Nursing Strategies for Success

Chapter 5

Successful Intelligence

• Two men out hunting

Successful intelligent thinking is BALANCED

Sabiduría• Knowledge vs. Wisdom• Knowledge:

– Gaining information, understanding concepts• Wisdom

– Collected meaning and significance gained from knowledge

What is thinking?

• Asking questions • Move towards answers

Is there such a thing as a “bad question”?

• Yesterday I was at my local COSTCO buying a large bag of Purina dog chow for my loyal pet, Jake, the Wonder Dog and was in the check-out line when a woman behind me asked if I had a dog.

Is there such a thing as a “bad question”?

• What did she think I had an elephant?• So since I'm retired and have little to do, on impulse I

told her that no, I didn't have a dog, I was starting the Purina Diet again.

• I added that I probably shouldn't, because I ended up in the hospital last time, but that I'd lost 50 pounds before I awakened in an intensive care ward with tubes coming out of most of my orifices and IVs in both arms.

Is there such a thing as a “bad question”?

• I told her that it was essentially a Perfect Diet and that the way that it works is, to load your pants pockets with Purina Nuggets and simply eat one or two every time you feel hungry.

• The food is nutritionally complete so it works well and I was going to try it again.

• (I have to mention here that practically everyone in line was now enthralled with my story.)

Is there such a thing as a “bad question”?

• Horrified, she asked if I ended up in intensive care, because the dog food poisoned me.

• I told her no, I stepped off a curb to sniff apoodle and a car hit me.

• I thought the guy behind her was going to have a heart attack he was laughing so hard.

• “Only students who have questions are really thinking and learning”

• Ask questions that stimulate thought.

• “The difference between good science and great science is the quality of the questions posed.” ~ William Hunter

You want to get an A in your anatomy class

• Use questions to analyze:– What do I need to memorize this week?– What multiple pathway to learning is my strength?

• Come up with creative ideas:– What are different ways to study using my strength?

• Apply practical solutions– What ways can I study my anatomy to memorize the

body systems?– When will I use these study skills?

Know your purpose!

• What are you trying to accomplish?• Are your questions leading you towards that

purpose?

Can you get smarter?

• “As jogging is to the body, thinking is to the brain.” ~ Nob Yoshigahara (puzzle master)

January 5, 2010Puzzles and Alzheimer's

• A new study adds to a growing body of evidence that mentally challenging activities like word games, playing cards, reading and writing may delay the rapid memory loss that occurs with Alzheimer’s disease.

• The study involved 488 people who were in their 70s and 80s. All were free from Alzheimer’s at the start. Each participant filled out questionnaires about how often they participated in six leisure-time activities: reading books, magazines or newspapers, writing, doing crossword puzzles, playing board or card games, participating in group discussions or playing music.

• “The effect of these activities in late life appears to be independent of education,” Dr. Hall said. “These activities might help maintain brain vitality.”

How can You improve your analytical thinking skills?

AKA: Critical Thinking• Gathering information• Analyzing & Clarify• Evaluating for the purpose of

– Gaining understanding– Solving a problem– Making a decision

Gather information

• (Define your purpose!)• Information

– How much do you need?– How much time do you spend gathering?– Is the information relevant?

Analyze & Clarify information

• Break information into parts– Separate the ideas– Compare and Contrast– Examine cause and effect*– Look for themes, patterns and categories

Analyze & Clarify information

• Examine whether examples support ideas• Distinguish fact from opinion

– Subjective Information– Objective Information

Objective information

• Is observable, able to be seen, heard or touched, smelled, tasted

• Factual• Able to be counted• Able to be described• The same from multiple reporters• is verifiable. Another person can repeat the

observation, you can perform some type of test, etc.

Objective language

• I saw…• I counted…• I observed…• This is what he did…• This is what it sounded like…

Subjective information

• Is opinion, judgment, Assumption, beliefs, rumor or suspicion

• Varies from person to person, day to day• Information that can be interpreted differently

by other people• is what comes out of the patient or family's

mouth.

Subjective language

• I feel …

Diabetes Case Study• M.G. is a 58 y/o white female who

presents to her primary care physician with a complaint of “tired all the time.”

• Height:5’4”• Weight:212 lbs.• It’s been going on for several months,

and she doesn’t report any concerns with nighttime sleep.

• She doesn’t note any new stress or other life changes, and denies depression or anxiety.

• Alcohol consumption is limited to one to two drinks per week, and she quit smoking over 10 years ago.

• BP:135/86

• Family history is notable for type 2 diabetes in an older sister; her mother had hypothyroidism and “heart disease.”

• The patient also has high cholesterol that she has been trying to treat with “weight loss and exercise.”

• She walks about 20 minutes three times weekly when the weather allows.

• Lung sounds are clear• Pulse regular and strong• She has been treated for about five

years for hypertension with hydrocholorthiazide.

• No thyromegaly

Analyze & Clarify information

• Examine whether examples support ideas• Distinguish fact from opinion

– Subjective vs. Objective • Examine perspective & Assumptions

– Bias– Prejudices

• Evaluate information

Assess Analytical Thinking Skills

• I tend to perform well on objective tests.• People say I’m a “thinker”, “brainy”, “studious”.• I am not comfortable with gray areas – I prefer

information to be laid out in black and white.• In a group setting, I like to tackle the details of a

problem• I sometimes over think things and miss my

moment of opportunity.

