NUR 155 Narrative Exam with complete solutions

What are the 4 stages of Tanner's Model? 1. Noticing 2. Interpreting 3. Responding 4. Reflecting What are the thinking skills for Noticing in Tanner's Model? 1. Identifying signs and symptoms 2. Gathering complete and accurate data 3. Assessing systematically and comprehensively 4. Predicting (and managing) potential complications 5. Identifying assumptions Noticing thinking skill IDENTIFYING SIGNS AND SYMPTOMS The ability to recognize that a situation is different, changed, and not of a normal state. Indicates that something is different that expected. Noticing thinking skill GATHERING COMPLETE AND ACCURATE DATA Collecting pertinent data from various sources. This data is used as the basis for identifying issues/concerns, solving problems, and making decisions. Must verify that data is complete and accurate. Noticing thinking skill ASSESSING SYSTEMATICALLY AND COMPREHENSIVELY An organized manner to collect data to make sure nothing is omitted or forgotten. Examining the whole, piece-by-piece in a thorough manner. Noticing thinking skill PREDICTING (AND MANAGING) POTENTIAL COMPLICATIONS Looking at the big picture to consider possible complications for an individual patient. Must know common complications and consider individual differences. In Noticing, you are predicting complications, which means you are identifying possible problems. Noticing thinking skill IDENTIFYING ASSUMPTIONS Taking something for granted or hastily arriving at a conclusion without supporting evidence. A misconception. What are the thinking skills for Interpreting in Tanner's model? 1. Clustering related information 2. Recognizing inconsistencies 3. Checking accuracy 4. Separating relevant and irrelevant data 5. Judging how much ambiguity is acceptable 6. Following legal and professional guidelines Interpreting thinking skill CLUSTERING RELATED INFORMATION Grouping together information with a common theme. A method of organizing data so that you put related things together in order to better understand the situation. Interpreting thinking skill RECOGNIZING INCONSISTENCIES Identifying mismatched data. Seeing if subjective data and objective data support each other. Interpreting thinking skill CHECKING ACCURACY AND RELIABILITY Realizing that something doesn't seem quite right and taking action to determine if it is accurate or not. Sounds suspicious and looking further into it. Interpreting thinking skill DISTINGUISHING RELEVANT FROM IRRELEVANT Deciding which information is pertinent or connects to the matter at hand. Nurses sort out what information relates to the current problem or situation. Interpreting thinking skill DETERMINING THE IMPORTANCE OF INFORMATION Nurses must be about to sort through clinical noise, act on important information, and disregard what's not important. Evaluate information to identify a possible new issue/problem that was not previously identified. Figure out what is new or what has changed. Interpreting thinking skill COMPARING AND CONTRASTING Looking at two similar cases, identifying the subtle differences, and acting on them. Interpreting thinking skill (PREDICTING AND) MANAGING POTENTIAL COMPLICATIONS Looking at the big picture to consider possible complications for an individual patient. Must know common complications and consider individual differences. In interpreting, you are planning interventions to help manage or reduce the risk of complications. Interpreting thinking skill JUDGING HOW MUCH AMBIGUITY IS ACCEPTABLE Ambiguity refers to an unclear, uncertain, or vague situation. How much wiggle room do you have when applying a rule to a particular situation? The nurse looks at a patient situation and assessment data to determine if assessment measures are acceptable for that specific patient. Interpreting thinking skill USING LEGAL, ETHICAL & PROFESSIONAL GUIDELINES Nurses must consider legal, ethical, and professional guidelines when providing care. Nurses must work within the legal guidelines of the state's nurse practice act, as well as make judgments based on ethical and professional guidelines. What are the thinking skill(s) for Responding in Tanner's model? 1. Setting priorities and delegating them What are the thinking skill(s) for Reflecting in Tanner's model? 1. Evaluating data What is critical thinking? Thinking with a purpose and is a complex process. Essential for providing quality nursing care. Examples of non-focused thinking 1. Habitual thinking 2. Random thoughts 3. Ruminative thinking 4. All-or-none thinking 5. Negative thinking Examples of focused thinking 1. Problem oriented thinking 2. Critical thinking What does critical thinking involve? Recognizing a problem exists or can exist, analyzing info about the problem, evaluating info, and making a conclusion. Factors that influence critical thinking 1. Upbringing and culture 2. Motivation 3. Attitude 4. Effective reading 5. Maturity 6. Problem solving and the nursing process 7. Communication skills 8. Self confidence 9. Moral development 10. Capacity in nursing 11. Collaboration 12. Anxiety 13. Mentors and experience in nursing