RNSG 1137 Fall 2019 Student Blueprint Exam 1 – San Antonio College | RNSG1137 Fall 2019 Student Blueprint Exam 1

1137 Blueprint Exam 1 RNSG 1137 Fall 2019 Student Blueprint Exam 1 – San Antonio College 1.Clinical Judgment: Promotion of Critical Thinking Skills Psychosocial integrity Nursing Process Critical thinking: multidimensional skill, cognitive or mental process or set of procedures, involves reasoning and purposeful, systematic, reflective, rational, outcome-directed thinking based on knowledge, examination and analysis of all information and ideas. Leads to the formulation of conclusions and alternatives most appropriate for the situation. Many definitions of critical thinking have been offered some consistent themes in those definitions are (1) strong formal and informal foundation of knowledge; (2) willingness to pursue or ask questions; (3) ability to develop new solutions, even those that don’t fit the standard or current state of knowledge or attitudes. Willingness and openness to various viewpoints are inherent in critical thinking, and it’s important to reflect on the current situation. Critical thinking includes metacognition—examination of one’s own reasoning or thought processes—to help refine thinking skills. Independent judgments and decisions evolve from a sound knowledge base and ability to synthesize information in the context in which it’s presented. Nursing practice today requires high-level critical thinking skills. Critical thinking enhances clinical decision making, helping to identify patient needs and best nursing actions that will assist in meeting those needs.1137 Blueprint Exam 1 Critical thinking is a conscious, outcome-oriented activity, it’s systematic and organized, not erratic. Critical thinkers are inquisitive truth seekers open to alternative solutions that might surface. Alfaro-LeFevre identified critical thinkers as people who are active thinkers, fair minded, open minded, persistent, empathic, independent in thought, good communicators, honest, organized, systematic, proactive, flexible, realistic, humble, cognizant of the rules of logic, curious, insightful, creative and committed to excellence. Skills involved in critical thinking are developed over time through effort, practice, and experience. Skills needed in critical thinking include interpretation, analysis, inference, explanation, evaluation, and self-regulation. Critical thinking requires background knowledge, knowledge of key concepts and logical thinking. Nurses use this disciplined process to validate accuracy of data and reliability of assumptions they have made, and then carefully evaluate effectiveness of what they’ve identified as necessary actions to take. Nurses evaluate reliability of sources, being mindful of and questioning inconsistencies. Nurses use interpretation to determine significance of data gathered, analysis to identify patient problems suggested by data, and inference to draw conclusions. Explanation is justification of actions or interventions used to address patient problems and to help patients move toward desired outcomes. Evaluation is the process of determining whether outcomes have been or are being met. Self-regulation is the process of examining care provided and adjusting interventions as needed.1137 Blueprint Exam 1 Critical thinking is reflective, involving metacognition, active evaluation, and refinement of thinking process. Nurses engaged in critical thinking consider the possibility of cultural differences and personal bias when interpreting data and determining appropriate actions. Critical thinkers must be insightful and have a sense of fairness, integrity, courage to question personal ethics, and perseverance to strive continuously to minimize effects of egocentricity, ethnocentricity, and other biases on the decision-making process. Critical thinking requires going beyond basic problem solving into a realm of inquisitive exploration, looking for all relevant factors that affect issues and being an “out-of-the-box” thinker. It includes questioning findings until a comprehensive picture emerges that explains the phenomenon, possible solutions, and creative methods for proceeding. Critical thinking in nursing practice results in a comprehensive plan of care with maximized potential for success. Critical Thinking and Clinical Reasoning in Nursing Practice Critical thinking and decision making are thought to be associated with improved clinical expertise. Critical thinking is the center of the process of clinical reasoning and judgment. Using critical thinking to develop a plan of nursing care requires considering human factors that might influence the plan. Nurses interact with patients, families, and health care providers in the process of providing appropriate, individualized care. The culture, attitude, and thought processes of nurses, patients, and others affect the critical thinking process from the data-gathering stage through1137 Blueprint Exam 1 the decision-making