• Home   /  
  • Archive by category "1"

Nursing Process And Critical Thinking Chapter 6

Presentation on theme: "Chapter 6 Nursing Process and Critical Thinking"— Presentation transcript:

1 Chapter 6 Nursing Process and Critical Thinking
Jeanelle F. Jimenez RN, BSN, CCRNMosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Introduction Nursing defined Nursing process
Organizational framework for the practice of nursingProblem solvingSix phases per the ANA or a modified 5 phases (ADPIE)

3 Relationships among the steps of the nursing process.
Figure 6-1(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 AKA “Data Collection” for the LVN/LPN
A systematic, dynamic process by which the nurse, through interaction with the patient, significant other, and health care providers, collects information and analyzes data about the patientSubjective vs. Objective Data

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

6 Methods of Data Collection
InterviewBiographical dataReason patient is seeking health careHistory of present illnessPast health historyEnvironmental historyPsychosocial historyPhysical ExamHead-to-toe format

7 DiagnosingAmerican Nurses Association defines as “A clinical judgment about the patient’s response to actual or potential health conditions or needs. Diagnoses provide the basis for determination of a plan of care to achieve expected outcomes.”The RN is responsible for formulating a nursing diagnosis.The LPN or RN may both observe and collect data.

8 Diagnosing Nursing Diagnosis
North American Nursing Diagnosis Association International (NANDA-I)The nursing diagnosis is an identification of a health problem stated by utilization of the approved NANDA format.

9 Diagnosing Constructing a Nursing Diagnosis
May be a 2-part or 3-part nursing diagnosisSelect a nursing diagnosis label from the NANDA listList the contributing, etiologic, or related factsThe specific cues, sings, and symptoms from the patient’s assessment

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

11 Planning Priority Setting
Nursing diagnoses are ranked in order of importance for the patient’s life and health.Physiologic needs come before safety and security.Safety and security needs come before love and belonging needs.Life-threatening and health-threatening problems are ranked before other types of problems.Actual problems may be ranked before risk problems.Priorities change as the patient progresses in the hospitalization; as some problems are resolved, new ones can be addressed.

12 Planning Establishing Desired Patient Outcomes
The nurse predicts the condition of the patient following nursing interventions.This prediction is expressed in a statement that indicates the degree of wellness desired, expected, or possible for the patient to achieve.Outcome: A statement provides a description of the specific, measurable behavior that the patient will be able to exhibit in a given time frame following the intervention.Goal: A statement about the purpose to which an effort is directed.

13 PlanningA Well-Written Patient-Centered Goal/Desired Outcome Statement Achieves the Following:Uses the word “patient” as the subject of the statementUses a measurable verbIs specific for the patient and the patient’s problemIs realistic for the patient and the patient’s problemIncludes a time frame for patient reevaluationInterventions may be done/developed by the nurse or ordered by the physician

14 ImplementationPhase of the nursing process in which the established plan is put into action to promote achievement of the outcome.This phase includes ongoing activities of data collection, prioritization, performance of nursing interventions, and documentation.Both nurse- and physician-prescribed therapy are included.Documentation is a vital component of the implementation phase.“If it was not charted, it was not done” is a constant principle of nursing.

15 EvaluationA 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.

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

17 NANDA, NIC, NOCThe NANDA-I Has Formed a Relationship With Two Other Groups.Nursing Intervention Classification (NIC) is a research group working at the University of Iowa to standardize the language used to organize and describe interventions.Nursing Sensitive Outcome Classification (NOC) is a research group working at the University of Iowa who have developed a standardized system to name and measure the results of patient outcomes.NANDA-I, NIC, and NOC are working together to standardize the language of nursing.

18 Role of the Licensed Practical/Vocational Nurse
The nursing process may vary from state to state; review the state’s nurse practice act.Provide direct bedside nursing care.This direct care position allows the LPN/LVN to closely observe, prioritize, intervene, and evaluate the care provided to and for the patient.

