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.