- Email: [email protected]
Playing Detective to Enhance Critical Thinking
Teaching and Learning in Nursing xxx (2016) xxx–xxx
Contents lists available at ScienceDirect
Teaching and Learning in Nursing journal homepage: www.jtln.org
Playing Detective to Enhance Critical Thinking☆ Theresa Jones, PhD, MSN, BSN, AASN, RN-BC ⁎ Fairmont State University, 146B Colebank Hall 26554
a r t i c l e
i n f o
Article history: Received 26 June 2016 Received in revised form 10 September 2016 Accepted 13 September 2016 Available online xxxx Keywords: Reverse case study Critical thinking Concepts Benners' theory
a b s t r a c t New nurses are expected to critically think and have the ability to quickly identify patient problems at an early stage upon entering the nursing profession. Nurse educators attempt to prepare students to think critically utilizing a multitude of teaching modalities such as clinical experiences, simulation experiences, course assessments, written assignments, and case studies. Although these are useful methods of learning, they do not necessarily initiate the critical thinking process. An innovative teaching strategy such as a reverse case study is one such strategy that initiates critical thinking. Students are given small amounts of information, and then, they identify what is important. They create a concept map, a synopsis, or scenario and apply appropriate interventions specific in meeting the needs of the patient. It makes them critically think, understand the how things are connected, and why certain interventions and actions are appropriate. The method brings together past concepts of learning to current situations, engaging student learning. Using creative and some different approaches will facilitate the critical thinking process. © 2016 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
When nursing students graduate and successfully pass the National Council Licensure Examination, they enter the nursing profession with considerable excitement about beginning the nursing profession. New nurses have varying degrees of struggles depending on their experiences and self-confidence levels. New nurses frequently have a feeling of being overwhelmed with all the information they need to know and all the tasks they must know how to do. New nurses often encounter phrases like think like a nurse, use critical thinking skills, you have to think on your feet, or you have to be able to anticipate problems. Benner's novice to expert can be used a framework to guide practice as they develop more competencies (Gardner, 2012). Nurses begin at the novice stage and progress to become experts over time. As educators, we try to prepare nurses for the profession during their experiences as students through work in varied clinical rotations, simulation experiences, course assessments, written assignments, and case studies. (See Fig. 1). Case Study Case studies have been used in medical and nursing education for a significant amount of time and date back hundreds of years, with one of the oldest records at New Haven Medical Society in 1788 (Gortner, 1983; Tomey, 2003). The scenarios typically front-load ☆ No financial support, grant, or presentation to date. ⁎ Corresponding author. Tel.: +1 304 368 7229. E-mail address: [email protected].
students with information about a patient's situation or condition and then conclude the learning activity with a standard set of questions. Students proceed to answer these standard questions, and this is supposed to ascertain that learning occurred. A concern with using typical case studies is that answering questions at the end does not necessarily build the capacity for someone to apply the knowledge to actual situations. A creative learning activity to increase the ability to apply knowledge to various situations is by providing an opportunity for students to build the case studies in reverse. Learning in this manner promotes more levels of critical thinking because the reverse case study promotes clinical reasoning skills and helps build confidence in this process.
Reverse Case Study The reverse case study is an active learning strategy, which can be used in a classroom or clinical setting. Only a small amount of information is required to spark discussions and promote critical thinking (Beyer, 2011; Morey, 2012; Nursing Education, 2011). One might wonder how a reverse case study is built. An educator begins with providing students with some basic information such as diagnostic studies, a set of laboratory values, a list of medications, a limited list of orders, some of the patient's complaints, and vital signs. What happens is students collaborate and identify what the medications are used for and what the diagnostic studies mean. After some discussion, they identify what they think could be the current patient problem, and they also create a history of problems from the information
http://dx.doi.org/10.1016/j.teln.2016.09.005 1557-3087/© 2016 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Please cite this article as: Jones, T., Playing Detective to Enhance Critical Thinking, Teaching and Learning in Nursing (2016), http://dx.doi.org/ 10.1016/j.teln.2016.09.005
2
T. Jones / Teaching and Learning in Nursing xxx (2016) xxx–xxx
Fig. 1. Reverse Case Study Activity.
