Connecting the dot with the Nursing Process and Critical thinking
Manda McIntyre
Debra Hunt
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Overview
Develop a educational program on the nursing process to first semester students.
Utilize advance nursing knowledge to assist students in understanding the nursing process, critical thinking skills, and implementation needed to deliver best nursing practice.
This practicum experience will involve teaching novice-nursing students beginning their first semester of the nursing program. It is at this time that students are introduced to the nursing process and critical thinking skills. Nurse educator teaches the students that the American Nurses Association Standards hold the nursing process as the framework for critical thinking. The writer chose the nursing as an educational curriculum to provide a thorough understanding of the nursing process for the nursing students to gain knowledge of critical thinking, problem soloing, and passing of the NCLEX-RN examination. The nursing process is used by nurses worldwide to explore the delivery of care.
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The nursing process was developed in the 1950’s as an educational tool to promote patient centered nursing.
It provides a solid framework for the nursing practice.
It is integrated throughout in the nursing curricular in most of the nursing colleges and the National Council Licensure Examination-Registered Nurse (NCLEX-RN).
It provides the student the ability to use critical thinking skills and response on the basic of the scientific method.
A scientific method that us a step-by-step process to identify and problem solve.
Critical thinking is a vital process for the students to connect the dot in the nursing process.
Introduction
The nursing process was introduced in the 1955 by Hall and Johnson (1959). Nursing process is the essential core of practice for the nurse to provide holistic, patient-centered care. It is provide critical thinking competency that should be taught through out the nursing curriculum. The nursing process is a systematic approach to identifying patient’s actual problem or potential problems and establish a plan to meet the identified needs. It is a process that can be implemented in all areas of nursing. The nursing process is a framework that nursing students and nurses should use consistently and methodically use throughout their career to enable them to organize data and deliver evidenced based practice-nursing care.
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Nursing students will:
Define and explain the importance of the nursing process.
Discuss the components of nursing process.
Analyze critical thinking in nursing practice’s
Implement the nursing process to a patient
care assignment.
Demonstrate the use of critical thinking to prior-
itize for a client assignment.
Program Objectives
The nursing process and critical thinking is the essential core of practice for nursing students to deliver holistic, patient, patient-centered care. It is important that novice-nursing student learn what the nursing process is and how it will be used throughout their nursing career. According (1998) to Ferguson objectives are statements of desired behaviors, observable, teachable, and learnable that exhibit evidence of learning. The objectives are written to assist the students to focus on what is the important to learn.The students chosen for this program are first year novice nursing students.
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Describe Development
Agenda
Welcome-Ice breaker
Content outline
Teaching strategies, Flipping Class
Powerpoint with speaker’s notes
Resources
Handouts
Post-Test
This is an ongoing program that will be taught every Monday from 10.00 am to 11:30am. Their will be two instructor teaching this program, and will have a total of fifteen students each. The class will be held on the first floor, room 128 and 130. At the beginning of class I introduced myself and give a short summary of my nursing experience. Overview of what is expected from the students for them to succeed in learning the nursing process and critical thinking skills. At the end of class time will be allowed for answers and questions and the students given a folder which included the syllabus, handouts ,and how to excess webinars and tutorials.
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Introduction I Ice Breaker
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An icebreaker exercise will be implemented as a means of showing a caring attitude toward the new nursing students. It is very important for the instructor to demonstrate behaviors of caring because it make it easier for the student and instructor to form a relationship early in the semester so they can work together as a team. The BINGO game will be used in a non-traditional method. The students will be asked to interview each other to obtain the information and write the name of the individual in the square and when they achieved “BINGO” call it out! Prizes of penlight, pens, bookmarks, and note pads will be handed out. Icebreaker provide students the chance to interact with other and begin to build a relationship and reduce anxiety. The students will spent 15 minutes talking and interacting with each other to get acquaint and answers to the question. The first three BINGO winners won a prize. At the end I asked each student to tell me one thing they learned about someone in the class
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Content/Teaching Strategies
| Content | Teaching Strategies |
Flipping Class Concept Mapping
Traditional Method Post-test
The Teaching strategies that will be implemented are to promote active learning process and critical thinking skills in the students. The flipped classroom is one of the method used which provide the student with instruction that is delivered online, outside of class. The student In a flipped classroom, content delivery may take a variety of forms such as such video lectures on line or may be provided on a DVD or a jump drive. The “value of a flipped class is in the repurposing of class time into a workshop where students can inquire about lecture content, test their skills in applying knowledge, and interact with one another in hands-on activities. During class sessions, instructors function as coaches or advisors, encouraging students to use their skills.” The second method is the Traditional method in which the instructor primary teach in the classroom.
