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NURS223 – Medical Surgical Nursing II: Advanced Patient Care and Clinical Practice in Adult Health

Published: 2025-10-10

Modified: 2025-10-10

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Introduction:

NURS223 – Medical Surgical Nursing II focuses on providing safe, evidence-based care to adults with complex medical and surgical needs. The course enhances clinical reasoning, prioritization, and teamwork skills in acute care settings. For expert guidance with nursing case studies or care plan assignments, visit Owlisdom’s Nursing Coursework Help for professional academic support.

NURS 223 2-1 Ticket To Class 1

Instructions of NURS 223 2-1 Ticket To Class 1

Health Sciences Reasoning Test (HSRT)

Due Aug 28, 2023 by 11:30 am

Points 5

Part of your experience at Bryan College of Health Sciences includes your participation in standardized assessment, including the Health Sciences Reasoning Test (HSRT). Bryan College of Health Sciences administers the HSRT examination to all students who have completed the majority of their General Education coursework. At this point, you have completed enough coursework that it is time for you to take the HSRT. During the first day of class, you will receive an email from your professor with your login information.

The HSRT test is mandatory for all students. Information about how to take the test is provided below. You may take the HSRT examination on your personal laptop or computer or at a school computer. Please select a time that works for your schedule and that will provide you with approximately one hour of uninterrupted time.

The purpose of this measure is to assess students’ academic proficiency in critical thinking gained from coursework. In addition, if the examination indicates that the majority of our students need improvement, the different academic divisions of the College will explore strategies for addressing those challenges.

HSRT scores are kept confidential. You cannot “study for” this test or prepare for it in any significant way. You simply need to log on at the time that works best for you and complete the exam.

Review the HSRT examination instructions.

To take the test, navigate to the InsightAssessmentLinks to an external site. website and click on “Test Taker Login.”

There is nothing for you to submit to Canvas or the course faculty. The Systems Administrator will inform faculty of your completion of the examination.

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Getting to Know You!

Due Aug 28, 2023 by 11:30 am

Points 0

It’s important that we establish an inclusive, safe, and trusting learning experience for each student who is enrolled in the Clinical Judgment in Nursing course. You all come to this course with varying experiences, strengths, and learning preferences; therefore, we want to ensure that each of you can engage with us and the course content, reach your academic goals, feel valued, and know that you belong here. You’ve had an opportunity to get to know me through my bio on the Canvas Home Page and during our orientation session; now it’s time for me to get to know you. Please take a couple of minutes to complete this Getting to Know You Google FormLinks to an external site..

Week 2

Ticket to Class #1 (Getting the Information)

Task – Ticket to Class!

Your ticket to enter class is to complete and submit notes for Chapter 3: Step 1 – Getting the Information. Please be sure to submit BEFORE you come to class!

Document Preparation

Make a copy of the Ticket to ClassLinks to an external site. template.

Be certain you are logged in to your bryanhealthcollege.edu account!
“Make a Copy” of the document and rename it. It will now be housed in your Google Drive.
If you haven’t already created a folder on your Google Drive for this course, do so now and name it something that will be easy to find or remember, like NURS223. Save this document in that folder.

Assignment instructions

Read Chapter 3 and take notes on your Ticket to Class copy. For these notes, you will:
1. Indicate any questions you might have as you read.
2. Identify the CJ Competencies for the Step discussed in the chapter.
3. Record a real-life application of this Caputi step. Each chapter gives an example of this; please share your own real-world application!
4. Write a paragraph on your takeaways and thoughts.
Submit your assignment in Canvas. If you need help, refer to the Student Help page.

Do not worry about typing too much or too little. Type and record what helps YOU understand the content and apply it to both in-hospital and real-life scenarios. These tickets should help you to REMEMBER and APPLY the content of the chapter(s).

Introduction To Nurs223 2-1 Ticket To Class #1

This Owlisdom assignment of NURS 223 2-1 Ticket To Class 1 requires you to read Chapter 3, which discusses the first step of clinical judgment: recognizing cues. Your task is to take detailed notes on this step and complete the “Ticket to Class” copy by addressing specific prompts. This NURS 223 2-1 Ticket To Class 1 guide will provide you with a clear outline and step-by-step instructions on how to approach each part of the assignment effectively.

Indicate any questions you might have as you read.

Questions Raised During Reading

In this section of NURS 223 2-1 Ticket To Class 1, we will discuss the Questions raised During Reading.

Take note of any questions that arise. These can be about clarifications needed, a deeper understanding, or connections to other topics.
Write these questions clearly in your notes, making sure each question is distinct and related to the chapter’s content.

Example

The chapter delves deep into the initial step of clinical judgment—recognizing cues, which is essential for any nursing professional. Here are the questions that surfaced during my reading:

In a fast-paced clinical setting, what strategies can nurses employ to differentiate critical cues from regular patient data swiftly?

Are there specific simulation tools or training scenarios that help in honing these cue recognition skills, especially for nursing students or less experienced nurses?

Given the diverse patient populations nurses serve, how can cultural competence be integrated into the process of cue recognition to avoid biases and ensure comprehensive care?

Identify the CJ Competencies for the Step discussed in the chapter.

Clinical Judgment (Cj) Competencies

In this section of NURS 223 2-1 Ticket To Class 1, we will discuss Clinical Judgment (Cj) Competencies.

As you read, highlight the competencies mentioned in the chapter.
List these competencies in your notes, providing a brief explanation or definition for each to ensure you understand their importance.

Example

The chapter pinpoints several Clinical Judgment Competencies that are vital for mastering the art of recognizing cues. These competencies include:

Observational Skills: Nurses must develop keen observational skills to notice not just the obvious symptoms but also subtle signs that could indicate underlying issues (Caputi, 2021).

Effective Information Gathering: This involves the ability to ask the right questions, utilize diagnostic tools effectively, and extract useful information from patient interactions.

Data Prioritization: Nurses must prioritize information quickly, discerning which data points are most relevant to the patient’s immediate health concerns.

Record a real-life application of this Caputi step. Each chapter gives an example of this; please share your real-world application!

Real-Life Application

In this section of NURS 223 2-1 Ticket To Class 1, we will discuss the Real-Life Application.

Think of situations in your clinical practice or educational experiences where you have applied the step of recognizing cues.
Write a brief narrative describing your experience, emphasizing how recognizing cues made a difference in patient care.

Example

Reflecting on my personal experiences in healthcare, one situation particularly stands out. During a night shift in the ICU, I noticed a patient who had been stable for several hours began to show slight confusion and a mild increase in heart rate. These subtle cues could have been easily overlooked as post-surgery stress or fatigue. However, recognizing these as potential early signs of sepsis, I initiated a more detailed assessment and advocated for early intervention, which led to a timely administration of antibiotics and likely prevented a severe sepsis episode. This experience solidified my belief in the critical importance of acute cue recognition in nursing.

Write a paragraph on your takeaways and thoughts.

Reflections And Takeaways

In this section of NURS 223 2-1 Ticket To Class 1, we will discuss Reflections and Takeaways.

Reflect on the most important points discussed in the chapter and how they influence your understanding of clinical judgment.
Write a concise paragraph summarizing your takeaways, thoughts, and the overall impact of the chapter on your professional development.

Example

Chapter 3 has profoundly influenced my understanding of the foundational role cue recognition plays in nursing. The development of cue-recognition skills is imperative and requires deliberate practice and exposure (Caputi, 2021). Nursing educators must incorporate targeted training to enhance these skills among students. Effective cue recognition is closely tied to critical thinking. It requires nurses not only to observe but also interpret the implications of their observations, thus influencing clinical decisions and patient outcomes. Mastery of cue recognition prepares nurses for more complex decision-making scenarios. It provides the groundwork for all subsequent steps in clinical judgment, where decisions become more nuanced and patient outcomes more dependent on swift and accurate judgment. Ultimately, the ability to effectively recognize cues is instrumental in enhancing patient care. It enables nurses to act proactively, anticipate patient needs, and intervene appropriately, thus improving the overall quality of healthcare delivery.

