clinical decision making
careful reasoning so that you choose the options for the best client outcomes on the basis of the client's condition and the priority of the problem
concept map
visual representation of client problems and interventions that shows their relationships to one another - primary purpose is to synthesize relevant data about a client, including assessment data, nursing diagnoses, health needs, nursing interventions, and evaluation measures
critical thinking
active, organized, cognitive process used to carefully examine one's thinking and the thinking of others. It involves recognizing that an issue exists (client problem), analyzing information about the issue (clinical data about the client), evaluating information (reviewing assumptions and evidence), and making conclusions.
decision making
product of critical thinking that focuses on problem resolution
diagnostic reasoning
process of determining a client's health status after you assign meaning to the behaviors, physical signs, and symptoms presented by the client
evidence-based knowledge
knowledge based on research or clinical expertise (makes you an informed critical thinker)
inference
drawing conclusions from related pieces of evidence. Involves forming patterns of information from data before making a diagnosis
nursing process
often called a blueprint for client care - its purpose is to diagnose and treat human responses to actual or potential health problems
problem solving
involves evaluating the solution over time to make sure that it is effective
prognosis
diagnosed problem
reflection
process of purposefully thinking back or recalling a situation to discover its purpose or meaning
scientific method
problem identification
collection of data
formulation of hypothesis
testing hypothesis
evaluating results of test or study
form a theory
Levels of Critical Thinking
Basic Critical Thinking - Thinking is concrete and based on a set of rules or principles (e.g. step-by-step method for inserting a Foley
Complex Critical Thinking - analyze and examine choices more independently, willing to consider different options aside from routine procedures
Commitment - anticipates the need to make choices w/o assistance from others, makes a choice based on alternatives available , supports it, and determines whether it was appropriate
Critical Thinking
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.
Evidence-based Knowledge
Knowledge based on research or clinical expertise, makes you an informed critical thinker
Critical Thinking Skill: Interpretation
Look for patterns. Clarify uncertain data.
Critical Thinking Skill: Analysis
Open-mindedness while looking at information. No not make careless assumptions.
Critical Thinking Skill: Inference
Look at the meaning and significance of findings
Critical Thinking Skill: Evaluation
Look at all situations objectively. Use criteria to determine results of nursing actions.
Critical Thinking Skill: Explanation
Support your findings and conclusions. Use knowledge and experience to choose strategies.
Critical Thinking Skill: Self-regulation
Reflect on experiences and identify ways to improve performance.
Concepts of Critical Thinking
Truth seeking, Open-mindedness, Analyticity, Systematicity, Self-confidence, Inquisitiveness, and Cognitive Maturity.
Basic Critical Thinking
Learner trusts experts for right answers for every problem. Thinking is concrete and based on a set of rules or principles. Answers right or wrong.
Complex Critical Thinking
Analyze and examine choices more independently. Each solution has benefits and risks that are weighed before making final decision.
Commitment
Anticipates when to make choices without assistance from others and accepts accountability for decisions made
Scientific Method
1. Identifying the problem
2. Collecting data
3. Formulating a question or hypothesis
4. Testing the question or hypothesis
5. Evaluating results of the test or study
Problem Solving
Evaluating the solution over time to make sure that it is effective.
Decision Making
Product of critical thinking that focuses on problem resolution.
Diagnostic Reasoning
Analytical process for determining a patient's health problems.
Inference
Process of drawing conclusions from related pieces of evidence and previous experience with the evidence.
Clinical Decision Making
Problem-solving activity that focuses on defining a problem and selecting an appropriate action
Nursing Process
Five-step Clinical decision-making approach. Purpose is to diagnose and treat human responses to actual or potential health problems.
