NURSING AS A SCIENCE

• Critical thinking


  The process of intentional higher level of thinking to define a client's problem, examine the evidence-based practice in caring for the client, and make choices in the delivery of care
• Clinical reasoning


  The cognitive process that uses thinking strategies to gather and analyze client information, evaluate the relevance of the information, and decide on possible nursing actions to improve the client's physiological and psychosocial outcomes
• Clinical reasoning


  • Requires the integration of critical thinking in the identification of the most appropriate intervention that will improve the client's condition
  • Guides nurses in assessing, assimilating, retrieving, and or discarding components of information that affect patient's care
  • Often defined in practice-based principles, such as nursing and medicine as the (application of critical thinking to the clinical situation)
• Purpose of critical thinking


  • An essential skill needed for the identification of client problem and the implementation of interventions to promote effective care outcomes
  • Helps nurses to develop new insights regarding practice that may lead to changes in their approach to practice
  • Metaphorical bridge between information and action
  • Fuels the intellectual artistic activity of creativity
• Ways nurses use critical thinking


  • Nurses uses knowledge from other subject and fields
  • Nurses deal with change in stressful environment
  • Nurses make important decisions
  • Generate many ideas rapidly
  • Be generally flexible and natural, that is, able to change viewpoints or directions in thinking rapidly and easily
  • Create original solutions to problems
  • Be independent and self-confident even when under pressure
  • Demonstrate individuality
• Techniques in critical thinking


  • Critical analysis
  • Inductive and deductive reasoning
  • Making valid inferences, differentiating facts from opinions
  • Evaluating the credibility of information sources
  • Clarifying concepts
  • Recognizing assumptions
• Critical analysis


  Application of a set of questions to a particular situation or idea to determine essential information and ideas and discard unimportant information and ideas

  • Use of Socratic questioning
• Inductive reasoning


  Generalizations are formed from a set of facts or observations. Moves from specific examples to generalized conclusion
• Deductive reasoning


  Reasoning from general premise to specific conclusions
• Types of statements


  • Facts: can be verified through investigation
  • Inferences: Conclusions drawn from the facts; going beyond facts to make a statement about something that currently known
  • Judgments: Evaluation of facts or information that reflects values or other criteria; type of opinion
  • Opinion: beliefs formed overtime; includes judgment that may fits facts or maybe erroneous
• Problem solving


  A mental activity in which a problem is identified that represents unsteady state. It requires a nurse to obtain information that clarifies the nature of the problem and suggest possible solutions. The nurse then carefully evaluates the possible solution and choose the best one to implement.
• Approaches to problem solving


  • Trial and error
  • Intuition
  • Research process
• Intuition


  The understanding or learning of things without the conscious use of reasoning. Also known as 6th sense, hunch, instinct, feeling or suspicion. Clinical judgment is a decision making process to ascertain the right nursing action to be implemented at the appropriate time in the client's care. Experience is important in improving intuition because the rapidity of judgment depends on the nurse having seen similar client situations many times before.
• Attitudes that foster critical thinking


  • Independence
  • Fair-mindedness
  • Insight to egocentricity
  • Intellectual humility
  • Intellectual courage to challenge the status quo and rituals
  • Integrity
  • Perseverance
  • Confidence
  • Curiosity
• Nursing process


  A systematic, rational method of planning and providing individualized nursing care. It is cyclical; its components follow a logical sequence, but more than one component may be involved at one time.
• Purposes of nursing process


  • 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 nursing process


  • Cyclic and dynamic
  • Client-centeredness
  • Focus on problem solving and decision-making
  • Interpersonal and collaborative style
  • Universal applicability
  • Use of critical thinking and clinical reasoning
• Assessing


  The systematic and continuous collection, organization, validation, and documentation of data (information). It is a continuous process carried out during all phases of the nursing process. All phases of nursing process depend on the accurate and complete collection of data.
• Types of assessment


  • Collecting data
  • Nursing health history
• Collecting data


  The process of gathering information about a client's health status. It must be both systematic and continuous to prevent the omission of significant data and reflect a client's changing health status.
• types of assessment

  • initial assessment: after admission: to establish a complete database
  • problem-focused assessment: ongoing process: determine the specific problem
  • emergency assessment: physiological or psychological crisis: identify the life-threatening problem
  • time-lapsed reassessment: month after: comparison
• Subjective data


  Also referred as 'SYMPTOMS' OR COVERT DATA. Apparently only to the person affected and can be described or verified only by the client.
• Objective data


  Also referred to as SIGNS OR OVERT DATA. Detectable by an observer or can be measured or tested against an accepted standard. Obtained by observation or physical examination.
• Constant data


  Information that does not change overtime.
• Variable data


  Information that changes quickly, frequently or rarely.
• Sources of data


  • Primary sources: Client
  • Secondary sources: Client, Support people, Client records, Health care professionals, Literature
• Data collection methods


  • Observing
  • Interviewing
• Observing


  A conscious, deliberate skill that involves noticing the data and selecting, organizing, and interpreting the data.
• Approaches to interviewing


  • Directive interview
  • Nondirective interview
• Directive interview


  Highly structured and elicits specific information. The nurse establishes the purpose of interview and controls the interview, at least at the outset.
• Nondirective interview


  Rapport building interview. The nurse allows the client to control the purpose, subject matter and pacing.
• Types of interview questions


  • Closed-ended questions
  • Open-ended questions
  • Neutral questions
• Try to avoid asking "why" questions as these questions can be perceived as a form of interrogation by the client.
• Directive interview


  Uses closed-ended questions that are restrictive and generally require only "yes or no" or short factual answers
• Nondirective interview


  Uses open-ended questions that invite clients to discover, explore, elaborate, clarify, or illustrate their thoughts or feelings
• Types of interview questions

  • Closed-ended
  • Open-ended
  • Neutral
• Closed-ended questions


  Used in directive interview, are restrictive and generally require only "yes or no" or short factual answers that provide specific information
• Open-ended questions


  Associated with nondirective interview, invites clients to discover or explore, elaborate, clarify, or illustrate their thoughts or feelings, specifies only the broad topic to be discussed and invites answer longer than 1 or 2 words
• Neutral questions


  A question that client can answer without direction or pressure from the nurse, is an open ended, and is used in nondirective interview