CRITICAL THINKING AND THE NURSING PROCESSNRS 101Unit IIISession 3
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 JudgmentNot a linear step by step processProcess acquired through hard work, commitment, and an active curiosity toward learningDecision making is the skill that separates the professional nurse from technical or ancillary staff
Critical Thinking and Nursing JudgmentGood problem solving skillsNot always a clear textbook answerNurse must learn to question, look at alternatives
How do nurse's accomplish this?Learns to be flexible in clinical decision makingReflect on past experiences and previous knowledgeListen to others point of viewIdentify the nature of the problemSelect the best solution for improving clients health
Definition of Critical ThinkingCognitive process during which an individual reviews data and considers potential explanations and outcomes before forming an opinion or making a decisionCritical thinking in nursing practice is a discipline specific, reflective reasoning process that guides the nurse in generating, implementing, and evaluating approaches for dealing with client care and professional concerns. NLN 2000
Critical Thinking in NursingPurposeful, outcome-directedEssential to safe, competent, skillful nursing practiceBased on principles of nursing process and the scientific methodRequires specific knowledge, skills, and experienceNew nurses must question
Critical Thinking in NursingGuided by professional standards and ethic codesRequires strategies that maximize potential and compensate for problemsConstantly reevaluating, self-correcting, and striving to improve
Formula for Critical ThinkingStart Thinking
Why Ask Why
Ask the Right Questions
Are you an expert?
Aspects of Critical ThinkingReflection
Language
Intuition
Levels of Critical ThinkingBasic
Complex
Commitment
Critical Thinking CompetenciesScientific methodProblem SolvingDecision MakingDiagnostic Reasoning and InferencesClinical Decision MakingNursing Process
Developing Critical Thinking Attitudes/SkillsNot easyNot either orSelf-assessmentTolerating dissonance and ambiguitySeeking situations where good thinking practicedCreating environments that support critical thinking
Nursing ProcessSystematic 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 actionInvolves the use of critical thinking skillsCommon language for nurses to think through clinical problems
Nursing Process
Thinking and LearningLifelong processFlexible, open processLearn to think and to ANTICIPATEWhat, why, how questionsLook beyond the obviousReflect on past experienceNew knowledge challenges the traditional way
Components Of Critical ThinkingScientific Knowledge BaseExperienceCompetenciesAttitudesStandards
Attitudes That Foster Critical ThinkingIndependenceFair-mindednessInsight into ethnocentricityIntellectual humilityIntellectual courage to challenge status quoIntegrityPreserveranceConfidenceCuriosity
Professional StandardsEthical criteria for Nursing judgment- Code of EthicsCriteria for evaluation- Standards of careStandards of professional responsibility that nurses strive to achieve are cited in Nurse Practice Acts, TJC guidelines, institutional policy and procedure, ANA Standards of Nursing Practice
Critical Thinking SynthesisReasoning process by which individuals reflect on and analyze their own thoughts, actions, & decisions and those of others
Not a step by step process
Nursing ProcessTraditional critical thinking competency5 Step circular, ongoing processContinuous until clients health is improved, restored or maintainedMust involve assessment and changes in condition
When using the Nursing ProcessIdentify health care needsDetermine Priorities Establish goals & expected outcomesProvide appropriate interventionsEvaluate effectiveness
Nursing Process
AssessmentDiagnosisPlanningImplementationEvaluation
AssessmentSystemically collects, verifies, analyzes and communicates dataTwo step process- Collection and Verification of data & Analysis of dataEstablishes 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 skillsPrior clinical experience contributes to assessment skillsApply Standards of PracticePersonal Attitudes
Assessment DataSubjective DataObjective DataSources of DataMethods of Data Collection-InterviewInterview initiates nurse-client relationshipUse open-ended questionsNursing health history
Nursing DiagnosisStatement that describes the clients actual or potential response to a health problemFocuses on client-centered problemsFirst introduced in the 1950sNANDA established in 1982Step of the nursing process that allows nurse to individualize care
Planning for Nursing CareClient-centered goals and expected outcomes are establishedPriorities are set relating to unmet needsMaslows Hierarchy of Needs is a useful method for setting prioritiesPriorities are classifies as high, intermediate, or low
Purpose of Goals and OutcomesProvides direction for individualized nursing interventionsSets standards of determining the effectiveness of interventionsIndicates anticipated client behavior or response to nursing careEnd point of nursing care
Goals of Care
Goal: Guideposts to the selection of nursing interventions and criteria in the evaluation of interventionsWhat you want to achieve with your patient and in what time frameShort term vs. Long termOutcome Of Care: What was actually achieved, was goal met or not met
Nursing InterventionsInterventions are selected after goals and outcomes are determinedActions designed to assist client in moving from the present level of health to that which is described in the goal and measured with outcome criteriaUtilizes critical thinking by applying attitudes and standards and synthesizing data
Types of InterventionsNurse-Initiated
Physician-Initiated
Collaborative Interventions
Selection Of InterventionUsing clinical decision making skills, the nurse deliberates 6 factors:
Diagnosis, expected outcomes, research base, feasibility, acceptability to client, competency of nurse
Nursing Care PlansWritten guidelines for client careOrganized so nurse can quickly identify nursing actions to be deliveredCoordinates resources for careEnhances the continuity of careOrganizes information for change of shift report
Nursing Care Plans vs Concept MapsNCPConcept/Mind Map
Implementation of Nursing InterventionsDescribes 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 InterventionsStanding 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 clients response to nursing actions and the clients progress toward achieving goalsData collected on an on-going basisSupports the basis of the usefulness and effectiveness of nursing practiceInvolves measurement of Quality of Care
Evaluation of Goal AchievementMeasures and Sources: Assessment skills and techniquesAs goals are evaluated, adjustments of the care plan are madeIf the goal was met, that part of the care plan is discontinuedRedefines priorities
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