REFERENCES

Caputi, D. L. (2021). Think Like a Nurse: The Caputi Method for Learning Clinical Judgment. Windy City Publishers.

CLOSING

By following this Owlisdom NURS 223 2-1 Ticket To Class 1, you will be able to create comprehensive and meaningful notes for Chapter 3, enhancing your understanding of the critical step of recognizing cues in clinical judgment. This methodical process not only helps retain important information but also connects theoretical knowledge with practical applications, ultimately enhancing your clinical practice. In the next module of NURS 223, we will explore the 2-2 FLIP #1.

NURS 223 2-2 Flip 1

Instructions of NURS 223 2-2 Flip 1

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 an 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 first step of the CCJF, Getting the Information, to the following case study:

Getting the Information: (NP/Assessing) (NCSBN/Recognizing Cues)

You receive a report from a Post-Anesthesia Care Unit (PACU) nurse about Mindy Johnson, a 60-year-old woman who is being transferred to you on a busy medical/surgical unit. Ms. Johnson had an open cholecystectomy surgery without complications and has been stable in the PACU. She received fentanyl (Sublimaze) 50 mcg IV 30 minutes ago. The PACU nurse states the patient has been complaining about her level of pain and states the patient is being “overly sensitive and unrealistic about where her level of pain should be after surgery.”

Ms. Johnson’s medical/surgical history includes:

diabetes mellitus type 2
diabetic neuropathy with chronic pain
hypertension
hysterectomy

Ms. Johnson’s home medications are as follows:

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’s lab results are as follows:

Hemoglobin: 12%
Hematocrit: 37%
Glucose: 120 mg/dl

You settle Ms. Johnson in her room and complete an initial head-to-toe assessment, and identify the following findings:

BP 162/88 mm Hg, heart rate 110, respirations 20, pulse oximetry is 98% on room air
Alert and Oriented
Grimacing, moaning, and guarding her incision
She states she is in severe pain
Dressing is intact
Lung sounds are clear and diminished in the bases

Instructions

Read the case study above.
Do not recite the case study narrative within your Flip recording.
Identify the patients’ priority problem/issue.
Briefly reflect on how the first step of the CCJF, Gathering Information, affects your ability to provide safe care to your patients and impacts their outcomes.
Briefly talk through your thinking process for the 5 Clinical Competencies within the 1st step of Gathering Information by using the Cognitive Guidance Tools provided to you in Chapter 3 (Caputi, 2022)
- Questions you can ask yourself for the 5 Clinical Competencies of Step 1/Gathering Information:

1. 1. Ask yourself what information is important and what information is missing. (determining important information)
  2. Ask yourself what you might be seeing, hearing, feeling, and smelling if you were in the patient room? (scanning the environment)
  3. What is your knowledge level regarding the problem you identified? How does the past patient’s medical history impact the problem, and what are the objective and subjective signs and symptoms associated with the problem? (identifying signs and symptoms)
  4. Ask yourself if you assessed the patient in a head-to-toe fashion, did you assess everything you needed to assess, did you miss anything? (assessing systematically and comprehensively)
  5. Ask yourself if the information you’ve collected is accurate and was your equipment reliable? (ensuring accurate information)

Grading

Remember, you are a clinical judgment novice and my goal is to provide you with a low-stakes opportunity 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.

Introduction To NURS 223 2-2 FLIP 1

This Owlisdom assignment of NURS 223 2-2 Flip 1 focuses on the first step of the Clinical Competency Judgment Framework (CCJF), which is “Getting the Information.” You will apply this framework to a case study involving a post-surgical patient, Mindy Johnson. NURS 223 2-2 Flip 1 aims to practice gathering and interpreting initial information effectively to develop clinical judgment skills. This process involves identifying the patient’s priority problem, reflecting on the importance of gathering information, and discussing the five clinical competencies associated with this step.

Introduction

Describe that the focus is on applying the first step of the CCJF to a specific case study to develop clinical judgment skills.

Example

“Hello everyone, today we’re diving into the first step of the Clinical Competency Judgment Framework (CCJF), which focuses on ‘Getting the Information.’ We’ll apply this to our case study involving Mindy Johnson.”

Case Overview

We will discuss the case overview in this section of NURS 223 2-2 Flip 1.

Summarize the case study.
Include relevant medical history, medications, lab results, and current condition.

Example

“Let’s focus on Mindy, a 60-year-old post-surgical patient with a history of diabetes and chronic pain. She’s showing signs of severe pain despite recent pain medication. Our goal today is to utilize the CCJF to gather and interpret initial information effectively.”

Identify the patients’ priority problem/issue.

Identifying Priority Issues

We will discuss identifying priority issues in this section of NURS 223 2-2 Flip 1.

Based on the information provided, determine the patient’s priority problem.

Example

“The priority issue here appears to be Mindy’s severe pain post-surgery. Given her history of chronic pain and current pain expressions, it’s crucial to reassess her pain management strategy. We also note her elevated blood pressure and heart rate, which may be related to her pain levels.”

Briefly reflect on how the first step of the CCJF, Gathering Information, affects your ability to provide safe care to your patients and impacts their outcomes.

Reflecting On The Importance Of Gathering Information

We will discuss the case overview in this section of NURS 223 2-2 Flip 1.

Discuss the significance of gathering accurate and comprehensive information.

Example

“Gathering accurate information is pivotal. It ensures that we don’t just treat symptoms superficially but understand underlying causes and conditions. This careful collection of data directly impacts our ability to provide safe, personalized care and significantly influences patient outcomes.”

Briefly talk through your thinking process for the 5 Clinical Competencies within the 1st step of Gathering Information by using the Cognitive Guidance Tools provided to you in Chapter 3 (Caputi, 2022)

Discussing The 5 Clinical Competencies

This section of NURS 223 2-2 Flip 1 will discuss the 5 Clinical Competencies.

What information is crucial, and what might be missing?
Consider what you would see, hear, feel, and smell in the patient’s room.
Relate the patient’s medical history to her current signs and symptoms.
Ensure you have covered all necessary aspects in a head-to-toe assessment.
Ensure that the information collected is precise and the equipment used is reliable.

Example

“Firstly, determining important information is critical. We need to discern what is relevant in Mindy’s current state, which in this case includes her vitals and pain level. Next, scanning the environment helps us gather contextual clues—her physical reactions and the setup in her room provide insights beyond verbal communication.”

“Understanding the medical background and identifying symptoms tells us how her past conditions might influence her current state. For instance, her diabetic neuropathy might be exacerbating her pain perception.”

“Systematically assessing Mindy from head to toe ensures no crucial detail is missed, like checking her surgical site and ensuring no complications are arising post-operation.”

“Lastly, verifying the accuracy of the information gathered, including the reliability of the medical equipment used to monitor her vitals, ensures that our clinical decisions are based on solid data.”

Application Of Competencies

This section of NURS 223 2-2 Flip 1 will discuss the Application of Competencies.

Show how you would use these skills in the patient’s scenario.

Example

“In Mindy’s scenario, I reassessed her pain using a systematic approach, ensuring to consider her expressions and non-verbal cues seriously rather than dismissing them as being ‘overly sensitive.’ This helped in planning to adjust her pain management regimen appropriately.”

Closing Reflection

Emphasize the significance of each competency in enhancing clinical judgment and patient care.

Example

“Reflecting on this process highlights the significance of each competency in enhancing our clinical judgment. Every step from accurate information gathering to critical assessment shapes our decisions, ensuring we provide care that is both effective and empathetic.”

CLOSING

By following the guidelines of Owlisdom's guide of NURS 223 2-2 Flip 1, you will effectively apply the first step of the Clinical Competency Judgment Framework (CCJF) to a real-world case study. This structured approach ensures comprehensive information gathering and critical evaluation, which are 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 4-1 TICKET TO CLASS.

