Putting practice to words
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Putting Practice to Words. Concept Mapping, Care Planning, & APA Formatting Ryan Rickley, SN Mentor Student Nurse National University. Objectives. Identify the proper use of concept mapping, as a means to deconstruct complicated ideas

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Putting practice to words

Putting Practice to Words

Concept Mapping, Care Planning,

& APA Formatting

Ryan Rickley, SN

Mentor Student Nurse

National University


Objectives

Objectives

  • Identify the proper use of concept mapping, as a means to deconstruct complicated ideas

  • Explain proper care planning technique – from conceptualization to evaluation

  • Discuss APA formatting and resources for help


Practice into words

Practice into Words

Concept Mapping

Breaking down & relating complex ideas.


Concept map

Concept Map

  • Takes complicated ideas and breaks them down

  • Allows you to see relationships between seemingly separate ideas

  • Helps to develop clinical judgment skills

  • Allows for prioritization, and elimination of data

  • When lost, start by mapping out your ideas, thoughts, experiences – it can guide you to the priorities


The concept map

The Concept Map


The concept map1

The Concept Map


Practice activity

Practice Activity

is an 88-year-old woman who presented with complaints of nausea, vomiting, and abdominal pain. Her vital signs on admission are temperature 99.6°F (37.6°C), blood pressure 145/90, pulse 125, and respiratory rate 24. Her laboratory tests reveal white blood cell count (WBC) 13,000/mm3, potassium (K+) 3.2 mEq/L, lipase 449 units/L, amylase 306 units/L, total bilirubin 3.4 mg/dL, direct bilirubin 2.2 mg/dL, aspartate aminotransferase (AST) 142 U/L, and alanine aminotrans- ferase (ALT) 390 U/L. Physical examination reveals a distended abdomen that is very tender on palpation. Bowel sounds are present in all four quadrants, but hypoactive. Mrs. Miller is admitted with a diagnosis of acute pancreatitis. She will be kept nothing by mouth (NPO). Intravenous (IV) fluid of D51/2 NS with 40 mEq of potassium chloride (KCl) per liter at 100 mL per hour is prescribed. The health care provider prescribes continued administration of her preadmission medica- tions, that is, pantoprazole sodium and levothyroxine sodium (in IV form because the client is NPO) and spironolactone (available in oral form), and adds the pre- scription of IV metoclopramide and morphine sulfate. A nasogastric (NG) tube is inserted and attached to low wall suction.

Mrs. Miller’s NG tube is draining yellow-brown drainage. Her pain is being man- aged effectively with IV morphine 4 mg every four hours. Mrs. Miller is anxious and has many questions for the nurse: “What is the test I am having done today? What is pancreatitis? Will I need to have surgery? Why did they put this tube in my nose? When will I be able to eat real food?” 


Practice into words1

Practice into Words

Care Planning

Guiding your practice with evidence.


Care plans

Care Plans

  • Are prioritized based on the client condition

  • Incorporate data gathered from assessment, patient chart, labs, etc.

  • Are SMART at every step

  • Formatted using APA

  • Speak to your practice – not a textbook’s

  • Convey what you did, will do, or should do for the patient to guide them towards wellness


Assessment

Assessment

Which data is important? (select all that apply)

  • Medical Diagnosis from Chart

  • Physical Findings from Assessment

  • Psychosocial Findings from Assessment

  • Suspected Problems/Issues from Assessment


Assessment1

Assessment

  • It’s a trick question: WE Look at EVERYTHING!!!

  • Ensure that your ASSESSMENT data is in your:

    • Diagnosis

    • Goals

    • Evaluations

  • Assessment data really doesn’t belong in Interventions


Diagnosis

Diagnosis

  • NANDA

    • ALWAYS use a NANDA. NEVER MAKE UP YOUR OWN!

  • Prioritize

    • WHICH problem is of greatest concern?

    • WHICH problem did you do the most work around?

    • WHICH problem requires the most re-assessment?

    • WHICH priority framework SUPPORTS your choice?

  • WHEN in doubt..

    • ABC’s or Maslow’s will guide your decision making


Prioritizing abc s

Prioritizing: ABC’s

  • Airway

    • Ineffective Airway Clearance

  • Breathing

    • Ineffective Breathing Pattern

    • Impaired Gas exchange

    • Inability to sustain spontaneous ventilation

  • Circulation

    • Altered Tissue Perfusion

    • Decreased Cardiac Output

    • Fluid Volume Excess


Putting practice to words

MASLOWS Hierarchy of Needs


Prioritizing mhon

Prioritizing: MHON

  • Physiological Needs: Food, Water, Warm, Rest

    • Fluid Volume Deficit

    • Imbalanced Nutrition

    • Ineffective Thermoregulation

    • Ineffective Sleeping Pattern

  • Physiological Needs: Safety

    • Impaired Skin Integrity

  • RISK Diagnosis START here!

