Student Version (Final) NUR1 222 F 23 W...cal ) Reasoning .pptx Oct 5 23 (5).pdf

NUR1 222 Strengths-Based Nursing and Professionalism Maria Di Feo B.Sc.(N.), M.A.Ed. Assistant Professor Nursing Process and Clinical Reasoning October 5, 2023 OUTLINE Clinical Reasonin Nursing Practice Nursing Process Review Discussio post #2 1. Identify and describe the phases of the clini...

NUR1 222 Strengths-Based Nursing and Professionalism Maria Di Feo B.Sc.(N.), M.A.Ed. Assistant Professor Nursing Process and Clinical Reasoning October 5, 2023 OUTLINE Clinical Reasonin Nursing Practice Nursing Process Review Discussio post #2 1. Identify and describe the phases of the clinical reasoning cycle. 2. Define clinical reasoning and describe the competencies that promote t development of clinical reasoning skills. 3. Explain how the SBN values can be incorporated in the clinical reasonin process. 4. Describe how the use of clinical reasoning, nursing knowledge, and oth evidence informs decision- making in diverse practice situations. Objectives Nursing Process/Clinical Reasonin • Guides nurses/nursing students in making cli judgements/clinical decisions • Organizing framework used by nurses throug the world • Nursing Process is a systematic (an organised) pr of thinking used to delivering patient centered c Nursing Process Applying Reasoning Process Develop clinic reasoning skill through delib and continuou practice ISoN Nursing Process Levett-Jones et al, (2010). Clinical reasoning cycle. Pearson Melnyk, BM., Fineout-Overholt, E., Stillwell, SB., Williamson, KM. EvidenceBased Practice: Step by Step: The Seven Steps of Evidence-Based Practice, The American Journal of Nursing. 110(1), 51-53. Gottlieb, L., & Gottlieb, B. (2012). Strengths-based nursing care: health and healing for person and family. NY. Springer Publishing Company. Indicates language used by the OIIQ. Cette publicité n'est pas une publicité de l'Ordre des infirmières et infirmiers du Québec et elle n'engage que son auteur. 1. 2. 3. 4. References The Nursing Process used at the ISON uses the Clinical Reasoning Cycle (CRC) to facilitate the cognitive process of clinical decision making guided by Evidence – based Nursing Practice (EBNP). We use a StrengthsBased Nursing (SBN) approach in our practice with individuals, families and communities. This process is documented and orally transmitted using language adapted for interprofessional communication (IC) ISON Nursing Process Diagram Evaluate outcomes 3 1 CRC ep 7-St 2 EBP H SBN 4 IC Clinical Reasoning Cycle Consider the patient situation Cultivating curiosity Process information evidence Evaluating practice change ISoN Nursing Process • The process is documented and orally tra using language adapted for Interprofessi Communication. • It incorporates the Strengths- Based Nur Approach in nursing practice. • ISoN Nursing Process utilizes the Clinical Cycle (Levitt Jones & al.) to facilitate the process of clinical decision making (break down into detailed steps) and is guided b Based Practice. ISoN Nursing Process Levett-Jones et al, (2010). Clinical reasoning cycle. Pearson Melnyk, BM., Fineout-Overholt, E., Stillwell, SB., Williamson, KM. EvidenceBased Practice: Step by Step: The Seven Steps of Evidence-Based Practice, The American Journal of Nursing. 110(1), 51-53. Gottlieb, L., & Gottlieb, B. (2012). Strengths-based nursing care: health and healing for person and family. NY. Springer Publishing Company. Indicates language used by the OIIQ. Cette publicité n'est pas une publicité de l'Ordre des infirmières et infirmiers du Québec et elle n'engage que son auteur. 1. 2. 3. 4. References The Nursing Process used at the ISON uses the Clinical Reasoning Cycle (CRC) to facilitate the cognitive process of clinical decision making guided by Evidence – based Nursing Practice (EBNP). We use a StrengthsBased Nursing (SBN) approach in our practice with individuals, families and communities. This process is documented and orally transmitted using language adapted for interprofessional communication (IC) ISON Nursing Process Diagram Evaluate outcomes 3 1 CRC ep 7-St 2 EBP H SBN 4 IC Clinical Reasoning Cycle Consider the patient situation Cultivating curiosity Process information evidence Evaluating practice change A process by which clinicians (nurses, nursing students) collect cues, process information, come to an understanding of a patient's health problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from the process. Clinical Reasoning Cycle Clinical Reasoni Cycle Levitt Jones & al. (2010) • Assumptions made with regards to age, culture, gender, stereo biases can result in clinical reasoning errors and negatively imp care. • The nurse is encouraged to question any assumptions, preconc and prejudices that they may have in regards to the clinical situ during any point in the Clinical Reasoning Cycle Questioning Assumptions (Something that yo accept as true without proof/evidence) Competencies that Facilitate a Nurse’s Clinical Reasoning Skills Knowledge • Nursing & related disciplines, personal knowledge.. Skills • Observation, health & physical assessment, communication, technica Attitudes • Curiosity, engaged in learning, self- awareness… A thinking process that is purposeful and focused on patient care which evolve Clinical Reasoning Collect Cues (Signs) & Information • Collects relevant information about the patient. • Explores and gets to know the patient Stage 2 Consider the Patient Situation Stage 1 Summary • Analyses/inte rprets information collected and generates hypotheses. Process Information Stage 3 • Synthesizes all the information collected and identifies the most salient patient problems/iss ues. Identify Problems/Issu es Stage 4 • Establishes goals that are specific, measurable, achievable, realistic and timely and (Desired outcomes) What is the desired change? Establish Goal/s Stage 5 Take Action • Selects the most appropriate course of action/s. Stage 6 • Evaluates t effectivene of the actio taken and evaluates t outcomes that were established Evaluate Outcomes Stage Your clinical reasoning is guided by the SBN values Specific to ISoN. An added layer. Using best available evidence when choosing you interventions/actions. 7-Step Evidence Based Practice • Share experiences with colleagues and other health care organizations.( Confe • Monitor and evaluate outcomes of interventions implemented Step Five: Evaluating Practice Change Step Six: Disseminating Results of Evaluation • Implement EBP interventions • Relevant, valid, reliable, and applicable to the clinical question. • To inform Clinical Practice Step Four: Integrating Evidence into Practice Step Three: Appraising the Evidence Step Two: Searching the Evidence Step One: Asking Answerable Questions Step Zero: Cultivating Curiosity 7-Step Evidence-Based Practice – Courses 7-Step Evidence-Base ISoN Nursing Process Explo patie Stren Colla with t Invol patie the Cl Reas Cycle https://mcgillmy.sharepoint.com/:v:/r/personal/katherine_logue_mcgill_ca/ Documents/NUR1%20222%20%20Fall%202020/Module%202%20%20videos%20for%20lessons%201%20and%202/Module%201 %20%20Clinical%20Conversations.mp4?csf=1&web=1&e=e8jTAa • https://lrs.mcgill.ca/embed?rid=c185134a-fc96-4633-b857f2431bd901be&d2lhost=mycourses2.mcgill.ca How we communicate our clinical reasoning process with other Healthcare Professionals ISoN Nursing Process – Interprofessional Communication Outcomes & Follow Up Interventions Assessment Outcomes & Follow Up Interventions Assessment Data Collection Interprofessional Communi Assessment Phase ISoN Nursing Process – Interprofessional Communication **In the SBN approach the patient/family the assessment process • Gathering of Data (objective subjective) • Establishing a profile/underst the client’s health situation • “Curiosity & Discovery” • Considering the patient’s/fa context and life experiences Nursing Analysis Phase ISoN Nursing Process – Interprofessional Communication **In the SBN approach the patient/fa in the identification of health problems/concerns/needs and in the e of goals. • What is the desired change/outcome? • Include identified health problem (O Problem for each Nursing Analysis St • Include the evidence /contributing fa the Health Problem • Include what the health problem ma to/possibly be related to • Identify goal/goals related to each Nursing Analysis Statement Example ISoN Nursing Process – Interprofessional Communication Patient is experiencing S. evidenced by R- 34/min, b rapid and labored, O2 sat 89% related to asthma. G return patient to baseline respiratory function. (can rate & O2 sat rate) Intervention Phase ISoN Nursing Process – Interprofessional Communication **In the SBN approach the patient/f involved in identifying interventions be taken. • Use patient’s/family’s strength • Establishing Care & Clinical