NR 226 Exam 1

NR 226 Exam 1

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Chamberlain University

NR-226: Fundamentals – Patient Care

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NR 226 Exam 1 Review: Clinical Judgement, Decision-Making, and Nursing Process

The clinical judgement process involves establishing and weighing criteria to decide the best therapy for a patient. It plays a significant role in the nursing process, which serves as a systematic decision-making approach to organizing and delivering care. The nursing process allows nurses to provide personalized, evidence-based care as part of a multidisciplinary healthcare team.

The Nursing Process (ADPIE) includes the following steps:

1. Assess: This involves the collection of subjective and objective data, including the patient’s history and physical examination.
2. Diagnose: This step includes interpreting the collected data to identify patient problems or health risks.
3. Plan: Setting nursing goals, desired outcomes, and planning interventions to achieve these goals.
4. Implement: This involves performing the nursing interventions.
5. Evaluate: The nurse evaluates the patient’s response to interventions and the effectiveness of the treatment plan.

Clinical Judgement Functions

1. Recognize Cues: Nurses must filter and recognize cues from a patient’s clinical presentation, health history, and current environment to identify problems.
2. Analyze Cues: Linking these cues to the clinical presentation and understanding the patient’s needs, concerns, or problems.
3. Prioritize Hypotheses: Establishing priorities based on health issues and considering lab values, diagnostic tests, and risk assessments.
4. Generate Solutions: Identifying expected outcomes and related nursing interventions to address patient needs.
5. Take Actions: Implementing interventions based on the planned outcomes.
6. Evaluate Outcomes: Assessing patient response to the interventions to determine the extent to which the expected outcomes have been met.

Assessment Data can be subjective (from the patient’s perspective) or objective (based on the nurse’s observations).

Table of Nursing Diagnosis Categories

Planning and Interventions

Goals and Outcomes should be specific, measurable, attainable, realistic, and time-based (SMART). Goals must be in direct relation to the patient’s health and required changes.

There are three types of interventions:

1. Nurse-Initiated (Independent): These actions are initiated by the nurse without supervision, such as patient education or health promotion activities.
2. Health Care Provider-Initiated (Dependent): These interventions require a provider’s order, such as medication administration or invasive procedures.
3. Collaborative (Interdependent): These involve teamwork, where nurses consult with other healthcare professionals, like physical therapists, to ensure comprehensive care.

Implementation of Care

Once a plan of care is established, the implementation phase begins. It includes direct care (e.g., assisting with ADLs, CPR, infection control) and indirect care (e.g., documentation, delegation, specimen collection). Effective implementation requires evaluating the expected outcomes and selecting interventions that align with the patient’s needs.

Evaluation and Revision of Plan of Care

During the evaluation phase, the nurse assesses whether the patient’s condition has improved, whether the goal was met, or if the patient’s condition has deteriorated. If the goals are not achieved, the plan of care should be revised based on the patient’s current condition and response to the interventions.

Clinical Decision-Making Skills

Priority Setting helps nurses focus on the most critical tasks, following Maslow’s Hierarchy of Needs. Immediate care needs (e.g., airway, breathing, circulation) take precedence, while long-term issues (e.g., chronic pain, family coping) can be addressed later.

Delegation in Nursing

Effective delegation is essential for patient care efficiency. Nurses are responsible for delegating tasks to appropriate staff (LPNs, UAPs) based on their scope of practice and the patient’s condition. The five rights of delegation ensure that tasks are assigned properly: right task, right circumstance, right person, right direction, and right supervision.

Ethical and Legal Considerations

The American Nurses Association (ANA) Code of Ethics provides ethical guidelines for nurses, emphasizing advocacy, responsibility, accountability, and confidentiality. Nurses are expected to uphold healthcare ethics, including autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity, ensuring fair and honest patient care.

Resolving Ethical Dilemmas involves several steps, such as gathering information, clarifying values, and exploring possible actions before implementing and evaluating an action plan.

