Chapters 1, 2 & 31. Review the use of critical thinking in diagnostic reasoning and clinical judgment (p. 2-6, Module 1 Chapter 1 PPT)Diagnostic reasoning- Critical thinking allows the nurse to recognize important cues (e.g., pieces of information, signs, symptoms, pieces of laboratory data) gathered during assessment, formulate diagnostic hypotheses based on said cues, gather data relevant to tentative hypotheses, and evaluate each hypothesis with new data collected to arrive at finalnursing diagnosis.Remember: A nursing diagnosis IS clinical judgment about a person’s response to an actual or potential health state. Clinical judgment is the result of critical thinking and clinical/diagnostic reasoning. It is the outcome/decision that is reached through those processes. (re: NSG 327 Module 1 PPT) Here are the steps of diagnostic reasoning (p. 4-6):- Identifying assumptions- Identifying an organized and comprehensive approach- Validation- Distinguishing normal from abnormal- Making inference- Clustering related cue- Recognizing inconsistencies- Identifying patterns- Identifying missing information- Promoting health- Diagnosing actual and potential (risk) problems- Setting priorities (treating 1st lvl, then 2nd lvl, then 3rd lvl priorities)- Identifying patient-center expected outcomes- Determining specific interventions- Evaluating and correcting thinking- Determining a comprehensive plan2. Differentiate between a novice and expert practitioner (p.3)- Novice-has no experience with a specified patient population and uses rules to guide performance- Expert-nurses that vault over the steps and arrive at a clinical judgment in one leap; has intuitive grasp of a clinical situation and zeroes in on the accurate solution; immediate recognition in patterns in assessment data3. Review the basic characteristics of culture, cultural competence, cultural sensitivity and cultural assessment (p.14, Module 1 Chapter 2 PPT, p. 17-19)- Culture- Thoughts, communications, actions, beliefs, values, and institutions of racial, ethnic, religious, or social groupso Four basic characteristics of culture:o Learned from birth through the processes of language acquisition and socializationo Shared by all members of the same cultural groupo Adapted to specific conditions related to environmental and technical factors and to the availability of natural resourceso Dynamic and ever changing- Cultural Competence- understanding and attending to the total context of a person’s situation, including awareness of immigration status, stress factors, and other social factors and cultural similarities and differences.- Cultural Sensitivity- possessing some basic knowledge of and constructive attitudes toward the diverse cultural populations found in the setting in which they are practicing- Cultural/Heritage Assessment- You assess factors related to culture/heritage of a patient to determine the depth to which you and the patient identify with a traditional heritage, that is, the cultural beliefs and practices of the family, extended family, and an ethnoreligious community4. Know the importance of being able to provide culturally sensitive care to patients and recognizing any cultural biases of your own (p. 14 and http://evolve.elsevier.com Student Resources)Before you can understand the role that beliefs and values play in a person’s life, you must understand culturally dominant values and personal values-including your own. Cultural conflicts between nurses and patients from diverse backgrounds are related to different timeand relationship perceptions. For example, in some cultures, the past may influence health practices. When making decisions about health, patients may rely on relationships with others, and their behavior may depend on the opinion of others. In a multicultural country, you must accept that differences exist and be open to the importance of these practices to the patient and not let your won biases and misconceptions get in the way of providing the best care for your patient.5. Know what the best approach would be for overcoming language barriers with patients (p. 45-48, re: Table 3-4, 3-5 for more information)For a patient with limited English proficiency, use a bilingual team member or a trained medical interpreter whenever possible. Avoid using a family member or close friend as an interpreter because this violates the patient’s confidentiality and you can’t be sure what exactly the family member or friend is telling the patient—they could be “softening the blow” by leaving out important information or they might not be familiar with medical terminology, hospital/clinical procedures, and medical ethics. If an interpreter is not available, use telephone translation services. When using an interpreter, be sure to focus questions at the patient, not the interpreter.6. Know the importance of asking another health care provider to validate assessment findings that you are unsure about, such as unfamiliar breath sounds (p. 2)It is important to always validate the data that you collect to make sure they are accurate. Asyou validate your information, look for gaps in data collection (i.e., missing pieces of information). How you validate data depends on experience. Some things, like vital signs, can be validated by you by repeating the process as well as eliminating any extraneous variables that could influence the data (e.g., recent exercise or cigarette smoking if you needto take BP). If you are still unsure, get another nurse to help you. However, some information, no matter how experienced you are, should be validated by another healthcare provider (e.g., a breast lump). If you report erroneous patient data, the patient will not receive the care they need (e.g., diabetic not getting insulin when it is needed because of erroneous glucose testing). The consequences could be deadly and could cost you your license/job. 7. Know the difference between subjective and objective data (p.2)Subjective-what a patient says about themselves during history taking (i.e., PQRST of a symptom)Objective-what you as the health professional observe by inspecting, percussing, palpating, and auscultating during the physical examination (e.g., results of diagnostic testing, vital signs, measurements and other observations noted by the nurse)8. Review the first, second and third-levels of priorities 1st- Emergent, life threatening, and immediate like establishing