nursing process & critical thinking cld

Nursing Health AssessmentNursing Health Assessment

Maria Carmela L. Domocmat, MSN, Maria Carmela L. Domocmat, MSN, RNRN

Instructor, Nursing Health Assessment Instructor, Nursing Health Assessment

School of NursingSchool of Nursing

Northern Luzon Adventist CollegeNorthern Luzon Adventist College

•• Review of the Nursing ProcessReview of the Nursing Process

•• Critical Thinking Critical Thinking

Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN

Nursing Process: A ReviewNursing Process: A Review

•• What is the nursing process and why What is the nursing process and why

learn about it? learn about it?


Nursing ProcessNursing Process

•• Nursing Process and Maslow are the Nursing Process and Maslow are the

main frameworks for the local board main frameworks for the local board

and the NCLEX Exams.and the NCLEX Exams.

•• Remember ONLY the RN can assess, Remember ONLY the RN can assess,

develop a plan of care, evaluate and develop a plan of care, evaluate and

educate clients.educate clients.Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN

Nursing Process Nursing Process cont.cont.

•• is the framework for professional is the framework for professional

nursing practice.nursing practice.



•• Is a Is a systematicsystematic,, dynamicdynamic way of giving way of giving

nursing carenursing care

•• Promotes Promotes humanistichumanistic, , outcomeoutcome--focusedfocused, ,

costcost--effectiveeffective carecare



•• Pushes nurses to continually examine Pushes nurses to continually examine

what they are doing and to study how it what they are doing and to study how it

can be done better.can be done better.

•• Consists of five interrelated stepsConsists of five interrelated steps



1.1. AssessmentAssessment2.2. DiagnosisDiagnosis3.3. PlanningPlanning4.4. ImplementingImplementing4.4. ImplementingImplementing5.5. EvaluatingEvaluating



Nursing ProcessNursing Process

•• Why systematic?Why systematic?

•• Why dynamic?Why dynamic?

•• Why humanistic? Why humanistic?

•• Why outcomeWhy outcome--focused? focused?

•• Why costWhy cost--effectiveeffective


Systematic Systematic

•• Like a problemLike a problem--solving methodsolving method

•• It consists of five steps during which It consists of five steps during which

you take deliberate steps to maximize you take deliberate steps to maximize

efficiency and attain longefficiency and attain long--term term

beneficial results. beneficial results.


DynamicDynamic

•• As you gain more experience, you’ll As you gain more experience, you’ll

find yourself moving back and forth find yourself moving back and forth

between the steps, sometimes between the steps, sometimes

combining activities, yet getting the combining activities, yet getting the

same end result.same end result.


Dynamic Dynamic cont.cont.

•• For example, new nurses often need to For example, new nurses often need to

methodically assess a patient for quite some methodically assess a patient for quite some

time before coming to a diagnosis, whereas time before coming to a diagnosis, whereas

experienced nurses often immediately experienced nurses often immediately

suspect a diagnosis, then assess the patient suspect a diagnosis, then assess the patient

more closely to see of they are correct. more closely to see of they are correct. Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN

HumanisticHumanistic

•• The nursing process involves looking at the The nursing process involves looking at the

whole patient at all times. whole patient at all times.

•• It personalizes the patient. It personalizes the patient.

•• As nurses, we deal with the body, mind and As nurses, we deal with the body, mind and

spirit.spirit.

•• He is not "the CVA in bed # 5."He is not "the CVA in bed # 5."Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN


•• We strive to understand each individual’s health We strive to understand each individual’s health

problems and the corresponding impact on one’s problems and the corresponding impact on one’s

sense of wellsense of well--being and ability to do daily being and ability to do daily sense of wellsense of well--being and ability to do daily being and ability to do daily

activities. activities.



•• The process provides a The process provides a

roadmap that ensures good roadmap that ensures good

nursing care and improves nursing care and improves nursing care and improves nursing care and improves

patient outcomes.patient outcomes.


OutcomeOutcome--focusedfocused

•• ResultResult--orientedoriented

•• The steps of the nursing process are The steps of the nursing process are

designed to keep the focus on designed to keep the focus on

determining whether people seeking determining whether people seeking

health care are getting the best results health care are getting the best results

in the most efficient way. in the most efficient way. Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN

Why learn about it?Why learn about it?

