ANSWERS (GRADED A+)
4 Steps of Tanner's Clinical Judgement model - ANSWER-Noticing, reflecting,
responding and interpreting
Critical thinking - ANSWER-uses principles of nursing process and evidence based
practice
What do we collect data in the noticing step - ANSWER-Primary, secondary, vitals,
patient, collaboration, medical records and assessments
Barriers to collecting data - ANSWER-Communication, culture, skills, education *watch
for select all that apply*
When do we report things? - ANSWER-ALWAYS! "Just Culture"
What do we always have to report? - ANSWER-HIV, airborne and (women who get
abused, if they agree)
What do we do whenever we notice something is off during the noticing step? -
ANSWER-GATHER MORE INFORMATION
APIE - ANSWER-assessment, planning, implementation, evaluation
Assessing systematically and comprehensively - ANSWER-piece by piece, body
systems, head to toe and focused assesment
Objective - ANSWER-signs (seen, heard, felt)
Evidence-based practice - ANSWER-means that everything we do in nursing is trial and
error before we use in practice
Subjective - ANSWER-symptoms (verbal statements)
Primary source - ANSWER-Patient
Secondary source - ANSWER-Sources other than the patient
NIRR - ANSWER-Noticing, interpreting, responding and reflecting
Outlines of what we are allowed to do as nurses - ANSWER-Scope of Practice, Nurse
Practice Act, Standard of Practice
, "Think with a purpose" (4 words) - ANSWER-Stop, think, ask and assess
Definition for Tanner's Model - ANSWER-dynamic process that accounts for changes in
the situation as they occur
Putting a plan in place - ANSWER-Interpreting
"Identifying assumptions" - ANSWER-No supporting evidence, jumping to conclusions,
how do you know, what do you know and based on WHAT evidence
"Increasing oxygen, going on a walk, taking patient to bathroom" - ANSWER-
Responding "interventions"
Looking back on everything - ANSWER-Reflecting
What can affect a nurses ability to provide care? - ANSWER-Scope of practice,
knowledge and skill level
Clinical Judgement - ANSWER-gives safe complete patient-centered care
therapeutic responses - ANSWER-ask open-ended questions, gather more information
Thinking skill from noticing - ANSWER-identifying signs and symptoms
What's the identifying assumption thinking skill? - ANSWER-Arriving at a conclusion
without any or enough evidence
What's the protocol for restraints? - ANSWER-Bruises, Pain, Circulation and
Documentation
What do we do if there is any change in the patient? - ANSWER-Gather more
information to see why it's changed
Predict and Manage potential complications - ANSWER-identifying risks that the patient
might encounter
Difference between Tanner's and Nursing Process - ANSWER-Planning to provide care
is nursing process, Tanner's is the THINKING behind it, "why we provide care."
Sources of data collection - ANSWER-family member, previous care team, medical
records
Primary - ANSWER-Patient