How to develop clinical judgment skills in nursing students IDEAS AND STRATEGIES FOR NURSE EDUCATORS LEARNING OUTCOMES Content in this chapter is designed to assist in: 1. Describing the epidemiology of cardiac disorders 2. Correlating clinical manifestations to pathophysiological processes of: Chapter 30 Coordinating Care for Patients With Cardiac Disorders Sherri Ulbrich Coordinating Care for Patient With Cardiac Disorders Sherri Ulbrich
a. Coronary artery disease b. Infective endocarditis
The Layers of the NCSBN Clinical Judgment Measurement Model* Using the NCSBN ® Clinical Judgment Measurement “Cue” Cards to Guide Teaching and Assessment The Next Generation NCLEX News, Winter, 2019 , provided specific examples of questions that address each of the 6 components of Layer 3 of the NCJMM. The contents of the Cue Cards can be used as a guide to improve clinical judgment teaching and assessment. CONCEPTS a. Coronary artery disease b. Infective endocarditis Aortic stenosis Atherosclerosis Cardiac rehabilitation Compensatory mechanism Coronary artery bypass graft (CABG) Coronary artery disease (CAD) Ejection fraction Embolization Exercise stress test Friction rub Heart failure Infective endocarditis (IE) Ischemia Murmur Myocardial tissue Myocarditis Percutaneous transluminal coronary angioplasty (PTCA) Pericardial effusion Pericardiocentesis Pericarditis Prinzmetal’s/variant angina Pulmonary edema Orthopnea Regurgitation Stable angina Stenosis Tamponade Transcatheter aortic valve replacement Unstable angina c. Myocarditis d. Pericarditis e. Valvular disease f. Heart failure 3. Describing the diagnostic results used to confirm the diagnosis of cardiac disorders 4. Discussing the interprofessional management of: ESSENTIAL TERMS Acute coronary syndrome Angina c. Myocarditis d. Pericarditis e. Valvular disease f. Heart failure 5. Developing a comprehensive plan of nursing care for patients with cardia disorders 6. Designing a teaching plan that includes pharmacological, dietary, and life considerations for patients with cardiac disorders Unit VI Promoting Health in Patients With Circulatory or Perfusion
LEARNING OUTCOMES Content in this chapter is designed to assist in: 1. Describing the epidemiology of cardiac disorders 2. Correlating clinical manifestations to pathophysiological processes of:
a. Coronary artery disease b. Infective endocarditis
c. Myocarditis d. Pericarditis e. Valvular disease f. Heart failure 3. Describing the diagnostic results used to confirm the diagnosis of cardiac disorders 4. Discussing the interprofessional management of:
9/20/23 3:06 PM a. Coronary artery disease b. Infective endocarditis Next Generation NCLEX Mini-Posters Jason A. Schwartz, MS Director of Outreach, NCSBN
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9/20/23 3:06 PM c. Myocarditis d. Pericarditis e. Valvular disease f. Heart failure 5. Developing a comprehensive plan of nursing care for patients with cardiac disorders 6. Designing a teaching plan that includes pharmacological, dietary, and lifestyle considerations for patients with cardiac disorders 9/20/23 3:06 PM 9/20/23 3:06 PM 9/20/23 3:06 PM 9/20/23 3:06 PM 9/20/23 3:06 PM l Caring l Infection l Inflammation 648
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Finding Connections To measure orthostatic hypotension, have the patient assume a supine position for at least 2 minutes and record the blood pressure and heart rate. Then have the patient assume an upright position and record the blood pressure and heart rate. Generally, a reduction of 20 mm Hg or more in the systolic reading and/or 15 mm Hg in the diastolic value denotes the presence of orthostatic hypotension, also known as postural hypotension . In the patient who is highly symptomatic or with a history of syncope, this procedure CASE STUDY: EPISODE 1 Follow this patient throughout the chapter. can be performed in three stages: supine, sitting, and standing. The patient with orthostatic hypotension should be cautioned to transition from the supine or sitting to the standing position slowly by sitting briefly before standing. Some antihypertensive medications should be given with caution, starting with a lower dose and evaluating the patient’s response, especially in older adults, to reduce the incidence of orthostatic hypotension. Mr. Walter Thompson is a 57-year-old man with no significant past medical history except high blood pressure. He admits to being nonadherent with his meds because “I feel okay.” He reports he was in his usual state of health until about 3 weeks ago. At that point, he reports feeling short of breath and fatigued unrelated to physical activity. Over the past 3 weeks, his symptoms have pro- gressed to the point where he sleeps in his recliner every night. He is admitted to the step-down unit for further management.
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1. Preparation for learning with Cue Cards Challenge students by initiating clinical judgment assignments as a part of class preparation. § Provide each student with a digital set of Cue Cards. § Ask students to apply the components of clinical judgment as they review a case study from their text or ebook. § Open class with a debriefing on what they prepared to clarify points of confusion and support the value of this assignment. • Fundamental students: Introduce one or two Cue Cards each week, unfolding additional steps as they progress in the semester. • Advanced students: Challenge students to apply all 6 Cue Cards to one or more case studies. Provide group debriefing as students compare and contrast their assignments. • Lab: Select a case study that supports the skill focus for that day. Connecting clinical application to skill performance adds context and realism. • Simulation: Develop a scenario around the text or ebook case study that the students were assigned to review with the Cue Cards. Have students care for this patient in the simulation lab. • Clinical: In post-conference, ask students to apply what they learned from the case study clinical judgment activity that they applied to the patient they cared for that day in clinical. 4736_Ch30_628-657.indd 628 628 CONCEPTS l Caring l Infection l Inflammation Finding Connections CASE STUDY: EPISODE 1 Follow this patient throughout the chapter.
