Unit 2

6 ways of developing critical-thinking abilities in order to practice safe, effective, professional nursing care.

Critical thinking is fundamental to safe, effective, and professional nursing practice. It enables you to go beyond simple task completion and engage in purposeful, directed mental activity that creates and evaluates ideas, analyzes data, anticipates problems, and constructs appropriate care plans.

Discuss and describe each phase of the nursing process of ADPIE

a. Assessment: Collect patient information (subjective and objective data). The RN does the initial assessment, but LPN/LVNs help gather data throughout care.

b. Diagnosis: Analyze the assessment data and identify clinical problems. The RN formulates nursing diagnoses with assistance from LPN/LVNs.

c. Planning: Set patient goals/outcomes and identify nursing interventions to achieve them. Include the patient in planning for better success. Focus on promoting wellness efficiently and cost-effectively.

d. Implementation: The action phase - prepare and perform the planned interventions. Gather supplies, perform procedures, assess patient responses, and document everything.

e. Evaluation: Determine if patient outcomes were met. If not, figure out why and revise the plan. This is an ongoing process that allows you to adjust care as the patient's condition changes.

Discuss the role of the 4 LPN in the nursing process with the 2 RN.

The RN leads the nursing process and is responsible for initial assessments and formulating diagnoses.

LPN/LVNs work collaboratively by assisting with data collection, helping with diagnoses, implementing interventions, and contributing to evaluation. It's a team approach with the RN in the supervisory role!

Apply the nursing process to nursing care.

Assessment (gathering information) Diagnosis “nursing” (putting info together) planning (what are the outcomes?) Implementing (what will help us get to those outcomes?) Evaluation

Discuss the use of the nursing process in prioritization of care.

• During Assessment: You gather data about all your patient's needs and problems.

• During Diagnosis: You analyze the data to identify which problems exist—this is where prioritization really begins. You recognize patterns and determine which issues are most urgent.

• During Planning: You decide the order in which to address problems based on: -Life-threatening issues first (airway, breathing, circulation), Safety concerns

• Other physical needs, then psychosocial needs

The planning phase is where you choose interventions "in the most efficient, cost-effective way" to achieve outcomes—meaning you're strategically deciding what to do first, second, and third.

• During Implementation and Evaluation: You continuously reassess as you carry out care. Patient conditions change, so priorities can shift. The nursing process allows for "constant alterations" as situations evolve.

Define evidence-based practice (EBP) and discuss the influence of EBP on clinical practice guidelines.

EBP (evidence based practice)

Term	Simple Explanation
Evidence-Based Practice (EBP)	Using the best research evidence + your clinical expertise + patient preferences to make care decisions
Why EBP Matters	Provides care that's scientifically proven to be safer and more effective, not just "how we've always done it"
Clinical Practice Guidelines	Standards of care created by reviewing current research, testing it in clinical settings, and distributing proven methods to practitioners
Who Creates Guidelines	Government agencies and professional organizations (like U.S. Preventive Services Task Force, ACOG, NAPNAP)
How EBP Influences Guidelines	Research findings are tested and used to create guidelines that advise practitioners on the current standard of care
Your Role as a Nurse	Continually seek scientific evidence, follow evidence-based guidelines, and use EBP to improve patient outcomes and confidence in decision-making

Bottom line: EBP creates the guidelines you follow in practice—ensuring you provide the safest, most effective care backed by science.

Identify methods to utilize effective evidence-based practice in nursing care.

Method	How to Use It
Systematic Problem-Solving	Ask a practice question → Search for evidence → Evaluate the evidence → Apply it to your patient
Use EBP Models	Follow structured approaches like the Johns Hopkins PET Process: Practice Question, Evidence, Translation
Incorporate Patient Preferences	Provide patients with evidence, offer professional advice, let them choose their care, and collaborate on decisions
Follow Clinical Practice Guidelines	Use guidelines that are evidence-based, scientifically proven safer/effective, and kept current
Commit to Lifelong Learning	Continually seek scientific evidence to enhance practice and increase confidence in decision-making
Draw from Multiple Sources	Use research findings, quality improvement data, and professional organization standards—not just tradition

Bottom line: Ask questions, find evidence, involve your patient, follow proven guidelines, and never stop learning!