19 Role of the Licensed Practical/Vocational Nurse
Role of the Licensed Practical/Vocational Nurse in the Nursing ProcessAssessmentObserve and report significant cues to the charge nurse or physician.DiagnosisAssist with the determination of accurate nursing diagnoses.Gather data to confirm or eliminate problems.

20 Role of the Licensed Practical/Vocational Nurse
Role of the Licensed Practical/Vocational Nurse in the Nursing ProcessPlanningAssist with setting priorities.Suggest interventions.Assist with the development of realistic patient-centered desired patient outcomes.ImplementationAssist with the establishment of priorities.Carry out physician and nursing orders.Evaluate the effectiveness of nursing activities.

21 Role of the Licensed Practical/Vocational Nurse
Role of the Licensed Practical/Vocational Nurse in the Nursing ProcessEvaluationAssist with reevaluation of the patient’s health state after nursing interventions.Suggest alternative nursing interventions when necessary.

22 Nursing Diagnosis and Clinical Pathways
Managed CareA health care system whose aim is to enhance specific clinical and financial outcomes within a specific time frameCase ManagementA 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 individualAssists the patient and family to receive required services, coordinates these services, and evaluates the adequacy of these services

23 Nursing Diagnosis and Clinical Pathways
Multidisciplinary plan that schedules clinical intervention over an anticipated time frame for high-risk, high-volume, high-cost types of casesIncludes such elements as diagnostic tests, treatments, activities, medications, consultations, education, daily outcomes, and discharge planningVariancePatient does not achieve the projected outcome

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

25 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.

26 Critical Thinking Individuals Can Become Better Critical Thinkers
Verbalize thoughts aloud.Hear others think aloud to help learn how other people reason.Study to gain specific theoretical knowledge; ask other people to evaluate their thinking; and use mistakes to learn.

27 Evidence-Based Practice
Research versus educational knowledge, consultation with peers, and own experience

  • 1. 

    What is the "Nursing Process"? Select all that apply

    • A. 

      Organizational framework for the practice of Nursing

    • B. 

      Systematic method by which nurses plan and provide care for patients

    • C. 

      The application of the nursing process only applies to RN's and not LPN's

    • D. 

      The Nursing Scope and Standards of Practice of the ANA outlines the steps of the nursing process

  • 2. 

    Match the Nursing Process on the left with its description on the right 

    • C. Plan and Identify Outcome
  • 3. 

    ANA defines it as a"systematic dynamic process by which the nurse, through interaction with the client, significant others  and health care providers collect and analyzes data about the client

    • A. 

    • B. 

    • C. 

    • D. 

  • 4. 

    Which of the following is not true about Focused ASSESSMENT

    • A. 

      When patient is critically ill or disoriented

    • B. 

      When patient is unable to respond

    • C. 

      Preferably early in the morning before breakfast.

    • D. 

      When drastic changes are happening to a patient.

  • 5. 

    A synonym for significant data that usually demonstrate an unhealthy response. 

    • A. 

    • B. 

    • C. 

    • D. 

  • 6. 

    Headache, itchiness, warmth

    • A. 

    • B. 

    • C. 

    • D. 

  • 7. 

    Secondary Source of Data. (Select all that apply) 

    • A. 

    • B. 

    • C. 

    • D. 

  • 8. 

    Which of the following is not a method of data collection?

    • A. 

    • B. 

    • C. 

    • D. 

  • 9. 

    If the first method of data collection is to conduct an interview, what is the second method?

    • A. 

    • B. 

    • C. 

    • D. 

      Performance of a physical examination

  • 10. 

    After establishing a database and before the identification of nursing diagnosis, what does a nurse do? 

    • A. 

      Documentation of database

    • B. 

    • C. 

    • D. 

      Acquiring a database of information

  • 11. 

    Data Clustering

    • A. 

      Analyzing signs and symptoms

    • B. 

      Identifying patient statements

    • C. 

      Grouping related cues together

    • D. 

      Entering patient data in the computer

  • 12. 

    Deficient Fluid Volume (Select all that apply)

    • A. 

    • B. 