stage; aspects of the nurse–patient interaction must be considered. Nurses must use critical thinking in all practice settings—acute, ambulatory, extended care, and home and community—and must view each patient as unique and dynamic. Key components of critical thinking behavior are withholding judgment and being open to options and explanations from one patient to another in similar circumstances. Unique factors that patients and nurses bring to the health care situation are considered, studied, analyzed, and interpreted. Interpretation of information allows nurses to focus on factors are most relevant and significant to the clinical situation. Decisions about what to do and how to do it are then developed into a plan of action. In decision making related to the nursing process, nurses use intellectual skills in critical thinking. Skills include systematic and comprehensive assessment, recognition of assumptions and inconsistencies, verification of reliability and accuracy, identification of missing information, distinguishing relevant from irrelevant information, support of evidence with facts and conclusions, priority setting with timely decision making, determination of patient-specific outcomes, and reassessment of responses and outcomes. Ex. nurses use critical thinking and decision-making skills in providing genetics related nursing care when they: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- o suggest appropriate guidelines for action. In essence, ethics is the formal, systematic study of moral beliefs, whereas morality is the adherence to informal personal values. Because the distinction between ethics and morality is slight, the terms are often used interchangeably.1137 Blueprint Exam 1 38. Ethical and Legal Precepts- Basic care and comfort- Characteristics of ethics- • Centrality of the caring relationship Promotion of the dignity and respect of patients as people Attention to the particulars of individual patients Cultivation of responsiveness to others and professional responsibility A redefinition of fundamental moral skills to include virtues like kindness, attentiveness, empathy, compassion, reliability 39. Ethical and Legal Precepts- Management of care- Ethical principle nursing obligation- Autonomy Beneficence Nonmaleficence Justice Veracity- truthfulness Fidelity- promises 44. Ethics & Legal: Standards: voluntary standards ● Voluntary standards, developed and implemented by the nursing profession itself, are not mandatory but are used as guidelines for peer review. Professional nursing organizations continually reassess the functions, standards, and qualifications of their members. These organizations are guided by their own assessment of society’s need for nursing and by the public’s expectations of1137 Blueprint Exam 1 nursing. Examples of voluntary standards include the American Nurses Association (ANA) standards of practice, professional standards for the accreditation of education programs and service organizations, and standards for the certification of individual nurses in general and specialty areas of practice (Taylor 116) 45. Ethics and Legal: Patient rights ● American Hospital Association developed “A Patient’s Bill of Rights” in 1972 (revised in 1992 and 2003; Box 7-6). Renamed “The Patient Care Partnership,” it addresses the expectations, rights, and responsibilities of the patient while receiving care in the hospital, and ranges from “high-quality hospital care” to “helping prepare you and your family for when you leave the hospital.” With care moving increasingly from the hospital to the community, legally prudent nurses must be familiar with how different institutions and professional groups define patient rights and responsibilities. (Taylor, 10/2014, p. 131) ● Patient Care Partnership: High-quality hospital care A clean and safe environment Involvement in your care Discussing your medical condition and treatment choices Discussing treatment plans Understanding your health care goals and values. Understanding who should make decisions when you cannot. Protection of your privacy1137 Blueprint Exam 1 Help preparing you and your family for when you leave the hospital. Help with your bill and filling insurance claims. 46. An incident report, also called a variance or occurrence report, is used by health care agencies to document the occurrence of anything out of the ordinary that results in, or has the potential to result in, harm to a patient, employee, or visitor (Fig. 7-3). These reports are used for quality improvement and should not be used for disciplinary action against staff members. They are a means of identifying risks. More harm than good results from ignoring mistakes. Incident reports improve the management and treatment of patients by identifying high-risk patterns and initiating in-service programs to prevent future problems. These forms also make all the facts about an incident available to the agency in case of litigation. Nurse responsible for a potential or