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Mr. Walter Thompson is a 57-year-old man with no significant past medical history except high blood pressure. He admits to
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HEART FAILURE Epidemiology Case studies examples above reflect content from Davis Advantage for Medical-Surgical Nursing , but Clinical Judgment NGN Case Studies are featured online as an assignment type for every Davis Advantage course area. The prevalence of heart failure (HF) is estimated at 6.5 million people aged 20 years or older in the United States, with about a million new cases each year. The lifetime risk of developing HF at age 40 is at least one in five for both CASE STUDY: EPISODE 2 Mr. Thompson is admitted to the step-down unit for further man- agement. On physical examination, he is lying in bed with the head of the bed in a semi-Fowler’s position. He is afebrile, with a temper- ature of 97.7°F (36.6°C). His blood pressure is 185/102 mm Hg. His heart rate is 124 bpm and appears to be irregular on the monitor. His respirations are 40 per minute and labored. Auscultation of his lung fields reveals crackles throughout. At a 30° angle, his jugular vein is distended and measures at 5 cm above the sternal border. He is on oxygen at 4 L/min via nasal cannula with an oxygen satura- tion of 95%. He has significant pitting edema of the lower extrem- ities. Capillary refill is decreased to the fingers, and his extremities are cool to the touch.
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About the author Karin Sherrill, MSN, RN, CNE, ANEF, FAADN has been a nurse educator for over 30 years. She works as a nursing education consultant, supporting faculty in creating better nurses.
2. Active learning with Cue Cards Incorporate clinical judgment for at least every 15 minutes of class. Open a Davis Advantage Clinical Judgment assignment in class, focusing on the electronic health record (EHR). § Place students in groups of 2-4 and ask them to review the components of the EHR and query each other using the 6 Cue Cards. • Fundamental students: Focus on Recognize and Analyze Cues initially. Roll out additional cards as the semester progresses and students build confidence, knowledge, and understanding. • Advanced students: Challenge them to apply all 6 Cue Cards within a group, or have them work independently through the process, comparing their answers with their peers. When students are periodically asked to work independently on clinical judgment application, it provides formative assessment of their learning. Early weakness identification and intervention can improve student success. • Lab: Provide skills in an EHR format, including medication records, provider orders, lab reports, or nursing notes. Have students discuss the entries, applying clinical judgment before performing a skill. Embed concerning conflicts, such as hypokalemia for a patient prescribed a nasogastric tube to suction to generate discussion. • Simulation: Before starting the simulation, allow students time to review the EHR and discuss questions from the 6 Cue Cards. Add the context of time pressure by giving students a pre-specified and limited amount to time to preform this analysis. • Clinical: Ask students to apply the 6 Cue Cards to the EHR of the patient who they cared for in clinical, discussing with the nurse mentor, instructor, or in post-conference. Select a client case from the text, ebook or Davis Advantage Clinical Judgment Cases. § Deliver a handoff report to the class. Perform this verbally or as a pre-recorded audio file. § Role model a nurse at the bedside with rate of delivery and use of medical terms. Allow students to use the Cue Cards to discuss afterwards. • Fundamental students: Provide a basic handoff report of a client in a long-term or skilled care facility, questioning students using the 6 Cue Cards as an entire class. Isolate each step of clinical judgment, explaining what it means. Debrief by explaining how a nurse thinks with each Cue Card. Nursing students need to develop a deep understanding of how a nurse thinks in order to apply clinical judgment. • Advanced students: Provide a comprehensive handoff report with multiple patients, requiring prioritization, or have the students develop and deliver the handoff report to a peer, based on a Clinical Judgment Case. • Lab: Provide some context to the skill, offering the patient’s background in the handoff report. Have students apply the 6 Cue Cards before practicing the skill. Using context will add realism and support clinical judgment thinking. • Simulation: Before starting the simulation, allow students time to analyze the handoff report and apply the 6 components of clinical judgment. Push students to identify priorities and delegation of care. • Clinical: Ask students to apply the 6 Cue Cards after receiving the shift handoff report and before providing care. Query students mid-shift about what has changed since the initial handoff report, framing the discussion around the 6 Cue Cards. 3. Assessment of learning with Cue Cards Provide clinical faculty with a set of Cue Cards. § Educate them on how to query students by asking questions from each card throughout the shift when receiving a report or assisting with a skill. • Fundamental students: Ask 1-2 questions, focusing on recognizing and analyzing cues at the start of the semester. Progress to all 6 Cue Cards as the semester progresses. • Advanced students: Facilitate students in self-reflection of clinical judgment through journaling. § Divide the class into 6 groups, providing them with a Next Gen NCLEX test item template. Have each group develop a test item that is focused on their assigned step of the Clinical Judgment Cue Cards. A text or ebook case, or Davis Advantage Clinical Judgment Case can be used as the patient. Learn More! Visit FADavis.com/NextGen or contact us at Hello@FADavis.com
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