Week 5 Planning Blackboard(1) PDF

Concept: Nursing Process Planning Generate Soutions COURSE OUTCOME Describe principles of safe, patient- centered, evidence-based nursing care to adults at the basic level, guided by the Caritas philosophy. Discuss critical thinking and clinical reasoning to provide quality patient...

Concept: Nursing Process Planning Generate Soutions COURSE OUTCOME Describe principles of safe, patient- centered, evidence-based nursing care to adults at the basic level, guided by the Caritas philosophy. Discuss critical thinking and clinical reasoning to provide quality patient care COMPETENCY Describe the elements of the nursing process. Discuss critical thinking strategies used when making clinical judgments. Discuss the use of critical thinking to prioritize basic elements of patient care when implementing the nursing process CONCEPT Clinical Decision Making: A process used to examine and determine the best actions to meet desired goals; requires anticipating, recognizing and organizing patient problems to respond with urgency and/or importance in a preferential order to avoid or minimize adverse changes in a patient’s condition UNIT OUTCOMES Discuss criteria used in priority setting Describe goal setting Discuss the difference between a goal and an expected outcome List the guidelines for writing a goal. Discuss the difference between independent nurse- initiated, dependent physician-initiated & collaborative interprofessional interventions. Discuss the selection of nursing interventions to meet the needs of young, middle and older adults. Identify basic concepts related to a TRANSITION (Discharge) plan Nursing Deliberate Process : Plannin g Systematic Generat e Uses patient Solutio assessment information/data ns and the nursing diagnosis to form goals and outcomes  Planning/Generate Solutions Third step of the Nursing Process Requires the use of your critical thinking skills, in which decision-making and problem-solving techniques are incorporated Setting priorities Identifying patient-centered goals and expected outcomes Identifying individualized nursing interventions Generating Solutions Requires A plan of care working closely is dynamic and with patients, will change as families, health your patient’s care team needs change. through communication  Planning/Generating Solutions Have you had a plan for the day with multiple things to do? How do we prioritize? Patient’s have multiple issues, we must prioritize  Helps nurses anticipate and sequence nursing interventions or Determini actions ng Priorities Requires critical thinking  Determining Priorities Deciding the importance of nursing diagnoses or patient problems uses determinations of urgency and/or importance to establish a preferential order for nursing actions Rapid or monitoring?  Essential skill As you graduate you will care for multiple patients and need to balance all of the needs of your patients Prioritizati on You will make decisions on what needs to be done and the urgency of each action Your ability to recognize and identify the most important actions is an important nursing skill  Classification of Priorities Classification of priorities: Clinically Important High—Emergent - life threatening Intermediate - non–life threatening Low—Effect the patient’s future well-being  Prioritize Examine the Nursing diagnoses ask, if untreated, what would result in harm to a patient? These have the highest priority. Intermediate-priority diagnosis may involve the comfort needs of the patient. The low-priority nursing diagnosis may call for an intervention that affects the patient’s future needs after discharge.  Establishing Priorities The order of priorities changes as a patient’s condition changes Priority setting begins at a holistic level when you identify and prioritize a patient’s main diagnoses or problems. Patient-centered care requires you to know a patient’s preferences, values, and expressed needs.  Establishing Priorities Influences: Culture Where the patient is at in life? Urgency of the situation Erikson Stages of Psychosocial Development Stages of life can influence patient priorities  Young Adult: Late teens - 35 Erikson: Intimacy vs Isolation Physical growth completed Focus on personal & social tasks: career choice, social and intimate relationships, self-concept, adult relationship with family Health Concerns: Accidents, violence, STIs, job & family stress, unhealthy lifestyle practices (ETOH, smoking). Middle Adult: 35 - 65 years Erikson: Generativity vs Stagnation Changes in physical state: Menopause, andropause Focus on family, work, aging parents (Sandwich Generation) Health Concerns: Health screening (mammograms, PSA), stress reduction, healthy lifestyle strategies, adjustment to life transitions Older Adult: 65 and older Erikson: Ego integrity vs Despair Aging is a normal, healthy process that begins at birth System-wide physical changes Cognitive changes due to illness not aging Numerous lifestyle changes Older Adult: 65 and older Example Goal for an older adult might be: Remain independent, accept aging, transitions, and loss. Knowing this is critical to the nursing plan Strategies: Reminisce/life review (Storytelling) Exercise, nutrition, sensory stimulation Health Concerns: Chronic illness, medications, depression, ETOH abuse, elder abuse  Nursing Process: Planning: Setting Goals Using the identified nursing diagnosis, what is the best approach to address the problem? A broad statement that describes the desired change in a patient’s condition or behavior ONLY ONE FOR EACH Nursing Concept/ Diagnosis  Setting goals how to’s: Once you identify nursing diagnoses for a patient, ask yourself: 1. “What is the best approach to address and resolve each problem? 2. What do I plan to achieve?”  Setting Goals Goals and expected outcomes are specific statements of patient behavior or physiological responses that you set to resolve a nursing diagnosis or collaborative problem. Goals and expected outcomes serve two purposes 1. It gives a clear direction for selecting and using nursing interventions and 2. Evaluating the effectiveness of the interventions  Goal vs Outcome Goal: Broad Outcome: statement Observable about what we criteria that want the inform us if the patient to goal has been achieve. met.  