•• The nursing process provides the basis The nursing process provides the basis

for the board exams for the board exams ––you need to be you need to be

thoroughly familiar with it to think thoroughly familiar with it to think

your way to through the questions.your way to through the questions.



•• It help you think critically in the clinical It help you think critically in the clinical

settingsetting——you must you must mastermaster the principles the principles

behind the nursing process. behind the nursing process.



•• Using the nursing process complements Using the nursing process complements

what other health care professionals do by what other health care professionals do by

focusing on both the medical problems and focusing on both the medical problems and

human response human response ––how the person respondshow the person responds to to

medical problems, treatment plans, and medical problems, treatment plans, and

changes in activities of daily life.changes in activities of daily life.Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN

ComparisonComparison

Physician’s dataPhysician’s data•• Disease focusDisease focus

Nurse’s dataNurse’s dataWholisticWholistic focus focus ––

considering their considering their problems and their problems and their problems and their problems and their effect on the effect on the person’s ability to person’s ability to function function independently. independently.


Physician’s dataPhysician’s data

•• Mrs. Garcia has pain and swelling in all Mrs. Garcia has pain and swelling in all

joints. Diagnostic studies indicate that she joints. Diagnostic studies indicate that she

has rheumatoid arthritis. We will start her has rheumatoid arthritis. We will start her

in a course of antiin a course of anti--inflammatoriesinflammatories to treat to treat

the rheumatoid arthritis. the rheumatoid arthritis.

•• (Focus is on treating the arthritis(Focus is on treating the arthritis) ) Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN

Nurse’s dataNurse’s data

•• Mrs. Garcia has pain and swelling in all Mrs. Garcia has pain and swelling in all

joints, making it difficult to dress herself. She joints, making it difficult to dress herself. She

has voiced that it’s difficult to feel worthwhile has voiced that it’s difficult to feel worthwhile

when she can’t even feed herself. She states when she can’t even feed herself. She states

that she is depressed because she misses that she is depressed because she misses

seeing her two small grandchildren. seeing her two small grandchildren. Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN

Nurse’s dataNurse’s data

•• We need to develop a plan to help her We need to develop a plan to help her

pain, to assist with her feeding and pain, to assist with her feeding and

dressing, to work through feelings of low dressing, to work through feelings of low dressing, to work through feelings of low dressing, to work through feelings of low

selfself--esteem, and for special visitations esteem, and for special visitations

with the grandchildren.with the grandchildren.

•• (Focus is on Mrs. Garcia)(Focus is on Mrs. Garcia)


WHAT IS CRITICAL WHAT IS CRITICAL THINKING IN NURSING?THINKING IN NURSING?

Maria Carmela L. Domocmat, RN, MSNMaria Carmela L. Domocmat, RN, MSN

Critical Thinking Critical Thinking


Critical Thinking Critical Thinking

•• Unlike the mindless thinking Unlike the mindless thinking

we do when we do our daily we do when we do our daily

routine, critical thinking is routine, critical thinking is

careful, deliberate, outcomecareful, deliberate, outcome--

focused (resultsfocused (results--oriented) oriented)

thinking. thinking. Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN

What is critical thinking in What is critical thinking in nursing?nursing?

Critical thinking in nursing:Critical thinking in nursing:

•• Entails purposeful, outcomeEntails purposeful, outcome--oriented oriented

(results(results--oriented) thinking.oriented) thinking.

•• Is driven by patient, family, and Is driven by patient, family, and

community needs.community needs.



•• Is based on principles of nursing Is based on principles of nursing

process and scientific methodprocess and scientific method

•• Requires knowledge, skills and Requires knowledge, skills and

experienceexperience

•• Is guided by professional standards and Is guided by professional standards and

ethics codes.ethics codes.Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN


•• The ability to:The ability to:

•• identify a problemidentify a problem

••analyze itanalyze it

••develop a responsedevelop a response

•• follow throughfollow through



•• Requires strategies that maximize Requires strategies that maximize

human potentialhuman potential (e.g., using individual (e.g., using individual

strengths) and compensate for strengths) and compensate for

problems created by problems created by human naturehuman nature (e.g., (e.g.,

the powerful influence of personal the powerful influence of personal

perspectives, values and beliefs.)perspectives, values and beliefs.)Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN


•• Is constantly reIs constantly re--evaluating, selfevaluating, self--

correcting, and striving to improve. correcting, and striving to improve.

