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199 Cards in this Set

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Clinical decision making
product of critical thinking that focuses on problem resolution

judgment that includes critical and reflective thinking and action and application of scientific and practical knowledge (Benner, 1984)
Concept map
a visual representation of client problems and interventions that shows their relationships to one another (Schuster, 2003)
Critical thinking
an active, organized, cognitive process used to carefully examine one's thinking and the thinking of others (Chaffee, 2002)
Decision making
a product of critical thinking that focuses on problem resolution

leads to informed conclusions that are supported by evidence and reason
Diagnostic reasoning
process of determining a client's health status after assigning meaning to the behaviors, physical signs, and symptoms presented by the client.
Evidence-based knowledge
knowledge based on active, organized, cognitive process used to carefully examine one's thinking and the thinking of others (Chaffee, 2002)
Inference
the process of drawing conclusions from related pieces of evidence (Smith Higuchi and Donald, 2002)

part of diagnostic reasoning
Nursing process
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation
Problem solving
involves evaluating the solution over time to make sure it's effective
3 levels of critical thinking
1. basic
2. complex
3. commitment
(Kataoka-Yahiro and Saylor, 1994)
4 requirements of critical thinking
1. cognitive skills
2. curiosity
3. honesty in facing personal bias
4. willingness to reconsider and think clearly
(Facione, 1990)
Scientific method (5 steps)
1. identify problem
2. collect data
3. formulate hypothesis
4. test hypothesis
5. evaluate results of test or study
Prognosis
likely outcome of diagnosed problem
6 steps in decision making
1. to recognize and define the problem/situation
2. assess all options
3. weigh each option against set of criteria
4. test possible options
5. consider consequences of decision
6. make final decision
3 steps of diagnostic reasoning
1. see context of client situation
2. observe patterns and themes
3. make decisions quickly
What's the vision of nursing practice according to DiVito-Thomas (2005)?
the ability to think critically, improve clinical practice, and decrease errors in clinical judgments
Attitudes of inquiry involve an ability to recognize that _____ exist and that there is a need for _______ to support what you suppose is true.
problems
evidence
As confidence grows, focus shifts from _______ to _______.
self
client
A critical thinker doesn't accept another person's ideas without _______.
question
A critical thinker deals with situations ______.
justly
Standards of practice
the minimum level of performance accepted to ensure high-quality care
2 things for which a professional nurse is accountable
1. decisions
2. outcomes
A critical thinker's favorite question
Why?
3 things to do when taking a risk
1. consider all options
2. analyze any danger to a client
3. act in a well-reasoned, logical and thoughtful manner
2 characteristics of a disciplined thinker
1. misses few details
2. follows an orderly or systematic approach when making decisions or taking action
Perseverance
to continue to look for more resources until you find a successful approach
A perseverent critical thinker works to achieve _______.
the highest level of quality care
Creativity involves _______ thinking.
original
A person of ______ is honest and willing to admit to mistakes or inconsistencies in his or her own behavior, ideas, and beliefs.
integrity
Humility
the ability to admit to any limitations in knowledge or skill
11 attitudes of critical thinking
1.confidence
2. independent thinking
3. fairness
4. responsibility and accountability
5. risk taking
6. discipline
7. perseverance
8. creativity
9. curiosity
10. integrity
11. humility
Intellectual standards
a guideline or principle for rational thought
Professional standards
ethical criteria for
1. nursing judgments
2. evaluation
3. professional responsibility
Professional standards promote the highest level of ___________.
quality nursing care
Critical thinkers maintain a sense of self-awareness through conscious awareness of 4 things
1.beliefs
2. values
3. feelings
4. the multiple perspectives that clients, family members, and peers present in clinical situations
Evidence-based criteria for making clinical decisions
clinical practice guidelines
Standards of professional responsibility that a nurse tries to achieve are those standards cited in ________, _______, and ________.
