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Description  |
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BACKGROUND OF THE INVENTION
This invention relates generally to evaluation systems, and more
particularly, to a system which employs a computer for assessing the
diagnostic reasoning skills of an individual, particularly of a
learner/trainee in any field of study using situations, including the case
method of study, or where evaluation of learner performance is achieved
using situation tests.
In a variety of disciplines, the situation test method of learner
evaluation has been accepted as the preferred approach. The case study
methodology has associated therewith the significant advantages of
providing a vehicle for generating discussion among learners and dialogue
with a teacher. Additionally, the study of a case affords the learner
considerable opportunity to apply his or her knowledge and reasoning
skills in a predetermined situation test.
One of the major problems in the case study method of teaching is in
grading a multiplicity of learners objectively and consistently. For
example, in institutional teaching situations where hundreds of learners
are taking the same test, the percentage of agreement among the various
experts who grade the tests is low. This percentage remains low even when
the experts are provided with grading criteria.
One field which has traditionally employed the case study method is health
care education. It is extremely important that persons involved in nursing
and other health-related disciplines have well-developed problem-solving
and critical thinking capabilities. An individual practicing in these
fields is required to determine the problems of a patient from a case
history, or narrative, which includes factual information derived
objectively and subjectively. The individual must then select from the
problems those which are of primary importance to warrant an intervention.
Of course, once there is a determined need for intervention, an
intervention plan must be developed. It is significant in the education
process of such individuals to ascertain, preferably by quantification,
the extent to which they have succeeded in developing their critical
thinking and problem-solving capabilities.
It is, therefore, an object of this invention to provide a system for
evaluating reasoning and analysis capability of individuals.
It is another object of this invention to provide an evaluation system
which assists a teacher/trainer in identifying aptitudes and deficiencies
in learners relating to identifying problems in given situations and
selecting data in support of these problems.
It is also an object of this invention to provide an evaluation system
which assists a teacher in identifying aptitudes and deficiencies in
learners relating to planning of corrective intervention after identifying
problems in given situations.
It is a further object of this invention to provide a computerized
evaluation system which assists a teacher in identifying aptitudes and
deficiencies in learners relating to identifying problems and planning
corrective intervention in given situations.
It is additionally an object of this invention to provide a computerized
system for assisting a teacher in assessing the ability of a learner to
identify major problems in a plurality of potential problems.
It is yet a further object of this invention to provide a computerized
system for assessing the diagnostic reasoning skills of learners in
health-related fields of study.
It is also another object of this invention to provide a computerized
system for assessing diagnostic reasoning skills of learners in fields of
study which use situation tests to assist in evaluating learners.
It is yet an additional object of this invention to provide a computerized
system for assisting a teacher of a field of study which employs the
situation test method in assessing the diagnostic reasoning skills of a
large number of learners.
It is still another object of this invention to provide a computerized
system for evaluating and assessing the problem identification skills of
learners.
It is a yet further object of this invention to provide an objective,
criterion-based, computerized testing and evaluation system.
It is also a further object of this invention to provide a testing and
evaluation system which can provide substantially immediate feedback of
learner performance to a teacher and a learner.
It is additionally another object of this invention to provide a testing
and evaluation system for use in conjunction with a computer, whereby the
examinations of a plurality of learners are objectively evaluated in
problem identification and intervention planning.
A still further object of this invention is to provide a testing and
evaluation system for use in conjunction with a computer, whereby the
diagnostic reasoning capability of a learner is evaluated substantially
irrespective of the extent to which the learner completed the examination.
An additional object of this invention is to provide a testing and
evaluation system for use in conjunction with a computer, whereby
evaluation of the diagnostic reasoning capability of a learner is
evaluated by monitoring the binary states of at least two software flags.
Yet another object of this invention is to provide a testing and evaluation
system for use in conjunction with a computer, whereby an overall
performance score of a learner is increased by extra effort on the part of
the learner in completing an examination.
Another object of this invention is to provide a testing and evaluation
system for use in conjunction with a computer, whereby correctness of
rationale in support of an action is considered in the grading of a
learner.
