NR 226 Exam 1

Student Name

Chamberlain University

NR-226: Fundamentals – Patient Care

Prof. Name

Date

NR 226 Exam 1 Review

Clinical Judgement and Decision-Making

Clinical judgment and decision-making in nursing are critical processes that allow nurses to evaluate patient conditions and make well-informed decisions to promote optimal health outcomes. Nurses employ critical thinking to identify appropriate interventions, prioritize care needs, and provide patient-centered care. The clinical decision-making process aligns closely with the nursing process, a structured and systematic approach to care. This process consists of five phases: Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE). Each phase contributes to comprehensive, evidence-based care.

During the assessment phase, nurses collect both subjective and objective data to gain a clear understanding of the patient’s health status. The diagnosis phase involves analyzing this data to identify existing or potential health problems, risk factors, and opportunities for health promotion. In the planning phase, measurable and attainable goals are established to guide interventions. The implementation phase involves executing these interventions, followed by evaluation, which assesses their effectiveness and informs adjustments to the care plan as needed (American Nurses Association, 2020).

Clinical Judgement Functions within the Nursing Process

Clinical judgment in the nursing process encompasses six essential functions that guide patient care:

Recognizing cues – identifying relevant patient symptoms, history, and environmental factors.
Analyzing cues – interpreting these observations to understand patient needs and concerns.
Prioritizing hypotheses – determining which health issues require immediate attention using lab results, diagnostics, and risk assessment.
Generating solutions – developing expected outcomes and selecting interventions aligned with patient needs.
Taking action – implementing interventions in a coordinated, effective manner.
Evaluating outcomes – assessing the results of interventions and modifying care based on patient responses (Smith & Brown, 2019).

Nursing Process and Interventions

The nursing process provides a framework for delivering consistent and high-quality care. Nurses utilize different types of interventions based on patient needs:

Nurse-initiated interventions: Independent actions, such as patient education and health promotion.
Health care provider-initiated interventions: Actions requiring a provider’s order, including medication administration or procedural preparation.
Collaborative interventions: Interventions involving multiple healthcare professionals for comprehensive care.

Effective intervention involves both direct (e.g., administering medication) and indirect (e.g., documentation, infection control) care. The evaluation phase ensures that health goals are met, identifies barriers, and allows for modification of the care plan to respond to changing patient conditions (Johnson, 2022).

Nursing Process Table

Phases of Nursing Process	Key Activities	Outcomes Expected
Assessment	Collect subjective and objective data through observation and patient interaction.	Detailed baseline information about the patient’s health.
Diagnosis	Interpret data to identify health problems, risks, and patient needs.	Clear understanding of patient health status and care priorities.
Planning	Develop measurable goals and select appropriate interventions.	Achievable objectives and tailored interventions.
Implementation	Execute interventions and coordinate care with healthcare teams.	Effective interventions that align with patient goals.
Evaluation	Assess the effectiveness of interventions and adjust care plans.	Outcome comparison to goals, guiding ongoing care decisions.

Evaluating Action Plans in Nursing Care

Standard of Care and Scope of Practice

The scope of practice defines what nurses are authorized to perform based on professional standards, legal requirements, and evidence-based knowledge. Regulatory frameworks, including State Nurse Practice Acts, the American Nurses Association (ANA), and The Joint Commission guidelines, define the professional boundaries of nursing practice. Institutional policies, procedures, and federal and state laws further shape the practice, ensuring safe, effective, and legally compliant care delivery (American Nurses Association, 2015).

Informed Consent

Informed consent is a foundational principle in healthcare, ensuring that patients understand the risks, benefits, alternatives, and potential consequences of declining a procedure. While healthcare providers are primarily responsible for obtaining consent, nurses play a key role in witnessing consent, verifying patient comprehension, and documenting appropriately. Nurses must report any gaps in understanding to the provider to ensure patient autonomy and informed decision-making (Emanuel, Wendler, & Grady, 2020).

Negligence and Malpractice

Negligence occurs when nursing actions fall below the standard of care, while malpractice refers to professional failures causing patient harm. Key elements of malpractice include duty, breach of duty, foreseeability of harm, potential for harm, and actual harm occurrence. Nurses must uphold professional standards and take proactive measures to avoid negligence and 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 results in significant physiological changes across multiple systems. The skin loses elasticity, hair grays, and nail growth slows. Respiratory changes, including decreased cough reflex and chest rigidity, reduce pulmonary efficiency. Cardiovascular aging involves thickened vessel walls, reduced cardiac output, and increased blood pressure, impacting overall health. Understanding these changes allows nurses to tailor interventions to maintain older adults’ health and comfort (World Health Organization, 2019).

Sensory and Cognitive Changes

Sensory impairments, such as presbyopia and presbycusis, affect vision and hearing. Declines in taste, smell, and proprioception influence quality of life and safety. Cognitive changes, including delirium, dementia, and depression, necessitate individualized care strategies to prevent further decline and promote well-being (Alzheimer’s Association, 2022).

End-of-Life and Palliative Care

End-of-life care emphasizes comfort, dignity, and symptom management for patients in their final stages. Hospice care provides palliative, rather than curative, interventions through a multidisciplinary team. Nurses support patients and families, facilitating informed decisions and delivering compassionate care aligned with patient wishes (National Hospice and Palliative Care Organization, 2020).

Managing Grief and End-of-Life Decisions

Grieving Process and Support

Grief is the emotional response to loss, while mourning encompasses culturally influenced practices that facilitate coping. The Kubler-Ross Grief Cycle—denial, anger, bargaining, depression, and acceptance—guides nurses in understanding patient and family experiences. Awareness of these stages allows nurses to provide empathetic support and address emotional needs effectively (Kubler-Ross & Kessler, 2014).

End-of-Life Decisions

Advanced directives, including living wills and Do Not Resuscitate (DNR) orders, provide guidance for patient care. Nurses educate patients and families about these directives, ensure wishes are respected, and perform postmortem care, including facilitating family presence and coordinating organ or tissue donations. Compassionate care during these moments is critical to supporting families 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.

American Nurses Association. (2020). Nursing: Scope and Standards of Practice. American Nurses Association.

Alzheimer’s Association. (2022). Cognitive health and aging. Retrieved from www.alz.org

American Society of Pain Management Nurses. (2019). End-of-life care guidelines. Retrieved from www.aspmn.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.

Johnson, M. (2022). Clinical Nursing Skills and Techniques. Elsevier Health Sciences.

NR 226 Exam 1

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

Smith, R., & Brown, L. (2019). Fundamentals of Nursing: The Art and Science of Person-Centered Care. Lippincott Williams & Wilkins.

World Health Organization. (2019). Ageing and health. Retrieved from www.who.int