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Critical Thinking and The Nursing Process

Published by Clara Barrett Modified over 9 years ago

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Presentation on theme: "Critical Thinking and The Nursing Process"— Presentation transcript:

Chapter Extension 1 Collaboration Information Systems for Decision Making, Problem Solving, and Project Management.

Theories of Nursing Practice

Mosby items and derived items © 2005 by Mosby, Inc. Chapter 16 Nursing Diagnosis.

Chapter 4 The Nurse-Client Relationship. 4-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Communication  Communication is.

Nursing Diagnosis Chapter Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis  The term nursing diagnosis.

Chapter 15 Evaluation.

Implementation Chapter Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Purposes of Implementation  The implementation.

Linda S. Williams / Paula D. Hopper Copyright © F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 1 Critical Thinking.

SUNITA RAI PRINCIPAL KV AJNI

Nursing professional standards Prepared by: Dr. Rawhia Dogham.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 1 Overview of Nursing Process, Clinical Reasoning, and Nursing Practice.

CRITICAL THINKING AND THE NURSING PROCESS

Slide 1 1 Critical Thinking and Nursing Judgment NPN 105 Joyce Smith RN, BSN.

Critical Thinking in Nursing. Definition  Critical thinking is an active, organized, cognitive process used to carefully examine one’s thinking and the.

CRITICAL THINKING in Nursing Practice: “…active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others.” Involves.

CRITICAL THINKING in Nursing Practice: chapter 14 “…active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others.”

Copyright 2002, Delmar, A division of Thomson Learning.

Outcome Identification and Planning

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10 — Nursing Diagnosis, Outcome Identification, Planning, Implementation,

Nursing Process- Evaluation. Evaluation Evaluation measures the client’s response to nursing actions and progress toward achieving health care goals.

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Critical Thinking in Nursing - PowerPoint PPT Presentation

Critical Thinking in Nursing

Critical thinking problem solving critical thinking in nursing clinical reasoning priority setting lipe, s. k. & beasley, s., (2004). critical thinking in nursing: a ... – powerpoint ppt presentation.

• Lipe, S. K. Beasley, S., (2004). Critical Thinking in Nursing A cognitive skills workbook. Lippincott. Philadelphia, PA.
• Utilize critical thinking to develop treatment plan in both simulated and clinical situations.
• Discuss the process of critically thinking.
• Identify common errors in utilizing the critical thinking process.
• Discuss the characteristics of a critical thinker and standards commonly applied when critically thinking.
• Explain how time management, client care needs/activities, multitasking, and nursing diagnoses are integral to the prioritizing processes.
• Prioritize nursing diagnoses using patient condition as the basis for decisions.
• Formulate priorities for management and delivery of nursing care in various settings.
• Apply critical thinking and prioritizing to client scenarios and NCLEX-style questions.
• Ennis reasonable, reflective thinking that is focused on deciding what to believe or do
• Lipe Beasley (Nosich, 2001, p.2)
• Critical Thinking is goal directed it is thinking with a purpose. (Lipe Beasley, 2004, p. 3)
• Decision Making
• Involves choosing from options
• It is a step in the problem solving process
• Problem Solving
• Systematic approach resulting in formation of solutions
• Independent thinker
• Questioning
• Recognizes biases assumptions
• Organize/cluster data
• Prioritizes
• Open minded
• Open to new ideas
• Flexible-willing to change
• Innovative, creative
• Communicator
• Knowledgeable
• Resourceful
• Out of the box
• http//www.criticalthinking.org/CTmodel/CTModel1.c fm
• Interpretation ability to explain the meaning of information
• Analysis examine subjective and objective, advantages, disadvantages, and consequences
• Evaluation Is info source credible? Any bias? Is info relevant?
• Inference draw a conclusion based on info
• Explanation ability to explain ones conclusions
• Self-regulation reflecting on our own thinking Did I have all the facts? Are my assumptions correct/ incorrect?
• Illogical Process
• Situation Frank Fellow, a 72-year-old patient admitted for acute confusion presented in the emergency department (ED) with a history of hypertension, diabetes type 1, and arthritis. He lives in a single-family home with his wife.
• The client is slightly confused and has an unsteady gait. He frequently forgets to use his walker and fails to call for assistance from the nursing staff when ambulating to the bathroom.
• Interpretation - clarifying
• Analysis - questioning
• Outcomes what do you expect?
• Inference - conclusion
• Self Regulation what else?
• Perceptions
• Social climate
• Self Confident
• Flexibility
• Ability to accept responsibility
• Ability to focus
• Priorities first
• Time Management
• Maslow Hierarchy of Needs
• Prioritizing Nursing Diagnoses
• Priority Activities
• Multitasking
• Nursing Process
• The 34 yr. patient with cirrhosis is admitted for dehydration and needs a central line for high volume fluid replacement. Vital signs upon arrival on the unit at 2 pm were temp 99, pulse 102, r 24, b/p 90/60. The nurse has finished report and the physician is on the way to the unit to place a central line. Which nursing activity is the highest priority?
• A. Ensure consent signed
• B. Take the patients vital signs
• C. Notify the family
• D. Listen to breath sounds
• E. Assess urinary output
• 16-year-old boy transported to the emergency department by ambulance following a MVA. Witnesses report his car slid on ice, and the vehicle became airborne, throwing the adolescent from his car. Initial assessment reveals that the patient has a patent airway, is responsive to painful stimuli, has a laceration to his left thigh that is covered with a dressing, and has contusions to the left flank area. Place the following activities in order of priority.
• ___Call the parents for consent to treat
• ___Immobilize head and neck
• ___Assess level of consciousness and neurologic deficits
• ___Assess left thigh and apply clean pressure dressing
• Inadequate Assessment and Evaluation of Client Needs
• Failure to Differentiate Between Priority and Non-priority Tasks
• Acceptance of Others Priorities Without Assessing All the Variables
• Performance of Tasks with a First Identified, First Completed Approach
• Completion of the Easiest Tasks First
• The patient is resting quietly, breath sounds clear, respirations easy and unlabored, skin color pink. O2 _at_ 3 Liters, and O2 sat is 98. After eating dinner , the patient rings the nurse. The nurses assessment reveals respirations are 30 breaths/min and labored, crackles are auscultated bilaterally, skin color dusky, and the SpO2 82.
• What are you the nurse going to do?
• The nurse intervenes by
• Elevating the head of the bed
• Applying prescried O2 through a nonrebreather
• Notify Physician
• Change in status
• Pain w/o ordered mgmt strategies
• Lack of treatment orders
• Risk to safety
• Do not consider lab values in isolation
• Evaluate data and compared to patients clinical status
• Compare to age, medical diagnosis, assessment data, physical status, physical orders, current treatment, previous labs
• Failure to assess, monitor, and report
• 13. Which patient should the nurse see first?
• A. a 40 yo 7 day postpartum female with bright red vaginal bleeding and a hgb of 7.0 g/dL.
• B. A diabetic patient with a blood sugar of 400 mg/dL and no orders for insulin coverage.
• C. A 46 yo ESRD patient who had an AV fistula placement 2 days ago. No thrill or bruit noted.
• D. A 50 yo woman, 2 days after knee replacement. She refuses to use CPM machine due to pain

