Module 5 - Think like a Nurse: Caputi Method Step 1

What are the 4 jobs of tools in nursing?

1) Help nurses assess patients (e.g., pain scale)

2) Record vital signs (e.g., charting)

3) Maintain health records (e.g., flowsheets)

4) Handle tasks efficiently (e.g., HTT assessment guide)

Tool example: assessing patients

A pain scale.

Tool example: recording vital signs

Charting (e.g., the VS Record).

Tool example: maintaining health records

Flowsheets (e.g., the Unit Flow Sheet).

Tool example: handling tasks efficiently

The HTT assessment guide.

Two assessment guides shown on the slides

Bedside systems review and symptoms analysis

What are Cognitive Guidance Tools?

Learning activities that help you learn the cognitive (thinking) process.

[Cognitive Guidance Tools] How many are there per competency?

One for each competency.

Cognitive Guidance Tools Purpose

"Tools" to help learn how to "think like a nurse."

Reflection-IN-action

Happens in real time while the nurse is providing care, in response to the patient's changing condition, unexpected happenings, and patient reactions/response.

Reflection-ON-action

Happens when the nurse mentally reviews what happened to determine what went right or wrong; learning from experience to improve thinking abilities.

In vs On

IN = during care, in real time. ON = afterward, reviewing what happened.

Name of Step 1 and its nursing process match

Getting the Information = the Assessing step of the nursing process.

Caputi's idea about information

Nurses must be information seekers: they dig deeper to discover all relevant information about a situation or patient care need.

Name the 5 competencies

a) Determining important information to collect

b) Scanning the environment

c) Identifying signs and symptoms

d) Assessing systematically and comprehensively

e) Ensuring accurate information

Important Info Definition

Collecting information (data) necessary to provide safe care for a patient and required for close monitoring of a patient.

Name 4 sources of information

1) Another nurse (during shift report)

2) The chart

3) The Kardex

4) MAR

What is forethought?

the ability to think ahead.

What is clinical forethought?

Thinking ahead in a clinical situation, which helps the nurse create a plan that is accurate.

Clinical forethought: what do you think about?

1) Situation

2) Background

3) General knowledge about medical conditions

4) Patient-specific information

Scanning Definition

Scanning the immediate surroundings to have environmental awareness: using your senses to determine meaning, identify any dangers, then use this information to make decisions.

Scanning One-word summary

Observe.

3 things scanning helps you do

Determine meaning, identify dangers, make decisions.

What does the nurse observe?

1) Equipment

2) Location of patient (bed, chair, etc.)

3) Position of patient

4) Visitors or other people present

What are the 4 senses used?

See, hear, smell, feel.

On-shift checklist: first 5 items

1) Quick visual assessment of patient's appearance

2) Patient armband on

3) Call bell in reach

4) Side rails up

5) Bed in lowest position with brakes on

On-shift checklist: last 5 items

6) O2/suction functional with correct equipment

7) IV (site, correct fluid, correct rate, etc.)

8) Risk concerns (restraints, entanglement risk, patient position, clutter at bedside)

9) Immediate needs assessed

10) "Is there anything you need before I leave?"

Signs & Symptoms Definition

The cognitive process used by a nurse to recognize cues to collect objective and subjective data in a situation.

What are clinical manifestations?

Objective (signs) and subjective (symptoms) data together in a clinical situation.

Signs = ?

Objective data.

Symptoms = ?

Subjective data.

Objective data

Measurable or observable by the nurse.

Subjective data

From the patient, a family member or others; not objectively measured.

What 3 factors decide which assessments a nurse makes?

1) The nurse's knowledge base

2) Personal characteristics of the nurse

3) Context of the individual patient and the health care environment

[Signs & Symptoms] Factor 1: knowledge base

General knowledge (school, textbook).

[Signs & Symptoms] Factor 2: personal characteristics

Pre-conceived attitude and self-confidence.

[Signs & Symptoms] Factor 3: context

The setting of the individual patient and health care environment.

Systematic Definition

Ensuring the data collected is complete so the nurse can identify any occurring or potential problems and develop an appropriate plan of care.

What does an appropriate plan of care aim for? (2)

1) Safe patient care

2) Improving patient outcomes

What does an appropriate plan address?

Occurring problems and potential problems.

Goals of the care plan

Improve the patient situation; prevent a worsening situation.

Systematic means…

Organized, methodical, follows a structured process or system.

Comprehensive means…

Complete and thorough, covering all or nearly all aspects of something.

[Systematic] patient having pain - what is obvious?

The patient tells you they have pain.

[Systematic] Pain example: what is NOT so obvious?

Patient safety and a safe environment.

Safe environment factors

Clutter; height of bed; call bell in reach; gloves available; sink for hand hygiene/hand sanitizer; sharps container; others.

Safe patient factors

Position; nonslip socks; tubes; equipment; other factors.

What does PQRSTUA stand for?

Provokes/Palliates, Quality, Radiates/Region, Severity, Time, Understanding, Associated symptoms.

Provokes/Palliates

what causes the pain/symptoms? Anything make it better or worse?

Quality

how would you describe the pain/symptom (e.g., sharp, dull, burning)?

Radiates/Region:

does the pain move to another location or stay in one spot?

Severity:

rate the pain 0-10 (0 = no pain, 10 = the most). The scale is usually for adults and may vary with pain tolerance, culture, gender, etc.

Time:

when did the pain start? How long does it last? Sudden or gradual onset?

Understanding:

what does the client think is causing the symptoms?

Associated symptoms:

are there any associated symptoms?

Accurate Info Definition

Verifying that the information collected is accurate, provided accurately, and communicated correctly.

3 things to verify about information

1) accurate

2) provided accurately

3) communicated correctly.

'Shift report, chart, Kardex, MAR' belongs to which competency?

Determining important information to collect.

'Using your senses; environmental awareness' belongs to which competency?

Scanning the environment.

'Objective and subjective data' belongs to which competency?

Identifying signs and symptoms.

'Organized, methodical and complete' belongs to which competency?

Assessing systematically and comprehensively.

'Does it make sense? If not, verify' belongs to which competency?

Ensuring accurate information.

Which competency uses PQRSTUA?

Assessing systematically and comprehensively (and pain assessment).

Which competency uses the on-shift checklist?

Scanning the environment.

Which competency uses clinical forethought?

Determining important information to collect.

Which competency checks BP cuff size and recheck?

Ensuring accurate information.