Transcript Nursing Strategies for Success

Nursing Strategies for Success
Chapter 5
Successful Intelligence
• Two men out hunting
Successful intelligent thinking is
BALANCED
Sabiduría
• Knowledge vs. Wisdom
• Knowledge:
– Gaining information, understanding concepts
• Wisdom
– Collected meaning and significance gained from
knowledge
What is thinking?
• Asking questions 
• Move towards answers
Is there such a thing as a “bad
question”?
• Yesterday I was at my local COSTCO buying a
large bag of Purina dog chow for my loyal pet,
Jake, the Wonder Dog and was in the checkout line when a woman behind me asked if I
had a dog.
Is there such a thing as a “bad
question”?
• What did she think I had an elephant?
• So since I'm retired and have little to do, on
impulse I told her that no, I didn't have a dog, I
was starting the Purina Diet again.
• I added that I probably shouldn't, because I
ended up in the hospital last time, but that I'd
lost 50 pounds before I awakened in an intensive
care ward with tubes coming out of most of my
orifices and IVs in both arms.
Is there such a thing as a “bad
question”?
• I told her that it was essentially a Perfect Diet and
that the way that it works is, to load your pants
pockets with Purina Nuggets and simply eat one
or two every time you feel hungry.
• The food is nutritionally complete so it works well
and I was going to try it again.
• (I have to mention here that practically everyone
in line was now enthralled with my story.)
Is there such a thing as a “bad
question”?
• Horrified, she asked if I ended up in intensive
care, because the dog food poisoned me.
• I told her no, I stepped off a curb to sniff a
poodle and a car hit me.
• I thought the guy behind her was going to
have a heart attack he was laughing so hard.
• “Only students who have questions
are really thinking and learning”
• Ask questions that stimulate thought.
• “The difference between good science and
great science is the quality of the questions
posed.” ~ William Hunter
You want to get an A in your anatomy
class
• Use questions to analyze:
– What do I need to memorize this week?
– What multiple pathway to learning is my strength?
• Come up with creative ideas:
– What are different ways to study using my strength?
• Apply practical solutions
– What ways can I study my anatomy to memorize the
body systems?
– When will I use these study skills?
Know your purpose!
• What are you trying to accomplish?
• Are your questions leading you towards that
purpose?
Can you get smarter?
• “As jogging is to the body, thinking is to the
brain.” ~ Nob Yoshigahara (puzzle master)
January 5, 2010
Puzzles and Alzheimer's
• A new study adds to a growing body of evidence that
mentally challenging activities like word games, playing
cards, reading and writing may delay the rapid memory loss
that occurs with Alzheimer’s disease.
• The study involved 488 people who were in their 70s and
80s. All were free from Alzheimer’s at the start. Each
participant filled out questionnaires about how often they
participated in six leisure-time activities: reading books,
magazines or newspapers, writing, doing crossword
puzzles, playing board or card games, participating in group
discussions or playing music.
• “The effect of these activities in late life appears to be
independent of education,” Dr. Hall said. “These activities
might help maintain brain vitality.”
How can You improve your analytical
thinking skills?
AKA: Critical Thinking
• Gathering information
• Analyzing & Clarify
• Evaluating for the purpose of
– Gaining understanding
– Solving a problem
– Making a decision
Gather information
• (Define your purpose!)
• Information
– How much do you need?
– How much time do you spend gathering?
– Is the information relevant?
Analyze & Clarify information
• Break information into parts
– Separate the ideas
– Compare and Contrast
– Examine cause and effect*
– Look for themes, patterns and categories
Analyze & Clarify information
• Examine whether examples support ideas
• Distinguish fact from opinion
– Subjective Information
– Objective Information
Objective information
• Is observable, able to be seen, heard or touched,
smelled, tasted
• Factual
• Able to be counted
• Able to be described
• The same from multiple reporters
• is verifiable. Another person can repeat the
observation, you can perform some type of test,
etc.
Objective language
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I saw…
I counted…
I observed…
This is what he did…
This is what it sounded like…
Subjective information
• Is opinion, judgment, Assumption, beliefs,
rumor or suspicion
• Varies from person to person, day to day
• Information that can be interpreted differently
by other people
• is what comes out of the patient or family's
mouth.
Subjective language
• I feel …
Diabetes Case Study
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M.G. is a 58 y/o white female who
presents to her primary care
physician with a complaint of “tired
all the time.”
Height:5’4”
Weight:212 lbs.
It’s been going on for several months,
and she doesn’t report any concerns
with nighttime sleep.
She doesn’t note any new stress or
other life changes, and denies
depression or anxiety.
Alcohol consumption is limited to
one to two drinks per week, and she
quit smoking over 10 years ago.
BP:135/86
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Family history is notable for type 2
diabetes in an older sister; her
mother had hypothyroidism and
“heart disease.”
The patient also has high cholesterol
that she has been trying to treat with
“weight loss and exercise.”
She walks about 20 minutes three
times weekly when the weather
allows.
Lung sounds are clear
Pulse regular and strong
She has been treated for about five
years for hypertension with
hydrocholorthiazide.
No thyromegaly
Analyze & Clarify information
• Examine whether examples support ideas
• Distinguish fact from opinion
– Subjective vs. Objective
• Examine perspective & Assumptions
– Bias
– Prejudices
• Evaluate information
Assess Analytical Thinking Skills
• I tend to perform well on objective tests.
• People say I’m a “thinker”, “brainy”,
“studious”.
• I am not comfortable with gray areas – I prefer
information to be laid out in black and white.
• In a group setting, I like to tackle the details of
a problem
• I sometimes over think things and miss my
moment of opportunity.
