Week 6 - 9 PNC121

Research

It is a systematic process in which questions that generate knowledge are asked and answered.

Nursing Research

is a systematic examination of phenomena important to the nursing discipline, as well as to nurses, their patients, and families. Its purpose is to expand the knowledge base for practice by answering nurses' questions. addresses a range of issues related to actual and potential patient populations and to individual and family responses to health problems.

quantitative nursing research

is the investigation of nursing phenomena that can be precisely measured and quantified. Examples are pain severity, rates of wound healing, and body temperature changes.

Qualitative nursing research

Poses questions about nursing phenomena that cannot be quantified and measured. Examples that may be used in nursing research include ethnography, phenomenology, grounded theory, participatory action research, interpretive descriptive research, and narrative inquiry.

Nursing Theory

is to organize knowledge about nursing to enable nurses to use it in a professional and accountable manner

Research Literacy

An essential competency for evidence-informed practice; It is the ability to locate, understand and critically evaluate empirical literature for application in practice

Evidence-Based Nursing

The evidence-based nurse knows what needs to be done, how it should be done, and the evidence that supports his or her practice.

Evidence-Informed Practice (EIP)

Continuous, interactive process involving the explicit, conscious, and judicious consideration of the best research evidence available to make collaborative decisions between the health care team and the patient and family when providing patient care

Steps of the Evidence-Informed Practice Process

1. Ask a question that clearly presents the clinical problem, using the PICOT format.

2. Identify and gather the most relevant and best evidence.

3. Critically appraise the evidence.

4. Integrate all evidence with clinical expertise, patients' preferences, and patients' values to make a practice decision or change.

5. Evaluate the outcome of the practice decision or change.

medical diagnosis

the identification of a disease condition on the basis of a specific evaluation of physical signs and symptoms, the client's medical history, and the results of diagnostic tests and procedures

Clinical Manifestations

· Signs evident upon examination
· Symptoms identified through client history and interview

Medical or Surgical Interventions

Interventions ordered based on medical diagnosis, e.g. medications, catheterization, wound care, g-tube insertion

Nursing Assessments

focus on the patient's response to health problems

Common Nursing Diagnoses/Nursing Problem Statements

· Nursing diagnoses or problems can include an actual problem or an at-risk problem that affects the patient
· Includes a diagnostic label of the problem e.g., impaired physical mobility

Nursing Interventions

Activities that the nurse plans and implements to help the patient achieve identified outcomes

Independent Nursing Interventions

actions that a nurse initiates without supervision or direction from others. Such as bathing, ongoing assessments, making referrals to other health care professionals, initiating wound care, raising an edematous leg

Dependent Nursing Interventions

actions that require an order from a physician or another health care professional. · E.g. medication administration, specific diet, test and treatments

Critical Thinking

is a complex phenomenon defined as a process acquired through learning and experience.
· Requires purposeful and reflective reasoning.

Importance of critical thinking in nursing

· allows you to test and refine nursing approached, learn from successes and failures, apply nursing research findings, and ensure holistic patient-centred care.
· Nurses recognize that an issue exists, analyzes information about the issue, evaluates information and draws conclusions

3 levels of critical thinking in nursing

Basic, Complex, Commitment

5 components of critical thinking

· specific knowledge base, experience, critical thinking competencies, attitudes and standards

General Critical Thinking Competencies

scientific method, problem solving, decision making

The Scientific Method

1. Identification of the problem

2. Collection of data

3. Formulation of a research question or hypothesis

4. Testing of the question or hypothesis

5. Evaluation of the results of the test or study

Problem Solving Process

· Involves working through a process of recognizing, clearly defining and then solving a problem
· The nurse obtains information that clarifies the nature of the problem and evaluates possible solutions, then possibly in collaboration with other health care professionals, chooses the best one to implement, and continues to monitor outcomes to determine the effectiveness of the solution

Decision Making

· The product of critical thinking that focuses on problem resolution

Decision making process

identifying the problem, assessing all options, weighing each option against a set of criteria, considering the consequences and then making a final decision

Specific Critical Thinking Competencies

diagnostic reasoning, clinical inference, and clinical decision making

Diagnostic reasoning

the process of determining a patient's health status after making behavioural and physical observations and after assigning meaning to the behaviours, signs and symptoms exhibited by the patient

Clinical Inference

part of diagnostic reasoning and refers to the process of drawing conclusions from related pieces of evidence.

