Application of the fundamental principles of critical thinking, client-centered approaches to treatment, goal-oriented tasks, evidence-based practice (EBP) recommendations, and nursing intuition, the nursing process functions as a systematic guide to client-centered care with five subsequent steps.
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“A concept is an organizing principle, or a classification of information” [4]. Faculty choose concepts that reflect nursing practice and organize the concepts in domains such as biophysical, psychosocial, health care systems, and professional practice [5].
A sampling of these concepts include: 1 Infection 2 Inflammation 3 Clinical judgment 4 Professionalism 5 Leadership 6 Nutrition 7 Elimination 8 Safety 9 Gas exchange 10 Perfusion 11 Fluids and electrolyte balance
In order to strengthen student mastery of content, many nursing programs have adopted a concept based curriculum. There are over 50 concepts according to Jean Giddens. A sampling of these concepts include:
The nursing process is a critical thinking model based on a systematic approach to patient-centered care. Nurses use the nursing process to perform clinical reasoning and make clinical judgments when providing patient care.
人, health, the environment, and nursing are the four basic concepts of the modern nursing discipline's framework. The contents of nursing work, practical categories, field of research, the function of the role of the nurse, and professional product are closely related to these four categories.
The three concepts important to nursing are person (recipient of care), health (the goal of nursing), and environment (the setting where nursing care takes place).
Care plans are structured as a five-step framework: assessment, diagnosis, outcomes and planning, implementation, and evaluation....What Are the Components of a Care Plan?Step 1: Assessment. ... Step 2: Diagnosis. ... Step 3: Outcomes and Planning. ... Step 4: Implementation. ... Step 5: Evaluation.
A nursing care plan (NCP) usually includes nursing diagnoses, client problems, expected outcomes, and nursing interventions and rationales. These components are elaborated below: Client health assessment, medical results, and diagnostic reports are the first steps to be able to design a care plan.
Any new approach in nursing should provide clear and precise definitions for the four nursing concepts of person (human being), environment, health and nursing.
According to the four concepts common in nursing theory; the person (patient), the environment, health & nursing (goals, roles, functions) can be analyzed. Each of these concepts is usually defined and described by a nursing theorist.
Here are four key steps to care planning:Patient assessment. Patient identified goals (e.g. walking 5km per day, continue living at home) ... Planning with the patient. How can the patient achieve their goals? ( ... Implement. ... Monitor and review.
Effective Care PlanningEmphasize an individual's strengths and abilities. Focus on what one can do, not what they are incapable of doing. ... Record service user's preferences. ... Utilize a positive narrative. ... Demonstrate the involvement of the service user. ... Contextualize behaviors rather than using labels.
Why are Care Plans Important? Care plans play a vital role in the treatment of a patient. They clearly define guidelines along with the nurse's role in patient care and help them create and achieve a solid plan of action. This equips nurses to provide focused care—without overlooking important steps.
The planning occurs in three phases: initial, ongoing, and discharge. Initial planning involves the development of a preliminary plan of care by the nurse who performs the admission assessment and gathers the comprehensive admission assessment data.
What processes are involved in the planning phase? Planning is the third step of the nursing process. It involves setting priorities, identifying expected outcomes, prescribing nursing interventions, and identifying patient-centered goals.
Planning gives more power over the future. Planning is deciding in advance what to do, how to do it, when to do it, and who should do it. This bridges the gap from where the organization is to where it wants to be. The planning function involves establishing goals and arranging them in logical order.
nursing care plan. is a type of documentation that demonstrates the individualized planning and delivery of nursing care for each specific patient using the nursing process.
The “Evaluation” Standard of Practice is defined as, “The registered nurse evaluates progress toward attainment of goals and outcomes.” [21] During evaluation, nurses assess the patient and compare the findings against the initial assessment to determine the effectiveness of the interventions and overall nursing care plan. Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated and modified as needed. [22]
Inductive reasoning. involves noticing cues, making generalizations, and creating hypotheses. are data that fall outside of expected findings that give the nurse a hint or indication of a patient’s potential problem or condition.
[1] Using critical thinking means that nurses take extra steps to maintain patient safety and don’t just “follow orders.”.
Registered nurses (RNs) create nursing care plans so that the care provided to the patient across shifts is consistent among health care personnel. Some interventions can be delegated to Licensed Practical Nurses (LPNs) or trained Unlicensed Assistive Personnel (UAPs) with the RN’s supervision.
The nursing process is a critical thinking model based on a systematic approach to patient-centered care. Nurses use the nursing process to perform clinical reasoning and make clinical judgments when providing patient care. The nursing process is based on the Standards of Professional Nursing Practice established by the American Nurses Association (ANA). These standards are authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently. [8] The mnemonic is an easy way to remember the ANA Standards and the nursing process. Each letter refers to the six components of the nursing process: A ssessment, D iagnosis, O utcomes Identification, P lanning, I mplementation, and E valuation.
