257 Exam 2

characteristics of nurses as good thinkers include:

-creative thinking
-critical thinking
-clinical reasoning
-clinical judgement
-reflection

describe the Paul-Elder critical thinking (reasoning) model

intellectual standards must be applied to elements of reasoning to develop intellectual traits

name the Paul-Elder elements of reasoning

-purpose
-questions
-points of view
-information
-inferences
-concepts
-implications
-assumptions

critical thinking is an

umbrella term

name the factors contributing to critical thinking

-critical thinking characteristics (attitudes / behaviors)
-theoretical and experiential knowledge (intellectual skills / competencies)
-interpersonal skills / competencies
-technical skills / competencies

nurses are always thinking:

-ahead (anticipating)
-in action (dynamic processing)
-back (reflecting)

critical thinking and clinical reasoning are processes resulting in

clinical judgement (conclusion, decision, or opinion)

what is the foundation for clinical reasoning?

the nursing process

assessment includes

assess the patient to be sure environment is safe and that information is accurate, complete, and up-to-date

diagnosis includes

identify problems, issues, and risks that must be managed

planning includes

-identify interventions individualized to the patient
-determine desired and undesired outcomes (benefits and risks) of interventions
-plan for safety, comfort, and privacy

implementation and evaluation includes

-perform interventions, closely monitoring (assessing) patient responses and fine-timing approached as needed
-record interventions and patient responses to the interventions
-update the plan of care as needed

name the steps in the nursing process

-assessment
-diagnosis
-planning
-implementation
-evaluation

name the 3 types of nursing diagnoses

-problem-focused
-risk diagnosis
-health promotion

describe a problem-focused diagnosis and how to write it

-a real problem
-should have related factors (related to) and defining characteristics (as evidenced by)
-"problem focused diagnosis related to \___ (related factors) as evidenced by \___ (defining characteristics)."

describe how to write a risk diagnosis

-should include risk factors as written by AEB, no related to
-"risk for \___ as evidenced by \___ (risk factors)."

describe how to write a health promotion diagnosis

should have defining characteristics (AEB), no related to

name the 13 NANDA domains

-health perception and management
-nutritional metabolic
-elimination/exchange
-activity/rest
-cognitive perceptual
-self-perception/self-concept
-role relationship
-sexuality reproductive
-coping-stress tolerance
-life principles/value-belief pattern
-safety protection
-comfort
-growth and development

which of the NANDA domains is the largest?

domain 11: safety protection

what does clinical reasoning consist of?

analyzing, synthesizing, reflecting, drawing conclusions

what is a nursing diagnosis?

-clinical judgement about a problem
-can include individual, family, or community (experiences or responses)
-provides a basis for nursing interventions
-helps achieve outcomes and deal with human responses

what is a medical diagnosis?

-medical determination of a disease or syndrome
-performed by a physician
-focus on disease process (physical, genetic, environmental)
-deals with disease or medical condition or pathology

what is the main focus of a nursing diagnosis?

-human responses (the impact of disease, trauma, or life changes upon patients, families, and communities)
-problems with functioning independently
-quality of life issues

what is NIC?

A comprehensive standardized classification of interventions that nurses perform

what is NOC?

-provides terminology for the outcomes identification and evaluation steps of the nursing process
-responses to interventions, not expected goals

when creating outcomes and/or goals, they must be

measurable

what are the purposes of a plan of care?

-directs care and documentation
-promotes communication among caregivers, thereby facilitating continuity of care
-creates a record that can be used later for evaluation, research, and legal reasons
-provides documentation of health care needs for Medicare, Medicaid, and other insurances

name the major care plan components

E: expected outcomes
A: actual and potential problems
S: specific interventions
E: evaluation/progress notes

outcomes direct

interventions (NOCs are the responses of NICS)

name the purposes of a plan of care

-attending to urgent priorities
-clarifying expected outcomes
-deciding which problems must be recorded
-determining individualized nursing interventions
-making sure the plan is adequately recorded

goals and objectives refer to

intent

outcomes and indicators refer to

results

goals and outcomes should be:

S: specific
M: measurable
A: agreed upon by all parties
R: realistic
T: time-bound

what is a nursing intervention?

