Nursing Process and Critical Thinking

Assessment Through interaction with the patient, significant others, and health care providers, collects information and analyzes data about the patient Physical examination of ALL body systems Cognitive, psychosocial, emotional, cultural, and spiritual components

Relationships among the steps of the nursing process. Figure 5-1 (Modified from Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.) Relationships among the steps of the nursing process.

Assessment Subjective Objective Observable and measurable signs Verbal statements provided by the patient Objective Observable and measurable signs Can be recorded

Sources of Data Primary Source Secondary Sources Patient Most accurate Family members, significant other, medical records, diagnostic procedures, and nursing literature When the patient is unable to supply information, secondary sources are used.

Methods of Data Collection Interview Reason patient is seeking health care History of present illness Past health history Environmental history Psychosocial history Physical Exam Head-to-toe format

Data Clustering Related cues are grouped together. Attention is then focused on health concerns that need support and assistance. This assists in the identification of major problems (nursing diagnoses).

Diagnosing Identify the type and cause of a health condition A clinical judgment about the patient’s response to actual or potential health conditions or needs. This data provides the basis for determination of a plan of care to achieve expected outcomes.”

Diagnosing Problem/Issue Any health care condition that requires diagnostic, therapeutic, or educational actions Deviations from the population norms Any change in the patient’s usual health status Any dysfunctional behavior

Diagnosing Contributing/Etiologic/Related Factors and Risk Factors Conditions that might be involved in the development of a problem May become the focus for nursing interventions Risk factors are those that increase the susceptibility of a patient to a problem. Clinical cues, signs, and symptoms that furnish evidence that a problem exists

Diagnosing Risk A clinical judgment that an individual, family, or community is more vulnerable to develop the problem than others in the same or similar situation The assessment indicates that risk factors are present that are known to contribute to the development of the problem

Other Types of Health Problems Collaborative Problems Certain physiologic complications that a treatment team monitor to detect onset or changes in status Treatment team manage problems using physician-prescribed and nurse-prescribed interventions to minimize the complications of the event.

Medical Diagnosis The identification of a disease or condition through a scientific evaluation of physical signs, symptoms, history, laboratory tests, and procedures Cancer Heart disease CVA Diabetes

Planning The treatment team establishes priorities of care, writes desired patient outcomes, selects and converts nursing interventions into nursing orders, and communicates the plan of care. The team must decide what can be done to lessen or solve an actual problem or prevent a risk problem from becoming an actual problem. The team decides what interventions will be effective.

Planning Priority Setting Interventions are ranked in order of importance for the patient’s life and health. Physiologic needs Safety and security needs Love and belonging needs. Actual problems Potential risk problems. Priorities change as the patient progresses in the hospitalization; as some problems are resolved, new ones can be addressed.

Planning Establishing Desired Patient Outcomes Goal: This is what the client is personally to achieve. Establish specific nursing interventions for treatment team and client to perform to achieve goal. Outcome: a description of the specific, measurable behavior that the patient will be able to exhibit in a given time frame following the intervention.

Planning A Well-Written Patient-Centered Goal/Desired Outcome Statement Uses the word “patient” as the subject of the statement Uses a measurable verb Is specific for the patient and the patient’s problem Is realistic for the patient and the patient’s problem Includes a time frame for patient reevaluation

Planning Selecting Nursing Interventions Activities that should promote the achievement of the desired patient outcome May include activities that the treatment team selects to resolve a client problem, to monitor for the development of a risk problem

Planning Physician-Prescribed Interventions Actions ordered by a physician for a health care providers to perform Medications, wound care, diagnostic tests Assessing, teaching, and validating the safety of physician orders expected of nursing practice

Planning Nurse-Prescribed Interventions Actions the nurse can legally order or begin independently Providing a back massage, turning patient every 2 hours, monitoring for complications When determining interventions, the nurse should consider the contributing/etiologic/ related factors; risk factors; patient-centered goal/desired outcome; and the nursing diagnosis label.

Planning Communicating the treatment Care Plan It is important to have written guidelines to promote the continuity of patient care. Formats for the written treatment care plan vary among institutions. Treatment care plans are to be designed to a specific problem that individual is having

Implementation Phase of the nursing process in which the established plan is put into action This phase includes ongoing activities of data collection, prioritization, performance of nursing interventions, and documentation. Documentation is a vital component of the implementation phase. “If it was not charted, it was not done” is a constant principle of nursing.

