CLASS 4 :   1 - Overload
                    2 - The Nursing Process
                    3 - The Process of Scientific Writing
                    4 - Test One: Time-limited open notes/book test

Announcements

Test 1 is today (10% of grade)
Class material and assignments related to Class 4 will be tested on the class 4 test.

 


TOPIC : Information Management For Health Care - The Nursing  Process

  • Elements of the process
  • Client involvement in the process

 


TOPIC : The Written Care Plan - A Reflection of The Nursing Process

This is an overview of the Nursing process. It will be discussed in detail in the next 5 classes.

STEP ONE IN THE PROCESS: ASSESSMENT

Two rounds of assessment start the Nursing Process. The first assessment is a generalized check of a patient(or client) as a whole. The second is a focused assessment into a particular area of concern.

When you write nursing care plans, the plan should begin with an Overview that includes a general assessment along with pertinent information about a patient's situation. Only after this overview of the patient is presented, are the findings of the second, more focused assessment spelled out in detail.

There are several formats for doing this first, generalized assessment. One of these, developed by Gordon(1987), divides functional abilities of a patient into 11 pattern. How well a patient is functioning in these different areas can be evaluated with questions and observation.

 

STEP TWO IN THE PROCESS: IDENTIFYING RISKS/ PROBLEMS/ WELLNESS GOALS

Because of a nurse's education s/he is prepared to recognize human responses to illness, injury or change by the cues that a client demonstrates. For each response the client will show a particular set of physical and behavioral evidence. A nurse looks for these patterns in the many bits of information that s/he gathers. When a pattern is noticed, the nurse in a sense sees a "RED FLAG" the client is waving. Using this particular set of clues the nurse can then name, or diagnose, that particular human response.

Before concluding that any nursing diagnosis applies to a client the nurse must validate that idea with the client. There are situations where a bit of missing information led a nurse to the wrong conclusion, but by discussing the preliminary diagnosis with the client, that client was able to complete the picture and a different diagnosis emerged.

To remember the three parts of a NURSING DIAGNOSTIC STATEMENT one can use the word RED as a mnemonic:

R = human Response to change
E = Etiology (what changed)
D = Data showing the response, and Data showing the etiology

STEP THREE IN THE PROCESS: SETTING GOALS WITH A CLIENT

Just as it was essential to validate the diagnosis with the client, it is necessary to work with the client to set health-related goals. What is seen as a priority by the nurse, may not be seen important to a client and the reverse can be true. Either the client (or his/ her family if the client can not participate) should be involved in picking the goals and discussing the methods to achieve them.

There are three parts to a correctly written goal statement

G = Goal statement is written as " The client will . . .'
T = a Time for evaluating goal achievement is part of the statement:
" ...by noon today..."
T = a Tool for measuring goal achievement is part of the statement:
"...as measured by..."

One example of a short term goal statement would be, "The client will show involvement in her own post-operative recovery by noon today as measured by turning side to side, deep breathing and coughing every hour."

Gtt is the abbreviation for drop. When a nursing student writes a complete and correct goal statement it can be said that s/he earns the Golden Drop (Gtt) Award.

STEP FOUR IN THE PROCESS: IMPLEMENTING NURSING INTERVENTIONS

This step encompasses most of the physical care, teaching, support and coordination that nurses do. Yet the nurse has already been working closely with her/ his client: establishing rapport, assessing, discussing. Now that the client's goals are established, nursing actions are selected that move those goals forward. The actions are specific to a particular goal, that is, each goal has it's own list of nursing actions. Accompanying each nursing intervention is a statement of its scientific rationale.

STEP FIVE IN THE PROCESS: EVALUATING PROGRESS TOWARD THE GOALS

In this Step 5 evaluation begins. It is evaluation of the client's progress toward her/ his goals exactly as they were written in Step 3. Begin this process of evaluation by stating the goal again. Part of the Goal Statement was a time frame for measuring progress. Indicate the time that the evaluation took place. The dates/ times should match. The original goal statement indicated how success was to be measured. Use these measures to evaluate the client's progress. Leave other measures of success or failure for the next step.

STEP SIX IN THE PROCESS: EVALUATING THE PLAN & MAKING CHANGES

If the plan worked as written, say so in this section. If the client outcomes were unexpected, discuss them here. Critique the assessments, the diagnosis, the goals and the interventions. Decide the strengths and flaws in the plan. Based on that information revise specific parts of the plan to improve it.

 


TOPIC : Overload in the Health Professions

  • Reactive and proactive responses to Role overload
  • Group work: Dead run - prioritizing nursing actions
  • The time crunch
  • Other's expectations
  • Your management of your resources
  • Group work: What works; what doesn't


TOPIC : Information Overload related to Scientific Writing

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  • Expanding the knowledge base vs. psuedo-scientific writing
  • Group work: Strategies r/t scientific writing


TOPIC: Scientific Writing

RESPONSIBLE WRITING

LaBonne, CH (Fairleigh Dickinson University, Teaneck, NJ)
Unpublished handout for Introduction to Nursing, NURS 1100, scientific writing

WRITING AS A MEMBER OF THE SCIENTIFIC COMMUNITY

In college and in your professional life as a nurse you will be doing scientific writing. Scientific papers that you write will build on knowledge published or expressed by other scholars. These scholars will include your teachers and authors who have written on the topics you are assigned to investigate. Even as a nursing student writing a paper, you add to the web of scholarly work that supports the discipline of nursing.

