The NCLEX-RN® 2023 Categories and Concepts

by Rhonda Lawes, PhD, RN

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    00:01 Have the RN categories and concepts been a little confusing? Well, let's walk through them together.

    00:06 Now there are basically four client need categories, but yet there's eight total.

    00:13 And how does that work? Well, we've got a graphic up there for you, but let me walk you through it.

    00:17 The four client need categories are safe and effective care, environment, health promotion and maintenance, psychosocial integrity and physiological integrity.

    00:27 Okay. So those are the four main client needs categories.

    00:31 Now, look over on the other side of your screen where you see the percentages.

    00:35 Well, safe and effective care and environment will range anywhere from 25 to 37% of your test.

    00:42 Now, why is there a range? Well, everyone who takes the NCLEX, I mean, everyone who takes the NCLEX follows this same test blueprint.

    00:51 And that's why there's a range in there as a test adjust itself.

    00:55 We've got four categories.

    00:56 Two of the categories don't have any sub categories.

    01:00 So health promotion and maintenance and psychosocial integrity, they're complete category. But the top one and the bottom one, you'll see that they have sub categories. So management of care is part of safe and effective care and environment Safety and infection control is also part of safe and effective care.

    01:19 So the bottom one is really the big one.

    01:22 And when you're looking at your test results, when you're studying and get your practice test results back, this is usually one of the areas where students struggle the most. But that's kind of fair because look what's in there.

    01:34 It can be 39 to 63% of your overall test.

    01:38 So it's got basic care and comfort farm, everyone's favorite reduction of risk and physiological adaptation.

    01:46 So know that when you're taking the test, if someone or one of your peers have told you my test was all this or my test was all that, it really wasn't, it might have felt that way to them. They might have emotionally responded to that, but it isn't.

    02:01 Everybody's test follows exactly the same blueprint.

    02:05 Now, what about these concepts? These aren't as easy to identify.

    02:09 There's six concepts and they're kind of woven through the four major client needs.

    02:13 There are things that would make sense to you.

    02:15 They look at caring, clinical judgment, communication and documentation, culture and spirituality, the nursing process and teaching and learning.

    02:24 So these are six concepts that you're being tested on throughout all of those categories.

    02:29 So let's break those down a little bit.

    02:31 So caring. This is how you interact with the client.

    02:34 So as the nurse, how do you interact with them? Do you develop mutual respect and trust? These should be fairly straightforward things for you to recognize.

    02:44 Think about being in a collaborative environment.

    02:46 Make sure you give the patient encouragement, hope, support, compassion so that together you can help them take steps toward their goals.

    02:54 The next one is clinical judgment.

    02:57 Now, this one is a little scarier, right? Because you've heard about the clinical nursing judgment model.

    03:01 We'll talk about that later.

    03:03 But really, this is just you making wise decisions to keep your patients safe and help them take the next step toward health.

    03:12 Okay. So here you're going to have to make use your critical thinking skills and make decisions that keep your patients safe.

    03:18 Now, there can be lots of steps in this and we'll walk through those, but you'll be presented with situations.

    03:23 You have to figure out who's the first patient or the highest priority patient that you should see and think about what is the best evidence based solution in order for you to deliver safe client care.

    03:35 Here it is the NCSBN clinical judgment measurement model.

    03:40 Now, this has been all over the literature, in case you missed it, but I bet you've seen it in your nursing school.

    03:46 It looks kind of intimidating, but I promise you it isn't.

    03:49 I'm going to help you focus on the most important part.

    03:52 This is where the questions are going to come from.

    03:55 So you see at the bottom, look at those steps in layer three.

    03:59 Recognize cues, analyze cues, prioritize hypothesis, generate solutions, take action, evaluate outcomes.

    04:07 I promise you you're already doing this.

    04:10 This is just spelling it out and making a model out of it.

    04:13 When you think about recognizing cues, when I walk into a room and a patient is breathing really fast, that's an important clue.

    04:21 I should recognize that, that that patient is in respiratory distress.

    04:25 That's all they're asking.

    04:27 When you're studying, do you recognize the cues that would tell you whether that's physical assessment or something? A patient communicates to you a symptom.

    04:37 Those are the types of cues you're looking for.

    04:40 And my pathophysiology course, we just studied all these respiratory diagnoses, but what we started with was, guys, what are the cues when a patient is in respiratory distress, right? Their increased respiratory rate, increased heart rate, extra muscles to breathe. That's all this is doing.

    04:58 Do you recognize the signs? That something is not right with this patient.

    05:03 They're experiencing something outside of normal.

    05:06 Then you analyze those cues, you put it together and figure out, Hey, this is what I think is happening.

