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Foundations Quiz 2
| Question | Answer |
|---|---|
| critical thinking | acquired through experience, commitment, and active curiosity; interwoven with the nursing process |
| clinical decision-making skills | separate professional nurses from technical staff |
| interpretation | be orderly in data collection, look for patterns to categorize data, clarify any data you are uncertain about |
| analysis | be open-minded as you look at information about a client, do not make careless assumptions |
| inference | look at the meaning and significance of findings |
| evaluation | look at all situations objectively, use criteria to determine results of nursing actions, reflect on your own behavior |
| explanation | support your findings and conclusions, use knowledge and experience to choose strategies you use in the care of clients |
| self regulation | reflect on your experiences, identify the ways you can improve your own performance |
| basic critical thinking | students think concretely on the basis of a set of rules or principles, following a step-by-step process without deviation form the plan |
| complex critical thinking | analyzes and examines choices independently; students learn to think beyond and synthesize knowledge |
| committment | students anticipate needs and make choices without assistance from others |
| critical thinking competencies in nursing | diagnostic reasoning and inference, clinical decision making, and nursing processes |
| Kataoka-Yahiro and Saylor (1994) | define the outcome of critical thinking as a nursing judgement that is relevant to nursing problems in a variety of settings |
| critical thinking model | serve to explain concepts and help nurses make decisions and judgements about patients |
| five components of critical thinking | knowledge base, experience, nursing process competencies, attitudes, and standards |
| concept mapping | a visual representation that allows nurses to graphically illustrate the connections between a client's health problems |
| critical thinking synthesis | a reasoning process used to reflect on and analyze thoughts, actions, and knowledge |
| concept mapping | a visual representation that allows nurses to graphically illustrate the connections between a client's health problems |
| critical thinking synthesis | a reasoning process used to reflect on and analyze thoughts, actions, and knowledge |
| nursing assessment | helps nurses to form a clear definition of the client's problems, which in turn provides the foundation for planning and implementing nursing interventions and evaluation the outcomes of care |
| cue | information that you collect through the use of your senses |
| working phase of the interview | gather data, using appropriate communication strategies (active listening, paraphrasing, summarizing, open-ended questions) |
| inference | your judgement or interpretation of the cues you just gathered |
| termination phase of the interview | give clients clues that the interview is about to conclude |
| orientation phase of the interview | you first meet the client, introduce yourself, and explain what you are trying to accomplish; it is important to establish trust and confidence with your client at this stage |
| nursing diagnostic process | critical analysis and interpretation of assessment data that reveal a client's response to health problems, identification of client needs, and formulation of nursing diagnoses |
| working phase of the interview | gather data, using appropriate communication strategies (active listening, paraphrasing, summarizing, open-ended questions) |
| termination phase of the interview | give clients clues that the interview is about to conclude |
| nursing diagnostic process | critical analysis and interpretation of assessment data that reveal a client's response to health problems, identification of client needs, and formulation of nursing diagnoses |
| medical diagnosis | the identification of a disease condition based on specific evaluation of signs and symptoms |
| collaborative problem | an actual or potential complications that nurses monitor to detect a change in client status |
| NANDA (North American Nursing Diagnosis Association) | formed in 1982 to develop, refine, and promote a taxonomy of nursing diagnostic terminology for use by all professional nurses |
| nursing diagnosis | a clinical judgement about the client in response to an actual or potential health problem |
| collaborative problem | an actual or potential complications that nurses monitor to detect a change in client status |
| NANDA (North American Nursing Diagnosis Association) | formed in 1982 to develop, refine, and promote a taxonomy of nursing diagnostic terminology for use by all professional nurses |
| defining characteristics | clinical criteria or assessment findings |
| diagnostic reasoning | the process of using assessment data to logically explain a clinical judgement, in this case a nursing diagnosis |
| defining characteristics | clinical criteria or assessment findings |
| clinical criteria | objective or subjective signs and symptoms |
| actual nursing diagnosis | describes human responses to health conditions or life processes |
| risk nursing diagnosis | describes human responses to health conditions/life processes that may develop |
| wellness nursing diagnosis | describes human responses to levels of wellness that have a readiness for enhancement |
| components of a nursing diagnosis | diagnostic label, related factors, etiology, definition, risk factors, and support of the diagnostic statement |
| diagnostic label | the name of the nursing diagnosis |
| related factors | a condition or etiology identified from the client's assessment |
| etiology | the cause of the nursing diagnosis |
| definition | describes the characteristics of the human response |
| risk factors | environmental, physiological, psychosocial, genetic, or chemical elements that increase the vulnerability of an individual, family, or community to an unhealthful event |
| sources of diagnostic errors | data collection, interpretation and analysis of data, data clustering, diagnostic statement, documentation |
| planning process | identify nursing behaviors in which client-centered goals, expected outcomes, and nursing interventions are developed; planning is holistic; prioritizing is necessary for the best client outcomes |
| establishing priorities | helps nurses to anticipate and sequence nursing interventions (high, intermediate, low) |
| high-priority tasks | safety, adequate oxygenation, and circulation |
| intermediate-priority tasks | non-emergent, non-life threatening needs |
| low-priority tasks | not related to a specific illness or prognosis but may call for an intervention that affects the client's future well-being; most deal with client's long-term health care needs |
