oPhysical oDevelopmental oIntellectual HOLISTIC HEALTH oEmotional - psychological HISTORY oSocial oCultural oSpiritual oFunctional health patterns Gathering data – How? Examining the patient Systematic data collection Use observation (Look, Listen & Feel) Techniques used o inspection o auscultation o palpation o percussion Fundamental of an A-G Assessment: Look, Listen & Feel Primary assessment (ABCDEFG) Secondary assessment Initial patient assessment  Conducted after the primary assessment To identify if emergency management is required  When the primary threats have been addressed Evaluate: History – AMPLE, Pain Airway Head to Toe Breathing  Neurological Circulation  Cardiac Disability  Respiratory Exposure  Gastrointestinal Fluids  Renal Glucose  Skin  Validate data Important to ‘double-check’ or verify the information gathered to confirm it is accurate & factual Helps the nurse to o ensure assessment information is complete o ensure objective & subjective data aligned o obtain additional information that may have been overlooked o avoid jumping to conclusions & focusing in the wrong direction Data documentation The nurse records the person’s data to complete the assessment phase. Data is recorded in a factual and accurate manner. Subjective data is recorded in the person’s own words, using quotation marks. (Berman et al., 2018, p. 217). Nursing assessment Health care facilities have a variety of forms & charts available to guide nurses in gathering data Some examples include o Patient admission form o Nursing history form o Observation charts o Risk assessment forms Nursing history/admission Interpreter Allergies required? Nutrition – special diet Assessment: Appearance Neurological Elimination Orientation: Staff/patients Mobility Bathroom Visual Visiting hours Call bell system Hearing TV, phone, radio Valuables Speech No smoking  Nursing history/admission (continued) Drug & alcohol history Pressure sore risk assessment Falls risk assessment Falls risk assessment Progress notes S - Subjective O - Objective A - Assessment P - Plan I - Intervention/Implementation E - Evaluation R - Revision (Berman et al., 2021, p. 265). Nursing assessment Implications for you? You need to develop knowledge & skills in performing systematic & comprehensive nursing assessments. Why? o Incomplete/inaccurate assessments can result in ‘problems’ being overlooked or making poor judgments about what is wrong with the patient. o Early detection & action saves lives. Consider the RN Standards for Practice in relation to assessment … o Nursing interventions are performed following comprehensive & accurate assessments o RNs conduct assessments that are sensitive to the needs of individuals o RNs use a range of data gathering techniques … observation, interview … measurement … health history & assessment o RNs collect … physiological, psychological, spiritual, socio-economic & cultural data o RNs establish therapeutic relationships … & communicate effectively … Nursing Process Diagnosing  Analyse data; identify health problems, risks & strengths Purpose  To identify patient strengths & health problems that may be prevented or resolved Nursing Process Planning  Prioritise problems; set goals; identify nursing interventions; develop a nursing care plan Purpose  To identify an individualised care plan that specifies patient goals/desired outcomes & related nursing interventions Nursing Process Implementing  Provide nursing care; reassess; document cares Purpose  To assist the patient to meet desired goals, promote wellness, prevent illness & facilitate coping with altered functioning Nursing Process Evaluating  Collect data & compare with desired outcomes; draw conclusions Purpose  To determine whether to continue, modify or conclude the nursing care plan Holistic assessment and care planning o Holistic assessment, care planning and documentation are essential clinical skills o RN Standards for practice requirement o Need to develop competency in this area o To make effective use of the Clinical Reasoning Cycle you need the help of hospital documentation and/or Models of Nursing to guide the assessment process  Clinical reasoning cycle Note Reprinted from Kozier & Erb’s Fundamentals of Nursing (p. 222) by A. Berman et al., 2021, Pearson Australia. Copyright 2021 by Pearson Australia BREAK Communication Communication “...conferring through speech, writing or non-verbal means (including body language) to create a shared meaning” (Higgs et al., 2012, p.6). So how do we communicate? Verbal methods The use of words in delivering a message Written or spoken Non verbal methods Sending and receiving wordless messages Body language: facial expressions, eye contact, posture or gestures Electronic Mechanical Computer technology Hearing Aids Visual Symbols Signage Verbal Communication Communication using spoken and written words to get our message and information across Language Simplicity Avoid jargon Clarity Timing Relevance Adaptability Credibility Non-verbal Body language Communication Appearance Posture and gait Facial expression Eye contact/movements Gestures/body movement Touch Proxemics (Use of space) Vocalics Pace Intonation Volume Emphasis Silence and pauses Vocalising without words Laughing Crying Skills in communication Person-centred Active listening or reading Empathic understanding Cultural competence Person-centred care Trust Empathy Dignity Autonomy Respect Choice Transparency (Levett-Jones & Reid-Searl, 2018, p.7). Registered Nurse Standards for Practice 1. Thinks critically and analyses nursing practice. 2. Engages in therapeutic and professional relationships. 3. Maintains the capability for practice. 4. Comprehensively conducts assessments. 5. Develops a plan for nursing practice. 6. Provides safe, appropriate and responsive quality nursing practice. 