SUMMARY OF THE INVENTION
The foregoing and other objects are achieved by this invention which
provides a method of operating a computing machine to assess the reasoning
ability of an individual to be evaluated. In accordance with the
invention, a situation test description which describes a plurality of
characteristics associated with a situation test is stored in a test file.
At least one question pertaining to the situation test, as set forth in
the situation test description, to be answered by the individual is stored
in a question file. In one embodiment of the invention, the question is in
the form of a listing of choices whereby the individual to be evaluated
selects one or more predetermined problems he or she believes is related
to the situation test. A problem identification file sees and stores a
problem identification response by the individual to be evaluated. The
information received by the problem identification file is in the form of
a code number corresponding to at least a selected one of the possible
choices.
In a preferred embodiment of the invention, the phrase identification
symbols associated with the plurality of phrases which form the situation
test description, are stored in an answer file by the learner being
evaluated to identify the specific ones of the phrases which support the
answers selected by the learner. Thus, the learner forms a data
relationship between the data provided in the narrative of the situation
test, and the data which forms the bases of the questions to be answered,
or problems to be solved, by the learner during the examination. The
stored answers, which may include identification numbers or symbols
associated with selected ones of listed possible problems, the components
of an intervention plan to be proposed by the learner, and the supporting
phrases of the situation test description are compared to predetermined
answers stored in an answer key, which will be discussed hereinbelow,
during grading.
Further in accordance with the invention, the intervention plan proposed by
the individual to resolve a major one of the problems identified in the
problem data relationship is stored in an intervention plan selection
file. As indicated, in certain embodiments, the intervention plan
selection file may be included in the answer file. The problem
identification file includes specific data elements from the situation
test description. The data elements are in the form of an identification
file which may be part of the intervention plan file. It is to be
understood that the term "files" correspond to any memorialization
arrangement, such as computer memory, and need not have associated
therewith any nomenclature.
In one embodiment of the invention, the intervention plan stored in the
intervention plan selection file consists of a plurality of coded
selection options selected by the individual to be evaluated. The plan may
included coded listings of objectives, criteria, interventions, and
reasons. Thus, within each such component of the intervention plan, there
are listings of choices, each choice having an associated code number. In
operation, the individual to be evaluated is requested to select one
objective and at least one criteria for each problem in the problem
identification file which has been identified as being major. The
individual to be evaluated therefore will select from a plurality of each
of objectives, criteria, interventions, and reasons. However, not every
intervention plan need incorporate all such components during testing.
Moreover, the identification of the problems, as well as the intervention
plan, can be edited by the learner being evaluated prior to submission of
the examination for grading.
In a computerized embodiment, an answer key is stored on a memory disk by a
teacher or administrator of the examination. In a practical embodiment of
the invention, the software can be accommodated on one disk, and includes
a file portion for making separate disks for administration of the
examination. The individual being evaluated can enter the answers to the
examination at a computer or an answer sheet which then is entered into a
computer.
The system permits a teacher to make disks containing the examination for
distribution to individuals being evaluated, or the administrators of the
examination. As will be described herein, the learner test disk will also
contain at least a portion of a known operating system, such as a disk
operating system, to permit the learner disk to be self-loading.
As previously noted, in a preferred embodiment of the invention, the
software system contains an editor portion which permits the teacher to
create an answer key for a given situation test. The answer key can be
edited by the teacher at any time. There is further provided a disk-making
portion which is used to place the examination on the separate learner
disks. Finally, a correction portion of the software package is employed
to grade the responses to the situation test. In a preferred embodiment,
the grading process generates a print-out which describes the pattern of
reasoning of the tested individual which yield three numerical scores:
problem identification score, intervention plan score, and total score.
The resulting plurality of scores can be subjected to group analysis.
Thus, groups of learners can be compared, thereby permitting diagnosis of
reasoning deficiencies which apply to the group of learners as a whole, so
as to enable development of corrective training program.
A measure of security is achieved by the production of an individual
disk(s) for each of the learners being evaluated. In this manner, a
learner cannot obtain the test results of any other learner. Additionally,
the learners can be identified by learner numbers, which permit posting of
grades in a conventional manner without identifying the particular
individuals.