provided. The students take the information and build the scenario for the instructor rather than the instructor or educator providing the scenario for the students. The students have the opportunity to piece together what initially started as basically fragmented information to an actual issue where they can apply real-world interventions in how they would care for the patient. The interventions are based on the actual patient problem and history of illnesses, thus allowing the shift from knowledge or comprehension to the application of concepts where the critical thinking process unfolds. Students are playing detectives, and they seem very excited when they connect the pieces of the puzzle. When the connections between concepts are made throughout their educational experiences and upon conclusion of their educational program, they can enter an organization with higher levels of reasoning and considered more advanced than Benners' novice stage (Ashley & Stamp, 2014; Benner, 1984). They have learned to collect data, reason, and analyze information, therefore placing them at the advanced beginner stage.
Benners' Theory Benners' theory of nursing consists of five levels of performance in regard to situations and experience. The levels range from novice, advanced beginner, competent, proficient, and expert (Benner, 1984). Novices are persons who do not have any experience or judgment in situations and who have limited decision-making skills. They focus on rules instead of being able to process through situations because of limited critical thinking skills. An advanced beginner possesses some experience with actual situations, and the situations become meaningful. A person is considered competent who practices with knowledge and experience, whereas this occurs after being on the job 2–3 years. A person is considered proficient and is one who practices skillfully and is experienced and organized, knowing what to expect in situations. An expert or practicing specialist has a deep understanding of situations and aspects and possesses intuition.
Please cite this article as: Jones, T., Playing Detective to Enhance Critical Thinking, Teaching and Learning in Nursing (2016), http://dx.doi.org/ 10.1016/j.teln.2016.09.005
T. Jones / Teaching and Learning in Nursing xxx (2016) xxx–xxx
Learning Objectives/Goals/Learning Outcomes Although many nursing programs are conceptual based, some institutions still use a medical model or a combination of a concept/ medical model. Regardless of which model is used, students still need to make the connection between disease processes, interventions, and purposes of medication for those disorders. 1. Differentiate between normal and abnormal laboratory data and the implications of the data. 2. Select appropriate nursing diagnoses and interventions that are applicable across different disease processes. 3. Explain medications and their use as it relates to a specific patient. 4. Identify a patient's primary problem and additional problems based on the patient complaints, vital signs, medications, laboratory data, diagnostic studies, and orders. 5. Develop a concept map and synopsis/scenario from the information. Innovative Learning Activity The learning activity took place in a classroom context as a supplemental activity toward a clinical experience with students in their second medical–surgical nursing course. Students worked together in a small group of seven. The students were provided with the guidelines for completing the assignment, which was based on the learning outcomes. The following information was given to the students: the diagnostic studies, laboratory values, a list of medications, a limited list of orders, the patient's complaints, and a set of vital signs, which includes basic physical assessment data. The students are not being asked to medically diagnose because this is not within their scope of practice. They are, however, expected to be able to link information together to provide care to the patient and alert the physician of an issue. They have to have a working knowledge of medical conditions in order to function effectively as a team member and to be an advocate for the patient when an issue arises. • The students discussed the patient orders, vital signs, current complaints, and the list of medications and