NR 511 Week 1 Notes: Reading: Chapters 4, 5 and 80 () Looking back on your first practicum week and classroom work, ask yourself the following: • Do I understand what a differential di agnosis is? • Do I know the difference between subjective and objective data? • Can I identify the CC and HP...
Looking back on your first practicum week and classroom work, ask yourself the
following:
Do I understand what a differential diagnosis is?
Do I know the difference between subjective and objective data?
Can I identify the CC and HPI for a patient encounter and incorporate review of
systems and physical exam findings to develop a differential?
Chapter 4: pg. 39-57
Circle of Caring Modeling – provides a framework for advanced nursing practice – nursing origin
approach with aspects of traditional medical model
Incorporates patient experience, context of experience, and environment of care
Traditional modes of medical practice (history taking, physical assessment data, labs, functional
measures, pharmacological)
Nursing perspective (holistic measures, functional health patterns)
Data collection process leads to a) medical diagnoses as listed by International Classification of
Disease 10th E and b) NANDA nursing diagnoses and human response to diagnosis (prevention
and wellness)
Includes elements from medical realm and expanded nursing base
Purpose and Goal of Diagnostic Reasoning pg. 40
Solve a physical problem
Health promotion
Disease prevention
Screening for high risk problems (using appropriate guidelines)
Utilize motivational interviewing techniques
Uncover “true concern”
Influence behavioral change
Unique Aspects of Primary Care
Different from acute care (presenting complaints, presentation of chronic illness)
Problem solving, symptom management, screening for problems undetected, supporting health
promotion, disease prevention, injury prevention, behavioral changes, patient education,
treatment options, health literacy considerations
Patients and their families are the ones that will carry out the care (versus inpatient)
, Nursing and the Medical Model
Nursing – consideration of individual and family responses to actual or potential threats to
health, helping patients cope with disease processes, anticipates human distress, works on the
level of what an illness experience means to the patient
Medical – new diagnostic reasoning possibilities, new treatment options for specific problems
NP designs a treatment or health promotion plan - patients are actively involved in their own
care
Patient-Advanced Practice Nurse Linkage Model
Clinical judgement – happens in a dialogue with the patient (not in the NP mind alone)
Effective and satisfactory encounters require quality communication and agreement about what
the encounter is meant to accomplish (common goals, understand the patient’s goal for the
encounter)
This model includes interactions between patient factors, nurse factors, and context
Patient Factors – symptom experience, resources, supports, commitments/obligations, personal
history, attention, goals
Nurse Factors – Knowledge (human development, disease trajectory, family dynamics,
psychological theory, spirituality, experience), Skill (interviewing, physical exam, teaching,
counseling), Attitude (Openness, courage, persistence, honesty, respect, confidence, humility,
attention, presence)
Context – Purpose of the visit, time constraints, resource constraints
Johnson’s phases of encounter – establishing agenda, elicit information from the patient, include
being alert to cues and helping to problem solve, conduct physical exam, attend to comfort level,
preparing and informing, developing a plan of care and using a teachable moment (patient
centered teaching)
NP personalizes solutions-based o knowing the patient
NP’s communication style is biopsychosocial or biomedical
Biopsychosocial – higher patient satisfaction and better adherence to treatment plan
Clinical Process – Limitations: Human Memory Limitations
Information process model – used to understand diagnostic reasoning – comprised of short (7
bits of data at a time, holds new pieces of info and elements of patient history and physical data)
and long term memory (unlimited, ability to retrieve a fact depends on frequency with which
fact is brought forward to use and on organizational structure like body systems and functional
health patterns systems of data organization)
Information processing model leaves out human experience (emotional responses, interactions,
empathize, being invested in patients)
Critical Thinking pg. 42
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