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CRITICAL THINKING AND THE NURSING PROCESS

Jan 04, 2020

540 likes | 576 Views

CRITICAL THINKING AND THE NURSING PROCESS. Summer 2009 Donna M. Penn RN, MSN, CNE. Critical Thinking and Nursing Judgment. How do we make decisions? How do nurses make decisions about patient care? What do we rely on to help us in decision making?. Critical Thinking and Nursing Judgment.

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Presentation Transcript

CRITICAL THINKING AND THE NURSING PROCESS Summer 2009 Donna M. Penn RN, MSN, CNE

Critical Thinking and Nursing Judgment • How do we make decisions? • How do nurses make decisions about patient care? • What do we rely on to help us in decision making?

Critical Thinking and Nursing Judgment • Not a linear step by step process • Process acquired through hard work, commitment, and an active curiosity toward learning • Decision making is the skill that separates the professional nurse from technical or ancillary staff

Critical Thinking and Nursing Judgment • Good problem solving skills • Not always a clear textbook answer • Nurse must learn to question, look at alternatives

How do nurse's accomplish this? • Learns to be flexible in clinical decision making • Reflect on past experiences and previous knowledge • Listen to others point of view • Identify the nature of the problem • Select the best solution for improving client’s health

Definition of Critical Thinking • Active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others • It involves the use of the mind in forming conclusions, making decisions, drawing inferences, and reflecting

Critical Thinking in Nursing • Purposeful, outcome-directed • Driven by patient, family, and community needs • Based on principles of nursing process and the scientific method • Requires specific knowledge, skills, and experience • New nurses must question

Critical Thinking in Nursing • Guided by professional standards and ethic codes • Requires strategies that maximize potential and compensate for problems • Constantly reevaluating, self-correcting, and striving to improve

Formula for Critical Thinking • Start Thinking • Why Ask Why • Ask the Right Questions • Are you an expert?

Aspects of Critical Thinking • Reflection • Language • Intuition

Levels of Critical Thinking • Basic • Complex • Commitment

Critical Thinking Competencies • Scientific method • Problem Solving • Decision Making • Diagnostic Reasoning and Inferences • Clinical Decision Making • Nursing Process

Nursing Process • Systematic approach that is used by all nurses to gather data, critically examine and analyze the data, identify client responses, design outcomes, take appropriate action, then evaluate the effectiveness of action • Involves the use of critical thinking skills • Common language for nurses to “think through” clinical problems

Nursing Process

Thinking and Learning • Lifelong process • Flexible, open process • Learn to think and to ANTICIPATE • What, why, how questions • Look beyond the obvious • Reflect on past experience • New knowledge challenges the traditional way

Level 3 Commitment Level 2 Complex Level 1 Basic Specific Knowledge Base Experience Competencies Attitudes Standards

Components Of Critical Thinking • Scientific Knowledge Base • Experience • Competencies • Attitudes • Standards

