Sheryl Abelew MSN RN. Chapter 4 Important step in the critical thinking process Includes effective time management Steve Covey (1989) states you.

Sheryl Abelew MSN RN

Chapter 4

Important step in the critical thinking process

Includes effective time management Steve Covey (1989) states you should

be “putting first things first”. There are three categories “must do, should do, and nice to do”.

Develop a time frame for priorities.

***Review box 4-2 Time Management Procedures

Use Maslow’s hierarchy of needs Five levels of needs

Physiologic needs Sleep, food, water, movement, comfort

Psychological needs Safety and security

Love and belonging Affiliation, affection, intimacy

Self-esteem Sense of self worth, self respect, dignity

Self-actualization Recognition of potential growth, health, autonomy

Place in level of priority High, Medium, and Low

High Life threatening, threats to pt safety, pain,

and anxiety, unstable or changes in condition Medium

Problems that could result in unhealthy consequences, like emotional or physical impairment, but no threat on life

Low Problems that can be resolved with minimal

intervention and have little potential to cause dysfunction

Four levels of priority according to Rubenfeld and Scheffer (1999) Life Threatening Issues

ABC’sSafety

Protecting the patient from injury, practicing within scope of nursing, doing no harm

Patient Priorities Plan of care based on patient activities and

conditionNursing Priorities

Examine all the patients strengths and health concerns, moral and ethical and Maslow’s hierarchy of needs

Setting priorities is not linear Addresses multiple concerns at the

same time Learning to take charge and make

efficient use of time is key in time management

Making a to do list will help with multitasking

Assessment Obtain complete information and sort and ID

problems Analysis

Prepare list of needs and diagnosis Outcome Identification

Have measureable goals based on Maslow, and prioritize diagnosis

Plan Select diagnosis and activities

Implementation Perform immediate actions to prevent harm first.

Highest priority to lowest priority Evaluation

May require reevaluation and/or adjustments

Priorities may change Inadequate assessment of clients needs Failure to differentiate priority and non

priority tasks Accepting others priorities without

seeing the big picture Performing tasks that were identified

first vs. those that are a priority Completing the easiest task first instead

of the priority

Chapter 5

“Nursing Process is considered to be a specialized form of systematic inquiry or problem solving process used in drawing conclusions about the patient’s problems and the corresponding nursing actions to resolve problems.” Saucier, Stevens * Williams (2002).

Allows for a consistent use of standards and standardized language providing for a way to measure and quantify the effects of nursing care and interventions

In order to keep terms consistent, ANA recognizes NANDA as the official language of nursing diagnosis, NIC for interventions classification, and NOC for outcomes classifications

Assessment Analysis (Diagnosis) Outcome Identification Plan Implementation Evaluation

Collect data Identify pertinent data Recognize deviations from normal Validate data Sort and Organize data in a logical order Identify patterns in the data

Examine for unmet needs and strengths and health concerns

Focus on problems the nurse can change

Develop diagnosis based on facts Validate the diagnosis Establish priorities

Establish outcomesRealisticAchievableMeasureable

Collaborate to review goals to meet needs

How to develop your strategies for meeting nursing interventions

Use NIC for nursing interventions Write plan of care using standardized

language Collaborate for planning delivery of care

Initiate actions to accomplish goals Manage care in order of priority Delegate care based on caregiver,

acuity, needs and plan of care Intervene as necessary Document interventions and response

Compare actual vs. expected outcomes Communicate findings Record attainment of goal Review and modify POC based on needs

Written documentation of the nursing process

See Box 5-3 for care plan formation

See Table 5-5 for sample care plan scenario

Chapter 6

Transferring tasks to a competent individual

Used most commonly with a skill mix based on scope of practice

Consider job description when delegating

Right Task Right Circumstance Right Person Right Direction and Communication Right Supervision and Evaluation

Delegator reluctant to take the risk and give up control

Subordinate fails to take responsibility Workplace issues

Assessment List patients need and assessment findings

Analysis Level of care and acuity

Outcome identification Establish priorities

Plan Nurse specifies nature of tasks and skill required

Implementation Delegation of tasks

Evaluation Compare outcomes with the POC

Chapter 7

Three levels of CommunicationSocial

Interactions for building relationshipsTherapeutic

Nurse listens to patient problems and focuses on needs

Collegial Enhancing relationships with colleagues,

improved pt care, and better documentation

Nursing Personnel Delegating Report Interdisciplinary Conflict resolution Physician notification Receiving phone calls

DocumentationOne way to validate critical thinkingKeep confidentialAccurate and objectivePerformed promptly

Chapter 8

Goal directed based on rationale thought processes

Involves critical thinking Approached analytically

4 areas must be assessedWhat the patient needs to learnCharacteristics of the patientPatients preferred learning styleWhether patient is ready/willing to learn

Conduct a learning needs assessment Assess cultural background Developmental stage consideration Literacy

Analyzing needsValidate with the patient

Outcome identification ID goals, clear objectives

Planning the lesson Instructional methods

Traditional i.e. lecture, discussion Non traditional i.e. role-playing, simulations, etc

