Week 6 Nursing Process and Clinical Reasoning PDF

NUR1 222 Strengths-Based Nursing and Professionalism Nursing Process and Clinical Reasoning October 6, 2022 Maria Di Feo B.Sc.(N.), M.A.Ed. Assistant Professor Nursing Process OUTLINE Clinical Reasoning in Nursing Practice 2 Nursing Process • Nursing Process is a systematic (an organised) pro...

NUR1 222 Strengths-Based Nursing and Professionalism Nursing Process and Clinical Reasoning October 6, 2022 Maria Di Feo B.Sc.(N.), M.A.Ed. Assistant Professor Nursing Process OUTLINE Clinical Reasoning in Nursing Practice 2 Nursing Process • Nursing Process is a systematic (an organised) process of thinking used to delivering patient centered care. • Organizing framework used by nurses throughout the world • Guides nurses/nursing students in making clinical judgements/clinical decisions 3 Applying Reasoning Process Develop clinical reasoning skills through deliberate and continuous practice 4 5 • ISoN Nursing Process utilizes the Clinical Reasoning Cycle (Levitt Jones & al.) to facilitate the cognitive process of clinical decision making (breaks process down into detailed steps) and is guided by Evidence Based Practice (EBP). • It incorporates the Strengths- Based Nursing (SBN) Approach in nursing practice – when caring for individuals, families and communities. ISoN Nursing Process • The process is documented and orally transmitted using language adapted for Interprofessional Communication (IC). 7 Specific to ISoN. An added layer. Your clinical reasoning is guided by the SBN values 8 9 10 11 12 13 14 15 16 7-Step Evidence Based Practice of the ISoN Nursing Process 17 7-Step Evidence Based Practice Using best available evidence when choosing your interventions/actions (Nursing Process). 7-Step Evidence-Based Practice – IBL Courses Step Zero: Cultivating Curiosity Step One: Asking Answerable Questions Step Two: Searching the Evidence Step Three: Appraising the Evidence Step Four: Integrating Evidence into Practice Step Five: Evaluating Practice Change Step Six: Disseminating Results of Evaluation • To inform Clinical Practice • Relevant, valid, reliable, and applicable to the clinical question. • Implement EBP interventions • Monitor and evaluate outcomes of interventions implemented • Share experiences with colleagues and other health care organizations.( Conferences, journals.. ) 19 7-Step Evidence-Based Practice 20 ISoN Nursing Process Involving the patient during the Clinical Reasoning Cycle Collaborating with the patient Exploring patient’s Strengths Reviewing Exploring Working Out Zeroing In 22 23 ISoN Nursing Process Interprofessional Communication 28 29 ISoN Nursing Process – Interprofessional Communication How we communicate our clinical reasoning process with other Healthcare Professionals Assessment Outcomes & Follow Up Nursing Analysis Interventions 30 Interprofessional Communication Assessment Data Collection Nursing Analysis Priority Problem Evidenced By Related To Outcomes & Follow Up Goals Interventions 31 ISoN Nursing Process – Interprofessional Communication Assessment Phase • Gathering of Data (objective & subjective) • Establishing a profile/understanding of the client’s health situation • “Curiosity & Discovery” • Considering the patient’s/families context and life experiences **In the SBN approach the patient/family is involved in the assessment process 32 ISoN Nursing Process – Interprofessional Communication Nursing Analysis Phase • Include identified health problem (One Health Problem for each Nursing Analysis Statement) • Include the evidence /contributing factors linked to the Health Problem • Include what the health problem may be related to/possibly be related to • Identify goal/goals related to each health concern. **In the SBN approach the patient/family is involved in the identification of health problems/concerns/needs and in the establishment of goals. 34 ISoN Nursing Process – Interprofessional Communication Nursing Analysis Statement • i.e. Patient is experiencing S.O.B as evidenced by R- 34/min, breathing rapid and labored, O2 saturation 89% related to asthma. Goal is to return patient to baseline respiratory function. ISoN Nursing Process – Interprofessional Communication Intervention Phase • Establishing Care & Clinical Follow- Up • Description of the interventions; including Health Promotion, Prevention, Rehabilitation &Therapeutic Process. • Interventions implemented and/or potential interventions. Interventions need to be linked to goal/s and priority health problem/issue. **In the SBN approach the patient/family are involved in identifying interventions/actions to be taken. • Use patient’s/family’s strengths 35 ISoN Nursing Process – Interprofessional Communication Outcomes & Follow up Phase • Description of how patient responded to interventions/actions implemented and the effects of the interventions on the priority health problem and the patient’s overall health and healing. • Were the interventions/actions effective? What data/information indicated that the goals were met or not met? • What follow- up/ongoing assessment is required? • Ensure continuity of care **In the SBN approach the patient/family are involved in evaluating outcomes. ISoN Nursing Process Interprofessional Communication 1. 