any treatment, based upon clinical judgement and knowledge, that a nurse performs to enhance patient outcomes in response to a nursing diagnosis

nursing interventions:

-include both direct and indirect care interventions
-include patient education, care coordination, and referral activities
-include health promotion as well as problem management interventions
-reflect the nursing process in that assessment/ongoing monitoring and evaluation activities are also included

the nursing diagnosis is aimed at:

altering the related factors (etiology), and if that is not possible, aimed at treating the defining characteristics (signs/symptoms)

name the bases for selection of nursing interventions

-the research/evidence base of the intervention
-acceptability of the intervention to the patient
-capability of the nurse to perform the intervention
-feasibility of performing the intervention

what is a physician-initiated treatment?

an intervention initiated by a physician in response to a medical diagnosis but carried out by a nurse in response to a "doctor's order"

give some examples of physician-initiated treatments

-medication orders
-IV therapy orders
-diet orders
-activity orders
-diagnostic test orders

documentation of implementation includes:

-ongoing assessments
-status of patient problems
-interventions and nursing care performed
-patient response
-safety

What does SBAR stand for?

Situation
Background
Assessment
Recommendation

how can errors in implementation be prevented?

-monitoring patient status and response to care
-check for care omissions
-make corrections or safety nets to reduce incidents

what is the key to excellence in nursing?

evaluation

what does evaluation do?

explains what happened during the nursing process

evaluation is:

answering questions

name and describe the 3 types of evaluation

-outcome evaluation: based on focus results
-process evaluation: based on how care was given
-structure evaluation: focus on setting

how is patient education important to the client?

-helps reduce health care costs
-improves health outcomes

describe the teaching process

-assess your learner
-develop a teaching diagnosis
-plan your learning objectives, content, and teaching methods
-interventions: present your teaching
-evaluation: did the learner understand?

ineffective communication is a root cause of nearly \___ percent of all sentinel events reported

66

what is communication?

the process by which information is exchanged between individuals, departments, or organizations

communication is effective when it

permeates every aspect of an organization

name and describe the standards of communication

-complete: communicate all relevant information
-clear: convey information that is plainly understood
-brief: communicate the information in a precise manner
-timely: offer and request information in an appropriate timeframe, verify authenticity, and validate or acknowledge information

name some strategies for information exchange

-SBAR
-call-out
-check-back
-handoff

SBAR provides

A framework for team members to effectively communicate information to one another

describe the components of SBAR

-situation: what is going on with the client?
-background: what is the clinical background or context?
-assessment: what do I think the problem is?
-recommendation: what would I recommend?

what is the purpose of SBAR?

a model for effective transfer of information by providing a standardized structure for concise factual communications between health professionals

describe how to use SBAR:

before speaking with a physician or other health professional about a patient problem, assess the patient yourself, read the most recent physician progress and nursing notes, and have the patient's chart available

what is a call-out?

-a strategy used to communicate important or critical information
-it informs all team members simultaneously during emergency situations
-it helps team members anticipate next steps

describe a check-back

-sender initiates message
-receiver accepts message, provides feedback confirmation
-sender verifies message was received

what is a handoff?

The transfer of information (along with authority and responsibility) during transitions in care to include an opportunity to ask questions, clarify, and confirm.

name some communication challenges

-language barrier
-distractions
-physical proximity
-personalities
-workload
-varying communication styles
-conflict
-lack of information verification
-shift change

what is therapeutic communication?

A dynamic interactive process consisting of words and actions, and entered into by a clinician and client for the purpose of achieving identified health-related goals.

name the modes of communication

-verbal: words/what we say (7%)
-para-verbal: tone/how we say it (38%)
-non-verbal: our expressions and actions (55%)

what does the sender do in the communication process?

initiates the communication process by encoding the message and selecting the channels for message delivery

what is the message in the communication process?

-what is actually said/written/body language
-how words are transmitted (channel)

what is the receiver in the communication process?

listener/decoder/perception of intention

name some barriers to communication

-stereotyping
-agreeing/disagreeing
-being defensive
-challenging
probing
-testing
-rejecting
-changing topics
-unwarranted reassurance
-passing judgement
-giving common advice

name the styles of communication

-assertive
-submissive
-aggressive

name the types of communication builders

-nonverbal
-paraverbal
-verbal
-environmental

name the types of communication blockers

-nonverbal
-verbal
-environmental

what is empathy?