Implementing educational session Evaluating the educational process

Chapter 9

When processing data, continually evaluate reasoning

Examine the evidence to determine what else is needed

Obtain and clarify data Examine logic and give reasons for

conclusions Review the consequences of possible

actions and draw conclusions if desired outcome can be obtained

Use professional standards as guidelines to decision making when evaluating patient circumstances, and then consider the textbook data, current diagnostic test findings, and assessments of the nurse

Nurses need to follow the regulations set forth according to scope of practice and standards of practice as well as the code of ethics for nurses when making decisions

Review box 9-2 pg 199

Nurse collects information and uses skill of interpretation to define what the patient is presenting as

Nurse establishes expected outcomes for interventions to determine if the problem will be resolved

After implementation, nurse will evaluate on an ongoing basis progress towards goals

After recognizing effects from intervention, nurse will offer rationale for the result

Lastly, nurse will reexamine thinking

Quality implies evaluation Evaluation requires standards which

define the acceptable levels of care Nurse must evaluate actions to the

professional practice standards from the ANA

Indicators that identify impossible workloadFailure to monitor when indicated by

patients condition Inadequate treatment for circumstancesExcessive delay of treatmentsFailure to provide ongoing care and

treatmentsLack of time to provide patient teaching

Use clinical reasoning to monitor patients change of condition and respond with the appropriate intervention

Two examples of monitoring the patients conditionCalling the physician

When there is a change in condition Pain without ordered meds that manage the pain Acute elimination problems Lab values that require orders Risk to safety

Interpreting lab values Are the findings abnormal and expected Are the findings abnormal and unexpected Are the findings normal

Failure to use appropriate decision making skills

Failing to assess, report, or omissions Failure to assess for changing of

condition Nurse fails to perform duties

appropriately results in negligence

Chapter 10

Ethics deals with the principles of right and wrong

Foundation of ethics is standards of conduct and moral judgment

Nurses must be aware of their own value system

ChoosingAllows for free choice identifying

alternatives and selecting alternatives Prizing

Individual satisfaction with choice of verbalization to others

Acting (Internalization and repetition)

Ethical PrinciplesAutonomy

Right to self-determinationNonmaleficence

Directs the nurse does no harmBeneficence

Doing good on the patients behalf Justice

Moral obligation to treat people fairly and equally Fidelity

Keeping your word and acting in the patient’s best interest

Veracity Telling the truth

ANA as developed a code of ethics Nine statements define this code Review pg 233 Box 10-3

Assessment Analysis Outcome Identification Plan Implementation Evaluation

**

Gather information to determine the facts that will have the most affect on the situation

Develop sensitivity to recognize ethical situation and its essence to nursing

Identify risks to the patients

Determine the values in conflict Become aware of the relevant

information Values clarification Generate multiple alternatives and rank

in order of what is right and wrong Explore emotional, social and physical

risks to patient and staff

Providing safe nursing care Expected outcome should serve as a

guide in making decisions Use clearly stated outcomes for success

to be measureable

Decision maker should choose the best options for prioritizing of needs to achieve the desired outcome

Organize information and alternatives that represent various moral views

Be prepared to defend your choice Stay focused on the outcome to stay

focused on the real problem

Implement the moral action selected to resolve the dilemma

Follow chain of command Support a blame free environment

Were the actions ethical? Did the solution generate the desired

outcome? Can you justify the consequences? Do the benefits outweigh the risks?

Hospitals and long term care facilities have groups of individuals who discuss, clarify, and resolve issues related to patient care welfare

Goal is to support objectivity in difficult patient care decisions

Best when whole team and patient and families are involved

Self-Determination Professional Caregiver Issues

Risk for injury Usually with the demented, depression, or

delirium Inadequate staffing

Staffing appropriate for acuity of patients Nurses practicing out of their specialty or

knowledge baseBiomedical advances

Transplants, in vitro, etc.

Disregard for othersUsing others without considering them

Inappropriate application of standardsMaking decisions that another prudent

professional would not make Personal gain

Having ulterior motives Conflict of values

Responding to needs without concern for those affected

Chapter 11

A skill required in choosing how to meet the needs of a group of patients

RequiresProblem solvingPriority settingDecision makingGood application of the nursing processAbility to identify variations in patientsStrong knowledge base Sound nursing decisions

First level prioritiesLife threateningUnstable, worsening of condition

Second level prioritiesDelay may cause untoward resultsNonemergent

Scheduled meds, mental status changes, acute pain

Third level prioritiesDeficits that can easily be resolved or do

not affect normal function Bathing, grooming, emotional support

Review implications if care/treatment were to be delayed

Develop and action planScheduled activities should be primary

consideration Determine who can do it

Consider the roles of available UAPEvaluate competency of staff

Nurses should not refuse because of a lack of skill

Focus on what they can do and what they can help with being supervised

Educational preparation is ideal Review pg 264 Box 11-3 Review pg 264 box 11-4 If an assignment is out of scope of

practice submit an occurrence report and request additional training

ED nurses Coronary intensive care nurses Pediatric nurses Obstetric nurses Oncology nurses Psychiatric nurses Medical/surgical nurses

Consider circumstances and need Gender LOC Acuity Special needs Age Medical dx Staffing Family requests

Failure to use nursing judgment Inability to gather data Inadequate decision making Inability to prioritize Incompetent application of cognitive

skills Failure to ID impact of action on an

outcome