1. Nursing Strategies for Success
Chapter 5

2. Successful Intelligence
Two men out hunting

3. Successful intelligent thinking is BALANCED

4. Sabiduría Knowledge vs. Wisdom Knowledge: Wisdom
Gaining information, understanding concepts
Wisdom
Collected meaning and significance gained from knowledge
Spanish word for the two sides of learning

5. What is thinking?
Asking questions 
Move towards answers

6. Is there such a thing as a “bad question”?
Yesterday I was at my local COSTCO buying a large bag of Purina dog chow for my loyal pet, Jake, the Wonder Dog and was in the check-out line when a woman behind me asked if I had a dog.

7. Is there such a thing as a “bad question”?
What did she think I had an elephant?
So since I'm retired and have little to do, on impulse I told her that no, I didn't have a dog, I was starting the Purina Diet again.
I added that I probably shouldn't, because I ended up in the hospital last time, but that I'd lost 50 pounds before I awakened in an intensive care ward with tubes coming out of most of my orifices and IVs in both arms.

8. Is there such a thing as a “bad question”?
I told her that it was essentially a Perfect Diet and that the way that it works is, to load your pants pockets with Purina Nuggets and simply eat one or two every time you feel hungry.
The food is nutritionally complete so it works well and I was going to try it again.
(I have to mention here that practically everyone in line was now enthralled with my story.)

9. Is there such a thing as a “bad question”?
Horrified, she asked if I ended up in intensive care, because the dog food poisoned me.
I told her no, I stepped off a curb to sniff a poodle and a car hit me.
I thought the guy behind her was going to have a heart attack he was laughing so hard.

10. “Only students who have questions are really thinking and learning”
Ask questions that stimulate thought.
Ask students – do you believe it?

11. “The difference between good science and great science is the quality of the questions posed.” ~ William Hunter

12. You want to get an A in your anatomy class
Use questions to analyze:
What do I need to memorize this week?
What multiple pathway to learning is my strength?
Come up with creative ideas:
What are different ways to study using my strength?
Apply practical solutions
What ways can I study my anatomy to memorize the body systems?
When will I use these study skills?
(Analyze)How bad is my money situation?
(Creative) What ways can I earn money?
(Practical) How do I get a job on campus?
Analyitical: What does it take to be a nurse? Get a nursing degree? What field do I want to work in?
Creative:

13. Know your purpose! What are you trying to accomplish?
Are your questions leading you towards that purpose?

14. Can you get smarter?
“As jogging is to the body, thinking is to the brain.” ~ Nob Yoshigahara (puzzle master)

15. January 5, 2010 Puzzles and Alzheimer's
A new study adds to a growing body of evidence that mentally challenging activities like word games, playing cards, reading and writing may delay the rapid memory loss that occurs with Alzheimer’s disease.
The study involved 488 people who were in their 70s and 80s. All were free from Alzheimer’s at the start. Each participant filled out questionnaires about how often they participated in six leisure-time activities: reading books, magazines or newspapers, writing, doing crossword puzzles, playing board or card games, participating in group discussions or playing music.
“The effect of these activities in late life appears to be independent of education,” Dr. Hall said. “These activities might help maintain brain vitality.”
For each activity, those who took part every day of the week were rated at seven points; several days a week was rated at four points; and once-a-week participation was rated at one point.
Researchers studied them for about five years, performing regular checks to look for signs of memory loss and other symptoms of Alzheimer’s disease. During that time, 101 developed Alzheimer’s or another form dementia. The findings appeared in Neurology, the medical journal of the American Academy of Neurology.
Among those who developed dementia, the more activity points someone had, the longer they went without showing obvious signs of memory loss and other symptoms. The researchers found that for every additional activity a person participated in, the onset of rapid memory loss was delayed by about two months.
“The point of accelerated decline was delayed by 1.29 years for the person who participated in 11 activities per week compared to the person who participated in only 4 activities per week,” said study author Charles B. Hall, Ph.D., of Albert Einstein College of Medicine in New York.
The results remained valid even after researchers factored in the education level of the participants. Having many years of formal schooling has been shown to reduce the risk of Alzheimer’s in old age. “The effect of these activities in late life appears to be independent of education,” Dr. Hall said. “These activities might help maintain brain vitality.”
The findings are consistent with earlier reports that mentally challenging activities may help to build up so-called cognitive reserve, or the ability of the brain to function normally despite showing signs of damage from Alzheimer’s disease. So while participating in these mentally stimulating tasks did not prevent the onset of Alzheimer’s altogether, it did delay the onset of memory loss and thinking problems.