Follow• Description of the interventions; i Health Promotion, Prevention, Rehabilitation &Therapeutic Proce • Interventions implemented and/or interventions. Interventions need t linked to goal/s and priority health problem/issue. Outcomes & Follow up Phase ISoN Nursing Process – Interprofessional Communication **In the SBN approach the patien are involved in evaluating outcom • Description of how patient resp interventions/actions implemen the effects of the interventions priority health problem and the overall health and healing. • Were the interventions/actions What data/information indicate goals were met or not met? • What follow- up/ongoing assess required? • Ensure continuity of care 1. 2. 3. 4. Assessment Phase Nursing Analysis Phase Interventions Outcomes and Follow Up ISoN Nursing Process Interprofessional Communication 1. Initial & Ongoing (Subj Objective Data) 2. Assessment Findings (i priority problems or N 3. Promotive, Preventativ Rehabilitation & Thera 4. Continuity of Care: Communication and C of Care OIIQ Terminology Putting it all togethe ACTIVITY Mr. Patch is 52 years old diagnosed with stage 4 pancreatic cancer ( liver) 3 months ago. He was admitted on the oncology unit following (now resolved). He received two courses of chemotherapy; poor res condition is worsening. He is getting weaker. He is alert and oriente difficulty eating. Pain is well controlled. He and his family came to M London England six years ago when he was promoted as VP of a co and his family live in Westmount. His wife does not work. He has a 2 son and a 15 year old daughter. His son is in Toronto in medical scho daughter is in high school. His oncologist informed him that the can responding to the chemotherapy. The oncologist told him that there ways of proceeding; another course of chemotherapy or stop chem receive palliative care. Oncologist gave him a few days to think abou Mr. Patch Scenario – Past Mr. Patch choose to stop chemotherapy and receive palliative care ago). Following the decision he was discharged home with follow CLSC. Last night Mr. Patch came to the emergency department by accompanied by his wife Susan, with complaints of increase in pai in level of alertness, increase S.O.B, and poor p.o. intake. In the ER an IV was started for hydration, he was administered morphine I.V. on Oxygen 3 liters via nasal prongs. Admission Dx Lung Cancer wit to liver and bones. Today during the day shift he was admitted to the Palliative Care U the student nurse assigned to him this evening. You enter his roo lying in his bed. No one else is with him. You want to assess his pr situation and plan for his care. Mr. Patch Scenario – Present Guided by SBN approach and Values Incorporating EBP ISoN Nursing Process – Interprofessional Communication Outcomes & Follow Up Interventions Assessment Data Collection Nurs Prio Evi R Assessm Exampl Questions Examples? Assessment Phase “I don’t have much of an appetite.” “Haven’t been eating much lately.” You note that he his coccyx are is red. States “I feel very weak, so little energy, have been spending the last few days m When you accompanied him to bathroom (he held on to you) he was very unstea “I prefer not to use the urinal.” Affect sad, poor eye contact Alert and oriented x3 O2 Sat 92% BP 102/58, P 106 (reg), R 28 and slightly labored, T: 37 degrees Celsius His pain is 3 on a scale of 1 to 10. “Much better.” Mostly in his back. During Your Assessment (some findings) What is your Nursing Analysis? Goal (short/long ter Need to be able to ev • Evidenced By • Related To Priority Problem Identify a Health Problem & Establish a Goal Write a Nursing Analysis 57 What are your Interventi to Meet Established Goal Outcomes and Follow up Was goal/s met/ met/partially me What are the Anticipated Outcomes? If Goal/s not met. W happens next? Happy Thanksgiving! References • Preparation Guide for the Professional Examination des infirmières et infirmiers du Québec, 5th edition Chantal; Desrochers, Anik 2018 • Levett-Jones, Tracy & Levett-Jones, Tracy, (editor.) (201 reasoning: learning to think like a nurse. Pearson Austr Forest, N.S.W • Gottlieb, L. (2013). Strengths-based nursing care: Heal for person and family. New York: Springer Pub. • ISoN McGill University (2018) Strengths Based Nursing Teaching Online Course • Alfaro-LeFevre, R. (2015). Critical Thinking, Clinical Rea Clinical Judgment E-Book: A Practical Approach. Elsevi Sciences.