Nura

• Critical thinking


  A skill that uses logic and reasoning to determine solutions, conclusions, and interventions to healthcare problems + what we do before we act + interventional and cognizant effort is required
• Critical thinking is a learned skill that takes practice and can be developed
• Terms of critical thinking

  • Clinical judgment
  • Clinical reasoning
  • Clinical decisions
  • Problem solving
  • Evaluating the nursing process
• Learning critical thinking

  1. Ask pertinent questions

  2. Analyze all forms of evidence

  3. Evaluate option before coming to conclusion
• Characteristics of critical thinking


  • Self confident
  • Broad contextual perspective
  • Creativity
  • Flexibility
  • Inquisitiveness
  • Humility
  • Honesty
  • Integrity
  • Intuition
  • Impartiality
  • Perseverance
  • Logical reasoning
  • Reflection
• Nursing process


  • Assessment
  • Nursing diagnosis
  • Identification of outcomes
  • Planning / goal setting
  • Implementation
  • Evaluation
• Positive influences of critical thinking


  • Relationships
  • How you ask questions
  • Intelligence
  • Knowledge
  • Creativity
  • Experience
  • Logic
  • Professionalism
  • Technical skills
• Antecedents of critical thinking


  • Age
  • Gender
  • Ethnicity
  • Experience
  • Education level
• Attributes to critical thinking


  • Open mindedness to other's beliefs and viewpoints
  • Honesty with any self bias
  • Inquisitiveness and ability to seek out what is known
  • Alertness to learning opportunities
  • Flexibility to alternatives
  • Empathy
  • Self awareness
• Steps of nursing practice

  1. Allows nurse to gather information

  2. Utilize clinical judgment

  3. Formulate patient centered goals

  4. Develop interventions to help the patient meet goals

  5. Evaluate process of effectiveness
• First "nursing process" by Lydia Hall - three step process
• Jean Orlando - Nursing process further developed by
• Nursing process


  Cycle that the client and nurse move through continually + is universal allowing all healthcare providers to communicate
• Assessment


  First step, subjective vs objective data, open ended questions + the RN collects all pertinent patient data that relates to the situation
• Nursing diagnosis


  Nursing vs medical diagnosis, NANDA or problem based care planning (Used by NSU college of Nursing), problem focused, "at risk" for wellness, syndrome + RN analyzes the assessment and formulates a potential or actual diagnosis / issue
• Planning


  Short and long term goals, smart goals, goals can be flexible and can change if clients need more time to achieve + RN develops plan of care that includes measurable strategies to meet the identified outcomes
• Intervention


  Developing and implementing interventions to support the patient, family, or community + putting the nursing care plan into "action" - maintain, restore, and promote health + interventions should include independent, dependent, and collaborative interventions + nurse is responsible for prioritizing interventions to share with healthcare team members + standardizes list of interventions - Nursing interventions (NIC)
• Nursing function as patient advocate - Ensuing that all interventions are aimed to help patient
• Interventions - Are constantly evaluated and modified to best meet patient's needs, not complete until nurse documents implementation + RN implements plan of care through evidence based interventions that's focused on care of plan
• Evaluation


  Begins with collection of assessment data, determine if data supports diagnosis and interventions and effectiveness of plan of care, modifications can be made to plan of care to provide optimal care to client and achieve goals + RN evaluates progress towards achieving the goals set in plan of care
• Subjective data


  The pain in my upper back, I feel nauseated, my stress level is high, he doesn't like carrots, she seems sad all the time
• Objective data


  Heart rate is 112 beats per minute, potassium level is 3.8 mm, consumed 75% of her lunch, eats low sodium 1800 calorie diet
• Nursing process - Used by nurses to formulate a plan of care. Includes all nursing diagnoses. Each patient has one nursing plan with several different diagnosis which one plan of care is developed to meet overall goals of patient
• Open ended questions (Do's)


  Be engaged in convo, ask short questions, talk eye level to patient, read patient body language to determine if uncomfortable, begin questions with word explain + how + what + tell me
• Don't - Interrupt, give prompts, force questions, stand over patient or ask questions while not facing them
• Care management


  Nurse as nurse manager collaborates with healthcare team to coordinate, plan, and meet patient's needs + holistic care approach and patient centered + patient also referred to as client or consumer of healthcare
• Infection prevention and care


  • Standard precautions (all professional for all patients) = PPE (personal protection equipment), handwashing, respiratory, etiquette, sharps safety and safe injections, sterile equipment and fields versus clean and disinfected, need for transmission based precautions
• Handwashing - ANA - "Better health begins with better hand hygiene." / CDC - "Handwashing is the simplest and most effective way to prevent infection."
• PPE


  Wash hands, gown, mask eye protection, gloves, ppe check (on) Remove gloves, wash hands, remove gown, wash hands, remove eye wear, wash hands, remove mask, wash hands (off)
• Transmission based precaution


  • Airborne
  • Droplet
  • Contact
• Airborne


  Infection transmitted through air + have face mask (respiratory face mask - N-95), eye protection or face shield, clean hands before entering and exit, door remains closed
• Contact


  Infections transmitted through direct or indirect contact + used with suspected or known infections, no sharing of equipment + gown and gloves required + hand washing before entering and when leaving
• Droplet


  Infection transmitted through talking, sneezing, and coughing + have face mask (regular), eye protection or face shield, clean hands before entering and when leaving
• Nursing skills


  • Soft
  • Technical
  • Clinical
• Clinical skills


  Skills nurses need to provide safe patient care, including reasoning, assessment gathering, physical examination, delegation, and documentation
• Technical skills


  Also called hard skills, require specialized nursing knowledge and experience to complete task or actions needed in providing care (obtaining blood pressure, administering medication, or changing a dressing on a wound)
• Soft skills


  Skills nurses use to develop relationships with people, including teamwork, professionalism, integrity, empathy, communication, listening, and time management
• Critical thinking


  • Humility
  • Integrity
  • Courage
  • Empathy
• NANDA (North American nursing diagnosis association) - Organization that defines, distributes, and integrates standard nursing for clinical nursing practice
• Care management


  Nurse that collaborates with others to plan, track, and manage patient care to meet healthcare goals. Patient and family are provide holistic care