Health Promotion -Fostering the highest state of well-being
-education Ex: nutrition
-counseling Ex: pregnant women on prenatal care, new mother benefits from breast feeding.
– advocacy. Ex: changes in policy that increase health awareness. Illness prevention focuses on avoidance of disease, infection, and other comorbidities. Primary prevention -preventing a disease from occurring Ex: encouraging annual physicals. Teaching self great/ testicular exams. Secondary prevention – The disease or precursor of the disease has started. Ex: has hypertension but eats low sodium diet.
-preventing progression Ex: checking a suspicious growth for skin cancer Tertiary prevention -prevent damage and pain from the disease.
-slow down the disease Ex: patient dying peacefully
-preventing the disease from causing other problems (they are called “complications”)
-give better care to people with the disease. Health restoration -Activities foster a return to health for those already ill.
-the nurse provides direct care to ill individuals, groups, families, or communities.
-provide hygiene and nutrition for someone unable to so by self.
-administrating medications or treatment.
– counseling individuals or groups
-lobbying for policy changes to improve access to care for an underserved group. critical thinking -a combination of reasoned thinking, openness to alternatives, ability to reflect, a desire to seek the truth, and logical thinking and common sense. clinical judgment -similar to critical thinking
-observing, comparing, contrasting, and evaluating the client’s condition Reflective thinking -looking back “could I have done that better? How?”
-involves collecting and analyzing info and carefully considering options for action. Problem solving -Considering an issue and attempting to find a satisfactory solution
– skills suck as organizing data, identifying relevant and important data, making references, making decisions, projecting consequences of actions, and applying theoretical knowledge to a specific patient context. Five major categories of critical thinking 1. contextual awareness
2. Inquiry (analyzing assumptions)
3. Considering alternatives
4. Using credible sources (evidence base practice)
5. reflecting critically and deciding contextual awareness – An awareness of what’s happening in the total situation including values, cultural issues, interpersonal relationships, and environmental influences.
– Ex: What is going on in the situation that may influence the outcome? Inquiry (analyzing assumptions) – applying standards of good reasoning to your thinking when analyzing a situation and evaluating your action.
-recognizing and analyzing assumptions you are making about the situation and examining the beliefs that underlie your choices.
– Ex: How do I go about getting the information I need? Considering alternatives – Exploring the imaging as many alternatives as you can think of for the situation.
– Ex: what is one possible explanation for what is happening or what happened? Using credible sources (evidence base practice) – years aho, if someone was diabeticc they would get OJ with added sugar, now we know that adding extra sugar makes them hyperglycemic, so now just given juice. Reflecting critically and deciding what to do – questioning. analyzing, and reflecting on the rationale for your decisions.
– Ex: what else night work in this situation Theoretical knowledge -consist of facts, principles, and evidence base theory.
– includes research findings and rationally constructed explanations of phenomena.
use it to describe patient, understand their health status, and explain you r reasoning for interventions, and predict patient response to interventions and treatments. Practical knowledge – knowing what to do and how to do it. Putting the theoretical to work.
– Ex; the decision process and the nursing process. Self-knowledge -self-awarenedd of values, cultural, and religious bias.
-self-understanding
-helps to find errors in your thinking and enables you to “tune in” to your patient.
-Ex “why did I do that?” Ethical knowledge – Knowledge of obligation and the sense of right and wrong.
– info about moral principles and processes for making moral decisions.
– helps to fulfill your ethical obligations to patients and colleagues. nursing process – systematic problem-solving process that guides all nursing actions.
– to help the nurse provide goal- directed, client center care. Phases of Nursing process – assessment
– diagnosis
– planning outcomes
– planning interventions
– implementations
– evaluation Assessment – the systematic gathering of info related to the physical, mental, spiritual, socioeconomic, and cultural status of an individual, grow, or community. Assessment includes ~collecting data- can subjunctive(anything provided by patient or someone else providing are. Anything in the med rec) or objective (data i have collected myself)
~using a systemic and ongoing process
~ categorizing data
~recording data Assessment: How are data used? (5) – By other discipline (collaboration)
– To plan for nursing care
– to ensure client receives: the proper care, by qualified individuals, and at the time needed.
– validating data
– documenting data Initial assessment – completes when the client first comes to the healthcare agency.
– initial assessment seeing if there is a need for further assessment.
– Ex; marital status, occupation Ongoing assessment – performed as needed, at any time after the initial database is completed.
– at any time after the initial database is completed
– use data to identify new problems or to follow up on previously identified problems.
-Ex: fall, pain, bladder. OR vital signs may change rapidly and serve as important indicators of dev. or resolving health problems. Comprehensive Assessment – consists of a nursing history and physical examination.
– both subjective and objective data/
– provides holistic info about the clients’ overall healthy status. Ex: SOAPIE
– includes data about the clients body systems and functional abilities, emotional status, spiritual health, and psychosocial situation.