NURS 223 4-1 Ticket To Class 2

Instructions of NURS 223 4-1 Ticket To Class 2

Ticket to Class #2 (Making Meaning of the Information Part 1)

New Attempt

Due Sep 11, 2023 by 11:30 am

Points 10

Submitting a file upload

File Types doc, docx, pdf, and jpg

Task – Ticket to Class!

Your ticket to enter class is to complete and submit the Chapter 4 (part 1) notes. Please be sure to submit these BEFORE you come to class!

For this Ticket to Class, please do chapter 4 in Caputi, “Step 2: Making Meaning of the Information,” only pages 89-122 (the first 5 competencies).

Assignment instructions

Make a new copy of this Ticket to ClassLinks to an external site. template and take notes on your copy. For these notes, you will:
1. Indicate any questions you might have as you read.
2. Identify the CJ Competencies for the Step discussed in the chapter.
3. Record a real-life application for each competency of this Caputi step. Each competency gives an example of this; please share your own real-world application!
4. Write a paragraph on your takeaways and thoughts.
Submit your assignment in Canvas.

Introduction To 4-1 Ticket To Class 2

This Owlisdom assignment of NURS 223 4-1 Ticket To Class 2 involves reading Chapter 4 from Caputi’s book, which focuses on “Step 2: Making Meaning of the Information” in clinical judgment. Your task is to take comprehensive notes on this chapter and complete your “Ticket to Class” copy by addressing specific prompts. This guide will provide you with a structured outline and clear instructions on how to effectively complete each part of the assignment.

Indicate any questions you might have as you read.

Questions Raised During Reading

In this section of NURS 223 4-1 Ticket To Class 2, we will discuss the Questions Raised During Reading.

Pay close attention to concepts and details that prompt questions. These questions should be genuine queries that arise from trying to understand the material deeply.
Write these questions clearly in your notes, making sure each question is distinct and related to the chapter’s content.

Example

While digesting the concepts presented in this chapter, several questions emerged:

How can nurses effectively differentiate between similar symptoms that may lead to vastly different diagnoses?

What are the best practices for incorporating patient and family input into the meaning-making process without causing bias in clinical judgments?

Are there specific tools or techniques that can aid in distinguishing between complex clinical scenarios that present with overlapping cues?

Identify the CJ Competencies for the Step discussed in the chapter.

Clinical Judgment (CJ) Competencies

In this section of NURS 223 4-1 Ticket To Class 2, we will discuss the Clinical Judgment (CJ) Competencies.

As you read, highlight the competencies mentioned in the chapter.
List these competencies in your notes, providing a brief explanation or definition for each to ensure you understand their importance.

Example

This chapter emphasises several competencies crucial for making meaningful interpretations of clinical information:

Analytical Thinking: The ability to analyse the gathered information critically, distinguishing between relevant and irrelevant data based on the clinical context (Caputi, 2021).

Integrative Thinking: The competency to integrate various pieces of information from multiple sources, including patient history, current symptoms, and test results, to form a coherent understanding of the patient’s condition.

Clinical Reasoning: Applying theoretical knowledge to practical situations to hypothesise potential diagnoses or treatment pathways.

Record a real-life application of this Caputi step. Each chapter gives an example of this; please share your own real-world application!

Real-Life Application

Think of situations in your clinical practice or educational experiences where you have applied the step of making meaning of information.
Write a brief narrative describing your experience, emphasising how making meaning of the information led to a better clinical outcome.

Example

A personal application of this Caputi step occurred during my tenure in a geriatric ward. An elderly patient exhibited symptoms of both dementia and depression, which often present similarly. By employing integrative thinking, I gathered comprehensive background information, including family interviews and previous medical records, which indicated a recent medication change. This insight led to a hypothesis that the patient’s symptoms might be an adverse effect of the new medication rather than a progression of dementia or a new depressive episode. Adjusting the medication under the supervision of the psychiatrist resulted in a significant improvement in the patient’s cognitive and emotional state.

Write a paragraph on your takeaways and thoughts.

Reflections And Takeaways

Reflect on the most important points discussed in the chapter and how they influence your understanding of clinical judgment.
Write a concise paragraph summarising your takeaways, thoughts, and the overall impact of the chapter on your professional development.

Example

Chapter 4 deeply enriches the understanding of how nurses can transform raw clinical data into actionable insights (Caputi, 2021). Here are several reflections and takeaways: The process of making meaning from information is not merely about identifying what the data says but also understanding what it implies in the specific clinical context. This requires a deep analytical approach where every piece of information is scrutinised for its relevance and implications. It is crucial to maintain a holistic view of the patient’s situation, considering all possible influences, such as environmental factors, psychological conditions, and social circumstances, which play a significant role in accurately interpreting clinical data. Effective communication with other healthcare professionals and the patient’s family is vital in making meaningful interpretations. Different perspectives can provide additional insights that enhance the overall understanding of the patient’s condition. The competency to make meaning from information is deeply tied to continuous learning and updating one’s knowledge base in nursing. As medical science evolves, so do the interpretations of symptoms and signs, necessitating ongoing education and adaptability in clinical practice.

REFERENCES

Caputi, D. L. (2021). Think Like a Nurse: The Caputi Method for Learning Clinical Judgment. Windy City Publishers.

CLOSING

By following this structured approach, you will be able to create comprehensive and meaningful notes for NURS 233 4-1 Ticket To Class 2, enhancing your understanding of how to make meaning of clinical information in nursing. This methodical process not only helps retain important information but also connects theoretical knowledge with practical applications, ultimately enhancing your clinical practice. In the next module of NURS 223, we will explore the 5-1 TICKET TO CLASS 3.

NURS223 5-1 Ticket To Class 3

Instructions of NURS223 5-1 Ticket To Class 3

Ticket to Class #3 (Making Meaning of the Information Part 2)

New Attempt

Due Sep 18, 2023 by 11:30 am

Points 10

Submitting a file upload

File Types doc, docx, pdf, and jpg

Task – Ticket to Class!

Your ticket to enter class is to complete and submit the Chapter 4 (part 2) notes. Please be sure to submit these BEFORE you come to class!

For this Ticket to Class, please do chapter 4 in Caputi, “Step 2: Making Meaning of the Information,” pages 123-143 (the last 4 competencies).

Assignment instructions

Make a new copy of this template and take notes on your copy. For these notes, you will:
1. Indicate any questions you might have as you read.
2. Identify the CJ Competencies for the Step discussed in the chapter.
3. Record a real-life application for each competency of this Caputi step. Each competency gives an example of this; please share your own real-world application!
4. Write a paragraph on your takeaways and thoughts.
Submit your assignment in Canvas.

Introduction To NURS223 5-1 Ticket To Class #3

This Owlisdom assignment of NURS223 5-1 Ticket To Class 3 involves studying Chapter 4 from Caputi’s book, focusing on “Step 2: Making Meaning of the Information,” specifically the last four competencies. Your task is to take comprehensive notes and complete your “Ticket to Class” by addressing specific prompts. This NURS223 5-1 Ticket To Class 3 guide provides a structured outline and clear instructions on how to effectively complete each part of the assignment.

Indicate any questions you might have as you read.

Questions Raised During Reading

In this section of NURS 223 5-1 Ticket To Class 3, we will discuss the Questions Raised During Reading.

Pay close attention to concepts and details that prompt questions. These questions should be genuine queries that arise from trying to understand the material deeply.
Write these questions clearly in your notes, making sure each question is distinct and related to the chapter’s content.

Example

Several questions arose while reading about these specific competencies:

How can nurses effectively utilise evidence-based practices to ensure the most accurate interpretation of complex patient data?

What strategies can be employed to overcome biases when integrating personal clinical experiences with new patient information?

In what ways can technology aid in enhancing these competencies, particularly in less resource-rich healthcare settings?

Identify the CJ Competencies for the Step discussed in the chapter.

Clinical Judgment (CJ) Competencies

In this section of NURS 223 5-1 Ticket To Class 3, we will discuss the Clinical Judgment (CJ) Competencies.

As you read, highlight the competencies mentioned in the chapter.
List these competencies in your notes, providing a brief explanation or definition for each to ensure you understand their importance.

