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Define Clinical Judgment - correct answers ✅The concept of clinical judgment in general refers to interpretations and inferences that influence actions in clinical practice. Holistic view of the patient situation - correct answers ✅Clinical judgment is inherently complex and influenced by many factors related to the particular patient and caregiving situation, and it therefore requires a holistic view. Process orientation - correct answers ✅Clinical judgment is circular, interactive, and moves fluidly between and among all of the aspects of the process. Reasoning and interpretation - correct answers ✅Clinical judgment involves reasoning and interpretation. As described previously, reasoning is the process that leads to clinical judgments. At least three types of reasoning are used: analytic, intuitive, and narrative. How Nurses make Judgments - correct answers ✅Noticing, Interpreting, Responding, Reflecting (IRRN)
Clinical Judgement - correct answers ✅The concept of clinical judgment in general refers to interpretations and inferences that influence actions in clinical practice. Define clinical reasoning - correct answers ✅Clinical reasoning is the thinking process by which a nurse reaches a clinical judgment. It is defined as "an iterative process of noticing, interpreting, and responding—reasoning in transition with a fine attunement to the patient and how the patient responds to the nurse's actions." Encompassed in clinical reasoning is the ability to perceive the relevance of scientific evidence and its fit with the specific patient situation. Evidence-Based Practice and Clinical Judgment - correct answers ✅All clinicians are expected to use the best evidence to inform practice. Using the interpretivist perspective of clinical judgment and clinical reasoning from the nursing literature, clinical judgment has three significant defining attributes that are useful to understand the concept: - correct answers ✅1)
linear relationship but, rather, continuously influence each other in complex ways.
- Reasoning and interpretation: Clinical judgment involves reasoning and interpretation. As described previously, reasoning is the process that leads to clinical judgments. At least three types of reasoning are used: analytic, intuitive, and narrative.9 The type of reasoning used depends on the caregiving situation and the nurse's previous experience. When a situation is unfamiliar, the nurse (expert and novice alike) tends to rely on analytic reasoning processes, consider the possibilities, and deduce the solution. At othe What are the 4 ways nurses make Clinical judgments? - correct answers ✅1) Noticing
- Interpreting
- Responding
- Reflecting How Nurses Make Judgments - correct answers ✅1) Notice - Noticing is most often the impetus for clinical reasoning and
is critical to making an effective judgment to address a patient issue. Several important factors impact what the nurse notices. In fact, Tanner asserts that the factors behind the nurse's eyes are as important as what is in front. These include the background of the nurse (including intrapersonal characteristics, ethical grounding for what is right, previous experiences, and theoretical knowledge), the nurse's relationship with the patient, and the context of care (for more detail about these precursors to noticing,
- Interpret - Using the particular patient data as well as germane theoretical and experiential knowledge, the nurse begins to assemble all the information to make sense of it. For the expert nurse, certain data carry more weight than others with respect to the patient. For example, in the long- term care setting, a patient's age and kidney function may well impact the nurse's clinical judgment about using ibuprofen for pain relief even though the drug may be ordered. The nurse uses reasoning to make that determination.
- Respond - Once the patient data have been sorted and interpreted, the nurse uses his or her interpretation to
- An infectious agent or pathogen: Microorganisms include bacteria, viruses, fungi, and protozoa. Microorganisms on the skin are either resident or transient flora. Resident organisms (normal flora) are permanent residents of the skin and within the body, where they survive and multiply without causing illness
- A reservoir or source for pathogen growth: A reservoir is a place where microorganisms survive, multiply, and await transfer to a susceptible host. Common reservoirs are humans and animals (hosts), insects, food, water, and organic matter on inanimate surfaces (fomites). Frequent reservoirs for HAIs include health care workers, especially their hands; patients; equipment; and the environment. Food, Oxygen, Water, Temperature, pH, Light.
- A port of exit from the reservoir: After microorganisms find a site to grow and multiply, they need to find a portal of exit if they are to enter another host and cause disease. Portals of exit include sites such as blood, skin and mucous membranes, respiratory tract, genitourinary (GU) tract, gastrointestinal (GI) tract, and transplacental (mother to fetus). Some viruses such as Ebola virus are transmitted through direct contact with the
blood or body fluids of a person who is sick with Ebola. However, droplets (e.g., splashes or sprays) of respiratory or other secretions from a person who is sick with Ebola could also be infectious. Therefore certain precautions (called standard, contact, and droplet precautions) are recommended for use in health care settings to prevent the transmission of the virus from patients who are sick with Ebola to health care personnel and other patients or family members. Skin and Muc Reflection-in-Action - correct answers ✅Reflection-in-action refers to the nurse's understanding of patient responses to nursing actions while care is occurring. In observations and interactions with the patient, the nurse determines patient status and adjusts care accordingly. It is the thinking that happens in "real time" during patient care. Reflection-on-Action - correct answers ✅Reflection-on-action is consideration of the situation after the patient care occurs. In reflection-on-action, the nurse contemplates a situation and considers what was successful and what was unsuccessful. Reflection-on-action is critical for development of knowledge and improvement in reasoning.
soap. Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails. Scrub your hands for at least 20 seconds. Before Patient Contact, Before an Aseptic Task, After Body Fluid Exposure Risk, After Patient Contact, After Contact with Patient Surroundings.
