Checking accuracy and reliability
realizing that something doesn't seem quite right and taking action to determine if it is accurate or not, sounds
... [Show More] suspicious and looking further into it
Nursing Process
step by step approach directed at planning and providing pt care.
Data collection(assessment), Planning, Implementation, Evaluation
Nursing process D
Data collection- gather and review info about the pt, assessment
Nursing process P
Planning- development of a nursing dx, goals, and interventions for a pt plan of care.
Nursing process I
implementation of planned interventions
actually carrying out the orders
Nursing process E
Evaluation- comparing actual outcomes with expected outcomes
Tanner's Model of Clinical Judgement
A model based on how a nurse thinks, it explains the 4 steps in the critical thinking process that nurses use to solve any problem:
Noticing
Interpereting
Responding
Reflecting
Step 1 Noticing
-Identifying signs and symptoms
-gathering complete and accurate data
-assessing systematically and comprehensivly
-predicting and (managing) potential complications
-identifying assumptions
Identifying signs and symptoms
Indicates when a situation is normal, abnormal, or has changed, something is different than expected
Gathering complete and accurate data
Data collected from all available sources is used as the basis for identifying issues, problems, concerns. Must verify that data is complete and accurate
Assessing systematically and comprehensively
A method of assessing information or data so nothing is omitted or forgotten. Focused, head to toe, body systems
Predicting (and managing) potential complications
Look at the big picture to prepare for potential future complications for an individual pt, you are predicting complications which means you are identifying possible problems. What will put our pt at risk
ex.recognize that all pt have risk for atelectasis after surgery
Identifying assumptions
Recognize information taken for granted, hastily arriving at a conclusion without supporting evidence, a misconception. EVIDENCE
ex. all thin people are healthy
Step 2- Interpreting
-clustering related information
-recognizing inconsistencies
-checking accuracy and reliability
-Distinguishing relevant from irrelevant
-determining the importance of information
-comparing and contrasting
-(predicting) and managing potential complications
-judging how much ambiguity is acceptable
-using legal, ethical and professional
HERE WE- PLANNING, PRIORITIZE, DESICIONS
WHAT ARE YOU GOING DO WITH THE DATA YOU RECIEVE, MAKE SENCE OF THE DATA*
Clustering related information
Grouping together information with a common theme. A method of organizing data so that you put .things together in order to understand the situation, what is alike
ex. headache-clustering orther related sx-sleepy, hit head, dizziness
Recognizing inconsistencies
does the objective data match the subjective data
ex. pt says they aren't in pain but face is telling you diff. they are grimacing, clinching fists, tearful, holding their side
Distinguishing relevant from irrelevant
decidingco what information is pertinent or connects to the matter at hand, sort out what info relates to the current problem
ex. pt tells cardiologist my back hurts
may be important to pt overall care but not the current problem
Comparing and contrasting
looking at 2 similar cases, identifying the subtle differences, and acting on them
ex. pts both have arthritis
look at similarities and subtle differences
(Predicting) and managing potential complications
look at big picture figure our possible complications for and individual pt. must know common complications and consider individual differences.
Interpreting- you are planning interventions to help manage or reduce the risk of complications
ex. plan interventions to reduce atelectasis and pneumonia- encourage use of incentive spirometer, ambulation schedule.
ex. pt fall risk. plan for bed down, toileting assisted, socks with grips
Judging how much ambiguity is acceptable
- unclear, uncertain, or vague situation. how much wiggle room do you have when applying a rule to a particular situation. look at pt situations and assessment data to determine if assessment measures are acceptable for that particular pt
ex. pt flu and temp 100.2, although temp above norm, this temp is ok based on the specific situation
Using legal ethical professional guidelines
nurses must consider legal ethical and professional guidline when providing care. work in guidelines of the states nurse practice act as well as make judgments that are ethical and professional
ex. HIPAA
Step 3- Responding
-setting priorities
-delegating
what a nurse does*, hand on
Setting priorities
comparing and sorting through information, ranking it in order of importance to decide what needs to be done first and what can wait
ex. triage, prioritize who is in greater more emergent need at that time.
pt needs dressing change, bp checked, give bp med, go to toilet
1.toilet- maslow basic need
2.vitals
3. bp med
4. change dressing
Delegating
asking someone to do part of your job that is not part of their expected job assignment. delegating to a competent UAP make sure willing and able to do the task
5 rights of delegation
right task
right circumstance ex. no rx for UAP
right person ex. competent, experience
right direction ex. exact directions
right supervision ex check if task done an done correctly
1.Evaluating data (Step 4- Reflecting)
after actions and interventions are preformed, assessment data is collected again to determine if the interventions were effective. helps determine what further actions are needed
REFLECTION IN ACTION
ex. pt 8/10 pain Demerol given at 3;30 IM 25mg, check back 45-1hr, check pain level again and maybe vitals
Evaluating and correcting thinking
reflecting on what just happened , how the situation was handled,, what lessons can be learned for use in similar situations in the future. how were the results, what could be done better.
REFLECTION ON ACTION
ex.code blue, came back to life, sent to icu, reflection on this what could have been done better, what was done good
Brenners stages of clinical competance
1. novice
2. advanced beginner
3. competent
4. proficient
5. the expert
Novice
beginner
no experience in situation, lack confidence to demonstrate safe practice and requires continual verbal and physical cues
Advanced beginner
demonstrate marginally acceptable performance because nurse has had prior experience in actual situations, efficient and skillfull in parts of the practice with occasional supportive cues,, knowledge developing
Competant
nurse on the job who has been on the same or similar situations for 2-3 years, demonstrates efficiency and has confidence in her actions
Proficient
perceives situations as a whole rather than chopped up parts
the expert
intuitive grasp of each situation , deep understanding of the total picture, fluid and flexible and highly proficient
Maslow's Hierarchy of Needs
(level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization
physiological needs
the most basic human needs to be satisfied- water, food, shelter, and clothing
Safety and security
security, freedom from harm, and protection
love and belonging
love, effection and companionship
ex, does pt have support for when leave hospital [Show Less]