their uses to determine what the patient's history included and the possible current diagnosis. • The diagnostic studies and laboratory values included below also produced validation to what medical history and current issue the patient possessed. • The list of orders was provided, and the reason they were somewhat limited in nature was to keep from giving the information away. • The case study essentially started in reverse with piecing together the information with the concept map and synopsis creation coming last. • The case study or scenario was built based on the information provided by the instructor. • Attached is a finished example of work, and the outcome was that the students seemed to have a sense of excitement and accomplishment. Based on the information, the students concluded that although there are several issues, the priority problem was heart failure because a normal BNP is 0–99 and requires immediate interventions to preserve cardiac output. The following steps are how this innovative strategy be carried out by another facilitator. Provide the following information to students in a class or small group setting: 1. Present a list of orders: Example orders: VS Q2 hrs. 2GM Sodium. 1800 cal ADA diet. I&O
3
WT Cleanse heel with NS, pat dry, apply cadexomer, and gauze dressing daily. Foley catheter to gravity drainage. Full Code. Condition guarded. Cardiac Monitor. Supplemental Oxygen 3 L/min, nasal cannula. FSBS with Coverage ac& hs. Regular Human Insulin Sliding Scale Coverage. 200–250 = 2 units. Cardiac Monitor. Supplemental Oxygen 3 L/min, nasal cannula. FSBS with Coverage ac& hs. Regular Human Insulin Sliding Scale Coverage. 200–250 = 2 units. 251–300 = 4 units. 301–350 units = 6 units. 351–400 = 8 units. 400 = 10 units. BS b80 or N400 Call MD. Activity Bedrest. I&O qshift. 2. Present patient information and complaints. Patient information and complaints. T-100.9. Pulse 98. Resp 24. Blood Pressure. 105/54. P. O 94%. A 68-year-old male was admitted to the medical–surgical telemetry unit with c/o urinary retention feeling poorly. 3. Current in-hospital medications. Medication List. Hydralazine. Piperacillin. Furosemide. Isosorbide. Ferrous Sulfate. Pantoprazole. Sertraline. Calcium Acetate. Aspirin. Cadexomer Iodine. Tamsulosin. Vancomycin. 4. Present laboratories and diagnostic studies. Laboratory Results. BNP 1837. BNP 1837. Glucose 166. Magnesium 1.6. Phosphorus 6.7. Calcium 8.3. Protein 5.6. Albumin 2.2. BUN 47. WBC 11.7. RBC 4.04. Creatinine 2.0. Alkaline Phosphatase 176.
Please cite this article as: Jones, T., Playing Detective to Enhance Critical Thinking, Teaching and Learning in Nursing (2016), http://dx.doi.org/ 10.1016/j.teln.2016.09.005
4
T. Jones / Teaching and Learning in Nursing xxx (2016) xxx–xxx
References
eGFR 18.1. Troponin 0.02. CK Total 22. Diagnostic Studies. Wound culture. +MRSA. WBC ceretec scan + for Osteomylitis. 5. Have the students discuss and determine the current major problem and additional medical problems based on the patient complaints, medications, and diagnostic studies. 6. Have the students write a scenario about the patient presenting the case study. Information provided to students
Ashley, J., & Stamp, K. (2014). Learning to think like a nurse: The development of clinical judgment in nursing students. Journal of Nursing Education, 53(9), 519–525. http://dx.doi.org/10.3928/01484834-20140821-14. Benner, P. (1984). From novice to expert. (Menlo Park). Beyer, D. (2011). Reverse case study: To think like a nurse. Journal of Nursing Education, 50(1), 48–50. http://dx.doi.org/10.3928/01484834-2010102906. Gardner, L. (2012). From novice to expert: Benner's legacy for nurse education. Nurse Education Today, 32(4), 339–340. Gortner, S. (1983). The history and philosophy of nursing science and research. Advances in Nursing Science, 5(2), 1–8. Morey, D. J. (2012). Development and evaluation of web-based animated pedagogical agents for facilitating critical thinking in nursing. Nursing Education Perspectives, 33(2), 116–120. http://dx.doi.org/10.5480/1536–5026-33.2.116 (5p). Nursing Education (2011). Research from Miami university, department of nursing provides new data about nursing education. Education Letter, 96. Tomey, A. M. (2003). Learning with cases. Journal of Continuing Education in Nursing, 34(1), 34.