All scientific disciplines have rules to ensure that this web of information has integrity:

  1. that what is written is based on accurately reported phenomena central to the discipline. Breaches of Rule #1 generate sanctions that are severe with long lasting repercussions. Authors who falsify data from any part of the nursing process, or any part of the research process are subject to sanctions from their local agency as well as profession wide disdain.
  2. that the person who actually creates knowledge gets credit for doing so. Authors who fail to cite their sources violate Rule #2. Ideas presented in such a paper make it impossible to trace the ideas to their sources and snarl the discipline's web of scholarly work.

Merriam - Webster (1993) identifies such acts of literary theft as plagiarism. Nursing programs colleges and the scientific community discredits such authors. Typically college students earn zero credit for the assignment or the course. Repeat offenders can be expelled from their program or university.

MECHANICS OF WRITING A SCIENTIFIC PAPER

Scientific papers required of nursing students include care plans, investigations of specific health problems, ethno-cultural interviews, critiques of nursing research, and needs assessments of specific populations.

Three requirements shared by these diverse assignments will be

  1. use of the third person,
  2. an organizing framework for the paper, and
  3. consistent, correct citation of sources.

To insure that your writing meets these requirements for scientific papers, you are advised to follow the following guidelines.

Impersonalization of the Paper

  1. Use the third person. Write the assignment recording your ideas formally. Rather than saying, "I found . . ." say, "This author found . . ." or " This interviewer noted . . ." or "This student nurse recognized . . ." If you wish you can abbreviate student nurse as SN. Rather than saying, " I conclude that . . ." you could say, "One may conclude that . . ." When editing your paper check to be sure that the pronoun I is nowhere in the text.
  2. Names of clients or research subjects are not to be used. Instead, initials or codes protect their privacy. Depending on the assignment your instructor may require separate documentation identifying the persons in your paper. For reasons of client safety instructors may want to be able to contact a client that you cared for as a student.
  3. Before you gather any data for the assignment find out if you will need to supply names, addresses phone numbers, or chart numbers.

Structured construction of the Paper

This section of the guidelines answers the question, how. How can a writer collect information from several different sources, combine that information with her or his own ideas, and structure the paper according to the requirements of the assignment? What might seem like extra steps at the beginning of the process will make writing the body of the paper easier, and will ensure that all parts of the assignment are included, and that researched information is correctly credited to it's authors.

1. Use your assignment instructions to identify every topic and every sub topic that is to be included in the paper. Write each sub topic on a separate large index card. If there is no required Introductory/Overview Section, make an index card for one. If there is no Summary/Concluding Remarks Section, make an index card for one of these as well.
2. Identify a theoretical framework that will give your paper its particular approach to data collection. For example if you elect to use Gordon's (1994) Functional Health Patterns to gather data for a nursing care plan, the patterns will structure the aspects of the assessment that you carry out with your client.
3. Gather first hand information about the focus of your paper (client/ population/ community/ research effort/ human phenomenon) by direct observation, interaction, and assessment. This activity is the core of your assignment. Without a critical mass of unique data that you personally discover and combine, the assignment can only be a rehash of the insights of other scholars.
Gathered cues should influence your decisions in nearly every sub topic of the paper. Ideally the paper sets the uniqueness of the client/ population, etc. into a base of established nursing knowledge in such a way that a reader's understanding of both the paper's focus, and Nursing's Knowledge Base increases.
Only when the investigative/ assessment aspect of a paper meets this criterion is it "A" quality work.
4. Review appropriate nursing texts and class notes for relevant information about the topics and sub topics.
5. Do a computerized literature review on your paper topics, and sub topics, giving preference to work published in the last 3 years.
6. Write each different idea you gather from these reviews and searches on the front of a separate index card!
7. As you make these note cards record the source of the information :

a. Write all citation information you will need on the back of the first index card you are using to gather information from an article/book. This will include:

  1. Authors' last names, initials, and gender (which helps with pronoun use when you refer to an author in your paper)
  2. Dates: year of publication, volume and number of journal, volume of book
  3. Pages: numbers of the whole article/ chapter, as well as the page on which this idea was found
  4. Titles: of article and journal/ chapter and book
  5. Publication information: city, publisher

b. For recording a second idea from the same source you only need to put on the back of this second card:

  1. Author
  2. Year
  3. Page on which this second idea was found

c. For recording a cue or a cue cluster include on the front of the card:

  1. Subjective data with quotation marks
  2. Objective data details

d. For recording a cue on the back include:

  1. The date of the assessment/ interview
  2. Sources of objective data (observation, chart, Health Team member's name and title, etc.)
8. Direct quotes deserve special attention. When copying published information word for word, put quotation marks around the entry. The page number on which a direct quote was found must always be included in its citation. Failure to do either of these is considered an Honor's Code violation for a student, or an instance of scholarly misconduct for a college graduate.
9. Mark a "P" next to paraphrased information that you put on an index card. While paraphrased lines do not call for quotation marks, they do call for citing the page number.