(Source: Alfaro(Source: Alfaro--LeFevreLeFevre (1999). Critical thinking in nursing: (1999). Critical thinking in nursing:

A practical approach. Philadelphia: W. B. Saunders. )A practical approach. Philadelphia: W. B. Saunders. )


How to Become a Critical How to Become a Critical ThinkerThinker

Critical thinking is like any other skill: Critical thinking is like any other skill:

if you practice it, it becomes more if you practice it, it becomes more if you practice it, it becomes more if you practice it, it becomes more

automatic. automatic.


•• Take a few moments to look at the list Take a few moments to look at the list

of the characteristics of critical thinkers, of the characteristics of critical thinkers,

and evaluate your current habits of and evaluate your current habits of

thinkingthinking

•• Check each characteristics and ask Check each characteristics and ask

yourself, “Is this me?”yourself, “Is this me?”

•• Put a mark next to the ones you want to Put a mark next to the ones you want to

develop or improve. develop or improve. Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN

Characteristics of Critical ThinkersCharacteristics of Critical Thinkers

Critical Thinkers are: Critical Thinkers are:

•• Aware of their strengths and Aware of their strengths and

capabilitiescapabilities: They’re confident that they : They’re confident that they capabilitiescapabilities: They’re confident that they : They’re confident that they

can reason to find answers and make can reason to find answers and make

good decision.good decision.


•• Sensitive to their own limitations and Sensitive to their own limitations and

predispositionspredispositions: They know their : They know their

weaknesses, values, and beliefs and weaknesses, values, and beliefs and

recognize when these may hamper their recognize when these may hamper their

ability to assess a situation or solve a ability to assess a situation or solve a

problem.problem.Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN

•• Open mindedOpen minded: They listen to new ideas : They listen to new ideas

and viewpoints and consider the and viewpoints and consider the

situation from many perspectives.situation from many perspectives.


•• HumbleHumble: They overcome their own : They overcome their own

tendency to feel that they should have tendency to feel that they should have

all the answers. all the answers.


•• CreativeCreative: They are constantly looking : They are constantly looking

for better ways to get things done. They for better ways to get things done. They

follow recommended procedures; follow recommended procedures;

however, they continually examine however, they continually examine

whether these are the best way to meet whether these are the best way to meet

the goals and objectives.the goals and objectives.Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN

The Client in ContextThe Client in Context

•• ProactiveProactive: they accept : they accept

responsibility and responsibility and

accountability for their accountability for their

actions. They study situations, anticipate actions. They study situations, anticipate

problems, and find ways to avoid them problems, and find ways to avoid them

beforebefore they happen.they happen.Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN

•• FlexibleFlexible: They recognize the : They recognize the

importance of changing priorities and importance of changing priorities and

interventions when planned interventions when planned

approaches don’t seem to be getting approaches don’t seem to be getting

results. results.


•• Aware that errors are steppingAware that errors are stepping--stones stones

to new ideasto new ideas: They turn mistakes into : They turn mistakes into

learning opportunities, reflecting on learning opportunities, reflecting on

what went wrong and identifying ways what went wrong and identifying ways

to avoid the same mistake in the future. to avoid the same mistake in the future.


•• Willing to persevereWilling to persevere: They know that : They know that

sometimes there are no easy answers sometimes there are no easy answers

and that there may be timeand that there may be time--consuming consuming

struggles to find the best answer. struggles to find the best answer.


•• Cognizant to the fact that we don’t live Cognizant to the fact that we don’t live

in a perfect worldin a perfect world: :

•• They realize that sometimes the They realize that sometimes the best answerbest answer

may not be the may not be the perfect answerperfect answer. .


•• IntrospectiveIntrospective: :

•• They evaluate and correct They evaluate and correct

their own thinking. their own thinking. their own thinking. their own thinking.