Orders
Vital Signs
Medications
Laboratories and diagnostic study
Major Problem concluded by students
Additional problems concluded by students
Nursing Diagnosis by students
Nursing Interventions by students
VS Q2 hrs 2GM Sodium 1800 cal ADA diet I&O WT Cleanse heel with NS, pat dry, apply cadexomer and gauze dressing daily Foley catheter to gravity drainage Full Code Condition guarded Cardiac Monitor Supplemental Oxygen 3 L/min, nasal cannula FSBS with Coverage ac& hs Regular Human Insulin Sliding Scale Coverage 200–250 = 2 units 251–300 = 4 units 301–350 units = 6 units 351–400 = 8 units 400 = 10 units BS b80 or N400 Call MD Activity Bedrest I&O qshift
T-100.9 Pulse 98 Resp 24 Blood Pressure 105/54 P. O 94% Pt Complaints A 68-year-old male was admitted to the medical surgical telemetry unit with c/o urinary retention & feeling poorly.
Hydralazine Piperacillin Furosemide Isosorbide Ferrous Sulfate Pantoprazole Sertraline Calcium Acetate Aspirin Cadexomer Iodine Tamsulosin Vancomycin
BNP 1837 BNP 1837 Glucose 166 Magnesium 1.6 Phosphorus 6.7 Calcium 8.3 Protein 5.6 Albumin 2.2 BUN 47 WBC 11.7 RBC 4.04 Creatinine 2.0 Alkaline Phosphatase 176 eGFR 18.1 Troponin 0.02 CK Total 22 Wound culture +MRSA WBC ceretec scan
CHF
Diabetes BPH GERD Foot Infection PTSD/Depression Anemia HTN Renal/Liver issue
Fluid volume overload Decreased cardiac output Decreased health maintenance Impaired skin integrity Impaired gas exchange
PRN Oxygen Pulse ox Telemetry monitor Vital signs q2 hrs Turn q2 hrs Cardiac diet Monitor I&O Elevate the head of bed Incentive spirometer Assess lung sounds every 2 hours Monitor Intake & Output, daily weights Foley for accurate I&O Dressing changes qday Measure wound daily Monitor for skin breakdown Monitor labs Place on sodium restrictions Monitor for side effects of diuretic therapy Dietary consult
Please cite this article as: Jones, T., Playing Detective to Enhance Critical Thinking, Teaching and Learning in Nursing (2016), http://dx.doi.org/ 10.1016/j.teln.2016.09.005
Contents lists available at ScienceDirect
Teaching and Learning in Nursing journal homepage: www.jtln.org
Playing Detective to Enhance Critical Thinking☆ Theresa Jones, PhD, MSN, BSN, AASN, RN-BC ⁎ Fairmont State University, 146B Colebank Hall 26554
a r t i c l e
i n f o
Article history: Received 26 June 2016 Received in revised form 10 September 2016 Accepted 13 September 2016 Available online xxxx Keywords: Reverse case study Critical thinking Concepts Benners' theory
a b s t r a c t New nurses are expected to critically think and have the ability to quickly identify patient problems at an early stage upon entering the nursing profession. Nurse educators attempt to prepare students to think critically utilizing a multitude of teaching modalities such as clinical experiences, simulation experiences, course assessments, written assignments, and case studies. Although these are useful methods of learning, they do not necessarily initiate the critical thinking process. An innovative teaching strategy such as a reverse case study is one such strategy that initiates critical thinking. Students are given small amounts of information, and then, they identify what is important. They create a concept map, a synopsis, or scenario and apply appropriate interventions specific in meeting the needs of the patient. It makes them critically think, understand the how things are connected, and why certain interventions and actions are appropriate. The method brings together past concepts of learning to current situations, engaging student learning. Using creative and some different approaches will facilitate the critical thinking process. © 2016 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
When nursing students graduate and successfully pass the National Council Licensure Examination, they enter the nursing profession with considerable excitement about beginning the nursing profession. New nurses have varying degrees of struggles depending on their experiences and self-confidence levels. New nurses frequently have a feeling of being overwhelmed with all the information they need to know and all the tasks they must know how to do. New nurses often encounter phrases like think like a nurse, use critical thinking skills, you have to think on your feet, or you have to be able to anticipate problems. Benner's novice to expert can be used a framework to guide practice as they develop more competencies (Gardner, 2012). Nurses begin at the novice stage and progress to become experts over time. As educators, we try to prepare nurses for the profession during their experiences as students through work in varied clinical rotations, simulation experiences, course assessments, written assignments, and case studies. (See Fig. 1). Case Study Case studies have been used in medical and nursing education for a significant amount of time and date back hundreds of years, with one of the oldest records at New Haven Medical Society in 1788 (Gortner, 1983; Tomey, 2003). The scenarios typically front-load ☆ No financial support, grant, or presentation to date. ⁎ Corresponding author. Tel.: +1 304 368 7229. E-mail address: [email protected].