Discuss the significance, importance, and evolution of nursing research.

Historical Significance	Nursing has long contributed to evidence-based practice—not a new phenomenon. Example: In the 1800s, Ignaz Semmelweis discovered the link between lack of handwashing and infection transmission, observing that physicians from the cadaver lab caused higher childbed fever rates than midwives
Nurses' Role in Research	Nurses play a vital role in producing research due to their unique position in healthcare. They may lead studies as principal investigators, collaborate as co-investigators, or contribute through data collection
Educational Requirements	Leading research studies requires specific skills acquired through doctoral-level graduate education and following protocols outlined by institutional review boards
Where Nurse Researchers Work	Most are affiliated with academic health sciences centers, private organizations/foundations with research departments, or government research agencies

Quality Improvement vs. Research

QI Projects: Improve patient care at the local level using current knowledge; use PDSA model; iterative methodology; seldom have outside funding; IRB approval not always required  Research Studies: Create new knowledge; follow rigid protocols; require IRB approval 1

Impact on Practice	Research creates different levels of evidence—systematic reviews and meta-analyses synthesize findings from multiple randomized controlled trials to determine treatment effectiveness 3. These findings inform clinical practice guidelines that become the standard of care 3
Quality of Evidence	Not all evidence is equal. Hierarchies and systems like GRADE help determine study quality and strength of recommendations. Randomized controlled double-blind studies are the "gold standard" for quantitative research because they introduce the least bias 4

Identify ways the nurse can participate in research activities in practice.

• Leading Research Studies

• Collaborating on Research

• Consuming and Applying Evidence

• Developing Policies and Procedures

• Implementing Evidence-Based Changes

• Quality Improvement Projects

Utilize research databases to retrieve EBP article.

1. Develop Question	Map out your clinical question first	Helps determine which keywords to use
2. Choose Database	Use healthcare databases (PubMed, CINAHL)	More efficient than Google
3. Search Strategies	• Use keywords with Boolean operators • OR = expand (synonyms) • AND = narrow • Use quotes for phrases • Spell out abbreviations • Use subject headings (more targeted)	Subject headings significantly narrow results
4. Refine Results	Too many: Add limits (language, age, dates) Too few: Remove keywords	Use filters for guidelines, age groups, study designs
5. Get Help	Consult medical librarian or use tutorials	Saves time; practice improves outcomes

Discuss the NCBON delegation tree

    🔵 LPN / NURSE

                       ▼

              🟢 ASSESS THE PATIENT

                       ▼

              🟡 IS THE TASK SAFE

                 TO DELEGATE?

                 /           \

              YES             NO

               │               │

               ▼               ▼

        🟠 DELEGATE        🔴 LPN DOES IT  TO UAP/CNA

               ▼

        🟣 SUPERVISE

               ▼

        🟢 FOLLOW UP /

          EVALUATE

               ▼

          💙 PATIENT SAFETY

Identify appropriate tasks to be delegated to the NA I and NA II

Tasks Appropriate for Delegation to Nursing Assistants

Task Category	Can Delegate to NA/AP	Cannot Delegate
Vital Signs	Routine vital signs on stable patients	Vital signs on unstable patients
Patient Hygiene	Bathing and hygiene assistance	Initial wound assessment
Mobility	Ambulating stable patients Moving and positioning patients	Ambulating unstable patients
Nutrition	Feeding and helping at mealtimes Measuring oral intake	Determining if intake is adequate
Elimination	Measuring urine output	Determining if output is adequate
Wound Care	Routine abdominal dressing changes (after initial)	First dressing change and assessment
Nursing Process	Assisting with data collection	Assessment, diagnosis, planning, evaluation

Differentiate between delegating and assigning a task.

