Ways of Thinking - Non-focused Thinking
Habitual
Random thoughts
Ruminative
All-or-none
Negative
Ways of Thinking - Directed (focused)Thinking
Problem - Oriented Thinking
Critical Thinking
Non - Focused Thinking
Brain engaged "out if habit", little conscious thought
Habitual
important daily routines, "autopilot"
Random Thoughts
thoughts come & go without purpose or goal
Ruminative
Same scene replayed without reaching outcome
All or None
mind is made up, won't con
Directed Thinking
Purposeful and outcome oriented
Direct Thinking - Problem-Oriented Thinking
Focused on solving particular problem
Collect information, set goal(s), request help, get others' input
so can solve
Once solved, no more attention given until another problem arises
Direct Thinking - Critical Thinking
Advanced way of thinking: problem-solving "+"....
Solve problem and find ways to improve sitution even though no problem exists
"How can we do this better?
Critical Thinkers
Think with a purpose
Logical & fair in their thinking
Question information, conclusions & points of view
Look beneath the surface
As nurses: use knowledge base( nursing science) to make decisons, generate new ideas & solve problems
Characteristics & Attitudes of Critical Thinkers
Self-confident
Inquisitive
Honest & upright
Alert to context
Open & fair-minded
Analytical & insightful
Logical & intutive
Reflective & self-corrective
Sensitivity to diversity
Critical Thinking Applied to Nursing
Purposeful, informed, out-come focused thinking
Driven by patient, family & community needs
Based on principles of nursing process
Uses Logic & intuition
Calls for stragtegies making most of human potential
Constantly reevaluating, self-correcting, strivi
Critical Thinking as A Student Nurse
Knowledge from classroom & clinical experiences will help you think critically
Add to your knowledge base by studying facts, principles, theories & clinical experiences
When encountering a patient, you will observe:
life-span development
nutrition
communi
Decision-Making in Nursing
Critical thinking process for choosing the best actions to meet a desired goal
Nurses... under stress:
prioritze actions
recognize important cues signaling changes in client condition
respond quickly
adapt interventions
Nursing decisions will be made:
ind
Critical Thinking & NCLEX-PN
questions require various levels of answer them
Cognitive levels of:
Knowledge
Recall & repeat knowledge you have memorized
Comprehension
Ability to basically understand info, recall it & ID examples of that info
To grasp the meaning of the material/repea
The Nursing Process
Serves as the organizational framework for the practice of nursing
Systematic methos used by nurses to plan & provide care for clients
Problem-solving approach that enables the nurse to ID client problems & potential problems
Once problems are ID'd nurse
Adopie Assessment
A systematic, dynamtic process by which the nurse through interaction with the client, significant others and health care providers, collects and analyzes data about the client
Nursing Process: The Practice Standard of Nursing Care - 6 Interrelated Standards
Assessment
Diagnosis
Outcome ID (setting goals)
Planning
Implementation
Evaluation "ADOPIE
Assessment
Gather info to ID condition of health
Make assessments on 1st contact with client
Continue throughout client's care
Rest of Nsg Process phases depend on accuracy & completeness of this inital data
LPN or RN can both observe & collect data
RN "assesses
Assessment
Complete Assessment:
Review & physical exam of all body systems
Also review cognitive, psychosocial, emotional cultural componentd
Appropriate for a stable client - no acute distress
Focused Assessment
Gathers info about a specific health problem
Good ide
Assessment Data
Cue: Significant data, unhealthy response
2 types of data:
Subjective: verbal statements/clients describing how they feel, symptoms they have
subjective data - hidden until shared
examples: pain, fatigue, anxiety, nausea
Objective: observable & measurable
Source of Assessment Data
Primary source
Client - is most accurate, if alert & oriented
Secondary source
client - is most accurate, if alert & oriented
Secondary source
Famiy members/significant others
Medical records
Diagnostic procedures
Other team members
Nursing literature
Methods of Data Collection - Interview to obtain client's health history
Biographical data
Reason seeking health care
History of present illness/health problem
Past health history
Family history
Environmental history
Psychosocial History
Review of systems physical exam
guided by subjective data provided
use head - to - toe sys
Assessment Data
Database - what you have after interview & physical exam
Organize the database
group related cues together (data clustering)
EXAMPLE:
"Thirst; dry skin, dry oral mucous membranes, increased body temperature, and decreased urine output"
Is cue cluster that
aDopie - Nursing Diagnosis
Diagnosis (DX)=
to ID the type & cause or health condition
ANA: Diagnosis is a .......
