Applying Nursing Process: The Foundation for Clinical Reasoning / Edition 8

Applying Nursing Process: The Foundation for Clinical Reasoning / Edition 8

by Rosalinda Alfaro-LeFevre MSN, RN, ANEF
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Applying Nursing Process: The Foundation for Clinical Reasoning / Edition 8

Publisher's Note: Products purchased from 3rd Party sellers are not guaranteed by the Publisher for quality, authenticity, or access to any online entitlements included with the product.

Because principles of nursing process are the building blocks for all care models, the nursing process is the first model nurses need to learn to “think like a nurse.” This trusted resource provides the practical guidance needed to understand and apply each phase of the nursing process, with an increased emphasis on developing both critical thinking and clinical reasoning skills.  With an easy-to-follow and engaging writing style, the author provides strategies, tools, and abundant examples to help nurses develop the skills they need to thrive in today’s complex health care setting.

Product Details

ISBN-13: 9781609136970
Publisher: LWW
Publication date: 02/01/2013
Edition description: Eighth
Pages: 264
Sales rank: 260,259
Product dimensions: 7.00(w) x 9.00(h) x 0.60(d)

Table of Contents

Chapter 1 Overview of Nursing Process, Clinical Reasoning, and Nursing Practice Today 1

Nursing Process: The Foundation for Clinical Reasoning 2

Goals of Nursing 4

Critical Thinking Versus Clinical Reasoning 4

How the Nursing Process Promotes Safe, Effective Reasoning 5

Nursing Process Phases 6

Five Phases 7

Relationships Among the Phases 9

Benefits of Using the Nursing Process 13

Nursing Process in Context of Today's Clinical Setting 13

Patient Safety and Welfare Is Top Priority 14

Quality and Safety Education for Nurses Competencies 15

Legal and Scope of Practice Concerns 16

Giving Ethical Patient-Centered Care 16

Additional Clinical Issues Impacting Reasoning 18

Developing Critical Thinking and Clinical Reasoning Skills 29

Critical Thinking Indicators 29

The 4-Circle CT Model 29

Using Simulation and Debriefing 33

Willingness and Ability to Care 35

Willingness to Care 35

Being Able to Care 36

Chapter 2 Assessment 45

Assessment: The Key to Safety, Accuracy, and Efficiency 46

Assessments that Promote Sound Clinical Reasoning 47

Six Phases of Assessment 48

Collecting Data 49

What Resources Do You Use? 49

Ensuring Comprehensive Data Collection 50

Data Base, Focus, and Quick Priority Assessments 50

Data Base (Start of Care) Assessment 51

Focus Assessment 55

Quick Priority Assessments (QPA) 55

Standard Tools, Evidence-Based Practice, and Electronic Health Records 57

Assessing Disease and Disability Management 59

Health Promotion: Screening for Risk Management and Early Diagnosis 60

Partnering With Patients to Make Informed Decisions 60

Ethical, Cultural, and Spiritual Concerns 61

The Interview and Physical Assessment 62

Developing Your Interviewing Skills 62

Guidelines: Promoting a Caring Interview 62

Developing Your Physical Assessment Skills 66

Guidelines: Performing a Physical Assessment 66

Checking Diagnostic Studies 68

Identifying Subjective and Objective Data 71

Identifying Cues and Making Inferences 72

Validating (Verifying) Data 72

Guidelines: Validating (Verifying) Data 73

Clustering Related Data 75

Clustering Data According to Your Purpose 76

Identifying Patterns/Testing First Impressions 80

Reporting and Recording 81

Reporting and Recording Abnormal Findings 81

Deciding What's Abnormal 81

Guidelines: Reporting and Recording 82

Chapter 3 Diagnosis 89

Diagnosis: Identifying Actual and Potential Problems 90

What ANA Standards Say 92

Diagnosis and Accountability 92

Increased Responsibilities Related to Diagnosis 92

Shifting to a Predictive Care Model (Predict, Prevent, Manage, Promote) 93

Failure to Rescue and Rapid Response Teams 94

Provider-Preventable Conditions and Health Care-Acquired Conditions 95

Clinical Pathways (Care Maps) 96

Point-of-Care Testing 97

Disease and Disability Management 97