Additionally, the nurse promotes patient safety by contacting the provider before administering a medication that could cause harm to the patient at this time. The ANA’s Standards of Professional Nursing Practice associated with each component of the nursing process are described below.
“Most nurses enter the profession because they are caring” (Corbin,2008). It is common for nurses to be naturally caring people from the beginning of their education as they chose the profession to care for those who are in need or in sickness. Compassionate care is one of the most important main key factors of nursing practice. It reflects the nurse as a person and also her/his ability to provide the correct care to a patient. The ability to empathise and to comfort patients continuously would be regarded as compassionately caring for the patient.
The key concept of Person Centred Care is deemed crucial to be exercised by healthcare professionals to benefit the comfort, trust and relationships formed between nurse and patient. “Quality care is an ongoing challenge” as (Rajamohan,2019) stated, it needs patience, awareness and care to be effective. Being cared for dependently comes with the feeling of vulnerability for most patients who were once independent. Being vulnerable is a human condition (Henriksen & Vetlesen , 2000, cited Angel.S,2016). This can be a distressing time for patients which is why the use of Person Centred Care is necessary to comfort and attend to the patients’ needs. “Nurses are in ideal positions to hear and honour the wishes, hopes, and dreams of recipients of care.” Said (Parse.R.R, 2019.)
The curriculum reflects the heart and soul of a nursing faculty. For each school, at least some of the current faculty were most likely involved in developing the existing curriculum and are invested in its success. The curriculum expresses the faculty’s values and beliefs about nursing and education, and reflects their professional identity. Faculty members have educated and mentored many students through the program and their courses have been the core of their daily work—in some cases, for many years. The curriculum is familiar and comforting. These factors mean that curriculum change is one of the most challenging undertakings for any faculty. It may prove difficult to build consensus about a new program based on different values and priorities among a diverse group of faculty members. Some faculty members have kept up with best practices and innovation in nursing education, while others are content with the status quo. Ideally curriculum revision is driven by the faculty and begins with an agreement by the faculty as a whole to enter into the process.
The conceptual framework (theoretical or organizational model) guides the development of the program of study and makes it unique; it unifies the curriculum and creates a coherent approach across courses and levels (Ervin, Bickes, & Schim, 2006). While there are some curricular elements that are common among schools based on the Essentials (AACN, 2008b), others define the particular identity of the program based on the characteristics of the parent institution and the philosophy of the nursing program. Traditional academic nursing frameworks no longer reflect the complexity of nursing education or practice. The use of a single theorist is an outdated approach and most nursing programs have an eclectic model that reflects their values and priorities (McEwen and Brown, 2002). The meta-paradigm for nursing that includes the key concepts of person, environment, health, and nursing is no longer an adequate foundation for an educational program (Webber, 2002). Theoretical models for BSN programs have shifted away from nursing process to critical thinking (McEwen & Brown, 2002) and reflect alternatives for the biomedical model that more closely reflect nursing concepts and values. If the theoretical model is basic and broad, it is possible for it to encompass and support a variety of views of practice and education that may be held by faculty (Ervin et al., 2006) and allow for new developments in nursing and health care (Newman, 2008).
The nursing education literature identifies curriculum design issues and trends that must be considered as the faculty moves forward with development of the prelicensure program of study. These include the historical overloading of content in nursing curricula, the mandate for IPE, consideration of the needs of an increasingly diverse student body, and changes in clinical education.
Chapter 11 provides an overview of the process of curriculum development for baccalaureate nursing programs. It reviews the utilization of the American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education for Professional Nursing Practice (2008b) in curriculum development and discusses fast track programs and RN to BSN programs. This chapter summarizes the advantages and challenges related to residency/externship programs for the new graduate. The following outlines the content of the chapter.
One of the most challenging aspects of curriculum revision is designing an approach to students’ clinical experiences that reflects the school’s theoretical model and integrates new learning pedagogies in the context of local realities regarding the availability of qualified clinical faculty and clinical sites. While clinical experience is essential in preparation for practice, what constitutes clinical experience? What kinds of clinical learning activities and how much time in what kind of health care settings is most effective for BSN students to meet generalist competencies and transition successfully into practice? The National League for Nursing Think Tank on Transforming Clinical Nursing Education (2008) made recommendations for the ideal clinical education model that described integrative experiences, including cross-disciplinary experiences; new relationships within learning communities, including innovative relationships with clinical partners; and reconceptualized learning experiences in which all students don’t have clinical experiences in traditional rotations. While there are scarce data about the effectiveness of either traditional or new clinical models, it is incumbent on nurse educators to develop and test models and approaches and contribute to the database. Each school of nursing needs to develop an approach that best utilizes its resources and fits its theoretical model.