• Assignment = doing what you're hired and paid to do within your job description 

• Delegation = RN transfers authority for a nursing duty to someone in a specific situation, requiring verification of competence

Differentiate between responsibility and accountability

Aspect	Responsibility	Accountability
Definition	The obligation to perform duties and tasks	Taking responsibility for one's actions; answering for the outcomes of your actions
In Delegation Context	The person performing the delegated task is responsible for completing it correctly	The RN who delegates remains accountable for the outcome of any task delegated to another
Who Holds It	Can be shared with or transferred to others	Cannot be transferred—stays with the RN who delegated
Focus	Doing the work assigned	Answering for the results and ensuring quality
Professional Nursing	Meeting patient health care needs through safe, effective, and caring actions	Being answerable for meeting patient health care needs; includes asking for help when unsure, safely performing tasks, reporting and documenting accurately

Commitment	Completing specific duties and interventions	Ongoing commitment to continuing education to stay current and knowledgeable
Example in Delegation	AP is responsible for taking vital signs as delegated	RN is accountable for verifying the AP's competence, appropriateness of delegation, and patient outcomes

Before Delegating:

• Verify AP has documented competency in the task

• Ensure AP is oriented to facility and unit

• Check state nurse practice act and agency job descriptions

• Observe AP perform task first time if no written documentation

What You CANNOT Delegate:

• Assessment, analysis, planning, or evaluation

• Interventions requiring clinical judgment

• Initial patient assessments

• Care of unstable/acute patients

What You CAN Delegate:

• Technical, repetitive skills with predictable outcomes

• Tasks within AP's routine job functions

• Care of stable patients

Maslow's Hierarchy of Needs

Level 5: Self-Actualization (reaching full potential)

Level 4: Self-Esteem & Love (beliefs and affections)

Level 3: Security & Belonging (emotionally and socially comfort)

Level 2: Safety (protection and freedom)

Level 1: Physiologic Needs (Bottom - Most Basic) (oxygen)

Subjective data

info based on personal opinions, feelings, or what a person tells you

Objective data

factual information that can be measured, observed, and verified

what is PICOT?

P = Population / Patient Problem - Who is your patient?

I = Intervention - What do you plan to do?

C = Comparison - What is the alternative?

O = Outcome - What outcome do you seek?

T = Time - What is the time frame? This element is not always included.

Describe how 6 QSEN focus promotes safe patient care.

 Evidence-based practice.

 Safety.

 Teamwork and collaboration.

 Patient-centered care.

 Quality improvement.

 Informatics.

 LPN/LVN participates in quality-improvement activities, such as collecting data or serving

on a QI committee.

Six EBP steps?

Ask

Search

Think critically

Measure outcomes

Make it happen

Evaluate.

Five Rights?

Right task,

circumstance,

person,

communication/directions,

supervision/evaluation.

Critical Thinking

Purposeful mental activity to evaluate ideas and solve problems

Uses reasoning and scientific method; involves analyzing data and constructing plans

Clinical Reasoning

Critical thinking applied in clinical settings

Helps make reliable observations and draw sound conclusions about patient health

Clinical Judgment

The outcome/decision from clinical reasoning

Results in evidence-based actions for safe, effective care

Problem-Solving Process

Systematic approach using scientific method

Steps: Define problem → Gather info → Analyze → Develop solutions → Decide → Implement & evaluate

Decision-Making Process

Selecting the best solution from options

Involves identifying problems, seeking information, and developing appropriate interventions

A PES statement is a three-part nursing diagnosis format that stands for:

• P = Problem (the nursing diagnosis)

• E = Etiology (the cause or related factors)

• S = Signs and Symptoms (the defining characteristics or evidence)

why is the nursing process important for quality care?

• - Collect complete information during assessment to understand the full picture of your patient's needs 

• - Analyze data accurately to identify the right problems and prioritize care 

• - Set measurable goals that let you track whether your interventions are actually working 

• - Take appropriate action based on evidence and clinical reasoning 

• Continuously evaluate outcomes to determine if care needs adjustment

why is the nursing process important to cost-effective care?