– helps identify problems and the strengths. Focused Assessment – keying in on one system ex: thoracic
– performed to obtain data about an actual, potential, or possible problem that has been identifies or is suspected. Special Needs Assessment – focused assessment
– in-depth info about a particular area of client functioning and often involves using a specially designed form.
– can be lengthy
– need enough data to provide elastic care. Assessment: nursing interview – subjective data (info communicated to the nurse by the client, fan or community. includes thoughts, feelings, beliefs, and sensations.)
– purposeful communication
– structured communication
– involved questioning the client
– purpose is to gather data for the nursing database Assessment: Basic physical assessment – We look, feel, or listen to something
– objective data
– inspection
-palpation
– Percussion
– auscultation objective data – gathered though a physical assessment or from laboratory or diagnostic tests. inspection – observation and visual examination of the client, as well as use of equipment such as an otoscpe or ophthalmoscope. palpation – to find out if soft or hard
– light touch, professing to deeper touch, using the pads of fingers Percussions – striking a body surface with the tip of a finger, which produces different vibrations and sounds depending on what is under the area that is tapped
– Ex: air, fluids, or solid Auscultation – Listening w/ the unaided ear for the sounds made by the patient (direct auscultation) and listen with the use of stethoscope (indirect auscultation) for normal and abnormal sounds within the body
– Ex: sounds of the heart or the lungs Assessment: Nursing interview -directive interviewing( always call by name)
– non-directive interviewing Directive interviewing – obtain factual, easily categorized information (ex: age, sex) or in an emergency situation.
– ask mostly closed questions to obtain specific answer. (yes or no questions)
– could miss important topics to the patient Non-directive interviewing – you allow the patient to control the subject matter.
– Your role is to clarify summarize, and ask mostly open-ended questions that facilitate convo and thought.
– find out what is important to the patient but time consuming and can produce irrelevant data. Critical thinking vs. nursing process -critical thinking and the nursing process are both thinking methods to solve problems
– nursing is a problem- solving process that uses many individual critical thinking skills
– they can be used together toward a common goal nursing diagnosis – second step in the nursing process
– hundreds of them
– using critical thinking skills to identify patterns in the data and draw conclusions about the client’s health status
– includes strengths, problems, and factors contributing to the problems.
– a formal diagnostic statement of the client’s health status, containing both the problem and the etiology (factors contributing to the problems)
– the list of standardized terms used to rite diagnostic statements. those are actually problems labels; you must add a second part in order to create a complete diagnostic statement. Medical diagnosis – describes a disease, illness, or injury.
– more narrowed focused than nursing diagnosis.
– nurses can’t legally treat these. Nursing diagnosis – is a clients response to a health problem (can be biological, emotional, interpersonal, social, or spiritual.)
– a statement of client health status that nurses can identify, prevent, or treat independently types of nursing problems/ diagnosis – actual
– risk
-possible
– syndrome
– wellness Actual nursing diagnosis – problem response that exists at the time of assessment (data support)
– Ex: hypertension, diabetes
– identify tit by signs and symptoms that are present. Risk nursing diagnosis – problem response that is likely to develop
– no signs or symptoms but risk factors
– using only for patients who have more susceptibility to the problem than others in the same or a comparable setting. Possible nursing diagnosis – Exists when intuition and experience directs (partial data)
– do not have enough data to support your diagnosis however you suspect that a diagnosis is present.
– main reason is to alert the other nursed to continue to collect data to confirm or to rule our the problem. syndrome nursing diagnosis – collection of nursing Dxs that occur together
– Ex: NANDA label risk of disuse syndrome is used to represent all the complications that can occur as a result of immobility. Pressure ulcer, constipation, stasis of pulmonary secretions. Wellness diagnosis – describes health status, not a health problem
– an individual group or community is in transition from one level of wellness to a higher level of wellness. Prioritizing problems/ diagnosis – places problems in order of importance
– does not mean that you must resolve one problem before attending to another
– determined by the theoretical framework you use Problem urgency: high priority – life- threatening
-Ex: ineffective airway clearance Problem urgency: medium priority – not a direct threat to life, but may cause destructive physical or emotional changes.
– Ex: ineffective denial, unilateral neglect Problem urgency: low priority – requires minimal supportive nursing intervention
– Ex: risk for delayed development, interrupted breastfeeding, mild anxiety. How to choose a NANDA nursing diagnosis – identify the broad topic ( or domain) that seems to fit the cue cluster
– narrow your search ( to the class or most likely labels)
– use a nursing diagnosis handbook; compare definitions and defining characteristics of the diagnostic labels with your cue cluster. how to write nursing diagnoses – use a 3 part statement
– Ex: alteration in comfort RELATED TO surgery AS EVIDENCED BY pain when ambulating, rates pain 6/10.
-must state diagnosis, related to something, as evidenced by… outcome What do you want to see happen?
– Short term
– long term Short term goal – those that you expect the patient to achieve within a few hours or days.
