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Instructions of NURS223 6-2 Flip 3
Flip #3 Determining Actions to Take and Taking Action
- Due Sep 29, 2023 by 11:59pm
- Points 10
- Submitting an external tool
- Attempts 1
- Allowed Attempts 3
Purpose
We will take some time upon the completion of each step of the CCJF to reflect and practice the information you’ve gained. Self-reflection and deliberate practice are two ways to develop your clinical judgment skills to transition from a novice to advanced beginner nursing student. Stopping to reflect and practice new skills you’ve learned before moving on to the next step of the framework supports information retention and provides cognitive scaffolding for subsequent steps in the framework.
Task
Use the Flip interactive video program embedded below to apply your learning of the second step of the CCJF, Determining Actions to Take to the following case study:
Determining Actions to Take: (NP/Planning) (NCSBN/Prioritize Hypotheses)
You are starting your shift on a busy medical surgical unit and will once again be caring for Mindy Johnson (Flip 1 patient), a 60-year-old woman who is post-op day 1 from a cholecystectomy surgery. Yesterday, it was difficult to manage Ms. Johnson’s pain and she continued to verbalize a moderate to severe pain level on the Functional Pain Scale. Ms. Johnson was unable to get out of bed for most of the shift and wasn’t reaching her 2,000 mL incentive spirometer goal. As a result, you updated Dr. Cameron and she ordered a Morphine Patient Controlled Analgesia (PCA) to run at 2 mg/hr with a 0.5 mg patient controlled bolus every 30 minutes. The PCA controlled Ms. Johnson’s pain and the night RN, who is now giving you report, informs you she slept well and her pain remained mild. Ms. Johnson’s last set of vital signs are as follows: BP 138/75 mmHg, heart rate 88, respirations 12, temp 99 degrees F and pulse oximetry is 93% on room air
You recall that Ms. Johnson’s medical/surgical history is as follows:
- diabetes mellitus type 2
- diabetic neuropathy with chronic pain
- hypertension
- hysterectomy
Ms. Johnson’s home medications were resumed and you are to give her morning doses:
- metformin (Glucophage) 500 mg po BID
- glipizide (Glucotrol) 5 mg po daily
- hydrochlorothiazide 25 mg po daily
- amitriptyline (Elavil) 50 mg po daily at HS
Ms. Johnson also has a left hand IV where the Morphine PCA is infusing
After receiving report from the RN you enter Ms. Johnson room to complete your head-to-toe assessment and identify the following findings:
- BP 140/78 mm Hg, heart rate 86, respirations 12, temperature 100.7 degrees F, pulse oximetry is 90% on room air
- Regular sinus rhythm with S1 and S2 heart sounds
- Groggy to arouse
- Alert and Oriented X 3
- Rates pain as mild
- Dressing is intact
- Bowel sounds are hypoactive in all quadrants
- Lung sounds are diminished in the bases with crackles bilaterally
- Upper and lower extremities have +1 edema
- Coccyx area is slightly red
- IV is patent but slightly red
- Total input is 1,500cc
- Total output is 1,250cc
Instructions
- Read the case study above.
- Do not recite the case study narrative within your Flip recording.
- Identify the patients’ problems/issues then determine the priority problem/issue.
- Briefly reflect on how third step of the CCJF, Determining Actions to Take, affects your ability to provide safe care to your patients and impacts their outcomes.
- Briefly reflect on how the fourth step of the CCJF, Taking Action, affects your ability to provide safe care to your patients and impacts their outcomes.
- Briefly talk your way through your thinking process for both the 3 Clinical Competencies of 3rd step (Determining Actions to Take) and how these lead to the 4 Clinical Competencies of the 4th step (Taking Action)
- For the THIRD STEP, consider these questions for yourself as you read and consider the scenario:
- Ask yourself what patient goal do you need to accomplish and what action do you need to take to accomplish your goal? (selecting interventions)
- Ask yourself what actions will I take if something goes wrong and how will I prevent potential complications from occurring? (managing potential complications)
- Ask yourself what issues/concerns are the most important and what is the order of the actions I will take to address my patient’s goal/need/issue/problem? (setting priorities)
- For the FOURTH STEP, consider these questions for yourself as you read the scenario
- Ask yourself how you should carry out the interventions you identified in step 3 based on your patients individual needs and the situation? (determining how to implement the planned interventions)
- Ask yourself what interventions are appropriate to delegate, why it’s appropriate and how you will follow up? (delegating)
- Ask yourself who, what and how do you need to communicate based on your clients status and situation? (communicating)
- Ask yourself who is your audience, what is the appropriate teaching method based on their needs and how will you know your they understand what you taught? (teaching others)
Here are you cognitive guidance tools for Chapter 5 (Step 3)Links to an external site. and Chapter 6 (Step 4)Links to an external site..
Grading
Remember, you are a clinical judgment novice and my goal is to provide you with lots of low-stakes opportunities to further understand and practice your newly learned Clinical Competencies. Each Flip should be approximately five minutes and address the criteria identified within the directions and rubric. The Flip video platform will automatically place a link back to the Canvas assignment in this section.
