Introduction Core Competencies for Healthcare Professionals Roles of the Nurse in Medical-Surgical Nursing Gordon’s Functional Health Pattern The Nursing Process and Critical Thinking Nursing Diagnosis for Patients with Complex Disorders. Core Competencies for Healthcare Professionals What is a Competency and Why is it Important? Competence is a multifaceted and dynamic concept that is more than knowledge and includes the understanding of knowledge, clinical skills, interpersonal skills, problem solving, clinical judgment, and technical skills. Nursing Professional Competencies 11 CORE COMPETENCIES IN NURSING SAFE AND QUALITY NURSING CARE MANAGEMENT OF RESOURCES AND ENVIRONMENT'S HEALTH EDUCATION LEGAL RESPONSIBILITY ETHIC/MORAL RESPONSIBILITY PERSONAL AND PROFESSIONAL DEVELOPMENT QUALITY IMPROVEMENT RESEARCH RECORD MANAGEMENT COMMUNICATION COLLABORATION AND TEAMWORK A. Safe and Quality Nursing Care 1. Demonstrates knowledge based on the health/illness status of individual groups. 2. Provides sound decision making in the care of individuals/groups. 3. Promotes wholeness and well-being including safety and comfort of patients. 4. Sets priorities in nursing care based on patients' need. 5. Ensures continuity of care. 6. Administers medications and other health therapeutics. 7. Utilizes the nursing process as framework for nursing. 8. Formulates a plan of care in collaboration with patients and other members of the health team. 9. Implements planned nursing care to achieve identified outcomes. 10. Evaluates progress toward expected outcomes. 11. Responds to the urgency of the patient's condition. B. Management of Resources and Environment 1. Organizes work load to facilitate patient care 2. Utilizes resources to support patient care 3. Ensures availability of human resources 4. Checks proper functioning of equipment/ facilities. 5. Maintains a safe and therapeutic environment. 6. Practices stewardship in the management of resources C. Health Education 1. Assesses the learning needs of the patient and family. 2. Develops health education plan based on assessed and anticipated. 3. Develops learning materials for health education. 4. Implements the health education plan. 5. Evaluates the outcome of health education. D. Legal Responsibility 1. Adheres to practice in accordance with the nursing law and other relevant legislation including contracts, informed consent 2. Adheres to organizational policies and procedures, local and national 3. Documents care rendered to patients E. Ethico-Moral Responsibility 1. Respects the rights of individuals/groups 2. Accepts responsibility and accountability for own decisions and actions 3. Adheres to the national and international code of ethics for nurses. F. Personal and Professional Development 1. Identifies own learning needs. 2. Pursues continuing education. 3. Gets involved in professional organizations and civic activities. 4. Projects a professional image of the nurse. 5. Possesses positive attitude towards change and criticism. 6. Performs function according to professional standards. G. Quality Improvement 1. Utilizes data for quality improvement. 2. Participates in nursing audits and rounds 3. Identifies and reports variances. 4. Recommends solutions to identified causes of the problems. 5. Recommends improvement of systems and processes. H. Research 1. Utilizes varied methods of inquiry in solving problems. 2. Recommends actions for implementation. 3. Disseminates results of research findings. 4. Applies research findings in nursing practice. I. Record Management 1. Maintains accurate and updated documentation of patient care. 2. Records outcome of patient care. 3. Observes legal imperatives in record keeping. 4. Maintains an effective recording and reporting system. J. Communication 1. Utilizes effective communication in relating with 2. 3. 4. 5. clients, members with the team and the public in general. Utilizes effective communication in therapeutic use of self to meet the needs of clients. Utilizes formal and informal channels. Responds to needs of individuals, families, groups and communities. Uses appropriate information technology to facilitate communication. K. Collaboration and Teamwork 1. Establishes collaborative relationship with colleagues and other members of the health team for the health plan. 2. Functions effectively as a team player. Gordon’s Functional Health Patterns Gordon's functional health patterns is a method devised by Marjory Gordon to be used by nurses in the nursing process to provide a more comprehensive nursing assessment of the patient. A guide for establishing a comprehensive nursing data base. These 11 categories make possible a systematic and standardized approach to data collection, and enable the nurse to determine the following aspects of health and human function: GORDON’ Functional Health Patterns 1. PATTERN OF HEALTH PERCEPTION & HEALTH MANAGEMENT How does the person describe her/ his current health? What does the person do to improve or maintain her/ his health? What does the person know about links between lifestyle choices and health? How big a problem is financing health care for this person? Can this person report the names of current medications s/he is taking and their purpose? If this person has allergies, what does s/he do to prevent problems? What does this person know about medical problems in the family? Have there been any important illnesses or injuries in this person's life? 2. NUTRITIONAL - METABOLIC PATTERN Is the person well nourished? How do the person's food choices compare with recommended food intake? Does the person have any disease that effects nutritionalmetabolic function? 3. PATTERN OF ELIMINATION Are the person's excretory functions within the normal range? Does the person have any disease of the digestive system, urinary system or skin? 4.PATTERN OF ACTIVITY & EXERCISE How does the person describe her/ his weekly pattern of activity and leisure, exercise and recreation? Does the person have any disease that effects her/ his cardio-respiratory system or musculo-skeletal system? 