1. nurse practice acts
2. institutional practice guidelines
3. professional organizations' standards of practice
To develop critical thinking skills, it is important to learn how to connect ________ and ________ with _______.
knowledge
theory
practice
Reflection
process of purposefully recalling a situation to discover its meaning
Tool in developing critical thought and reflection through clarifying concepts
reflective journal writing
Keeping a journal of your client care experiences will help you become aware of how you use _______.
clinical decision-making skills
Assessment
gathering and analysis of information about client's health status
Back channeling
tools like active listening skills which encourage client to give more details
Closed-end questions
yes or no questions
Cue
information obtained through use of senses (all except taste!)
Data analysis
1. recognizing patterns or trends in clustered data,
2. comparing them with standards, 3. then coming to reasoned conclusion about client's responses to a health problem
Database
information gathered about a client
Functional health patterns
models offering holistic framework for assessment of any health problem
Inference
your judgment or interpretation of cues
Interview
an organized conversation with client
Nursing health history
information obtained by exploring:
1. client's current illness,
2. health history, and
3. expectations of care
Nursing process
continuous process of:
1. assess
2. diagnose
3. plan
4. implement
5. evaluate
Objective data
information obtained through observation or measurement
Open-ended questions
queries posed to elicit explanation
Review of systems (ROS)
systematic method for collecting data on all body systems
Standards
generally accepted theoretical framework
Subjective data
information provided by client
Validation
comparison of data with another source to determine data accuracy
2 types of data
1. subjective
2. objective
6 data sources
1. client
2. family/significant others
3. health care team
4. medical records
5. other records and literature
6. nurse's experience
3 phases of nursing interview
1. orientation phase
2. working phase
3. termination phase
A good interview environment is free of _______, _________, and _______.
distractions
noise
interruptions
5 dimensions of client health history
1. physical and developmental
2. intellectual
3. spiritual
4. social
5. emotional
T/F: The nurse practice acts of all states and the ANA's Nursing's Social Policy Statement (2003) mandate accurate data collection and recording as independent functions essential to the role of the professional nurse.
True
When recording data, pay attention to ____ and be as _______ as possible.
facts
descriptive
3 steps of data analysis
1. recognize a pattern or trend
2. compare with normal standards
3. make reasoned conclusion
How do you record subjective information from a client?
use quotation marks
Concept mapping is an effective learning strategy to understand the ________ between client problems.
relationship
Perhaps the best lesson a new nursing student can learn is to value every _______ _______, which become stepping stones for building new knowledge and inspiring innovative thinking.
client experience
11 attitudes for critical thinking
1. confidence
2. independence
3. fairness
4. responsibility
5. risk taking
6. discipline
7. perseverance
8. creativity
9. curiosity
10. integrity
11. humility
14 intellectual standards for critical thinking
1. clear
2. precise
3. specific
4. accurate
5. relevant
6. plausible
7. consistent
8. logical
9. deep
10. broad
11. complete
12. significant
13. adequate
14. fair
standards of practice
minimum level of performance accepted to ensure high-quality care
medical diagnosis
identification of a disease condition based on
1. a specific evaluation of physical signs, symptoms, client's medical history, and
2. results of diagnostic tests and procedures
nursing diagnosis
clinical judgment about individual, family/community responses to actual and potential health problems or life processes (NANDA-I, 2007)
collaborative problem
complication requiring treatment by several disciplines
T/F: A nurse can independently treat a medical diagnosis.
False
4 things used in reaching nursing diagnosis
1. knowledge
2. standards (ANA Scope of Nursing Practice)
3. attitudes (critical thinking)
4. experience
When was nursing diagnosis first introduced in nursing literature?
1950
When was first national conference for classification of nursing diagnosis?
1973
NANDA was established in _____ with the purpose to ______, _____, and _____ a taxonomy of nursing diagnostic terminology of general use for professional nurses.
1982
develop
refine
promote
ANA endorses ________ as having the responsibility to classify nursing diagnosis.
