Nursing 102 Unit 1

Nurse of the Future: Nursing Core Competencies

• Nursing is an art and science that is based on a framework of caring and resect for human dignity.

• Competence is defined as the ability to demonstrate an integration of knowledge, attitudes and skills necessary to function in a specific role and work setting.

• As applied to nursing, competence is an expected and measurable level of nursing performance that integrates knowledge, skills and judgement, based on established scientific knowledge and expectations for nursing practice

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Nurse of the Future: Nursing Core Competencies

• Patient-centered care

• Professionalism

• Leadership

• Systems-based practice

• Informatics and technology

• Communication

• Teamwork and collaboration

• Safety

• Quality improvement

• Evidence-based practice

• Concepts integrated throughout the Essentials

• Clinical judgment

• Communication

• Compassionate care

• Diversity

• Equity and inclusion

• Ethics

• Evidence-based practice

• Health policy

• Social determinants of health

Nurse of the Future: Nursing Core Competencies (6 of 6)

• Health: Experience, often expressed in terms of wellness and illness, that may occur in the presence or absence of disease or injury

• Nursing: The protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities,and populations

Critical Thinking, Clinical Judgment, and Clinical Reasoning in Nursing Practice (1 of 3)

• Thinking Important in Nursing Practice?

• Why is critical thinking important in nursing practice

• Essential to providing safe, competent, and skillful nursing care

• The inability of a nurse to set priorities and work safely, effectively, and efficiently may delay patient treatment in a critical situation and result in serious life-threatening consequences

Critical thinking for decision-making in nursing is the ability to think in a

• systematic and logical manner, with openness to question and reflect on the

• reasoning process used to ensure safe nursing practice and high-quality care. It

• is providing effective care based on sound reasoning (Scriven and Paul, 2017).

Critical thinking and clinical judgment in nursing are:

• Purposeful, informed, outcome-focused thinking

• Carefully identifies key problems, issues, and risks

• Based on principles of the nursing process, problem-solving, and scientific

• method

• Applies logic, intuition, and creativity

Critical Thinking, Clinical Judgment, and Clinical Reasoning in Nursing Practice (3 of 3)

• Driven by patient, family, and community needs

• Calls for strategies that make the most of human potential

• Requires constant reevaluating

Thinking Like a Nurse

• Clinical judgment: A complex observed outcome that includes critical thinking,

• problem solving, ethical reasoning, and decision making.

• Clinical reasoning: The processes by which nurses and other clinicians make their judgments, and includes both the deliberative process of generatin alternatives, weighing them against the evidence, and choosing the most appropriate, and those patterns that might be characterized as engaged, practical, and reasoning

Clinical Judgment

• Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand

• Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as engagement with the patient and his or her concerns

• Clinical judgments are influenced by the context in which the situation occur and the culture of the nursing unit

• Nurses use a variety of reasoning patterns alone or in combination

• Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the development of clinical knowledge and improvement in clinical reasoning

Characteristics of Critical Thinking

• Rational and reasonable

• Involves conceptualization

• Requires reflection

• Includes cognitive skills and attitudes

• Involves creative thinking

• Requires knowledge

What Are the Characteristics of a Critical Thinker?

• Flexible

• Bases judgments on facts and reasoning

• Doesn’t oversimplify

• Examines available evidence before drawing conclusions

• Thinks for themselves

• Remains open to the need for adjustment and adaptation throughout the inquiry

• Accepts change

• Empathizes

• Welcomes different views and values examining issues from every angle

• Knows that it is important to explore and understand positions with which they

• disagree

• Discovers and applies meaning to what they see, hear, and read

Approaches to Developing Critical Thinking Skills

• Nursing process

• Concept mapping

• Journaling

• Group discussions and reflection

Nursing Process (ADPIE)

• The nursing process is a systematic problem-solving approach to providing

nursing care that allows the nurse to be accountable by using critical thinking

before taking action.

• Assessment- what is happening and what could happen

• Diagnosis/ Analysis- derive meaning from assessment

• Planning- Determine appropriate nursing actions and interventions

• Implementation- executing the plan of care

• Evaluation- comparison between current condition and patient outcome goal

Concept Mapping

• Visual representation of the relationships among concepts and ideas

• Useful for summarizing information, consolidating information from different sources, thinking through complex problems, and presenting information in a format that shows an overall structure of the subject

Journaling

• Allows you to view your own thinking, reasoning, and actions.