students with information about a patient's situation or condition and then conclude the learning activity with a standard set of questions. Students proceed to answer these standard questions, and this is supposed to ascertain that learning occurred. A concern with using typical case studies is that answering questions at the end does not necessarily build the capacity for someone to apply the knowledge to actual situations. A creative learning activity to increase the ability to apply knowledge to various situations is by providing an opportunity for students to build the case studies in reverse. Learning in this manner promotes more levels of critical thinking because the reverse case study promotes clinical reasoning skills and helps build confidence in this process.
Reverse Case Study The reverse case study is an active learning strategy, which can be used in a classroom or clinical setting. Only a small amount of information is required to spark discussions and promote critical thinking (Beyer, 2011; Morey, 2012; Nursing Education, 2011). One might wonder how a reverse case study is built. An educator begins with providing students with some basic information such as diagnostic studies, a set of laboratory values, a list of medications, a limited list of orders, some of the patient's complaints, and vital signs. What happens is students collaborate and identify what the medications are used for and what the diagnostic studies mean. After some discussion, they identify what they think could be the current patient problem, and they also create a history of problems from the information
http://dx.doi.org/10.1016/j.teln.2016.09.005 1557-3087/© 2016 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Please cite this article as: Jones, T., Playing Detective to Enhance Critical Thinking, Teaching and Learning in Nursing (2016), http://dx.doi.org/ 10.1016/j.teln.2016.09.005
2
T. Jones / Teaching and Learning in Nursing xxx (2016) xxx–xxx
Fig. 1. Reverse Case Study Activity.
provided. The students take the information and build the scenario for the instructor rather than the instructor or educator providing the scenario for the students. The students have the opportunity to piece together what initially started as basically fragmented information to an actual issue where they can apply real-world interventions in how they would care for the patient. The interventions are based on the actual patient problem and history of illnesses, thus allowing the shift from knowledge or comprehension to the application of concepts where the critical thinking process unfolds. Students are playing detectives, and they seem very excited when they connect the pieces of the puzzle. When the connections between concepts are made throughout their educational experiences and upon conclusion of their educational program, they can enter an organization with higher levels of reasoning and considered more advanced than Benners' novice stage (Ashley & Stamp, 2014; Benner, 1984). They have learned to collect data, reason, and analyze information, therefore placing them at the advanced beginner stage.
Benners' Theory Benners' theory of nursing consists of five levels of performance in regard to situations and experience. The levels range from novice, advanced beginner, competent, proficient, and expert (Benner, 1984). Novices are persons who do not have any experience or judgment in situations and who have limited decision-making skills. They focus on rules instead of being able to process through situations because of limited critical thinking skills. An advanced beginner possesses some experience with actual situations, and the situations become meaningful. A person is considered competent who practices with knowledge and experience, whereas this occurs after being on the job 2–3 years. A person is considered proficient and is one who practices skillfully and is experienced and organized, knowing what to expect in situations. An expert or practicing specialist has a deep understanding of situations and aspects and possesses intuition.
