TMU NSE 111 LAB Final Exam Review - Foundations of Patient Care and
Infection Control Toronto Metropolitan University
Week 1 - NSE 111 Foundations for Nursing Practice Lab
Patient Centered Care
- A standard of care that places the patient as the focus of care
- Includes the patient as a partner in care & one who participates in their care
- Having concern for the dignity, independence, preferences, privacy and safety of
patients at all times (P & P p 300, 331, Sorentino p 16-17)
Approach to Care
DIPPS DIPPERS
D – Dignity D – Dignity
I – Independence I – Independence
P – Preferences P - Partner
P – Privacy P – Preference
S - Safety P- Privacy
E – Empathy
R - Respect
S - Safety (Sorentino p 16-17)
Approach to Care
- Dignity
- The state of feeling worthy, values and respected
- Independence
- Encourage patients to do what they can themselves
- Preferences
- Allow patients to make choices and how they would like to have things done
- Privacy
- Ensure to provide privacy during care and keep the patients
- Safety
- Patients need to be in an environment that will keep them safe from harm
Approach to Care
- Nursing Process
- A clinical decision making approach to care
- Assists nurses with identifying and treating
health related concerns & helps patients to
attain health outcomes
- P & P p 178 CT is described as a cognitive process
that a nurse uses to make judgements about the
clinical care of patients
1
, - P & P p 181
- •Nurses apply the nursing process as a critical thinking competency when delivering
pt. care
- •The NP is a clinical decision making approach
- •The NP is unique to the nursing profession and has been known as a blueprint for a
plan of care
- Sherrill (2019)
- •A framework for developing holistic, patient focused care and a method of thinking
was developed in 1958
The Nursing Process
- Assessment
- Involves the collection of data or cues important to the patient’s health care
status or situation in order to fully understand the patient's priority needs
- Diagnosis
- Involves the analysis of the assessment data in order to determine key issues
and make clinical judgements in the form of a nursing diagnosis
- This step also involves the creation of outcomes or goals for the patient and
their specific situation
- Planning
- Involves the creation of a plan that identifies strategies to reach the outcomes
or goals
- Implementation
- Involves implementing or carrying out the plan ie. Care delivery, teaching
- Evaluation
- Involves determining if the implementation of the plan was successful in
reaching the outcomes or goals
- P & P p 188
- A framework for developing holistic, patient focused care and a method of thinking
was developed in 1958
The National Council of State Boards of Nursing (NCSBN) Clinical Judgement Model
- The NCSBN Clinical Judgment Model describes the identification and
analysis of cues as the preliminary skill that builds clinical judgment.
- This analysis is then used to develop skill in generating hypotheses. These
hypotheses are then prioritized, actions are taken, and outcomes are
evaluated. This iterative (repeated cycle of operation) process corresponds
with the nursing process, which is introduced early in nursing programs and
emphasized throughout. However, the identification and analysis of cues are
not specifically highlighted in the nursing process. When this component of
2
, the Clinical Judgment Model is emphasized, it provides specific direction for
teaching-learning activities which we may not have focused on in the past.
What is Clinical judgement?
- The NCSBN (2018) describes CJ as “the observed outcome of critical
thinking and decision-making.
- It is an iterative process that uses nursing knowledge to observe and assess
presenting situations, identify a prioritized client concern, and generate the best
possible evidence-based solutions to deliver safe client care” (p. 12).
- Focus of year 1 is layer 3 – notice the 6 steps in comparison to the nursing
process
- https://www.ncsbn.org/index.htm
- NCSBN website
- Sherrill (2019)
- Offers a new approach to bedside decision making
Recognizing Cues
- Identify relevant and important information from different sources (e.g., medical
history, vital signs).
- Gather accurate information
- Identify or notice any cues
- What information is relevant / irrelevant?
- What information is most important?
- What data is of immediate concern?
Analyze Data or Cues
- Organize and link the recognized cues and data to the client’s clinical presentation.
- What client conditions are consistent with the cues?
- Are there cues that support or contraindicate a particular condition?
- Why is a particular cue or subset of cues of concern?
3
, - What other information would help establish the significance of a cue or set of
cues?
- Compare to nursing process & analysis / diagnosis
- https://www.ncsbn.org/NGN-Educator-Webinar.pdf
- Recognizing cues & analyzing cues necessary to form hypothesis
- Analyzing cues will develop over the course of year 1 as the student gains
more knowledge because it requires application of knowledge to the assessed
cues
- Need to organize and link the recognized cues to the clients clinical
presentation
Prioritize Hypothesis
- Evaluating and ranking hypotheses according to priority (urgency, likelihood, risk,
difficulty, time, etc.).
- Which explanations are most / least likely?
- Which possible explanations are the most / least likely?
- Prioritizing hypothesis helps the nurse to determine what to do first or how to
intervene first
- **failure to recognize prioritize can lead to omission of care
- Prioritizing will also help to generate solutions
- Hypothesis are evaluated and ranked according to priority – this depends on
urgency, risk, time factors, etc
Generate Solutions
- Identify expected outcomes and using hypotheses to define a set of interventions for
the expected outcomes.
- What are the desirable outcomes?
- What interventions can achieve these outcomes?
- What should be avoided?
Take Action
- Implementing the solution(s) that addresses the highest priorities.
- Which intervention or combination of interventions is most appropriate?
- How should the intervention(s) be accomplished (performed, requested,
administered, communicated, taught, documented, etc.)?
- Administer, document, communicate, perform a skill
- The solutions that address the highest priorities are implemented
Evaluated Outcomes
- Compare observed outcomes against expected outcomes
- What signs point to improving / declining / unchanged status?
