Lehman College, CUNY NUR 301 CT MIDTERM STUDY GUIDE.

Week 1: - **Definition of Nursing (ANA, 2015) Nursing is the: o Protection, promotion, and optimization of health and abilities. o Prevention of illness and injury. o Facilitation of healing. o Alleviation of suffering through the diagnosis and treatment of human response. o Advocacy in the care of individuals, families, groups, communities, and populations. - Human Responses o Patients/families/communities reactions to actual or potential health problems, injuries, or life processes. o Human Responses include identification of the NDx/problem (label) and likely causes or etiologies of the diagnosis/problem. o Each NANDA dx has a definition, defining characteristics (or signs and symptoms) and related factors (etiologies). - Clinical Reasoning and the Nursing Process o ADPIE  1 st: ASSESS: the situation and identify important cues or pt data.  2 nd : Generate multiple hypotheses: to describe the possible problem  3 rd : Make a CLINICAL JUDGMENTor a NURSING DIAGNOSIS: NDx are HUMAN RESPONSES of a patient/family/community actual/potential health problem  4 th: PLANNING: Identify OUTCOME GOALS and INTERVENTIONS:  5 th : IMPLEMENT plan: coordination of care, health teaching and promotion  6 th : EVALUATE: COMPARE the actual pt outcome to predetermined GOALS  Modify diagnosis, goals, and plans as indicated (if GOALS have been achieved—continue the plan. If NOT achieved, REFLECT! o Thinking errors in any phase of this process can lead to inaccurate diagnoses, ineffective/harmful nursing interventions and poor patient outcomes. - Nurses’ Judgments Impact Patient Outcomes and Safety o Over 200,000 pts die in hospitals every year due to medical errors o Clinical Judgment: a nurses’ interpretation and/or conclusions about a situation. Nursing diagnosis+patient problems = clinical judgment - Judgment or Diagnostic Error o Incorrect interpretation of patient data and thinking errors missed, incorrect or delayed Dx, delayed care and poor pt outcomes. - Nurses’ Clinical Decisions Impact Patient Safety and Outcomes o Implements appropriate interventions to positively impact patient outcomes and safety. - Accurate Clinical Judgment Good Clinical Decisions o The NDx consist of the problem or label and includes likely etiologies of the problem. o Interventions are designed to impact the causes of the problem o Clinical Decision (intervention): EHOB, encourage and assist with deep breaths, VS - Focus of pt care -Factors That Positively Impact Nurses’ Decision Making Processes o Art of nursing: (Experiences, sensitivity, caring behaviors, creativity, and ability to adapt care) o Science of nursing: Theoretical knowledge---includes knowledge, skills, and attitudes Nursing o Dx, Tx, prevent human response to health px o Care for the pt o Holistic o Promote health self-management o promote wellness Medical o Diagnose and treat disease o Cure disease o Focus on pathophysiology o Teach patients about the tx for their disease/injury o Have very good clinical reasoning abilities to identify and help solve pt problems and enhance health o Focus on promoting wellness, preventing illness, and restoring health. o Intellectual skills: clinical reasoning, domain knowledge - Critical Thinking and Standards of Care o We use CT processes that include applying standards such as QSEN (Quality and Safety in Educating Nurses) and ANA when developing our nursing plans of care. o We must assure that our POC are pt Centered, Evidence Based, Collaborative, Safe AND within our scope of practice. - Theory: We use nursing theories to guide our practice--Helps us to explain our nursing actions in explicit terms and then communicate those actions to others - Ethical and Cultural Considerations o ANA’s Standard #7: Ethics o Delivers care in a manner that preserves/protects pt autonomy, dignity and rights, values, and beliefs o Respects centrality of patient/family o Therapeutic and professional nurse-pt relationship o Contributes to resolving ethical issues o Demonstrates professional comportment (honest, integrity, openness, authenticity) - Plans of care: should be- Pt centered, Dx/problem driven(actual, risk, health promotion), outcome focused. “Nursing process chapter 1” - What is nursing? Blend of art and science, applied within context of interpersonal relationships, purpose to promote well, preventing illness, and restoring health, used to care for individuals, families and communities. - **ANA definition: Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations - ANA’s social policy statement: consider human experience, not the problem, integration patient’s subjective experience with objective data, use CT, provide caring relationship, promote social justice. - Nursing theory overview: o Nursing is a unique blend of art and science (knowledge and problem solving processes), Holistic(concerned about the pt’s physical, psychosocial, cultural and spiritual needs), Its purpose is to promote wellness; Prevent illness and restore health in individuals, families and communities. - Interdisciplinary practice: collaborative practice. HCPs work together to plan and provide pt care. - Nursing process: specific to the nursing profession, a framework for CT, purpose: diagnose and treat human responses to actual or potential health problems, organized framework to guide practice, problem solving method-client focused, systematic(5 sequential steps), goal orientedoutcome criteria, dynamic(always changing and flexible), utilizes CT processes.  