Nursing Exam Preparation: Critical Thinking and Clinical Judgment, Exams of Nursing

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Tanner's Model of Clinical Judgement - CORRECT ANSWERS A "MODEL" based on how a nurse thinks. Explains 4 steps in the "CRITICAL THINKING PROCESS" that nurses use to solve any problem: *Noticing *Interpreting *Responding *Reflecting Nursing Process - CORRECT ANSWERS Uses the Scientific Method to complete a Step-by- step approach to plan patient-centered care: "ADPIE" *Assessment *Diagnosis *Planning/Outcomes *Implementation *Evaluation Why do we study Critical Thinking? - CORRECT ANSWERS To think with a purpose, and know why you do what you do. A strict reasoning process that ensures a nurse is generating, implementing, and evaluating approaches. Benner's Theory of Stages and Clinical Competence - CORRECT ANSWERS What theory of stages have 5 Stages? The 5 stages:

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Stage 1: Novice Stage 2: Advanced Beginner Stage 3: Competent Stage 4: Proficient Stage 5: Expert Credit to nursing-theory.org Stage 1: Novice - CORRECT ANSWERS Nursing Students first year of clinical education; inexperienced, text book knowledge, limited ability to predict what might happen in any situation. Credit to nursing-theory.org Stage 2: Advanced Beginner - CORRECT ANSWERS Newly graduated in their first jobs; Nurses have more experience and are able to recognize recurrent, meaningful components of a situation. They have the knowledge and the knowhow but not the in-depth experience. Credit to nursing-theory.org Stage 3: Competent - CORRECT ANSWERS These nurses lack the speed and flexibility of proficient nurses, but they have some mastery and can rely on advanced planning and organizational skills. Can recognize patterns and nature of clinical situations more quickly and accurately than advanced beginners. Credit to nursing-theory.org Stage 4: Proficient - CORRECT ANSWERS At this level nurses are capable to see situations as wholes rather than parts. "PROFICIENT" nurses learn from experience what events typically occur and are able to modify plans in response to different events. Credit to nursing-theory.org Stage 5: Expert - CORRECT ANSWERS Nurses that are able to recognize demands and resources in situations and attain their goals. No longer do they rely solely on rules to guide

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actions under certain situations. They area able to intuitively grasp the situation based on their deep knowledge and experience. Credit to nursing-theory.org Noticing - CORRECT ANSWERS First step of Tanner's model of clinical judgement.

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: (1) Identifying signs and symptoms - CORRECT ANSWERS The ability to recognize that a situation is different, changed, or not a normal state. Noticing: (2) Gathering complete and accurate data - CORRECT ANSWERS Collecting relevant data from various sources. This data is used as the basis for identifying issues/concerns, solving problems, and making decisions. Must verify that the data is complete and accurate. Noticing: (3) Assessing systematically and comprehensively - CORRECT ANSWERS 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: (4) Predicting and managing potential complications - CORRECT ANSWERS Looking at the "BIG PICTURE" to consider possible complications of the patient. You must know common complications and consider individual differences. In Noticing, you are predicting complications, which means you are identifying possible problems.

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Noticing: (5) Identifying assumptions - CORRECT ANSWERS Taking something for granted or quickly arriving at a conclusion without supporting evidence. (A Guess) Nursing Process: Assessment - CORRECT ANSWERS Observe and report to Charge Nurse or HCP. Determine risk for injury or infection. Nursing Process: Diagnosis - CORRECT ANSWERS Assist with accurate diagnosis. Gather data to confirm or eliminate problems. Specific causes of safety risk to an individual. Nursing Process: Planning/Outcomes Identifications - CORRECT ANSWERS Assist with setting priorities and goals, suggestions interventions. To prevent threats to safety. Nursing Process: Implementation (putting a decision or plan into effect) - CORRECT ANSWERS Carry out planned interventions. Interventions, education, environment/development considerations. Nursing Process: Evaluation - CORRECT ANSWERS Assist with re-evaluation and make suggestions. Compare response/results to the original goals, plan of care. Data Collection-Scope of Practice - CORRECT ANSWERS LPN's collect data, RN's complete Assessments. Main Assessments - CORRECT ANSWERS 3 types: *Focus Assessment *Systemic Assessment *Head to Toe Assessment (FOCUS) Assessment - CORRECT ANSWERS Focusses on one body part. example: Heart, Lung, Stomach, etc...