"clinical judgment about the client's response to actual or potental health conditions or needs. The diagnosis provides the base for determination of a plan of care to
Working to a Nsg Diagnosis
Problem is any health condition that needs
diagnostic
therapeudic
educational action
When client has a problem or potential problem... cues will usually be present to help ID area of concern
Cues the have significance to nursing care:
Deviations from popu
Nursing Diagnosis
Nurses have a legal right to:
ID & prescribe primary interventions to treat or prevent problems that are nursing diagnosis
If a nurse is not able to prescribe the primary treatment, the problem is NOT a nursing diagnosis
FYI: Some older diagnosis are comm
Components of a Nursing Dx
4 Components Addressed:
Nursing diagnosis title or label
Definition of title or label
Contributing, etiologic or relates factors
Defining characteristics
1st Component of Nsg Diagnosis: Title of Label
Title of label
the problem is ID'd from cue clustering & analysis of the data
Nsg Dx provides a concise name for the ID'd problem (constipation, pain, hopelessness)
Lists of these diagnoses are usually presented on concepts)
Component of Nsg Dx
Adjectives add meaning to the Nsg Dx label by describing or modifying the label (excess, impaired)
We look up Nsg Dx by label, the noun mobility, impaired physical becomes...impaired physical mobility
Are efforts to simplify NANDA diagnostic language
Some
2nd Component of Nsg Dx: Definiton of Title
Need a clear, precise description of the problem
Need to ID differences between similar Nsg Dx
constipation vs perceived constipation
Constipation defined as "decrease in normal frequency of defecation accompanied by difficult or incomplete passage of sto
3rd Component of Nsg Dx: Contributing Factors
Contributing, Etiologic and Related Factors and Risk Factors
conditions that are often involved in development of the problem...& are found in nsg interventions
factors that may be the focus for nsg interventions
contributing factors frequently called the
4th Component of Nsg Dx: Defing Characteristics
Defining Characteristics are:
the clinical cues, signs, symptoms that give evidence that the problem exists
writtten as the "manifested by " ("m/b") link in the Nsg Dx statement:"consipation related to insufficient fluid intake manifested by increased abd
Types of Nsg Diagnoses
4 Type of Nursing Diagnoses
Actual
Risk
Syndrome
Wellness
Actual Nsg Diagnosis
Represents a condition currently present in an individual, family or community
Cues obtained from Nsg Assessment indicate that the problem exists
Actual Nursing Diagnosis strictly written as a 3 - part statement
Nsg Dx Title or label from NANDA
Contributi
Actual Nsg Dx
3 parts evident in Actual Nsg Dx:
(1)Constipation
(2) related to insufficient fluid intake
(3) manifested by increased abdominal pressure no bowel movement for 5 days straining with defecation
Risk Nsg Diagnosis
The human responses to health conditions/life processes that may develop in a vulnerable indivdual, family, or community
It is supported by risk factors that contribute to increased vulnerability
Written as a 2 part statement:
1. Nsg Dx title/label
2.The
Wellness Nsg Dx
Human responses to levels of wellness in an individual, family or community" (NANDA-1 2009)
Written as 1-part statement
"readiness for enhanced" are words used in a wellness statement (NANDA -1 2009)
"Readiness for enhanced decision making"
"Readiness fo
Syndrome Nsg Dx
Used when a cluster of actual or risk nursing diagnosis are predicted to be present in certain circumstances
Written as 1-part statements because they are so specific
Current syndrome diagnoses:
Post-trauma syndrome diagnoses:
Impaired environmental intep
Confused with Nsg Dx:
Collaborative Problems
Medical Diagnosis
Collaborative Problems:
Certain physiologic complications that nurses monitor to detect their onset or changes in the client's status
Manage collaborative problems with physician-prescibed interventions to minimize
Confused with Nsg Dx:
Medical Diagnosis
ID of a disease or condition by scientific evaluation of physical signs, symptoms, history, lab test & procedures
Made by physician: heart failure, pneumonia, diabetes
Remember:
Nsg Dx are about human responses to health probs & life pro
adOpie - Outcomes Identification
