Patient Centered Care Class Padlet by Trevor Youngquist

Definition of SMART

youngqut — 2024-06-27 23:37:42 UTC

Goals that are Specific, Measurable, Attainable, Realistic, Timely

1. Librarian's name, along with date and time of your meeting

youngqut — 2024-06-27 23:40:30 UTC

My librarian's name was Steven, from Lawrence Technological University in Southfield.

We met virtually on June 3, 2024 at 1:00pm.

What keywords and databases did you work with?

youngqut — 2024-06-27 23:43:18 UTC

Steven and I looked at the Health Sciences category in the Research Databases section. We began by looking at the Nursing Reference Center Plus database for initial search information. We were led to this database because by searching for "nursing process" and "nursing guidelines," both times we were led to Nursing Reference Center Plus.

List a citation in APA for a scholarly journal article

youngqut — 2024-06-27 23:53:25 UTC

From the Nursing Reference Center Plus database, I was able to identify a great resource to utilize:

Schub, Eliza & Karakashian, Arsi. (2018). Critical Thinking: the Nursing Process and Competent Patient Care. Armenian American Medical Society of California. Link.

What is clinical judgement?

youngqut — 2024-06-27 23:58:41 UTC

According to Giddens (2021), one of the complexities in the nursing process is the use of clinical judgement, or the "inference or interpretation made in a caregiving setting." Moreover, these inferences and interpretations lead to the application "of knowledge, both tacit and explicit, to the unique patient situation to made sense of it and respond appropriately in the specific context of care."

Early approaches to clinical judgement

youngqut — 2024-06-28 00:01:41 UTC

According to Giddens (2021), early assessments on the application of clinical judgement led to a "rules-based or standards-based approach that located the nurse and the individual needs of the patient outside the caregiving situation rather than situating the patient issue in a specific context of care."

Critique of rules- and standards-based approaches to clinical judgement

youngqut — 2024-06-28 00:04:39 UTC

According to Giddens (2021), although a guideline may directly apply to a situation, it is still necessary for nurses to utilize discretion to ascertain whether said guideline is "applicable or appropriate in a given patient care situation [...] expert nurses rarely rely on [standard guidelines] alone."

Evidence-Based Rationale (EBP)

youngqut — 2024-06-28 00:07:14 UTC

According to Giddens (2021), evidence used to inform practice, or EBP, is based on utilizing "a problem-solving approach to clinical decision-making that combines the best available scientific evidence with the best available patient and practitioner experiential evidence toward optimal health outcomes."

Interventionist Applications

youngqut — 2024-06-28 00:12:24 UTC

According to Giddens (2021), because the nature of nusing care "is not linear" with "numerous situations [in which] there are many unknowns," it is necessary to consider the "influence of the individual patient circumstances and context of care" to "situate the nurse squarely in the context of care and account for what the nurse personally contributes to the caring encounter, including previous experiences, values, and emotions." While use of empirical knowledge has its importance, an interventionist approach considers "engaged, practical reasoning that is reasoning based on epxerience."

How does care coordination apply to the Nursing Process?

youngqut — 2024-06-28 00:20:08 UTC

Care coordination contributes to the "holistic" nature of nursing (ANA, n.d.). According to the Agency for Healthcare Research and Quality, care coordination relates to the "deliberate organization of patient care activities" across a continuum of care between coordinating parties, such as the patient and the care team, "to facilitate the appropriate delivery of healthcare services." Given that goals set for patients often entail multiple parties to coordinate and work collaboratively to deliver on outcomes, care coordination is inherent to the Nursing Process.

McDonald, K. M., Schultz, E., Albin, L., et al. (2014). Care coordination measures atlas, version 4 (Prepared by Stanford University under subcontract to American Institutes for Research on Contract No. HHSA_290-2010-00005I). AHRQ Publication No. 14-003-EF. Rockville, MD, Agency for Healthcare Research and Quality.

How does transitional care affect the Nursing Process?

youngqut — 2024-06-28 00:24:08 UTC

According to the AHRQ's Care Coordination Measures Atlas, care coordination relates to the navigation of healthcare, given that transitional care may "occur across or within settings, among those involved with the patient's care, and may be longitudinal with transitions occurring between episodes of care." When a high acuity patient's needs require a broad care team across care settings, it is critical that a care plan incorporate any needed navigation and compliance goals necessary to successively meet outcomes desired across care settings. The Nursing Process is the doorway to this navigation.

Core benefit of The Nursing Process

youngqut — 2024-06-28 00:27:59 UTC

According to the American Nurses Association (n.d.), a core function of nursing is "to deliver holistic, patient-focused care."

American Nurses Association. (n.d.). The Nursing Process. Link.