Clinical Reasoning

· nurses collect cues, process the information, come to an understanding of a problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process.

Clinical Decision Making

recognizing the most important aspects of a clinical situation, interpreting their meanings, and responding appropriately

How does critical thinking influence clinical judgement and clinical decision making?

· Critical thinking is central to both these processes.
· It helps to help choose the best action to meet a desired goal

How do nurses apply critical thinking to nursing?

· Nurses apply the nursing process as a critical thinking competency by assessing , diagnosing, planning, implementing and evaluating patient care

Reflective Practice

a tool for developing critical thought that uses the process of reflection to purposefully recall a situation in order to discover its purpose or meaning.

Reflective writing

gives you the opportunity to describe a clinical experience in your own words, explore your perceptions and understanding of the experience, and become more aware of how you use clinical decision-making skills.Helps you monitor your competency in nursing practice.

Concept Mapping

· Technique that uses a graphic depiction of linear and nonlinear relationships to represent critical thinking
· Allows one to organize (and reorganize) and connect information, making meaning of the concepts

3 steps of concept mapping

5 steps of the nursing process

1. Assessment

2. Diagnosis

3. Planning

4. Implementation

5. Evaluation

Assessment Phase

· Systematic collection of data to determine the client's current and past health and functional status

Diagnosis Phase

Analyze data
Identify health problems, risks, and strengths
Formulate diagnostic statements
the nurse's perspective on the appropriate focus for the patient

Planning Phase

Creations of a formal plan, prescribes strategies and alternatives to attain the expected outcome.

Intervention Phase

A phase when The plan of care would be carried out.

Evaluation Phase

compares the patient's current health status with the desired outcome,

Types of Data

subjective and objective

Subjective Data

are obtained through the health history and the nurse's questions. Patient's verbal descriptions of their health concerns

Objective Data

are observations or measurements of a client's health status, based on an accepted standard (Celsius, kilograms, known characteristics of behaviour such as anxiety or paranoia).

primary source of data

‐Information obtained from the patient (only)

secondary source of data

data acquired from another individual (such as a family member, health care team, or medical records)

tertiary source of data

literature, nurse's experience

Methods of Data Collection

Nursing Health History, Family history, physical exam including observation of client behavior, diagnostic and laboratory data

Body system method

· data is clustered under body systems such as cardiovascular, respiratory, integumentary, etc.

Interpreting Assessment Data:

nurses think about the assessment information, they determine the presence of abnormal findings, validation of assessment data is necessary to avoid making incorrect inferences.

Components of Nursing Diagnosis

diagnostic label, related factors, "as evidenced by" portion

Diagnostic Label

describes the essence of the client's response to health condition in as few words as possible

related factor

A condition or etiology identified from the client's assessment data. Associated with the clients actual or potential response to the health problem and can be altered though the use of nursing interventions

"As evidenced by" portion

connects the diagnoses to the signs and symptoms

Establishing Goals and Expected Outcomes

• Statements of client behavior or physiological responses that a nurse sets to achieve problem resolution

• Provide a clear focus for the type of interventions necessary

• Aim, intent or end

• When the goals and outcomes are met, the client's health problems are resolved

client-centered goal

specific and measurable behavior or response that reflects a client's highest possible level of wellness and independence in function

short-term goal

objective behavior or response that the client is expected to achieve in a short time, usually less than 1 week or in acute care may be in just a few hours

long-term goal

expected to achieve over a longer period, several days, weeks, or months.