• You avoid unnecessary interventions

• You catch problems early before they become expensive complications

• You ensure care is delivered in a time-efficient manner 

• You promote patient wellness and independence, reducing long-term care needs 

6 Critical-thinking characteristics

• Curiosity

• Truth-seeking

• Open-mindedness

• Self-confidence

• Attentive listening

• Reflection

Reflective Practice

Processing and consolidating learning about caregiving situations through verbal and written reflection

Engage in clinical post conferences, debriefing, and journaling to analyze your clinical experiences

Redection-on-practice

Contemplating a situation after patient care to consider what was successful and unsuccessful

Analyze at the end of your shift why you acted in specific ways and whether your nursing actions were successful

Reflection-in-Practice

Understanding the patient situation while care is occurring; thinking in "real time"

Continuously assess and observe patient responses during interventions and adjust care accordingly

Recognizing Strengths

Identifying and reinforcing things that went well and why

Don't focus only on deficits—acknowledge successful interventions to develop confidence and expertise

Identifying Growth Areas

Recognizing knowledge deficits and shortcomings in performing skills

Use awareness of limitations to guide learning priorities and ask for help when needed

Managing Biases

Recognizing both conscious and unconscious biases in caregiving

Enact habits of reflection and self-awareness to identify and manage personal biases that affect care

Ethical Self-Awareness

Understanding your personal values and how they influence patient care

Develop ethical comportment through experience, practical learning, and grounding in personal values

Learning From Others

Actively considering patients described by classmates and peers

Participate in group discussions and share experiences to multiply exposure to different patient issues

Professional Growth

Using reflection as a mark of professionalism and pathway to skillfulness

Foster personal habits of reflection throughout your career to continue learning from experiences

Concept maps

can help organize related patient data, identify relationships, and visualize

priorities.

Validate obtained information:

make sure the information you collect is correct.

Think purposefully:

use reasoning and logical thought to decide whether your actions are

appropriate for optimal patient care.

CJMM + Nursing Process Connection

 Assessment → Recognize Cues.

 Data analysis/Diagnosis -→Analyze Cues + Prioritize Hypotheses.

 Planning → Generate Solutions.

 Implementation → Take Action.

 Evaluation → Evaluate Outcomes.

Describe the evidence-based practice process

and list the six steps. ASKMME

 Step 1 - Ask the burning question: 'Why do we do it that way?' or 'How could we do that

better?'

 Step 2 - Search and collect the most relevant and best evidence available, including

computer databases.

 Step 3 - Think critically: appraise the evidence for validity, relevance to the situation, and

applicability.

 Step 4 - Measure outcomes before and after the change.

 Step 5 - Make it happen: implement the practice change.

 Step 6 - Evaluate the practice change.

Delegation Process - 4 Steps from the NCBON Decision Tree

• Step 1: Assessment and Implementation

• Step 2: Communication

• Step 3: Supervision and Monitoring

• Step 4: Evaluation and Feedback

Levels of Evidence Quality 1

Systematic Reviews; strongest

Levels of Evidence Quality 2

Randomized Controlled Trials

Levels of Evidence Quality 3

Quasi-Experimental Studies

Levels of Evidence Quality 4

Evidence from Well-Designed Case- Control or Cohort Studies

Levels of Evidence Quality 5

Systematic Review of Qualitative or Descriptive Studies

Levels of Evidence Quality 6

Qualitative or a Single Descriptive Study

Levels of Evidence Quality 7

Expert Opinion; weakest

Scope of Practice 7 components

• Participating in assessment

• Recording and reporting results of assessment

• Participating in implementing health care plan developed by RN

• Assigning or delegating nursing interventions to other qualified personnel

• Participating in teaching and counseling of patients as assigned by RN

• Reporting and recording nursing care rendered and patient’s response to care

• Maintaining safe and effective nursing care