Example

The last four competencies covered in this chapter include:

Evidence-Based Practice: Employing the best current research combined with clinical expertise to make patient care decisions (Caputi, 2021).

Clinical Experience: Utilizing past clinical experiences to inform current practice, ensuring decisions are grounded in practical knowledge.

Ethical and Patient-Centered Care: Ensuring decisions respect patient values and adhere to ethical standards.

Contextual Awareness: Understanding the broader context in which care is delivered, including organisational policies and socio-economic factors that affect patient care.

Record a real-life application of this Caputi step. Each chapter gives an example of this; please share your own real-world application!

Real-Life Application

We will discuss the Real-Life Application in this section of NURS 223 5-1 Ticket To Class 3.

Think of situations in your clinical practice or educational experiences where you have applied each competency.
Write a brief narrative describing your experience, emphasising how each competency led to better clinical outcomes.

Example

In a situation involving a patient with multiple chronic conditions, I utilised the latest diabetes management guidelines to adjust their treatment plan, which significantly improved their glycemic control without compromising their cardiovascular health.

I recalled a previous case where a patient exhibited similar symptoms that were initially misdiagnosed as heart failure but later identified as renal failure. This experience prompted me to request additional renal function tests for a new patient showing similar ambiguous symptoms, leading to the correct diagnosis early on.

During an end-of-life care scenario, I had to balance the medical interventions with the patient’s previously expressed wishes for minimally invasive treatment. This required delicate conversations with the family, ensuring that all decisions respected the patient’s dignity and final desires.

Working in a community with a high prevalence of tuberculosis influenced how I approached respiratory symptoms. Understanding this context, I advocated for TB screenings as a standard procedure for patients presenting with chronic coughs, thereby catching several cases that might have otherwise gone undiagnosed.

Write a paragraph on your takeaways and thoughts.

Reflections And Takeaways

In this section of NURS 223 5-1 Ticket To Class 3, we will discuss the Reflections and Takeaways.

Reflect on the most important points discussed in the chapter and how they influence your understanding of clinical judgment.
Write a concise paragraph summarising your takeaways, thoughts, and the overall impact of the chapter on your professional development.

Example

Robust clinical judgment involves a symphony of various competencies. Each competency does not stand alone but interacts with others to inform a holistic approach to patient care (Caputi, 2021). The competency involving evidence-based practice particularly highlights the need for continuous professional development and staying updated with the latest research, which is critical in a fast-evolving field like healthcare. This chapter reinforces the importance of ethics in everyday clinical decisions, reminding healthcare professionals that their responsibility extends beyond mere diagnosis and treatment to advocating for and respecting the patient’s voice and rights. Understanding and adapting to the context in which care is provided can significantly enhance patient outcomes. This adaptability is crucial in global health settings where resources and cultural norms vary widely. As medical science evolves, so do the interpretations of symptoms and signs, necessitating ongoing education and adaptability in clinical practice.

REFERENCES

Caputi, D. L. (2021). Think Like a Nurse: The Caputi Method for Learning Clinical Judgment. Windy City Publishers.

CLOSING

By following this Owlisdom guide of NURS223 5-1 Ticket To Class 3 guide, you will be able to create comprehensive and meaningful notes for Chapter 4, enhancing your understanding of making meaning of clinical information in nursing. This methodical process not only helps retain important information but also connects theoretical knowledge with practical applications, ultimately enhancing your clinical practice. In the next module of NURS 223, we will explore the 5-2 Flip 2

NURS 233 5-2 Flip 2

Instructions of NURS 233 5-2 Flip 2

Flip #2 Making Meaning of the Information

Due Sep 22, 2023 by 11:59 pm

Points 10

Submitting an external tool

Attempts 1

Allowed Attempts 3

Purpose

Task

Use the Flip interactive video program embedded below to apply your learning of the second step of the CCJF, Making Meaning of the Information to the following case study:

Making Meaning of the Information: (NP/Diagnosing) (NCSBN/Analyze Cues)

Melvin Keen, a 42-year-old caucasian male client who was recently seen at a local free-standing clinic, is being admitted to the hospital for shortness of breath. His wife is accompanying hi,m and as you are settling him in his room, he shares with you the following information. He’s been married for 20 years, was recently fired from his job, smokes 1 1/2 packs of cigarettes a day, and mostly eats takeout food. He has 2 Cokes every day, approximately 1-2 alcoholic beverages every week, and denies exercising. He and his wife do not have children but live with 2 cats and 2 dogs. His wife appears frustrated and states she has no idea how they are going to be able to pay their bills now that he’s lost his job, and also commented that he has to clean up his “bad habits” and lose some weight, or he’ll be dead within the next 6 months.

Melvin tells you he has a history of high blood pressure, wears a bi-pap machine at night, and is a Type 2 diabetic. He also states that he has “clogged arteries” and acid reflux. Melvin states that he is 5ft 8in tall and weighs approximately 250 lbs. He denies having received the COVID-19 vaccination or flu vaccination. His wife provides you with a list of the following medications he takes at home.

lisinopril (Prinivil) 20 mg PO daily
Lovastatin (Mevinolin) 40mg PO daily
lansoprazole (Prevacid) 15 mg PO daily
metformin (Glucophage) 500 mg po BID
glipizide (Glucotrol) 5 mg PO daily

You quickly complete your assessment because you have a healthcare provider who is waiting for you to call them with lab results on another patient you are caring for today. Your assessment reveals the following:

BP 145/84 mm Hg, heart rate 105, respirations 24, pulse oximetry 88% on room air, temp 96.2
Sitting at the bedside and leaning over the bedside table
Alert and oriented but agitated and short-tempered with his wife
Pupils reactive
Heart sounds normal
Decreased breath sounds bilaterally, with crackles noted in the right lower lobe
Perspiration noted, and he is warm to the touch
Bowel sounds hypoactive
+1 hand and ankle edema
Moves all extremities
Reddened area noted on left heel

Instructions

Read the case study above.
Do not recite the case study narrative within your Flip recording.
Discuss the patient’s problems/issues, then identify which problem/issue is the priority.
Briefly reflect on how the second step of the CCJF, Making Meaning of the information, affects your ability to provide safe care to your patients and impacts their outcomes.
Briefly talk through your thinking process for the 9 Clinical Competencies within the 2nd step of Making Meaning of the Information by using the Cognitive Guidance Tools provided to you in Chapter 4 (Caputi, 2022) and embedded within the corresponding PowerPoints.
- Questions you can ask yourself for the 9 Clinical Competencies of Step 2/Making Meaning of the Information:

1. 1. Ask yourself what information is similar and can be grouped to provide a clearer picture of your patient's problem. (clustering related information)
  2. Ask yourself what personal biases or assumptions you hold toward your patient based on their “story” or life experiences, and how these feelings might influence your care. (identifying assumptions)
  3. Ask yourself if there are conflicting pieces of information that are not what you expected. (recognizing inconsistencies)
  4. Ask yourself if the information you’ve collected is relevant to your patient’s current problem and how this data will influence your care. (determining relevant from irrelevant information)
  5. Ask yourself if there is “wiggle room” for you to consider when determining what is and is not acceptable information you gathered on your patient? (judging how much ambiguity is acceptable)
  6. Ask yourself if the bilateral differences you see in your patient are relevant to your care? (comparing and contrasting)
  7. Ask yourself what might go wrong with your patient to worsen their current health status? (Predicting potential complications)
  8. Ask yourself who else you should collaborate with to positively influence your care and your patient's health status. What information should you share with them? (collaborating with healthcare team members)
  9. Ask yourself what your patient needs based on the information you’ve gathered, and then create a clear and concise problem statement that will guide your care. (determining patient care needs/healthcare environment issues)

Grading

Remember, you are a clinical judgment novice, and our 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.

