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81 Cards in this Set
- Front
- Back
The reflective, systematic, goal-directed, thought process that serves as a basis for creative decising making in nursing.
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critical thinking
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The nursing profession uses critical thinking to -
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make astute observations, analyze data, draw sound conclusions
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Examples of decision making models that use critical thinking -
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The scientific meathod
Differential Diagnosis - narrow down to a few possible diagnoses and focus data collection on eliminating one and/or strengthening another to hone in on correct diagnosis The Nursing Process - 5 steps: Assess, Diagnose, Plan, Implement, Evaluate (ADPIE) to systematically approach patient care in a way that consciously evaluates interventions to reveal best treatment path for each patient. |
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What 6 skills are used to critically think?
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Interpretation, Analysis, Inference, Evaluation, Explanation, Self-regulation
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What are the 5 components of critical thinking
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Knowledge Base
Experience Competency in using the Nursing Process Attitudes Standards |
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Attitudes for critical thinking
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Confidence, independent thinking, fairness, accountability, risk taking, discipline, perserverance, creativity, curiosity, integrity, humility
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5 Steps in the Nursing Process
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ADPIE -
Assess Diagnose Plan Implement Evaluate |
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Assess
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The data collection phase
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Primary and secondary sources of Assesment data
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Primary - the patient
Secondary - medical records, close family/friends, health care team, other records, nursing/medical/pharmacological literature |
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Data types -
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Subjective - The client's verbal description of his or her health problem. Includes feelings, perceptions, self-report of symptoms
Objective - Observations, measurements. i.e. vital signs, lab results, nursing assessment |
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Methods of data collection
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The interview
structured database format problem-oriented approach 3 Phases Orientation phase Working phase Termination phase create a comfortable interview environment and use open and closed-ended questions strategically |
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11 Components of nursing health history
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Biographical info
Reason for seeking care Expectations History of Present Illness Health history (all previous medical conditions) Lifestyle factors Family History Psychosocial history (coping mechanisms, support, recent loss, abuse) Review of systems (establish normal/abnormal functioning of every sys) Environmental History Physical Examination |
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Key elements of nursing data documentation
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Clear and concise
Timely, thorough and accurate Record both subjective (use quotes when possible) and objective data Avoid generalization or judgement |
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Step 2 of the nursing process - (Nursing) Diagnosis - is
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A clinical judgement about individual, family, or community responses to actual and potential health problems or life processes
A statement that describes an actual or potential response to a health problem that a nurse is licensed to treat. Holistic - not necessarily disease-focused. |
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A nursing diagnosis is different from a Medical Diagnosis. Describe the qualities of a medical diagnosis.
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Identification of a disease process
Based on specific evaluation of physical signs, history, and diagnostic testing or procedures. Physicians treat diseases described in medical diagnostic statements (myocardial infarction, diabetes mellitus) |
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Origin of Nursing Diagnosis
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First introduced in 1950
First incorporated into ANA Standards of Practice in 1971 NANDA (North American Nursing Diagnosis Association) established in 1982 NANDA - International established in 2003 |
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What is the purpose of using nursing diagnoses?
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To maintain a common language for client needs.
Enables nurses to communicate what they do Distinguishes the nurse's role from that of a physician, etc. Gives focus to scope of nursing practice Fosters development of nursing knowledge |
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What are the 4 types of Nursing Diagnoses?
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Actual Diagnosis (i.e. Impaired Gas Exchange)
Risk Diagnosis (i.e. Risk for infection) Health Promotion Diagnosis (Readiness for …) Wellness Diagnosis |
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3 components of a nursing diagnosis
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Diagnostic label
Etiology "related to" Evidence "as evidenced by" Example: Acute pain related to uterine contractions as evidenced by moaning, facial grimacing, and pain scale rating of 10/10 |
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Diagnostic label
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Name of the nursing diagnosis approved by NANDA-I
Describes client response Includes descriptors (impaired, compromised, decreased, deficient, delayed, effective, imbalanced, impaired, increased) |
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How to risk factors relate to nursing diagnoses?
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They serve as cues to indicate a "Risk" nursing diagnosis.