In the practice of the invention, the system, from the standpoint of the
learner, is initialized, illustratively by booting in a conventional
manner, and identification information is requested. After the entry of
the identification information, the answer files are opened and
instructions are displayed on the screen to commence the examination. When
the examination is completed, the information is stored in the answer
files on the disk, and the answer files are closed.
During the examination, the test begins with the problem identification
section. After reading the situation test description, the individual
being evaluated selects from a listing of possible problems, those codes
which are believed associated with problems raised by the situation test
description, which in a specific illustrative embodiment may be a medical
situation in narrative form. Prior to proceeding with the generation of an
intervention plan, the learner being evaluated is afforded an opportunity
to edit the answers to the problem identification section, prior to their
being entered on the computer disk.
Upon completion of the problem identification section, the learner being
evaluated commences the intervention plan section. In this section, the
learner is requested to select a predetermined number of the problems
identified in the previous section on the basis of a determination by the
learner that their significance as problems is sufficient to warrant
intervention. As previously indicated, the intervention plan is created by
selecting appropriate choices from several options within listings of
problems, objectives, criteria, interventions, and rationale, for each
major problem, or each problem of primary importance. As also previously
indicated, the listings are coded by number, each listing including
correct and incorrect choices.
An "objective" is defined as a measurable behavior expected to guide
intervention. "Criteria" is an outcome which describes achievement of
objectives. An "intervention plan" is defined as a plan of action for
solving a given situation. In a nursing embodiment of the invention,
multiple interventions, illustratively five interventions, can be listed
for each major problem along with rationale. "Rationale" is a reason cited
by the learner for specific action.
In this embodiment, the intervention plan for each major problem is rated.
For example, each correct action and an associated correct reason receive
a score of one point. Thus, only one-half point is given if action is
correct, but the rational is incorrect. Thus, in this embodiment, the
classifications of intervention plan can include "correct intervention,"
"intervention plan with some validity," and "intervention plan without
validity." In this particular embodiment, if the intervention plan for a
selected major problem is correct, it is labeled as "correct
intervention." If three of five actions are correct, it is labeled as
"intervention with some validity." A rating of "intervention without
validity" occurs when four of five actions entered are incorrect. An
intervention rating is calculated for each of the major problems.
In a specific illustrative embodiment of the invention which is suitable
for use in health care education, particularly nursing education, an
illustrative respondent version of an examination directed to a case study
would appear as follows:
NURSING CASE STUDY EXAMINATION
Directions
You are the nurse responsible for the situation described in the following
case study. Read the following definition of terms before you begin with
the case study.
Definitions:
Nursing Assessment and Nursing Care: The elements inherent in this process
are (1) problem identification, (2) major problem identification, (3)
objectives, (4) criteria, (5) interventions, and (6) rationale.
Patient or Client Problems: an identified or potential unmet need of the
client, family, or nurse.
Problem Choices: choices of all problems for case study description.
Supporting Data: direct or implied data from the case study description
resulting in the identification of a particular problem.
Major Problems: most important problems for case study description.
Objectives: behaviors expected in the patient which provide direction for
the intervention plan/nursing care section.
Criteria: measurable outcomes of an objective.
Interventions: intervention choices to be taken by nurse for each major
problem.
Rationale for Interventions: reason cited by nurse for a specific nursing
intervention.
There are two answer sheets provided. Complete the problem identification
section by selecting the problems from the list provided. Indicate your
choices by number on the problem identification section of the answer
sheet. Next select the supporting data phrases from the case study
description. Indicate your choices by number on the supporting data
section of the answer sheet.
Next you will complete the nursing care section. Select from your problem
choices the most important problems. Next select the patient-centered
objective, criteria, interventions and rationale for each major problem
identified using the listings provided. Indicate your choices by number on
the nursing care answer sheets. Feel free to mark up this case study.
Avoid guessing so your choices reflect what you would actually do in a
situation of this nature.
You may use the work sheet to briefly write your answers in short phrases
and as a means to visualize your choices. Use an identifying number by
each short phrase so your choices can be easily transferred to the answer
sheets.
Thanks for your participation.