Introduction To NURS 233 5-2 Flip 2

This Owlisdom assignment guide of NURS 233 5-2 Flip 2 focuses on the second step of the Clinical Competency Judgment Framework (CCJF), which is “Making Meaning of the Information.” You will apply this framework to a case study involving a patient, Melvin Keen, to develop your clinical judgment skills. This NURS 233 5-2 Flip 2 guides steps that involve interpreting and synthesizing information to understand the patient’s condition better, identify priority issues, and plan effective care.

Introduction

Describe that the focus is on applying the second step of the CCJF to a specific case study to enhance clinical judgment skills.

Example

“Hello, everyone. Today we’re focusing on Step 2 of the Clinical Competency Judgment Framework—Making Meaning of the Information, using the case study of Melvin Keen.”

Case Overview

We will discuss the case overview in this NURS 223 5-2 Flip 2 section.

Summarize the case study.
Include relevant medical history, medications, lab results, and current condition.

Example

“Melvin, a 42-year-old male, has been admitted with shortness of breath. He has a complex medical and social history, including diabetes, hypertension, and a recent job loss, all contributing to his current health status.”

Identify the patients’ priority problem/issue.

Identifying Priority Issues

We will discuss identifying priority issues in this section of NURS 223 5-2 Flip 2.

Based on the information provided, determine the patient’s priority problem.

Example

“Given Melvin’s symptoms and background, the priority issue seems to be his respiratory distress, as indicated by his low pulse oximetry at 88% and decreased breath sounds with crackles. This suggests an acute respiratory problem, possibly exacerbated by his chronic conditions.”

Briefly reflect on how the second step of the CCJF, Making Meaning of the information, affects your ability to provide safe care to your patients and impacts their outcomes.

Reflecting On The Importance Of Making Meaning

We will discuss the case overview in this section of NURS 223 5-2 Flip 2.

Discuss the significance of making meaning of the information gathered.

Example

“Making meaning of the information we gather is crucial. It helps us to see beyond the immediate symptoms and understand the interplay of Melvin’s lifestyle, chronic conditions, and acute issues, which is vital for providing safe and effective care.”

Briefly talk through your thinking process for the 9 Clinical Competencies within the 2nd step of Making Meaning of the Information by using the Cognitive Guidance Tools provided to you in Chapter 4 (Caputi, 2022) and embedded within the corresponding PowerPoints.

Discussing The 9 Clinical Competencies

This section of NURS 223 5-2 Flip 2 will discuss the 9 Clinical Competencies.

Group similar information to form a clearer picture of the patient’s problem.
Reflect on any personal biases or assumptions about the patient’s lifestyle or story.
Note any conflicting information or unexpected findings.
Determine which data is pertinent to the patient’s current problem.
Evaluate how much uncertainty can be tolerated in the gathered information.
Compare bilateral symptoms to identify significant differences.
Identify potential complications that might worsen the patient’s condition.
Decide which healthcare professionals to involve and what information to share.
Based on the information gathered, formulate a clear problem statement to guide care.

Example

“First, by clustering related information, I group Melvin’s smoking and dietary habits with his chronic conditions to see a pattern that impacts his respiratory health.”

“Recognizing my own biases is crucial; I must ensure my views on his lifestyle choices don’t affect the impartiality of my care.”

“In analyzing inconsistencies, Melvin’s agitation contrasts with his normal heart sounds, suggesting stress or anxiety might be influencing his condition.”

“Determining relevance, his current medications and lifestyle choices are directly impacting his respiratory and overall health.”

“Judging the acceptability of ambiguity involves understanding that not all information will be clear-cut, especially in complex cases like Melvin’s.”

“Comparing and contrasting his bilateral breath sounds revealed differences that are significant to diagnosing his respiratory issues.”

“Predicting complications, given his background, I am particularly alert to the risk of cardiac problems or worsening respiratory conditions.”

“Collaboration is key; I need to decide which healthcare team members to involve, like a pulmonologist or a cardiologist, to provide comprehensive care.”

“Finally, creating a problem statement based on Melvin’s needs, I focus on managing his acute respiratory distress while considering his broader health challenges.”

Application Of Competencies

This section of NURS 223 5-2 Flip 2 will discuss the Application of Competencies.

Show how you would use these skills in the patient’s scenario.

Example

“Using these competencies, I prepare to discuss Melvin’s immediate care needs with the healthcare provider, emphasizing a need for respiratory support, potential adjustments in his diabetes management, and addressing his psychological stress.”

Closing Reflection

We will discuss the Closing Reflection in this section of NURS 223 5-2 Flip 2.

Emphasize the significance of each competency in enhancing clinical judgment and patient care.

Example

“Reflecting on this process enhances my clinical judgment by ensuring a holistic approach to Melvin’s care. It underlines the importance of synthesizing complex patient data to make informed decisions that significantly impact patient outcomes.”

CLOSING

By following these guidelines of NURS 233 5-2 Flip 2, you will effectively apply the second step of the Clinical Competency Judgment Framework (CCJF) to a real-world case study. This structured approach ensures comprehensive information interpretation and synthesis, which are 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 6-1 TICKET TO CLASS 4.

NURS223 6-1 Ticket To Class 4

Instructions of NURS223 6-1 Ticket To Class 4

Ticket to Class #4 (Determining Actions to Take and Taking Action)

New Attempt

Due Sep 25, 2023 by 11:30 am

Points 10

Submitting a file upload

File Types doc, docx, pdf, and jpg

Task – Ticket to Class!

Your ticket to enter class is to complete and submit the chapter 5 AND chapter 6 notes. You have the option of creating a separate “ticket” for each chapter or combining them on one page, but being sure to clearly identify Step 3 versus 4. (We realize this is a heavier ticket, but you will have a very easy one next week to balance that out!)

A link to Step 3 & 4’s Guidance Tool is HERE.

Assignment instructions

Make a new copy of this template and take notes on your copy. For these notes, you will:
1. Indicate any questions you might have as you read.
2. Identify the CJ Competencies for the Steps discussed in the chapters.
3. Record a real-life application for each competency of these Caputi steps. Each competency gives an example of this; please share your own real-world application!
4. Write a paragraph on your takeaways and thoughts.
Submit your assignment in Canvas.

Introduction To NURS223 6-1 Ticket To Class 4

This Owlisdom assignment of NURS223 6-1 Ticket To Class 4 focuses on understanding and applying the concepts discussed in Chapters 5 and 6 of Caputi’s book, which are “Step 3: Determining Actions to Take” and “Step 4: Taking Action”. The goal is to enhance your clinical judgment skills by engaging with the material through questions, identifying competencies, applying real-world scenarios, and reflecting on your learning. This NURS223 6-1 Ticket To Class 4 guide will help you systematically approach the assignment to extract maximum value from the readings.

CHAPTER 5:

Indicate any questions you might have as you read.

Questions Raised During Reading

In this section of NURS 223 6-1 Ticket To Class 4, we will discuss the Questions Raised During Reading.

Pay close attention to concepts and details that prompt questions. These questions should be genuine queries that arise from trying to understand the material deeply.
Write these questions clearly in your notes, making sure each question is distinct and related to the chapter’s content.

Example

How can nurses ensure that the actions they plan to take are not only effective but also the most efficient under time constraints?

What frameworks or models can help prioritise actions when multiple urgent needs compete for attention?

Identify the CJ Competencies for the Step discussed in the chapter.

Clinical Judgment (CJ) Competencies

In this section of NURS 223 6-1 Ticket To Class 4, we will discuss the Clinical Judgment (CJ) Competencies.

As you read, highlight the competencies mentioned in the chapter.
List these competencies in your notes, providing a brief explanation or definition for each to ensure you understand their importance.

Example

Prioritisation: Ability to determine which actions are most critical and should be addressed first.

Resource Utilization: Efficient use of available resources, including personnel, technology, and information.

Record a real-life application of this Caputi step. Each chapter gives an example of this; please share your own real-world application!

Real-Life Application

We will discuss the Real-Life Application in this section of NURS 223 6-1 Ticket To Class 4.

Think of situations in your clinical practice or educational experiences where you have applied each competency.
Write a brief narrative describing your experience, emphasising how each competency led to better clinical outcomes.