7. Evaluates outcomes to inform nursing practice. Nursing and Midwifery Board. (2016, June 1). Registered nurse standards for practice. Nursing and Midwifery Board. https://www.nursingmidwiferyboard.gov.au/News/2016-02-01-revised-standards.aspx Communication in Healthcare Why is it important to have effective and coordinated communication in healthcare settings? Communication goals specific to nursing Gather Professional Therapeutic information relationships relationships https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Safety-and-Quality-Health-Service-Standards-second- edition.pdf  Summary Today we have discussed: What it means for nurses to think critically How nurses use the nursing process and the clinical reasoning cycle frameworks during the provision of nursing care. The components of a nursing health history. Observation, interview and examination patient data collection approaches. Subjective and objective data. Numeracy in Nursing Fluid Balance When do nurses use numeracy? Body measurements Weight, height, head circumference, waist circumference, BMI Fluid balance Input Output Medication Calculations Medication dosages Liquid medications Concentrations Calculation of rates of fluids Interpreting test results Blood tests Imaging tests What kind of numeracy this Semester? Fundamental: Fluid balance calculation Addition, Subtraction, Multiplication, Division Addition and subtraction Progressive (cumulative) Metric conversions between: totals kg, g, mg, microg. L and mL m and cm secs, mins and hours Key Conversion Concepts microg. Usually by 1000 except when converting cm, m and mm  Conversion Example How many grams are in 4.58 kilograms? Bigger to smaller unit (kg to g) Multiply by 1000 4.58 x 1000 = 4580 = 4580g Conversion Example Convert 1.58m to cm Bigger to smaller (metres to centimetres) Multiply by 100 1cm is a 100th of base unit (there are 100cm in a metre) 1.58 x 100 = 158 = 158cm Rounding of Decimals Rounding is expressing a value to its nearest whole number or nearest 10th, 100th or 1000th for decimals 0 to 4 Round DOWN ↓ “Zero to four, to the floor” 5 to 9 Round UP ↑ “five to nine, up the line” Look at the digit to the right ie. Rounding to two decimal places, look at the third digit  Rounding of Decimals 2.51 to nearest whole number Look at first decimal place 2.51 1.423 to two decimal 5 rounds up↑ places =3 Look at third decimal place 0.78 to one decimal place 1.423 Look at the second decimal place 0.78 3 rounds down↓ 8 rounds up↑ = 1.42 = 0.8 Fluid Balance We all are in a state of equilibrium Homeostasis We need to maintain a reasonable fluid balance in our bodies Fluid in and fluid out Too much fluid in - oedema (swelling) Too much fluid out - dehydration Fluid Balance Nurses are required to keep track of a patient's fluid balance This involves calculating how much Input and Output It may also include weighing the patient every day This is calculated every hour in critical patients It is recorded on a Fluid Balance Chart Fluid Balance Chart Types of input & output Input Output Intravenous input Urine IV fluids indwelling or suprapubic catheter or ileal conduit IV medications Blood Vomitus / Gastric aspirate Nasogastric or PEG Oral input Drainage Oral Enteral Faeces  Progressive totals Added to each hour to determine how much the patient has either consumed or excreted in the day so far There two types of Input: IV Input (Which will be a focus in PP3) (P column) Oral / Enteral input (OE column) Combined make a Total Input (X column) One Output (Y column) Number increases throughout the day as it is on-going determination of how much fluid has either gone into the body or come out. Determining the Progressive Balance 1. First, determine the progressive total input (X) and progressive total output (Y) as per previous slide 2. Then perform the calculation X – Y to determine the progressive balance 3. Ask yourself, o Has there been more input than output? Positive balance o Has there been more output than input? Negative balance  Progressive Balance vs. Progressive Total Both calculated each hour i.e. No empty boxes in columns Progressive totals are calculated for each type of input and output Total Input ( P + OE = X column) IV Input (P column) Oral/Enteral Input (OE column) Total Output (Y column) Progressive balance is the last calculation for each hour to check the fluid status (X – Y = progressive balance) When to record? From midnight 0:00 to midnight As a rule, charts are completed hourly (you may see different in clinical practice) The time that the input/output occurs needs to be recorded Which column to write in? Anything from 1 minute past the hour to the next hour e.g., 09:01 until 10:00 gets written in the 10:00 row This is important for continuous infusions, (e.g., enteral feeds and IV fluids) and drains (urinary catheters) The infusion cannot be recorded as fully inside the patient until the hour has elapsed Electronic charting will not allow you to enter the input/output until the hour has elapsed Med Safe Assessment Practice Any issues with logging in please email your course coordinator, not your tutor Prepare for Assessment 3 in Week 7 Practice with the software as much as possible! You have unlimited access providing you with flexibility across your mobile devices at any time. Check the rounding procedure within the software to ensure you are applying this correctly to the questions; But mostly - have fun! The software is interactive and fun to use, with many hospitals and facilities also incorporating it for their staff You are welcome to practice other areas but focus on Maths for Clinicians, Metric System. In coming semesters, you will explore and be assessed on the other sections. Maths Workshops In Week 6 Live Maths support on Zoom…TBA QUESTIONS