16. How can You improve your analytical thinking skills?
AKA: Critical Thinking
Gathering information
Analyzing & Clarify
Evaluating for the purpose of
Gaining understanding
Solving a problem
Making a decision

17. Gather information (Define your purpose!) Information
How much do you need?
How much time do you spend gathering?
Is the information relevant?
Writing a paper on nursing ethics:
Review assignment – what are the requirements
- research out relelcant information
Choose two topics, find 4-5 comprehensive pieces on each
Sick patient:
Diagnosis of diabetes
Review in mind pathophysiology of diabetes? What might be wrong?
Obtain data:
-read their chart lab values, medications
FSBS
Vital signs
Assess urine output
Assess skin for dryness, color,

18. Analyze & Clarify information
Break information into parts
Separate the ideas
Compare and Contrast
Examine cause and effect*
Look for themes, patterns and categories
Separate the ideas
Paper:
ER nurse: different types of ER nurses. Triage. Cardic monitor. Major trauma
ICU: CCU, Neonatal ICU(NICU) Telemetry
Diabetic patient:
Vital signs
FSBS
Medications

19. Analyze & Clarify information
Examine whether examples support ideas
Distinguish fact from opinion
Subjective Information
Objective Information

20. Objective information
Is observable, able to be seen, heard or touched, smelled, tasted
Factual
Able to be counted
Able to be described
The same from multiple reporters
is verifiable. Another person can repeat the observation, you can perform some type of test, etc.

21. Objective language I saw… I counted… I observed… This is what he did…
This is what it sounded like…

22. Subjective information
Is opinion, judgment, Assumption, beliefs, rumor or suspicion
Varies from person to person, day to day
Information that can be interpreted differently by other people
is what comes out of the patient or family's mouth.

23. Subjective language I feel …
Example: "I feel hot" is subjective as someone may feel hot to themselves but another might touch them and say "no, you're freezing". As opposed to: "I have a temperature of 101 degrees" - this can be measured with a thermometer and the fact remains the same no matter who is looking at the thermometer.

24. Diabetes Case Study
M.G. is a 58 y/o white female who presents to her primary care physician with a complaint of “tired all the time.”
Height:5’4”
Weight:212 lbs.
It’s been going on for several months, and she doesn’t report any concerns with nighttime sleep.
She doesn’t note any new stress or other life changes, and denies depression or anxiety.
Alcohol consumption is limited to one to two drinks per week, and she quit smoking over 10 years ago.
BP:135/86
Family history is notable for type 2 diabetes in an older sister; her mother had hypothyroidism and “heart disease.”
The patient also has high cholesterol that she has been trying to treat with “weight loss and exercise.”
She walks about 20 minutes three times weekly when the weather allows.
Lung sounds are clear
Pulse regular and strong
She has been treated for about five years for hypertension with hydrocholorthiazide.
No thyromegaly

25. Analyze & Clarify information
Examine whether examples support ideas
Distinguish fact from opinion
Subjective vs. Objective
Examine perspective & Assumptions
Bias
Prejudices
Evaluate information

26. Assess Analytical Thinking Skills
I tend to perform well on objective tests.
People say I’m a “thinker”, “brainy”, “studious”.
I am not comfortable with gray areas – I prefer information to be laid out in black and white.
In a group setting, I like to tackle the details of a problem
I sometimes over think things and miss my moment of opportunity.
Score =least like me; 5 most like me.

27. How to Improve your creative thinking skills

28. Improving creativity
Brainstorming
Divergent thinking
Group think

29. Improving creativity Shift your perspective Challenge assumptions
Take a new and different look
Ask “what if” questions

30. Improving creativity Set the stage for creativity
Choose – or create environments that free your mind
Be curious
Give yourself time to “sit” with a question
Believe in yourself as a creative thinker

31. Improving Creativity Take risks Fly in the face of convention
Let mistakes be Okay

32. Assess creative thinking
I tend to resist rules and regulations.
People say I’m “expressive,” “full of ideas,” innovative.
I break out of my routine and find new experiences
In a group setting I like to toss ideas into the ring
If you say something too risky, I’m all for it.
5-12 Weak
13-19: average
20-25: strong

33. Improving practical thinking skills
Experience
“Experience is the greatest teacher!”
Benjamin Franklin (Poor Richard's Almanack, Nov. 1743) offered, "Experience keeps a dear school, yet fools learn in no other.“

34. The emotional intelligence connections

35. Practical thinking means action!
Stay motivated
Make the most of your personal strengths
When things go wrong, accept responsibility and reject self pity
Focus on the goal and avoid distractions
Manage time and tasks effectively
Believe in yourself

36. Assess practical thinking skills
I can find a way around any obstacle
People say I’m a “doer” and “go-to” person “organized”.
When I have a vision, I translate it into steps from A to B to C.
In a group setting, I like to set up the plan
I don’t like to leave loose ends dangling – I’m a finisher.