– important in situations in which patient may be discharged before evaluating long term goals. also for providing positive reinforcement to clients who are working towards long term goals. Long term goals – changes in health status that you wish to achieve over a longer period. describe the optimum level of functioning you expect the patient to achieve, given health status and available resources. Nursing interventions – What are you doing to do to make that outcome happen?
– area actions, based on clinical judgment and nursing knowledge, that nurses perform to achieve client outcome. Independent intervention – one that registers nurses are licensed to prescribe, perform, or delegate based on knowledge and skills.
– provide patient teaching for a newly diagnosed diabetic dependent interventions – one that is prescribed by a physical or advanced practice nurse but carried out by bedside nurse.
– Given Tylenol 65 mg PO 4 hrs PRN Importance of a care plan Planning can be formal or informal
– ensures care is complete
– provides continuity of care (shift to shit)
– promotes efficient use of nursing efforts
– provides a guide for assessing and charting
– meets requirements of accrediting agencies informal planning making mental notes or plans What information does a comprehensive nursing care plan contain? 1. Basic needs and activities of daily living
2. medical/multidisciplinary treatment
3. nuring diagnoses and collaborative problems
4. special discharge needs or teaching needs
** 4-6th grade level of teaching needs to be done because most people have lower education levels implementation – DOING, DELEGATING, AND DOCUMENTING **
– you will perform or delegate planned interventions- carry out the care plan.
-ends when you document the nursing actions in the chart.
– put your plan into action
– nursing interventions- individualized to the patient evaluation ** always do this!
– final step in nursing process
– planned, ongoing, systematic, activity in which you will make judgements.
-make sure your plan worked, if it didn’t work what could i have done differently?
– How will you evaluate the care provided?
– if it doesn’t you need to start your nursing process from the beginning. Nursing science – a blend of knowledge that is unique to nursing and knowledge that is borrowed from other disciplines Nursing theory – aims to describe, predict and explain the phenomenon of nursing
– should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future. Nursing theory importance – it helps us to decide hat we know and what we need to know
– helps to distinguish what should form the basis of practice by explicitly describing nursing.
– include better patient care, enhances professional states for nurses, improved communication between nurses, and guidance for research and education
– vital to have theory to analyze and explain what nurses do.
– nursing continues to strive to establish a unique body of knowledge. Florence Nightingale – Environmental Theory
– Considered the first nursing theorist
– unsanitary conditions posed health risk (needs to provide clean environment -> improved patients health)
– external influence can prevent suppress or contribute to disease
– “every person deserves care, regardless if status, religion or wealth” 5 components of environment (Florence Nightingale) 1. ventilation- windows opened
2. light
3. warmth
4. effluvia (gases)- not being exposed to too much oxygen.
5. noise Patricia Benner 1984 – Phases of nursing
– nurse theorist
– stage 1: novice (just learning now)
– stage 2: advanced beginner
– stage 3: competence
– stage 4: Proficient
– stage 5: expert
* progression through the staged involved continual dev. of thinking and technical skills * Christine Tanner 2006 – Why we act in a certain fashion or way intuitive reasoning – our immediate interpretation of the data Analytic reasoning – the objective/subjective data that leads us to the interpretation Narrative reasoning – the story the data is giving Licensure – the process by which boards of nursing grant permission to an individual to engage in nursing practice after determining that the applicant has attained the competency necessary to perform a unique scope of practice.
– is necessary when the regulated activities are complex, require specialized knowledge and skill and independent decision making. Licensure provides that: – a specifies scope of practice may only be performed legally by licensed individuals
– title protection
– authority to take disciplinary action should the license violated the law or rules in order to assure that the public is protected. Continuing education (CE) – professional strategy to maintain current clinical knowledge; 22 state require CE courses for renewal of a nursing license In-service education – programs offered at the work site
– every 2 years, the even year Master’s degree programs – prepare advanced practice nurses (APNs) to teach and to function in a more independent role Doctoral programs in nursing – DNS degree prepares nurse for advanced clinical practice
– PhD is a research degree BC “board certified American Nurses Credentialing Center (ANCC) – offers testing for family, adult, acute care, geriatric, pediatric, and psychiatric- mental health nurse practitioner certification. American Academy of Nurse Practitioners (AANP) – offers testing for adult, family and gerontologic nurse practitioner certification National Certification Corporation (NCC) – offers testing for women’s health and neonatal nurse practitioner certification. Pediatric Nursing Certification Board (PNCB) – offers testing for pediatric and acute care pediatric nurse practitioner certification. Sigma Theta Tau: Organizational Mission -The mission of the Honor Society of Nursing, Sigma Theta Tau International is to support the learning, knowledge, and professional development of nurses committed to making a difference in health worldwide. Sigma Theta Tau: Society Vision The vision of the Honor Society of Nursing, Sigma Theta Tau International is to create a global community of nurses who lead in using knowledge, scholarship, service and learning to improve the health of the world’s people.