Ns develops expected client outcomes for the established diagnosis
Outcome statement indicates the degree of wellness desired, expected or possible for client to achieve
Might refer to/think of this step other ways:
Client goal, an behavioral objective,pt
Outcomes Identification
Goal Statement
is a statement about the purpose to which effort is directed. (Focus on actions to be taken to reach, not behavior of client after interventions)
VS
Outcomes Statement
is a statement about the desired patient outcomes, in observable & measu
Outcomes Identification
Purpose of desired patient outcome statements:
Guide selection of nursing interventions
Outcome statement establishes the measuring standard that is to be used to evaluate effectiveness of nursing interventions
Measurable verbs indicate the precise patien
adoPie - Planning
Planning Phase
Establish priorities of care
Select & convert nursing interventions into nsg orders
Communicate the plan of care using recognized terminology to document the plan
Priority Setting
Once have list of Nsg Dxs, rank problems in order of importa
Planning
Selecting Nursing Interventions
Want activities to promote achievement of desired patient outcome
May include activities:
That nurse selects to resolve Nsg Dx
To monitor for the development of a risk problem
To carry out a physician order
Nursing Interven
Planning
Physician Prescribed interventions
Actions ordered by a physician, for a nurse, or other health team member to perform
Are prescriptive instructions for patients
Even though physician prescribed, is still necessary to use nursing judgment
Nursing follow o
Planning
Nurse Prescribed Interventions
Actions the nurse can order or begin independently
Written for themselves or other nursing staff
Independent Nsg Interventions include:
turning patient every 2 hours
monitoring for complications
providing back massage
provid
Planning
Writing Nursing Orders
Change the guiding general statement about interventions to a more specific statement
This specific NursingOrder must include:
Date
Signature of nurse responsible for the care plan
Subject (who will be carrying out the activity)
Act
Planning - Communicating the Nsg Care Plan
Is nurse's responsibility to communicate the detailed plan of care for pt
Written Nsg Care Plan is the tangible product of the Nursing Process
Fomats for written nsg care plan varies among institutions
Nsg Care Plans may be prepared for each patient drawi
Formulas for Written Nsg Care Plans
Linear Care Plans
Traditional 4 - 5 column format
Concept Maps
Different shapes and connecting lines to show relationships to provide visual representation of the care plan
adopIe - Nursing Implementations
Put established plan into action to promote outcome achievement
Includes on-going activities of:
Data collection
Prioritzation
Performance of nsg interventions
Documentation < vital component of implementation phase of Nsg Process
legal record of what hap
adopiE - Evaluation
Determination is made about the extent to which the established outcomes have been achieved
Review the established pt-centered goals or desired pt outcomes
outcome statements are observable & measurable
Reassess pt to gather data indicating pt's actual re
Standardized Language for Nsg Diagnosis
Standardized language: understandable, exact, consistent vocabulary has many benefits
Nsg Diagnosis organziations have formed relationships to accomplish this
North American Nursing Diagnosis Association International (NANDA-I)
Nursing Interventions Class
Role of LPN in the Nursing Process
Can vary from state to state and with different institutions
LPN provides direct bedside care
Direct care position allows LPN to closely
Observe
Prioritize
Intervene
Evaluate
Care provided to and for patient and assistance with appropriate use of Nsg Care
Nsg Dx & Clincal Pathways
Nursing goes beyond technical skills & providing direct care. Also includes working with:
Outcomes
Cost
Resources
Other members of the health care team
Advent of Managed Care has brought about attention to clincal and financial outcomes, and initiatives t
Clinical Pathways
Are multidisciplinary plans that schedule clincial interventions over an anticipated or planned time frame for:
high - risk
high volume
high - cost type of cases
Also known as critical paths, multidisciplinary action plans, care maps
Variance is when the