Reviewww …………………………………Revieww

Learn the personalities

Roy - adaptation

How patient satisfaction affect the institution

• Cost.
• Recommendation
• Reputation review - no patients.
• Lawsuit.
• Long length of stay.

Sentinel event. Unexpected accident.

Evidence base practice and how that affect us today

Crimea war ⇒ we learned about nutrition, hygine, to facilitate patiente outcome. Multidiciplinary aproach to care.

Interdiciplinary → Different heakth care providers.

Levels of Critical Thinking in Nursing: basic, complex, and commitment

Nursing diagnosis, Steps.

Nursing diagnosis, Steps.

• Actual diagnosis → Problem exists now.
• Potential, Risk diagnosis → Problem may occur if not prevented

Structure of a Nursing Diagnosis of Actual diagnosis 1. Problem (Diagnostic Label) 2. Related To (Etiology / Cause) 3. As Evidenced By (Defining Characteristics)

Structure of a Nursing Diagnosis of otential, Risk diagnosis

. Problem (Diagnostic Label) 2. Related To (Etiology / Cause)

but we don’t have evidence cause it hvent happend yet

Technology on nursing disadvantage.

• Providers spend so much on computer that he forgets about the patient.

Community vs Public Health Nurse

Community: You need to know the are, the unofficial leader, available resources. Know about culture, economics and factors that affect them.

Levels of care: Preventitive ( no sike yet).

Primary (Sick) Secondary (Specialty areas) Tertiary care.

Assisted Living Facilities: older adults or people with disabilities who cannot live independently but do not require the intensive care of a nursing home. Focus is on support with daily living activities while maintaining as much independence and dignity as possible.

Differences from Nursing Homes

• Assisted living: more independence, focus on personal support and social engagement, not continuous skilled nursing. More expensive, prices not regulated by the government.
• Nursing homes: provide skilled medical care and 24/7 nursing services for residents with serious health conditions.

Palliative Hospice both ment to provide comfort.

Patient center care.

Diversity, equity and inclusion:

Take care of everyone, no matter the differences.

Medical underserved population: old population, people with disabilities.

Metaparadigm: Patient, Health, Nursing, Environment or situation.

Genogram: Family tree.

Faces of the interview: Introduction

Provide comfort, privacy, safety, minimize distraction.

Working phase: Gather data.

Termination: Summarize, ask if they need anything else or if they agree with the findings and say . Validate findings. thank you to them.

Check validation with Family members, medical records, physical examination.

Who makes the goal? In collaboration with the patient.

Prescribe nursing intervention appropriate for each diagnosis.

Critical Thinking in Planning

Clinical judgment during planning uses six components:

• Knowledge
• Environment
• Experience
• Standards
• Attitudes
• Clinical decision making

(See Fig. 18.2, p. 259)

Review figure 18.2 Critical Thinking.

Establishing Priorities (Think ABC)

• Priority setting – ordering of nursing diagnoses or patient problems to establish a preferential order for nursing interventions.
• Problem-focused diagnoses and problems take priority over wellness, possible risk, and health promotion problems.
• Helps anticipate and sequence nursing interventions when a patient has multiple nursing diagnoses and collaborative problems.
• Establish priorities in relation to the ongoing clinical importance of a patient’s diagnosis and problem.
• Patient’s priorities can change sometimes in a matter of minutes.

Methods for Prioritizing

• Importance
• Low
• Not always directly related to a specific illness or prognosis but affect a patient’s future well-being.
• Intermediate
• Nonemergent and not life-threatening
• High
• Nursing diagnoses that, if untreated, result in harm to a patient or others
• Based on Maslow’s hierarchy of needs
• Review priorities each time you see the patient.

Critical Judgment in Outcomes Identification (MEMO)

• An outcome the result or the effect a health care service or intervention
• It is time limited.
• Goal – What’s your goal with the patient.
• Short-term (Emergency situation: respiratory distress, will fix that in 45 minutes.)
• Long-term (Open wound, the wound will be heald by the time the patiente will be discarhced.)
• Often based on standards of care or clinical guidelines established for minimal safe practice.

Expected Outcomes

Outcomes must be SMART (MEMO)

• Specific
• Measurable
• Attainable
• Realistic
• Timed

Short term, Outcome Example: The patient’s surgical incision will show a 50% reduction in drainage with no signs of redness or swelling within 72 hours.

Long term, Outcome Example: The patient’s pressure ulcer will demonstrate healing, epithelialization with no signs of infection by the time of discharge.

Role of Patients and Health Care Team in Setting Outcomes

As a Nurse there are things you can still do, like clean the wounds.

Types of Interventions (MEMO)

• Select interventions designed to help patients reach the present level of health described in the goal and measured by the expected outcomes.
• Types of interventions:
• Independent nursing ( —You do it—Nurse-initiated )
• Dependent (Health care provider-initiated –
• Interdependent (Other provider intervention )

Use of Care Plans in Health Care Agencies

• Student Care Plans – must have scientific rationale to support interventions
• Care Plans in Community-Based Settings
• Hand-off Reporting: When reciving a patient from night shift they will give you a writing infromation, we do that in front of the patiente to check patient is ok with the plan propose.
• Concept Maps:
• Critical Pathways: They tell you the sequence of project activities that determines the longest overall project duration

Consulting With Health Care Professionals

• One way to initially consult is to use the ISBAR approach:
• I – Identify
• S – Situation
• B – Background
• A – Assessment
• R – Recommendation

It's used for clinical handover to ensure clear, concise, and complete communication between professionals, improving patient safety and outcomes by providing essential information in a logical order.

🩺 Example – Nurse Consulting a Doctor

• I – Identify: “This is Nurse Lopez from 3 West, calling about Mr. Smith in room 312.”
• S – Situation: “The patient is experiencing shortness of breath and oxygen saturation has dropped to 86% on 2 L nasal cannula.”
• B – Background: “He was admitted yesterday with pneumonia and has a history of COPD.”
• A – Assessment: “Lung sounds are diminished in the lower lobes, respiratory rate is 28, and he is using accessory muscles to breathe.”
• R – Recommendation: “I recommend increasing his oxygen to 4 L, ordering a STAT chest X-ray, and evaluating him for possible respiratory therapy treatment.”
• Consultation can occur anytime. Requires awareness of your strengths and limitations.
• An experienced nurse is a valuable consultant when faced with unfamiliar patient care situations.