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(SYSTEMIC) Assessment - CORRECT ANSWERS Focusses on one body system. example: Respiratory, Digestive, Cardiac, etc... (Head-to-Toe) Assessment - CORRECT ANSWERS Total body examination. Parts of Clinical Thinking - CORRECT ANSWERS *Assess/learn/gain knowledge *Understand and ask questions *Store information/memorize *Recall information/bring it back *Know what to do when information isn't in memory (know where to look it up) *Draw your own conclusion Humble Attitude - CORRECT ANSWERS We don't know everything. 2 main types of data - CORRECT ANSWERS Objective vs Subjective Objective Data - CORRECT ANSWERS (Signs) Observable and measurable data that can be seen and heard, or felt, smelled by someone other than you, or by physical examination and lab data. example: elevated temperature, vomiting, skin moisture... Subjective Data - CORRECT ANSWERS (Symptoms) Information perceived only by the affected person, personal taste, symptoms, verbal statements provided by the patients point of view or perception. What the patient tells you. Clinical - CORRECT ANSWERS _____________ observation Is related to/or conducted in a healthcare setting involving direct observation of the patient. Judgement - CORRECT ANSWERS Your interpretation that influences your actions to take.

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Clinical Judgement - CORRECT ANSWERS Interpretation or conclusion about a patient's needs, concerns, or health problems. Whether or not you should take action. Sometimes you have to improvise new actions or plans. Why do we need Clinical Judgement? - CORRECT ANSWERS We need it to provide safe quality care. How do we develop Clinical Judgement? - CORRECT ANSWERS We use the Nursing Process, and Tanner's Model to develop the skills to establish Clinical Judgement. Emergency! - CORRECT ANSWERS Emergencies cease to exist when you prepare for them! SPICES: - CORRECT ANSWERS A tool that can be used to obtain information necessary to prevent health alterations in older adult patients. SPICES: S - CORRECT ANSWERS SLEEP Disorders SPICES: P - CORRECT ANSWERS PROBLEMS with Eating or Feeding SPICES: I - CORRECT ANSWERS Incontinence bowel and/or bladder SPICES: C - CORRECT ANSWERS Confusion SPICES: E - CORRECT ANSWERS EVIDENCE of Falls SPICES: S(2) - CORRECT ANSWERS SKIN Breakdown

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Epworth Sleepiness Scale - CORRECT ANSWERS Tool used to measure average daytime sleepiness. determines if person is getting enough sleep. Scored 0-6: healthy 7- borderline 9-10 seek medical attention! (Most nursing students) Advanced Nursing Knowledge - CORRECT ANSWERS What type of "knowledge" uses 6 Questions that Critical Thinkers use?

1. What are you on alert for with this patient?
2. What are important assessments to make? *Focus *Systemic *Head-to-Toe
3. A. What complications may occur? B. What could go wrong?
4. What interventions will prevent complications?
5. How will you prioritize implementation of nursing interventions? Explain why?
6. What actions will you take for each complication, should it occur? Maslow's Hierarchy of Needs Theory - CORRECT ANSWERS Name the theory that has 5
7. Physiological
8. Safety
9. Belonging
10. Self-Esteem

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5. Self-actualization
6. Physiological - CORRECT ANSWERS Breathing, sustenance, water, exertion, sex, sleep, homeostasis.
7. Safety - CORRECT ANSWERS Body, home, employment, family, health, property.
8. Belonging - CORRECT ANSWERS a feeling of having friends, family, and sexual intimacy.
9. Self-esteem - CORRECT ANSWERS a feeling of self-esteem, confidence, achievement, respect.
10. Self-actualization - CORRECT ANSWERS Realization of one's full potential. Reflection: IN action - CORRECT ANSWERS You are in the situation and you are thinking/processing as you go. Present tense. Reflection: ON action - CORRECT ANSWERS Looking back, Past tense, reflecting on the situation after the fact. Debriefing on the situation.