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Etiology portion of nursing diagnosis
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"Related to"
Supports diagnosis must be a condition that responds to nursing intervention should not include medical diagnosis |
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Evidence portion of nursing diagnosis
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"as evidenced by"
related factors to support diagnosis use data from assessment |
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In Step 3 of nursing process - Planning - the nurse:
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Outlines client goals
Sets Priorities Develops expected outcomes Develops a nursing plan of care |
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Guidelines for formulating goals and expected outcomes -
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Must be client-centered and mutually agreed upon by patient and nurse
Each goal and outcome should address only one behavior Must be observable Must be measureable Time-limited Realistic |
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In order to achieve patient goals, nurse must have:
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Buy-in from the patient
Time-management and organizational skills Appropriate use of resources Priority setting Client adherence |
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Step 4 of nursing process - Implementation:
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Begins after plan of care is developed
Involves nursing interventions Interventions should be evidence-based and current. May involve direct or indirect nursing care Standard nusing interventions may be in the form of clinical practice guidelines and protocols, standing orders, or NIC interventions |
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Interventions
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What nursing care will you provide to help the patient meet his or her goals?
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3 types of interventions
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Independent
Dependent Collaborative |
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Step 5 of nursing process - Evaluation
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Determines whether nursing care was effective
Were expected outcomes met? |
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How to conduct evaluation
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Collect evaluative data
Interpret and summarize findings Document your findings Revise plan of care |
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Nurse's Role in overall evaluation
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Use self-reflection to evaluate individual practice
Participate in facility-based QI activities that evaluate the quality of nursing care Maintain data to ensure the valuing of nursing services Participate in resesearch on the efficacy of nursing interventions |
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Types of Care Plans
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Institutional Care Plan
Computerized Care Plan Critical Pathways Concept Maps |
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Critical thinking
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is an active, organized, cognitive process used to carefully examine one's thinking and the thinking of others
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Describe the 6 SKILLS of critical thinking
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Interpretation - be orderly when collecting data, look for patterns to categorize data and clarify an data you are uncertain about.
Analysis - Be open-minded and see if the data leads you down a path other than your expected one. Inference - Look at the meaning and significance of findings. Find relationships Evaluation - Look at all situations objectively and use criteria to determine results of nursing actions Explanation - Support findings and conclusions Self-regulation - Reflect on your experiences and identify ways to improve. |
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Kataoka-Yahiro and Saylor developed a critical thinking model that incldues 3 levels of critical thinking:
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Basic - Experts are right, follow procedure for best way
Complex - More independent, knows when procedure can be adjusted to better-suit patient needs. Commitment - Identifies an appropriate solution based on independent thinking and implements it, accepting full accountability for outcomes. |
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Diagnostic reasoning
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A process of determining a client's health status after you assign meaning to the behaviors, physical signs and symptoms presented by the client. Begins right away with interaction - nurse is constantly examining the meanings behind every observation.
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Inference
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is part of diagnostic reasoning. This is the process of drawing conclusions from related pieces of evidence.
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Clinical decision-making
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requires careful reasoning so that you choose the options for the best client outcomes on the basis of the client's condition and the priority of the problem.
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14 intellectual standards for critical thinking
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clear, precise, specific, accurate, relevant, plausible, consistent, logical, deep, broad, complete, significant, adequate, fair
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Why is CONFIDENCE an important attitude of critical thinking -
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Instills confidence in care you can provide. A goal of confidence helps to ensure that you have well-prepared yourself for the activity
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Why is RISK TAKING an important attitude of critical thinking -
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If your knowledge causes you to question a health care provider's order, do so. Be willing to respectfully advocate for client even when it may cause some conflict with collegues' views.
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Why is DISCIPLINE an important attitude of critical thinking -
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It helps you to: be thorough in whatever you do; use evidence-based criteria; take time to be thorough; manage time wisely. A disciplined thinker misses few details and follows an orderly or systematic approach.
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Why is PERSEVERANCE an important attitude of critical thinking -
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It helps you to: be cautious of an easy answer; if facts don't seem clear or complete, always clarify information; if a pattern of problems seems to be occuring, bring co-workers together to work toward a solution rather than let the pattern continue.
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The standards of professional responsibility that a nurse tries to achieve are those cited in the
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Nurse Practice Acts, institutional practice guidelines, and professional organizations' standards of practice.
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Reflection
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is the process of purposefully recalling a situation to discover its purpose or meaning.
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Concept map
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a visual representation of client problems and interventions that shows their relationships to one another.
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Assessment
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is the deliberate and systematic collection of data to determine a client's current and past health status and functional status and to determine the client's present and past coping patterns.
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Nursing Assessment includes 2 steps
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1 - Collection and verification of data from primary and secondary sources.