Components of Critical Thinking
1. Specific knowledge base in nursing
2. Experience
3. Critical thinking competencies
4. Attitudes for critical thinking
5. Standards for critical thinking:
A. Intelectual standards
B. Professional standards
Critical Thinking Attitude: Confidence
Learn how to introduce self, speak with conviction
Critical Thinking Attitude: Thinking Independently
Read nursing literature and talk to other nurses and share ideas about nursing interventions
Critical Thinking Attitude: Fairness
Listen to both sides
Critical Thinking Attitude: Responsibility and Authority
Ask for help if uncertain about nursing skill. Report any problems and follow standards
Critical Thinking Attitude: Risk Taking
If knowledge causes questioning physician's orders, do so. Be willing to recommend alternative approaches.
Critical Thinking Attitude: Discipline
Be thorough in whatever you do.
Critical Thinking Attitude: Perseverance
Be cautious of an easy answer.
Critical Thinking Attitude: Creativity
Look for different approaches if interventions are not working.
Critical Thinking Attitude: Curiosity
Always ask why.
Critical Thinking Attitude: Integrity
Do no compromise nursing standards or honesty in delivering nursing care.
Critical Thinking Attitude: Humility
Recognize when you need more information to make a decision.
Reflection
Process of purposefully thinking back or recalling a situation to discover its purpose or meaning.
Concept map
Visual representation of patient problems and interventions that shows their relationships to one another.
Critical Thinking DEFINED
Continuous process CHARACTERIZED by:
-Open-mindedness
-continual inquiry
-perseverance
Combined with a willingness to look at each unique patients situation and determine which identified assumptions are true and relevant
SKILLS (Nursing Practice applications)
interpretation
analysis (use of assessment data to arrive at a decision)
inference ("maybe" "perhaps", infer a decision)
evaluation
explanation (explanation as to why something happened)
self-regulation ("how did you do it", self evaluate what you did)
CHARACTERISTICS (concepts for critical thinking)
truth seeking
open-mindedness
analytic approach
systematic approach (nursing process)
self-confidence
inquisitiveness
maturity
Critical thinking model CREATORS
Kataoka-Yahiro and Saylor (1994)
Critical Thinking Model Level 1
Basic Critical Thinking
Learner trusts that experts have the right answers for every problem. Thinking is concrete and based on a set of rules or principles
Critical Thinking Model Level 2
Complex Critical Thinking
Thinkers begin to separate themselves from experts. They analyze and examine choices more independently. Each solution has benefits and risks that you weigh before making a final decision
Critical Thinking Model Level 3
Commitment
Person anticipates when to make choices without assistance from others and accepts accountability for decisions made (you take accountability for the decisions, you consider results of the decisions and determine whether it was appropriate)
Critical Thinking COMPETENCIES (3)
1. General Critical Thinking
2. Specific Critical Thinking in clinical situations
3. Specific Critical Thinking in Nursing: Nursing Process
1. General Critical Thinking
Involves:
Scientific method
Problem solving
Decision making
2.Specific Critical Thinking in clinical situations
Involves:
Diagnostic Reasoning and Inference
Clinical Decision Making
3. Specific Critical Thinking in Nursing: Nursing Process
5 step clinical decision-making process
The Nursing Process...
-assessment
-diagnosis
-planning
-implementation
-evaluation
5 COMPONENTS of Critical Thinking Model (Clinical Decision Making)
1. Specific Knowledge Base
2. Experience
3. Nursing Process Competency
4. Attitudes for Critical Thinking
5. Standards for Critical Thinking
Specific Knowledge Base
Prepares you to anticipate and identify patients problem by understanding their origin and nature
Experience
Clinical learning experiences are necessary to acquire clinical decision-making skills
The Nursing Process Competency
In your practice you apply critical thinking components during each stop of the nursing process
Attitudes for Critical Thinking
Thinking independently
Fairness
Responsibility and Accountability
Risk Taking
Discipline
Perseverance
Creativity
Curiosity
Integrity
Humility
Standards for Critical Thinking
1. Intellectual Standards
-follow standards and policy
-BE CLEAR
2. Professional Standards
-be non-judgemental (abortions)
Critical Thinking SYNTHESIS
Knowledge, Standards, Attitudes, Experience
-A reasoning process use 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