Midterm Exam Review: RNSG 1125 - Professional Nursing Concepts I

Clinical Judgement

  • Definition:

    • An interpretation or conclusion about a patient’s needs, concerns, or health problems and/or the decision to take action or not.
    • Incorporates standard approaches or improvises new ones based on patient response (Tanner).

  • Attributes:

    • Appropriate response.
    • Holistic view of patient: Considers various factors related to the patient and caregiving situation.
    • Situation perception: Understanding environmental elements in relation to time and space.
    • Process orientation, reasoning, and interpretation.

  • Antecedents:

    • Sound judgement skills.
    • Analytical reasoning skills.
    • Awareness of patient and self.
    • Creativity/inquisitiveness.
    • Sound knowledge base and persistence.

  • Nursing Process:

    • ADPIE: Assessment, Diagnosis, Planning, Implementation, Evaluation.
    • Provides a structured way to think through patient care and supports clinical judgement.
    • Clinical judgement allows nurses to examine factors influencing decision-making in real-time during patient care.

  • Prioritization Strategies:

    • ABCs (Airway, Breathing, Circulation).
    • Maslow’s Hierarchy of Basic Needs.
Nursing Responsibilities

  • Medication Administration:

    • Adhere to the 7 rights: patient, medication, dose, route, time, documentation/education, refuse.

  • Physician Orders:

    • Verify unclear orders; accountability lies with nurses even when following incorrect orders.

  • Patient Teaching:

    • Use plain language tailored to the patient’s learning styles and health literacy.

  • Documentation:

    • A legal record of care; must be accurate, timely, and objective.
Types of Errors
  • Errors Commission: Care not provided correctly.
  • Errors Omission: Care not provided at all.
  • Errors Execution: Performing correctly but ineffectively.
  • Active Errors: Directly related to the individual providing care.
  • Latent Errors: Organizational or systemic issues, such as understaffing.
Tanner’s Clinical Judgement Model (2006)
  1. Noticing: Initial grasp of the situation shaped by context and experience.
    • Example: Assessing clinical findings and patient demeanor.
  2. Interpreting: Attributing meaning through reasoning patterns and collaboration.
  3. Responding: Making decisions on action or inaction and monitoring outcomes.
  4. Reflecting: Evaluating actions in real-time (reflection-in-action) and retrospective analysis (reflection-on-action).
Evidence-Based Practice (EBP)

  • Definition:

    • Integrates best current evidence with clinical expertise and patient family preferences for optimal health care delivery.

  • Attributes:

    • Replicability, reliability (consistent outcomes), validity (accurate measure), individualized care.

  • Antecedents:

    • Knowledge of research importance, identification of patient preferences.

  • PICOT Framework:

    • P: Patient population or problem.
    • I: Intervention of interest.
    • C: Comparison of interest.
    • O: Outcome of interest.
    • T: Time for comparison and outcomes.
    • Example: How does a low sodium diet (I) compare to a regular diet (C) for lowering blood pressure (O) in elderly patients with hypertension (P) in 6 months (T)?
Florence Nightingale (Queen of EBP)
  • Established nursing standards, emphasizing the importance of nutrition, education, and continuing education for nurses.
  • Conducted research through observations and statistics, laying the groundwork for modern nursing.
Professionalism

  • Definition:

    • Integration of nursing skills and knowledge with respect, dignity, accountability, and ethical values.

  • Antecedents:

    • Self- and professional awareness, communication, skills, integrity.

  • Attributes:

    • Competence, critical thinking, accountability, responsibility, lifelong learning, advocacy.

  • Professional Identity:

    • Influenced by norms and values of nursing, leading to behaviors aligned with the nursing discipline.
Patient-Centered Care

  • Definition:

    • Recognizing the patient as a full partner in care based on respect for their preferences and values.

  • Attributes:

    • Non-judgmental, empathetic, culturally competent, adaptive.

  • 6 Cs of Nursing:

    1. Compassion
    2. Competence
    3. Confidence
    4. Consciousness
    5. Commitment
    6. Comportment
Safety

  • Definition:

    • Protection from harm or injury through effective systems and individual performance.

  • Types of Safety Errors:

    1. Diagnostic errors: Delay or failure in diagnosis or tests.
    2. Treatment errors: Errors during procedures or administering medications.
    3. Preventive errors: Failures to provide prophylactic treatment.
    4. Communication failures: Lack of clarity or information sharing.

  • National Patient Safety Goals:

    1. Identify patients correctly using at least two identifiers.
    2. Ensure timely communication of important information.
    3. Use medications safely; label all medications.
    4. Utilize alarms safely in medical equipment.
    5. Prevent healthcare-associated infections.
    6. Identify patient safety risks, including suicide.
    7. Prevent surgical mistakes with verification processes.
Events and Culture of Safety

  • Sentinel Event: Serious incidents requiring immediate investigation.

  • Adverse Event: Unintended harm due to an action, not underlying conditions.

  • Near Miss: Potential harm avoided by chance.

  • Never Event: Serious medical errors that should never happen.

  • Culture of Safety:

    • Shift focus from blame to addressing errors for learning and prevention.
Quality and Safety Education for Nurses (QSEN)
  • Focuses on patient-centered care, teamwork, EBP, quality improvement, safety, and informatics to enhance nursing education and practice.