• Helps create and clarify meaning and new understandings of experiences.

• When you encounter a similar situation, you should be able to recall what you did or would do differently and your reasoning.

• What was the setting?

• What were the important elements of the event?

• What preceded the event, and what followed it?

• What should I be aware of if the event recurs?

• What happened? What are the facts?

• What feelings and senses surrounded the event?

• What did I do?

• How and what did I feel about what I did?

Nursing Process Questions

1. Elizabeth is a nursing student at WKU and is in clinical on an oncology floor. Currently, the student is interviewing the patient and identifying potential/actual issues associated with the patient. Which part of the nursing process is being utilized?

Assessment

1. Noi is discussing his patient with his clinical instructor. He initiates a short-term goal for his patient, the patient will ambulate (walk) 100 feet throughout his clinical shift February 2, 2022. Which part of the nursing diagnosis are goals initiated for patients?

Planning

1. Luke’s patient was admitted for an injury to his right knee. Upon assessment, the patient denies pain, but states it gets worse throughout the day. Luke is preparing to implement pain relieving strategies to his patient if the opportunity arises. When organizing his plan of care, he identifies a patient issue “Risk for acute pain”. This identification is known as what?

Nursing Diagnosis

1. Casey is working on his care plan for a nursing diagnosis of “Ineffective breathing” and is assisting the patient with the following: ensuring oxygen saturation levels are above 95%, monitoring respirations, encouraging deep breathing exercises, assessing chest expansion. Which phase does this occur in the nursing process?

Implementation

1. Gina is completing her plan of care on her patient admitted for a total hip replacement. Gina recognized the patient surpassed her set goals for the shift and is demonstrating positive improvement during the recovery. When are goals measured in the nursing process?

Evaluation

The Art of Nursing

Is based on respect for human dignity and

requires sensitivity to:

• Cultural aspects

• Diversity, Equity, and Inclusion

• Moral and Social Justice

• Ethical judgements

• Values and Beliefs

Professional Socialization

• Socialization involves a process by which a person acquires the knowledge, skills, and sense of identity that are characteristic of a profession.

• Involves internalization of values and norms of the profession.

• Formation is the development of perceptual abilities, the ability to draw on knowledge and skilled know-how, and a way of being and acting in practice and in the world.

Goals of Professional Socialization

• To learn the technology of the profession

• To learn to internalize the professional culture

• To find a personally and professionally acceptable version of the role

• To integrate this professional role into all of the other life roles

Essential Features of Nursing

• Provision of a caring relationship that facilitates health and healing

• Attention to the range of experiences and responses to health and illness within the physical and social environments

• Integration of assessment data with knowledge gained from an appreciation of the patient or group

• Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking

• Advancement of professional nursing knowledge through scholarly inquiry Influence on social and public policy to promote social justice

• Assurance of safe, quality, and evidence-based practice

Associate Degree

• 2-3 years to complete

• Minimum degree to take licensure exam

• Considered technical-level degree

Bachelor of Science Degree

• Primary pathway to professional nursing

• ANA and other nursing organizations recognize as the minimum educational requirement for professional nursing practice

• 4 years to complete

• BSN nurse is “preferred” by nurse executives

• Graduate Nursing Degrees

• Master Entry Professional Nurse (MPEN)

• Master of Science in Nursing (MSN)

• Doctor of Nursing Practice (DNP)

• Doctor of Nursing Science (DNS)

• Doctor of Philosophy (PhD)

Master Entry Professional Nurse

• For those with a bachelor's or graduate degree in another discipline

• 2-3 years to complete

Master of Science in Nursing

• For those with associate or bachelor degree

• 18-24 months to complete (full time study)

Doctoral Programs

• Two principal types: Research focused (DNS, PhD), Practice focused (DNP)

• Considered the terminal degree in nursing

• For those with a bachelor or master degree.