NANDA-I
All/Most/No state Nurse Practice Acts include nursing diagnosis as part of the domain of nursing practice
Most
diagnostic reasoning
process of using assessment data to logically explain a clinical judgment/nursing diagnosis
3 decision-making steps of diagnostic process
1. data clustering
2. identifying client needs
3. formulating diagnosis/problem
defining characteristics
clinical criteria/assessment findings supporting a nursing diagnosis
3 clinical criteria
1. objective/subjective signs & symptoms
2. clusters of signs & symptoms
3. risk factors leading to a diagnostic conclusion
The ______ of certain defining characteristics suggests that you ______ a diagnosis under consideration.
absence
reject
Always examine the _____ _______ carefully to support/eliminate a nursing diagnosis.
defining characteristics
Review a client's ________ before finalizing a nursing diagnosis.
general health care needs or problems
It is critical to select the correct ____ _____ for a client's need.
diagnostic label
4 types of nursing diagnoses (NANDA-I, 2007)
1. actual diagnoses
2. risk diagnoses
3. wellness diagnoses
4. health promotion nursing diagnoses
actual nursing diagnosis
describes human responses to health conditions/life processes that EXIST in a person.
Selection of an actual nursing diagnosis indicates that sufficient ______ ____ are available to establish the nursing diagnosis.
assessment data
risk nursing diagnosis
describes human responses to health conditions/life processes that will POSSIBLY develop in a vulnerable person.
health promotion nursing diagnosis
clinical judgment of a person's motivation and desire to increase well-being and actualize human health potential
wellness nursing diagnosis
describes human responses to levels of wellness in a person that have a readiness for enhancement
2 components of a nursing diagnosis
1. diagnostic label
2. related factors
3. in addition, all NANDA-I approved diagnoses include a definition
diagnostic label
the name of the nursing diagnosis as approved by NANDA-I
related factor
a condition/etiology identified form the client's assessment data
4 categories of related factors for NANDA-I diagnoses
1. pathophysiological
2. treatment related
3. situational
4. maturational
The etiology of a nursing diagnosis is always within the domain of ______ and a condition that responds to ________.
nursing practice
nursing interventions
(do NOT use medical diagnosis as etiology for nursing diagnosis!)
risk factors
environmental, physiological, psychological, genetic/chemical elements that increase the vulnerability of a person to an unhealthful event.
A client's culture influences the type of _________ he/she faces.
health care problems
When making a diagnosis, consider how culture influences the ______ ______ for your diagnostic statement.
related factor
Few clients have _______ problems.
single
concept map
a scheme that displays visual knowledge in the form of a hierarchical graphic network
Concept mapping _______ and _____ information and links information to allow you to see new wholes and appreciate the complexity of client care. (Ferrario, 2004).
organizes
links
Assessment data needs to support the ____________ and the related factor needs to support the _________.
diagnostic label
etiology
Data sources include these 3 domains:
1. physical
2. psychological
3. sociocultural
4 error sources in nursing diagnosis process
1. data collection
2. clustering
3. interpretation
4. statement of diagnosis
To avoid errors in data collection, be _______ and _________ in all assessment techniques.
knowledgeable
skilled
4 errors in collecting data
1. lack of knowledge or skill
2. inaccurate data
3. missing data
4. disorganization
5 errors in interpreting data
1. inaccurate interpretation of cues
2. failure to consider conflicting cues
3. using an insufficient number of cues
4. using unreliable or invalid cues
5. failure to consider cultural influences or development state
5 errors in labeling
1. wrong diagnostic label selected
2. evidence exists that another diagnosis is more likely
3. condition is a collaborative problem
4. failure to validate nursing diagnosis with client
5. failure to seek guidance
Use of standardized language from NANDA-I helps ensure ______.
accuracy
Identify the client's ______, not the medical diagnosis.
response
Identify a NANDA-I diagnostic statement rather than the ________.
symptom
Identify a _______ ________ rather than a clinical sign or chronic problem.
