1. Nursing Process and Critical Thinking

2. 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

3. 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.

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

5. 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.

6. 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

7. 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).

8. 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.”

9. 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

10. 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

11. 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

12. 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.

13. 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

14. 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.

15. 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.

16. 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.

17. 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

18. 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

19. 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

20. 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.

21. 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

22. 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.

23. 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.

24. 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.

25. 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.

26. 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

27. 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.

28. 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.

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

30. 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

31. 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

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

33. 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.

34. 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

35. 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.

36. 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.

37. 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.

38. 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.

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

40. 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.

41. 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

42. The end