Please cite this article as: Jones, T., Playing Detective to Enhance Critical Thinking, Teaching and Learning in Nursing (2016), http://dx.doi.org/ 10.1016/j.teln.2016.09.005
T. Jones / Teaching and Learning in Nursing xxx (2016) xxx–xxx
Learning Objectives/Goals/Learning Outcomes Although many nursing programs are conceptual based, some institutions still use a medical model or a combination of a concept/ medical model. Regardless of which model is used, students still need to make the connection between disease processes, interventions, and purposes of medication for those disorders. 1. Differentiate between normal and abnormal laboratory data and the implications of the data. 2. Select appropriate nursing diagnoses and interventions that are applicable across different disease processes. 3. Explain medications and their use as it relates to a specific patient. 4. Identify a patient's primary problem and additional problems based on the patient complaints, vital signs, medications, laboratory data, diagnostic studies, and orders. 5. Develop a concept map and synopsis/scenario from the information. Innovative Learning Activity The learning activity took place in a classroom context as a supplemental activity toward a clinical experience with students in their second medical–surgical nursing course. Students worked together in a small group of seven. The students were provided with the guidelines for completing the assignment, which was based on the learning outcomes. The following information was given to the students: the diagnostic studies, laboratory values, a list of medications, a limited list of orders, the patient's complaints, and a set of vital signs, which includes basic physical assessment data. The students are not being asked to medically diagnose because this is not within their scope of practice. They are, however, expected to be able to link information together to provide care to the patient and alert the physician of an issue. They have to have a working knowledge of medical conditions in order to function effectively as a team member and to be an advocate for the patient when an issue arises. • The students discussed the patient orders, vital signs, current complaints, and the list of medications and their uses to determine what the patient's history included and the possible current diagnosis. • The diagnostic studies and laboratory values included below also produced validation to what medical history and current issue the patient possessed. • The list of orders was provided, and the reason they were somewhat limited in nature was to keep from giving the information away. • The case study essentially started in reverse with piecing together the information with the concept map and synopsis creation coming last. • The case study or scenario was built based on the information provided by the instructor. • Attached is a finished example of work, and the outcome was that the students seemed to have a sense of excitement and accomplishment. Based on the information, the students concluded that although there are several issues, the priority problem was heart failure because a normal BNP is 0–99 and requires immediate interventions to preserve cardiac output. The following steps are how this innovative strategy be carried out by another facilitator. Provide the following information to students in a class or small group setting: 1. Present a list of orders: Example orders: VS Q2 hrs. 2GM Sodium. 1800 cal ADA diet. I&O
3
WT Cleanse heel with NS, pat dry, apply cadexomer, and gauze dressing daily. Foley catheter to gravity drainage. Full Code. Condition guarded. Cardiac Monitor. Supplemental Oxygen 3 L/min, nasal cannula. FSBS with Coverage ac& hs. Regular Human Insulin Sliding Scale Coverage. 200–250 = 2 units. Cardiac Monitor. Supplemental Oxygen 3 L/min, nasal cannula. FSBS with Coverage ac& hs. Regular Human Insulin Sliding Scale Coverage. 200–250 = 2 units. 251–300 = 4 units. 301–350 units = 6 units. 351–400 = 8 units. 400 = 10 units. BS b80 or N400 Call MD. Activity Bedrest. I&O qshift. 2. Present patient information and complaints. Patient information and complaints. T-100.9. Pulse 98. Resp 24. Blood Pressure. 105/54. P. O 94%. A 68-year-old male was admitted to the medical–surgical telemetry unit with c/o urinary retention feeling poorly. 3. Current in-hospital medications. Medication List. Hydralazine. Piperacillin. Furosemide. Isosorbide. Ferrous Sulfate. Pantoprazole. Sertraline. Calcium Acetate. Aspirin. Cadexomer Iodine. Tamsulosin. Vancomycin. 4. Present laboratories and diagnostic studies. Laboratory Results. BNP 1837. BNP 1837. Glucose 166. Magnesium 1.6. Phosphorus 6.7. Calcium 8.3. Protein 5.6. Albumin 2.2. BUN 47. WBC 11.7. RBC 4.04. Creatinine 2.0. Alkaline Phosphatase 176.
