HEALTH ASSESSMENT & PRAXIS I Learning Outcome 1: Describe Health Assessment of the Adult Client

CONTACT INFO Instructor: Alysha Falk Phone: (306) Website:

KNOWLEDGE ASSESSMENT  Health Assessment Assignment20%  Lab Preparation Assignments15%  Participation5%  Midterm Exam (LO1-5)25%  Final Exam (Comprehensive)35%  Performance Exam: Vital SignsPass/Fail

CLINICAL PERFORMANCE ASSESSMENT  Clinical Evaluation Process Record  (Older Adult Experience)

PASSING GRADE  60%  Clinical portion graded Pass/Fail  No supplemental exam

 Attendance in both class and labs is MANDATORY- review guidelines in coursepack  For course assignments not handed in on or before the date and time specified, 10% will be deducted for each day the assignment is late (including weekends). An assignment more than 7 days late will receive 0. Regardless, all course components must be completed.  Cell phones and cameras are not to be used in classroom or labs without prior permission from instructor.

LAB GROUPS  Alysha’s Lab Group  Jessie’s Lab Group

LAB  Vocabulary terms to know are in Appendix A- you can find the definitions for these terms in your required readings.  There are lab preparation activities included in your course pack (See Appendix B). Your lab prep activities are due at the beginning of CLASS- PRIOR to LAB

HEALTH ASSESSMENT  Nursing History  A Behavioural & Physical Exam  Cultural Assessment

PURPOSES OF PHYSICAL EXAM (P&P )  Gathering a Health History  Identify client’s ___________________  Be thorough, pay close attention to _______________  Interview: Focus on the _____________ not the _________________  Your physical exam will help supplement, confirm, or refute data obtained in the history.

PURPOSES OF PHYSICAL EXAM  Developing Nursing Diagnoses and a Care Plan  Think critically about the data collected to create a picture of the patient’s health status  __________________ together significant data into clusters helps create nursing diagnoses.  ___________________ findings suggest the need to get more information.  A _____________________ to be used for comparison  Assessment is ongoing and therefore the care plan changes with the client’s condition

PURPOSES OF PHYSICAL EXAM  Managing Patient Problems  We need to recognize changes in the status of our patients so that we can modify our interventions to gain the most desirable outcomes.  “Performing the mechanics of physical assessment is relatively simple. The more difficult challenge lies in using findings to make decisions.”

PURPOSES OF PHYSICAL EXAM  Evaluating Nursing Care  We need to be __________________ and evaluate the results of our nursing care.  Through physical exam we can monitor physiological and behavioral outcomes of care  Physical assessment is used to assess a condition and evaluate response to care

DATA COLLECTION (P&P )  Must think critically about what to assess  Initially, this is often an overview of the client  We must learn to differentiate important data from the total data collected.

DATA COLLECTION  Cue:  Inference:

DATA COLLECTION  Begins with a comprehensive nursing HEALTH HISTORY(Box p.157)  Identifying Data  Source of History  Reason for Health History interview  Current Status of Health  Developmental Variables  Psychological Variables  Spiritual Variables  Sociocultural Variables  Physiological Variables- past illnesses/injuries, current medications, review of systems

SOURCES OF DATA  Client  Family and Significant Others  Health Care Team  Medical Records  Literature  Nurse’s Experience

DATA COLLECTION  Subjective Data : only provided by ________________. It is their ________________ descriptions of their health problems.  Includes feelings, perceptions, self-report of symptoms.

DATA COLLECTION  Objective Data: Are observations or ____________________ of a client’s health status.  Examples: measurement of blood pressure, inspection of a condition of a wound.  Measurements are based on an accepted standard.

CULTURAL ASSESSMENT (P&P )  An examination of cultural care values, beliefs, and practices of individuals, families, and communities  The goal is to have the patients give information that will help us to provide culturally congruent care- to have them give information that will describe their values, beliefs, and practices that will be significant to their care.  We get this information through: asking open-ended questions (What do you think caused your illness?), focused questions (Have you had this problem before?), and contrast questions (How different is this from problems you had previously?)

LEININGER’S SUNRISE MODEL- PAGE 115 P&P Explains why culture is inclusive to our everyday life.

PHYSICAL ASSESSMENT TECHNIQUES  Inspection  Palpation  Percussion  Auscultation

INSPECTION Using vision and hearing to distinguish normal from abnormal findings

To Inspect Body Parts Accurately:  Need adequate _________________  Position and expose body parts so that ____________________ can be viewed  Inspect area for:

 When possible, _____________ each area inspected with the same area on the opposite side of the body.  Use additional ___________ (ex. ____________) to insect body cavities.  Do not _____________. PAY ATTENTION TO DETAIL!

PALPATION  Involves the use of the ________________ to touch body parts to make sensitive assessments  It’s important that client is ___________________  _______________, __________________________ pressure is best when palpating  Can palpate to assess:

PERCUSSION  Involves __________________ the body with the ____________________ to produce a vibration that travels through body tissues  Character of the sound determines the location, size, and density of underlying __________________, helps to verify ___________________.  Most often a skill used by __________________________________.