Standards of Care: Knowledge and Skills

Nursing practice is grounded in healthcare laws, best practices, and evidence-based knowledge, all of which inform the standards of care. These standards ensure that nurses deliver safe, effective, and ethically sound care. The State Nurse Practice Act, the American Nurses Association, and The Joint Commission are key entities that shape these guidelines. Furthermore, facility policies, state and federal laws, and informed consent protocols also contribute to the ethical and legal framework for nursing practice.

Informed Consent

Informed consent refers to the process by which a patient agrees to undergo a medical procedure after being fully informed of the risks, benefits, alternatives, and consequences of refusing the procedure. While the healthcare provider performing the procedure is responsible for obtaining consent, the nurse’s role is to witness the consent, ensure the patient has all necessary information, verify understanding, and document the process. If there is a lack of clarity in the consent process, the nurse must notify the healthcare provider for further explanation.

Negligence and Malpractice

Negligence and malpractice represent the unintentional and intentional harm that can occur within healthcare settings. Negligence refers to conduct falling below the standard of care expected from a reasonably prudent person in a similar situation. When this negligence is related to professional care, it can lead to malpractice, especially if it causes harm to the patient. For malpractice to be considered, elements such as the duty to provide care, breach of duty, foreseeability of harm, and actual harm must be present.

Unintentional Torts

Unintentional torts are those acts that unintentionally cause harm to a patient. Negligence is one such example, where a healthcare provider fails to meet the expected standard of care. For instance, a nurse who administers the wrong medication to a patient due to a lack of attention may be considered negligent. The elements necessary to establish malpractice include a duty of care, breach of that duty, foreseeability of harm, and actual harm occurring as a result.

Intentional Torts

Intentional torts involve deliberate actions that violate a patient’s rights. These include defamation, false imprisonment, battery, and assault. Defamation can occur through slander (verbal) or libel (written) if a healthcare provider makes harmful remarks about a patient. False imprisonment can result from improper confinement, such as using restraints without proper justification. Battery refers to wrongful physical contact, while assault involves making threats that instill fear in the patient.

Aging and Coping Assessment of Older Adults

The assessment of older adults requires careful consideration of common physiological changes and challenges associated with aging. Nurses must be vigilant in identifying signs such as sleep disorders, incontinence, confusion, and skin breakdown. Various physiological systems undergo changes with age, affecting the integumentary, respiratory, cardiovascular, gastrointestinal, musculoskeletal, neurological, sensory, genitourinary, and reproductive systems. For instance, the skin loses elasticity, the respiratory system becomes less efficient, and there is a decline in cardiovascular function. Nurses must tailor interventions to address these changes, ensuring older adults receive appropriate care and support.

Cognitive Impairment in Older Adults

Cognitive impairment in older adults can manifest in different forms, including delirium, dementia, and depression. Delirium is an acute condition that often has a sudden onset and can be reversed. It is characterized by impaired attention and confusion, typically worsening at night. Dementia, on the other hand, involves a progressive, irreversible decline in intellectual functioning, often interfering with daily activities. Depression may occur due to significant life changes and is often marked by minimal impairment of attention and worse symptoms in the morning.

Table: Key Aspects of Older Adult Care

End of Life Care

End-of-life care aims to provide comfort, manage symptoms, and ensure a dignified death. Hospice care, for those with terminal illness, emphasizes palliative care over curative measures. This care model involves a multidisciplinary team, including nurses who specialize in pain and symptom management. Nurses also play a vital role in supporting families during this challenging time and ensuring that the patient’s physical, psychological, and social needs are met.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association.

The Joint Commission. (2018). National patient safety goals. The Joint Commission.

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA.

Blais, K. K., & Hayes, J. S. (2016). Professional nursing practice: Concepts and perspectives (7th ed.). Pearson Education.

NR 226 Exam 1

Marquis, B. L., & Huston, C. J. (2021). Leadership roles and management functions in nursing: Theory and application (9th ed.). Wolters Kluwer.