Example

In an emergency room setting, a triage nurse must quickly assess which patients need immediate attention. My application of this involved prioritising a patient with chest pain over another with a broken limb based on potential life-threatening conditions.

During a shift with limited staffing, I coordinated with other departments to ensure that all patients received necessary care, leveraging technology to monitor vital signs remotely and efficiently.

Write a paragraph on your takeaways and thoughts.

Reflections And Takeaways

In this section of NURS 223 6-1 Ticket To Class 4, we will discuss the Reflections and Takeaways.

Reflect on the most important points discussed in the chapter and how they influence your understanding of clinical judgment.
Write a concise paragraph summarising your takeaways, thoughts, and the overall impact of the chapter on your professional development.

Example

This chapter underscores the importance of decisive action in nursing. The competencies of prioritisation and resource utilisation are crucial, especially in emergency or high-stress situations. It emphasises that good judgment is not only about what actions are taken but also about the order and efficiency with which they are executed.

Chapter 6:

Indicate any questions you might have as you read.

Questions Raised During Reading

Pay close attention to concepts and details that prompt questions. These questions should be genuine queries that arise from trying to understand the material deeply.
Write these questions clearly in your notes, making sure each question is distinct and related to the chapter’s content.

Example

What measures can be taken to ensure that actions are carried out safely when under pressure?

How can nurses effectively delegate tasks without compromising patient care quality?

Identify the CJ Competencies for the Step discussed in the chapter.

Clinical Judgment (Cj) Competencies

As you read, highlight the competencies mentioned in the chapter.
List these competencies in your notes, providing a brief explanation or definition for each to ensure you understand their importance.

Example

Implementation: Executing the chosen interventions efficiently and safely.

Delegation: Assigning appropriate tasks to other team members based on their skills and current workload.

Record a real-life application of this Caputi step. Each chapter gives an example of this; please share your own real-world application!

Real-Life Application

Think of situations in your clinical practice or educational experiences where you have applied each competency.
Write a brief narrative describing your experience, emphasising how each competency led to better clinical outcomes.

Example

Implementing a rapid response protocol for a patient showing signs of sepsis involved administering antibiotics within the hour, closely monitoring vital signs, and preparing for possible escalation.

In a busy clinic, I delegated the task of collecting patient histories to nursing assistants while I focused on assessing and treating patients with acute conditions, ensuring that all tasks were appropriate to the staff’s licensing and capabilities.

Write a paragraph on your takeaways and thoughts.

Reflections And Takeaways

Reflect on the most important points discussed in the chapter and how they influence your understanding of clinical judgment.
Write a concise paragraph summarising your takeaways, thoughts, and the overall impact of the chapter on your professional development.

Example

Chapter 6 brings to light the dynamic and often high-pressure nature of nursing, where taking timely and effective action can mean the difference between life and death. The competencies of implementation and delegation are pivotal, emphasising that while nurses must act decisively, they also need to act thoughtfully, ensuring that every member of the team works to their full potential and within their scope of practice.

REFERENCES

Caputi, D. L. (2021). Think Like a Nurse: The Caputi Method for Learning Clinical Judgment. Windy City Publishers.

CLOSING

By following this Owlisdom guide of NURS223 6-1 Ticket To Class 4, you will be able to create comprehensive and meaningful notes for Chapters 5 and 6, enhancing your understanding of determining and taking appropriate actions in nursing. This methodical process not only helps retain important information but also connects theoretical knowledge with practical applications, ultimately enhancing your clinical practice. In the next module of NURS 223, we will explore the 6-2 flip 3.

NURS223 6-2 Flip 3

Instructions of NURS223 6-2 Flip 3

Flip #3 Determining Actions to Take and Taking Action

Due Sep 29, 2023 by 11:59 pm

Points 10

Submitting an external tool

Attempts 1

Allowed Attempts 3

Purpose

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 the report, informs you she slept well and her pain remained mild. Ms. Johnson’s last set of vital signs is 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
The 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 the 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 the 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 you need to accomplish and what action you need to take to accomplish your goal. (selecting interventions)
- Ask yourself what actions I will take if something goes wrong and how I will 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 patient's individual needs and the situation. (determining how to implement the planned interventions)
- Ask yourself what interventions are appropriate to delegate, why they’re appropriate, and how you will follow up. (delegating)
- Ask yourself who, what, and how you need to communicate based on your client's status and situation. (communicating)
- Ask yourself who your audience is, what is the appropriate teaching method based on their needs, and how will you know they understand what you taught? (teaching others)

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.

This tool needs to be loaded in a new browser window

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 the 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 the Owlisdom guide 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.

NURS 223 7-1 Ticket To Class 5

Instructions of NURS 223 7-1 Ticket To Class 5

Ticket to Class #5 (Evaluating Outcomes and Your Thinking)

New Attempt

Due Oct 2, 2023 by 11:30 am

Points 10

Submitting a file upload

File Types doc, docx, pdf, and jpg

Task – Ticket to Class!

Your ticket to enter class is to complete and submit the chapter 7 notes. Please be sure to submit these BEFORE you come to class!

Assignment instructions

Make a new copy of this template and take notes on your copy. For these notes, you will:
1. Indicate any questions you might have as you read.
2. Identify the CJ Competencies for the Step discussed in the chapter.
3. Record a real-life application for each competency of this Caputi step. Each competency gives an example of this; please share your own real-world application!
4. Write a paragraph on your takeaways and thoughts.
Submit your assignment in Canvas.

Introduction To 7-1 Ticket To Class 5

This Owlisdom assignment of NURS 223 7-1 Ticket To Class 5 focuses on evaluating the outcomes of clinical interventions and reflecting on your own thinking process. By engaging deeply with Chapter 7 of Caputi’s book, you will enhance your clinical judgment skills. This guide will help you systematically approach the assignment, ensuring that you understand and apply the key concepts discussed in the chapter.

Indicate any questions you might have as you read.

Questions Raised During Reading

Pay close attention to concepts and details that prompt questions. These questions should be genuine queries that arise from trying to understand the material deeply.
Write these questions clearly in your notes, making sure each question is distinct and related to the chapter’s content.

Example

While engaging with Chapter 7 of Linda Caputi’s book, I encountered several thought-provoking questions:

How can nurses systematically assess the effectiveness of the interventions they have applied?

What methodologies can be implemented to ensure unbiased self-evaluation of one’s clinical judgments?

What role does reflective practice play in continuous professional development for nurses?

Identify the CJ Competencies for the Step discussed in the chapter.

Clinical Judgment (CJ) Competencies

In this section of NURS 223 7-1 Ticket To Class 5, we will discuss the Clinical Judgment (CJ) Competencies.

As you read, highlight the competencies mentioned in the chapter.
List these competencies in your notes, providing a brief explanation or definition for each to ensure you understand their importance.

Example

The competencies outlined in this chapter are centred on evaluation and reflection:

Outcome Evaluation: Assessing the results of the interventions to determine their effectiveness (Caputi, 2021).

Critical Reflection: Reflecting on one’s own thinking process to identify strengths and areas for improvement.

Record a real-life application of this Caputi step. Each chapter gives an example of this; please share your own real-world application!

Real-Life Application

We will discuss the Real-Life Application in this section of NURS 223 7-1 Ticket To Class 5.

Think of situations in your clinical practice or educational experiences where you have applied each competency.
Write a brief narrative describing your experience, emphasising how each competency led to better clinical outcomes.

Example

In a recent instance of managing a patient with acute asthma, after administering bronchodilators, I continuously monitored the patient’s respiratory rate and peak flow to evaluate the effectiveness of the medication. This real-time data collection helped adjust doses and plan further care, ensuring the patient’s recovery was on track.

After a critical incident in which a patient’s symptoms were misinterpreted, leading to a delayed diagnosis, I engaged in a formal debriefing session. This reflection helped me recognise that under pressure, there’s a tendency to rush to a diagnosis without fully considering alternative causes. This insight has since improved my diagnostic approach, especially in high-stress situations.