MISS G: ACUTE CARE
(1) Miss Giordano is an 84 year old woman who was admitted to the hospital
from a nursing home last night. (2) She required hospitalization due to a
fractured right hip which she sustained when she fell last evening. (3)
Miss Giordano fell when she tried to climb out of bed over the side rails
(4) while wearing a posey vest restraint.
(5) Miss Giordano was admitted to the nursing home from a sheltered
boarding home one month ago. (6) According to nursing home staff, she
required nursing home admission because in the boarding home she became
(7) increasingly confused over a period of several months, (8) began to
wander, and (9) became incontinent of bowel and bladder. (10) During her
one month nursing home stay, Miss Giordano lost 10 pounds although (11)
she consistently ate all of the food on her tray at every meal. (12) She
paced around the unit all day, (13) despite efforts to get her to rest or
(14) participate in Recreation Therapy. (15) She was usually restless at
night (16) and often required restraints to get her to stay in bed. (17)
The nursing home staff provided complete assistance with bathing and
dressing, (18) although they were able to encourage her to comb her own
hair in front of the mirror. (19) Miss Giordano frequently asked nursing
home staff where the bathroom was, (20) but often soiled her clothing or
the floor. (21) When this happened, the nursing home staff reported that
she either cried or attempted to hide.
(22) Miss Giordano was never married, lived alone and was a grammar school
teacher until her retirement at age 65. (23) Her parents came to America
from Italy and her religion is Roman Catholic. (24) Her sister, who is her
only living relative, says that she was a hard-working fastidious person
all of her life. (25) She was devoted to her job and (26) kept to herself
for the most part after she retired. (27) Her health was always good, and
she was never hospitalized until now. (28) Her medical diagnosis in the
nursing home was Dementia, and her only (29) medication was Restoril 15 mg
po HS.
(30) In the hospital, Miss Giordano has been quiet and cooperative with the
nursing staff. (31) She is disoriented to time and place, (32) but
responds to her own name and can identify herself. (33) She seemed to
recognize her sister and brother-on-law when they visited last night, (34)
however, she called them by the wrong names. (35) She is on complete bed
rest (36) but in no apparent discomfort except during position change.
(37) The admitting physician prescribed Darvocet N-100, which she received
at 2 AM. (38) Miss Giordano herself tells you: "This is a nice place, but
I have to go home to my mother and father."
MISS G: PROBLEM CHOICES
Directions: Select relevant problems and supporting data which are actual
phrases from the case study. Record your choice by number on the answer
sheet.
1. Alteration in thought processes
2. Alteration in nutrition: less than body requirements
3. Impaired verbal communication
4. Potential for ineffective airway clearance
5. Decreased activity tolerance
6. Alteration in comfort
7. Self-care deficit: toileting
8. Potential for violence
9. Potential for ineffective coping
10. Noncompliance
11. Ineffective family coping
12. Impaired mobility
13. Self-care deficit: bathing, dressing, grooming
14. Self-esteem disturbance
15. Sleep pattern disturbance
16. Potential for injury
17. Knowledge deficit
18. Potential for impaired skin integrity
19. Potential for infection
INTERVENTION PLAN FOR MISS G
Choices for Objectives
Directions: Choose one objective for each major problem, and place choice
by number on answer sheet.
Objectives
1. Miss G will return to independent ambulation.
2. Miss G's mental state will not deteriorate during hospitalization.
3. Miss G will increase her activity.
4. Miss G will not develop pressure sores during hospitalization.
5. Miss G will become more compliant.
6. Miss G will accept toileting assistance from nursing staff.
7. Miss G will not sustain physical injury during hospitalization.
8. Miss G's infection will subside.
9. Miss G will cope with stress of hospitalization.
10. Miss G's verbal communication will improve.
Choices for Criteria
Directions: Choose 1-3 criteria for each major problem and indicate choice
by number on answer sheet.
Criteria:
1. Miss G is compliant.
2. Miss G will not exhibit periods of agitation during hospitalization.
3. Miss G converses with staff effectively.
4. Absence of abrasions, bruises, soft tissue injuries and fracture.
5. Miss G is evaluated as a food candidate for gait training post repair of
fractured hip.