actual harmful incident or who witnesses an injury is the one who completes the incident form. This form should contain the complete name of the person or people involved and the names of all witnesses; a complete factual account of the incident; the date, time, and place of the incident; pertinent characteristics of the person or people involved (e.g., alert, ambulatory, asleep) and of any equipment or resources being used; and any other variables believed to be important to the incident. Physician completes one section of the incident form with documentation of the medical examinatio 47. Torts may be intentional or unintentional acts of wrongdoing. Some of the intentional torts for which nurses may be held liable include assault and battery, defamation of character, invasion of privacy, false imprisonment, and fraud. A person1137 Blueprint Exam 1 committing an intentional tort is considered to have knowledge of the permitted legal limits of his or her words or acts. (Taylor, 10/2014, p. 118) Unintentional torts are referred to as negligence. A nurse who fails to initiate proper precautions to prevent patient harm (falls, skin breakdown) is subject to the charge of negligence. (Taylor, 10/2014, p. 118) An act that is a tort may also be a crime. For example, gross negligence demonstrating that the offender is guilty of complete disregard for another’s life may be tried as both a civil and criminal action. It is then prosecuted under both civil and criminal law. (Taylor, 10/2014, p. 118) 48. Ethical dilemmas are common and diverse in nursing practice. Situations vary, and experience indicates that there are no clear solutions to these dilemmas. However, the fundamental philosophical principles are the same, and the process of moral reflection helps nurses justify their actions. The approach to ethical decision making can follow the steps of the nursing process. (Hinkle, 11/2013, p. 31) ● Steps of an Ethical Analysis: Assessment 1. Assess the ethical/moral situations of the problem. This step entails recognition of the ethical, legal, and professional dimensions involved. a. Does the situation entail substantive moral problems (conflicts among ethical principles or professional obligations)? b. Are there procedural conflicts? (For example, who should make the decisions? Any conflicts among the patient, health care providers, family, and guardians?)1137 Blueprint Exam 1 c. Identify the significant people involved and those affected by the decision. d. Identify agency or hospital policy or protocol to use when a conflict exists. Is there an ethics committee or council? How is an ethics consult made, and who may request this consultation? What other resources are available to help resolve this conflict? Planning 2. Collect information. a. Include the following information: the medical facts, treatment options, nursing diagnoses, legal data, and the values, beliefs, cultures, and religious components. b. Make a distinction between the factual information and the values/beliefs. c. Validate the patient’s capacity, or lack of capacity, to make decisions. d. Identify any other relevant information that should be elicited. e. Identify the ethical/moral issues and the competing claims. Implementation 3. List the alternatives. Compare alternatives with applicable ethical principles and professional code of ethics. Choose either of the frameworks that follow, or other frameworks, and compare outcomes. a. Utilitarian approach: Predict the consequences of the alternatives; assign a1137 Blueprint Exam 1 positive or negative value to each consequence; choose the consequence that predicts the highest positive value or “the greatest good for the greatest number.” b. Deontologic approach: Identify the relevant moral principles; compare alternatives with moral principles; appeal to the “higher-level” moral principle if there is a conflict. (Hinkle, 11/2013, p. 32) Evaluation 4. Decide and evaluate the decision. a. What is the best or morally correct action? b. Give the ethical reasons for your decision. c. What are the ethical reasons against your decision? d. How do you respond to the reasons against your decision? (Hinkle, 11/2013, p. 32) 49. The ethical obligation to care for all patients is clearly identified in the first statement of the Code of Ethics for Nurses (ANA, 2001a). Lachman (2009) asserts, “As a professional, the nurse is expected to reflect and move beyond feelings to provide the same level of care to every patient, regardless of diagnosis, skin color, ethnic origin, or economic status”. To avoid facing ethical dilemmas, nurses can follow certain strategies. For example, when applying for a job, a nurse should ask questions regarding the patient population. If a nurse is uncomfortable with a particular situation, then not accepting the position would be an option. Denial of care, or providing substandard nursing care to some members of society, is not acceptable nursing practice.1137 Blueprint Exam 1 50. See question 46