    • Risk for: Injury, Falls, Infection, Body Temp, Aspiration


  • Let s talk about risk

    Let’s Talk about RISK

    • IF it’s a risk Dx, then:

      • IT HAS NOT HAPPENED YET!

      • You CANNOT have EVIDENCE (NO AEB!!)

      • It CANNOT be the priority

        • UNLESS….

      • Use THOUGHTFULLY! Probably not the most important.


    When use risk

    When use risk?

    Maybe use as a 3rd or 4th Dx… or in well-patients (I.E. OB):

    • Risk for Falls

    • Risk for Impaired Skin Integrity

    • Risk for Aspiration

      “Lame” Risk Dx:

    • Risk for Injury

    • Risk for Infection

    • Risk for Pain

      Can anyone tell me WHY these are “Lame”?

      Answer: Everyone is at risk for these things in the hospital.


    Let s write a dx

    Let’s write a Dx

    • Priority NANDA Diagnosis

    • R/T: disease processes, &/or suspected processes, &/or “the problem”

    • AEB

      • Think of this as “making your case” that you are correct in your diagnosis. Your diagnosis needs clinical support


    Example dx

    Example Dx

    Good:

    Ineffective gas exchange R/T pulmonary edema secondary to fluid volume overload d/t CHF AEB crackles bilaterally upon auscultation, ABG abnormalities (7.32, 50, 22), SPO2 91% on 6L per NC, BLE pulses +4, patient complaints of shortness of breath, difficulty breathing, and “feeling like their drowning”

    Bad:

    Ineffective gas exchange R/T problems breathing AEB low o2 levels, CHF, and crackles in their lungs


    How do you get the r t

    How do you get the R/T?

    Think:

    WHAT can cause this problem to occur? Use a concept map to look for the root-cause of the problem.

    If they can’t breath – WHY?

    If their o2 SATS are low – WHY?

    If their pulses are bounding – WHY?

    This will get you to your R/T – the medical diagnosis should confirm your results, not be your result


    How do you get the aeb

    How do you get the AEB?

    YOUR ASSESSMENT DATA!

    • Physical Assessment

    • Psychosocial Assessment

    • Patient Complaints

    • Medical Records / LAB data

    • GET IT ALL!! The more assessment data, the stronger your case.


    Practice activity1

    Practice Activity

    Pair in groups of 2-3

    1 minute

    Formulate your PRIORITY Dx


    Goals

    Goals

    • SMART GOALS

      • Specific: What is success?

      • Measureable: How will you evaluate?

      • Achievable/Realistic: Can you do it?

      • Timely: WHEN will your goal be evaluated?


    Goals1

    Goals

    • Short-Term

      • END of shift (as defined by..)

      • Very tangible

    • Long-Term

      • End of week, by discharge, etc.

      • (definite point in time still)


    Smart

    SMART

    • Specific

      • Patient will experience no seizure activity

    • Measureable

      • AEB absence of tonic-clonic events

    • AR

      • Yes, because nursing can control seizures with interventions (we don’t write this part…)

    • Timely

      • Through end of shift (1900).


    Put it together

    Put it together

    • Patient will be free of seizure activity AEB absence of tonic-clonic events through end of shift (1900).

      vs.

    • Patient will not experience any seizures during my shift.


    Practice activity2

    Practice Activity

    Pair in groups of 2-3

    1 minute

    Formulate your PRIORITY GOAL for Dx


    Interventions

    Interventions

    • THEY ARE WHAT YOU DID or WOULD do!

      • They should be SPECIFIC

      • They should be TIMELY

      • They should be MEASUREABLE

    • Seeing a pattern? 

    • Always include a rationale with your intervention.


    Strong vs weak

    Strong vs. Weak

    • Weak

      • Copying from the book

      • Saying things you would never do

      • Pulling stuff out of your, you know what

    • Strong

      • Real interventions that will impact the goal, and guide the client towards wellness

      • Something that you really did, or would do.

      • Something that would make the biggest improvement in the patient condition

      • You prioritize these as well, based on MOST helpful, to least helpful and/or least critical


    Interventions1

    Interventions

    • Infuse Magnesium Sulfate @ 125mL/hr per MD orders. Mg will prevent seizure activity by increasing the threshold of CNS activity.

    • Monitor VS/Neuro Vitals Q1H. S/Sxof impending seizures including ALOC, visual disturbances, and headaches, which would warrant further internvetion.