treatable etiology
Identify the ________ caused by the treatment or diagnostic study rather than the treatment or study itself.
problem
Identify the client ______ to the equipment rather than the equipment itself.
response
Identify the ______ problems rather than your problems with nursing care.
client's
Identify the ______ _______ rather than the nursing intervention
client problem
Identify the client problem rather than the _____.
goal
Make _______ rather than prejudicial judgments.
professional
avoid legally inadvisable ________.
statements
Identify the ______ and _______ to avoid a circular statement.
problem
etiology
Identify only one ____ _______ in the diagnostic statement.
client problem
When initiating the original care plan, always place the highest-priority nursing diagnosis _______.
first
planning
category of nursing behaviors in which a nurse sets client-centered goals and expected outcomes and plans nursing interventions
priority setting
ordering of nursing diagnoses or client problems using notions of urgency and/or importance to establish a preferential order for nursing actions
5 things on which priorities should be based
1. problem urgency
2. client safety
3. client desires
4. nature of treatment indicated
5. relationship among diagnoses
Establishing priorities is not merely a matter of numbering the nursing diagnoses on the basis of ______ or _______ __________.
severity
physiological importance
3 classifications of priorities
1.high
2. intermediate
3. low
What nursing diagnoses have highest priority?
those involving ABCs and safety
Intermediate nursing diagnoses involve the _________, ________ needs of the client.
non-emergent
non-life-threatening
Low priority nursing diagnoses are not always directly related to a specific _______ or ________ but affect the client's ______ __________.
illness
prognosis
future well-being
Ongoing _____ ______ is CRITICAL to determine the status of your client's _______ ________.
client assessment
nursing diagnoses
3 phases of nursing care
1. initial
2. ongoing
3. discharge
What does initial planning involve?
1. development of preliminary plan of care
2. initial selection of nursing diagnoses
What does ongoing planning involve?
continuous updating of care plan
What does discharge planning involve?
critical anticipation and preparation for meeting client's needs after discharge
Involve ______ in priority setting whenever possible.
client
Always assign priorities on the basis of good ______ _________.
nursing judgment
Nursing care is a ________ process.
nonlinear
cognitive shift
shift of attention from one client to another during the conduct of the nursing process
3 keys to staying organized when working with multiple clients
1. work from your plan of care
2. use priorities to organize the order for delivering interventions
3. use priorities to organize documentation of care
goal
a broad statement that describes the desired change in a client's condition/behavior
expected outcome
measurable criteria to evaluate goal achievement
2 purposes of goals and expected outcomes
1. provide clear direction for selection and use of nursing interventions
2. to provide focus for evaluating effectiveness of the interventions
6 ways that goals and outcomes need to meet established intellectual standards
1. by being relevant to client needs
2. specific
3. singular
4. observable
5. measurable
6. time-limited
client-centered goal
a specific and measurable behavior/response that reflects a client's highest possible level of wellness and independence in function
A goal is ______ and based on client ______ and ________.
realistic
needs
resources
short-term goal
objective behavior/response that you expect a client to achieve in a short time (1 week or less)
long-term goal
objective behavior/response that you expect a client to achieve in a period of weeks or months
Goal setting establishes the framework for the __________.
nursing care plan
For clients to participate in goal setting, they need to be ______ and have some degree of ____________.
alert
independence
If a client is not able to participate in goal development, the nurse ______ ________.
assumes responsibility
expected outcome
specific measurable change in client's status that you expect to occur in response to nursing care
Always write expected outcomes ________, with ____ _______, and in _______ ______.
sequentially
time frames
measurable terms
Nursing Outcomes Classification (NOC)
Iowa Intervention Project published the NOC and linked outcomes to NANDA diagnoses
nursing-sensitive client outcome
a person's state, behavior, or perception that is measurable along a continuum in response to a nursing intervention
NOC contains outcomes for ________, ________, __________, and _________ for all types of health care settings.
individuals
family caregivers
the family
the community
The NOC standardizes the way to measure ______ ___________.
client outcomes
number of outcomes included in NOC
330
NOC include 3 things for each outcome
1.definitions
2. indicators
3. measurement scales
7 guidelines for writing goals and expected outcomes
1. client-centered
2. singular goal/outcome
3. observable
4. measurable
5. time-limited
6. mutual factors
7. realistic
nursing interventions
treatments/actions, based upon clinical judgment and knowledge, that nurses perform to meet clients' outcomes.