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Step-By-Step Guide on NURS223 6-2 Flip 3
Introduction To NURS223 6-2 Flip 3
This Owlisdom assignment of NURS223 6-2 Flip 3 focuses on applying Steps 3 and 4 of the Clinical Competency Judgment Framework (CCJF): “Determining Actions to Take” and “Taking Action.” You will use these steps to develop and execute a care plan for a patient, Mindy Johnson, who is recovering post-operatively. These NURS223 6-2 Flip 3 steps are crucial for transitioning from a novice to an advanced beginner nursing student, enabling you to make informed clinical decisions and implement effective interventions.
Introduction
- Describe that the focus is on applying Steps 3 and 4 of the CCJF to a specific case study to enhance clinical judgment skills.
Example
“Hello, everyone. Today, we’ll apply Steps 3 and 4 of the Clinical Competency Judgment Framework—Determining Actions to Take and Taking Action—using the case of Mindy Johnson, who is recovering post-op.”
Case Overview
- Summarise the case study.
- Include relevant medical history, medications, lab results, and current condition.
Example
“Mindy is now post-op day 1 from a cholecystectomy. Despite using a Morphine PCA, managing her pain has been challenging. Today, we need to reassess her situation, especially considering her new symptoms and overall condition.”
Identify the patients’ problems/issues and then determine the priority problem/issue.
Identifying Priority Issues
We will discuss identifying priority issues in this section of NURS 223 6-2 Flip 3.
- Based on the assessment, determine the patient’s priority problems.
Example
“Upon assessment, Mindy’s priority issues appear to be her elevated temperature, reduced oxygen saturation, and potential infection risks indicated by redness at the IV site and coccyx area. Managing these acute concerns must take precedence to prevent complications.”
Briefly reflect on how the third step of the CCJF, Determining Actions to Take, affects your ability to provide safe care to your patients and impacts their outcomes.
Step 3: Determining Actions To Take
In this step of NURS 223 6-2 Flip 3, we will discuss determining actions to take.
- Determine what needs to be achieved and the actions required to accomplish these goals.
- Plan for possible complications and how to prevent them.
- Decide the sequence of actions based on their importance.
Example
“First, selecting interventions—Mindy’s goal is to stabilize her condition. We need to adjust her pain management to accommodate her activities like using the incentive spirometer. Secondly, preparing for potential complications is crucial; we must monitor her for signs of infection or respiratory distress closely. Lastly, setting priorities involves addressing her most life-threatening issues first, such as her potential respiratory infection.”
Briefly reflect on how the fourth step of the CCJF, Taking Action, affects your ability to provide safe care to your patients and impacts their outcomes.
Step 4: Taking Action
In this step of NURS 223 6-2 Flip 3, we will discuss Taking Action.
- Adjust interventions to fit the patient’s specific needs.
- Delegate tasks to nursing assistants while ensuring proper follow-up.
- Update the healthcare team about the patient’s status and care plan.
- Provide necessary information and instructions.
Example
“Implementing planned interventions—Given Mindy’s current state, personalized care adjustments are necessary, particularly in administering medications and oxygen therapy. Regarding delegation, tasks such as routine monitoring can be assigned to nursing assistants, ensuring I follow up regularly. Communication is key; I need to update the healthcare team about her status changes and potential risks. Lastly, educating Mindy and her family about her care plan, warning signs to watch for, and the importance of mobility to aid her recovery is essential.”
Briefly talk your way through your thinking process for both the 3 Clinical Competencies of 3rd step (Determining Actions to Take) and how these lead to the 4 Clinical Competencies of the 4th step (Taking Action)
Reflecting On Step 3 Impact
In this section of NURS 223 6-2 Flip 3, we will discuss the impact of Reflecting On Step 3.
- Explain how this step helps in creating an effective care plan.
Example
“Reflecting on Step 3, determining the right actions to take is foundational in creating an effective care plan. It helps in structuring our interventions systematically to address the most critical needs first, enhancing Mindy’s safety and recovery prospects.”
Reflecting on Step 4 Impact
This section of NURS 223 6-2 Flip 3 will discuss Reflecting On Step 4 Impact.
- Explain how implementing interventions ensures effective care.
Example
“Moving to Step 4, taking action ensures that the planned care is executed effectively. It involves not just carrying out interventions but also continually assessing their effectiveness and adjusting as needed to align with Mindy’s evolving health status.”
“Throughout both steps, clinical competencies like managing complications and setting priorities ensure that we are prepared for worst-case scenarios while striving for the best outcomes. Delegating effectively and communicating clearly are crucial for team-based care, ensuring everyone involved understands their role in Mindy’s care continuum.”
Closing Reflection
We will discuss the Closing Reflection in this section of NURS 223 6-2 Flip 3.
- Emphasise the significance of each competency in enhancing clinical judgment and patient care.
Example
“In conclusion, applying these steps of the CCJF not only helps in managing Mindy’s immediate health concerns but also prepares us to handle potential future challenges. It demonstrates the dynamic nature of nursing, requiring us to be proactive, thoughtful, and responsive to our patients’ needs.”
CLOSING
By following these guidelines of NURS223 6-2 Flip 3, you will effectively apply the third and fourth steps of the Clinical Competency Judgment Framework (CCJF) to a real-world case study. This structured approach ensures comprehensive planning and execution of patient care, which is essential for developing advanced clinical judgment skills. Practicing these competencies will enhance your ability to provide safe, effective, and empathetic patient care. In the next module of NURS 223, we will explore the 7-1 TICKET TO CLASS 5.
