NURSING AS A SCIENCE 2

• Approaches to Problem Solving


  • Trial and Error
  • Intuition
  • Research Process
• Trial and Error


  A number of approaches are tried until a solution is found
• Intuition


  • Understanding or learning of things without the conscious use of reasoning
  • Also known as 6th sense, hunch, instinct, feeling or suspicion
  • Clinical judgment - a decision making process to ascertain the right nursing action to be implemented at the appropriate time in the client's care
  • Experience is important in improving intuition because the rapidity of judgment depends on the nurse having seen similar client situations many times before
• Research Process


  A formalized logical, systematic approach to problem solving
• Attitudes that Foster Critical Thinking


  • Independence
  • Fair-mindedness
  • Insight to Egocentricity
  • Intellectual Humility
  • Intellectual Courage to Challenge the Status Quo and Rituals
  • Integrity
  • Perseverance
  • Confidence
  • Curiosity
• Independence


  Critical thinkers consider seriously a wide range of ideas, learn from them, and then make their own judgment about them
• Fair-mindedness


  Critical thinkers make impartial judgments. They assess all viewpoints with the same standards and do not base their judgments on personal or group bias or prejudice
• Insight to Egocentricity


  Critical thinkers are open to the possibility that their personal biases or social pressures and customs could unduly affect their thinking. They actively try to examine their own biases and bring them to awareness each time they think or make a decision
• Intellectual Humility


  Having an awareness of the limits of one's own knowledge. Critical thinkers are willing to admit that they do not know; they are willing to seek new information and to rethink their conclusions in light of new knowledge
• Intellectual Courage to Challenge the Status Quo and Rituals


  With an attitude of courage, a nurse is willing to consider and examine fairly his or her own ideas or views, especially those to which the nurse may have a strongly negative reaction. This type of courage comes from recognizing that beliefs are sometimes false or misleading
• Integrity


  Intellectual integrity requires that individuals apply the same rigorous standards of proof to their own knowledge and beliefs as they apply to the knowledge and beliefs of others
• Perseverance


  Critical thinkers show perseverance in finding effective solutions to client and nursing problems. The nurse needs to continue to address the issue until it is resolve
• Confidence


  Critical thinkers believe that well-reasoned thinking will lead to trustworthy conclusions
• Curiosity


  The mind of a critical thinker is filled with questions
• Collecting Data


  • The process of gathering information about a client's health status
  • Must be both systematic and continuous to prevent the omission of significant data and reflect a client's changing health status
  • Data base - contains all the information about a client; includes nursing history, physical assessment, primary care provider's history and physical examination, results of lab and diagnostic tests and material contributed by other HCP
  • Also includes past history and current problems
  • To collect data accurately, both the client and nurse must actively participate
• Focused Interview


  The nurse asks the client specific questions to collect information related to the client's problem
• Planning the Interview and Setting

  1. The nurse reviews available information before beginning an interview

  2. Both the nurse and the client must be made comfortable in order to encourage an effective interview

  3. Time - The nurse needs to plan the interview with clients when the client is physically comfortable and free of pain, when interruptions from friends, family or other HCP are minimal

  4. Place - well lighted, well-ventilated room that is relatively free of noise, movements, and distractions encourages communication, the place should not allow others to overhear or see the interview

  5. Seating Arrangement - The nurse can sit at a 45-degree angle to the bed when the client is in bed (less formal), Seating with no table in between, a few feet apart, creates a less formal atmosphere

  6. Distance - the distance should neither too small nor too great because some feel uncomfortable when talking to someone who is too close or too far away, Proxemics - the study of use of space

  7. Language - failure to communicate in language the client can understand is a form of discrimination, the nurse must use words that the client can understand, the nurse must avoid using medical terms, if giving written documents to client, the nurse must determine that the client can read in his or her own native language, ensure confidentiality of information is observed
• Stages of Interview


  1. Opening - sets the tone of the interview, purpose is to establish rapport and orient the interviewee

  2. Body - The client communicates what he/she thinks, feels, knows, and perceives in response to questions from the nurse

  3. Closing - The nurse terminates the interview when the needed information has been obtained
• Examining


  Physical examination or physical assessment is a systematic data collection method that uses observation to detect health problems, to conduct the examination, the nurses use techniques of inspection, auscultation, palpation, and percussion, must be carried out systematically (organized according to examiner's preference, cephalocaudal (head-to-toe approach), body systems approach – screening examination /review of systems)
• Organizing Data


  • The nurse uses a written or electronic format that organizes the assessment data systematically, referred as NURSING HEALTH HISTORY, NURSING ASSESSMENT, OR NURSING DATABASE FORM
  • Most schools and health care agencies developed their own STRUCTURED ASSESSMENT FORMAT based on selected nursing models/ frameworks (Gordon's Functional Health Patterns, Orem's Self-care Model, Roy's Adaptation Model)
  • Nurses use wellness models to assist clients to identify health risks and to explore lifestyle, habits and health behaviors, beliefs, values, and attitudes that influence level of wellness
  • Frameworks and models from other disciplines like BODY SYSTEM MODEL, MASLOW'S HIERARCHY OF NEEDS. DEVELOPMENTAL THEORIES
• Validating Data


  Is an act of double checking or verifying data to confirm that it is accurate and factual, validating data helps the nurse complete these tasks: 1) Ensure that assessment information is complete, 2) Ensure that objective data and related subjective data agree, 3) Obtain additional info that may have been overlooked, 4) Differentiate cues and inferences (Cues - subjective or objective data that can be directly observed by the nurse, Inferences - nurses interpretation or conclusion made based on the cues), 5) Avoid jumping to conclusions and focusing on the wrong direction to identify problems
• Documenting Data


  To complete the assessment phase, the nurse records the client data, accurate documentation is essential and should include all the data collected about the client's health status, data are recorded in factual manner and not interpreted by the nurse, to increase accuracy, the nurse records subjective data in the client's own words, using quotation marks, rechanging on other words what someone says increases the chance of changing original meaning