2 - The analysis of all data as a basis for developing nursing diagnoses, identifying collaborative problems and developing a plan of individualized care. |
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The purpose of assessment is to -
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establish a database about the client's perceived needs, health problems, and responses to these problems. In addition, the data reveal related experiences, health practices, goals, values, and expectations about the health care system.
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Cue
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is information that you obtain through the use of the 5 senses
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inference
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is your judgement or interpretation of cues.
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Gordon's 11 functional health patterns describe -
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Areas of overall health including: sleep, nutrition, activity, stress, values, elimination, understanding of health needs
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Orientation phase
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Establish trust and confidence, collect demographic data, explain confidentiality policies, least personal.
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Working phase of interview
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Nursing health history, begins exploring current illness, expectations of care.
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Closed-ended questions
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require short (usually "yes" "no") answers and are used to clarify previous information or provide additional information.
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Back-chaneling
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use of active listening prompts such as "all right" "go on" or "uh-huh" to indicate that you have heard what the client said.
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Psychosocial history
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receals the client's support system which often includes spouse, children, other family members, close friends.
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Validation of assessment data
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is the comparison of data with another source to determine data accuracy. For example, you observe a client crying and make certain assumptions about the client's anxiety or pain however, you validate this with the client to confirm - it is possible that they are concerned about something unrelated to the current treatment.
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Data analysis
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involves recognizing patterns or trends in the clustered data, comparing them with standards and then coming to a reasond conclusion about the client's responses to a health problem
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3 steps of analysis
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Recognize a pattern or trend based on relevant cues
Compare observations to normal standards Make a reasoned conclusion |
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Collaborative problem
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is an actual or potential physiological complication that nurses monitor to detect the onset of changes in a client's status.
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expected outcomes
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measureable, critera to evaluate goal achievement - achievement of all expected outcomes supports the conclusion that a goal has been met.
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goal
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an aim, intent, or end. A goal is a broad statement that describes the desired change in a client's condition of behavior. All nursing goals are time-limited. While it may be broad, the goal still only describes 1 particular behavior or response. Example: Client achieves improved pain control before surgery.
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client-centered goal
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a specific and measureable behavior or response that reflects a client's highest possible level of welleness and independence in function. Goal describes only 1 particular behavior or response.
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Short-term goal
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Expected to be achieved in a short time - typically less than 1 week.
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Long-term goal
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Expected to take a long time to achieve - typically more than 1 week but could be shorter in some cases.
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independent nursing interventions
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Nurse-initiated interventions are
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When choosing interventions, consider these 6 factors
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Characteristics of diagnosis
Goals and expected outcomes Evidence Base Feasibility Acceptability to the client Your own competency |
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Nursing care plan
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enhances the continuity of nursing care by listing specific nursing interventions needed to achieve the goals of care.
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Critical Pathways
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are multidisciplinary treatment plans that outline the treatments or interventions clients need to have while thiey are in a health care setting for a specific disease or condition.
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Implementation
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4th step of the nursing process, formally begins after the nurse develops a plan of care. In this stage, the nurse initiates interventions that are aimed at achieving the goals and expected outcomes laid out in the planning phase.
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Psychomotor skills
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require the integration of cognitive and motor activities - having both the knowledge and dexterity to perform nursing procedures. Example: correctly giving an injection requires both "book knowledge" and "hands-on" skills.
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Indirect care
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treatment performed away from the client but on behalf of the client or a group of clients. Examples: Safety, infection control, documentation, interdisciplinary collaboration.
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Physical care techniques
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techniques that require hands-on skills such as properly turning and positioning a client, performing invasive procedures, administering medications, providing comfort measures.
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Anticipating and preventing complications
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know the risks of any treatment before you begin and take steps to avoid complications. Note any client conditions (obesity, hemiplegia, etc.) that may cause this particular client to be more suceptable to certain complications.
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Controlling for adverse reactions
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an adverse reaction is a harmful or unitended effect of a medication, diagnostic test, or therapeutic intervention. Anticipate the potential adverse reactions to a particular intervention and be alert for early signs.
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You conduct evaluative measures to determine if you met ___________
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You conduct evaluative measures to determine if you met expected outcomes, not if nursing interventions were completed.
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evaluative measures
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the same as assessment skills but used to evaluate a client's response.
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When does evaluation occur
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It is continuous - we are always watching for outcomes both positive and negative.
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Evaluation involves 2 components
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Examination of a condition or situation
Judgement as to whether change has occurred or not |