Failure to credit paraphrased ideas is a relatively common Honor's Code violation that results in the same sanctions as failure to include quotation marks (see #8).
10. Sort the index cards, making one stack for each sub topic. Rubber band each stack.
11. Review the cards one stack at a time. Think about the information you have gathered in relation to the assignment. If some cards do not help you, set them aside. If there are gaps that you believe call for more reference material, get the information you need now.
12. Each stack should generate a deeper understanding of the sub topic than you had before you started gathering information. Write down your insights - one idea per card. Write "me" on the back of these cards. Add the cards to the stack you are reviewing.
13. Put each stack into an order that you want to use in writing your paper.
14. Check to see that each sub topic stack has all of its essential parts:
  1. An introductory or topic sentence covering the whole sub topic
  2. A point followed by its' evidence (This evidence could be cues from a client or facts or ideas from your literature review.) The next point followed by its evidence, and so on.
  3. A concluding remark for the sub topic

Whatever parts are missing, write them now, and add them to the stack.
15. Create an Overview/ Introductory Section, which presents the bones of the paper.
  1. This section should be in your own words rather than paraphrased or quoted.
  2. If you include portions of the assignment instructions in your introduction, you must cite that source.
  3. Write the section so that, after reading it, a reader knows
  1. The main topic of the paper
  2. The sequence of topics and sub topics
  3. Any particular slant, or theoretical framework that the paper uses
  4. The main conclusions of the author (which is you).
16. Create the ending Summation Section. This section should also be in your own words.
In this part include:
  1. A reminder of the main topic
  2. A restatement of what the slant or theoretical framework was used
  3. Conclusions from the sub topic sections.
  4. Overall conclusions that can be made
  5. Questions raised that call for further investigation (by you or others)

 
17. Now you have a written Overview, and written Summation, and several stacks of index cards. You are now ready to write the body of the paper using your sub topic stacks.

Rules for writing the body of the paper

  1. Use formal headings and sub headings as required by the assignment. Never force an instructor to search for the information that was supposed to be included.
    Example: These guidelines use headings and sub headings.
  2. The text must be mainly your ideas and language; never simply a string of ideas from your sources.
  3. Every idea that comes from a source must include or be directly followed by the citation. Using APA style, this would include the author's last name and year of publication.
    Example: (Smith, 1996)
  4. Every quote or paraphrased idea must be directly followed by its appropriate information. This includes the page number.
    Example: (Smith, 1966, p. 147)

Editing

Editing your work is an essential part of completing a written assignment. At the college level it is assumed that if you hand in a piece of work, that you intended to be judged on that document. The errors you leave in your paper will lower your grade. Check the following:

  1. English usage is correct. Read out loud. Get a proofreader if you need one.
  2. There is a logical flow to the text without being redundant, or wordy.
  3. There are more active than passive verbs, making it interesting to read.
  4. Any casual, folksy, crude, or judgmental comments have been edited out.
  5. Every section required by the assignment is included and has it own heading.
  6. All sources have been cited including :
    a. Course material sources (lectures, handouts, and consultations)
    b. Client data (subjective data, objective data)
    c. Written sources (texts, care plan guides, computer search materials)
    d. Assignment related sources (consultations with peers, nurses, Learning Center personnel)
  7. The product as a whole looks good.
    a. The paper, the margins, the typeface and size are standard.
    b. Corrections can not be easily detected.
    c. The length is within designated limits.
    d. Printer quality is good.
    e. Headers or page numbers are present if required.

The Beginning and the End

Each scientific paper submitted should start with a title page and end with a Bibliography page. The title page should include:

  1. The title of the assignment
  2. The course for which the assignment was written
  3. The due date and the submission date
  4. The author of the paper
  5. Any other information requested by the instructor

The Bibliography page includes:

  1. Every source that was cited in the paper - which should be every text and person whose ideas were used in the final product.
  2. No source that was not cited in the paper.
  3. Form for the Bibliography follows guidelines of the Publication Manual of the American Psychological Association, 4th ed. (1995)
  4. Citations are alphabetically arranged.

Duplicate your paper. Make 3 copies.

  1. Turn in two copies to your instructor. One, with comments and a grade, will be returned to you. The other will be kept on file.
  2. Keep one copy for yourself.

CHL 1/97b-honest

 


TOPIC: TESTING

  1. 30 MINUTE TIME LIMITED TEST
  2. TEST TAKING SKILLS
  • Learning techniques useful after a test
  • Log work: Assessment of testing techniques used for test #1.

 


TOPIC: Assignments

Assignments for Class 5