Evidence-Based Practice Chapter 1

Evidence-Based Practice Chapter 1

Today's Topics: Announcements: Homework: • Evidence-Based Assessments • Collecting Data • Nursing Process • Priority Problems and Collaborative Problems Study

Lecture Topic: Evidence-Based Assessments

• Subjective data - everything patient reports; pain is always subjective • Objective data - everything that is observable ○ Inspecting ○ Percussing ○ Palpating ○ Auscultating ○ Subjective and Objective data collectively form database ▪ Purpose of assessment is to make judgement and diagnosis • Diagnostic reasoning - analyzing health and making conclusions ○ Cues - information; sign or symptom, data ○ Hypothesis - explanation for cue ○ Collecting Data ○ Evaluating ▪ cluster assessment data ▪ validate data for accuracy • Nursing Process ○ Assessment - collect data, evidence-based assessment ○ Diagnosis - clinical findings, clusters and interpretation, validation ○ Outcome Identification - identify, timeline ○ Planning - priorities, timelines, interventions ○ Implementation - provide interventions, coordinate care ○ Evaluation - outcomes, revise diagnosis, outcome and plan

• Priority Problems and Collaborative Problems ○ Priority Problems ▪ First-Level - emergent, life threatening, and immediate (breathing, airway) ▪ Second-Level - next in urgency, prompt interventions (mental status, acute pain, urinary elimination, abnormal labs, risks to safety/ infections) ▪ Third-Level - important to patient's health, long-term interventions, response to treatment may take more time ○ Collaborative Problems - approach to treatment involves multiple disciplines

• Evidence-Based Practice - emphasizes best evidence as well as patient's preferences and values ○ Evidence from research and evidence theories ○ Physical examination and assessment ○ Clinical expertise ○ Patient preference and values • Four Types of Data Collecting ○ Complete - health history and full physical exam ○ Focused on Problem-Centered - short-term problem, collect mini database for targeted ○ Follow-Up - status of problem is evaluated and updated ○ Emergency - urgent, rapid collection of crucial information; requires fast diagnosis.

Summary

To Know:

• Types of Data: subjective and objective

• Diagnostic Reasoning - cues, hypothesis, data collection, evaluating • Nursing Process - assessment, diagnosis, outcome, planning, implementation, evaluation • Priority and Collaborative Problems - level one, two, three, collaborative • Evidence - Based Practice; evidence, physical exam, expertise, patient values • Data Collecting - complete, focused, follow-up, emergency

Cultural Competence Chapter 2

Today's Topics: Announcements: Homework: • Health and Illness Beliefs • Demographic Profile • Cultural Competence Homework

Lecture Topic: Cultural Competency

• Demographic Profile of US ○ More than one-third are non-Hispanic Whites ○ Hispanics are the largest and fastest growing group ○ Blacks are second largest population ○ Asians, American Indians, Alaska Natives, Native Hawaiians, etc. one-third • Cultural Competence ○ ○ ○ ○ • Culture ○ ○ ○ ○

U n d e r s t a n d i n g nurse's values, beliefs, attitudes, practices Identifying "health" and how health care system works Knowledge of social backgrounds Familiarize with languages, interpretive services

Learned - from birth or language acquisition and socialization Shared - all members of same culture Adapted - specific conditions related to environmental and technical Dynamic - ever changing □ includes thoughts, communications, actions, beliefs, values, etc.• Health-Related Beliefs and Practices ○ Biomedical -scientific theory ▪ Cause and effect, body is a machine, life can be divided into parts, germ theory ○ Naturalistic - holistic theory (yin and yang, hot and cold) ▪ Nature kept in balance ▪ Opposing categories or forces ○ Magico-religious - supernatural powers predominate in health and illness ▪ Hispanics and American Indians believe that cure is incomplete unless healing is carried out for body, mind, and spirit.

Summary

To Know:

• Cultural Competence - nurse's values, identify to patient what "health" is, learn backgrounds • Demographic Profile - Hispanics fastest growing, blacks second • Culture - learned, shared, adapted, dynamic • Health-Related Beliefs and Practices - Biomedical, Naturalistic, Magico-religious

Study Questions

Competency Questions:

Who are you meeting for first time?Where does patient come from?What is their heritage, cultural background: ethnicity and religion? What language do they speak and read?What is their health and illness beliefs and practices?

The Interview Chapter 3

Today's Topics: Announcements: Homework: • Data Types • Interview Guidelines • Communication • Interviewing Traps • Use of an Interpreter Study

Lecture Topic: The Interview

• Subjective - data self-reported by patient • Objective - data observed using evidence-based assessments ○ Inspecting ○ Percussing ○ Palpating ○ Auscultating • Subjective and Objective data collectively form database ▪ Purpose of assessment is to make judgement and diagnosis • The Interview ▪ Time and Place, Introduction and explanation of role, purpose of interview, length of time, expectations of patient, other's present, confidentiality, cost • Process of Communication ▪ Sending ▪ Behavior, conscious and unconscious, verbal and nonverbal

▪ Body language: posture, gestures, expressions, eye contact etc.

▪ Receiving ▪ Attaches meaning based on past, culture, self-concept, and physical and emotional state ▪ Patient's problems intensify; dependent on problem to better ▪ Communication can be learned and polished ▪ Communication is a tool ▪ Internal and External Factors ▪ Internal and external factors influence that allows max communication

□ Internal factors: liking others, empathy, ability to listen

□ External factors: privacy, interruptions, environment, dress,

video recording ▪ Techniques of Communication