1. Rate yourself according to your confidence level performing the skills identified in the Clinical Skills Self-Assessment Form. 

2. Based on your ratings, summarize your strengths and opportunities for improvement.  

3. Based on your self-assessment and theory of nursing practice, develop four (4) measurable goals and objectives for a practicum experience. 

4. Include them on the designated area of the form.

Self-Assessment Form

Desired Clinical Skills for Students to Achieve

Confident (Can complete independently)

Mostly confident (Can complete with supervision)

Beginning (Have performed with supervision or needs supervision to feel confident)

New (Have never performed or does not apply)

Comprehensive psychiatric evaluation skills in: 

Recognizing clinical signs and symptoms of psychiatric illness across the lifespan

X

Differentiating between pathophysiological and psychopathological conditions 

X

Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies) 

X

Performing and interpreting a mental status examination 

X

Performing and interpreting a psychosocial assessment and family psychiatric history 

X

Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational).

X

Diagnostic reasoning skill in:

Developing and prioritizing a differential diagnoses list

X

Formulating diagnoses according to DSM 5 based on assessment data 

X

Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes

X

Pharmacotherapeutic skills in:

Selecting appropriate evidence based clinical practice guidelines for medication plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management) 

X

Evaluating patient response and modify plan as necessary 

X

Documenting (e.g., adverse reaction, the patient response, changes to the plan of care)

X

Psychotherapeutic Treatment Planning:

Recognizes concepts of therapeutic modalities across the lifespan

X

Selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management, modality appropriate for situation) 

X

Applies age appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers

X

Develop an age appropriate individualized plan of care

X

Provide psychoeducation to individuals and/or any caregivers

X

Promote health and disease prevention techniques

X

Self-assessment skill:

Develop SMART goals for practicum experiences 

X

Evaluating outcomes of practicum goals and modify plan as necessary 

X

Documenting and reflecting on learning experiences

X

Professional skills:

Maintains professional boundaries and therapeutic relationship with clients and staff

X

Collaborate with multi-disciplinary teams to improve clinical practice in mental health settings 

X

Identifies ethical and legal dilemmas with possible resolutions

X

Demonstrates non-judgmental practice approach and empathy

X

Practices within scope of practice

Selecting and implementing appropriate screening instrument(s), interpreting results, and making recommendations and referrals:

Demonstrates selecting the correct screening instrument appropriate for the clinical situation 

X

Implements the screening instrument efficiently and effectively with the clients

X

Interprets results for screening instruments accurately

Develops an appropriate plan of care based upon screening instruments response

X

Identifies the need to refer to another specialty provider when applicable

X

Accurately documents recommendations for psychiatric consultations when applicable

X

Summary of strengths:

Opportunities for growth:

write four (4) possible goals and objectives for this practicum experience. Ensure that they follow the SMART Strategy, as described

SMART STRATEGY:

Goals

• Is it specific?

• Is it measurable?

• Is it achievable?

• Is it relevant?

• Is it timely?

1. Goal:

a. Objective:

b. Objective:

c. Objective:

2. Goal:

a. Objective:

b. Objective:

c. Objective:

3. Goal:

a. Objective:

b. Objective:

c. Objective:

4. Goal:

a. Objective:

b. Objective:

c. Objective:

Chapter 5 Evidence-Based Practice

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Definitions #1

Variety of definitions, interpretations

Definition according to David Sackett

Definition by Sigma Theta Tau International

Use of the term best practice by industries

Association with “benchmarking”

Now, one of the less scientific forms of evidence used

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Definitions #2

Goal: provide optimal patient care

Enhancement of nursing practice

Improvement of patient or system outcomes

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Use of Evidence-Based Practice #1

Why?

Control of health care costs: early stimulus

Provision of highest quality patient care: selection of optimal interventions for patients

Patient satisfaction

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Use of Evidence-Based Practice #2

When and Where?

Priority across nursing specialties (see Table 5.1)

Valued across nursing roles and responsibilities

Preparation of nurse leaders and administrators

Refinement of nursing curricula

Expectation of staff nurses to participate in or lead initiatives

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Use of Evidence-Based Practice #3

Around the World

Worldwide commitment

Australia (the Joanna Briggs Institute)

Canada (Registered Nurses’ Association of Ontario)

United Kingdom

Nursing Knowledge International (NKI): international clearinghouse, facilitator

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Question #1

Is the following statement true or false?

The term evidence-based practice was first defined during the time of Florence Nightingale.

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Answer to Question #1

False

Evidence-based practice emerged as a term in response to the ongoing expansion and demanding changes in health care.

It evolved when discussions of evidence-based medicine were expanded to include an interdisciplinary audience.

David Sackett, one of the leaders of the movement, defined evidence-based medicine.

Sigma Theta Tau expanded the definition to address nursing.

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Determination of Evidence-Based Practice

Questions arising in practice settings

Nurses empowered to ask critical questions (see Box 5.1)

Questions leading to decision making to affect outcomes

Best answers, decisions from informed, evidence-based analysis of each situation

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Sources of Evidence #1

Tradition based

Consultation with more experienced, educated, higher-authority-level nurse

Institutional standards, procedure manuals

Coworkers, other health care providers

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Sources of Evidence #2

Evidence based

Research

Randomized controlled trial (RCT): considered the gold standard of clinical evidence

Integrative review

Meta-analysis

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Additional Sources of Evidence

Benchmarking data

Clinical expertise

Cost-effectiveness analyses

Infection control data

Medical record review data

National standards of care

Pathophysiologic data

Quality improvement data

Patient and family preferences

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Question #2

Is the following statement true or false?

Institutional standards are considered evidence based.

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Answer to Question #2

False

Institutional standards and procedure manuals are typically considered sources for tradition-based evidence rather than evidence-based information.

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Support Mechanisms for Best Evidence

Garner administrative support

Collaborate with research mentor (see Box 5.3)

Seek assistance from professional librarians

Search already reviewed or summarized research (journals, Cochrane Collaboration, AHRQ)

Access resources from professional organizations (AACN, AWHONN, AORN, ONS)

Benchmark with high-performing teams, units, institutions

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Mechanisms for Incorporation Into Practice

Development, refinement of research-based policies, procedures

Protocols, algorithms, decision trees, standards of care, critical pathways, care maps, institutional clinical practice guidelines

Consensus of interdisciplinary team

Patient, family support

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Challenges to Implementation #1

Accessibility of research findings

Anticipated outcomes of using research

Support from others

Lack of organizational support (Funk et al., 1991)

Spiva and colleagues (2017) used this instrument in the implementation of a mentoring program to promote evidence-based practice

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Challenges to Implementation #2

Practicing nurses often feel overwhelmed by the volume of research on their topics of interest

Practicing nurses often lack the time and experience to be able to efficiently read and synthesize the literature

Practicing nurses struggle with the political challenges of attempting to change long-standing policies and procedures in their clinical settings

See Box 5.4

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Question #3

Which of the following would a nurse most likely need to address as the greatest obstacle when planning to implement evidence-based practice?

A. Accessibility of research findings

B. Support from others

C. Setting

D. Organizational support

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Answer to Question #3

D

On the basis of research about barriers to implementing evidence-based practice, lack of organizational support was perceived to be the most significant limitation.

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End of Presentation

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