Critical Thinkers also:Critical Thinkers also:

•• Maintain questioning attitudeMaintain questioning attitude: :

•• They ask questions like: “What’s going on They ask questions like: “What’s going on

here?”; “What does it mean?”; and “What here?”; “What does it mean?”; and “What here?”; “What does it mean?”; and “What here?”; “What does it mean?”; and “What

else could it mean, and how else could it be else could it mean, and how else could it be

interpreted?”interpreted?”


•• Ask for clarification when they don’t Ask for clarification when they don’t

understandunderstand: :

•• For example, they say, “I’m not clear about For example, they say, “I’m not clear about

this. Can you tell me more?” this. Can you tell me more?” oror ask ask

questions like, “What do you mean by questions like, “What do you mean by

better,better, better in what way?”better in what way?”


•• Apply previous knowledge to new Apply previous knowledge to new

situationssituations: :

•• They see similarities and differences They see similarities and differences

between one experience and another, between one experience and another,

between one concept and another. between one concept and another.


•• See the situation from many See the situation from many

perspectivesperspectives: :

•• They value all viewpoints and watch that They value all viewpoints and watch that

their judgments are based on their judgments are based on factsfacts, not , not

personal feelings, views, or selfpersonal feelings, views, or self--interests. interests.


•• Weigh risks and benefits (advantaged Weigh risks and benefits (advantaged

and disadvantages) before making a and disadvantages) before making a

decisiondecision: :

•• They avoid risky decisions and find ways They avoid risky decisions and find ways

to reduce adverse reactions before putting to reduce adverse reactions before putting

a plan into action.a plan into action.


•• Seek help when neededSeek help when needed..

•• Put first things firstPut first things first: :

•• They ask, “What is the most They ask, “What is the most

important thing to do important thing to do

here?”here?”


Critical Thinkers use logic. Critical Thinkers use logic.

•• They tThey test first impressions to make est first impressions to make

sure they are as they appearsure they are as they appear: :

•• They doubleThey double--check the logic of their check the logic of their

thinking and workability of their solutions.thinking and workability of their solutions.


•• Distinguish between fact and fallacyDistinguish between fact and fallacy: :

•• They take time to verify important They take time to verify important

information to be sure it’s true. information to be sure it’s true. information to be sure it’s true. information to be sure it’s true.


•• Distinguish fact from inference (what Distinguish fact from inference (what

they they believebelieve the fact means)the fact means): :

•• For example, they recognize that because For example, they recognize that because

someone is sitting quietly in a corner may someone is sitting quietly in a corner may

not mean that the individual is not mean that the individual is withdrawnwithdrawn; ;

It means that they are sitting quietly in a It means that they are sitting quietly in a

corner and that it would be helpful to find corner and that it would be helpful to find

out why. out why.


•• Support views with evidenceSupport views with evidence: :

•• They wouldn’t state that the person above They wouldn’t state that the person above

is withdrawn without providing additional is withdrawn without providing additional is withdrawn without providing additional is withdrawn without providing additional

supporting evidence, such as the supporting evidence, such as the

individual saying he wants nothing to do individual saying he wants nothing to do

with anyone. with anyone.


•• Determine what’s relevant and what’s Determine what’s relevant and what’s

irrelevantirrelevant: :

•• They recognize what’s important for They recognize what’s important for

understanding a situation and what’s understanding a situation and what’s

unimportant. unimportant.


•• Apply the concept of “cause and effect”Apply the concept of “cause and effect”: :

•• They look for what’s causing a problem to They look for what’s causing a problem to

more fully understand the problem itself. They more fully understand the problem itself. They

anticipate responses to their actions before anticipate responses to their actions before

performing the actions. For example, critical performing the actions. For example, critical performing the actions. For example, critical performing the actions. For example, critical

thinkers would attempt to find out the thinkers would attempt to find out the cause cause of of

pain before deciding how to pain before deciding how to treattreat it. They it. They

would determine how someone might would determine how someone might respondrespond

to a medication before to a medication before administeringadministering it. it.


•• Withhold judgment until all the Withhold judgment until all the

necessary facts are innecessary facts are in: :

•• They realize the dangers of jumping to They realize the dangers of jumping to

conclusions.conclusions.



15 minutes

Health & Medicine

nursing process & critical thinking cld