| initial planning | involves the development of a preliminary care plan following the client's initial assessment and initial selection of nursing diagnoses |
| ongoing planning | involves continuous updating of the client's plan of care; continual assessments are made, and revisions may be necessary |
| discharge planning | involves the important aspects and preparations needed for the client to go home |
| goal | a broad statement that describes the desired change in a client's condition or behavior |
| expected outcome | measurable criteria to evaluate goal achievement (ex. patient will be able to retain 400 cc of liquid by 4:00 pm); provides focus or direction; determines when a specific, client-centered goal has been met |
| client-centered goal | reflects a client's highest possible level of wellness and independence in function; a specific and measurable behavior or response |
| short-term goal | an objective behavior or response expected within hours to a week; what you expect the client to achieve in a short period of time |
| long-term goal | an objective behavior or response expected within days, weeks, or months; expected to be achieved in a longer period of time |
| combining goals and outcome statements | goals and outcomes are presented in the same statement; sometimes they are used interchangeably |
| client-centered | client-centered outcomes and goals reflect the client behavior and responses expected as a result of nursing interventions; the goal must be written to reflect the desires of the client rather than the nurse |
| singular (specific) goal or outcome | must be defined precisely before a client response to a nursing action can be evaluated; each goal and outcome addresses only one behavior or response |
| observable | observable changes occur in physiological findings and the client's knowledge, perceptions, and behavior |
| measurable | measurable outcomes are of paramount importance; do not use the phrase "normal"; time-limited time frames for each goal and expected outcome indicate when nurses expect the identified response to occur |
| mutual factors | combine goals and expected outcomes to ensure that the client and nurse agree on the direction and time limits of care; by setting mutual goals and expected outcomes, nurses can increase a client's motivation and cooperation |
| realistic | for the client to succeed, the goals and outcomes must be attainable; factor in the client's physiological, emotional, cognitive, and sociocultural potential as well as the economic cost and resources available to reach these in a timely manner |
| choosing interventions | must be competent in knowing the scientific rationale for the interventions, possessing the necessary psychomotor and interpersonal skills, and being able to use available health care resources effectively |
| nurse-initiated interventions | independent (elevating bed, assessing patients) |
| physician-initiated interventions | dependent (administer Colace at bedtime) |
| collaborative interventions | interdependent (may include psychosocial and family); team approach |
| selection of interventions | 6 factors include: characteristics of nursing diagnosis, goals and expected outcomes, evidence base for interventions, feasibility of the intervention, acceptability to the client, and nurse's competency |
| nursing care plan | helps to ensure continuity of care by all nurses |
| student care plan | helps you organize your plan for the day; helps you to apply theory you learned |
| institutional care plan | part of the client's legal record |
| standardized care plan | individualized to each client |
| clinical guidelines and protocols | documents that guide decisions and interventions for specific health care problems or conditions; developed on the basis of current scientific evidence and help health care providers make decisions about appropriate health care |
| standing order | reprinted document containing orders for the conduct of routine therapies, monitoring guidelines and/or diagnostic procedures for specific clients with identified clinical problems |
| NIC interventions | offer a level of standardization to enhance communication of nursing care across settings |
| implementation process | reassess the client, review and revise the existing nursing care plan, organize resources and care delivery, anticipate and prevent complications |
| implementation skills | cognitive (critical thinking), interpersonal (communication for a trusting relationship), and psychomotor (integration of cognitive and motor activities) |
| direct care | ADLs, IADLs, physical care techniques, lifesaving measures, counseling, teaching, controlling for adverse reactions, preventative measures |
| indirect care | communicating nursing interventions (written or oral); delegating, supervising, and evaluating the works of other health care team members |
| client adherence | clients and their families invest time in carrying out require treatments |
| evaluation | the last step; you determine if your client's condition or well-being has improved; determine if they have met client outcomes, not if their nursing interventions were complete |
| the evaluation process | identify evaluative criteria and standards, collect data, interpret and summarize findings, document findings and clinical judgements, and terminate, continue, or revise the care plan |
| quality/performance improvement | an approach to the continuous study and improvement of the processes involved in providing health care services to meet the needs of clients and others |
| culture | thoughts, communications, actions, customs, beliefs and institution of racial, ethnic, religious, or social groups |
| subcultures | represent various ethnic, religious, and other groups with distinct characteristics from the dominant culture |
| ethnicity | a shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics |
| emic worldview | the insider, or native, perspective |
| etic worldview | an outsider's perspective |
| enculturation | socialization into one's primary culture as a child |
| acculturation | the process of adapting to and adopting a new culture |
| assimilation | results in varying degrees of affiliation with the dominant culture |
| biculturalism (multiculturalism) | occurs when an individual identifies equally with two or more cultures |
| selected components of cultural assessment | ethnic heritage and ethnohistory, biocultural history, social organization, religious and spiritual beliefs, communication patterns, time orientation, caring beliefs and practices, experiences with professional health care |
Created by:
tdombros
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