Prof Nursing 2- midterm 1

what is Critical Thinking

process and set of skills, analyze and evaluate info, draw conlcusions, evidence informed knowledge, basis of clinical reasoning, systemic and organised, use of cognitive framework to identify and analyse problems

what are characteristics of a critical thinker during the making of clinical decisions? (like steps one takes)

Process, Act, Reflect

what are some critical thinking examples in clinical setting?

ability to ask questions, being well informed, being honest when facing personal biases, being willing to reconsider and think differently about issues

what are critical thinking skills?

Interpretation, analysis, inference, evaluation, explanation, self regulation

what are some critical thinking dispositions?

truth seeking, open mindedness, analyticity, systematicity, self confidence, inquisitiveness, maturity

what is utilitarian model?

ethical model, based on most good or usefulness

what is deontologic model

centres on duty of healthcare providers

what is human rights based model

centred on maintaining basic human rights

when does an ethical dilemma occur?

when an actual or potential conflict occurs regarding principles, duties or rights

what are 3 bioethical guiding principles

autonomy and the illness experience, beneficence and non-maleficence, justice

What is Tanner’s model of clinical judgement?

Noticing, interpreting, responding, reflecting

what is the Kataoka-Yahiro and Saylor model of nursing judgement?

levels of thinking- basic, complex, commitment

what is basic critical thinking?

level 1- thinking is concrete and based on a set level of principles

what is complex critical thinking?

level 2- analyse and examine choices more independently

what is commitment critical thinking?

level 3- anticipate choices without assistance and assume responsibility and accountability for those choices

what is included in ‘specific knowledge base’

information literacy skills, proficiency in knowing when information is needed, how to effectively find, retrieve, evaluate and apply research findings

what are 3 general critical thinking competencies

the scientific method, problem solving, decision making

what are the steps of the scientific method

identify the problem, collect data, formulate research question, test question/hypothesis, evaluate results

what does ADPIE stand for?

Assessment, Diagnosis, Planning, Implementation, Evaluation

intellectual standards

guideline or principle for rational thought, thoroughness, precision, accuracy and consistency

professional standards

ethical criteria for nursing judgement, criteria for evaluation, professional responsibility

what are some barriers to critical thinking?

attitudes and habits, cognitive dissonance, personal values vs professional values

examples of tools to develop critical thinking

case based learning, reflective writing, concept mapping

what are the 10 critical thinking steps

clarify concepts, identify your own personal + professional values, integrate date and identify missing information, collect new data, identify significant problems and prioritise, examine sceptically, apply criteria, generate options and look at alternatives, consider whether factors change depending on context, make decision, implement and evaluate

who developed the nursing process?

Ida Jean Orlando in 1961

critical thinking during assessment

nurse has a broader perspective, elicit openness from the patient to gather more data, deciding which data is important, cue and inference, identifying patterns and potential problems

what does cue mean?

what pt answers when asked a question

what is inference

the judgement made from snippets of data

what are primary source of data?

just the patient

what are secondary sources of data?

family, health care team, health records

what are tertiary sources of data?

literature and nurse’s experience

interview with pt

organised conversation, open and closed ended questions

steps of interview with pt

orientation phase, working phase, termination phase

what are some methods of data collection

nursing health history, family history, documentation of findings

developmental variables (potter and perry 191)

relationship status, # of children, developmental stage, occupation, significant life experiences (education, finance, stress), safety hazards (housing, environmental, occupational), safety measures (smoke detectors, helmets, etc)

psychological variables

mental processes (mental acuity), relationships, support systems, statements regarding pt feelings about themselves

spiritual variables

rituals, religious practices, beliefs about life, pt source of guidance on beliefs, relationship with family in exercising faith

sociocultural variables

culture, primary language and other languages spoken, recreation, family and significant others including power of attorney

physiological variables

history of illness and injuries, current medications, review of systems

family history

data about immediate blood relatives, information of family structure, interaction and function, documentation of history findings

physical examination

observation of pt behaviour, diagnostic and lab data, interpreting assessment data and making nursing judgements

making nursing judgement (critical thinking)

recognise patterns, data validation, analysis and interpretation, comparison with normal standards, making a reasoned decision

nursing diagnosis steps

screening assessment, potential diagnosis, in-depth assessment, nursing diagnosis

screening assesment

data collection, data analysis, clustering of information

potential diagnosis

consider all diagnosis that match information available

in depth assessment

focused data collection, data analysis, confirming or refuting potential diagnosis

nursing diagnosis

determine priority nursing diagnosis

types of diagnosis: nursing diagnosis

nursing scope of practice based on nurse’s assessment, judgement abt pt response to actual or potential problem, based on diagnostic reasoning, defining characteristics or clinical criteria

type of diagnosis: medical

identification of disease by symptoms by physican or nurse practitioner

type of diagnosis: collaborative

actual or potential complication that nurse’s monitor made by multiple healthcare staff

example of collaborative problem

client has surgical wound → at risk for developing infection → physical prescribes antibiotics → nurse monitors client for fever and signs of infection and implements wound care (physical prescribes antibiotics while nurse monitors)

