NURSING AS SCIENCE

• Critical Thinking


  The process of intentional higher level thinking to define a client's problem, examine the evidence-based practice in caring for the client, and make choices in the delivery of care
• Clinical Reasoning


  The cognitive process that uses thinking strategies to gather and analyze client information, evaluate the relevance of the information, and decide on possible nursing actions to improve the client's physiological and psychosocial outcomes
• Problem Solving Process


  1. The systematic identification of a problem

  2. Determination of goals related to the problem

  3. Identification of possible solutions to achieve the goals

  4. Implementation of selected solutions

  5. Evaluation of goal achievement
• Nursing Process


  A systematic, rational method of planning and providing individualized nursing care
• Characteristics of the Nursing Process

  • Cyclic and dynamic nature
  • Client centeredness
  • Focus on problem solving and decision making
  • Interpersonal and collaborative style
  • Universal applicability
  • Use of critical thinking and clinical reasoning
• Assessing


  Collecting, organizing, validating, and documenting client data
• Diagnosing


  Analyzing and synthesizing data
• Planning


  Determining how to prevent, reduce, or resolve the identified priority client problems; how to support client strengths; and how to implement nursing interventions in an organized, individualized, and goal-directed manner
• Implementing

  Carrying out (or delegating) and documenting the planned nursing interventions
• Evaluating

  Measuring the degree to which goals/outcomes have been achieved and identifying factors that positively or negatively influence goal achievement
• Nursing assessments focus on a client's responses to a health problem. A nursing assessment should include the client's perceived needs, health problem
• Hypotheses

  Proposed explanations that need to be evaluated
• Evaluating


  Deciding whether hypotheses are correct
• Making criterion-based evaluations


  Making evaluations based on established criteria
• Assessing


  • The systematic and continuous collection, organization, validation, and documentation of data (information)
  • A continuous process carried out during all phases of the nursing process
  • All phases of the nursing process depend on the accurate and complete collection of data
• Types of assessments


  • Initial assessment
  • Problem-focused assessment
  • Emergency assessment
  • Time-lapsed reassessment
• Initial assessment


  Performed within specified time after admission to a health care agency to establish a complete database for problem identification, reference, and future comparison
• Problem-focused assessment


  Ongoing process integrated with nursing care to determine the status of a specific problem identified in an earlier assessment
• Emergency assessment


  During any physiological or psychological crisis of the client to identify life-threatening problems and to identify new or overlooked problems
• Time-lapsed reassessment


  Several months after initial assessment to compare the client's current status to baseline data previously obtained
• Data collection


  The process of gathering information about a client's health status
• Database


  Contains all the information about a client, including the nursing health history, physical assessment, primary care provider's history and physical examination, results of laboratory and diagnostic tests, and material contributed by other health personnel
• Types of data


  • Subjective data
  • Objective data
  • Constant data
  • Variable data
• Subjective data


  Apparent only to the person affected and can be described or verified only by that person
• Objective data


  Detectable by an observer or can be measured or tested against an accepted standard
• Constant data


  Information that does not change over time
• Variable data


  Can change quickly, frequently, or rarely
• Subjective data


  • "I feel weak all over when I exert myself."
  • "I feel sick to my stomach."
  • "I'm short of breath."
  • "He doesn't seem so sad today."
  • "I would like to see the chaplain before surgery."
• Objective data


  • Blood pressure 90/50 mmHg
  • Vomited 100 mL green-tinged fluid
  • Lung sounds clear bilaterally; diminished in right lower lobe
  • Client cried during interview
  • Holding open Bible, Has small silver cross on bedside table
• Sources of data


  Primary source: the client

  Secondary sources: family members, other health professionals, records and reports, laboratory and diagnostic analyses, and relevant literature
• Data collection methods


  • Observing
  • Interviewing
  • Examining
• Observing


  Gathering data by using the senses, a conscious, deliberate skill that is developed through effort and with an organized approach
• Interviewing


  A planned communication or a conversation with a purpose, to get or give information, identify problems of mutual concern, evaluate change, teach, provide support, or provide counseling or therapy
• Types of interview questions

  • Closed questions
  • Open-ended questions
  • Neutral questions
  • Leading questions
• Closed questions


  Restrictive and generally require only "yes" or "no" or short factual answers
• Open-ended questions


  Invite clients to discover and explore, elaborate, clarify, or illustrate their thoughts or feelings
• Neutral questions


  The client can answer without direction or pressure from the nurse, are open ended, and are used in nondirective interviews
• Leading questions


  Usually closed, used in a directive interview, and thus directs the client's answer
• Examining


  The physical examination or physical assessment, a systematic data collection method that uses observation (i.e., the senses of sight, hearing, smell, and touch) to detect health problems
• Accurate documentation of client data is essential and should be complete, concise, and timely