Professional Standards • Ethical criteria for Nursing judgment- Code of Ethics • Criteria for evaluation- Standards of care • Standards of professional responsibility that nurses strive to achieve are cited in Nurse Practice Acts, JCAHO guidelines, institutional policy and procedure, ANA Standards of Professional Practice

Critical Thinking Synthesis • Reasoning process by which individuals reflect on and analyze their own thoughts, actions, & decisions and those of others • Not a step by step process

Critical Thinking Case Study • Mrs. Lutz is a 78 yr old woman who has undergone radiation therapy and three surgeries for cancer. She is not responding well, cannot eat, and is losing weight. The physician has decided to place a subclavian catheter to administer total parenteral nutrition. The nurse takes the informed consent form to the patient to sign and explains to her that “the doctor will place a small tube in your vein to give you more nutrients to help you regain your strength and heal”. Mrs. Lutz says, “I’m so tired of all this pain. I’m not sure I want anything else done, and I surely don’t want to be hurt again.”

Case Study Questions • What factors does the nurse need to assess that might affect Mrs. Lutz’s ability to consent? • Before she signs the consent form, how can the nurse be certain that her consent was truly “informed”?

Case Study Continued • The nurse replies to Mrs. Lutz: “Now, now, your doctor has ordered this to make you well. Don’t worry, we’ll make sure you don’t feel a thing. Your doctor will be here soon and he will expect this consent to be signed. Won’t you please sign it now?”

Case Study Questions • Evaluate the nurse’s approach to Mrs. Lutz in regard to the invasive procedure. What do you think about it and why?

Nursing Process • Traditional critical thinking competency • 5 Step circular, ongoing process • Continuous until clients health is improved, restored or maintained • Must involve assessment and changes in condition

When using the Nursing Process • Identify health care needs • Determine Priorities • Establish goals & expected outcomes • Provide appropriate interventions • Evaluate effectiveness

Nursing Process • Assessment • Diagnosis • Planning • Implementation • Evaluation

Assessment • Systemically collects, verifies, analyzes and communicates data • Two step process- Collection and Verification of data & Analysis of data • Establishes a data base about client needs, health problems, responses, related experiences, health practices, values. lifestyle, & expectations

Critical Thinking and Assessment Process • Brings knowledge from biological, physical, & social sciences as basis for the nurse to ask relevant questions. Need knowledge of communication skills • Prior clinical experience contributes to assessment skills • Apply Standards of Practice • Personal Attitudes

Assessment Data • Subjective Data • Objective Data • Sources of Data • Methods of Data Collection-Interview • Interview initiates nurse-client relationship • Use open-ended questions • Nursing health history

Nursing Diagnosis • Statement that describes the client’s actual or potential response to a health problem • Focuses on client-centered problems • First introduced in the 1950’s • NANDA established in 1982 • Step of the nursing process that allows nurse to individualize care

Planning for Nursing Care • Client-centered goals and expected outcomes are established • Priorities are set relating to unmet needs • Maslow’s Hierarchy of Needs is a useful method for setting priorities • Priorities are classifies as high, intermediate, or low

Purpose of Goals and Outcomes • Provides direction for individualized nursing interventions • Sets standards of determining the effectiveness of interventions • Indicates anticipated client behavior or response to nursing care • End point of nursing care

Goals of Care • Goal: Guideposts to the selection of nursing interventions and criteria in the evaluation of interventions • What you want to achieve with your patient and in what time frame • Short term vs. Long term • Outcome Of Care: What was actually achieved, was goal met or not met

Nursing Interventions • Interventions are selected after goals and outcomes are determined • Actions designed to assist client in moving from the present level of health to that which is described in the goal and measured with outcome criteria • Utilizes critical thinking by applying attitudes and standards and synthesizing data

Types of Interventions • Nurse-Initiated • Physician-Initiated • Collaborative Interventions

Selection Of Intervention • Using clinical decision making skills, the nurse deliberates 6 factors: • Diagnosis, expected outcomes, research base, feasibility, acceptability to client, competency of nurse

Nursing Care Plans • Written guidelines for client care • Organized so nurse can quickly identify nursing actions to be delivered • Coordinates resources for care • Enhances the continuity of care • Organizes information for change of shift report

Nursing Care Plans vs Concept Maps NCP Concept/Mind Map

Implementation of Nursing Interventions • Describes a category of nursing behaviors in which the actions necessary for achieving the goals and outcomes are initiated and completed • Action taken by nurse

Types of Nursing Interventions • Standing Orders: Document containing orders for the use of routine therapies, monitoring guidelines, and/or diagnostic procedure for specific condition • Protocols: Written plan specifying the procedures to be followed during care of a client with a select clinical condition or situation (Pneumonia, MI, CVA)

Implementation Process involves: • Reassessing the client • Reviewing and revising the existing care plan • Organizing resources and care delivery (equipment, personnel, environment)

Evaluation • Step of the nursing process that measures the client’s response to nursing actions and the client’s progress toward achieving goals • Data collected on an on-going basis • Supports the basis of the usefulness and effectiveness of nursing practice • Involves measurement of Quality of Care

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