      Dry skin and dry oral mucous

    • C. 

    • D. 

  • 13. 

    Which of the following refers to the definition of a Nursing Problem?

    • A. 

      Nurse overload and nurse burnout

    • B. 

      When the nurse calls in sick

    • C. 

      Any health care condition that requires diagnostic, therapeutic, or educational actions.

    • D. 

  • 14. 

     Clinical judgment

    • A. 

    • B. 

      Job description of a clinical nurse

    • C. 

    • D. 

  • 15. 

    Components of a Nursing Diagnosis. Select all that apply  

    • A. 

      Nursing diagnosis title or label

    • B. 

      Definition of the title or label

    • C. 

    • D. 

      Contributing, etiologic or related factors

    • E. 

  • 16. 

    Which of the following are true regarding nursing diagnosis? 

    • A. 

      A nursing diagnosis is any problem related to the health of a patient

    • B. 

      When writing a nursing diagnosis, place the adjective before the noun modified

    • C. 

      A nursing diagnosis is usually the etiology of the disease

    • D. 

      Both medical and nursing diagnosis can be converted into a nursing intervention.

  • 17. 

    Clear, precise description of a problem 

    • A. 

    • B. 

    • C. 

    • D. 

  • 18. 

    Risk factors

    • A. 

    • B. 

      Analysis of a health issue

    • C. 

    • D. 

      Circumstances that increase the susceptibility of a patient to a problem

  • 19. 

    Clinical cues, signs, symptoms that furnish evidence that the problem exists. 

    • A. 

    • B. 

    • C. 

    • D. 

  • 20. 

    How cues, signs and symptoms identified in patient's assessment are written

    • A. 

    • B. 

    • C. 

    • D. 

  • 21. 

    "Constipation related to insufficient fluid intake manifested by increased abdominal pressure". What is the defining characteristic? 

    • A. 

    • B. 

    • C. 

      Increased abdominal pressure

    • D. 

  • 22. 

    What is RISK NURSING DIAGNOSIS as described by NANDA-I?  Select all that apply

    • A. 

      Human responses to health conditions/life processes that may develop in a vulnerable individual/family

    • B. 

      Describes the symptoms of the disease

    • C. 

      Supported by risk factors that contribute to increased vulnerability

    • D. 

      Proof that the person is suffering from an illness

  • 23. 

    How many parts does a RISK NURSING DIAGNOSIS have?

    • A. 

    • B. 

    • C. 

    • D. 

  • 24. 

    Which of the following is a Risk Nursing Diagnosis statement? 

    • A. 

      Risk for falls related to unstable balance

    • B. 

      Constipated because of fecal impaction

    • C. 

    • D. 

      Constipation related to dehydration

  • 25. 

    Syndrome Nursing Diagnosis

    • A. 

      An isolated disease with numerous symptoms

    • B. 

      Numerous symptoms describing a single disease

    • C. 

      Used when a cluster of actual or risk nursing diagnosis are predicted to be present

    • D. 

      Numerous symptoms leading to an idiopathic disorder

  • 26. 

    Wellness Nursing Diagnosis

    • A. 

    • B. 

    • C. 

      Human responses to levels of good health in an individual, family or community

    • D. 

  • 27. 

    Certain Physiologic complications that nurses monitor to detect their onset or changes in the patient's status.    

    • A. 

    • B. 

    • C. 

    • D. 

  • 28. 

    Potential complications: hypoglycemia.  This is a sample of what?

    • A. 

    • B. 

    • C. 

    • D. 

  • 29. 

    Identification of a disease or condition by a scientific evaluation of physical signs, symptoms, history, laboratory test and procedures. 

    • A. 

    • B. 

    • C. 

    • D. 

  • 30. 

    Difference between Medical and Nursing Diagnoses

    • A. 

      Medical is etiology; Nursing is human response

    • B. 

      Medical is disease; Nursing is the cause of disease

    • C. 

      Medical is illness; Nursing is illness too

    • D. 

      Medical is to heal the disease: Nursing is to discover the disease

  • 31. 