AUSCULTATION  Listening to sounds the body makes to detect ____________________ from normal  Most often use a _____________________  Most often used to assess ________________________, ___________________, and _____________________ systems

OLFACTION  Helps detect abnormalities that you cannot recognize by any other means

CRITICAL THINKING  “A complex phenomenon- a set of skills that emphasize the use of logic and reasoning to make accurate clinical judgements and decisions”  Recognizing issues, analyzing information, evaluating information, and drawing conclusions  Helps nurses make informed decisions that are focused on the patient

CRITICAL THINKING  Asking questions:  What do I know about this situation?  What do I need to understand the situation better?  How might I change the situation?  How can I obtain more information?  Are other options available?

CRITICAL THINKING  Involves ___________________  Use of evidence-informed knowledge- knowledge based on research or clinical expertise  Involves: interpretation, analysis, inference, evaluation, self-regulation, asking questions, being well-informed, recognizing biases.

CRITICAL THINKING Experiences with patients Recognize patterns of behavior & see commonalities in signs & symptoms Anticipate patient’s reactions to nursing interventions

LEVELS OF CRITICAL THINKING  Basic  Complex  Commitment

BASIC CRITICAL THINKING  Trust in “the experts” for answers  Thinking is concrete and based on a set of rules and principles  Complex problems are seen as either right or wrong

COMPLEX CRITICAL THINKING  Begin to separate your thinking from those of authorities and analyze and examine choices more independently  Begin to realize alternative, and sometimes conflicting solutions to problems exist  Willing to consider other options in addition to routine procedures when complex situations develop  Thinking is creative & innovative

COMMITMENT  Anticipate the need to make choices without assistance from other professionals, then assume responsibility and accountability for those choices  Choose and action and stand by your choice.  Evaluate results and determine whether it was appropriate.

COMPONENTS OF CRITICAL THINKING  1. Specific Knowledge Base  2. Experience in Nursing  3. Critical Thinking Competencies  General Critical Thinking Competencies- scientific method, problem solving, decision making  Specific Critical Thinking Competencies in Clinical Situations- diagnostic reasoning, clinical inference, clinical decision making  Specific Critical Thinking Competency in Nursing- use of nursing process  4.Attitudes for Critical Thinking  5. Standards for Critical Thinking  Intellectual Standards  Professional Standards- ethical criteria for nursing judgment, criteria for evaluation, professional responsibility

SPECIFIC KNOWLEDGE BASE  Information from basic sciences, humanities, behavioural sciences, and nursing.  Holistic thinking regarding health concerns  Need a breadth and depth of knowledge base

EXPERIENCE  Learn from clinical situations by observing, sensing, talking with patients and families, and reflecting on experiences  Taking “text-book” knowledge and applying it in the real world- adapting it to client’s unique needs  Helps us to recognize problems, know how to act on them, and seek knowledge as needed

COMPETENCIES  The cognitive processes a nurse uses to make judgements about the clinical care of patients.  General Critical Thinking  Scientific Method- Identify problem, collect data, formation of research question or hypothesis, testing of the question or hypothesis, evaluation of the results  Problem Solving  Decision Making- recognize the problem, assess all options, weigh options against a set criteria, test possible solutions, then make a final decision

COMPETENCIES  Specific Critical Thinking Competencies in Clinical Situations  Diagnostic Reasoning and Inference  Diagnostic reasoning- a process determining a patient’s health status after you make physical and behavioural observations and after you assign meaning to the behaviours, physical signs, and symptoms exhibited by the patient  Clinical Inference- the process of drawing conclusions from related pieces of evidence- recognizing patterns of information from data

COMPETENCIES  Specific Critical Thinking Competencies in Clinical Situations  Clinical Decision Making- focuses on defining patient problem and selecting appropriate treatments  Clinical judgment- noticing or grasping the situation, interpreting sufficient understanding of the situation, responding or deciding on course of action, reflecting on actions taken and their outcomes

NURSING PROCESS  Nursing Process as a Critical Thinking Competency  To assist nurses in identifying and treating patients’ health-related concerns and to help patients meet agreed-upon outcomes for better health  Incorporates general and specific critical thinking competencies  The blueprint or plan for our nursing care  Analysis as part of each step

ATTITUDES  Affect the way we approach problems  What types of attitudes do you think would be helpful to have as a nurse?

STANDARDS FOR CRITICAL THINKING  Intellectual Standards- a guideline or principle for rational thought. – thoroughness, precision, accuracy, consistency  Professional Standards  Ethical Criteria for Nursing Judgment- focusing on patients’ values and beliefs to make just choices that are faithful to the patient’s decisions and beneficial to their health.  Criteria for Evaluation  Professional Responsibility

DEVELOPING CRITICAL THINKING SKILLS  Reflective Journal Writing  Reflection: the process of purposefully thinking back or recalling a situation to discover its purpose or meaning.  A tool for developing critical though and reflection through clarifying concepts  Helps us monitor our competence and transfer our knowledge, and recognize our assumptions

DEVELOPING CRITICAL THINKING SKILLS  Concept Mapping  Clients have multiple nursing diagnoses  A concept map is a visual representation of patient problems and interventions that depicts their relationships to one another

THE NURSING PROCESS (P&P , 162)  “A problem-solving approach to identifying, diagnosing, and treating the health issues of clients”  There are five steps- they are interrelated and overlapping.

THE NURSING PROCESS- ADPIE COURSE PACK-PAGE 3  Assessment  Nursing Diagnosis  Planning  Implementation  Evaluation

THE NURSING PROCESS

FOR NEXT WEEK…  Lab Prep Activities Due!  For learning outcomes 1&2  Appendix B- pages  Due at the BEGINNING OF CLASS  Do your vocabulary terms!