Using NANDA NIC and NOC NNN Language for Clinical

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model Pesut Herman 1998 Figures 1 and 2 illustrate the structure of the Clinical Reasoning Web and OPT. model worksheets completed by a student for a patient with decreased cardiac output related to septic shock. Pesut and Herman 1999 have defined clinical reasoning as reflective concurrent creative critical thinking. processes embedded in practice used to frame juxtapose and test the match between a present state and. outcome state and make judgments about achievement of desired outcomes p 4. Figure 2 Sample of One Student s OPT Model Worksheet This OPT model worksheet corresponds to. the Clinical Reasoning Web in Figure 1, The OPT model is unique in that the juxtaposition of an identified keystone nursing issue is contrasted with a. specified outcome state The present state is derived from an analysis and synthesis of relationships between. and among nursing and client nursing care needs Several teaching learning strategies support the use of the. OPT model as a concurrent information processing model of clinical reasoning These strategies include. reliance on the patient story creation of a clinical reasoning web that reveals balancing and reinforcing. relationships between and among nursing diagnoses and the use of a structured OPT model worksheet to. organize thinking and reflection on client care issues. The OPT model provides a conceptual structure for the use of standardized languages Present states in the. nursing model can be defined as NANDA nursing diagnoses Outcomes in the OPT model serve as desired. states and can be defined in terms of NOC nursing sensitive outcomes NIC interventions are nursing actions. that help transition patients from problem states to more desirable outcome states. Teaching learning strategies associated with application and implementation of the OPT model of clinical. reasoning include attention to the OPT structure the use of NNN content to represent nursing knowledge work. and combining critical creative and systems thinking and reasoning skills The model provides a structure that. challenges students to become more conscious of the way they frame and attribute meaning to the facts of the. client story Relationships and associations among competing nursing diagnoses interventions and outcomes. are emphasized The model structures the contrast of nursing problems with desired outcomes Nurses. implement interventions and actions to transition clients from problem or present states to more desired. outcomes states Pesut 2006 notes four C s contrast criteria concurrent considerations and conclusions as. essential thinking strategies that support clinical judgment The four C s in clinical judgment in the model. involve reflection about the contrast between present and desired state criteria regarding achievement of the. desired state concurrent considerations of the problem outcome and intervention and conclusions or. judgments about outcome achievement Pesut 2004 2006 Pesut Herman 1999. Because NNN languages exist and are being incorporated into nursing information systems it is important that. educators consider how to promote the use of standardized languages and help students think learn and reason. with these standardized nursing languages as they learn to provide care in patient settings The authors. considered standardized language represented in the NNN classification systems as a clinical vocabulary for. clinical reasoning This research examined the degree to which students used NNN language as they developed. clinical reasoning skills using the OPT model as a guide for thinking and reasoning about nursing care needs of. clients during the students clinical practicum,Research Aims. The research aims of this retrospective analysis were to evaluate the use of the OPT model as a structure or. scaffold for application and learning about relationships between and among standardized nursing language. terms as they support clinical reasoning and client care planning In addition a second goal was to determine. the extent of students use of the NNN language to represent nursing diagnoses interventions and outcomes. associated with clinical reasoning about client care stories and situations. The research was conducted in a midsize city in the southeastern United States at a school of nursing in a. historically black college and university This long standing nursing program admits a heterogeneous. population of students however the majority of students and faculty are African American Clinical settings for. students completing their medical surgical nursing practicums include a Level 1 trauma center 1000 beds and. a nonprofit tertiary care hospital 850 beds During the study students had clinical experiences on acute care. units with cardiac monitored beds for 10 weeks in one of these two institutions At the time of initial data. collection two of the researchers were faculty members at the university at the same time clinical instructors. for the junior level medical surgical nursing course in which this sample of students were enrolled. For this study OPT worksheets from 10 students were purposively chosen from a cohort of 23 junior. baccalaureate nursing students completing their clinical practicum for their junior year medical surgical course. This sample of 10 students all spoke English as their primary language The mean age of the sample was 28. years One was a male student six were African American and four were Caucasian Six students were single. and five had children Three had a previous degree and eight were certified nursing assistants The mean. number of hours per week of employment was 15 and the mean course load was 12 semester hours This sample. could be considered nontraditional yet typical of nursing programs throughout the country The 10 students. were chosen to reflect the same demographics as the whole student group and to include some students who had. done well when completing the OPT model worksheets and some who had done poorly as well as some. students who had been evaluated by clinical faculty members as being strong and some who had been evaluated. as having been weak in clinical preparation and performance. Procedures, Data for this study was derived from a sample of students who participated in an educational research project. Kautz Kuiper Pesut Knight Brown Daneker 2005 The overall aim of that project was to evaluate the. effects of the OPT clinical reasoning model on the thinking processes of undergraduate nursing students on. acute care units with clients who had multiple health problems As a part of the clinical assignment in the 10. week clinical practicum the students completed clinical reasoning webs A sample web is included as Figure 1. A clinical reasoning web is a visual representation of all the potential and actual nursing diagnoses related to a. client s story Once diagnoses are identified students are asked to draw lines of association linking