Client safety

The aim of the Canadian health care system is to provide quality care and access for all.
This includes the following:
· Cultural Competence, Safety and Humility
· Evidence-Informed Practice (EIP)
· Quality and Patient Safety
· Quality Workplaces
· Improved Patient Outcome Metrics

Quality Improvement

Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.

Risk Management

· a system of ensuring appropriate care by identifying potential hazards and preventing harm from occurring.

Patient Safety Incidents

An event or circumstance that could have resulted, or did result in unnecessary harm to a patient
· Harmful incident - resulted in patient harm
· Near miss- did not reach the patient
· No-harm incident - reached the patient but did no harm

Factors Affecting Patient Safety:

· Patient and Provider Factors
· Task Factors
· Technology Factors
· Environmental Factors
· Organizational Factors

Risk Factors at Developmental Stages

· Infant/toddlers - poisoning
· Toddlers/preschoolers - not restrained properly in vehicles, drowning
· Adolescents - risk taking behavior, substance use
· Adults - accidents due to alcohol or drugs
· Older people - age related changes

Prevention of falls

room environment safe - call light within reach at all times, bed in low position, wheels locked, side rails, visual cues to alert staff (label doors, wristbands)

Medication Errors

any event that could lead to a patient either receiving inappropriate medication therapy or failing to receive appropriate medication therapy.
· Causes of medication errors include nurse fatigue, burn out, distractions and interruptions.

Code Red

Fire Safety in the Clinical Setting

If a fire is suspected call a code RED

R - Remove those in immediate danger
E - Ensure fire is contained, close doors
A - Activate the nearest fire alarm
C - Call fire department
T - Try to extinguish the fire if able to do so safely

Class A fire

ordinary combustibles such as paper, wood, cloth

Class B Fire

fires involving flammable or combustible liquids

Class C Fire

fires involving live electricity or power

Class D Fire

combustible metals such as magnesium, uranium spills (not very common)

Class K Fire

fires involving cooking materials such as cooking oils and grease

How to use a fire extinguisher

P - *PULL* the pin;
A - *AIM* at the base of the fire;
S - *SQUEEZE* the levers;
S - *SWEEP* extinguisher from side to side, covering area of the fire

Code Green

evacuation

Code White

Violet Patient

Steps to reduce risk of injury

· Prevention - know history, potential for violence, look for signs and symptoms
· De-escalate - use strategies to prevent further escalation and ensure safety of self and others

two types of evacuation

· Horizontal- Evacuation through smoke/fire barrier doors to a safe area on the same floor
· Vertical - Evacuation of all occupants on a floor to another safe floor

Global Harmonized System

· includes criteria for the classification of health, physical and environmental hazards, as well as specifying what information should be included on labels of hazardous chemicals as well as safety data sheets.

WHMIS

Workplace Hazardous Materials Information System

3 Main Elements of WHMIS

· worker education programs, cautionary labelling of products and the provision of Material Safety Data Sheets (MSDS)

Compressed Gases

Flammable and Combustible Material

Oxidizing Materials

Materials causing immediate and serious toxic effects

Material causing other toxic effects

biohazardous infectious material

Corrosive Materials

Dangerously Reactive Material

Infection prevention and control

consists of the implementation of policies and procedures in hospitals and other health care facilities to minimize the spread of health care-associated or community-acquired infections to patients and other staff members

restrain

are physical, chemical or environmental measures used to control the physical or behavioural activity of a person or a portion of his/her body

alternative to restraints

involve family, quiet environment, remove hazards, therapeutic touch, activities (folding towels, crossword puzzles), physical therapy

Code Blue

cardiac arrest

Code Pink

Cardiac Arrest/Medical Emergency - Child (18 and under)

Code Amber

Missing child

Code Yellow

missing person

Code Black

Bomb threat

Code Brown

Hazardous spill