5. COGNITIVE - PERCEPTUAL PATTERN Does the person have any sensory deficits? Are they corrected? Can this person express her/ himself clearly and logically? How educated is this person? Does the person have any disease that effects mental or sensory functions? If this person has pain, describe it and it's causes. 6. PATTERN OF SLEEP & REST Describe this person's sleep-wake cycle. Does this person appear physically rested and relaxed? 7. PATTERN OF SELF PERCEPTION & SELF CONCEPT Is there anything unusual about this person's appearance? Does this person seem comfortable with her/ his appearance? Describe this person's feeling state? 8. ROLE - RELATIONSHIP PATTERN How does this person describe her/ his various roles in life? Has, or does this person now have positive role models for these roles? Which relationships are most important to this person at present? Is this person currently going though any big changes in role or relationship? What are they? 9. SEXUALITY - REPRODUCTIVE PATTERN Is this person satisfied with her/ his situation related to sexuality? How have the person's plans and experience matched regarding having children? Does this person have any disease/ dysfunction of the reproductive system? 10. PATTERN OF COPING & STRESS TOLERANCE How does this person usually cope with problems? Do these actions help or make things worse? Has this person had any treatment for emotional distress? 11. PATTERN OF VALUES & BELIEFS What principals did this person learn as a child that are still important to her/ him? Does this person identify with any cultural, ethnic, religious, regional, or other groups? What support systems does this person currently have? Test Check your understanding of the differences between these 11 functional patterns, and how a nursing diagnosis might express a dysfunction in one or more patterns. Identify the specific functional pattern(s) that would be at-risk or dysfunctional for the following nursing diagnoses to be made: 1. Social isolation related to immobility (presence of contagious infection). 2. Chronic low self-esteem related to obesity 3. knowledge deficit (signs of hypoglycemia) (signs and symptoms of hyperglycemia) 4. Spiritual distress related to inability to practice religious rituals 5. Diversional activity deficit related to long-term confinement to home. 6. Sleep pattern disturbance related to sensory overload. 7. Ineffective family coping: disabling related to recurrent marital discord. 8. Role performance disturbance related to effects of chronic pain. 9. Potential for violence directed at others related to effects of hallucinations. The Nursing Process Assessment Nursing assessment Collection and verification of data Analysis of data Database Consists of client’s perceived needs, health problems, and responses to problems Ex: Newly diagnosed Diabetes Mellitus Type 1 client coming to physician’s office for a routine appointment. Client’s verbalized that she has been losing weight ( 7 pounds in 2 weeks), keep waking up at night to go to bathroom and always thirsty. Her mood also changed – irritable and moody. The MD ordered to check client’s blood sugar level. After checking noted BSL is 600 mg/dl. Assessment Subjective data Objective data Sources of data Client Family and significant others Health care team Medical record Methods of Data Collection Interview Nursing Health History Biographical Information Client expectations Present illness or health concerns Health history Family history Environmental history Psychosocial history Spiritual health Review of systems Documentation of findings Physical Examination Data Documentation The last component of assessment Legal and professional responsibility Requires accurate and approved terminology and abbreviations Nursing Diagnosis 1. Medical diagnosis A clinical judgment about the client in response to an actual or potential health problem 2. Nursing diagnosis The identification of a disease condition based on specific evaluation of signs and symptoms 3. Collaborative problem An actual or potential complication that nurses monitor to detect a change in client status Critical Thinking and the Nursing Process Diagnostic reasoning A process of using assessment data to create a nursing diagnosis Defining characteristics Clinical criteria or assessment findings Clinical criteria Objective or subjective signs and symptoms Concept Mapping Nursing Diagnosis A way to graphically represent the connections between concepts and ideas that are related to a central subject such as a client’s health problem. Concept maps promote problem solving and critical thinking skills by organizing complex client data, analyzing concept relationships and identifying interventions. Nursing Diagnosis: Application to Care Planning By learning to make accurate nursing diagnoses, your care plan will help communicate the client’s health care problems to other professionals. A nursing diagnosis will ensure that you select relevant and appropriate nursing interventions. Planning Establishing Priorities Helps nurses to anticipate and sequence nursing interventions Classification of priorities: High Intermediate Low Critical Thinking in Establishing Goals and Expected Outcomes Goal A broad statement that describes the desired change in a client’s condition or behavior An aim, intent, or end Expected outcome Measurable criteria to evaluate goal achievement Guidelines for Writing Goals Combining goals and outcomes statements Client centered Singular goal or outcome Observable Measurable Time limited Mutual factors Realistic Implementing Nursing Care Critical Thinking in Implementation. Review the set of all possible nursing interventions. Review all possible consequences associated with each possible nursing action. Determine the probability of all possible consequences. Make a judgment of the value of that consequence to the client. Evaluation Evaluation is an ongoing process. If outcomes are met, client goals are met. Positive evaluations occur when nurses meet desired outcomes. Positive evaluations lead nurses to conclude that interventions were successful.