Adult Nursing

The joint Commission & Institute of Medicine

• quality
• safety
• education
• nursing

• knowledge 
• skills
• attitude

Furosemide, treats fluid retention R/T CHF side effects

pt is source of control; respect for pt values and beliefs

• all ppl have same basic needs
• physiological
• safety & security
• love & belonging
• self-esteem
• self-actualization

intentional higher level thinking process

set of questions to a situation to determine essential information and discard superfluous information

techniques to look beneath the surface, recognize & examine assumptions, search inconsistencies

generalizations formed from a set of facts or observations

reasoning from general premise to specific conclusion

• can be verified through investigation 
• eg... BP affected by blood volume

• conclusions drawn from facts, going beyond facts to make a statement about something not currently know 
• eg...if blood volume is decreased BP will drop

• evaluation of facts or info that reflects values or a type of opinion
• eg...it is harmful to health if BP drops too low

• beliefs formed over time; judgments that may fit facts or be in error
• eg...nursing intervention can assist in maintaining clients BP WNL

examine beliefs in the light of new evidence

assessing all viewpoints with the same standards, not basing judgment on personal or group prejudice

examine their own biases & bring them to awareness before making decisions

awareness of the limits of ones own knowledge

attitude of courage, nurse examines fairly his/hers own ideas or views, especially those with strongly negative reactions

individuals apply the same rigorous standards of proof to their own knowledge

finding effective solutions to client and nursing problems

well reasoned thinking will lead to trustworthy conclusions

systematic rational method of planning & providing individualized nursing care

what is an example of this

how can i find out if that is true

can i be more specific?

how does that help me with the issue?

what makes this a difficult problem

do I need to consider another point of view?

does that follow from the evidence

which of these facts is most important?

am i considering the thinking of others?

Thinkers use universal standards as a guide in thinking to achieve excellence; thinking is conscious and systematic.

• only abnormal or significant findings are recorded
• uses 3 key elements:
• flow sheets, standards of nursing care & bedside assess to chart forms

a goal that is not met

info about patient is communicated in a consistent manner including an opportunity to ask & respond to questions

• intro, patient, assessment, situation, safety/concerns
• background, action, timing, ownership & next

intro, situation, background, assessment, recommendation

patient/problem, assessment/actions, continuing, evaluation/changes

patient, plan, purpose, precautions, physicians

• O2
• safety, elimination, f & e, nutrition
• comfort, sensory, rest, activity
• human interaction, learning, spirituality & sexuality

traditional client record

written notes, routine care, normal findings & client problems

data arranged according to the problem the client has

subjective data, objective data, assessment, plan

interventions, evaluation & revision

problem, intervention & evaluation

specific assessment criteria in a particular format, such as, human needs or functional health patterns

makes the clients concerns & strengths the focus of care