NR 226 Exam 1

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Chamberlain University

NR-226: Fundamentals – Patient Care

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NR 226 Exam 1 Review

Clinical Judgement and Decision-Making

Clinical judgement and decision-making in nursing involve assessing patient conditions and making informed choices to enhance health outcomes. Nurses utilize critical thinking to select the most suitable interventions, establish priority settings, and ensure patient-centered care. The clinical decision-making process integrates the nursing process, a universal, systematic approach for delivering care. This methodology includes phases of assessment, diagnosis, planning, implementation, and evaluation (ADPIE), each contributing to a comprehensive and evidence-based care approach. During the assessment phase, nurses gather subjective and objective data to form a clear understanding of the patient’s condition. The diagnosis phase focuses on interpreting data to identify health issues, risk factors, and opportunities for health promotion. Planning involves setting measurable, attainable goals for desired outcomes. Nurses implement interventions in the implementation phase and evaluate outcomes in the final phase to assess the effectiveness of interventions and adjust care plans if necessary (American Nurses Association, 2020).

Clinical Judgement Functions within the Nursing Process

Clinical judgement in the nursing process entails six primary functions that guide the nurse in patient care. Recognizing cues, such as symptoms, health history, and environmental factors, is essential in identifying the patient’s clinical presentation. Analyzing cues links these observations to client needs and concerns. Nurses prioritize hypotheses to determine which health issues require immediate attention, often considering lab values, diagnostic tests, and risk assessments. In generating solutions, nurses establish expected outcomes aligned with patient needs and determine the most appropriate interventions. Actions are then taken through the implementation of these planned interventions, and outcomes are evaluated to reach a conclusion on the effectiveness of the care provided. Nurses must continuously adapt and personalize care approaches based on the patient’s response to interventions (Smith & Brown, 2019).

Nursing Process and Interventions

The nursing process encompasses a structured framework to provide consistent care. Nurses employ various types of interventions to address patient needs. Nurse-initiated interventions, or independent actions, include patient education and health promotion activities that do not require provider orders. Health care provider-initiated interventions require a prescription, such as medication administration or surgery preparation. Collaborative interventions involve the input of multiple health care professionals, ensuring comprehensive care that integrates various expertise. Effective implementation involves both direct and indirect care activities, such as infection control and documentation. During the evaluation phase, nurses assess whether the patient’s health goals have been met, identifying any barriers to success and revising care plans as needed to meet the patient’s changing health needs (Johnson, 2022).

Nursing Process Table

Phases of Nursing Process	Key Activities	Outcomes Expected
Assessment	Gathering subjective and objective data through patient interaction and observation.	Detailed patient information to establish health baseline
Diagnosis	Interpreting data to identify health issues, risks, and needs.	Clear statement of patient’s health status and priorities
Planning	Setting achievable, measurable goals and selecting interventions.	Concrete goals and interventions tailored to patient needs
Implementation	Performing planned interventions, coordinating care with health teams.	Effective interventions aligned with patient care goals
Evaluation	Assessing intervention effectiveness and revising care plan as needed.	Outcome comparison to goals, guiding ongoing patient care

EVALUATING ACTION PLANS IN NURSING CARE

Standard of Care

Scope of Practice

The scope of practice in nursing encapsulates the values and abilities that nurses bring to patient care. It defines what nurses are authorized to do based on professional standards, healthcare laws, and evidence-based knowledge. State Nurse Practice Acts, the American Nurses Association (ANA), and guidelines from The Joint Commission outline these standards. Additionally, facility policies, procedures, state, and federal laws help shape the practice framework, ensuring that nurses provide quality care within legally defined boundaries (American Nurses Association, 2015).

Informed Consent
Informed consent is fundamental in medical procedures, requiring that patients are informed about potential risks, benefits, alternatives, and consequences if they decline a procedure. While healthcare providers bear the primary responsibility for obtaining informed consent, nurses play a critical role in this process. They witness the consent, verify the patient’s understanding, and ensure proper documentation. Nurses are obligated to report any lack of clarity to the healthcare provider, ensuring that patients make informed decisions (Emanuel et al., 2020).

