Spirit Of Inquiry

Class Outline

  • History of Nursing

  • Nursing Professionalism

  • Critical Thinking

  • Clinical Reasoning

  • Clinical Judgement   - Decision Making   - Problem Solving

  • Nursing Process

  • Care Planning

  • Application Exercises

History of Nursing and Nursing Professionalism

The Origins of Nursing

  • Nursing is described as the oldest of arts and the youngest of professions.

  • The act of nursing has been practiced across various cultures throughout history.

Development of Nursing Organizations

  • Early nursing was closely associated with:   - Religious Orders: Provided care as a charitable act.   - Hospitality Rooms: Established places for those needing care.   - Monastic Nursing: Nurses often came from monastic orders.

Florence Nightingale

Biography

  • Recognized as the founder of modern nursing.

  • Advocated for a divine purpose in nursing as a vehicle for social reform and progress.

  • Transformed medical practice from a pre-scientific to a more scientific approach.

  • Emphasized holistic nursing as a cornerstone of care.

Nursing in America

  • Highlights the impact of the Civil War (1861-1865) on nursing, featuring key figures:   - Dorothea Dix: Advocate for mental health reform.   - Clara Barton: Founder of the American Red Cross.

What Makes Nursing a Profession?

  • Nursing is defined by:   - The protection, promotion, and optimization of health and abilities.   - The prevention of illness and injury.   - The facilitation of healing and alleviation of suffering through the diagnosis and treatment of human responses.   - Advocacy in the care of individuals, families, groups, communities, and populations.   - Source: American Nursing Association (2015)

Spirit of Inquiry in Professional Nursing

  • Defined as a persistent sense of curiosity that shapes both learning and practice.

  • A nurse with a spirit of inquiry will:   - Raise questions.   - Challenge traditional practices.   - Seek creative solutions in problem-solving.

  • Fosters innovative thinking and broadens possibilities for discovering novel solutions in various circumstances. (National League of Nursing, 2014)

Work Ethic

  • You achieve results based on the effort that you put in:   - "You don't get what you wish for; you get what you work for."

Magnet Designation

  • Recognition for nursing excellence, promoting:   - High quality patient care within healthcare organizations.   - Awarded to institutions such as Bayhealth Medical Center, Christiana Care Hospital, and Nemours Children's Health.

  • Forces of Magnetism include:   - Transformational Leadership   - Structural Empowerment   - Exemplary Professional Practice   - New Knowledge, Innovation, & Improvements   - Empirical Outcomes

Spirit of Inquiry and Nursing Skills

  • Interrelated concepts:   - Critical Thinking   - Clinical Reasoning   - Clinical Judgement

  • Nursing Process

  • Care Planning

  • Problem Solving

Critical Thinking, Clinical Reasoning, and Clinical Judgement

  • Thinking in Nursing: Involves caring, alongside technical skills and decision-making processes.

Critical Thinking

  • Defined as a combination of:   - Reasoned Thinking: Logical analysis and evaluation of information.   - Openness to Alternatives: Willingness to consider different perspectives.   - Ability to Reflect: Self-examination and evaluation of one’s thought processes.   - Desire to Seek Truth: Committed to finding what is accurate or true.

Scenario Illustrating Critical Thinking

Running Out of Gas on the Way to Visit a Relative:

  • Without Critical Thinking:   - Notices the fuel warning light but ignores it, thinking, "I’ll make it. I don’t have time to stop."

  • With Critical Thinking:   - Observes the fuel warning light and evaluates:     - Distance to destination     - Proximity to gas stations     - Available time for a stop

Clinical Reasoning

  • Described as:   - “Thinking like a nurse” or “Thinking in action.”   - Involves connecting clinical concepts and applying knowledge to specific client situations.

  • Utilizes evidence-based information and principles from education, research, and clinical experience.

Clinical Judgement

  • Defined as:   - The outcome of clinical reasoning, described as an iterative process.   - Involves using nursing knowledge to assess situations, prioritize concerns, and generate evidence-based solutions to ensure safe care.

  • Source: NCSBN

Clinical Scenario: Post-Operative Patient with Sudden Shortness of Breath

  1. Scenario A: Nurse attributes symptoms to anxiety with no further assessment, leading to a missed pulmonary embolism and worsening condition.

  2. Scenario B: Nurse considers life-threatening causes, performs assessments, elevates the head of the bed, administers oxygen, and informs the physician based on detailed findings, leading to timely identification and treatment of pulmonary embolism.

NCSBN Clinical Judgment Model

  • Layers of Clinical Judgement:   - Layer 0: Client Needs   - Layer 1: Recognize Cues   - Layer 2: Analyze Cues   - Layer 3: Environmental Factors and Individual Factors   - Layer 4: Nursing Process     - Assessment     - Analysis     - Planning     - Implementation     - Evaluation

  • The model emphasizes the relationship between clinical judgement skills and the nursing process.

Steps of Clinical Judgment Skills

  1. Recognize Cues: Identify relevant information from various sources.

  2. Analyze Cues: Organize recognized cues and establish client needs or problems.

  3. Prioritize Hypotheses: Determine care priorities based on client needs.

  4. Generate Solutions: Identify expected outcomes and nursing interventions.

  5. Take Action: Implement interventions based on knowledge,    priorities, and planned outcomes.

  6. Evaluate Outcomes: Compare observed outcomes against expectations to assess the extent of goal achievement.

Clinical Judgement and Nursing Process

  • Importance in Nursing Practice:   - Relation to academic journey and curriculum objectives.   - Essential for success in licensure exams (NCLEX) and ensuring safe practice with positive patient outcomes.

Nursing Process and Care Planning

What is the Nursing Process?

  • Acronym: ADPIE   - Assessment   - Diagnosis/Analysis (Nursing)   - Planning   - Implementation   - Evaluation

Step 1: Assessment

  • Importance: Gather and evaluate data to inform care.

  • Methods of collecting data:   - Observation   - Physical Assessment   - Interviewing   - Reviewing the patient’s health record

Step 2: Nursing Diagnosis/Analysis

  • Involves gathering and analyzing data to identify patient issues.

  • Example: Walking into a house with a flooded floor, determining possible causes.

Step 3: Planning

  • Setting realistic and measurable goals using the SMART criteria:   - Specific   - Measurable   - Attainable   - Realistic   - Timed

Step 4: Implementation

  • Outlines actions the nurse must take to meet the set goals, which may involve collaboration with other disciplines.

Step 5: Evaluation

  • Determine whether goals have been met based on subjective (patient-reported) and objective (measurable) data.

Types of Data Collected in Assessment

  • Subjective Data: Information verbally expressed by the patient, caregiver, or family, including sensations and feelings. (Examples include “I’m cold” or “I’m in pain.”)

  • Objective Data: Quantifiable data gathered through assessments, laboratory results, or test reports (e.g., vital signs).

Gathering Assessment Data Examples

  • Situation: You witness a person fall in a restaurant and provide assistance.   - The individual is conscious, yet their speech is garbled, necessitating immediate assessment.

  • Scenario: Conducting a health fair at a community wellness center, where student nurses offer health screenings and educational information.

Types of Assessment

  • Initial assessment: Comprehensive data gathering.

  • Focused assessment: Targeted data collection based on specific needs.

  • Ongoing assessment: Continuous evaluation throughout care.