2. 3. 4. Assessment Phase Nursing Analysis Phase Interventions Outcomes and Follow Up OIIQ Terminology 1. Initial & Ongoing (Subjective & Objective Data) 2. Assessment Findings (including priority problems or Needs) 3. Promotive, Preventative, Rehabilitation & Therapeutic 4. Continuity of Care: Communication and Coordination of Care 37 Putting it all together… 38 39 40 41 42 Mr. Patch Scenario – Past Mr. Patch is 52 years old diagnosed with stage 4 pancreatic cancer (metastases to liver) 3 months ago. He was admitted on the oncology unit following a GI bleed (now resolved). He received two courses of chemotherapy; poor response. His condition is worsening. He is getting weaker. He is alert and oriented. Having difficulty eating. Pain is well controlled. He and his family came to Montreal from London England six years ago when he was promoted as VP of a company. He and his family live in Westmount. His wife does not work. He has a 20 year old son and a 15 year old daughter. His son is in Toronto in medical school. His daughter is in high school. His oncologist informed him that the cancer was not responding to the chemotherapy. The oncologist told him that there were two ways of proceeding; another course of chemotherapy or stop chemotherapy and receive palliative care. Oncologist gave him a few days to think about it. Mr. Patch Scenario – Present Mr. Patch choose to stop chemotherapy and receive palliative care (7 months ago). Following the decision he was discharged home with follow up from the CLSC. Last night Mr. Patch came to the emergency department ,by ambulance accompanied by his wife Susan, with complaints of increase in pain, decrease in level of alertness, increase S.O.B, and poor p.o. intake. In the ER department an IV was started for hydration, he was administered morphine I.V and started on Oxygen 3 liters via nasal prongs. Admission Dx Lung Cancer with metastases to liver and bones. Today during the day shift he was admitted to the Palliative Care Unit. You are the student nurse assigned to him this evening. You enter his room Mr. Patch is lying in his bed. No one else is with him. You want to assess his present situation and plan for his care. Assessment Data Collection ISoN Nursing Process – Interprofessional Communication Guided by SBN approach and Values Incorporating EBP Nursing Analysis Priority Problem Evidenced By Related To Outcomes & Follow Up Goals Interventions 45 Assessment Phase Questions Assessments 46 During Your Assessment (some findings) His pain is 3 on a scale of 1 to 10. “Much better.” Mostly in his back. BP 102/58, P 106 (reg), R 28 and slightly labored, T: 37 degrees Celsius O2 Sat 92% Alert and oriented x3 Affect sad, poor eye contact “I prefer not to use the urinal.” When you accompanied him to bathroom (he held on to you) he was very unsteady on his feet. States “I feel very weak, so little energy, have been spending the last few days mostly in bed.” You note that he his coccyx are is red. “I don’t have much of an appetite.” “Haven’t been eating much lately.” What is your Nursing Analysis? Priority Problem • Evidenced By • Related To Goal (short/long term). Need to be able to evaluate them. 49 What are your Interventions to Meet Established Goal/s? Outcomes and Follow up Anticipated Outcomes? How will you know if goal/s was met/not met/partially met? 50 If Goal/s not met. What happens next? 51 52 Health Problem/Concern/Need (actual or potential) • • • • • • • • Anxiety Pain Nausea Risk of Constipation Risk of Fall Confusion Dehydration …… • Alfaro-LeFevre, R. (2015). Critical Thinking, Clinical Reasoning, and Clinical Judgment E-Book: A Practical Approach. Elsevier Health Sciences. • ISoN McGill University (2018) Strengths Based Nursing in Clinical Teaching Online Course References • Gottlieb, L. (2013). Strengths-based nursing care: Health and healing for person and family. New York: Springer Pub. • Levett-Jones, Tracy & Levett-Jones, Tracy, (editor.) (2013). Clinical reasoning: learning to think like a nurse. Pearson Australia, Frenchs Forest, N.S.W • Preparation Guide for the Professional Examination of the Ordre des infirmières et infirmiers du Québec, 5th edition Lemay, Chantal; Desrochers, Anik 2018 53