What is nursing process: Systematic, creative approach used to identify, prevent and treat actual or potential health problems, identify pt strength and poromote wellness. - Scientific method of problem solving: ID problem, collect data, form hypothesis, plan of action, hypothesis testing, interpret results, evaluate findings. - Advantages of NP: individualized care, client is active participant, promote continuity of care, provides more effective communication among nurses and HCPs, develops clear and efficient POC, provides personal satisfaction as you see patient achieve goals, professional growth as you evaluate effectiveness of your interventions. - 6 steps in NP: Assessment, Dx, planning outcomes, planning interventions, implementing, evaluating. - Assessment: Gather info, collect data. Nursing interview, health assessment(physical exam) o Primary Source - Client / Family o Secondary Source - physical exam, nursing history, team members, lab reports, diagnostic tests, etc. o Subjective -from the client (symptom) - “I have a headache” o Objective - observable data (sign)- Blood Pressure 130/80 - NDx: Interpret and analyze clustered data, identify pt problems and strengths. Formulate nursing dx(NANDA-North American Nursing Diagnosis Association): Statement of how the client is RESPONDING to an actual or potential problem that requires nursing intervention. o NDx: Identify responses to health and illness. Can change from day to day o MD Dx: focuses on curing pathology, stays the same as long as disease is present. o Formulating a NDx: 3 parts:  Problem statement (dx label)- client’s response to problem.  Etiology- what’s causing/contributing to the client’s problem  Defining Characteristics- what’s the evidence of the problem. o Types of NDx: Actual, risk, wellness - Planning Outcomes and interventions: Nurse organizes a nursing care plan based on NDx. Nurse and pt formulate goals to help pt with problems, expected outcomes identified, interventions(Nursing orders) are selected to aid the client reach these goals. o Notes: Goals allow us to determine the specific outcome desired by the client o Short term- goal in which a specific time frame with date ie Able to identify 20 foods which are low in sodium within 2 days o Long term goal in which desired outcome is expected in a broader time frame ie Client be able to develop a daily meal plan based on 2 Gm Na restrictions by the end of the monthl o Cognitive goal - goal in which client gains new knowledge ie able to correctly identify foods high and low in sodium o Pyschomotor goal- goal in which client’s acquire a new skill ie client able to correctly monitor B/P using stethoscope and sphygmomanometer o Affective goal - goal in which the client’s values or attitudes change ie client able to accept the need for maintaining life time dietary changes to control B/P o Planning- begin by prioritizing client problems:  Prioritize using Maslows!! Physiological needssafetysocialesteemselfactualization.  High-Priority Problem: life threatening (ex: severe fluid and electrolyte loss or resp. obstruction)  Medium-priority Problem: does not directly threaten life; may produce physical/emotional changes (rape, trauma syndrome)  Low-Priority Problem: one that arises from normal developmental needs or requires only minimal supportive nursing interventions (ex: ineffective sexuality patterns r/t deficient knowledge).  Maslow’s Hierarchy: provides framework for prioritizing nursing diagnoses. 1)Physiological needs 2) safety/security 3) Feelings of Love and belonging 4)self-esteem 5) self actualization (achieving one’s full potential, engaging in creative activities) o Planning developing a goal and outcome statement: Goal and outcome statements are client focused, worded positively, measurable, specific observable, time-limited, realistic. Goal=broad statement. Expected outcome=objective criterion for measurement of goal. Utilize NOC (nursing outcome classification) as standard. o Types of goal: Short term goals, long term goal, cognitive goals, psychomotor goals, affective goals. o Goals are patient-centered and SMART: Specific, Measurable, Attainable, Relevant, Time bound. o Planning- select interventions. Nurse uses clinical judgement and professional knowledge to select appropriate interventions that will aid the client in reaching their goal.