    • Monitor client for mag toxicity. S/SX including RR depression AEB <10 RR/min, Dysreflexia AEB Reflexes > or < +2, all indicate a critical change in condition.

    • Implement and maintain seizure precautions including padded bed rails, bed down, call light in reach, all ambulation with nursing assist, and bed alarm. Safety is the priority and responsibility of the nurse.


    Practice activity3

    Practice Activity

    Pair in groups of 2-3

    1 minute

    Formulate your PRIORITY

    Interventions for Dx


    Evaluations

    Evaluations

    • Guess what?

      • They should be SPECIFIC

      • They should be TIMELY

      • They should be MEASUREABLE

    • This is your chance to reflect on your practice, and recommend how to move forward with the care of this patient.

    • They should evaluate your interventions – did it work? Did your patients condition:

      • Improve

      • Worsen

      • Stay the Same


    Evaluations outcomes

    Evaluations/Outcomes

    • The short-term goal was not achieved as per evaluation at 1730. Although the interventions were implemented, the patient still displays the same s/sxof ineffective tissue profusion and requires reevaluation and new interventions that attempt to better address the patient’s needs.

    • The long-term goal cannot be evaluated at this time, however the nursing team should evaluate the effectiveness of their interventions based upon the results of ongoing assessment of the patient. The nurse should continue to advocate for the patient and work with the interdisciplinary team to identify treatment interventions that address the underlying medical conditions.


    Practice activity4

    Practice Activity

    Pair in groups of 2-3

    1 minute

    Formulate your Evaluation Statements


    Apa sources

    APA & Sources

    American Psychological Association

    Formatting


    Journals

    Journals

    • Are not scary!

      • You need them to legitimize your work.

      • They are your evidence to base your practice

    • Only peer reviewed-journals

    • Nursing sources are always preferred

    • Recent is always better (Past 5 years)

    • Use the library – it has great resources and saves you a lot of time

    • Check the automatic citations for errors


    General considerations

    General Considerations

    Running Head + Page Number in Header

    Title Page

    Headings

    In-text citations

    2 spaces after each sentence

    NO spaces between paragraphs

    Double spaced – 12 point fonts

    1 Inch Margins ALL sides

    References Page


    Running head 1 st page

    Running Head – 1st Page

    • Running Head: TITLE OF RUNNING HEAD

    • NO MORE THAN 50 characters TOTAL

    • Running Head = normal capitalization

    • TITLE IS ALL CAPS

    • “Running Head” is ONLY on title page


    Title page

    Title Page

    Title

    Subtitle

    Name

    School


    Second page first page of paper

    Second Page(first page of paper)

    Running Head (All CAPS – doesn’t say running head)

    Restate the title (center, NOT bold)

    Start the paper with your introduction

    All paragraphs have a .5 inch indent, but no spacing between paragraph

    ALWAYS USE HEADINGS to guide the reader

    • NOTE: THERE IS NOT an “Introduction” Header!!


    Title page1

    Title Page


    Second page first page of paper1

    Second Page(first page of paper)


    Headings

    Headings


    Listing facts

    Listing Facts


    Listing facts1

    Listing Facts


    In text citations

    In-Text Citations

    • 1 Author: (Author, Year)

    • 1 Author + Page (Author, Year, p. #)

    • Up to 3 Authors: (Author, Author, & Author, Year)

    • More than 3 Authors: (Author et al., Year)

    • Rickley (2013) states that effective in-text citations are utilized this way.


    In text citations1

    In-Text Citations

    • 1 Author: (Author, Year)

    • 1 Author + Page (Author, Year, p. #)

    • Up to 3 Authors: (Author, Author, & Author, Year)

    • More than 3 Authors: (Author et al., Year)

    • Rickley (2013) states that effective in-text citations are utilized this way.


    In text citations2

    In-Text Citations


    Reference list

    Reference List

    • Listed alphabetical by author/organizations

    • Title center, not bolded

    • Hanging indent on second line

    • When referring to books, chapters, articles, or Web pages, capitalize only the first letter of the first word of a title and subtitle, the first word after a colon or a dash in the title, and proper nouns.

      • Do not capitalize the first letter of the second word in a hyphenated compound word.

    • Maintain capitalization of journal title, or book title


    Reference list1

    Reference List


    Apa formatting resources

    APA FormattingResources

    • APA Purdue OWL

      • http://owl.english.purdue.edu/owl/resource/560/01/

    • NU Library

      • http://nu.libguides.com/nursing

    • APA Style

      • http://www.apastyle.org


    Putting practice to words

    Q&A

    1 thing you’ll do differently

    1 thing you need to learn more about


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