Nursing schools rely on a robust evaluation plan to provide information that guides curriculum revision. In addition, there are compelling factors external to individual nursing programs that influence the need for curricular change within baccalaureate nursing programs across the country.
In the next step, essential knowledge, skills, and attitudes that students will need to accomplish related to each outcome are identified. This is the content that is organized into coherent and logical groupings, which become courses. There are many possible ways to cluster the information and the faculty should be guided by their previous research and philosophical work. The identification of new courses can be an exciting and creative activity but has the potential to be a phase of the curriculum development process that creates conflict. Issues of territoriality and “sacred cows” may assert themselves; it is sometimes difficult to think creatively and safer to regress to what is known (the old model). At this juncture, decisions must be made about which concepts to integrate and which to organize into a separate course. In the creation of a working course template, a program of study by term begins to emerge. Table 11.3 shows the courses in the plan of study for the generic BSN curriculum at LGSSON.
Though there are literally 101 definitions of critical thinking in the nursing literature, the essence of critical thinking is the ability of the nurse to UNDERSTAND and apply concepts as well is content that has been taught and apply it to the bedside in a wide variety of unique patient situations and presentations.
In order to prepare nursing students for autonomous professional practice, they must be able to think like a nurse using the thinking skills of critical thinking and clinical reasoning to make a correct clinical judgment.
Making a correct clinical judgment is a complex process that is directly influenced by the clinical experience of the nurse and by what the nurse brings to the patient care scenario, including the ability of the nurse to use knowledge and grasp the essence of the current clinical scenario by using the skill of clinical reasoning.
Though clinical reasoning represents the ability of the nurse to recognize relevant data, think in action and grasp the essence of the current problem, it is NOT the end point of nurse thinking. It’s a critical component in the equation of clinical practice to make a correct clinical judgment.
The first exercise is concept mapping. Concept mapping is the practice of visually representing ideas on paper and showing connections between these ideas (2). They are often presented in either a hierarchical or web pattern with the key ideas at the top or center of the diagram, respectively.
Environment. The learning environment also plays an important role in a nurse’s ability to learn critical thinking skills. The environment should be inclusive, non-judgmental, and allow for open discussion (1). This applies to both nursing schools and nurses being trained into a new unit.
Feeling accepted on a unit allows for better learning and has a positive impact on critical thinking skills (1). It is important for nurses looking for a new work unit to find one with a welcoming, safe environment to aid in learning.
Studies found that nurses with higher critical thinking skills work more efficiently (1). If you are thinking critically you are better able to prioritize and plan to avoid wasting time and energy .
Critical thinking is a broad way of thinking that involves gathering information, investigating, and evaluating the information in order to solve a problem. Critical thinking is best learned and practiced with an open mind. We can foster critical thinking in each other through case studies, simulations and targeted questioning. We can improve our critical thinking in nursing skills ourselves by practicing reflective writing and concept mapping. If you are a nurse educator or preceptor, I hope you have found something you use to shape future nurses. If you are a nurse looking to better understand critical thinking, I hope you have learned something you can take to your nursing practice.
As we all know, nursing can be very demanding, and efficiency is important for tending to all our patients’ needs. Also, if the nurse manager of a unit has higher critical thinking skills, they implement changes that improve overall efficiency and morale (7).
Education System. The education system also impacts the teaching of critical thinking. Education systems, for one, largely shape the learning environment and educators. The education system should strive to create the type of learning environment where critical thinking skills can grow.
The complexity of health care today requires nursing graduates to use effective thinking skills. Many nursing programs are revising curricula to include concept-based learning that encourages problem-solving, effective thinking, and the ability to transfer knowledge to a variety of situations—requiring nurse educators to modify their teaching ...
Many nursing programs are revising curriculum from a traditional educational approach to a concept-based curriculum to improve thinking skills. In a traditional curriculum, the teacher provides extensive content and facts to passive students. Presenting extensive information allows minimal time for students to organize and apply ...
In contrast, the learning paradigm involves students discovering and constructing knowledge, which requires active thinking. Constructing knowledge consists of creating frameworks of concepts and skills that can be applied in different situations.
Practice thinking in the classroom evolves from a teacher-centered learning to a student-centered learning environment, focusing on clinical practice. However, the development of a concept-based curriculum does not change the teaching practices of faculty and ways students learn.
Students need a practice environment to support their practice of thinking and performing skills : Active learning activities in the classroom.
Finding meaning is supported by three main themes: preparing for the change, teaching in a concept-based curriculum, and understanding the teaching-learning process. Conclusion: Changing to a concept-based curriculum required a major shift in thinking and application.
The purpose for active learning activities is to bring the students as close to the real experience as possible in the classroom, which takes time and creativity. Because active learning in the classroom takes time, students need to be prepared before class to practice thinking in the classroom.