the. diagnoses and explain the patterns of relationships between and among the diagnoses For example if pain and. anxiety were linked together the student is expected to state how specifically pain and anxiety are related The. teaching learning intervention behind the use of clinical reasoning webs is to help students make connections. about the interactive dynamic cause effect and associational interactions among multiple nursing diagnoses. and clients core needs The OPT model worksheets reflect the model structure and provide a way for students. to organize and record this work A sample OPT model worksheet corresponding to the sample web is included. as Figure 2 In order to promote reflection while creating and explaining clinical reasoning webs and OPT. model worksheets students kept written journals during the practicum experience For more information on. journaling using OPT model and Self Regulated Learning structured prompts with this sample of students see. Kautz et al The webs and OPT model worksheets were rated each week and the students received feedback. regarding their progress from the clinical faculty. For this study retrospective descriptive evaluation of OPT model worksheets was done to analyze the extent to. which students used NNN language The purpose of the analysis was to determine how often NNN language. was used for outcomes and interventions because the students used clinical resources such as medical surgical. textbooks and a variety of nursing diagnoses and care plan texts as the source of nursing language The medical. surgical texts and nursing diagnoses texts all incorporated some NNN language. The first step in the protocol involved the student completing a clinical reasoning web to assist in identifying the. keystone issue or priority NANDA diagnosis that would become the focus of the OPT model worksheet In the. sample web included as Figure 1 the student identified the NANDA diagnosis of decreased cardiac output as. the keystone issue for a client with sepsis Decreased cardiac output would determine the input in the present. state space of the OPT model worksheet Decreased cardiac output would then be contrasted with the desired. outcome of Effective Cardiac Output The student then completed the OPT model worksheet Figure 2 to. develop the outcomes tests and interventions related to the priority NANDA diagnosis. As a way to measure use of standardized nursing language the authors developed the NNN scoring instrument. for data collection which is included as Figure 3 Using the NNN scoring instrument the students use of NNN. language was evaluated each week Since the OPT model emphasizes outcomes instead of problems the first. step was to document the students use of NOC language The Outcome State portion of the OPT model. worksheet was evaluated and the rater determined if the student had included either a stated or implied. NOC for the appropriate nursing diagnosis that had been selected as the priority keystone problem for that. client The raters then evaluated the students choices of outcomes and tests to see how many matched official. NOC indicators The NOC indicators serve as criteria for outcome achievement as illustrated in Figure 4 The. second step repeated the process to evaluate the use of NIC language The raters chose a NIC category and the. accompanying NIC activities for the keystone issue that were the best matches for the student s choice of. interventions Figure 5 Using the NNN scoring grid 100 OPT worksheets were evaluated by three. independent raters for frequency and use of NNN language on the OPT model worksheets In the majority of. cases student outcomes and interventions were not consistently labeled in NNN language Thus raters were. challenged to make a best match of the student s words to the appropriate NICs and NOCs A check of interrater. reliability between the three raters for coding a random sample of 20 worksheets for NNN language was 65. for NOCs and 45 for NICs A possible explanation for the low percentages of interrater reliability could be. linked to the differing clinical backgrounds of the raters e g critical care neurologic rehabilitation and. medical telemetry intermediate critical care and their interpretation of nursing care needs given this past. knowledge and experience,FIGURE 3 IS OMITTED FROM THIS FORMATTED DOCUMENT. FIGURE 4 IS OMITTED FROM THIS FORMATTED DOCUMENT,FIGURE 5 IS OMITTED FROM THIS FORMATTED DOCUMENT.
Students stated the priority keystone problem in the appropriate NANDA format 92 of the time An outcome. stated in NOC language was juxtaposed with a NANDA diagnosis 22 of the time and implied with other. language 72 of the time Students were more proficient at identifying problems or NANDA diagnoses and. less proficient at specifying outcomes Interventions stated in NIC language corresponded to the NANDA. diagnosis 61 of the time Students included interventions that were appropriate for the client s priority. keystone problem but did not correspond to NIC language 39 of the time Students consistently linked nursing. interventions activities with NANDA diagnoses rather than NOC outcomes. Discussion, This research reveals that NNN language was not used consistently by students in completing the OPT model. worksheets in the clinical area Because this is a retrospective analysis the authors speculated regarding a few. possible explanations for these findings Either the resources used by the students were not consistent in the use. of NNN language or the students did not choose NNN language from the resources when completing their OPT. model worksheets If consistent use of NNN is an educational goal our findings suggest that clinical instructors. need to promote the use of NNN and give consistent feedback each time the student turns in clinical. assignments to encourage students to use NNN language when completing their clinical assignments The need. for consistent feedback each week is based on our research with these students in helping them learn the OPT. model Kautz et al 2005 We recommend faculty members use the OPT tools to give students feedback on. their work A systematic approach to teaching the relationships between and among diagnoses NIC. interventions and NOC outcomes is not possible unless faculty make these relationships explicit Despite the. inconsistent use of NNN language the OPT model worksheets promoted identification of priority nursing. diagnoses that were often associated with implied outcomes and a list of appropriate interventions Evaluation. of OPT model worksheets provided the faculty with guidance about studen. Using NANDA NIC and NOC NNN Language for Clinical Reasoning With the Outcome Present State Test OPT Model By Donald Kautz Ruth Anne Kuiper Daniel Pesut and Randy Williams Kautz D D Kuiper R Pesut D J and Williams II R L 2006 Using NANDA NIC and NOC NNN Language for clinical reasoning with the Outcome Present State Test OPT Model International Journal of Nursing

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