NRG 106 CRITICAL THINKING

• Critical thinking in nursing practice


  An essential skill that involves the interpretation of a patient's needs, concerns, or health problems
• Clinical judgment


  Making accurate & appropriate decisions
• Clinical decision


  Nurses must learn to question, wonder, and explore different perspectives and interpretations to find a solution that benefits the patient
• Decision making


  Separates nurses from technical personnel
• Application of components of critical thinking

  • Knowledge
  • Attitude
  • Clinical experiences
  • Professional standards
• Critical


  • Exercising or involving careful judgment or judicious evaluation
  • Involving the objective analysis and evaluation of an issue in order to form a judgement
• Critical thinking


  The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process
• Critical thinking


  1. Recognizing that an issue exists

  2. Analyzing information

  3. Evaluating information

  4. Drawing conclusions

  
• Concrete thinker


  • A learner trusts that experts have the right answers for every problem
  • Thinking is concrete and based on a set of rules or principles
• Transitional thinker


  • A thinker learns to accept the diverse opinions and values of experts
  • Negative components of CT can restrict thinkers ability to move to next level
• Abstract thinker


  • Thinkers begin to separate themselves from experts and analyze the clinical situation and examine choices more independently
  • Each solution has benefits and risks that you weigh before making a final decision
  • Thinking becomes creative and innovative
  • Can anticipate when to make choices without assistance from others and accept accountability for decisions made
  • Chooses an action or belief that is based on the available alternatives and support it
• Types of critical thinking

  • General critical thinking
  • Scientific method
  • Problem solving
  • Decision making
  • Specific critical thinking
  • Diagnostic reasoning and inference
  • Clinical decision making

  
• Problem solving


  • Solve problems using reasoning
  • Systematic & ordered approach when data gathering & problem solving
  • Involves evaluating a situation over time, identifying possible solutions, & trying a solution over time to make sure that it is effective
• Decision making


  • A product of critical thinking that focuses on problem resolution
  • Following a set of criteria helps to make a thorough and thoughtful decision
• Diagnostic reasoning and inference


  • The analytical process for determining a patient's health problems
  • Accurate recognition of a patient's problems is necessary before acting on problem
• Clinical decision making


  • A problem solving activity which focus on defining a problem & selecting appropriate actions to reduce severity of problem
  • Used as a competency when delivering patient care
  • A five-step clinical decision-making approach
• Nursing process system

  • Assessment
  • Diagnosis
  • Planning
  • Implement
  • Evaluation
• Nursing process system


  A systematic, rational method of planning and providing individualized nursing care
• Lydia E. Hall originated the term nursing process


  1955
• Dorothy Johnson first used the nursing process


  1959
• Ida Jean Orlando first used the nursing process


  1961
• Ernestine Wiedenbach first used the nursing process


  1963
• The American Nurses Association (ANA) gained additional legitimacy for the nursing process


  1973
• Purposes of the nursing process system

  • To identify a client's health status and actual or potential health care problems or needs
  • To establish plans to meet the identified needs
  • To deliver specific nursing interventions to meet those needs
• Characteristics of the nursing process

  • Cyclical and dynamic nature
  • Client centeredness
  • Focus on problem solving and decision making
  • Interpersonal and collaborative
  • Universal applicability
  • Use of critical thinking and clinical reasoning
• Nursing assessment


  • A critical thinking process that professional nurses use to apply the best available evidence to caregiving & promoting human functions and responses to health & illness
  • Dynamic and continuous
• Nursing assessment


  Deliberate & systematic collection of information about a patient to determine his/her current & past health and functional status & his/her present and past coping patterns
• Types of nursing assessment

  • The patient-centered interview during a nursing health history
  • A physical examination
  • The periodic assessments you make during rounding or administering care
• Types of data collected during nursing assessment

  • Subjective (patient's verbal descriptions of their health problems)
  • Objective (observations or measurements of a patient's health status)
• Methods of data collection during nursing assessment

  • Patient-Centered Interview
  • Nursing Health History
  • Physical Examination
  • Results of Laboratory & Diagnostic tests
• Patient-centered interview


  A relationship based and organized conversation focused on learning about the well and the sick as they seek care
• Interview techniques


  • Observation
  • Open-ended questions
  • Leading questions
  • Back channeling
  • Direct closed-ended questions
• Nursing health history


  Data collected about a patient's present level of wellness, changes in life patterns, sociocultural role, and mental & emotional reactions to illness
• Basic components of a nursing health history

  • Biographical information
  • Reasons for seeking health care
  • Patient expectations
  • Present illness or health concerns
  • Health history
• Physical examination


  • Investigation of the body to determine state of health
  • Involves the use of inspection, palpation, percussion, auscultation and smell
• Results of laboratory & diagnostic tests


  Provides further explanation of problems identified during nursing health history and physical examination
• Data interpretation & validation

  • Involves continuous interpretation of information
  • Critical thinking aspect of assessment
  • Comparison of data with another source to determine data accuracy
• Data documentation


  • Requires a timely, thorough & accurate documentation of facts
  • Legal & professional responsibility of a nurse
• Nursing diagnosis


  A clinical judgment concerning a human response to health conditions/ life processes, or a vulnerability for that response, by an individual, family, group, or community
• Medical diagnosis


  Identification of a disease condition based of specific evaluation of physical symptoms, patient's medical history & the results of diagnostic tests