NRSG 126 Midterm

Clinical Judgement in nursing

Critical thinking and clinical reasoning

Insight into egocentricity and sociocentricity

Thinking of the greater good and not just thinking of yourself. Knowing when you are thinking of yourself (egocentricity) and when you are thinking or acting for the greater good

At-risk populations

A groups of people who share a sociodemographic characteristics, health/family history, stages of growth/development, exposure to certain events/experiences that cause each member to be susceptible to a particular human response.

Associated conditions

Medical diagnoses, diagnostic/surgical procedures, medical/surgical devices, or pharmaceutical preparations

Dependent nursing intervention.

Require a prescription or order before they can be performed

Inductive

Notice cues, make generalizations, create hypothesis

Deductive

Top down, general standards, make rules. d=data

What to know when critical thinking with a patient with delirium?

What there normal is, history, what daily life looks like

First prioritization

ABC

Cardiac arrest priority

CAB

Maslow’s Hierarchy level 1

Physiological needs

Maslow’s Hierarchy level 2

Safety & security

Maslow’s Hierarchy level 3

Love and belonging

Maslow’s Hierarchy level 4

self-esteem

Maslow’s Hierarchy level 5

Self-actualization

Assessment

Involves discovery, decision making, critical thinking skills, and data collection.

Diagnosis

Using the data, what is the problem? Analyze data collected in the assessment. Identify health problems, risks & strengths.

Nursing diagnosis

A clinical judgement about client responses to an actual or potential health problem or life processes

Medical diagnosis

A clinical judgement about client responses to an actual or potential health problem or life processes

Collaborative problem

A actual or potential complication that nurses monitor to detect a change in client status

Planning

Where (SMART) goals and outcomes are formulated that directly impact client care. Write PoC

Implementation

Carrying out or delegating nursing interventions. Putting the plan into action

Evaluation

Process of comparing pt responses to preselected outcomes to determine whether goals have been met.

Acute before…

chronic

Actual before…

potential

Least invasive before…

most invasive

Safety…

first

Where we gather data

Kardex, chart, Meditech, nursing documentation, allied health, reports

Assessment- Prepare

Data, safety, assessment type

Assessment- Adjust

Older adult, clients needs

Assessment - Complete

Start with POCRA and QPA, inspect patient, auscultation, palpation, percussion

Disability

LOC, pain, ability to mobilize, strength. Look for/ consider causes; consider immediate treatment

Environmental Exposure

Equipment, safety, drains/dressings, client needs. Look for/ consider causes; consider immediate treatment

Assessment - Conclude

Report & document findings

Reasons fro documentation

Communication, safe and appropriate care, professional and legal standards

SBAR

Situation, background, assessment, recommendation

Intellectual humility

Recognizing your intellectual limitations and abilities

Verbal Communication

an exchange of information using words understood by the receiver in a way that conveys professional caring and respect

Nonverbal communication

includes facial expressions, tone of voice, pace of the conversation, and body language. more powerful than the verbal message and can have a tremendous impact on the communication experience

Assertive communication

a way of conveying information that describes the facts and the sender’s feelings without disrespecting the receiver’s feelings.

Differences in cultural beliefs

The norms of social interaction vary greatly in different cultures, as well as the ways that emotions are expressed.

Physical barriers for nonverbal communication

When possible, it is best to deliver important information to others using face-to-face communication so that nonverbal communication is included with the message.

Preinteraction Phase

reviews the medical record or other data in preparation for the orientation phase

Orientation phase

A brief encounter where the nurse addresses the client by name and then introduces themself to the client, including their name and role

Working phase

The majority of a nurse’s time is spent in the working phase with a client. Communication during the working phase should be client- focused and based on what is important to the client.