How to Improve your creative thinking skills

Improving creativity

• Brainstorming– Divergent thinking– Group think

Improving creativity

• Shift your perspective– Challenge assumptions– Take a new and different look – Ask “what if” questions

Improving creativity

• Set the stage for creativity– Choose – or create environments that free your

mind– Be curious– Give yourself time to “sit” with a question– Believe in yourself as a creative thinker

Improving Creativity

• Take risks– Fly in the face of convention– Let mistakes be Okay

Assess creative thinking

• I tend to resist rules and regulations.• People say I’m “expressive,” “full of ideas,”

innovative.• I break out of my routine and find new

experiences• In a group setting I like to toss ideas into the

ring• If you say something too risky, I’m all for it.

Improving practical thinking skills

• Experience– “Experience is the greatest teacher!”– Benjamin Franklin (Poor Richard's Almanack, Nov.

1743) offered, "Experience keeps a dear school, yet fools learn in no other.“

• The emotional intelligence connections

Practical thinking means action!

• Stay motivated• Make the most of your personal strengths• When things go wrong, accept responsibility

and reject self pity• Focus on the goal and avoid distractions• Manage time and tasks effectively• Believe in yourself

Assess practical thinking skills

• I can find a way around any obstacle• People say I’m a “doer” and “go-to” person

“organized”.• When I have a vision, I translate it into steps

from A to B to C.• In a group setting, I like to set up the plan• I don’t like to leave loose ends dangling – I’m a

finisher.

How is this type of thinking used in Nursing?

• NURSING PROCESS!

Overview of the Nursing Process

• Consists of 5 steps– Assessment– Diagnosis– Planning– Implementation– Evaluation

• Build on each other• Not linear

• Nursing process is dynamic and requires creativity in its application– Steps remain the same– Application and results different

• Used throughout the life span in any care setting

Small group questions:

1. How many steps are in the nursing process?2. What are the names of each of the steps?3. What is the purpose of the nursing process?4. In what clinical setting is the nursing process

used?

Assessment

• Step #1• Involves

– Collecting data (from variety of sources)– Validating the data– Organizing the data– Interpreting the data– Documenting the data

Assessment

• Validating the Data• Organizing the Data• Interpreting the Data

– Relevant vs. irrelevant– Gaps?– Identify patterns

• Document the Data

Small Group Questions

Which of the following are objective data and which are subjective data.A. NauseaB. VomitingC. Unsteady gaitD. AnxietyE. Bruises on the right arms and faceF. Temperature 101 F

Diagnosis

• Step 2 in the nursing process– Formulating a nursing diagnosis– Analysis and synthesis of data

• Nursing diagnosis:– “A clinical judgment about individual, family or

community responses to actual or potential heal problems / life processes.

– A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.”

Medical vs. Nursing diagnosis

Medical diagnosis Nursing diagnosis

Identifies conditions the MD is licensed & qualified to treat

Identifies situations the nurse is licensed & qualified to treat

Medical vs. Nursing diagnosis

Medical diagnosis Nursing diagnosis

Identifies conditions the MD is licensed & qualified to treat

Identifies situations the nurse is licensed & qualified to treat

Focuses on illness, injury or disease processes

Focuses on the clients responses to actual or potential health / life problems

Medical vs. Nursing diagnosis

Medical diagnosis Nursing diagnosis

Remains constant until a cure is effected

Changes as the clients response and/or the health problem changes

Medical vs. Nursing diagnosis

Medical diagnosis Nursing diagnosis

Remains constant until a cure is effected

Changes as the clients response and/or the health problem changes

i.e. Breast cancer i.e. Knowledge deficitPowerlessnessGrieving, anticipatoryBody image disturbanceIndividual coping, ineffective

DiangosisNursing diagnosis Medical diagnosis

Breathing patterns, ineffective

Chronic obstructive pulmonary disease

Activity intolerance Cerebrovascular accident

Pain Appendectomy

Body image disturbance Amputation

Body temperature, risk for altered

Strep throat

Planning & Outcome identification

• Step Three: Planning• Identifying outcomes

– Goals• An aim, intent or end.

– Short term goals• Hours to days (less than a week)

– Long term goals• Weeks to months

Planning & Outcome identification

• Developing specific nursing interventions– Independent nursing interventions

• No order needed– Elevate edematous legs

– Interdependent nursing interventions• In conjunction with an interdisciplinary team member

– Assist client with physical therapy exercises

– Dependent nursing interventions• Require an order

– Administering of medications

• Prioritizing the nursing diagnosis– Maslow’s hierarchy of needs

Maslow’s Hierarchy of Needs

Implementation

• 4th step:– Execution of the nursing care plan– Delegation

–DO IT–DO IT RIGHT–DO IT RIGHT NOW!

Evaluation

• 5th step– Determining whether

the clients goals have been met, partially met or not met.

Solving a problem

• Define the problem• Analyze the problem• Solutions

– Potential positive effects– Potential negative effects

• Practical action• Final Evaulation

Decision making thoughts

• Look at the given options – then try to think of more

• Think how decision effects others• Gather perspectives• Look at the long term effects• Ethical dilemmas –• Keeping your balance

Solving a problem

• SOAP!– Subjective– Objective– Assessment– Plan