6. Miss G will be free of infection.
7. Skin is intact.
8. Miss G will be able to identify herself.
9. Miss G is free of contractures.
10. Miss G will continue to respond to her own name.
11. Incontinence will be eliminated.
12. Absence of rash.
13. No redness.
Choices for Nursing Interventions
Directions: Choose 1-5 nursing interventions for each major problem and
indicate choice by number on answer sheet.
Nursing Interventions:
1. Use positive reinforcement for continent voiding and defecation.
2. Relate to Miss G in a positive warm manner.
3. Place commode at bedside.
4. Locate Miss G in a room near the nurse's station if possible.
5. Apply sugar and Maalox mixture to buttock area.
6. Ambulate with walker 3 times a day.
7. Provide a consistent care-giver when possible.
8. Keep skin clean and dry.
9. Explain all procedures to Miss G simple, concisely, and calmly.
10. Assess the need for posey restraint while in bed (try to avoid this if
possible).
11. Write on a tracking sheet each incident of voiding and defecation
(continent and incontinent) for 3 days.
12. Place Miss G on a fracture pan according to toileting schedule.
13. Ambulate with walker 3 times a day.
14. Offer diet high in fluids and fiber.
15. Maintain side rails up in bed.
16. Provide soft plush object (e.g., stuffed animal, pillow, blanket) for
Miss G.
17. Massage around bony prominences 3 times daily.
18. Turn and position Miss G every 2 hours.
19. Establish toileting schedule for Miss G based on her identified
elimination pattern.
20. Apply water barrier ointment to perineal and buttock area.
21. Arrange for a consistent volunteer to visit Miss G on a regular basis.
22. Provide clock, calendar, radio, and/or tv for Miss G.
23. Arrange for foot board or heel protectors.
24. Answer Miss G's calls for help/assistance promptly (provide alternative
to call bell if Miss G is unable to use it).
25. Assess incidence of pain.
26. Arrange for trapeze.
27. Guide Miss G through passive range of motion exercises within
prescribed restrictions OD.
28. Orient Miss G to time, place, and person as needed.
29. Obtain air mattress.
30. Note changes in behavior exhibited by Miss G.
Choices for Rationale
Directions: Match rational with nursing intervention choices. Choose 1-5
rationale for each major problem and indicate choice by number on answer
sheet.
Rationale:
1. Promotes self-esteem & confidence in plan of care.
2. Ambulation promotes optimum functioning of cardio-respiratory system.
3. Facilitates exercise and activity.
4. Promotes awareness of environment.
5. Irritants and moisture contributes to skin breakdown.
6. Placement in restraints prevents falls.
7. Prevents unsafe independent initiatives by Miss G.
8. Protects skin from irritation due to incontinence.
9. Nurturing communication promotes security.
10. Promotes dorsiflexion of feet.
11. Physical restraints often precipitate agitation and retard mobility.
12. Discomfort restricts movement.
13. To decrease or eliminate episodes of incontinence.
14. Meaningful visual and auditory stimulation are motivators for staying
in touch with reality.
15. Familiarity with care-givers and routine promotes trust and security.
16. Promotes extra vigilance by nursing staff.
17. Knowing what to expect decreases fear and anxiety and enhances coping.
18. Establishment of an unconditional relationship promotes comfort,
well-being, and some motivation to stay in touch with reality.
19. Pleasant tactile stimulation promotes comfort and well-being.
20. Promotes regular elimination.
21. To identify Miss G's elimination pattern.
22. Prevents constant pressure to any one are of skin surface.
23. Scheduled toileting based on individual elimination pattern is likely
to be acceptable to the client and successful in preventing incontinence.
24. Promotes circulation and maintains joint mobility and muscle strength.
25. Prevents falls from bed.
26. Promotes circulation and maintains joint mobility and muscle strength.
27. Early detection enhances changes of successful intervention.
28. Allows for equal distribution of pressure to all areas of body.
##STR1##
Directions for Problem Identification Section:
Select problems from the list provided. Indicate your choices by number on
the problem identification section of this answer sheet.
Next select the supporting data phrases from the case study description.
Indicate your choices by number on the supporting data section of this
answer sheet.
##STR2##
Directions for Planning Section
Select from your problem choices the most important problems.
Next, select the objective, criteria, interventions, and rational for each
major problem identified using the listings provided.