Example: Goal vs Outcome Goal: Preform all activities of daily living prior to discharge Outcomes: Patient can ambulate to the bathroom independently Patient can bathe independently.  Setting Goals Once an outcome is met, you know that a goal has been at least partially achieved Selection of goals, expected outcomes, and interventions requires consideration: previous experience with similar patient problems established standards for clinical problem management.  Setting Goals Goals and outcomes need Critical thinking is to meet established used in selecting standards by being: interventions with the relevant to patient needs greatest likelihood of specific success and move singular people to achieve observable the goal and measurable outcomes time limited  The Question to be Answered Hypotheses created next question “What do I plan to achieve?” Goals are specific statements of patient behavior or physiological responses that you, “the nurse” set to guide your decision if the nursing concept/nursing diagnosis is resolved or not resolved.  Goals of Care Patient-centered goal: A specific and measurable behavior or response that reflects a patient’s highest possible level of wellness and independence in function Short-term goal: An objective behavior expected within hours to a week Long-term goal: An objective behavior expected within weeks, or months  Goals of Care Partner with patients when setting their individualized goals. If the patient is unable to –Ask the significant others Patient/Family want to understand. Want to see the value of nursing therapies. Talk With Your Patients Guidelines for Writing Goals SMART Patient centered Specific Realistic Measurable Time limited Attainable/ Observable Achievable Did the answer meet the following: Guidelines for Goals Patient centered Specific Observable Measurable Time limited Achievable/ Realistic Attainable  Collaborative – Consulting/collaborating Other Health Care Professionals Planning involves consultation with members of the interprofessional health care team. Consultation is a process by which you seek the expertise of a specialist such as your nursing instructor, the nurse caring for the patient, a physician, a clinical nurse educator, physical therapy, etc. to identify ways to handle problems in patient management or in planning and implementation of therapies.  Collaboration: Requires Clarification of Order When preparing for physician-initiated or collaborative interventions, do not automatically implement the therapy, but determine whether it is appropriate for the patient. The ability to recognize incorrect therapies is particularly important when administering medications or implementing procedures. Competent nurses recognize orders that are not appropriate and seek clarification  Orders that come from the physician. Medications, IV’s, diagnostics, diet, activity orders Depend Dependent upon the physician. ent Nurse executes the order Orders Together/collaboratively the intervention is completed.  Another term for a collaborative intervention is Interdependent Interprofessional interventions Require combined knowledge, skill, and expertise of interprofessional health care providers.  Transition Care Discharge Begins at the time of admission assessment During planning stage arrangements for post-facility care must be made – allows time for coordination of services outside of the facility.  Thinking about discharge from a health care facility Requires consideration from the moment of Transiti admission on Lends itself to the same Care nursing process (Assessment, Diagnose, Plan, Implement and Evaluate) ADPIE Preparation  Transition Care Discharge You will be required to complete a transition of care/discharge plan in clinical NUR 1090. You will need to apply the principles of transition care/discharge.  Assess the learning needs of the patient and what they will need to know to be independent (if possible), maintain safety, and continue to move toward wellness. Transiti Diagnose: Develop a diagnosis on Care Use clear, concise descriptions using words that the patient Dischar understands ge Provide step-by-step descriptions of how to perform a procedure (e.g., home medication administration).  Transition Care Discharge Review signs and symptoms of Reinforce complications the explanations with patient needs to printed report to the instructions. health care provider  Obtain feedback regarding discharge Transiti instructions. on Verify patient Care understanding using TEACH BACK Dischar List names and phone ge numbers of health care providers and community resources to contact.  Safety: Guidelines for Transition Planning Example; Safety in immediate home environment. Does the patient have a telephone, stairs, bathroom access, working appliances, ramp for wheelchair. Medication list of what to take, when, why, 2 side effects to report to prescriber. Do they live alone or have family/friends that assist them? Safety- Application of Guidelines Transfer to rehabilitation for continued 1 person assist with transfer, gait unsteady Assist to put rubber sole shoes on before getting out of bed Plan to use walker independently with steady gait and return to ranch home with spouse Plan continue to review Medications with each dose to develop a consistent medication adherent pattern in the patient’s daily activities Guidelines for Transition Planning Example; Nutrition and Fluids Special diet – provide copies of facility menu Ethnic influences that effect balanced diet Collaborate and consult with dietician to create a balanced diet  Nutrition and Fluids-Application of Guidelines Examples Heart Healthy with 1,000 ml fluid restriction. Adhering to diet with encouragement Patient and family requesting consult with dietician to discuss diet and guide them about foods they can bring patient while in facility.  What are some key points to consider in evaluating discharge/transition information? Obtain feedback regarding transition instructions from the patient and family. Verify understanding using Teach Back Questions?