• Allow study on full time or part time basis

• BSN-DNP 3 years to complete

Didactic Learning

• A didactic approach to teaching refers to a manner of instruction in which information is presented directly from the teacher to the pupil, in which the teacher selects the topic of instruction, controls instructional stimuli, obligates a response from the student, evaluates student responses, and provides reinforcement ..

Clinical Learning

• Competency of knowledge and application is necessary in nursing. Didactic learning focuses on content learning, while clinical learning focuses on the ability to apply the content in the care of patients, families, communities, and populations.

Roles of the Professional Nurse

• Provider of care

• Designer/manager/coordinator of care

• Member of a profession (AACN, 2008)

Professional Nursing Values

• Commitment to public service

• Autonomy

• Commitment to lifelong learning and education

• Belief in the dignity and worth of each person

View of nursing as a job:

• Obtains least amount of education needed for nursing licensure

• Obtains the minimum continuing education units required for licensure and/or the job Continues with job as long as it meets personal needs of nurse; expects reasonable work for reasonable pay; responsibility ends with shift

View of nursing as a career:

• Obtains a BSN and often pursues an advanced nursing degree

• Engages in formal and informal lifelong learning experiences across the career

• Actively and joyfully engages in practicing the art and science of professional nursing as a member and possibly leader in professional nursing initiatives within the nurse’s healthcare agency and in professional nursing

Trends to Consider in Nursing Career Decisions

• Where health care is delivered

• The types of practitioners needed

• The nursing educational preparation required to provide this care

Key Messages from The Future of Nursing

• Nurses should practice to the full extent of their education and training.

• Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

• Nurses should be full partners with physicians and other healthcare professionals in redesigning health care in the U.S.

• Effective workforce planning and policy making require better data collection and an improved information infrastructure.

Recommendations from The Future of Nursing

• Remove scope-of-practice barriers.

• Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.

• Implement nurse residency programs.

• Increase the percentage of nurses with a baccalaureate degree to 80% by 2020.

• Double the number of nurses with a doctorate by 2020.

• Ensure that nurses engage in lifelong learning.

• Prepare and enable nurses to lead change to advance health.

• Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data.

Showcasing Your Professional Self

• Professional portfolio

• Resume

• The interview

Characteristics of the Organization That You Should Assess

• Manifest a philosophy of clinical care emphasizing quality, safety, interdisciplinary collaboration, continuity of care, and professional accountability.

• Recognize the value of nurses’ expertise on clinical care quality and patient outcomes.

• Promote executive-level nursing leadership.

• Empower nurses’ participation in clinical decision making and organization of clinical care systems.

• Demonstrate professional development support for nurses.

• Maintain clinical advancement programs based on education, certification, and advanced preparation.

• Create collaborative relationships among members of the healthcare team.

• Utilize technological advances in clinical care and information systems.

Mentoring: The Benefits

• Increased self-confidence

• Enhanced leadership skills

• Accelerated acclimation to the culture of a unit/facility

• Advancement opportunities

• Enhanced communication skills

• Reduced stress

• Improved networking ability

• Political savvy

• Legal and ethical insight

Education and Lifelong Learning

• ANA’s standards of professional performance, standard number 8, indicates that it is the responsibility of every nurse to seek “knowledge and competence that reflects current nursing practice.”

• Every state board of nursing should require mandatory continuing education for all practicing RNs, but they do not.

Nursing Career Paths Supported by Graduate-Level Academic Programs

• Expert clinician (APRN)

• Clinical nurse leader (CNL)

• Nurse executive

• Nurse educator

• Nurse researcher

Professional Engagement

• Engagement in your healthcare organization

• Engagement in professional nursing organizations

Expectations of Your Performance

• Self-appraisal

• Work performance evaluations conducted by nurse managers on behalf of healthcare organizations

• Collegial evaluations

Care of Self

• Eating a balanced diet

• Getting enough sleep

• Avoiding addictive substances

Managing Stress

• Prevent burnout.

• Prevent compassion fatigue.

• Maintain a civil work environment.

• Sustain a resilient self

Who regulates the National Licensure Council Exam?

• National Council of State Boards of Nursing (NCSBN)

• NCSB’s mission is to ensure public protection, including the development of the NCLEX licensure exam.