Evaluation A determination is made about the extent to which the established outcomes have been achieved. Review the patient-centered goals/desired patient outcomes that were established in the planning phase. Reassess the patient to gather data indicating the patient’s actual response to the nursing intervention. Compare the actual outcome with the desired outcome, and make a critical judgment about whether the patient-centered goals/desired patient outcome was achieved.

Evaluation The treatment team should make one of three judgments or decisions The outcome was achieved. The outcome was not achieved. The outcome was partially achieved.

How did the plan work? The plan of care is changed during this phase of the nursing process. Modifications can be made if the outcome has been achieved, partially achieved, or not achieved.

Managed Care Case Management A health care system whose aim is to enhance specific clinical and financial outcomes within a specific time frame Case Management A certified nursing specialty; refers to the assignment of a health care provider to a patient so that the care of that patient is overseen by one individual Assists the patient and family to receive required services, coordinates these services, and evaluates the adequacy of these services

Critical Thinking Critical thinkers think with a purpose. They question information, conclusions, and points of view. Critical thinking is a complex process, and no single simple definition explains all of the aspects of critical thinking. The PT must be able to not only perform skills but also think about what he or she is doing. PT’s use a knowledge base to make decisions, generate new ideas, and solve problems.

Critical Thinking Characteristics of Critical Thinkers Reflect or think about what is being learned. Look for relationships between concepts or ideas. Analyze or critique behaviors. Make self-correction. Realize they do not know everything. Involve creative thinking.

Confucious Thought “ He who learns but does not think is lost” “He who thinks but does not learn is in danger”

Critical thinking It is thinking that allows you to think outside of the box and generate some new solutions Its getting you point or thought across Critical thinking is the central theme for psychiatric technician

The development of critical thinking is your key to success It is required or you do not meet the PT Board requirements to sit for the licensure test Critical thinking is essential for successfully answering the board exam questions correctly As a practitioner you will be required to make decisions in complex situations and quickly identify priorities

This process is the framework for the practice of nursing. Outcomes process Management Process Nursing Process Assessment process

The assessment process is best described as a process in which the nurse…. Orients the patient to the environment and ensures safety. Collects information ande analyzes data. Collects data and reports data to the physician. Collects subjective date and reports the data to the charge nurse.

Objective Subjective Primary Secondary You are admitting a Pt who is confused and lethargic. The Pt’s family gives you information about the Pt. This data is called Objective Subjective Primary Secondary

Components of the nursing process consist of the following Title, definition of the title, related factors, and defining characteristics. Medical label, risk factors, and characteristics. Nursing interventions, evaluation and defining characteristics. Label, definition, of the problem, and outcome.

A “possible” nursing diagnosis is utilized when: There is no other option A problem is likely or feasible. A problem arises and there is a possibility of complications There are no problems or complications, but a risk is noted.

Deficient knowledge related to disease process. Nursing diagnoses are ranked in order of priority of the Pt’s health and safety issues. Which of the following nursing diagnoses would be of highest priority? Deficient knowledge related to disease process. Ineffective breathing pattern related to shortness of breath. Impaired skin integrity related to immobility. Ineffective coping mechanisms related to medical diagnosis.

Nursing interventions are: Broad and general statements Steps to complete the evaluation process Nurse selected or prescribed actions to achieve the desired patient outcome Part of the nursing diagnosis.

Concise Collaborative Measured Multidisciplinary Clinical pathways are a __________plan that schedules clinical interventions over an anticipated time frame. Concise Collaborative Measured Multidisciplinary

Managed, timely, or accurate Accurate, concise or patient-centered During the evaluation phase the nurse should make one of three judgments regarding the desired outcome. These judgments regarding the outcome are Managed, timely, or accurate Accurate, concise or patient-centered Achieved, not achieved, or partially achieved Reasonable, timely, or achieved.

Nurse Physician Insurance agent nurse Case management is the assignment of a health care provider to a patient so the care of that patient is over seen by one individual this individual typically is a (n) Nurse Physician Insurance agent nurse

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