Indicate your choices by number on this answer sheet.
##STR3##
Directions for Intervention Section
Select from your problem choices the most important problems.
Next, select the objective, criteria, interventions, and rationale for each
major problem identified using the listings provided.
Indicate your choices by number on the answer sheet.
##STR4##
It is to be understood that the principles of the invention are not limited
in their applicability to case studies, and in fact, are not content or
situation specific. The principles of the invention are broadly applicable
to evaluation of diagnostic reasoning in almost all situations, including
general management situations, as will become evident from the following
respondent version of an illustrative nursing management examination:
NURSING MANAGEMENT EXAMINATION
Directions:
You are the nurse responsible for the situation described in the following
case study. Read the following definition of terms before you begin with
the case study.
Definitions:
Nursing Assessment and Nursing Care: The elements inherent in this process
are (1) problem identification, (2) major problem identification, (3)
objectives, (4) criteria, (5) interventions, and (6) rationale.
Patient or Client Problems: an identified or potential unmet need of the
client, family, or nurse.
Problem Choices: choices of all problems for case study description.
Supporting Data: direct or implied data from the case study description
resulting in the identification of a particular problem.
Major Problems: most important problems for case study description.
Objectives: behaviors expected in the patient which provide direction for
the intervention plan/nursing care section.
Criteria: measurable outcomes of an objective.
Interventions: intervention choices to be taken by nurse for each major
problem.
Rationale for Interventions: reason cited by nurse for a specific nursing
intervention.
There are two answer sheets provided. Complete the problem identification
section by selecting the problems from the list provided. Indicate your
choices by number on the problem identification section of the answer
sheet. Next select the supporting data phrases from the case study
description. Indicate your choices by number on the supporting data
section of the answer sheet.
Next you will complete the nursing care section. Select from your problem
choices the most important problems. Next select the patient-centered
objective, criteria, interventions and rationale for each major problem
identified using the listings provided. Indicate your choices by number on
the nursing care answer sheets. Feel free to mark up this case study.
Avoid guessing so your choices reflect what you would actually do in a
situation of this nature.
You may use the work sheet to briefly write your answers in short phrases
and as a means to visualize your choices. Use an identifying number by
each short phrase so your choices can be easily transferred to the answer
sheets.
Thanks for your participation.
NURSING MANAGEMENT ON 11-7 SHIFT
CASE STUDY DESCRIPTION:
(1) You are the 11-7 RN in charge of 25 patients working with an LPN on
Unit A, an acute medical floor. (2) On Unit B there is another RN and LPN.
(3) The night supervisor is available on call.
(4) It is 1 AM and you have an emergency admission, Mrs. McDonald, who is
80 years old and has a diagnosis of (R) CVA. (5) She responds only to
painful stimuli.
(6) Her BP is 200/90. (7) She has orders to be transcribed including: (8)
Neuro check q 30 min. (9) A STAT IM medication (Vasodilator) to be given.
(10) IV to be started.
(11) Mrs. Jones, a 54 year old patient with diagnosis of cardiac
arrhythmia, is complaining of chest pain.
(12) The blood bank has called and stated the second unit of packed cells
is ready for Mr. Block, a GI bleeder, who has one unit running now.
(13) You have ten medications to be given at 2 AM.
(14) Rounds must be made on all patients on your wing. (15) Five of the 25
patients have IV's running without pumps. (16) You have four incontinent
patients who require care.
HOW WILL YOU MANAGE THE NURSING REQUIREMENTS BETWEEN 1 AM AND 3 AM?
Nursing Management: Problem Choices
Directions: First, select any number of relevant problems and the
supporting data which are actual phrases from the case study. Record your
choice by number on the answer sheet.
Second, select major problems and record them by number on the nursing care
answer sheet.