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Define Importance of Nursing Process.
Scientific method
Flexible and constantly evolving
Problem solving approach
Organize framework for nursing profession
Nursing utilizes critical thinking skills
Provides continuity of care for patients
Five steps identify by acronym: ADPIE,
The nursing process is a educational tool integrated in nursing schools to assist novice nursing students and nurses to provide best practice care. It offers nursing a organizal framework for the critical thinking process. It is a process that is flexible and steps are develop upon each other. Each phase overlap the previous phase. The importance of the nursing process is that it provide holistic, patient-focused, and effective care. The five steps of the nursing process start with Assessment, Diagnosis, Planning, Intervention, and end with Evaluation. These steps are taught to assist the the students to explore patients health status, identify problems, interpret results, and develop a collaborative care plan to meet the need of the patients.
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Teaching Steps of Nursing Process
The nursing process is a educational tool integrated in nursing schools to assist novice nursing students and nurses to provide best practice care. It offers nursing a organized framework for the critical thinking process. It is a process that is flexible and steps are develop upon each other. Each phase overlap the previous phase. The importance of the nursing process is that it provide holistic, patient-focused, and effective care. The five steps of the nursing process start with Assessment, Diagnosis, Planning, Intervention, and end with Evaluation. These steps are taught to assist the the students to explore patients health status, identify problems, interpret results, and develop a collaborative care plan to meet the need of the patients.
The nursing process consist of five steps. The acronym ADPIE is use to discuss each steps of the nursing process. Assessment is the collection of data. Nursing Diagnosis specific problem is identify. Planning: when nurses collaborative with patient to set goals. Implementation: phase when intervention are carried out. Evaluation: this phase the patient is assess to the response of the nursing interventions. Nursing process is an excellent tool for novice nursing students, it present a problem-solving approach that enables the student to recognize patient’s problems and potential problems and facilitate a plan of to meet the patient’s need. Nursing process framework is a template for care that connect the dot to the critical thinking process.
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ASSESSMENT
Initial Assessment: Performed on a patient with a specified time after admission to health care organization.
Problem Focused Assessment: Continuing process integrated with nursing care to verify exact illness identified in previous assessment and to detect new or unnoticed problems.
Emergency Assessment: Completed during physiological or psychiatric crisis to detect life threatening.
Time lapsed Reassessment: Completed several moths after initial assessment to compare the patient status to baseline
data previously collected.
Assessment is the first step of the nursing process. Assessment is a continuous process carried out during each steps of the nursing process. Assessment is the initial phase of the nursing process. There are four steps in collecting information from the patient. The four steps enable the nurse to gather information about the overall health status and establish a plan of care according to the needs identify. Connecting the dots are part of the assessment and critical thinking skills..
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Assessment
Assessment is the first step of the nursing process. Assessment is a continuous process carried out during each steps of the nursing process. Assessment is the initial phase of the nursing process. There are four steps in collecting information from the patient. The four steps enable the nurse to gather information about the overall health status and establish a plan of care according to the needs identify. Connecting the dots are part of the assessment and critical thinking skills..
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Assement
Collect Data
Validate Data
Documenting
Data
Organize Data
Assessment
Collection Data
Subjective data or covert data
Objective data or covert data
To collect comprehensive data the nurses use a variety of skills to complete thorough assessment. When the nurse first meet the patient assessment start immediately. The patient is the primary source of information. The data can be subjective or objective data. Subjective date is the verbal statement communicate by the patient. This data is not measurable and obtained verbally from the patient. For example “I have sharp pain in my stomach after I eat.” Objective data is obtain by observation, measureable , and tested. Objective information is obtain by using the senses other diagnostic tests for example an abdominal x-ray.