Informatics and Electronics Decision Support 97

Nursing Versus Medical Diagnoses 98

Using Standard Terminology 98

ANA-Recognized Terminologies 100

Standard Medical Terms 101

How Do You Know What Terms to Use? 102

Becoming a Competent Diagnostician 103

Key Terms Related to Diagnosis 103

Fundamental Principles of Diagnostic Reasoning 106

Mapping Diagnoses/Problems 111

Be on Your Patients' S.I.D.E. 116

Recording Summary Statements Using the PES or PRS Format 117

Identifying Potential Complications 119

Guidelines: Identifying PCs 119

Identifying Problems Requiring Multidisciplinary Care 121

Chapter 4 Planning 128

Clinical Reasoning During Planning 129

Four Main Purposes of the Plan of Care 130

Standard and Electronic Plans 130

Patient Safety, Infection Prevention, and Pain and Restraint Management 131

Attending to Urgent Priorities 131

Clarifying Expected Outcomes (Results) 133

Goals, Objectives, Outcomes, and Indicators 133

Principles of Patient-Centered Outcomes 134

Guidelines: Determining Patient-Centered Outcomes 136

Relationship of Outcomes to Accountability 136

Clinical, Functional, and Quality-of-Life Outcomes 137

Discharge Outcomes and Discharge Planning 138

Case Management 139

Deciding Which Problems Must be Recorded 139

Determining Nursing Interventions 142

Assessment-Monitoring Health Status and Responses to Care (Surveillance) 143

Patient Education-Empowering Patients and Families 143

Guidelines: Planning Patient Education 144

Counseling and Coaching: Helping People Make Informed Choices 144

Consulting and Referring: Key to Multidisciplinary Care 145

Individualizing Interventions 145

Evidence-Based Practice: Weigh Risks and Benefits 146

Individualizing Nursing Orders 148

Making Sure the Plan is Adequately Recorded 149

Addressing Patient Needs on Multidisciplinary Plans 152

Chapter 5 Implementation 159

Implementation: Putting the Plan into Action 160

Giving and Taking Reports (Hand-Offs) 162

Guidelines: Giving Reports (Hand-Offs) 162

Setting Daily Priorities 163

Guidelines: Prioritizing Care for Several Patients 164

When and How to Delegate 165

Coordinating Care 167

Surveillance-Preventing Errors and Omissions-Creating Safety Nets 168

How to Identify, Interrupt, and Correct Errors 168

Keeping an Open Mind 168

Performing Nursing Interventions 170

Be Proactive-Promote Safety, Comfort, and Efficiency 170

Implementation and Evidence-Based Practice 170

Guidelines: Preparing to Perform Interventions 170

Clinical Reasoning-What to Do When Things Go Wrong 171

Standard Plans and Care Variances 172

Ethical and Legal Concerns 172

Charting 176

Six Purposes of Charting 176

Various Ways of Charting 177

Principles of Effective Charting 178

Avoiding Dumping Syndrome With Electronic Charting 181

Learning to Chart Effectively 181

Guidelines: Charting During Implementation 181

Charting Memory-Jogs 183

Keeping the Plan Up-to-Date and Evaluating Your Day 183

Chapter 6 Evaluation 188

Evaluation: Key to Excellence in Nursing 189

Evaluation and the Other Phases of Nursing Process 189

Evaluating an Individual Plan of Care 190

Guidelines: Determining Outcome Achievement 190

Identifying Variables (Factors) Affecting Outcome Achievement 191

Deciding Whether to Discharge the Patient 191

Quality Improvement 193

Research and Evidence-Based Practice 194

Reflective Practice 194

Consumer Satisfaction-Maximizing Value 195

Examining How Health Care Systems Affect Outcomes 195

Three Types of Evaluation: Outcome, Process, and Structure 196

Staff Nurses' Responsibilities 197

Examining Mistakes, Infections, and Injuries 197

Example Responses to Critical Thinking and Clinical Reasoning Exercises 203


Appendix A Example Critical Pathway 213

Appendix B Building Healthy Workplaces and Safety and Learning Cultures 219

Appendix C Key Elements of Critical Thinking in Context of ANA Standards and QSEN and IOM Competencies 221

Appendix D DEAD ON!! A Critical Thinking and Clinical Reasoning Game 223

Glossary 225

Index 229

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