• The NCLEX exam ensures nurses are tested on the same entry level of competencies needed to provide safe nursing.

• Do no harm, competent, safe, nurse practice acts, state board, state licensure, and state practice act

• Graduate from nursing program and NCLEX, licensure is a privilege, a commitment between you and the public, and your responsibility to keep current, and follow guidelines \

• Fil to renew every year can result in a fine, all the way up to a retake of the NCLEX

• Single or multi-state license, state board protect

Why the need to have a change in NCLEX questions?

• To meet today’s complex client needs, improved measurement of the nurse’s clinical judgment is critical.

• The NGN exam uses case studies, similar to real world, to reflect the diverse critical decisions nurses have to make in a variety of settings.

• Focus is on interactions between nurse and patient, the patient’s needs and expected outcomes.

• The goal of NGN exam is to ask better questions to help nurses think critically when providing care and making the right decisions.

NEXT GENERATION NCLEX

• The purpose of NGN is to Improve the measurement of clinical judgment

Nursing Tests

• Nursing Tests are designed to test how much you remember or understand about a subject

• Nursing Tests are designed to test your ability to think at the higher cognitive levels

• Because Thinking like a nurse is essential to safe and competent nursing practice at the entry level

What do I need to do to change my learning habits?

• Create a study plan (30 hours/week – minimum)

• Come lecture prepared: Read, complete assignments, and be prepared to apply your knowledge in classroom activities

• Create an effective study group: learning nursing concepts is a process

• Memorization alone doesn’t work in Nursing School

What is being tested??

• Safety

• Hierarchy of needs (Maslows)

Nursing Process

• Assessment (Recognize Cues)

• Diagnosis/Analysis (Analyze Cues)

• Plan (Generate Solutions)

• Interventions (Take Action)

• Evaluation (Evaluate Outcomes)

Phase 1-Signs, Symptoms, Health history, Physical Assessment, Environment

Phase 2-Linking recognized ncues to client’s clinical presentation, Establish probable client needs, concerns, and problems

Phase 3-Establish priorities of care based on client’s health problems (S/S, tests, lab values)

Phase 4- Identify expected outcomes and critical nursing interventions to ensure a client’s needs are met

Phase 5- Implement appropriate interventions to restore client’s health

Phase 6- Evaluate client’s response and reach a nursing judgment regarding the extent to which outcomes have been met

Let's analyze this patient!

• Carlos is a 36 year old non-Hispanic white male who arrives by private vehicle complaining of nausea, vomiting, chills, fever of 39 degree Celsius, severe pain lower abd and groin, and difficulty passing urine. They state a history of obesity, smoking, diabetes, and kidney stones.

• Additional VS- HR 115, BP 90/45, RR 24

• Initial CBC shows a WBC of 15,000.

What are your next steps?

• Treat the infection Usually treated 1st, will help other problems

• Treat the nausea

• Treat the hydration

• Treat the pain

What are your next steps?

• Establish IV access- bloodwork/labs, antiemetic, fluids, pain meds

• Diagnostics

• Evaluate labs/diagnostic results

• Possible prep for surgery

Personal Empowerment!

Before the next Test

• Follow your study plan

• Don’t Cram

• Get a good night’s sleep

• Eat before the Test

On Test Day

• Be early!

• Have all your supplies ready

• Budget your time across the questions

Reading the Question

• Cover the answer choices while you read the question

• Read the entire question (twice) before looking at the answers

• Identify keywords in the stem

• First, priority, initial, early, primary, most important

• These words may or may not be in a bold font

Test Anxiety

• When you excessively worry about doing well on a test

• Remember, a little anxiety can jump-start your studying and keep you motivated.

• Too much anxiety can interfere with your studying.

• You may have difficulty learning and remembering what you need to know for the test.

• Too much anxiety may block your performance during the test.

• You may have difficulty demonstrating what you know

Professional Boundaries Document

• Over involvement

• Therapeutic Relationship

• Violation of Relationship

• Under Involvement

• SBON facilitates standards, scope of practice, licensure requirements & disciplinary actions

Multistate Licenses Explained for Nurses

• Read and understand this document

• Multi-state license (Compact), your license is home based so its on the drivers license

• Single state license