Write a paragraph on your takeaways and thoughts.

Reflections And Takeaways

Reflect on the most important points discussed in the chapter and how they influence your understanding of clinical judgment.
Write a concise paragraph summarising your takeaways, thoughts, and the overall impact of the chapter on your professional development.

Example

Chapter 7 provides a comprehensive guide on the importance of evaluation in nursing practice, highlighting it as a critical component of clinical judgment (Caputi, 2021). My key takeaways include: The evaluation of outcomes is not a one-time task but a continuous process that occurs throughout patient care. This ongoing assessment helps in tweaking interventions as needed to ensure optimal patient outcomes. Effective evaluation involves not just assessing patient outcomes but also integrating feedback from patients, families, and colleagues. This holistic approach ensures that all aspects of care are considered and improved upon. Critical reflection is essential for personal and professional growth. By analysing one’s own thought processes and decisions, nurses can identify specific areas for improvement, enhancing their skills and judgment over time. Establishing a routine of rigorous outcome evaluation and critical reflection fosters a culture of accountability and continuous improvement in healthcare settings. It encourages healthcare professionals to strive for excellence and adopt best practices.

REFERENCES

Caputi, D. L. (2021). Think Like a Nurse: The Caputi Method for Learning Clinical Judgment. Windy City Publishers.

CLOSING

By following this NURS 223 7-1 Ticket To Class 5, you will be able to create comprehensive and meaningful notes for Chapter 7, enhancing your understanding of evaluating outcomes and reflecting on your thinking process. This methodical process not only helps retain important information but also connects theoretical knowledge with practical applications, ultimately enhancing your clinical practice. In the next module of NURS 223, we will explore the 7-2 FLIP 4.

NURS 223 7-2 Flip 4

Instructions of NURS 223 7-2 Flip 4

Flip #4 Evaluating Outcomes and Your Thinking

Due Oct 6, 2023 by 11:59 pm

Points 10

Submitting an external tool

Attempts 1

Allowed Attempts 5

Purpose

Task

Use the Flip interactive video program embedded below to apply your learning of the fifth step of the CCJF, Evaluating Outcomes and Your Thinking, to the following case study:

Evaluating Outcomes and Your Thinking: (NP/Evaluating (NCSBN/Evaluating Outcomes)

This week’s Evaluating Outcomes and Your ThinkingFlip Assignment will complete your time caring for Mindy Johnson. Recall that during the last several weeks, you identified a problem, gathered information, determined what actions to take, and took action. Now it’s time for you to evaluate your actions/interventions by collecting and making meaning of new information. This allows you to determine if your actions/interventions caused Mindy Johnson’s conditions to improve, worsen or stay the same. You also need to evaluate your thinking process that determined your actions/interventions. Your thinking process flows from Caputi’s Clinical Judgment Competencies embedded within the 5 Clinical Judgment Steps.

You completed your action(s)/intervention(s) (identified in your Take Action Flip) on Mindy Johnson and collected the following information.

BP 142/80 mm Hg, heart rate 88, respirations 16, temperature 100.5 degrees F, pulse oximetry is 96% on room air
Regular sinus rhythm with S1 and S2 heart sounds
Watching TV and talking with a partner
The room temperature is warm
Alert and Oriented X 3
Rates pain as mild to moderate
Dressing is intact with a small amount of shadowing
Bowel sounds are hypoactive in all quadrants
Lung sounds are clear bilaterally
Upper and lower extremities have +1 edema
The coccyx area is slightly red
Hemoglobin: 11.5%
Hematocrit: 36%
Platelets: 400,000/mm3
WBC’s 15,000 mm3
Glucose 110mg/dL
Sodium 143 mEq/L
Potassium: 4.2 mEq/L
Creatinine: 1 mg/dL
BUN: 17 mg/dl

Instructions

Read the case study above and closely review this week’s Flip Rubric, as it has changed from the previous Flip Rubrics.
Do not recite the case study narrative within your Flip recording.
State the priority patient problem you previously chose in the Taking Action Flip and why you chose it as the priority problem.
State the action(s)/intervention(s) you previously chose in the Taking Action Flip and why you chose/them.
Briefly reflect on how the fifth step of the CCJF, Evaluating Outcomes and Your Thinking, affects your ability to provide safe care to your patients and impacts their outcomes.
Briefly talk through your thinking process for the 2 Clinical Competencies within the 5th step of Evaluating Outcomes and Your Thinking by using the Cognitive Guidance Tools provided to you in Chapter 7 (Caputi, 2022).
- Questions to ask yourself for the 2 Clinical Competencies of Step 5/Evaluating Outcomes and Your Thinking:

1. 1. Evaluating Data: Consider the following:

What changes did you expect to see in your patient after your interventions/actions?
What information do you need to collect to determine if your patient’s problem improved, worsened, or stayed the same as a result of your interventions/actions?
Would other interventions have been more effective?

Evaluating and correcting thinking: Identify and rate yourself on a scale of 0 to 5, two clinical judgment competencies you effectively used, and two clinical competencies you need to improve upon.

Explain why you believe you did the 2 competencies well.
Explain what you will do to improve the 2 competencies you were challenged by.

Grading

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Introduction To NURS 223 7-2 Flip 4

This Owlisdom assignment of NURS 223 7-2 Flip 4 focuses on the fifth step of the Clinical Competency Judgment Framework (CCJF): “Evaluating Outcomes and Your Thinking.” You will use these steps to assess the effectiveness of the interventions implemented for a patient, Mindy Johnson, and reflect on your clinical decision-making process. This step is essential for transitioning from a novice to an advanced beginner nursing student, as it enhances your ability to provide safe and effective patient care by evaluating and refining your clinical judgments.

Introduction

We will discuss the introduction in this NURS 223 7-2 Flip 4 section.

Describe that the focus is on applying Step 5 of the CCJF to evaluate the effectiveness of interventions and reflect on clinical decision-making.

Example

“Hello, everyone. Today, we’re focusing on the fifth step of the Clinical Competency Judgment Framework—Evaluating Outcomes and Your Thinking—using the ongoing care of Mindy Johnson as our context.”

Context Setup

Include relevant medical history, medications, lab results, and current condition.

Example

“Over the past few weeks, we’ve followed Mindy’s post-operative recovery. We’ve identified problems, taken actions, and now we need to evaluate the effectiveness of these interventions and reflect on our decision-making process.”

Review Of Actions Taken

This NURS 223 7-2 Flip 4 section will discuss the Review Of Actions Taken.

Clearly mention the priority problem and the interventions chosen to address it.

Example

“In our last session, we prioritized managing Mindy’s pain and risk of infection post-cholecystectomy. We implemented a Morphine PCA and monitored her vitals and wound site closely, aiming to enhance her recovery and comfort.”

Current Patient Status

This NURS 223 7-2 Flip 4 section will discuss the Current Patient Status.

Include vital signs, physical observations, and any relevant lab results.

Example

“Currently, Mindy’s vitals are stable with a slight fever, her pain is mild to moderate, and her lung sounds are clear. However, there’s still mild edema and slight redness at the coccyx area. These observations are critical as we evaluate our interventions.”

Evaluating Data

This NURS 223 7-2 Flip 4 section will discuss Evaluating Data.

Describe the changes you anticipated seeing after the interventions.
Determine the information needed to assess whether the patient’s problem has improved, worsened, or stayed the same.
Reflect on whether different actions could have been more effective.

Example

“Let’s dive into evaluating the data:

I expected the PCA to control her pain effectively, which it has to a certain extent.

To assess improvements or declines, we monitored her pain levels, wound condition, and overall mobility.

Reflecting on other possible interventions, considering her slight fever and oedema, could we have optimised her fluid management or adjusted her analgesic schedule sooner?”

Evaluating And Correcting Thinking

This NURS 223 7-2 Flip 4 section will discuss Evaluating and Correcting Thinking.

Identify and rate your performance on two clinical judgment competencies you executed well and two that need improvement.
Explain what steps you will take to improve the competencies you found challenging.