Negligence and Malpractice

Negligence occurs when a nurse’s actions fall below the accepted standard of care, whereas malpractice, a subset of negligence, involves harm due to professional failure. Essential elements for malpractice consideration include duty to provide care, breach of duty, foreseeability of harm, potential for harm, and actual occurrence of harm. Nurses must be vigilant in upholding the standard of care, taking proactive measures to prevent instances of negligence or malpractice (National Council of State Boards of Nursing, 2018).

AGING AND CARE FOR OLDER ADULTS

Physiological Changes in Aging

Integumentary, Respiratory, and Cardiovascular Systems

Aging impacts various body systems, leading to visible and functional changes. The skin loses elasticity, hair grays, and nail growth slows. In the respiratory system, cough reflexes decrease, and chest rigidity increases, challenging respiratory efficiency. Cardiovascular changes include vessel wall thickening, reduced cardiac output, and increased blood pressure due to vascular rigidity. Recognizing these age-related changes helps healthcare providers tailor interventions to maintain the health and comfort of older adults (World Health Organization, 2019).

Sensory and Cognitive Changes

Age-related sensory changes, such as presbyopia and hearing loss (presbycusis), affect vision and hearing. The decline in taste, smell, and proprioception can impact an older adult’s quality of life and safety. Cognitive impairments, including delirium, dementia, and depression, present unique challenges in care, requiring personalized approaches. Each condition requires specific strategies to ensure safety, prevent further cognitive decline, and improve the patient’s overall well-being (Alzheimer’s Association, 2022).

End-of-Life and Palliative Care

End-of-life care aims to provide comfort and dignity to patients in their final stages of life. Hospice care focuses on palliative rather than curative treatment and involves a multidisciplinary team to manage symptoms effectively. Nurses play an integral role in assisting patients and their families through the decision-making process, providing support, and ensuring respectful, compassionate care that aligns with patients’ wishes (National Hospice and Palliative Care Organization, 2020).

MANAGING GRIEF AND END-OF-LIFE DECISIONS

Grieving Process and Support

Grief and Mourning

Grief is an emotional response to loss, often experienced before or after death. Mourning includes socially and culturally specific practices that help individuals cope with their losses. The Kubler-Ross Grief Cycle outlines five stages—denial, anger, bargaining, depression, and acceptance—that individuals often experience in response to significant loss. Nurses must understand these stages to provide empathetic and supportive care to grieving patients and families (Kubler-Ross & Kessler, 2014).

End-of-Life Decisions

Advanced directives, such as living wills and Do Not Resuscitate (DNR) orders, help guide patient care near the end of life. Nurses are essential in educating patients and families about these documents and ensuring that their wishes are respected. They play a critical role in postmortem care, including facilitating family viewing and coordinating organ or tissue donations when appropriate. Compassionate care in these moments is crucial to supporting families through grief and providing a dignified farewell (American Society of Pain Management Nurses, 2019).

References

American Nurses Association. (2015). Nursing: Scope and Standards of Practice (3rd ed.). American Nurses Association.
Alzheimer’s Association. (2022). Cognitive health and aging. Retrieved from www.alz.org
Emanuel, E. J., Wendler, D., & Grady, C. (2020). What makes clinical research ethical?. The Journal of the American Medical Association, 283(20), 2701-2711.
Kubler-Ross, E., & Kessler, D. (2014). On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss. Scribner.
National Council of State Boards of Nursing. (2018). Professional boundaries in nursing. Retrieved from www.ncsbn.org
National Hospice and Palliative Care Organization. (2020). Standards of practice for hospice programs. Retrieved from www.nhpco.org

NR 226 Exam 1

American Nurses Association. (2020). Nursing: Scope and Standards of Practice. American Nurses Association.
Johnson, M. (2022). Clinical Nursing Skills and Techniques. Elsevier Health Sciences.
Smith, R., & Brown, L. (2019). Fundamentals of Nursing: The Art and Science of Person-Centered Care. Lippincott Williams & Wilkins.