Chapter 11 Blended Skills and Critical Thinking … IV/NUR 1020 Week 2... · Blended Skills and Critical Thinking Throughout the Nursing ... The nursing process is dynamic in that

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Chapter 11 Blended Skills and Critical

Thinking Throughout the Nursing Process


Historical Development of the Nursing Process

• 1955—nursing process term used by Hall

• 1960s—specific steps delineated

• 1967—Yura and Walsh published first comprehensive book on nursing process

• 1973—ANA Congress for Nursing Practice developed Standard of Practice

• 1982—state board examinations for professional nursing uses nursing process as organizing concept


Five Steps of the Nursing Process

• Assessing—collecting, validating, and communicating of patient data

• Diagnosing—analyzing patient data to identify patient strengths and problems

• Planning—specifying patient outcomes and related nursing interventions

• Implementing—carrying out the plan of care

• Evaluating—measuring extent to which patient achieved outcomes


Question

Which step of the nursing process is a nurse using when she analyzes patient data to determine her patient’s strengths following a CVA?

A. Assessing

B. Diagnosing

C. Planning

D. Implementing

E. Evaluating


Answer

Answer: B. Diagnosing

Rationale:

The diagnosing step involves analyzing patient data to determine strengths and weaknesses.

The assessing step refers to the collection, validation, and communication of patient data.

In the planning step, the nurse determines patient outcomes and related nursing interventions, and in the Implementing step, the nurse carries out the plan.

When evaluating, the nurse measures the extent to which the patient achieved outcomes.


The Steps of the Nursing Process


Question

Which of the following characteristics of the nursing process describes the interaction and overlapping of steps within the process itself?

A. Systematic

B. Dynamic

C. Interpersonal

D. Universally Applicable


Answer

Answer: B. Dynamic

Rationale:

The nursing process is dynamic in that there is much interaction and overlapping of the steps.

It is systematic since it is an ordered sequence of activities.

Interpersonal refers to the human being at the heart of nursing.

The nursing process is universally applicable in that it is a framework for all nursing activities.


Characteristics of the Nursing Process

• Systematic—part of an ordered sequence of activities

• Dynamic—great interaction and overlapping among the five steps

• Interpersonal—human being is always at the heart of nursing

• Outcome oriented—nurses and patients work together to identify outcomes

• Universally applicable—a framework for all nursing activities


Problem Solving and the Nursing Process

• Trial-and-error problem solving

• Scientific problem solving

• Intuitive thinking

• Critical thinking


Question

Tell whether the following statement is true or false.

Critical thinking occurs when a nurse directly apprehends a situation based on its similarity or dissimilarity to other situations.

A. True

B. False


Answer

Answer: B. False

Intuitive thinking occurs when a nurse directly apprehends a situation based on its similarity or dissimilarity to other situations.


Benefits of the Nursing Process

• Patient

– Scientifically based, holistic individualized patient care

– Continuity of care

– Clear, efficient, cost-effective plan of action

• Nurse

– Opportunity to work collaboratively with other healthcare workers

– Satisfaction of making a difference in lives of patients

– Opportunity to grow professionally


Four Blended Skills

• Cognitive skills—using critical thinking; a systematic way to form and shape one’s thinking

• Technical skills—manipulating equipment skillfully to produce desired outcome

• Interpersonal skills—promoting the dignity and respect of patients and establishing caring relationships

• Ethical/legal skills—establishing a personal moral code and professional role responsibilities


Question

A nurse’s personal moral code is to assist all patients to the best of her ability. What blended skill would she use when seeking out special services for a homeless patient with a diabetic foot ulcer?

A. Cognitive

B. Technical

C. Interpersonal

D. Ethical/Legal


Answer

Answer: D. Ethical/Legal

Rationale:

Using ethical/legal skills is the best answer as it involves following a moral code and acting professionally.

Cognitive skills involve thinking through a situation to achieve outcomes.

Technical skills relate to the proper use of equipment.

Interpersonal skills are used to develop caring relationships.


Cognitively Skilled Nurses

• Offer scientific rationale for patient plan of care.

• Select nursing interventions most likely to yield desired outcomes.

• Use critical thinking to solve problems creatively.

• Display purpose of thinking and adequacy of knowledge.

• Work through potential problems and use helpful resources.

• Critique judgments/decisions.


Technically Skilled Nurses

• Use technical equipment with competence and ease to achieve goals with minimal distress to patients.

• Creatively adapt equipment and technical procedures to needs of patients in diverse circumstances.


Interpersonally Skilled Nurses

• Use interactions with patients and significant others and colleagues to promote human dignity and respect.

• Elicit personal strengths and abilities of patients to achieve health goals and establish caring relationships.

• Provide the healthcare team with knowledge about patient goals and expectations.

• Work collaboratively with healthcare team as respected and credible colleagues.


Ethically and Legally Skilled Nurses

• Are trusted to act in ways that advance interests of patients

• Are accountable for the practice

• Act as effective patient advocates

• Mediate ethical conflict among patient, significant others, and healthcare team


Four Domains of Critical Thinking

• Elements of thought—basic building blocks of thinking

• Abilities—the skills essential to higher-order thinking

• Affective dimensions—attitudes, dispositions, passions, traits of mind essential to higher-order thinking

• Intellectual standards—used to critique higher-order thinking


Elements of Thought: Basic Building Blocks of Thinking

• Purpose

• Question at issue or central problem

• Point of view

• Empirical dimension

• Concepts and ideas

• Assumptions

• Implications and consequences


Characteristics of Interpersonal Caring

• Promotion of dignity and respect of patients

• Centrality of the caring relationship

• Mutual enrichment of both participants in the nurse–patient relationship


Developing Ethical/Legal Skills

• Developing accountability

• Reporting incompetent, unethical, or illegal practice


Steps in Concept Map Care Planning

• Develop a basic skeleton diagram.

• Analyze and categorize data.

• Analyze nursing diagnoses relationships.

• Identify goals, outcomes, and interventions.

• Evaluate patient’s responses.


Question

Tell whether the following statement is true or false.

Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts.

A. True

B. False


Answer

Answer: A. True

Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts.


Critical Thinking and Clinical Reasoning

• Is purposeful, informed, outcome-focused thinking

• Is driven by patient, family, and community needs

• Is based on principles of nursing process and scientific method

• Uses both intuition and logic, based on knowledge, skills, and experience

• Requires strategies that make the most of human potential

• Is constantly reevaluating, self-correcting, and striving to improve

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Chapter 11 Blended Skills and Critical Thinking … IV/NUR 1020 Week 2... · Blended Skills and Critical Thinking Throughout the Nursing ... The nursing process is dynamic in that