    Difference between a goal statement and an outcome statement

    • A. 

      A good outcome statement is specific to the patient

    • B. 

      Goals are general deadlines that are to be met

    • C. 

      An outcome statement refers to what the nurse will do

    • D. 

      Goals and Statements are practically the same

  • 32. 

    The purpose to which an effort is directed 

    • A. 

    • B. 

    • C. 

    • D. 

  • 33. 

    Which of the following statements describe a well-written patient outcome statement? Select all that apply.  

    • A. 

    • B. 

      Focuses on the completion of nursing interventions

    • C. 

      Does not interfere with the medical care plan

    • D. 

      Includes a time frame for patient reevaluation

  • 34. 

    A common framework that helps guide the prioritization of nursing tasks during the process of planning

    • A. 

      Ericsson's psychosocial development

    • B. 

    • C. 

    • D. 

  • 35. 

    Nursing interventions

    • A. 

      Depend on the tasks delegated by the nursing supervisor

    • B. 

      A sequence of prioritized tasks that describe a nurse's job

    • C. 

      Activities that promote the achievement of the desired patient outcome

    • D. 

      An act of taking care of the sick

  • 36. 

    Which of the following is not a Physician Prescribed intervention?

    • A. 

      Ordering diagnostic tests

    • B. 

    • C. 

    • D. 

      Elevating an edematous leg

  • 37. 

    Which of the following is not a nurse-prescribed intervention?

    • A. 

      Turning the patient every two hours

    • B. 

    • C. 

      Offering a vitamin supplement

    • D. 

      Monitoring a patient for complications

  • 38. 

    Which of the following statements about the nursing process is true. 

    • A. 

      A nursing process is written together with a nursing care plan

    • B. 

      A nursing care plan is a product of the nursing process

    • C. 

      Both the nursing process and the nursing care plan are purely critical thinking strategies

    • D. 

      The nursing process is not an accurate clinical theory

  • 39. 

    IN which of the following scenarios would a standardized nursing care plan be appropriate? 

    • A. 

    • B. 

      Center for infection control

    • C. 

    • D. 

      Maternity floor without a single Cesarean delivery

  • 40. 

    Prioritization of tasks belongs to which phase of the Nursing Process? 

    • A. 

    • B. 

    • C. 

    • D. 

    • E. 

  • 41. 

    Documentation is a vital component of which phase of the nursing process?

    • A. 

    • B. 

    • C. 

    • D. 

    • E. 

  • 42. 

    Validation of patient outcome and goals

    • A. 

    • B. 

    • C. 

    • D. 

  • 43. 

    Evidence based practice

    • A. 

      Past educational knowledge

    • B. 

    • C. 

    • D. 

      Integration of research and clinical experience

  • 44. 

    Which of the following is not considered a standardized language in nursing?

    • A. 

    • B. 

    • C. 

    • D. 

  • 45. 

    Variance

    • A. 

    • B. 

      Patient does not achieve expected outcome

    • C. 

    • D. 

  • 46. 

    Which of the following is not the role of the LPN/LVN in the nursing process?

    • A. 

    • B. 

      Gather further data to confirm problems

    • C. 

      Discuss details of the disease as part of patient education

    • D. 

      Observe and report signficant cues

  • 47. 

    Which of the following are functions of managed care? Select all that apply. 

    • A. 

      Provides control over health care services

    • B. 

      Standardized diagnosis and treatment

    • C. 

    • D. 

      Primary resource for patient advocacy

  • 48. 

    Clinical pathway

    • A. 

      Nursing career development plan

    • B. 

    • C. 

      A concept map for care plans

    • D. 

      Specific location in a healthcare facility

  • 49. 

    A reflective reasoning process that guides a nurse in generating, implementing and evaluating approaches for dealing with client care and professional concerns

    • A. 

    • B. 

    • C. 

    • D. 

  • One thought on “Nursing Process And Critical Thinking Chapter 6

    Leave a comment

    L'indirizzo email non verrà pubblicato. I campi obbligatori sono contrassegnati *