1. All patients must be turned and positioned every 2 hours.
2. LPN needs emotional support and empathy.
3. Incontinent patients,
4. Pick up and hang second unit of packed cells for Mr. Block.
5. Mrs. Jone's chest pain.
6. Hourly nursing rounds.
7. Evaluate Mrs. McDonald for transfer to ICU.
8. Admit Mrs. McDonald.
9. Start I.V. on Mrs. McDonald.
10. Administer 2 AM medications.
11. Neuro check on McDonald every 30 minutes.
12. Check I.V. flow rates.
13. Unsafe staffing.
14. Transcribe doctors orders for Mrs. McDonald.
15. Stat vasodilator on Mrs. McDonald.
16. Staffing.
INTERVENTION PLAN CHOICES
Choices for Objectives:
Directions: Choose one objective for each major problem, and place choice
by number on answer sheet.
Objectives:
1. Doctors orders for Mrs. McDonald will be carried out.
2. Skin integrity will be maintained for incontinent patients.
3. The medical regiment will be executed appropriately for all assigned
patients.
4. Mrs. McDonald's condition will stabilize.
5. Comfort and safety of all assigned patients will be maintained.
6. Doctors orders for Mr. Block will be carried out.
7. Client needs will be met safely and adequately.
8. Staffing on the night shift will be increased to allow for emergencies.
9. Emergency medication route will be established and maintained.
10. Mrs. McDonald's condition is closely monitored.
11. Skin integrity of all patients will be maintained.
12. Stat medication for Mrs. McDonald will be available.
13. Mrs. Jones' cardiac status will be stabilized.
Choices for Criteria
Directions: Choose 1-3 criteria for each major problem and indicate choice
by number on answer sheet.
Criteria:
1. Drugs for Mrs. McDonald are dispensed promptly.
2. The comfort and safety of all assigned patients will be maintained.
3. The medication regiment will be executed appropriately for all assigned
patients.
4. Incontinent patients are turned and changed.
5. I.V. line will be functional.
6. An additional R.N. is regularly assigned to the night shift on Unit A.
7. Mrs. McDonald is transferred to ICU.
8. Doctor's orders for Mrs. McDonald will be carried out.
9. Mrs. McDonald's BP will be lowered.
10. Mrs. McDonald's CVA will not progress to an arrest.
11. 2 AM medications are given within limits of no more than one hour
delay.
12. I.V. flow rates remain accurate.
13. LPN will accept directives without exhibiting signs and symptoms of
stress.
14. The general condition of all assigned patients will continue to be
assessed.
15. No pressure sores will develop tonight on any patient.
16. Mr. Block gets his second unit of packed cells within limits of safety
(30 min.).
17. The execution of doctor's orders for Mrs. McDonald will be documented.
18. Mrs. Jones' cardiac pain will be relieved.
NURSING INTERVENTION CHOICES
Directions: Choose 1-5 nursing interventions for each major problem and
indicate choice by number on answer sheet.
Nursing Interventions:
1. LPN will perform 30 minute neuro checks on Mrs. McDonald.
2. LPN will administer 2 a.m. medications during rounds.
3. RN will ask night supervisor to send another RN to start Mrs. McDonald's
I.V.
4. RN will inform night supervisor of the status of the floor.
5. RN will assess Mrs. McDonald's neuro status.
6. LPN will check I.V. flow rate Q30 minutes with neuro checks.
7. Ask for nursing assistant to be floated to floor to change incontinent
patients.
8. LPN will change incontinent patients and turn later in night during
rounds.
9. RN will check I.V. flow rates during rounds on unstable patients.
10. Allow LPN to verbalize feelings about working under stress.
11. RN will ask night supervisor to send another RN to start Mrs.
McDonald's I.V.
12. LPN will give stat IM vasodilator to Mrs. McDonald.
13. LPN and RN will take turns making 30 minute neuro checks and I.V.s on
Mrs. McDonald with LPN reporting neuro checks to RN.
14. Refuse to continue tour of duty unless additional help is sent to
floor.
15. RN will make rounds on unstable patients.
16. RN delegates 2 AM medication administration and rounds to LPN.
17. RN will hang 2nd unit of packed cells within 30 minutes of delivery.
18. Contact Mrs. McDonald's attending physician, apprise him/her of
patient's condition, staffing situation, and urge transfer to ICU.
19. Inform supervisor of work load and assignments for your tour of duty.
20. Call supervisor to inform of under staffing.
21. Ask supervisor about availability of infusion pumps for use on your
floor.
22. Recommend that an add | | |
