Exam 2

• Blended Competencies


  Cognitive competencies, technical competencies, interpersonal competencies, ethical/legal competencies
• Clinical Reasoning

  Purposeful, informed, outcome-focused thinking guided by standards, policies, ethics codes, and laws, driven by patient, family, and community needs, based on principles of the nursing process, problem solving, and the scientific method, focuses on safety, quality, reevaluating, and self-correcting
• Person-Centered Care


  Care that is customized and reflects patient needs, values, and choices, where the patient is the source of control for their care
• ANA Definitions of Nursing

  • Provision of a caring relationship that facilitates health and healing
  • Attention to the range of human experiences and responses to health and illness within the patient's physical and social environments
  • Integration of assessment data with knowledge gained from an appreciation of the patient's or group's subjective experience
  • Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking
  • Advancement of professional nursing knowledge through scholarly inquiry
  • Influence on social and public policy to promote social justice
  • Assurance of safe, quality, and evidence-based practice
• Components of Thoughtful Person-Centered Practice

  • The person
  • The professional nurse
  • Reflective practice leading to personal learning
  • Clinical reasoning, judgment, and decision making
  • Person-centered nursing process
  • The nurse's action in response to individual clinical need
• 10 Guiding Principles of Person-Centered Care

  • All team members are considered caregivers
  • Care is based on continuous healing relationships
  • Care is customized and reflects patient needs, values, and choices
  • Knowledge and information are freely shared between and among patients, care partners, physicians, and other caregivers
  • Care is provided in a healing environment of comfort, peace, and support
  • Families and friends of the patient are considered an essential part of the care team
  • Patient safety is a visible priority
  • Transparency is the rule in the care of the patient
  • All caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient
  • The patient is the source of control for their care
• The Professional Nurse


  • Personal attributes: Open-mindedness, sense of the value of the person; self-awareness; sense of personal responsibility; motivation to do the best; leadership skills; bravery to question the system
  • Knowledge base: Ability to draw upon a body of nursing knowledge and evidence
• Blended Competencies


  • Cognitive competencies: Critical thinking, purpose of thinking, adequacy of knowledge, potential problems, helpful resources, critique of judgment/decision
  • Developing technical competencies
  • Developing interpersonal competencies
  • Promoting human dignity and respect
  • Establishing caring relationships
  • Enjoying the rewards of mutual exchange
  • Developing ethical/legal competencies: Understanding legal boundaries, scope of practice, owning personal strengths and weaknesses
• QSEN Competencies


  • Patient-centered care
  • Teamwork and collaboration
  • Evidence-based practice
  • Quality improvement
  • Safety
  • Informatics
• Clinical Reasoning & Decision Making


  Process used to think about patient problems in the clinical setting, leads to clinical judgment, purposeful, informed, outcome-focused thinking guided by standards, policies, ethics codes, and laws, driven by patient, family, and community needs, based on principles of the nursing process, problem solving, and the scientific method, focuses on safety, quality, reevaluating, and self-correcting
• Clinical Reasoning & Decision Making

  • Identifies key problems, issues, and risks
  • Includes patients, families, and key stakeholders in decision-making early in the process
  • Uses logic, intuition, and creativity
  • Grounded in specific knowledge, skills, and experiences
  • Calls for strategies that make the most of human potential and compensate or problems created by human nature
• Problem Solving

  • Trial-and-error: Involves testing solutions until one is found that works
  • Scientific: Systematic, seven-step process
  • Intuitive: Direct understanding o a situation based on a background of experience, knowledge, and skill that makes expert decision making possible
  • Creative thinking
• Clinical Judgment Models

  • Tanner Model: Noticing, interpreting, responding, reflecting

  Nursing Process: Assessing, diagnosing, planning, implementing, evaluating
• The Steps of the Nursing Process Are Dynamic and Interrelated


  The steps interact and overlap with one another
• Benefits of the Nursing Process

  • For the patient: Scientifically based, holistic individualized patient care, continuity of care, clear, efficient, cost-effective plan of action

  For the nurse: Opportunity to work collaboratively with other health care workers, satisfaction of making a difference in lives of patients, opportunity to grow professionally
• Steps in Concept Mapping

  • Collect patient problems and concerns on a list

  Connect and analyze the relationships

  Create a diagram

  Keep in mind key concepts: the nursing process, holism, safety, and advocacy
• Reflective Practice


  Reflection in action: Happens in the here and now of the activity and is also known as "thinking on your feet"

  Reflection on action: Occurs after the fact and involves thinking through a situation that has occurred in the past

  Reflection for action: Helps the person to think about how future actions might change as a result of the reflection
• Clinical Judgment

  Critical thinking, clinical reasoning, clinical judgment, situational awareness
• Clinical Judgment Models

