Potter: Fundamentals of Nursing, 10th Edition Chapter 15: Critical Thinking in Nursing Practice Key Points - Printable • Clinical judgments are influenced by a nurse’s experience and knowledge and a reliance on knowing the patient and his or her typical pattern of responses, as well as engaging with the patient and his or her concerns. • The ability to ask questions and to seek and examine information for answers and deeper meanings is essential in critical thinking. • Purposefully reflecting on a past situation and taking the time to honestly review everything you remember about it allows you to gain new knowledge and raise questions about your practice. • A basic critical thinker learns to accept the diverse opinions and values of experts, while complex critical thinkers begin to rely less on experts. • Effective problem solving involves obtaining information that clarifies the nature of a problem, suggesting possible solutions, and trying the solution over time to ensure it is effective, thus adding to nurses’ knowledge in future patient situations. • In inductive reasoning one reviews a specific set of facts and observations about a patient, forms generalizations, and then interprets the data and makes a conclusion about the related pieces of evidence. • In deductive reasoning one analyzes facts and observations from a conceptual viewpoint, then forms an inference and interprets the patient’s condition with respect to the conceptual view. • The critical thinking model for decision making includes five elements of critical thinking in nursing judgment: competence, knowledge, experience, attitudes, and standards (intellectual and professional). • Competence involves the ability to perform nursing skills proficiently, while knowledge prepares a nurse to better anticipate and identify patient problems by understanding their origin and nature. • Intellectual standards provide guidelines for rational thought and decision making that you apply during all steps of the nursing process. • Reflective journaling involves keeping a written record of clinical experiences to develop critical thought and reflection so that you can improve practices and apply theory in practice in the future.. Copyright 2021 © by Elsevier, Inc. All rights reserved. Potter: Fundamentals of Nursing, 10th Edition Chapter 16: Nursing Assessment Key Points - Printable Nursing assessment includes the collection of information from primary and all secondary sources and the interpretation and validation of the data collected. • A patient-centered interview is utilized when you conduct a comprehensive nursing history about a patient. • Periodic assessments collected during rounding or while you administer patient care include quick screenings to rule out or follow up on patient problems. • A physical examination, conducted during a nursing history and at any time a patient presents a symptom, provides objective data about a patient’s clinical status. • A patient is the primary source of assessment information. Be sure to consider the setting for your assessment and your patient’s condition. • Family members, when appropriate, are useful data sources for confirming assessment findings or identifying important health patterns of the patient. • A therapeutic nurse-patient relationship enables patients to tell their stories and enables nurses to understand patients and the experiences they express. • Demonstrate courtesy by introducing yourself, ensuring confidentiality of information shared by the patient, and sitting down next to the patient. Avoid exiting the room too soon. Take time to be present during patient interactions. • When making a connection with patients, begin with open-ended questions that encourage patients to tell their stories, and do not interrupt patients to allow them to fully describe their symptoms. • During the working phase of a patient interview use open-ended questions, attentively listen to the patient’s response, and summarize key issues to validate your understanding of the patient’s story. • To display professionalism during an interview, look at the patient, not the computer screen, and do not let the computer distract you during history taking. • A nursing health history includes a patient’s chief concern, expectations, and a thorough review of present illness and past health history. • During the assessment process you determine which questions or measurements are appropriate based on what you initially learn from a patient. You identify cues and form patterns as you make inferences and interpret the clinical meaning of the data.. Copyright 2021 © by Elsevier, Inc. All rights reserved. Potter: Fundamentals of Nursing, 10th Edition Chapter 17: Nursing Diagnosis Key Points - Printable • When making a diagnosis, a clear label or term that is familiar to all those involved in a patient’s care is necessary to understand a patient’s needs. • Nursing diagnoses provide clear direction as to the types of nursing interventions nurses are licensed to provide independently. • Nurses cannot treat medical diagnoses; instead, they treat patients’ responses to the medical health conditions. • Nurses intervene in collaboration with personnel from other health care professions to manage collaborative problems. • Using standardized terminology leads to diagnostic clarity and effective communication and enables nurses to formulate nursing diagnoses, associated interventions, and to assess the outcomes of nursing care. • The nursing diagnostic reasoning process involves using the assessment data gathered about a patient to logically explain a clinical judgment in the form of a nursing diagnosis. • Your review and analysis of assessment data involve critically organizing all data elements about a patient into meaningful patterns, also called data clusters or sets of assessment findings/defining characteristics. • As you recognize data elements from an assessment, you will cluster or group them together in meaningful patterns in a logical way that during interpretation will reveal the nursing diagnoses. • Data interpretation involves placing a label on a data pattern or cluster to clearly identify a patient’s responses to health problems. • Errors occur in the nursing diagnostic process during data collection; analysis of data, clusters, or patterns; and interpretation in choosing a nursing diagnostic statement. • Identify nursing diagnoses from a cluster of assessment findings and not just a single symptom. • Identify a patient need rather than the goal of care when forming a diagnostic statement.. 