Bloom's Taxonomy A system for categorizing levels of abstraction of questions that commonly occur in educational settings. Includes the following competencies: knowledge, comprehension, application, analysis, synthesis, and evaluation Bloom's Taxonomy: Knowledge Ability to recall and repeat information memorized. Lowest level of learning. Bloom's Taxonomy: Comprehension Ability to basically understand the information, recall it, and identify examples. Lowest level of understanding. Bloom's Taxonomy: Application Being able to use learned information in new situations. Higher level of understanding. Bloom's Taxonomy: Analysis Being able to break down complex information into basic parts and relate those parts to the whole picture. Higher level of application. Types of data Subjective and objective data What is subjective data? Data that only the subject or "patient" can feel and will tell you. Usually in a statement. What is objective data? What you observe and can measure. What is the nursing process? Provides the framework in which nurses use their knowledge and skills to express human caring. What are the 5 stages of the nursing process? 1. Assessment 2. Diagnosis 3. Planning 4. Implementation 5. Evaluation Which stage of Tanner's model is interrelated with assessment in the nursing process? Noticing Which stage of Tanner's model is interrelated with planning in the nursing process? Interpreting Which stage of Tanner's model is interrelated with implementation in the nursing process? Responding Which stage of Tanner's model is interrelated with evaluation in the nursing process? Reflect Maslow's Hierarchy of Needs 1. Physiological needs 2. Safety and Security needs 3. Love and Belonging Needs 4. Self esteem 5. Self actualization Examples of physiological needs Nutrition Elimination Oxygenation Sexuality Examples of safety and security needs Stability Protection Security Freedom from fear and anxiety Examples of love and belonging needs Affection Acceptance by peers and community Examples of self-esteem needs Self-confidence Feelings of self worth Examples of self-actualization needs Full use of individual talents Scope of practice as a Licensed Practical Nurse Providing to individuals and groups nursing care requiring the application of basic knowledge of the biological, physical, behavioral, social, and nursing sciences at the direction of a licensed physician, dentist, podiatrist, optometrist, chiropractor, or registered nurse. Licensed Practical Nurse care includes 1. Observation, patient teaching, and care in a diversity of health care settings. 2. Contributions to planning, implementation, and evaluation of nursing. 3. Administration of medications and treatments authorized by an individual who is authorized to practice in this state and is acting within the course of the individuals professional practice, except in the administration of IV therapy. 4. Administration to an adult of IV therapy authorized by an individual who is authorized to practice in this state and is acting within the course of the individuals professional practice, on the condition that the licensed practical nurse is authorized. 5. Delegation of nursing tasks as directed by a registered nurse. 6. Teaching nursing tasks to licensed practical nurses and individuals to whom the licensed practical nurse is authorized to delegate nursing tasks as directed by a RN Scope of practice as a Registered Nurse Providing to individuals and groups of nursing care requiring specialized knowledge, judgement, and skill derived from the principles of biological, physical, behavioral, social, and nursing sciences. Registered Nurse care includes 1. Identifying patterns of human responses to actual or potential health problems amenable to a nursing regimen. 2. Executing a nursing regimen through the selection, performance, management, and evaluation of nursing actions. 3. Assessing health status for the purpose of providing nursing care. 4. Providing health counseling and health teaching. 5. Administering medications, treatments, and executing regimens authorized by an individual who is authorized to practice in this state and is acting within the course of the individual's professional practice. 6. Teaching, administering, supervising, delegating, and evaluating nursing practice. LPNs are prohibited to 1. Engage in nursing practice without RN or authorized health care provider direction. 2. Administer IV push medications (other than Heparin or Saline) 3. Teaching the "practice of nursing" 4. Supervising and evaluating "nursing practice" 5. Assessing health status for purposes of providing nursing care. What is the LPNs role in the nursing process? LPN assists in data collection, identifying patient needs, planning care, evaluating outcomes of care and contributes to revision of nursing care plan. What is the RNs role in the nursing process? RN's responsible for all steps of nursing process, performs the assessment, identifies nursing diagnoses, implements and communicates the plan of nursing care, evaluates/documents patient's response, and reassess/revise the nursing plan of care as appropriate.