Foundations: Fundamentals of Nursing - Chapter 15 Critical Thinking in Nursing Pratice
Clinical decision making requires ____________ thinking.
Clinical __________-__________ skills separate professional nurses from technical and ancillary staff.
Patients often have problems for which no ___________ answers exist.
Nurses need to seek ____________, act quickly, and make sound clinical decisions.
A continuous process characterized by open-mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant.
Recognizing that an issue exists analyzing information, evaluating information, and making conclusions.
What are the 6 Critical Thinking Skills?
__________ is a lifelong process.
_______________ and _____________ growth involves learning new knowledge, as well as refining the ability to think, solve problems, and make judgments.
The ____________ of nursing continues to grow. Nurses need to be flexible and open to new information.
Truth Seeking, Analytic approach, Maturity
Concepts for a Critical Thinker:
Knowledge base, Experience, Nursing process competencies, Attitudes, and Standards
What are the 5 components of Critical Thinking?
Scientific, Problem, Decision, Diagnostic, Clinical, Competency
What are the 6 Critical Thinking Competencies?
____________ reasoning and inference
___________ decision making
Nursing process as a ______________
Assessment, Diagnosis, Planning, Implementation, and Evaluation
What are the 5 steps of the nursing process?
Confidence, Responsibility, Discipline
Attitudes a nurse needs:
Nursing Assistive Personnel (NAP)
Effective communication is needed between registered nurses (RNs) and __________ _____________ _____________ for giving feedback and clarifying tasks and patient status.
When patients' clinical conditions __________, warranting attention by RNs, clear directions are necessary to avoid missed care.
Applying critical thinking can help an RN make the decision about when to appropriate delegate _______.
Circle of Meaning
The ________ of ____________ model adapted to nursing encourages concept clarification and a search for meaning in nursing practice. Uses a series of questions to help you through a clinical experience and to find meaning.
A tool used to clarify concepts through reflection by thinking back or recalling situations.
A visual representation of patient problems and interventions that illustrates an interrelationship.
When nurses have a form means to discuss their experiences such as a staff meeting or a unit practice council, the ____________ allows for questions, differing viewpoints, and sharing of experiences.
When nurses are able to discuss their practices, the process validates good practice and offers challenges and constructive ______________.
Assessment, Nursing Diagnosis, Planning, Implementation, and Evaluation
What is the five-step nursing process model?
Critical Thinking Synthesis
A reasoning process used to reflect on and analyze thoughts, actions, and knowledge. Requires a desire to grow intellectually. Requires the use of nursing process to make nursing care decisions.
Clinical decision making
requires careful reasoning so that the options for the best client outcomes are chosen on the basis of the client's condition and the priority of the problem
visual representation of client problems and interventions that shows their relationship to one another.
involves using knowledge and thinking skills to evaluate evidence and explanations
the process of making a choice or finding a solution
process of determining a client's health status after you assign meaning to the behaiors, physical signs, and symptoms presented by the client
Knowledge that comes from scientific investigation or knowledge that is based on clinical expertise
logical interpretation based on prior knowledge and experience
Systematic problem-solving method by which nurses individualize care for each client. The five steps of the nursing process are ASSESSMENT,NURSING DIAGNOSIS, PLANNING, IMPLEMENTATION, and EVALUATION.
process of cognition that occurs when a goal must be reached by thinking and behaving in certain ways
a prediction of the course of a disease
process of purposefully thinking back or recalling a situation to discover it's purpose or meaning.
Problem identification, collection of data, formulation of a research question or hypothesis, testing the question or hypothesis, evaluating results of the test or study
clinical decision making
Problem-solving approach that nurses use to define patient problems and select appropriate treatment.
-Care-planning tool that assists in critical thinking and forming associations between a patient's nursing diagnoses and interventions
-a visual representation of patient problems and interventions that shows their relationships to one another
Active, purposeful, organized, cognitive process used to carefully examine one's thinking and the thinking of other individuals.
Process involving critical appraisal of information that results from recognizing a problem and ends with generating, testing, and evaluating a conclusion. Comes at the end of critical thinking
Process that enables an observer to assign meaning to and classify phenomena in clinical situations by integrating observations and critical thinking.
Knowledge that is derived from the integration of best research, clinical expertise, and patient values.
Systematic problem-solving method by which nurses individualize care for each patient. The five steps of the nursing process are assessment, diagnosis, planning, implementation, and evaluation.
Methodical, systematic approach to explore conditions and develop solutions, including analysis of data, determination of causative factors, and selection of appropriate actions to reverse or eliminate the problem.
Process of thinking back or recalling an event to discover the meaning and purpose of that event. Useful in critical thinking.