Please cite this article as: Jones, T., Playing Detective to Enhance Critical Thinking, Teaching and Learning in Nursing (2016), http://dx.doi.org/ 10.1016/j.teln.2016.09.005
4
T. Jones / Teaching and Learning in Nursing xxx (2016) xxx–xxx
References
eGFR 18.1. Troponin 0.02. CK Total 22. Diagnostic Studies. Wound culture. +MRSA. WBC ceretec scan + for Osteomylitis. 5. Have the students discuss and determine the current major problem and additional medical problems based on the patient complaints, medications, and diagnostic studies. 6. Have the students write a scenario about the patient presenting the case study. Information provided to students
Ashley, J., & Stamp, K. (2014). Learning to think like a nurse: The development of clinical judgment in nursing students. Journal of Nursing Education, 53(9), 519–525. http://dx.doi.org/10.3928/01484834-20140821-14. Benner, P. (1984). From novice to expert. (Menlo Park). Beyer, D. (2011). Reverse case study: To think like a nurse. Journal of Nursing Education, 50(1), 48–50. http://dx.doi.org/10.3928/01484834-2010102906. Gardner, L. (2012). From novice to expert: Benner's legacy for nurse education. Nurse Education Today, 32(4), 339–340. Gortner, S. (1983). The history and philosophy of nursing science and research. Advances in Nursing Science, 5(2), 1–8. Morey, D. J. (2012). Development and evaluation of web-based animated pedagogical agents for facilitating critical thinking in nursing. Nursing Education Perspectives, 33(2), 116–120. http://dx.doi.org/10.5480/1536–5026-33.2.116 (5p). Nursing Education (2011). Research from Miami university, department of nursing provides new data about nursing education. Education Letter, 96. Tomey, A. M. (2003). Learning with cases. Journal of Continuing Education in Nursing, 34(1), 34.
Orders
Vital Signs
Medications
Laboratories and diagnostic study
Major Problem concluded by students
Additional problems concluded by students
Nursing Diagnosis by students
Nursing Interventions by students
VS Q2 hrs 2GM Sodium 1800 cal ADA diet I&O WT Cleanse heel with NS, pat dry, apply cadexomer and gauze dressing daily Foley catheter to gravity drainage Full Code Condition guarded Cardiac Monitor Supplemental Oxygen 3 L/min, nasal cannula FSBS with Coverage ac& hs Regular Human Insulin Sliding Scale Coverage 200–250 = 2 units 251–300 = 4 units 301–350 units = 6 units 351–400 = 8 units 400 = 10 units BS b80 or N400 Call MD Activity Bedrest I&O qshift
T-100.9 Pulse 98 Resp 24 Blood Pressure 105/54 P. O 94% Pt Complaints A 68-year-old male was admitted to the medical surgical telemetry unit with c/o urinary retention & feeling poorly.
Hydralazine Piperacillin Furosemide Isosorbide Ferrous Sulfate Pantoprazole Sertraline Calcium Acetate Aspirin Cadexomer Iodine Tamsulosin Vancomycin
BNP 1837 BNP 1837 Glucose 166 Magnesium 1.6 Phosphorus 6.7 Calcium 8.3 Protein 5.6 Albumin 2.2 BUN 47 WBC 11.7 RBC 4.04 Creatinine 2.0 Alkaline Phosphatase 176 eGFR 18.1 Troponin 0.02 CK Total 22 Wound culture +MRSA WBC ceretec scan
CHF
Diabetes BPH GERD Foot Infection PTSD/Depression Anemia HTN Renal/Liver issue
Fluid volume overload Decreased cardiac output Decreased health maintenance Impaired skin integrity Impaired gas exchange
PRN Oxygen Pulse ox Telemetry monitor Vital signs q2 hrs Turn q2 hrs Cardiac diet Monitor I&O Elevate the head of bed Incentive spirometer Assess lung sounds every 2 hours Monitor Intake & Output, daily weights Foley for accurate I&O Dressing changes qday Measure wound daily Monitor for skin breakdown Monitor labs Place on sodium restrictions Monitor for side effects of diuretic therapy Dietary consult
Please cite this article as: Jones, T., Playing Detective to Enhance Critical Thinking, Teaching and Learning in Nursing (2016), http://dx.doi.org/ 10.1016/j.teln.2016.09.005