actual nursing diagnosis

human response to health conditions or life conditions

risk nursing diagnosis

human response to health conditions or life processes that develop

health promotion nursing diagnosis

clinical judgement of pt motivation and desire to increasing well being

wellness nursing diagnosis

levels of wellness in a pt that can be enhanced

NANDA

international-approved nursing diagnosis, means of translating nursing observations and assessments into standard conclusions in a common nomenclature, all healthcare team members use this common language

confirm nursing diagnosis

assessment activities, defining characteristics, nursing diagnosis, etiology

components of diagnostic statement

diagnostic label, related factors, definition, risk factors, how to write statement

diagnostic errors

data collection, interpretation and analysis, data clustering, diagnostic statement labelling, documentation

patient education

important for pt and family so they can make informed decisions to prevent future admissions to hospital

focused form ********(week one slideshow)

instructional communication, examples: cope with diagnosed health disruptions, self manage effects of chronic disorders, make effective health decisions, slow or prevent disease progression FINISH

complexity of pt education

depends on overarching goals and self management skills

basic learning principles

learning environment, ability to learn, motivation

i yearn to frolick

mhm

goals of pt education

maintain and promote health while preventing illness, restoring health, coping with impaired function

core dimensions of pt education

pt perspective, self management, opportunities for health teaching, use plain language, technology integration

mandates during health education

sufficient for making informed decisions, provided in a way that they can understand, evidenced with documentation proving what was taught

theoretical framework: carl rogers

meeting patient at their level with empathy and authenticity

theoretical framework: science of teaching

pedagogy (people learn in different ways)- cognitive, affective and psycomotor

theoretical framework: bandura’s social cognitive model

understanding and influencing human behavior on both individual or societal levels

theoretical framework: blooms taxonomy

remembering → understanding → applying → analysing → evaluating → creating

teaching as communication

listening empathically, observing astutely, speaking clearly

health teaching categories

information gathering, information giving, relationship building

domains of learning

cognitive, affective, psychomotor

developing individualised teaching plans

preparation, coaching, self awareness, assessment data

factors that influence the ability to learn

development factors- mental acuity

social determinants- non health factors that affect health

framework for human development

social network, then civil society, then national socioeconomic environment

establishing priorities

helps nurses anticipate sequence of nursing interventions (based on harlows hierarchy of needs), split into high priority (physiology based, save their life), intermediate priority (ensures they wont go into high priority, get them back to normal state) or low priority (improves health in future)

planning of nursing care

initial- gather data to provide intervention

ongoing- time doing intervention

discharge- getting pt prepped to leave hospital

priority setting depends on

client acuity, availability of resources, interruptions from care providers, nurse-client relationship, ward organisation, priority setting strategies, philosophies and models of care, experience and expertise of nurse

types of nursing diagnosis in teaching

health maintenance, health seeking behaviours, health self management, mastery of health related skill, deficient knowledge

integrating teaching and learning in assessment

assess learning needs, ability to learn, motivation to learn, teaching environment, resources for learning, preferred learning style, health literacy, preparation, health teaching responsibilities, coaching, self awareness, assessment data in teaching and coaching

integrating nursing and teaching process in planning

develop teaching plan, set goals with expected outcomes, works with pt to select a teaching method, set priorities, come up with timing plans, organise materials, maintain attention and participation, build on existing knowledge, selecting teaching methods, select resources, write teaching plans, family involvement, special needs, creating successful teaching plan,

Implementation teaching approaches

telling, selling, participating, entrusting, reinforcing, one to one, group instruction, preparatory instruction, demonstrations, analogies, role playing, simulation, pay attention to barriers, pay attention to learning barrier- illiteracy, learning disabilities, health literacy, sensory alterations, language, cultural diversity and needs of pt with severe illness, logical flow of info, use clear and concrete language, visual aids, prepare handouts, advance organisers

evaluation in the teaching process

determine whether pt learned the material, help reinforce correct behaviour and change incorrect behaviour, success depends on pt performance and expected outcomes

coaching

listening, guiding, supporting

factors affecting ability to learn

developmental factors and social determinants

evaluation during teaching

measurement methods, patient expectation, documentation

role of pt during goal setting

mutual goal setting, include pt and family, active participation

family involvement

educate of pathophysiology, what to expect if they are sick, lifeless, using appropriate equipment

self management strategies

skill development, coaching, providing transitional cues, give feedback

behavioural approaches

behavioural strategies, learning contracts, reinforcement of positive behaviours and review negative behaviours

personal action plan

assess, advise, agree, assist, arrange

group presentations

pros and cons, establish rapport, audiovisuals, timing, handling questions

nursing informatics

speciality area of nursing practice dedicated to the optimal use of technology to support professional practice and optimal pt outcomes, historically known as an absence of clinical nursing data, composed of nursing science + computer science + information science (data science)

digital health (informatics used in nursing)- field of knowledge associated with developing technologies to improve health

eHealth, mHealth (mobile healthcare- hc applications), uHealth (ubiquitous technologies- devices you can wear), connected health care (hc delivered across settings),

eHealth (electronic)

use of information and communication technologies in health (ICT), examples include treating pts, conducting research, educating health workforce, tracking diseases and monitoring public health

eHealth graphic if needed (week 2)

mHealth

apps on phones used for pt health

ICT applications

pt scheduling and transfer, billing and financial management, diagnostic imaging, laboratory reporting, order entry applications, pharmacy, pt documentation system, clinical support tools, remote consultation and triage, resource management and application