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Assessment cont
| Organizing data | Validating data | Documenting data |
| Using a framework to categorize and organize the data. Frameworks provide a guide during the nursing interview and physical examination to prevent omission of pertinent data. Nursing conceptual models provide one framework. Example of framework is Orem’s self care model and Neuman’s systems model. | Act of “double checking” the information that present. Validating that information is accurate and factual. Validate that cues and inferences are accurate and free of from bias and interpreted correctly (Alfaro-LeFevre, 2001). Validation of information prevent inappropriate nursing diagnoses and nursing plan of care. | Data is recorded actually and factually. Information become a permanent part of the chart. Types of documentation can be used: Traditional written assessment record or Computerized assessment record. Nursing can used format of SOAPnotes, PIE notes, and DAR notes to summarize the nursing assessment. |
The assessment is a critical steps of the nursing process and is essential to provide best practice care. The four activities of the assessment phase is collecting data, organizing data, validating data, documenting data. The steps enable the nurse to gather information about the patient and family that can be implemented in diagnosis, planning, goals, and evaluation. SOAP notes are usually related to primary health issues.
S-stand for subjective data and symptoms,
O- objective finding the nurses are using their senses and relevant laboratory data, vital signs, and diagnostic procedures
A- stands for assessment, condition change
P-stands for plan, nursing intervention that deal with the specific problem
P-stand for problem
I-stand for interventions
E-evaluations
PIE notes include nursing progress note, goals and reviewed daily to prevent less redundary
Focus DAR notes
D-data
A-action
R-response
Dar focus notes are used on broader scale. The nurse can focus on the patient’s strengths as well as problem areas.
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Nursing Diagnosis
Second step of the Nursing Process
Interpret & analyze collected data
Clinical judgment concerning a patient’s actual or potential health problem
Nursing Diagnosis is formulate according to (NANDA : North American Nursing Diagnosis Association)- Statement of how the patient is RESPONDING to an actual or potential problem that requires nursing intervention
Nursing Diagnosis is a tool used by nurse educators, nursing colleges, and health care organization. Nursing diagnosis is not a medical diagnosis, it a problem present during the nursing assessment which is caused by the disease. NANDA enables the nurses to use a common language to describe the patients health relate to illness. A total of 206 nursing diagnosis labels are currently approved by NANDA. Nursing diagnosis is the foundation for establishing a patient’s nursing care plan.
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Nursing Diagnosis Types
The nurses use the nursing diagnoses as a way to communicate nursing requirements for patient care to other nurses and medical care team. It is important for the patients to have a have accurate nursing diagnosis to ensure patient receive quality nursing care.
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Actual Nursing Diagnosis
3 part statement
Related to (R/T)
Defining Characteristics
(signs & symptoms)
Risk Nursing Diagnosis
Two-part statements because they do not include defining charactertics.
Ex: Risk for Aspiration related to loss of consciousness
Wellness Diagnosis
Diagnostic Label
Related Factors
(etiology)
Ex: Readiness for to enhance well-being
One part statements without risk factors or defining character tics
Nursing Diagnosis Case Study
Mrs. Lorraine is a 36 –year-old house wife, mother of three –year-old triple girls, who was admitted to the hospital yesterday with bilateral pneumonia.
Vital signs:T-101.2 P-104 R-29 BP-116/66.
IV D51/2 NS infusing at 125cc/hr.
Appetite is poor; drinking only small amount of fluids.
Auscultation of chest reveals bilateral crackles and wheeze.
Frequent productive cough of thick green-yellow mucous.
States she get “short of breath “ with any activity.
Her husband is home with the triple, and she is worried about him having to take care of the girls.