  • Tanner's Clinical Judgment Model, Lasater Clinical Judgment Rubric, Developing Nurses' Thinking Model, California Critical Thinking Disposition Inventory, National Council of State Boards of Nursing, Nursing Process
• Tanner's Clinical Judgment Model

  • Noticing: initial grasp and perceptions of the situation that are impacted by context, the nurse's practical experience, knowledge of expected versus unexpected data, ethical perspectives, and the nurse–patient relationship

  Interpreting: attributing meaning to the data through multiple reasoning patterns

  Responding: deciding on an action (or inaction) and monitoring outcomes

  Reflecting: in-action and on-action
• Lasater Clinical Judgment Rubric

  • Effective Noticing: Focused observation, recognizing deviations from expected patterns, information seeking

  Effective Interpreting: Prioritizing data, making sense of data

  Effective Responding: Calm, confident manner, clear communication, well-planned intervention/flexibility, being skillful
• National Council of State Boards of Nursing

  Clinical judgment measurement model (CJMM): New focus of the new NCLEX coming in 2023, also known as the Next-Generation (NG) NCLEX

  Clinical judgment action model (CJAM): Aligns the six cognitive operations from layer 3 of the CJMM with specific situational factors from layer 4
• Nursing Process

  Mental Model: Organized way of thinking that assists in understanding complex aspects of a situation and guides assessments and behaviors

  Assessment: Diagnosing/Identifying actual or potential problems

  Planning: Identifying interventions with rationales

  Evaluation
• Competency Outcomes Performance Assessment Model (COPA)

  • Assessment and Intervention Skills

  Communication Skills

  Critical Thinking Skills

  Human Caring and Relationship Skills

  Management Skills

  Leadership Skills

  Teaching Skills

  Knowledge Integration Skills
• Clinical Decision-Making Theories, Models, and Frameworks


  • Humanistic–Intuitive Approach

  Information-Processing Model

  Cognitive Continuum Theory

  Rest Framework
• Integrating Previous Knowledge

  • Educational Experience

  Life Experience

  Health Care Experience

  Reflection
• Assessment


  Systematic and continuous collection, analysis, validation, and communication of patient data, reflecting how health functioning is enhanced by health promotion or compromised by illness/injury, enabling the nurse to partner with patients to develop a comprehensive and effective care plan
• Critical Thinking Activities Linked to Assessment

  • Assessing systematically and comprehensively to identify nursing and medical concerns

  Detecting bias and determining the credibility of information sources

  Distinguishing normal from abnormal findings and identifying the risks for abnormal findings

  Making judgments about the significance of data, distinguishing relevant from irrelevant data

  Identifying assumptions and inconsistencies, checking accuracy and reliability, and recognizing missing information
• Characteristics of Nursing Assessments


  • Purposeful

  Prioritized

  Complete

  Systematic

  Factual and accurate

  Relevant

  Recorded in a standard manner
• Five Types of Nursing Assessments

  • Initial

  Focused

  Quick priority

  Emergency

  Time-lapsed

  Triage

  Patient-Centered Assessment Method (PCAM)
• Initial Assessment


  Performed shortly after admittance to a health care facility, to establish a complete database for problem identification and care planning, by the nurse to collect data on all aspects of patient's health
• Focused Assessment


  May be performed during initial assessment or as routine ongoing data collection, to gather data about a specific problem already identified, or to identify new or overlooked problems, by the nurse to collect data about the specific problem
• Quick Priority Assessments


  Short, focused, prioritized assessments completed to gain the most important information needed first, can flag existing problems and risks
• Emergency Assessment


  Performed when a physiologic or psychological crisis presents, to identify life-threatening problems, by the nurse to gather data about a life-threatening problem
• Time-Lapsed Assessment


  Performed to compare a patient's current status to baseline data obtained earlier, to reassess health status and make necessary revisions in care plan, by the nurse to collect data about current health status of patient
• Triage Assessment


  A screening assessment to determine the extent and severity of patient problems and recommend appropriate follow-up, can be completed on the phone or in person, requires highly specialized nursing knowledge and clinical reasoning and judgment skills
• Patient-Centered Assessment Method


  Tool used by health care practitioners to assess patient complexity using social determinants of health, helps ask questions to gain understanding about the patient's health and well being, social environment, health literacy and communication skills
• Patient-Centered Assessment Method


  Tool used by health care practitioners to assess patient complexity using social determinants of health
• Patient-Centered Assessment Method


  Helps ask questions to gain understanding about the patient's health and well being, social environment, health literacy and communication skills
• Establishing Assessment Priorities

  • Health orientation
  • Developmental stage
  • Culture
  • Need for nursing