3 competency areas for selecting interventions
1. knowing scientific rationale for the intervention
2. possessing necessary psychomotor and interpersonal skills
3. being able to function within a particular setting to use the available health care resources effectively
3 categories of interventions
1. nurse-initiated
2. physician-initiated
3. collaborative
Nurse-initiated interventions do not require ______ or ________.
direction
order from another health care professional
As a nurse, you act __________ on a client's behalf.
independently
According to MOST states' Nurse Practice Acts, independent nursing interventions pertain to what 3 things
1. ADLs
2. health education and promotion
3. counseling
2 publications for which Iowa Intervention Project is responsible
NOC (nursing outcomes classification)
NIC (nursing interventions classification)
3 levels of the NIC model
1. domains
2. classes (there are 30)
3.interventions (there are 542)
NIC interventions are linked with ________ for ease of use.
NANDA-I nursing diagnoses
T/F: Both NIC and NOC are linked to NANDA-I nursing diagnoses.
true
3 parts of written nursing care plan
1. nursing diagnoses
2.goals and/or expected outcomes
3. specific interventions
A nursing care plan is a written guideline for what 3 things
1. coordinating nursing care
2. promoting continuity of care
3. listing outcome criteria to be used in evaluation
3 things made possible by a written nursing care plan
1. coordination of nursing care
2. coordination of sub-speciality consultations
3. coordination of scheduling of diagnostic tests
A written plan should be designed to reduce the risk of _______, ________, or _______ care.
incomplete
incorrect
inaccurate
4 areas in which student care plans are useful
1. learning problem-solving technique
2. learning nursing process
3. learning written communication skills
4. learning organizational skills needed for nursing care
6 categories of student care plan
1. assessment
2. goals
3. expected outcomes
4. interventions
5. rationale
6. evaluation
4 frequent errors in writing nursing interventions
1. failure to precisely/completely indicate nursing actions
2. failure to indicate frequency
3. failure to indicate quantity
4. failure to indicate method
Kardex nursing care plan
card-filing system used in many hospitals
How does an institutional care plan differ from a student care plan?
institutional plan lacks scientific rationale
The focus of a nursing care plan will differ by ___ and ___________.
setting
the evolving client situation
EHR
electronic health record
Most hospitals now have some type of _______.
EHR and documentation system
Failure to ________ a standarized care form for a particular client results in incomplete and inaccurate care.
customize
Care plans for community-based settings require a more comprehensive assessment of __________, _______, and _______.
community
home
family
critical pathways
multidisciplinary treatment plans outlining treatments/interventions clients needed in a health care setting for a specific disease/condition
concept map
a visual representation of client problems and interventions that shows their relationships to one another
consultation
process in which you seek expertise of a specialist
2 problems solved through consultation
1. problems in delivery of nursing care
2. problems related to use of resources
when to consult
when you identify problem you can't solve using
1. personal knowledge,
2. skills and
3. resources
6 steps of consultation
1. identify problem
2. direct consultation to the right professional
3. provide consultant with relevant information
4. avoid bias by not overloading consultants with subjective/emotional conclusions about client/problem
5. be available to discuss consultant's findings and recommendations
6. incorporate consultant's recommendations into care plan.
The success of advice gained through consultation depends on the _______ of the problem-solving techniques.
implementation
Always give the consultant _______ regarding outcome of the recommendations.
feedback
When it comes to implementation, ALWAYS ______ before you ____.
think
act