Critical Thinking in Nursing Practice, Nursing Assessment

CRITICAL THINKING

Critical thinking is an active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others Recognize that an issue exists Analyzing information about the issue Evaluating information Making conclusions

Critical Thinking Requires…

Cognitive skills Ask questions Remain well-informed Be honest in facing personal biases Be willing to reconsider and think clearly

about issues

So why learn about critical thinking?

Nurses need to make critical decisions all the time

Nurses are the ones with the patients all day and night, unlike doctors who usually only spend a few minutes with patients (sometimes from the doorway)

Nurses are the ones who are most likely to pick up on slight changes in patient conditions and then decide what to do…

Who to call? Call the doctor?

Watch & wait? What to do first?

Critical thinking

Successful organizations are staffed by people who think, not just follow orders

The biggest threat to critical thinking is just focusing on tasks to be done or “putting out fires” and not thinking about what you are doing and why

Critical thinking & assessment

Data collection is not an end in itself-

it isn’t done just to get the forms filled out

and assignments completed

Assessments are done

so that the findings can be analyzed

and problems can be identified

Autonomy Patients have the right to self-determination

That means that they have the right to decide for themselves about their health and treatment options

Patients have the right to refuse treatment or medication even if they may die without it

If the patient is a minor, parents are expected to make these decisions

If an adult patient is unable to make decisions for himself, decisions are made by the family members or a court-appointed legal guardian

Delegation

RNs may delegate tasks to other members of the health care team Licensed practical nurses (LPNs) Nursing assistants (NAs)

Do not delegate tasks that require nursing assessment or judgment Formulating nursing diagnoses Notifying doctors of changes in a patient’s condition Changing plan of care for a patient Advanced nursing procedures & interventions

Delegation

So what might you delegate?

Bed baths and bedpans Changing incontinent patients

Feeding patients Taking vital signs

Walking patients in the hall Getting patient up in the chair

Making beds Bringing ice water to patients

But there’s a catch…

You have to use your nursing judgment to know if a particular tasks should be delegated!

For instance… Your elderly patient just had a stroke and has difficulty

swallowing. Since there is a good chance that the patient might choke on his food, it would not be a good idea to have the nursing assistant feed this patient

If your patient is very unstable (going into shock, perhaps!) you would want to take the vital signs yourself to make sure that they are accurate

Nursing Process (ADPIE)

Assessment

Nursing Diagnosis

Planning

Implementation/Intervention

Evaluation

Assessment

The deliberate and systematic collection of data to determine a client’s current and past health status and functional status and to determine the client’s present and past coping patterns. Collection and verification of data

Primary source = patient Secondary source = family, medical record

Analysis of data

Data Collection

Subjective Patient states

Objective Observations or Measurements

Vitals Inspection of a wound

Assessment DataAssessment 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

Methods of Data Collection

Interview Helps clients relate their own interpretation and

understanding of their condition Three phases

Orientation Begin a relationship Understand client’s primary needs

Working Gather information about the client’s health status

Termination

Types of InterventionsTypes of Interventions

Nurse-Initiated

Physician-Initiated

Collaborative Interventions

Nursing Care Plans vs Concept Nursing Care Plans vs Concept MapsMaps

NCP Concept/Mind Map