Assessment

youngqut — 2024-06-28 00:31:58 UTC

According to the ANA (n.d.), an assessment is used to "collect and analyze data" about a patient. It is the first step to the Nursing Process. According to the ANA (n.d.), an assessment may include data for the patient's:

Physiological state
Psychological state
Sociocultural context
Spiritual habits
Economic state
Lifestyle factors/influences (e.g., living situation, family/friend support)

Diagnosis

youngqut — 2024-06-28 00:35:11 UTC

According to the ANA (n.d.), the "nursing diagnosis" utilizes the clinical judgement of the nurse and applies it to the "actual or potential health conditions or needs" of the patient. Aspects of the nursing diagnosis may include:

The ailment at hand (e.g., STI)
Factors contributing to the ailment (e.g., relationship instability or personal grief caused by the STI)
Other ailments caused by the diagnosis (e.g., decline in mental health caused by STI/factors stemming from it)

Planning

youngqut — 2024-06-28 00:37:28 UTC

According to the ANA (n.d.), the achievement of outcomes will be driven by a set of "measurable and achievable short- and long-term goals" for the patient. In the planning documented by the nurse, an account of the nurse's data collection and identifications will be captured in the plan to ensure continuity for any other caregivers attending to the patient during the implementation of the care plan.

Implementation

youngqut — 2024-06-28 00:38:43 UTC

The plan is implemented. According to the ANA (n.d.), during this stage, care that is implemented from the plan is "documented in the patient's record" so that progress can be tracked.

Evaluation

youngqut — 2024-06-28 00:41:10 UTC

The Nursing Process is a cyclical process. Evaluation is not the end of the process; in fact, it may usher many successive beginnings. According to the ANA (n.d.), the "effectiveness of the nursing care must be continuously evaluated." Evaluation will likely reveal new progressions, either positive or negative. These progressions will lead to new goals, new approaches, and perhaps an adjustment on what should be considered as attainable.

Nursing Process Scenario

youngqut — 2024-06-28 00:43:27 UTC

Maggie is a 37 year-old, single woman who works as a grocery store checkout clerk. She has no past medical history, no allergies, and is not taking any medication.

Maggie was admitted to the hospital with problems breathing. Upon taking a history, Maggie admitted that she did not receive a COVID vaccine.

Her breathing has been getting worse since admission, and her nurse practitioner is concerned that Maggie may need to be placed on a ventilator if her breathing does not get better.

What is subjective data?

youngqut — 2024-06-28 00:47:40 UTC

According to Giddens (2021), subjective data includes patient-collected information, such as:

Present health status
- Chronic diseases (e.g., diabetes, renal failure)
- List of medications
- Use of recreational or illicit drugs
Past medical history
- Medical conditions or defects (e.g., heart disease)
Family history
Psychosocial history

What is objective data?

youngqut — 2024-06-28 00:50:24 UTC

According to Giddens (2021), objective data or assessment is information that can be quantified or measured. These data can include vitals, measurements or quantitative screenings.

Role of prioritizing

youngqut — 2024-06-28 00:57:12 UTC

According to Vera (2024), a key role of the Nursing Process is to produce nursing diagnoses, which help to "identify nursing priorities and helps direct nursing interventions based on identified priorities."

Vera, Matt. (2024). Nursing Diagnosis Guide: All You Need to Know to Master Diagnosing. Nurselabs. Link.

Types of Nursing Diagnoses

youngqut — 2024-06-28 01:00:42 UTC

According to Vera (2024), types of nursing diagnoses, which differ from condition-based medical diagnoses, include:

Problem-focused diagnoses (e.g., ineffective breathing)
Risk (e.g., risk for ineffective airway clearance)
Health promotion statements (e.g., readiness for enhanced family coping)
Syndrome (e.g., chronic chest pain)
Possible ailments (e.g., possible chronic low self-esteem)

Tanner's Model of Clinical Judgement

youngqut — 2024-06-28 01:04:16 UTC

According to Giddens (2021), the data collection process allows the nurse to "understand a particular context" in which the patient exists currently to " notice what factors are the most salient for a particular patient."

Maslow's Hierarchy of Needs

youngqut — 2024-06-28 01:08:00 UTC

According to Liefer and Fleck (2022), the attainment of successive foundational needs affect humans' abilities to achieve stability, such as first needing basic needs met (e.g., shelter, sustenance, voiding), then safety, then belonging, then esteem, then self actualization.

"Knowing" A Patient

youngqut — 2024-06-28 01:10:37 UTC

According to Giddens (2021), clustering of cues related to a nursing diagnosis may come from "knowing the patient" within their particular context and environmental influences. Patients may exhibit different cues and tendencies within varying care settings (e.g., ICU v. within their home).