How to Improve your creative thinking
skills
Improving creativity
• Brainstorming
– Divergent thinking
– Group think
Improving creativity
• Shift your perspective
– Challenge assumptions
– Take a new and different look
– Ask “what if” questions
Improving creativity
• Set the stage for creativity
– Choose – or create environments that free your
mind
– Be curious
– Give yourself time to “sit” with a question
– Believe in yourself as a creative thinker
Improving Creativity
• Take risks
– Fly in the face of convention
– Let mistakes be Okay
Assess creative thinking
• I tend to resist rules and regulations.
• People say I’m “expressive,” “full of ideas,”
innovative.
• I break out of my routine and find new
experiences
• In a group setting I like to toss ideas into the
ring
• If you say something too risky, I’m all for it.
Improving practical thinking skills
• Experience
– “Experience is the greatest teacher!”
– Benjamin Franklin (Poor Richard's Almanack, Nov.
1743) offered, "Experience keeps a dear school,
yet fools learn in no other.“
• The emotional intelligence connections
Practical thinking means action!
• Stay motivated
• Make the most of your personal strengths
• When things go wrong, accept responsibility
and reject self pity
• Focus on the goal and avoid distractions
• Manage time and tasks effectively
• Believe in yourself
Assess practical thinking skills
• I can find a way around any obstacle
• People say I’m a “doer” and “go-to” person
“organized”.
• When I have a vision, I translate it into steps
from A to B to C.
• In a group setting, I like to set up the plan
• I don’t like to leave loose ends dangling – I’m a
finisher.
How is this type of thinking used in
Nursing?
• NURSING PROCESS!
Overview of the Nursing Process
• Consists of 5 steps
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Assessment
Diagnosis
Planning
Implementation
Evaluation
• Build on each other
• Not linear
• Nursing process is dynamic and requires
creativity in its application
– Steps remain the same
– Application and results different
• Used throughout the life span in any care
setting
Small group questions:
1.
2.
3.
4.
How many steps are in the nursing process?
What are the names of each of the steps?
What is the purpose of the nursing process?
In what clinical setting is the nursing process
used?
Assessment
• Step #1
• Involves
– Collecting data (from variety of sources)
– Validating the data
– Organizing the data
– Interpreting the data
– Documenting the data
Assessment
• Validating the Data
• Organizing the Data
• Interpreting the Data
– Relevant vs. irrelevant
– Gaps?
– Identify patterns
• Document the Data
Small Group Questions
Which of the following are objective data and
which are subjective data.
A. Nausea
B. Vomiting
C. Unsteady gait
D. Anxiety
E. Bruises on the right arms and face
F. Temperature 101 F
Diagnosis
• Step 2 in the nursing process
– Formulating a nursing diagnosis
– Analysis and synthesis of data
• Nursing diagnosis:
– “A clinical judgment about individual, family or
community responses to actual or potential heal
problems / life processes.
– A nursing diagnosis provides the basis for
selection of nursing interventions to achieve
outcomes for which the nurse is accountable.”
Medical vs. Nursing diagnosis
Medical diagnosis
Nursing diagnosis
Identifies conditions the Identifies situations the
MD is licensed &
nurse is licensed &
qualified to treat
qualified to treat
Medical vs. Nursing diagnosis
Medical diagnosis
Nursing diagnosis
Identifies conditions the Identifies situations the
MD is licensed &
nurse is licensed &
qualified to treat
qualified to treat
Focuses on illness,
injury or disease
processes
Focuses on the clients
responses to actual or
potential health / life
problems
Medical vs. Nursing diagnosis
Medical diagnosis
Nursing diagnosis
Remains constant Changes as the clients
until a cure is
response and/or the health
effected
problem changes
Medical vs. Nursing diagnosis
Medical diagnosis
Nursing diagnosis
Remains constant Changes as the clients
until a cure is
response and/or the health
effected
problem changes
i.e. Breast cancer
i.e. Knowledge deficit
Powerlessness
Grieving, anticipatory
Body image disturbance
Individual coping, ineffective
Diangosis
Nursing diagnosis
Medical diagnosis
Breathing patterns,
ineffective
Activity intolerance
Chronic obstructive
pulmonary disease
Cerebrovascular accident
Pain
Appendectomy
Body image disturbance
Amputation
Body temperature, risk for
altered
Strep throat
Planning & Outcome identification
• Step Three: Planning
• Identifying outcomes
– Goals
• An aim, intent or end.
– Short term goals
• Hours to days (less than a week)
– Long term goals
• Weeks to months
Planning & Outcome identification
• Developing specific nursing interventions
– Independent nursing interventions
• No order needed
– Elevate edematous legs
– Interdependent nursing interventions
• In conjunction with an interdisciplinary team member
– Assist client with physical therapy exercises
– Dependent nursing interventions
• Require an order
– Administering of medications
• Prioritizing the nursing diagnosis
– Maslow’s hierarchy of needs
Maslow’s Hierarchy of Needs
Implementation
• 4th step:
– Execution of the nursing care plan
– Delegation
–DO IT
–DO IT RIGHT
–DO IT RIGHT NOW!
Evaluation
• 5th step
– Determining whether
the clients goals have
been met, partially
met or not met.
Solving a problem
• Define the problem
• Analyze the problem
• Solutions
– Potential positive effects
– Potential negative effects
• Practical action
• Final Evaulation
Decision making thoughts
• Look at the given options – then try to think of
more
• Think how decision effects others
• Gather perspectives
• Look at the long term effects
• Ethical dilemmas –
• Keeping your balance
Solving a problem
• SOAP!
– Subjective
– Objective
– Assessment
– Plan