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Assessment, Clinical Judgment and Nursing Diagnoses

Assessment, Clinical Judgment and Nursing Diagnoses

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Assessment, Clinical Judgment and Nursing Diagnoses

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  1. Assessment, Clinical Judgmentand Nursing Diagnoses Chapter Two

  2. Assessment, Clinical Judgmentand Nursing Diagnoses ContributorMargaret Lunney

  3. Nursing Process • Conceptual Description of What Nurses Do • Broadly Accepted Worldwide • Five Phases, Cyclical: • Assessment • Diagnosis • Planning • Implementation • Evaluation

  4. Continuous Clinical Judgment Definition “Interpretation or Conclusion About a Patient’s Needs, Concerns, or Health Problems, and/or the Decision to Take Action (or Not), Use or Modify Standard Approaches, or Improvise New Ones as Deemed Appropriate by the Patient’s Response” (Tanner, 2006, p.204)

  5. Assessment Data are Interpreted • What Happens? • Nurses Convert Data to Interpretations • Why? • Nurses, as Other People, Have Limited Space in Short-Term Memory, Cannot Remember All Data But Remember Interpretation • How? • Connect Patient Data with Knowledge in Memory

  6. 1973: First Conference to Identify the Names for Data Interpretations 80 Nursing Diagnoses First Identified Evolved to NANDA International (I) Purpose of NANDA-I: Approve Nurse-Developed Research-Based Names for Data Interpretations, Labels and Descriptions

  7. Nurses are Diagnosticians • Nurses Use a Diagnostic Process in Partnership with Patients • Why? • Focus is Health • People Make Themselves Healthy

  8. Diagnostic Competencies • Intellectual • Interpersonal • Technical • Personal Strengths: • Tolerance of Ambiguity • Use of Reflective Practice

  9. Intellectual Competencies Knowledge Mental Processes

  10. Mental Processes: Cognitive Skills and Habits of the Mind • Examples of Cognitive Skills: • Analyzing • Logical Reasoning • Applying Standards • Studies Show That: • Adults Vary in Cognitive Abilities • Thinking Processes can be Improved

  11. To Develop Thinking Abilities • Use Thinking • Think About Nursing Concepts, e.g.: • Health Management • Sleep • Seek Support • Develop Confidence

  12. Interpersonal Competencies Trust Enables Patients to Share Valid and Reliable Data with Nurses Communication Skills Enhance Trust Work in Partnership with Patients Listen

  13. Technical Competencies • Nursing Assessment: • Health History • Physical Examination • Use a Framework That Yields Nursing Concepts, e.g. Functional Health Patterns

  14. Personal Strength: Tolerance of Ambiguity Why? Numerous Factors Influence Clinical Situations Human Beings are Complex and Unique Enables Consideration of Many Factors

  15. Reflective Practice Re-examine Feelings and Behaviors Reflection Needed for Self-Evaluation

  16. Assessment and Nursing Diagnosis Units of Analysis: Individual, Family or Community Books That Appropriately Link Assessment to Nursing Diagnosis

  17. Principles of Diagnostic Reasoning and Assessment Work in Partnership with Individual, Family or Community Think About Diagnostic Hypotheses; Collect Data to Support or Reject Hypotheses Complete Data Collection Before Deciding on Diagnoses Validate Diagnoses with Patients

  18. Recognize Cues Cues: Units of Data That Have Meaning in Relation to Diagnoses, e.g. Rate of Breathing and Ineffective Breathing Pattern Recognition of a Cue and Its Meaning Depends on Knowledge in Memory For Meaning: Compare Cues to Knowledge and the Individual Patient

  19. Mentally Generate Possible Diagnoses Consider Context of Situation Compare Cues with Knowledge in Memory Consider Multiple Possible Explanations Avoid Deciding Too Soon (Premature Closure) Be Flexible in Thinking

  20. Conduct Focused Data Collection Collect Additional Data to Support Diagnostic Hypotheses Collect Data to Rule Out Competing Hypotheses Summarize Data with a Possible Explanation or Diagnosis

  21. Validate Diagnoses with Patients and Others Collaborate with Patient and Family If Patient is Unable to Validate, Collaborate with Other Nurses or Providers

  22. Name Diagnoses Using NANDA-I

  23. References Belenkey MF, Clinchy BM, Goldberger NR, Tarule JM. (1983) Women's Ways of Knowing: The Development of Self, Voice, and Mind. New York: Basic Books. Benner PA. (1984) Novice to Expert: Promoting Excellence and Power in Professional Nursing Practice. Menlo Park, CA: Addison Wesley. Bulechek GM, Butcher H, DochtermanJC. (2008) Nursing Interventions Classification (NIC), 5th edn. St Louis, MO: Mosby. DoaneGH, Varcoe C. (2005) Family Nursing as Relational Inquiry: Developing Health Promoting Behavior. Philadelphia: Lippincott. Herdman TH. (ed). (2012) NANDA International Nursing Diagnoses: Definitions and Classification, 20122014. Oxford: Wiley-Blackwell. Institute of Medicine. (2004) Keeping Patients Safe. Washington, DC: National Academy Press. Kassirer JP. (1983) Teaching clinical medicine by iterative hypothesis testing. Let’s preach what we practice. New England Journal of Medicine 309: 921-923. Levin RF, Lunney M, Krainovich-Miller B. (2004) Improving diagnostic accuracy using an evidenced-based nursing model. International Journal of Nursing Terminology Classification 15(4): 114-122. Lunney M. (1992) Divergent productive thinking and accuracy of nursing diagnoses. Research in Nursing and Health 15: 303-311. Lunney M. (2008) Critical need to address nursing diagnosis. Online Journal of Issues in Nursing. www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No1Jan08/ArticlePreviousTopic/AccuracyofNursesDiagnoses.aspx Lunney M. (2009) Critical thinking to achieve positive health outcomes: nursing case studies and analyses. Ames, IA: Wiley-Blackwell. Miller CA. (1956) The magical number seven, plus or minus two: some limits on our capacity for processing information. Psychological Review 63: 81-97. Moorhead S, Johnson M, Maas M, Swanson E. (2008) Nursing Outcomes Classification (NOC). 4th edn. St Louis, MO: Mosby. Munhall PL. (1993) ‘Unknowing’: toward another pattern of knowing in nursing. Nursing Outlook 41: 125-128. Rubenfeld MG, Scheffer BK. (2010) Critical Thinking Tactics in Nursing. Boston: Jones and Bartlett. Scheffer BK, Rubenfeld MG. (2000) A consensus statement on critical thinking. Journal of Nursing Education 39: 352-359. Tanner CA. (2006) Thinking like a nurse: a research-based model of clinical judgment. Journal of Nursing Education 45(6): 204-211.