Interpreting

youngqut — 2024-06-28 01:14:11 UTC

According to Giddens (2021), in addition to the nurse's familiarity with "theoretical and experiential knowledge," the nurse must then compile and prioritize it. Giddens (2021) discusses the role of certain data "carry[ing] more weight" than others in relation to prioritization. This prioritization, or clustering, allows the nurse to interpret what is important to achieving the most pertinent goals in the patient's care, or the nursing diagnosis.

Subjective data for Maggie (Scenario)

youngqut — 2024-06-28 01:18:58 UTC

Single
Works as a grocery store checkout clerk
No past medical history, no allergies, and is not taking any medication
Maggie stated problems with breathing
Maggie stated that she was not vaccinated against COVID19
Maggie states a decline in breathing since admission

Nursing Diagnosis for Maggie (Scenario)

youngqut — 2024-06-28 01:20:07 UTC

Decline in ability to breathe

Care plan for Maggie (scenario)

youngqut — 2024-06-28 01:26:06 UTC

Short-term goals (e.g., while admitted)
- Stabilize breathing
- Order testing to determine pathogen affecting her breathing
- Order diagnostics to check for other vitals
- Determine support system (e.g., contact family members, other loved ones, or spiritual mentors if applicable)
Long-term goals (e.g., upon discharge)
- Discuss openness to risk mitigation in line of work (e.g., frontline worker who encounters others during shift). If she is open to mitigating her personal risk to future infection, determine best education for:
  - Masking, hand washing, and other sanitary habits for frontline workers
  - Vaccination
- Discuss healthy lifestyle habits that may contribute to enhanced immunity, including:
  - Healthy diet
  - Exercise
  - Overall disinfectant and sanitation habits

Objective data for Maggie

youngqut — 2024-06-30 01:36:40 UTC

These data could include her O2 saturation, BP, lab results (e.g., if a comprehensive panel is run while admitted), or results/observations of a physical examination. These data could be presented in her chart as:

O2 saturation: 98%
BP: 141/87
eGFR: >60
HENT visual assessment...

Possible interventions for Maggie

youngqut — 2024-06-30 01:39:54 UTC

In the scenario, if the nursing plan was implemented as proposed, interventions could include:

Application of oxygen while bed-ridden; check O2 saturation as oxygen is applied
Run diagnostic lab tests; interface with physician if abnormal results are presented
Present applicable workplace hygienic education materials to Maggie to reduce her risk; assess for teach-back outcomes to gauge success

The circular nature of the nursing process

youngqut — 2024-06-30 01:43:09 UTC

As care plans and interventions are implemented, subsequent evaluation and retrospectives may provide insight into:

A care plan being too ambitious and needing to rein back expectations to ensure SMART goals can be met
A care plan may be on pace and goals may be attainable, but new contraindications or challenges may present - so the plan may need to be reevaluated to incorporate whatever is relevant (e.g., Maggie may be found to have a learning disability so interventions involving education may need to be refocused to meet her needs)
A care plan may not be aggressive enough if the patient is willing and engaged, yet their condition declines; further steps may need to be taken to meet these new needs

Related to the scenario with Maggie...

youngqut — 2024-06-30 01:44:10 UTC

If she is able to attain her short-term goals, it is then time to address the success of long-term goals as they are implemented. Part of the evaluation phase may include scheduled check-in's to ensure that Maggie feels that her goals and needs are being met.

Details not included in the scenario text but are relevant to Maggie's care...

youngqut — 2024-06-30 01:47:11 UTC

Is she engaged in her care?
What is her mental health state? Would this state affect her goals?
Does Maggie have comorbidities upon obtaining her medical records (e.g., her admittance to this ED may not be her regular health system) that she did not disclose?
What is Maggie's health literacy and cultural preferences? Do these factors affect how she regards healthcare and her willingness to participate in her care goals?

Appointment with Buu-Tran Duong

youngqut — 2024-07-08 18:43:06 UTC

Writing Center Appointment (Virtual)

Date: 7/8/2024

Time: 2:10pm

Writing Consultant Name: Buu-Tran Duong

Review of Paper

youngqut — 2024-07-08 18:44:17 UTC

Approximate length of minimum 400 words (1,235 words as of appointment)
Focuses on the subject throughout the paper (yes, need to add scenario content)
Organized and succinctly written (yes)
Correctly used APA format (yes)

Feedback from Buu

youngqut — 2024-07-08 18:56:20 UTC

[GET 2 PEER REVIEWED ARTICLES TO INSERT INTO THIS ESSAY HOWEVER WAY YOU WANT]

Add (IN TEXT CITATION) for definition of SMART