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Planning/Goal/Outcomes
Third step of Nursing Process
Four critical elements of planning include:
Decision making/Establishing priorities
Formulating goals and developing outcomes using the SMART
Individualized nursing interventions
Documentation
Third step of the nursing process includes the construction of guidelines that establish the proposed direction of nursing practices in the resolution of nursing diagnoses and the development of the patient’s plan of care. Prior to this step is the collection of assessment data and the development the of nursing diagnoses. A plan of action is formulated with specific goals to resolve the nursing diagnoses or health issues of the patient . S- specific to the patient, M-measurable, A-action oriented, R-realistic, and T- time specific.
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Types of Planning
| Initial Planning | Ongoing Planning | Discharge Planning |
| Individualize care plan Base on initial assessment Prioritized problem, identifying appropriate patient goals. Implement nursing care to increase resolution of the patient’s problems. Patient is the primary source of information. | Nurses continue to update patient’s plan of care Nurses who care for the patient are all involve in the patient care. Plan of care is revise as new information is collected and evaluated. | Includes critical anticipation and planning for the patient’s needs after discharge. Involves patient and family in discharge planning. Anticipate date of discharge. |
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Planning Goals/Outcomes
Patient will experience adequate respiratory function within 48 hours as evidenced by:
Respiratory rate 12-18, decrease dyspnea
Goals should be:
Short-term goals
Long-term goals
Expected outcomes
Patient-centered
Measurable and observable
Time-limited
Reasonable and realistic
Clearly stated
Goals derived from the nursing diagnosis are broad statement about what the patient will be after the nursing interventions has been implemented.
A goal or expected outcome statement describes patient behaviors that would demonstrate a reduction, resolution, or prevention of a particular problem identified in the nursing diagnosis. Short term goals- is an objective behavior or response that expects the patient to achieve in a short period of time, usually less than a week, a few hours or days.
Long-term-goals-Is an objective behavior or response that expects the patient to achieve over a longer period of time, several hours, weeks and or months.
Expected outcomes: is an objective behavior that expects the patient to achieve.
Goals/expected outcomes must be congruent with the response component of the nursing diagnosis statement.
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Intervention/Implementation
Safe for the patient
Based on scientific rationale
Stated clearly and concisely
Realistic for the patient, nurse, and resources available
Congruent with other therapies the patient is receiving.
Nursing intervention are based on the nursing diagnoses and identified goals/expected outcomes. interventions are prioritized according to the order in which they will be implemented. Interventions should be individualized to meet biopsychosocial needs of the patient.
All phases of the nursing process, it is important to include the patient and family or significant others in the process of planning and implementing appropriate nursing actions. Nursing interventions assist patient to maximize her capabilities. Nurse must understand the rational, technique, and possible effects of each intervention action.
Finally the nurse must document care given to patient. “the old saying, “if it is not charted it has not been done”
Accurate and completed documentation of patient care is a legal requirement in all health care settings.
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Intervention/Implementation
Independent
Dependent
Collaborative
Patients with multifaceted it takes a team of nurses and other health professionals to provide the best quality care. The patient is the most important part of the team, and through a collaborative team based approach, patients can receive the highest quality of care. Independent- nurse initiates intervention and act independently without doctor orders. Dependent- Nurse requires a doctor to implement intervention. Collaborative-requires a multiple team of nurses and health care professional with skills and knowledge. Implementation this phase is the “doing and documenting of the process. Intervention that was identified in the original planning is implemented.
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Example of Nursing Care Plan
Evaluation
What the expected behavior?
Was the patient able to perform the expected behavior in the time
specified in the goal?
Was the patient able to perform the behavior as well as described in the expected outcomes statement?
The patient’s role in the nursing process is never more important than in the evaluation process.
The nurse can assess through objective data whether or not the nursing actions were effective.
The patient provides necessary subjective data regarding the effectiveness of the plan of care.
Goals should be sign by RN and indicate whether the goal was resolved, partially resolved, or not resolved at all.
