A Student’s Guideline to Using the Critical Thinking Rubric to meet the Performance Objectives in Developing Nursing Car

1. This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation • In Slide Show, click on the right mouse button • Select “Meeting Minder” • Select the “Action Items” tab • Type in action items as they come up • Click OK to dismiss this box • This will automatically create an Action Item slide at the end of your presentation with your points entered. A Student’s Guideline to Using the Critical Thinking Rubric to meet the Performance Objectives in Developing Nursing Care Plans Suffolk Community College School of Nursing Susan McCabe A Continuation of the Project Plan from the Summer Institute the TITLE III grant: “The Development of the Critical Thinking Rubric to Analyze Nursing Care Plans”

2. What Are the Characteristics of an Excellent Nursing Care Plan? There are three characteristics that distinguish excellent student performers from their peers.

3. CHARACTERISTICS OF AN EXCELLENT NCP Evidences adequate inquiry, research and use of best resources.

4. CHARACTERISTICS OF AN EXCELLENT NCP Deduces the most accurate human response (diagnostic label) from the data collected.

5. CHARACTERISTICS OF AN EXCELLENT NCP Analyzes the human responses and selects the the diagnostic labels that would have the greatest impact on the client’s outcome.

6. Meeting the behavioral objective: How can the student achieve this objective? Evidences adequate inquiry, research and use of best resources.

7. The groundwork for an excellent care plan begins with the utilization of inquiry, research and resources at the clinical site.

8. It begins in preconference when the student receives report.

9. Preconference exercise You receive report on the following client: 79 y/o female admitted for pneumonia, exacerbation of COPD who has CHF by history with the following orders: • nasal cannula oxygen at 2 lpm • albuterol drug nebs q 4hrs and q 2 hours prn • IV D51/2 NS at 75 cc/hr • Solumedrol 80 mg IVP q 6 hrs • ABG’s on room air and electrolytes to be drawn this AM.

10. Exercise your inquiry,research and best resources.

11. Reflect on knowledge and skills 79 y/o female admitted for pneumonia, exacerbation of COPD who has CHF by history with the following orders: • nasal cannula oxygen at 2 lpm • albuterol drug nebs q 4hrs and q 2 hours prn • IV D51/2 NS at 75 cc/hr • Solumedrol 80 mg IVP q 6 hrs • ABG’s on room air and electrolytes to be drawn this AM. ASK YOURSELF WHO, WHAT WHY, WHERE, WHEN AND HOW?

12. Identify your best resources and references • What handbooks would you access immediately to prepare for caring for your client? • How can each resource facilitate the attainment of knowledge and skills? • MED/SURG handbook • drug reference • lab test reference • nursing diagnosis handbook • hospital procedure manual

13. Develop a plan to evidence adequate inquiry and assess your client.

14. Initial client assessment: • LOC:level of consciousness • A:airway • B: breathing • C: circulation/bleeding • I/O:everything going in/out • wound: what does it look like? • Pain: present? Scale? Treatment? • safety:bed low? Call bell? Siderail?

15. After performing the initial assessment, gather any additional information you need from the chart and return to perform a focused assessment.

16. The Interview SPECIFIC QUESTIONS RELATED TO THE CHIEF COMPLAINT AND RELATED SYSTEMS

17. The Interview • Interview questions should identify the client’s response to their situation • should include both positive and negative findings that you might suspect a client experiencing those stressors could experience • record all the clients responses using all available space

18. APPROACH TO EXAM DO YOUR ABC's, THEN • INSPECTION • PALPATION • PERCUSSION • AUSCULTATION

19. Don’t just fill in the blanks….Use all available space to communicate the pertinent findings integrating the health assessment framework.

20. Seek clarification • Check your findings against the what has been previously recorded for the client….. a variation in the client’s status should be clarified with your best resource on the unit…… your clinical instructor.

21. Develop a narrative that reflects the “thinking and doing” of the nurse: the assessment, actions and client response.

22. Clarify significance of data, actions and client response in post-conference.

23. Organize your data to perform additional research to prepare the NCP. Assessment form daily nursing process plan lab data results sheet medication sheets

24. INQUIRY, RESEARCH, SOURCES RESEARCH THE SUBJECTIVE AND OBJECTIVE DATA UNTIL YOU OWN THE MATERIAL. • DON’T PUT ANYTHING ON PAPER THAT YOU CAN NOT EXPLAIN IN YOUR OWN WORDS.

25. Develop a reference list IDENTIFY THE BEST RESOURCES TO FACILITATE YOUR UNDERSTANDING. • Instead of compiling a list of resources that you think are relevant…. Read the references and decide which help you to grasp the meaning of the client’s situation.