Codified sequence of steps used in the formulation, testing, evaluation, and reporting of scientific ideas.
basic critical thinking
think concretely and on the basis of a set of rules or principles. Follow step-by-step process without deviation. Trust expert has the right answers.
basic critical thinking
Ex: Hygiene/Creating a Sterile Field - follow return demonstration step by step - DO NOT DEVIATE. Once have more experience - may change procedure slightly to individualize patient care. Clean to Dirty
complex critical thinking
analyzes and examines choices independently. Students learn to think beyond and synthesize knowledge
complex critical thinking
EX: Pt refusing to take medication, trouble shooting an IV pump, caring for a pt how leaves the room al the time.
the third level of critical thinking. Students (soon to be future nurses) anticipate needs and make choices without assistance from others. You choose an action or belief based on the alternatives.
5 steps of scientific method
identify problem, collect data, formulate hypothesis, test hypothesis, evaluate results
Product of critical thinking that focuses on problem resolution. Does not have to be a problem.
as soon as you receive info about a patient
when does Diagnostic reasoning & inference begin?
EX. Turn a pt, notice a redden area on the coccyx (tailbone), press it, redden color does not go away, form a __ that the pt has a pressure ulcer.
While assessing a patient, the nurse observes that the patient's intravenous (IV) line is not infusing at the ordered rate. The nurse assesses the patient for pain at the IV site, checks the flow regulator on the tubing, looks to see if the patient is lying on the tubing, checks the point of connection between the tubing and the IV catheter, and then checks the condition of the site where the intravenous catheter enters the patient's skin. After the nurse readjusts the flow rate, the infusion begins at the correct rate. This is an example of:
The nurse collects information and tries options until she is able to find a solution to the slowed infusion rate. The focus is on solving the problem with the patient's IV and not on solving the patient's health problem; thus this is an example of __.
diagnostic reasoning process
when you are trying to solve the patient's health problem, you use the __
The nurse sits down to talk with a patient who lost her sister 2 weeks ago. The patient reports she is unable to sleep, feels very fatigued during the day, and is having trouble at work. The nurse asks her to clarify the type of trouble. The patient explains she can't concentrate or even solve simple problems. The nurse records the results of the assessment, describing the patient as having ineffective coping. This is an example of:
conducting reflective practice
A patient on a surgical unit develops sudden shortness of breath and a drop in blood pressure. The staff respond, but the patient dies 30 minutes later. The manager on the nursing unit calls the staff involved in the emergency response together. The staff discusses what occurred over the 30-minute time frame, the actions taken, and whether other steps should have been implemented. The nurses in this situation are:
a conscious process of thinking, analyzing, and learning from previous work situations.
analyticity and self-confidence
A nurse has worked on an oncology unit for 3 years. One patient has become visibly weaker and states, "I feel funny." The nurse knows how patients often have behavior changes before developing sepsis when they have cancer. The nurse asks the patient questions to assess thinking skills and notices the patient shivering. The nurse goes to the phone, calls the physician, and begins the conversation by saying, "I believe that your patient is developing sepsis. I want to report symptoms I'm seeing." What examples of critical thinking concepts does the nurse show?
analyzing information, gathering additional findings, and sensing a problem
clinical decision making for groups of patients
Considering how to involve patients in decisions and how to combine nursing activities to be more organized and allow for resolving more than one problem at a time are examples of:
The surgical unit has initiated the use of a pain-rating scale to assess patients' pain severity during their postoperative recovery. The registered nurse (RN) looks at the pain flow sheet to see the pain scores recorded for a patient over the last 24 hours. Use of the pain scale is an example of which intellectual standard?
Use of the same pain scale for assessing pain acuity is an example of being
The nurse reviews the position of requiring exercises to restore function and decides to try a different approach to proceed, which is an example of:
basic critical thinking
A nurse has been working on a surgical unit for 3 weeks. A patient requires a Foley catheter to be inserted, so the nurse reads the procedure manual for the institution to review how to insert it. The level of critical thinking the nurse is using is:
A patient had hip surgery 16 hours ago. During the previous shift the patient had 40 mL of drainage in the surgical drainage collection device for an 8-hour period. The nurse refers to the written plan of care, noting that the health care provider is to be notified when drainage in the device exceeds 100 mL for the day. On entering the room, the nurse looks at the device and carefully notes the amount of drainage currently in it. This is an example of:
The nurse asks a patient how she feels about her impending surgery for breast cancer. Before the discussion the nurse reviewed the description of loss and grief and therapeutic communication principles in his textbook. The critical thinking component involved in the nurse's review of the literature is:
Anticipating when to make choices during decision making is unique to the __ level of critical thinking
thinking concretely is __ critical thinking
Analyzing and examining choices and weighing benefits and risks are characteristic of __ critical thinking
process of drawing conclusions from related pieces of evidence and previous experience with the evidence
-Five step clinical decision making approach: assessment, diagnosis, planning, implementation, and evaluation.
-Its purpose is to diagnose and treat human responses to actual or potential health problems.