-understanding another's feelings or perceptions
-embracing attitude of another person
-acknowledging importance of another's words or feelings
-interprets feelings without inserting own

true or false: empathy is the same as sympathy

false

what is active listening?

-mindful listening
-paying attention to verbal and nonverbal cues
-noting congruence
-absorbing content and feeling
-listening for key themes
-being aware of own biases

name some blocks to active listening

-rehearsing
-being concerned with oneself
-assuming
-judging
-early identification
-filtering
-getting off track/distraction

describe physical attending

-face the person squarely
-adopt an open posture
-lean toward the person
-maintain good eye contact
-try to be relatively relaxed

what is silence?

-encouraging patient to communicate
-allowing time to think about what has been said and what to say next

name some common mistakes with communication

-giving advice
-minimizing or discounting feelings
-deflecting
-interrogating
-sparring

name some barriers to therapeutic communication

-failure to listen fully
-improperly decoding intended message
-placing nurse's needs above the patient's

name the 3 C's of nurse-patient communication

-confirm feelings and thoughts
-clarify information
-collaborate to evaluate healing

name the therapeutic relationship characteristics

-intellectual and emotional bond
-respects client as an individual
-respects client confidentiality
-focuses on client wellbeing
-based on mutual trust, respect, acceptance

name some skills for the therapeutic relationship

-listen actively
-help identify client's feelings
-be empathetic, honest, genuine, credible
-use ingenuity (the quality of being clever, original, inventive)
-be aware of cultural differences
-maintain confidentiality
-know your role and your limitations

name some strategies for establishing trust

-include patient in discussion and decisions
-listen more than you talk
-avoid distractions
-follow through on promises
-respect confidentiality
-be truthful, even if it isn't what they want

tips for communication with elderly

-approach patient with respect
-position yourself near the patient
-speak clearly and slow down
-actively and systematically inquire into problem (have a plan)
-pace the interview
-pay attention to nonverbals
-touch and eye contact
-be realistic but hopeful

verbal handoff occurs:

any time one health care provider transfers the responsibility for the care of a patient to another

verbal handoff is critical in:

creating a shared mental model around the patient's condition, creates situational awareness and helps to minimize errors

according to ANA standards, the nursing process is:

a critical thinking model used to promote a competent level of care, encompasses all significant actions taken by RNs and forms the foundation for decision making

applying nursing process principles helps the nurse to:

-organize and prioritize patient care
-keep the focus on what's important: patient safety, health status, quality of life, and how the patient is responding to care
-form thinking habits that help you gain the confidence and skills needed to think through clinical, theoretical, and testing situations
-use EHR and decision-support systems as they are meant to be used: as guides that boost your brain, not replace it

the nursing process is said to be

dynamic

what are the main goals of nursing?

-prevent illness and promote, maintain, or restore health (in terminal illness, a peaceful death)
-maximize sense of wellbeing, independence, and ability to function in desired roles (as defined by the patient)
-provide cost-effective, efficient care that pays attention to individual biological, spiritual, and cultural needs
-continually work to improve patient outcomes, care practices, and consumer satisfaction

what is clinical reasoning?

a specific term that refers to the assessment and management of patient problems at the point of care

what is critical thinkning?

a broad term that includes clinical reasoning about other clinical issues such as promoting teamwork and streamlining work flow

critical thinking and clinical reasoning are forms of what kind of thinking?

outcome-focused

true or false: a nurse can make a medical diagnosis

false

describe "assess, re-assess, revise, record"

-assess patients before you perform nursing actions
-re-assess them to determine their responses immediately after you perform nursing actions
-revise your approach if needed
-record patient responses and any changes you made in the plan

the nursing process phases are described as:

fluid and interrelated

an accurate nursing diagnosis depends on:

an accurate and complete assessment

accurate planning depends on:

accurate nursing diagnosis

planning guides:

interventions that are performed during implementation

comprehensive evaluation involves examining:

what happened in all of the other steps of the nursing process

the holistic approach of nursing helps to ensure that interventions are:

tailored to the individual, not just the disease