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Critical Thinking
Scientific Knowledge Base
Nursing Process
Experience
Competencies
Problem -solving
Nursing students need for critical thinking in nursing has been accentuated in response to the rapidly changing health care organization. Nurses must think critically to provide effective evidence based practice care whilst coping with the expansion in role associated with the complexities of current health care systems.” According to Simpson & Courtney (2008) It is important that nurse educator assist nursing students in gaining competences in critical thinking skills by using a varies of teaching strategies that include case studies, role play small group discussion and questioning. Critical thinking and the nursing process are connected by the problem solving method.
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Describe Implementation Learning Agreement
Clear written Objectives
Measurable
Time
Methods of Achievement
Methods to Evaluate
The learning agreement is a process used to transfer the responsibility of learning from the instructor to the nursing student (Barrington & Street,2009). This process enables the student to move from passive learning to active learning process. This higher level of thinking enables the nursing students to grow and achieve their career goals. The objectives are clearly stated and by the end of the program the students will be able to define, and implement the nurse process and critical thinking skills.
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Reflection Value Professional Career
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Accomplishing the outcomes that the novice nursing students gain a understanding of the nursing process and critical thinking skill will provide a solid foundation to provide holistic patient centered care. My goals for the future include becoming a nursing professor at the university I graduate from. As nurse educator I will be able to prepare novice nursing students to face challenges of life –threatening situations. Nursing students will be provide hand on experience that helps to develop personal philosophies and values that will inevitably follow them into their own practice.
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Highlight Professional Relationships
Dean of program
Program Director
Faculty Fulltime & part-time
First semester students
New Class of Spring 2014
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To implement this program required the support of the Dean of the Nursing Department, Program Director current nursing instructors, and mentor. The effects of the program focus will be immediately, seen pass taking the course. The students will be given a questionnaire evaluation upon completing the course. The Dean of the Nursing allowed me to attend faculty meetings to observe the interactions between the different faculty of the department. Meeting new students each semester and welcoming them to the school was highlight of relationship.
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Resources
Faculty
Student Support Services
Computer Labs
Webinar ,video
Center for the Global learner
Center for Academic Excellence
Nurse educators should provide students with information on available resources to help deal with potential problems. Novice nursing students explore their support systems and begin to formulate a record of available sources to help them to be successful. The school’s web page will be opened and the students were shown how they could access the information needed to contact the different resources for students. Faculty information was provided for each students and office hours.
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Summary Overview Program Objectives Project Agenda Introduce/Icebreaker Content Outline Teaching Strategies, Flipping Class, Traditional Method PowerPoint’s with strategies with speaker’s notes Resources Handouts
Fast pace changes in the health care system have put a large demands on nurse educators to educate novice nursing students on the nursing process and critical thinking skills. Nurses must be able to make quit accurate decision in the time of emergency situation. The nursing process will enables nurses to identify health care needs, determine priorities, establish goals, outcomes, implement intervention, and evaluate provide evidence based practice care.
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References
BuzzBuzzBingo.com.Create,Download, Print, Play, BINGO. (2015). Retrieved from http://BuzzBuzzBingo.com
Kowalczyk, N., Hackworth, R., & Case-Smith, J. (2012). Perceptions of the use of Critical thinking teaching methods. Radiologic Technology, 83(3), 226-235.
MacLeod, L. (2012). Making SMART Goals Smarter. Perspective on behavior, 10(26), 68-72.
Redman, R. (1999). Competency assessment: methods for development and implementation in nursing. Competency Assessment: Methods for Development and Implementation in Nursing Education, 4(2), 1-7.
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References cont
Simpson, E., & Courtney, M. (2008). Implementation and evaluation of critical thinking strategies to enhance critical thinking skills in Middle Eastern nurses. International Journal of Nursing Practice, 14(6), 449-454.
Year Nursing Students, T. (2007). Nursing students, nursing process and quality care. Nursing Journal of India, 98(1), 49-55.
Yildirim, B., & Ozkahraman, S. (2011). Critical thinking in nursing process and education. International Journal of Humanities and Social Science, 13(1), 257-262.
http://research.nla.gov.au
https://upload.wikimedia.org/wikipedia/commons/b/be/Flower_reflection.jpg. (2013). Retrieved from http://ttps://upload.wikimedia.org/wikipedia/commons/b/be/Flower_reflection.