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Potter: Fundamentals of Nursing, 10th Edition Chapter 18: Planning Nursing Care Key Points - Printable • After identifying a patient’s nursing diagnoses and collaborative problems, you begin planning, which involves setting priorities based on patient diagnoses and problems, identifying patientcentered goals and expected outcomes, and prescribing nursing interventions for each diagnosis. • Symptom pattern recognition from patient assessment and certain knowledge triggers (e.g., pathophysiology or knowing patients) help you understand which diagnoses require intervention and the associated time frame during which you need to intervene. • By ranking a patient’s nursing diagnoses in order of importance and always monitoring changing signs and symptoms of patient problems, you attend to each patient’s most important needs and better organize ongoing care activities. • A goal is a broad statement that describes a desired change in a patient’s condition, perceptions, or behavior, while an outcome is the measurable change needed to reach a goal. • Goals and outcomes must be measurable so that you can measure or observe whether a change takes place in a patient’s physiological status or in a patient’s knowledge, perceptions, and behavior. • Mutual goal setting increases a patient’s motivation and cooperation to achieve a goal. • Nurse-initiated interventions are autonomous actions based on scientific rationale. • Dependent nursing interventions require an order from a health care provider to perform. • Care plans identify a plan of care based on a patient’s appropriate nursing diagnoses, outcomes, and interventions individualized to the patient’s unique needs. • You initiate a consult when your patient is experiencing a problem you cannot solve independently as a professional nurse or when you need the advice of another health care professional to provide quality patient care. • Interprofessional collaboration is a process that is formed between two or more people from various professional fields to achieve common goals for a patient.. 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Potter: Fundamentals of Nursing, 10th Edition Chapter 19: Implementing Nursing Care Key Points - Printable • A nursing intervention is any treatment based on clinical judgment and knowledge that a nurse is licensed to perform within the professional scope of practice. • Standard interventions, based on scientific evidence and clinical expertise, are developed for patients with common health problems to assist nurses to intervene more efficiently and appropriately. • Use of care bundles shows promising benefits but requires implementation of the full set of interventions and use of clinical judgment when practicing within guidelines of a care bundle. • Nurses use critical thinking in implementation when considering the complexity of interventions, changing priorities, alternative approaches, and the amount of time available to act. • As a nurse you are responsible for deciding whether to perform an intervention, delegate it to an unlicensed member of the nursing team, or have an RN colleague assist you. • Time management allows you to competently provide timely, thoughtful, safe, and efficient care. • The decisions a nurse makes about how time is allocated, prioritized, and sequenced are always interpreted by the patients you serve within the sociocultural context of a health care institution. • Expert nurses learn to anticipate changes in patients’ conditions even before confirming that diagnostic signs of complications develop. • Knowledge of pathophysiology and experience with previous patients helps nurses identify the risk of complications. • Nursing practice requires cognitive, interpersonal, and psychomotor skills to implement direct and indirect nursing interventions. • Direct care interventions include providing ADLs, assisting with IADLs, performing physical care, lifesaving measures, counseling, teaching, preventive interventions, and controlling for adverse reactions. • Communication of information about patients (e.g., hand-off report, hourly rounding, and consultation) is critical, ensuring that direct care activities are planned, coordinated, and performed with the proper resources. 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Potter: Fundamentals of Nursing, 10th Edition Chapter 20: Evaluation Key Points - Printable • Critical thinking is integral to evaluation as evidenced by the following nursing actions: (1) examining the results of care according to clinical data collected; (2) comparing achieved effects with goals and expected outcomes; (3) recognizing errors or omissions; and (4) understanding a patient situation, participating in self-reflection, and correcting errors. • Although you may measure or observe assessment and evaluation data in the same way, your assessment identifies what, if any, problems exist while your evaluation determines whether the problems you identified during assessment have remained the same, improved, worsened, or otherwise changed. • By using the right evaluative measure you are more likely to accurately identify whether there has been a change in a patient’s condition. • During the evaluation phase of the nursing process you perform evaluative measures to compare clinical assessment data, patient behavior, and patient self-reported data collected before implementation with data gathered after administering nursing care to determine whether the results of care match the expected outcomes and goals set for a patient. • The evaluation process involves the use of observational skills, critical thinking intellectual standards, knowledge, and reflection to recognize errors or omissions so that adjustments to interventions can be made in care plan revision. • Conducting evaluation involves reviewing evaluative measures to determine whether goals and outcomes are met successfully so that decisions can be made to either continue, discontinue, or revise a plan of care. • When patients do not meet goals and outcomes, you perform a reassessment and identify the factors that interfere with their achievement, which usually involves a change in a patient’s condition, needs, or abilities. 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