Termination Phase

occurs at the end of a communication session. Generally occurs when the goals of the therapeutic communication session have been met. Should inform the client that termination is approaching rather than abruptly ending the interaction

Thereputic communication

The purposeful, interpersonal information-transmitting process through words and behaviors based on both parties’ knowledge, attitudes, and skills, which leads to client understanding and participation

Active listening

Communicating verbally and nonverbally that we are interested in what the other person is saying while also actively verifying our understanding with the speaker

Expressive aphasia

Difficulty putting thoughts into words

Aphasia

Inability to produce/understand language

TIP (Trauma Informed Practice)

Includes safety, trust & transparency, peer support, empowerment & voice & choice, collaboration & mutuality, and cultural & historical & gender issues

Implicit bias

Unknowingly

Explicit bias

knowingly/ recognized bias

Ethnocentrism

You should take that crucifix off f your wall, it’s not right

Stereotypes

Kelowna people are super snotty

Prejudice

The thought: I don’t want to hire a young woman… she may get pregnant.

Discrimination

The action: I am not hire the young woman.

Dementia

structural and physiological changes within the brain are normal with aging.

Delirium

An acute, reversible state of disorientation, inattention, and confusion

Depression

A mood disorder characterized by feelings of sadness and despair. Last 2+ weeks and is not a normal part of aging.

Mini mental (MMSE) score of 24/24

Cognitively impairment

GSD

Geriatric depression scale

Receptive aphasia

Difficulty in understanding what is being communicated to them.

Acceptance

Isn’t necessarily the same thing as agreement; it can be enough to simply make eye contact and say, “Yes, I hear what you are saying.”

nonthereputic response

Often block the client’s communication of the feelings or ideas.

Global aphasia

Caused by injuries to multiple language-processing areas of the brain.

Broca’s aphaisa

Often understand speech and know what they want to say, but frequently speak in short phrases that are produced with great effort

Health Insurance Portability and Accountability Act (HIPAA)

Provides standards for ensuring privacy of client information that are enforceable by law

Introduction

Introduce your name, role, and the agency from which you are calling.

Situation

Provide the client’s name and location, why you are calling, recent vital signs, and the status of the client.

Background

Provide pertinent background information about the client such as admitting medical diagnoses, code status, recent relevant lab or diagnostic results, and allergies.

Assessment

Share abnormal assessment findings and your evaluation of the current client situation.

Request/recommendations

State what you would like the provider to do, such as reassess the client, order a lab/diagnostic test, prescribe/change medication, etc.

Repeat back

If you are receiving new orders from a provider, repeat them to confirm accuracy. Be sure to document communication with the provider in the client’s chart.

Handoff reports

A transfer and acceptance of client care responsibility achieved through effective communication

Bedside handoff reposts

increase client safety, as well as client and nurse satisfaction, by effectively communicating current, accurate client information in real time.

Professional communication

Certain expectations in terms of your professional conduct specifically in terms of how you communicate

Level of formality

Different than the informal communication that you may engage in with your friends and family. It also applies to your verbal and written communication including emails

Principles of professional

being truthful, accurate, clear, and both concise and comprehensive

Cultural humility

A humble and respectful attitude toward individuals of other cultures that pushes one to challenge their own cultural biases, realize they cannot know everything about other cultures, and approach learning about other cultures as a life-long goal and process

Intimate

0-18in

Personal

18in-4ft

Social

4-10 ft

Public

10+ft

You can do it!

Yes I can!

Agesim

The stereotyping and discrimination against individuals or groups on the basis of their age

Gerontology

The study of the social, cultural, psychological, cognitive, and biological aspects of aging.

Geriatrics

Old age

Older adult life changes

Integrity vs despair, retirement, social isolation, modified living environment

Health and healing changes with aging

Physiological, cognitive, psychosocial, spirituality

Mind

Focusing on maintains mental activity, managing dementia, treating delirium, and treating depression.

Mobility

Maintains ability to walk, maintain balance, and prevent falls.

Medications

Reducing poly-pharmacy and build awareness of harmful medications.

Multi-complexity

Managing a variety of concerns and assessing living conditions.

Matters most

Coordinating advanced care planning, managing goals, and make sure that the care plan matches the patients needs.

Spirituality

A dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence and experience relationship to self, family, others, community, society, nature, and the significant or sacred.

Transcendence

An understanding of being part of a greater picture or of something greater than oneself, such as the awe one can experience when walking in nature.

Suffering

Occurs at physical, mental, emotional, and spiritual levels