26. Use a systematic approach to develop a priority list. Challenge assumptions from your research and place it in the context of your client’s unique response.

27. What is the source of the client’s unique response? Assessment form daily nursing process plan lab data results sheet medication sheets

28. What is the priority list? A list of diagnostic labels each label conforms to PES format developed from the systematic analysis of all the relevant data

29. Where do I begin? Begin with the stressors that the client is currently experiencing. Consider continuing stressors that the client faces that influence their adaptation to the stressor precipitating the current admission.

30. What are the stressors? • Examine the following: • admitting diagnosis • previous medical history • previous medications • current medications • current therapies • current procedures CAN YOU IDENTIFY ANY COLLABORATIVE PROBLEMS THAT THE CLIENT MAY BE EXPERIENCING?

31. Accurate nursing diagnosis requires that the nurse effectively cluster data that irrefutably supports the diagnosis.

32. HOW IS A DATA CLUSTER FORMED? • Developed when one piece of data signals a potential problem • It may be a positive or negative finding • triggers analysis of inferences identified • many closely related nursing diagnoses come to mind • leads to a collection of cues (units of information) • requires inclusion of major defining characteristics

33. HOW DOES A STUDENT NURSE IDENTIFY INFERENCES? • Abnormal units of data may indicate a dysfunctional health pattern • systematically review diagnosis definitions and defining characteristics that relates to the functional health pattern • determine if a data cluster exists to support the diagnosis

34. What if you don’t have a data cluster? You can not use the diagnosis. Additional assessment would be required to ascertain the client’s health status in relation to the suspected dysfunction.

35. What if you do have a data cluster? Proceed in creating your diagnostic statement using PES format and add to priority list

36. What does your priority list include? • One part statements • collaborative problems and syndromes • make sure supporting data is recorded in first column of NCP form • 2 part statements • “risk for” statements • 3 part statements • diagnostic label • etiological factor • supporting data

37. How do I rank my priority sheet? Consider possible frameworks but remember to consider the context of the client’s current circumstances as it is recorded in the daily nursing process plan.

38. Organizing framework • Ask yourself how the diagnoses fit according to the following framework? • Life-threatening concerns • safety concerns • patient concerns • nursing concerns

39. Maslow’s framework • Basic/ Physical Needs • Safety Needs • Social Needs • Esteem Needs • Self Actualization

40. Assessment framework • LOC:level of consciousness • A:airway • B: breathing • C: circulation/bleeding • I/O:everything going in/out • wound: what does it look like? • Pain: present? Scale? Treatment? • safety:bed low? Call bell? Siderail?

41. Rank diagnoses in the order of the highest priority to the lowest. Your nursing narrative is your argument to support your selections. Place a number that corresponds to its rank in front of each diagnosis listed.

42. NCP#1 Assessment SUBMIT TO YOUR CLINICAL INSTRUCTOR • ASSESSMENT FORM • DAILY NURSING PROCESS PLAN • LAB DATA SHEET • MEDICATION SHEET • REFERENCE LIST • PRIORITY NURSING DIAGNOSIS LIST ENSURE THAT IS COMPREHENSIVE AND COMPLETE.

43. Review your feedback on your part one assessment to integrate into your next performance. Successive performances are measured to ensure that you show progression in the performance.

44. Selecting the appropriate diagnoses Review the contextual circumstances of your client and determine which of the diagnostic plans would have the greatest impact on the client’s health status.

45. The care plan format • Demographic information • supporting data • collaborative problem/nursing diagnosis • outcome • interventions • scientific rationale • evaluation

46. SUPPORTING DATA • THE ACTUAL DATA • Subjective and objective that must be present in your database; assessment form, daily nursing process plan, medication sheets, lab data, diagnostics. • Must be major and minor manifestations relevant to the diagnosis

47. NURSING DIAGNOSIS Look at your priority list: • 1 and 2 part statements • 3 part statement • Label • NANDA label • Etiology • Physiologic, situational, treatment related, environmental, maturational • Evidencing data

48. Predicting outcomes Nurses make statements about what they would like to see the client achieve to manage or resolve the client’s response that triggered the diagnostic label.

49. OUTCOME CRITERIA Outcomes are statements that include the following: • An action verb • a measurable, observable behavior written in terms of what the client will do/accomplish to resolve or manage the human response • a time frame • a specific target date/time for achieving the outcome that can realistically be accomplished • May require more than one statement

50. Nurses design plans of care to assist the client in achieving outcomes. Interventions are nursing actions that directly and indirectly influence client’s health and environment