Overview
This lecture covers the nursing process, critical thinking, and related test-style questions, emphasizing core steps, decision-making, and clinical judgment in nursing practice.
The Nursing Process (ADPIE)
- The nursing process includes Assessment, Nursing Diagnosis, Planning, Implementation, and Evaluation (ADPIE).
- Assessment involves gathering information from physical exams, patient interviews, or chart reviews.
- Nursing diagnosis identifies the patient's response to a medical diagnosis (e.g., impaired gas exchange in asthma).
- Planning sets patient goals and desired outcomes.
- Implementation is carrying out nursing actions or interventions.
- Evaluation checks if interventions were effective and if goals were achieved; if not, reassess and repeat the process.
Clinical Judgment & Prioritization
- Always attend to patients with compromised physiologic integrity first (e.g., BP 90/50 after surgery).
- Post-operative priorities: assess for bleeding, infection, and deep vein thrombosis (DVT).
Critical Thinking & Reflection
- Reflection involves recalling and discussing a patient event to gain deeper understanding.
- Critical thinking is identifying a problem and taking appropriate actions to resolve it (using ADPIE).
Accountability & Incident Reporting
- Filing an incident report after an error demonstrates accountability.
- Incident reports are for the facility, never placed or mentioned in the patient's chart.
Problem Solving in Nursing
- Problem solving requires trying different solutions to see what works best for the patient.
- Actions like trialing various wound dressings demonstrate effective problem-solving.
Implementation Versus Other Steps
- Implementation means actively performing tasks for the patient (e.g., crushing meds for easier swallowing).
- Assessment collects data; planning organizes interventions.
Answering Nursing Questions
- Avoid "always," "never," or "only" in answers; individualized care is essential.
- Use clinical reasoning and the nursing process to avoid blanket approaches to patient care.
Key Terms & Definitions
- ADPIE — Steps of nursing process: Assessment, Diagnosis, Planning, Implementation, Evaluation.
- Nursing diagnosis — Patient's response to a medical condition.
- Reflection — Thinking back on situations to better understand and respond.
- Accountability — Taking responsibility for actions, such as reporting errors.
- Incident report — Documentation for facility use when errors occur, not for patient charts.
- Problem solving — Testing different solutions to address patient care issues.
Action Items / Next Steps
- Review the nursing process and practice identifying each step in clinical scenarios.
- Watch videos on patient prioritization and answering challenging nursing questions, as mentioned.
- Study the concept of individualized patient care and avoid absolute statements in test answers.