Discussion: Preparing for Clinical Practice

Discussion: Preparing for Clinical Practice

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UNIT-3-Clinical Practice

Preparing for Clinical Practice

Critical Thinking in Nursing Practice

Medical treatment stabilized Mr. Lawson’s condition. He had a pulmonary embolus, but he is now on anticoagulants, medications that will reduce likelihood of more clot formation. Knowing that Mr. Lawson is on anticoagulants and has had recent surgery and the processes of normal wound healing (see Chapter 48 (Links to an external site.)Links to an external site.), Tonya believes that the patient is at risk for bleeding from his surgical wound. She acts by increasing assessments of the wound and teaching Mr. Lawson how to avoid placing stress on the wound

1. Describe the critical thinking skill that Tonya is demonstrating.After Tonya assesses the wound, she enters a note in the medical record. She describes the appearance of the incision in detail, reports on the length of the incision, and notes that one suture is loose but there is no drainage.

2. Identify the three intellectual standards that Tonya uses in making a note in the record.

3. Mr. Lawson complains of more discomfort after lying on his right side for 30 minutes. Tonya asks him to describe the pain; it is focused more on his right shoulder and ribs. Tonya sees that the drainage tubing exiting the surgical wound is caught underneath the patient. She moves it, questions the patient further to find out that he has a history of arthritis in the shoulder, and then repositions and aligns him. This is an example of which critical thinking competencies?

Nursing Assessment

Tonya is planning to return to Mr. Lawson’s room and spend more time discussing his concerns about going home and what to expect. She knows that Mrs. Lawson usually comes to visit around 11 AM, just before lunchtime. Tonya believes that Mrs. Lawson will be an important source of support in providing Mr. Lawson’s ongoing home care. The surgeon has ordered directions for wound care and standard activity restrictions.

1. Tonya goes to Mr. Lawson’s room and asks the patient, “What concerns do you and your wife have about cleaning the wound?” Which type of assessment question is this and why has Tonya asked it?

2. Tonya and Mr. Lawson have the following interaction:

Tonya: Mr. Lawson, What do you understand about the reason for the activity restrictions your doctor ordered?

Mr. Lawson: I think it will prevent me from not hurting myself.Tonya: Uh huh … go on

Mr. Lawson: I think the doctor said I could pull my stitches.

Tonya’s phrase “uh huh … go on” is an example of which interviewing technique? Explain why it is useful.

3. Tonya returns to Mr. Lawson’s room to discuss his discharge instructions, but she notes as she enters the room that the patient is grimacing. She asks him, “Tell me where the pain is.” Mr. Lawson is asked to rate the pain on a scale of 0 to 10 and rates it a 6. Tonya looks at the patient’s surgical wound and notes that the area of separation is still inflamed. Match the assessment technique on the left with the type of measurement on the right.

1. Patient rates pain 6 on a 0 to 10 scale.

___ A. Determining location of a symptom

2. Tell me where the pain is.

___ B. Observation

3. Patient is seen grimacing.

___ C. Inspection

4. Nurse looks at condition of wound.

___ D. Determining severity of a symptom

Managing Patient Care

You are a staff nurse on a 32-bed cardiac step-down unit. You are assigned as the preceptor for Tony, RN, a new graduate nurse, who just started his nursing career on your floor.

1. You and Tony just received morning shift report on your patients. You are assigned the following patients. Which patient do you and Tony need to see first? Explain your answer.

1. Mr. Dodson, a 52-year-old patient who was admitted yesterday with a diagnosis of angina pectoris. He is scheduled for a cardiac stress test at 0900.

2. Mrs. Wallace, a 60-year-old patient who was transferred out of intensive care at 0630 today. She had uncomplicated coronary artery bypass surgery yesterday.

3. Mr. Workman, a 45-year-old patient who experienced a myocardial infarction 2 days ago. He is complaining of chest pain rated as 6 on a scale of 0 to 10.

4. Mrs. Harris, a 76-year-old patient who had a permanent pacemaker inserted yesterday. She is complaining of incision pain rated as a 5 on a scale of 0 to 10.

2. As you work with Tony on your unit, you notice that he has trouble with time-management skills when providing patient care. Which strategies will you suggest to Tony to help him improve organization of his delivery of patient care?

3. Sonya, a nursing assistive personnel (NAP), is paired to work with you and Tony. You overhear Tony giving Sonya directions for what she needs to do. Tony says, “Sonya, assist Mrs. Harris in room 418 with her afternoon walk. Take her pulse before and after she walks and record it in her chart. I’ll check with you when you’re finished to see how she did.” On the basis of what you know about delegation, did Tony give appropriate or inappropriate directions to Sonya? Provide rationale for your answer.

Discussion: Preparing for Clinical Practice

Discussion: Preparing for Clinical Practice

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.