Dynamic Nursing Process: Blended Skills for Holistic Care

1. Chapter 11Blended Skills and Critical Thinking Throughout the Nursing Process

2. Historical Development of the Nursing Process • 1955—nursing process term used by Hall • 1960s—specific steps delineated • 1967—Yura and Walsh published first comprehensive book on nursing process • 1973—ANA Congress for Nursing Practice developed Standard of Practice • 1982—state board examinations for professional nursing uses nursing process as organizing concept

3. Five Steps of the Nursing Process • Assessing—collecting, validating, and communicating of patient data • Diagnosing—analyzing patient data to identify patient strengths and problems • Planning—specifying patient outcomes and related nursing interventions • Implementing—carrying out the plan of care • Evaluating—measuring extent to which patient achieved outcomes

4. Question Which step of the nursing process is a nurse using when she analyzes patient data to determine her patient’s strengths following a CVA? A. Assessing B. Diagnosing C. Planning D. Implementing E. Evaluating

5. Answer Answer: B. Diagnosing Rationale: The diagnosing step involves analyzing patient data to determine strengths and weaknesses. The assessing step refers to the collection, validation, and communication of patient data. In the planning step, the nurse determines patient outcomes and related nursing interventions and in the Implementing step the nurse carries out the plan. When evaluating, the nurse measures the extent to which the patient achieved outcomes.

6. The Steps of the Nursing Process

7. Question Which of the following characteristics of the nursing process describes the interaction and overlapping of steps within the process itself? A. Systematic B. Dynamic C. Interpersonal D. Universally Applicable

8. Answer Answer: B: Dynamic Rationale: The nursing process is dynamic in that there is much interaction and overlapping of the steps. It is systematic since it is an ordered sequence of activities. Interpersonal refers to the human being at the heart of nursing. The nursing process is universally applicable in that it is a framework for all nursing activities.

9. Characteristics of the Nursing Process • Systematic—part of an ordered sequence of activities • Dynamic—great interaction and overlapping among the five steps • Interpersonal—human being is always at the heart of nursing • Outcome oriented—nurses and patients work together to identify outcomes • Universally applicable—a framework for all nursing activities

10. Problem Solving and the Nursing Process • Trial-and-error problem solving • Scientific problem solving • Intuitive thinking • Critical thinking

11. Question Tell whether the following statement is true or false. Critical thinking occurs when a nurse directly apprehends a situation based on its similarity or dissimilarity to other situations. A. True B. False

12. Answer Answer: B. False Intuitive thinking occurs when a nurse directly apprehends a situation based on its similarity or dissimilarity to other situations.

13. Benefits of the Nursing Process • Patient • Scientifically based, holistic individualized patient care • Continuity of care • Clear, efficient, cost-effective plan of action • Nurse • Opportunity to work collaboratively with other healthcare workers • Satisfaction of making a difference in lives of patients • Opportunity to grow professionally

14. Four Blended Skills • Cognitive skills—make sense of the situation and grasp what is necessary to achieve goals • Technical skills—manipulate equipment skillfully to produce desired outcome • Interpersonal skills—establish and maintain caring relationships that facilitate achievement of goals • Ethical/legal skills—personal moral code and professional role responsibilities

15. Question A nurse’s personal moral code is to assist all patients to the best of her ability. What blended skill would she use when seeking out special services for a homeless patient with a diabetic foot ulcer? A. Cognitive B. Technical C. Interpersonal D. Ethical/Legal

16. Answer Answer: D. Ethical/Legal Rationale: Using ethical/legal skills is the best answer as it involves following a moral code and acting professionally. Cognitive skills involve thinking through a situation to achieve outcomes. Technical skills relate to the proper use of equipment. Interpersonal skills are used to develop caring relationships.

17. Cognitively Skilled Nurses • Offer scientific rationale for patient plan of care • Select nursing interventions most likely to yield desired outcomes • Use critical thinking to solve problems creatively

18. Technically Skilled Nurses • Use technical equipment with competence and ease to achieve goals with minimal distress to patients • Creatively adapt equipment and technical procedures to needs of patients in diverse circumstances

19. Interpersonally Skilled Nurses • Use interactions with patients and significant others and colleagues to affirm their worth • Elicit personal strengths and abilities of patients to achieve health goals • Provide the healthcare team with knowledge about patient goals and expectations • Work collaboratively with healthcare team as respected and credible colleagues

20. Ethically and Legally Skilled Nurses • Are trusted to act in ways that advance interests of patients • Are accountable for the practice • Act as effective patient advocates • Mediate ethical conflict among patient, significant others, and healthcare team

21. Considerations When Posed With a Thinking Challenge • Purpose of thinking • Adequacy of knowledge • Potential problems • Helpful resources • Critique of judgment/decision

22. Characteristics of Interpersonal Caring • Promotion of dignity and respect of patients • Centrality of the caring relationship • Mutual enrichment of both participants in the nurse-patient relationship

23. Developing Ethical/Legal Skills • Developing accountability • Reporting incompetent, unethical, or illegal practice

24. Steps in Concept Map Care Planning • Develop a basic skeleton diagram • Analyze and categorize data • Analyze nursing diagnoses relationships • Identify goals, outcomes, and interventions • Evaluate patient’s responses

25. Question Tell whether the following statement is true or false. Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts. A. True B. False

26. Answer Answer: A. True Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts.

27. Critical Thinking and Clinical Reasoning • Is purposeful, informed, outcome-focused thinking • Is driven by patient, family, and community needs • Is based on principles of nursing process and scientific method • Uses both intuition and logic, based on knowledge, skills, experience • Requires strategies that make the most of human potential • Is constantly reevaluating, self-correcting, and striving to improve