    05:11 So since this is what I think is happening, this is the solution, this is what I think would fix it.

    05:18 Next step, I'm going to take action and then I'm going to evaluate if what I did worked.

    05:24 So let's go back to our respiratory example.

    05:26 I walk into my patient's room.

    05:27 I see their respiratory rate is up.

    05:29 They look like they are working really hard to breathe.

    05:31 I look over at the pulse ox.

    05:32 It's low.

    05:34 I'm recognizing these cues.

    05:36 I'm putting them all together.

    05:37 I know that they're here for pneumonia.

    05:39 What's going to be my hypothesis? Okay. They're in respiratory distress.

    05:44 What might I do? Well, the first thing I'm probably going to do is if that head of the bed is not raised all the way up, I'm going to think about raising that up.

    05:52 I take that action and see if that made any difference for my patient.

    05:56 I'm going to evaluate the outcome.

    05:58 Now. I know that's a pretty simple example, but I promise you, just thinking through things in a straightforward manner, it's how you think already.

    06:07 They're just going to ask you questions along the way.

    06:09 So don't let it panic you.

    06:11 You really can do this, I promise.

    06:14 Now, the third one is communication and documentation.

    06:17 Okay? This can get a little different on the NCLEX exam, and I'm going to teach you some strategies as you go through it.

    06:25 But remember, whatever the patient communicates to you, verbal, nonverbal, whatever the patient says or communicates is critically important to the topic of that question. So you want to make sure that you pay attention to those signs, right? Those are the kind of cues that you should be looking for.

    06:44 So verbal and nonverbal interactions, also how you interact with other members of the health care team, they're going to expect you to be clear, concise and objective.

    06:54 Avoid subjective terms like bad good.

    06:59 You want just record what you see When we talk to students about maybe documenting signs of what you suspect is abuse, you don't chart child abuse suspected, right? That's not what you put in the chart.

    07:15 You put in the chart the wounds that you see.

    07:17 Describe the signs that they are, how many of them, what stage they are in healing clear, concise and objective things that you can see and accurately document.

    07:28 You've also got events and activities, electronic records, all types of things that are involved in here. But you can be asked questions about verbal communication, documentation. Expect any of those examples to be a possibility.

    07:41 Just remember, the most clear, concise and objective communication is always going to be your best answer.

    07:50 Number four is culture and spirituality.

    07:52 Now, this is how the nurse interacts with the client, which could be an individual, a family, a group, even significant others or populations.

    08:00 So when we say client, it doesn't represent just one person, but they're going to ask to make sure that you know how to recognize and consider the client's self-identified unique and individual preferences to their care.

    08:14 Okay, This is do you respect how they present, how they prefer to be referred to you? This is where those types of questions will come from.

    08:22 Fifth is the nursing process.

    08:24 Remember, this is just a scientific clinical reasoning approach to client care.

    08:28 It's assessment, analysis, planning, implementation and evaluation.

    08:32 So do they come right out and say which step according to the nursing process would you take? No, but it's right back to those things that we talked about in recognizing the cues that is the nursing process spelled out.

    08:45 Six is teaching and learning.

    08:47 So how are you at facilitating a patient, understanding what's going on with their care, what the next step is, how to keep themselves safe, or maybe even to promote a change in their behavior.

    08:59 You are expected as a nurse to be able to facilitate state that process and to keep the patient safe.

    09:06 Now, while we're here talking about teaching and learning, remember on the NCLEX exam, only an RN can do initial teaching.

    09:13 An LPN or a UAP can reinforce what the RN has taught, but only in RN can do the initial teaching. Also, an RN has to do the admission or the discharge because there's additional teaching that's needed there.

    09:28 So keep that in mind.

    09:29 That'll come really handy in management of care.

    09:33 Now all task statements on the 2023 NCLEX RN tasks require you as the nurse.

    09:39 You just have to apply fundamental principles of clinical decision making and critical thinking to nursing practice.

    09:46 Wow, that sounds really intense.

    09:49 But all they're asking you to do is read the stem thoroughly.

    09:53 Make sure you're clear on what it's asking you, and then make wise decisions, things that will clinically keep the patient safe.

    10:01 And can you prioritize which one is most important to do first? Now, it also assumes that you have basic knowledge of social sciences, biological sciences and physical sciences.

    10:12 Those are your prerequisite courses before nursing school.

    About the Lecture

    The lecture The NCLEX-RN® 2023 Categories and Concepts by Rhonda Lawes, PhD, RN is from the course NCLEX-RN® Introduction to the Exam.

    Author of lecture The NCLEX-RN® 2023 Categories and Concepts

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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