- Were the interventions effective?
4
Infection Control Toronto Metropolitan University
Week 1 - NSE 111 Foundations for Nursing Practice Lab
Patient Centered Care
- A standard of care that places the patient as the focus of care
- Includes the patient as a partner in care & one who participates in their care
- Having concern for the dignity, independence, preferences, privacy and safety of
patients at all times (P & P p 300, 331, Sorentino p 16-17)
Approach to Care
DIPPS DIPPERS
D – Dignity D – Dignity
I – Independence I – Independence
P – Preferences P - Partner
P – Privacy P – Preference
S - Safety P- Privacy
E – Empathy
R - Respect
S - Safety (Sorentino p 16-17)
Approach to Care
- Dignity
- The state of feeling worthy, values and respected
- Independence
- Encourage patients to do what they can themselves
- Preferences
- Allow patients to make choices and how they would like to have things done
- Privacy
- Ensure to provide privacy during care and keep the patients
- Safety
- Patients need to be in an environment that will keep them safe from harm
Approach to Care
- Nursing Process
- A clinical decision making approach to care
- Assists nurses with identifying and treating
health related concerns & helps patients to
attain health outcomes
- P & P p 178 CT is described as a cognitive process
that a nurse uses to make judgements about the
clinical care of patients
1
, - P & P p 181
- •Nurses apply the nursing process as a critical thinking competency when delivering
pt. care
- •The NP is a clinical decision making approach
- •The NP is unique to the nursing profession and has been known as a blueprint for a
plan of care
- Sherrill (2019)
- •A framework for developing holistic, patient focused care and a method of thinking
was developed in 1958
The Nursing Process
- Assessment
- Involves the collection of data or cues important to the patient’s health care
status or situation in order to fully understand the patient's priority needs
- Diagnosis
- Involves the analysis of the assessment data in order to determine key issues
and make clinical judgements in the form of a nursing diagnosis
- This step also involves the creation of outcomes or goals for the patient and
their specific situation
- Planning
- Involves the creation of a plan that identifies strategies to reach the outcomes
or goals
- Implementation
- Involves implementing or carrying out the plan ie. Care delivery, teaching
- Evaluation
- Involves determining if the implementation of the plan was successful in
reaching the outcomes or goals
- P & P p 188
- A framework for developing holistic, patient focused care and a method of thinking
was developed in 1958
The National Council of State Boards of Nursing (NCSBN) Clinical Judgement Model
- The NCSBN Clinical Judgment Model describes the identification and
analysis of cues as the preliminary skill that builds clinical judgment.
- This analysis is then used to develop skill in generating hypotheses. These
hypotheses are then prioritized, actions are taken, and outcomes are
evaluated. This iterative (repeated cycle of operation) process corresponds
with the nursing process, which is introduced early in nursing programs and
emphasized throughout. However, the identification and analysis of cues are
not specifically highlighted in the nursing process. When this component of
2
, the Clinical Judgment Model is emphasized, it provides specific direction for
teaching-learning activities which we may not have focused on in the past.
What is Clinical judgement?
- The NCSBN (2018) describes CJ as “the observed outcome of critical
thinking and decision-making.
- It is an iterative process that uses nursing knowledge to observe and assess
presenting situations, identify a prioritized client concern, and generate the best
possible evidence-based solutions to deliver safe client care” (p. 12).
- Focus of year 1 is layer 3 – notice the 6 steps in comparison to the nursing
process
- https://www.ncsbn.org/index.htm
- NCSBN website
- Sherrill (2019)
- Offers a new approach to bedside decision making
Recognizing Cues
- Identify relevant and important information from different sources (e.g., medical
history, vital signs).
- Gather accurate information
- Identify or notice any cues
- What information is relevant / irrelevant?
- What information is most important?
- What data is of immediate concern?
Analyze Data or Cues
- Organize and link the recognized cues and data to the client’s clinical presentation.
- What client conditions are consistent with the cues?
- Are there cues that support or contraindicate a particular condition?
- Why is a particular cue or subset of cues of concern?
3
, - What other information would help establish the significance of a cue or set of
cues?
- Compare to nursing process & analysis / diagnosis
- https://www.ncsbn.org/NGN-Educator-Webinar.pdf
- Recognizing cues & analyzing cues necessary to form hypothesis
- Analyzing cues will develop over the course of year 1 as the student gains
more knowledge because it requires application of knowledge to the assessed
cues
- Need to organize and link the recognized cues to the clients clinical
presentation
Prioritize Hypothesis
- Evaluating and ranking hypotheses according to priority (urgency, likelihood, risk,
difficulty, time, etc.).
- Which explanations are most / least likely?
- Which possible explanations are the most / least likely?
- Prioritizing hypothesis helps the nurse to determine what to do first or how to
intervene first
- **failure to recognize prioritize can lead to omission of care
- Prioritizing will also help to generate solutions
- Hypothesis are evaluated and ranked according to priority – this depends on
urgency, risk, time factors, etc
Generate Solutions
- Identify expected outcomes and using hypotheses to define a set of interventions for
the expected outcomes.
- What are the desirable outcomes?
- What interventions can achieve these outcomes?
- What should be avoided?
Take Action
- Implementing the solution(s) that addresses the highest priorities.
- Which intervention or combination of interventions is most appropriate?
- How should the intervention(s) be accomplished (performed, requested,
administered, communicated, taught, documented, etc.)?
- Administer, document, communicate, perform a skill
- The solutions that address the highest priorities are implemented
Evaluated Outcomes
- Compare observed outcomes against expected outcomes
- What signs point to improving / declining / unchanged status?
- Were the interventions effective?
4