37. How is this type of thinking used in Nursing?
NURSING PROCESS!

38. Overview of the Nursing Process
Consists of 5 steps
Assessment
Diagnosis
Planning
Implementation
Evaluation
Build on each other
Not linear

39. Nursing process is dynamic and requires creativity in its application
Steps remain the same
Application and results different
Used throughout the life span in any care setting

40. Small group questions:
How many steps are in the nursing process?
What are the names of each of the steps?
What is the purpose of the nursing process?
In what clinical setting is the nursing process used?

41. Assessment Step #1 Involves Collecting data (from variety of sources)
Validating the data
Organizing the data
Interpreting the data
Documenting the data

42. Assessment Validating the Data Organizing the Data
Interpreting the Data
Relevant vs. irrelevant
Gaps?
Identify patterns
Document the Data

43. Small Group Questions
Which of the following are objective data and which are subjective data.
A. Nausea
B. Vomiting
C. Unsteady gait
D. Anxiety
E. Bruises on the right arms and face
F. Temperature 101 F

44. Diagnosis Step 2 in the nursing process
Formulating a nursing diagnosis
Analysis and synthesis of data

45. Nursing diagnosis:
“A clinical judgment about individual, family or community responses to actual or potential heal problems / life processes.
A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.”

46. Medical vs. Nursing diagnosis
Medical diagnosis
Nursing diagnosis
Identifies conditions the MD is licensed & qualified to treat
Identifies situations the nurse is licensed & qualified to treat

47. Medical vs. Nursing diagnosis
Medical diagnosis
Nursing diagnosis
Identifies conditions the MD is licensed & qualified to treat
Identifies situations the nurse is licensed & qualified to treat
Focuses on illness, injury or disease processes
Focuses on the clients responses to actual or potential health / life problems

48. Medical vs. Nursing diagnosis
Medical diagnosis
Nursing diagnosis
Remains constant until a cure is effected
Changes as the clients response and/or the health problem changes

49. Medical vs. Nursing diagnosis
Medical diagnosis
Nursing diagnosis
Remains constant until a cure is effected
Changes as the clients response and/or the health problem changes
i.e. Breast cancer
i.e. Knowledge deficit
Powerlessness
Grieving, anticipatory
Body image disturbance
Individual coping, ineffective

50. Diangosis Nursing diagnosis Medical diagnosis
Breathing patterns, ineffective
Chronic obstructive pulmonary disease
Activity intolerance
Cerebrovascular accident
Pain
Appendectomy
Body image disturbance
Amputation
Body temperature, risk for altered
Strep throat

51. Planning & Outcome identification
Step Three: Planning
Identifying outcomes
Goals
An aim, intent or end.
Short term goals
Hours to days (less than a week)
Long term goals
Weeks to months

52. Planning & Outcome identification
Developing specific nursing interventions
Independent nursing interventions
No order needed
Elevate edematous legs
Interdependent nursing interventions
In conjunction with an interdisciplinary team member
Assist client with physical therapy exercises
Dependent nursing interventions
Require an order
Administering of medications

53. Prioritizing the nursing diagnosis
Maslow’s hierarchy of needs

54. Maslow’s Hierarchy of Needs

55. Implementation DO IT DO IT RIGHT DO IT RIGHT NOW! 4th step:
Execution of the nursing care plan
Delegation
DO IT
DO IT RIGHT
DO IT RIGHT NOW!

56. Evaluation
5th step
Determining whether the clients goals have been met, partially met or not met.

57. Solving a problem Define the problem Analyze the problem Solutions
Potential positive effects
Potential negative effects
Practical action
Final Evaulation

58. Decision making thoughts
Look at the given options – then try to think of more
Think how decision effects others
Gather perspectives
Look at the long term effects
Ethical dilemmas –
Keeping your balance

59. Solving a problem
SOAP!
Subjective
Objective
Assessment
Plan