In-depth Notes on The Nursing Process and Clinical Judgment

Critical Thinking in Nursing

• Critical Thinking: Involves skillful reasoning and logical thought to determine the merits of a belief or action.

• Validating Information: Ensures correctness of obtained information to support nursing decisions.

• Purposeful Thinking: Nurses must utilize reasoning and logic to decide on actions that promote optimal patient care.

The Nursing Process

• Framework for Decision Making:

  • Assessment: Gathering subjective (patient's feelings) and objective (observable data) findings through interviews and physical exams.

  • Diagnosis: Analyzing collected assessment data to formulate nursing diagnoses that differ from medical diagnoses.

Steps of the Nursing Process

• Planning: Establishing priorities for patient care based on assessments.

• Implementation: Carrying out nursing interventions.

• Evaluation: Reflecting on the effectiveness of the interventions performed.

Roles of RN and LPN/LVN

• RN Responsibilities: As per the American Nurses Association (ANA), RNs are responsible for all nursing process steps.

• LPN/LVN Involvement: Under NALPN standards, LPNs/LVNs take part in planning, intervention, and evaluation but may not perform assessments independently.

Performing the Nursing Process

• Assessment:

  • Subjective Data: Information based on patients’ feelings and perceptions.

  • Objective Data: Observable facts through the senses.

  • Interview Technique: Establish rapport, gather primary and secondary data.

• Physical Assessment Techniques:

  • Inspection: Visual examination of the patient.

  • Palpation: Using touch to assess.

  • Auscultation: Listening to bodily sounds.

  • Percussion: Tapping the body to assess organs and structures.

Nursing Diagnosis

• Unique Function: Formulating nursing diagnoses is a distinct nursing skill.

• Prioritizing Diagnoses: Apply Maslow's hierarchy of needs.

• NANDA-I: Use the North American Nursing Diagnosis Association (NANDA-I) lists for selecting diagnoses.

• PES Statements: Write nursing diagnoses in Problem, Etiology, Signs/Symptoms format.

Planning

• Nursing Goals: Set goals to direct progress in improving patient conditions.

• Expected Outcomes: Specific, measurable actions within a time frame aligned with nursing interventions.

  • Nursing Outcomes Classification (NOC): A list of 500 expected outcomes mirroring NANDA-I diagnoses.

• Outcome Statements Must Include:

  • A specific, realistic, and measurable action able to be performed by the patient within a defined time frame.

Types of Nursing Interventions

• Direct Care: Interventions where the nurse interacts directly with the patient (e.g., teaching, administering medications).

• Indirect Care: Actions performed away from the patient that support their care (e.g., documentation, communicating with health professionals).

• Interventions Can Be:

  • Independent: Those the nurse can perform without physician orders.

  • Dependent: Require physician orders before execution.

  • Collaborative: Involves collaboration with other health care team members.

Implementation Steps

• Initial Procedures:

  • Verify healthcare provider's order.

  • Refer to established procedures.

  • Prepare necessary equipment and ensure hand hygiene.

  • Identify the patient, explain the procedure, and ensure privacy.

• End Implementation Steps:

  • Evaluate patient response, ensure comfort and safety.

  • Document interventions and their effectiveness; handle materials safely.

Evaluation

• Evaluate nursing diagnoses and whether desired outcomes were achieved by asking:

  • Were nursing diagnoses correct?

  • Were the goals realistic and reachable?

  • Were the correct interventions selected and implemented?

  • Has the patient’s condition changed?

Types of Nursing Care Plans

• Computerized Care Plans

• Standardized Care Plans

• Multidisciplinary Care Plans

• Critical Pathway: Offers daily interventions based on patient progression.

• Student Care Plans.

Preparing for Clinical Experience

• Step-by-Step Approach:

  • Research potential nursing diagnoses and expected outcomes.

  • Develop interventions prior to clinical placement.

Concept Maps

• Concept maps are used to organize nursing diagnoses and assess data, aiding in planning care.

Clinical Judgment

• Definition: The ability to apply critical thinking in executing nursing actions.

  • Steps:

  1. Recognize and analyze cues.

  2. Formulate hypotheses about patient conditions.

  3. Prioritize and take necessary actions.

  4. Evaluate the effectiveness of interventions.

Upcoming NCLEX Changes

• Starting 2023, NCLEX-PN will assess clinical judgment abilities through innovative test items developed by the NCSBN, moving beyond traditional knowledge assessments.