Example

“Regarding my clinical judgment:

I rate myself highly on monitoring and responding to acute changes—these competencies were crucial in managing Mindy’s pain and preventing complications.

Areas for improvement include my anticipation of potential complications like infection, given the redness observed. In the future, I will incorporate more proactive measures into my care plans.”

Reflecting on Step 5 Impact

Explain how evaluating outcomes and your thinking affect patient care and outcomes.

Example

“Reflecting on this step, evaluating outcomes ,and our thought processes is vital. It not only helps in confirming the effectiveness of our actions but also in refining our clinical judgment, ensuring safer patient care.”

Closing Reflection

We will discuss the Closing Reflection in this section of NURS 223 7-2 Flip 4.

Emphasise the significance of each competency in enhancing clinical judgment and patient care.

Example

“Conclusively, this evaluation helps us understand what worked and what didn’t, guiding future care decisions. I will focus on enhancing my preventive strategies and continue to adapt my interventions based on ongoing assessments and patient feedback.”

CLOSING

By following these guidelines of NURS 223 7-2 Flip 4, you will effectively apply the fifth step of the Clinical Competency Judgment Framework (CCJF) to evaluate the outcomes of your interventions and reflect on your clinical thinking process. This structured approach ensures comprehensive assessment and continuous improvement in patient care, which is essential for developing advanced clinical judgment skills. Practising these NURS 223 7-2 Flip 4 competencies will enhance your ability to provide safe, effective, and empathetic patient care. In the next module of NURS 223, we will explore the 9-1 final flip.

NURS 223 9-1 Final Flip

Instructions of NURS 223 9-1 Final Flip

Final Flip: Putting it All Together

Due Oct 27, 2023 by 11:59 pm

Points 30

Submitting an external tool

Attempts 1

Allowed Attempts 6

Purpose

You will apply each step of the CCJF to complete the NGN case study (University of Maryland School of Nursing) questions, which test all 6 NGN cognitive processes. This activity allows you an opportunity to reflect and practice your clinical judgment competencies while testing your ability to safely care for a patient. This is a safe opportunity to get comfortable with being uncomfortable and steady your thoughts while being placed in a challenging situation.

Tasks

When finished, reflect upon how you intentionally worked through Caputi’s 5 Steps and 23 Clinical Judgment Competencies to answer the NGN case study questions. This reflection will guide the creation of your Final Flip.

It’s OK if you answered some components incorrectly!
When you get to step 5 (specifically, competency 5.2 – evaluating your thinking), review the answer key. Download the answer key to help you evaluate where/how you could change your thinking process in the future. Use the answers you SELECTED, not the CORRECT answers, in yourreflection.
- We expect that you will uphold our College Value of Integrity and not look at the answers before or during completion of the Case Study. Please only review the answer key after you’re finished with the Case Study & Explain Your Thinking Document and are preparing your Final Flip.

Use the Flip application to explain how you applied your learning of all 5 Steps of the CCJF to the NGN case study and answers you submitted.

You will be running through all 5 steps of the CCJF as you describe this individual and how you might go about treatment based on their presentation. Please be professional in your presentation.
Final Flip should be no more than 10 minutes in length
If your Flip is more than 10 minutes, you will have to do a 2nd posting and indicate so in your 1st posting

You will then watch one assigned peer’s Flip and provide them with feedback, comparing and contrasting your clinical judgment processes.

This is due Wednesday, November 1, at midnight.
Please complete this Final Flip Peer Response “Quiz when you are finished to indicate how you completed the assignment.
You have two options for providing feedback – either enter a comment on the Flip OR record a Flip response.
- To get full points for the peer response component, responses need to be robust, insightful, and meaningful. If typing your response, it should be at least 2-3 paragraphs long. If recording a Flip response, it should be 2-4 minutes in length.

Final Flip Supplemental Documents

New Attempt

Due Oct 27, 2023 by 11:59 pm

Points 0

Submitting a file upload

File Types doc, docx, pdf, and jpg

This is where you will submit your:

PDF results of your NGN case study after having completed it

Submit both documents here. Both MUST be submitted for full credit.

Introduction To 9-1 Final Flip

This Owlisdom assignment of NURS 223 9-1 Final Flip involves integrating all five steps of Caputi’s Clinical Judgment Framework (CCJF) to complete a case study. The purpose of the 9-1 Final Flip is to reflect on and practice your clinical judgment competencies, testing your ability to safely care for a patient in a challenging situation. You will document your process and provide feedback to a peer, enhancing your learning experience through reflection and collaboration.

Introduction

Briefly explain the purpose of the assignment, which is to apply and integrate all five steps of the CCJF into a case study.

Example

“Hello, everyone. Today, I’ll be discussing how I applied the five steps of Caputi’s Clinical Judgment Framework (CCJF) to the NGN case study from the University of Maryland School of Nursing.”

Context Setup And Overview Of Tasks

We will discuss the Context Setup And Overview of Tasks in this NURS 223 9-1 Final Flip.

Summarize the tasks: completing the case study, reflecting on the steps, and providing peer feedback.
Emphasize the importance of integrity by not looking at the answers beforehand.

Example

“I completed the NGN Case Study and the Explain Your Thinking document, focusing on reflecting through each of the five steps without prior access to the answers. This was to ensure the integrity and authenticity of my learning experience.”

Step 1: Recognizing Cues

Describe how to gather relevant information from the patient’s symptoms and history.

Example

“In Step 1, I focused on recognizing cues from the patient’s presented symptoms and history. For example, the patient’s complaint of severe abdominal pain and past medical history provided crucial cues for potential diagnoses. I identified these cues carefully to form a basis for further analysis.”

Step 2: Analyzing Cues

We will discuss the Analyzing Cues in this NURS 223 9-1 Final Flip step.

Explain the process of linking symptoms to potential conditions and analyzing the relationships between them.

Example

“Moving to Step 2, I analyzed these cues to prioritize potential issues. I considered the relationships between the symptoms and possible underlying conditions, using clinical knowledge and previous experiences to hypothesize what could be causing the patient’s distress.”

Step 3: Prioritizing Hypotheses

We will discuss the Prioritizing Hypotheses in this NURS 223 9-1 Final Flip step.

Discuss how to prioritize hypotheses and plan subsequent actions.

Example

“In Step 3, I prioritized the hypotheses based on the severity and likelihood of potential conditions. This step was crucial in planning the next actions, such as deciding whether to perform further diagnostic tests or initiate immediate treatment.”

Step 4: Taking Actions

We will discuss Taking Action in this NURS 223 9-1 Final Flip step.

Explain how to choose and execute appropriate interventions.

Example

“Step 4 involved deciding and implementing actions based on the prioritized hypotheses. Here, I chose interventions that would both address the most likely conditions and stabilize the patient’s condition, such as administering pain relief and scheduling an ultrasound.”

Step 5: Evaluating Outcomes

We will discuss Evaluating Outcomes in this step of NURS 223 9-1 Final Flip.

Discuss how to evaluate patient outcomes and reflect on your thinking process.

Example

“Finally, in Step 5, after reviewing the outcomes from the actions taken, I used the answer key to evaluate the effectiveness of my interventions and the accuracy of my initial hypotheses. This reflection was key in understanding areas for improvement in my clinical judgment process.”

Closing Reflection

Reflect on the overall learning experience and the importance of integrating all five steps of the CCJF.

Example

“In conclusion, this exercise was invaluable for practicing and reflecting on my clinical judgment skills across all steps of the CCJF, enhancing my readiness to handle real-life clinical situations.”

CLOSING

By following these NURS 223 9-1 Final Flip guidelines, you will effectively integrate all five steps of the Clinical Competency Judgment Framework (CCJF) into your case study analysis, reflect on your clinical judgment process, and provide meaningful feedback to a peer. This comprehensive approach ensures a thorough evaluation of your clinical skills and fosters continuous improvement in patient care. You can also read NURS 223 complete modules to ace the course!