- Before and after direct pt contact
- After bodily fluid/ mucous membrane/ non intact skin/ wound dressing contact
- Before and after gloving
- After touching equipment What is the Nursing Process? - correct answers ✅1) Assessment - During the assessment process thoroughly assess each patient and critically analyze findings to ensure that you make patient-centered clinical decisions required for safe nursing care. Determine how the patient feels about the illness or risk for infection. Assess his or her defense
mechanisms, susceptibility, and knowledge of how infections are transmitted
- Nursing Diagnosis - During assessment gather objective data such as inspection of an open incision or a reduced caloric intake record and subjective data such as a patient's complaint of tenderness over a surgical wound site. Review the data carefully, looking for clusters of defining characteristics or risk factors that create a pattern. he following are examples of nursing diagnoses that often apply to patients with infection:
- Risk for Infection
- Imbalanced Nutrition: Less Than Body Requirements
- Impaired Oral Mucous Membrane
- Risk for Impaired Skin Integrity
- Social Isolation
- Impaired Tissue Integrity
- Planning - The patient's care plan is based on each nursing diagnosis and related factor (see the Nursing Care Plan). Develop a plan that sets realistic outcomes so interventions
- Protective eyewear
- Gown
- Cap
- Isolation precautions
- Sterility
- Collecting specimens for culture
- Medication administration Interrelated Concepts: How are these concepts related to the concept of infection? - correct answers ✅Infection: Nutrition, Tisse Integrity, Immunity, Stress, Inflammation Immunity is critical in providing a level of surveillance for early identification of pathogen entry into the body. The immune system is the first line of defense against infection and the body's primary method of response to an invading organism. Inflammation is part of the body's response to a foreign antigen, with many of the symptoms of infection being those of the body's inflammatory response (redness, swelling, and pain). Tissue Integrity is critical to avoiding infection, with the skin being the largest component of the immune system.
Intact tissues are less vulnerable to pathogen entry and form natural barriers to infection. As noted previously, Stress— whether physical, emotional, or environmental—challenges the immune system and makes it more vulnerable to damage, less able to respond effectively and efficiently to pathogen invasion, and more difficult for the body to respond to treatment for an infection. Finally, maintaining adequate Nutrition and rest is also necessary for the body to respond to active infection treatment regimens and support the work of an immune response. The nursing process is a critical thinking five-step process that professional nurses use to apply the best available evidence to caregiving and promoting human functions and responses to health and illness. It is the fundamental blueprint for how to care for patients. A patient-centered care approach is holistic and essential when applying the nursing process. Such an approach enhances patient assessment and education, family centeredness, patient adherence to interventions, and patient outcomes. The Quality and Safety Education for Nurses (QSEN) institute defines patient-centered care as "recognizing
temperature measurements previously obtained. Inspection of the IV site involves further assessment. As a nurse you learn to make clinical judgments from assessment data to identify a patient's level of wellness and desire for health promotion or to identify existing health problems. Nursing assessment includes two steps: - correct answers ✅1. Collection of information from a primary source (a patient) and secondary sources (e.g., family or friends, health professionals, and the medical record)
- The interpretation and validation of data to ensure a complete database In the case study Tonya collected information from the patient through observation and asking questions. She saw the inflammation in the incisional area and validated its presence by asking the patient if it was tender. She interpreted her data: an open area of an incision, draining fluid, and the resultant tenderness around the site indicating a pattern of altered wound healing. She also measured the body temperature to
see if an early sign of a more serious systemic infection was present. Critical thinking is a vital part of assessment. While gathering data about a patient, you synthesize relevant knowledge, recall prior clinical experiences, apply critical thinking standards and attitudes, and use professional standards of practice to direct your assessment in a meaningful and purposeful way. The nursing process is a critical thinking 5 step process (KNOW FOR EXAM) - correct answers ✅1) Assessment - Gather information about the patients condition / Critical thinking is a vital part of assessment / Assessment is the first part and involves collecting information from a patients and secondary source such as family members. Once patient provides subjective data explore the findings further by collecting objective data.
- Nursing Diagnosis - Identify the patients problems
- Scientific and medical literature (evidence about disease conditions, assessment techniques, and standards). ASSESSMENT CUE AND INFERENCE - correct answers ✅A cue is information that you obtain through use of the senses. An inference is your judgment or interpretation of these cues (Figure 16-3). For example, a patient crying is a cue that possibly implies fear, pain, or sadness. You ask the patient about any concerns and make known any nonverbal expressions that you notice in an effort to direct the patient to share his or her feelings. It is possible to miss important cues during an initial overview. However, always try to interpret cues from the patient to know how in depth to make your assessment. Remember, thinking is human and imperfect. You will acquire appropriate thinking processes the more you conduct assessments, but sometimes you will make mistakes and miss important cues. Assessment is dynamic and allows you to freely explore relevant patient problems as you discover them. Ex: a old man in bed
Cue: lies with arms on side and feels tense. Reports pain on scale 7. Inferences: Pain is severe, pain enables patient to move Gordon's 11 functional health patterns - correct answers ✅Health perception-health management pattern: Describes patient's self-report of health and well-being, how patient manages health (e.g., frequency of health care provider visits, adherence to therapies at home), knowledge of preventive health practices
- Nutritional-metabolic pattern: Describes patient's daily/weekly pattern of food and fluid intake (e.g., food preferences or restrictions, special diet, appetite), actual weight, weight loss or gain
- Elimination pattern: Describes patterns of excretory function (bowel, bladder, and skin)
- Activity-exercise pattern: Describes patterns of exercise, activity, leisure, and recreation; ability to perform activities of daily living
- Sleep-rest pattern: Describes patterns of sleep, rest, and relaxation
