Foundations: Fundamentals of Nursing, Chapter 15 better set of "critical thinking in nursing practice

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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

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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

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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.

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decision making

product of critical thinking that focuses on problem resolution

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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

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evidence-based knowledge

knowledge based on research or clinical expertise (makes you an informed critical thinker)

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inference

drawing conclusions from related pieces of evidence. Involves forming patterns of information from data before making a diagnosis

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nursing process

often called a blueprint for client care - its purpose is to diagnose and treat human responses to actual or potential health problems

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problem solving

involves evaluating the solution over time to make sure that it is effective

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prognosis

diagnosed problem

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reflection

process of purposefully thinking back or recalling a situation to discover its purpose or meaning

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scientific method

problem identification
collection of data
formulation of hypothesis
testing hypothesis
evaluating results of test or study
form a theory

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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

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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.

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Evidence-based Knowledge

Knowledge based on research or clinical expertise, makes you an informed critical thinker

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Critical Thinking Skill: Interpretation

Look for patterns. Clarify uncertain data.

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Critical Thinking Skill: Analysis

Open-mindedness while looking at information. No not make careless assumptions.

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Critical Thinking Skill: Inference

Look at the meaning and significance of findings

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Critical Thinking Skill: Evaluation

Look at all situations objectively. Use criteria to determine results of nursing actions.

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Critical Thinking Skill: Explanation

Support your findings and conclusions. Use knowledge and experience to choose strategies.

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Critical Thinking Skill: Self-regulation

Reflect on experiences and identify ways to improve performance.

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Concepts of Critical Thinking

Truth seeking, Open-mindedness, Analyticity, Systematicity, Self-confidence, Inquisitiveness, and Cognitive Maturity.

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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.

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Complex Critical Thinking

Analyze and examine choices more independently. Each solution has benefits and risks that are weighed before making final decision.

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Commitment

Anticipates when to make choices without assistance from others and accepts accountability for decisions made

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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

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Problem Solving

Evaluating the solution over time to make sure that it is effective.

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Decision Making

Product of critical thinking that focuses on problem resolution.

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Diagnostic Reasoning

Analytical process for determining a patient's health problems.

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Inference

Process of drawing conclusions from related pieces of evidence and previous experience with the evidence.

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Clinical Decision Making

Problem-solving activity that focuses on defining a problem and selecting an appropriate action

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Nursing Process

Five-step Clinical decision-making approach. Purpose is to diagnose and treat human responses to actual or potential health problems.

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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

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Critical Thinking Attitude: Confidence

Learn how to introduce self, speak with conviction

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Critical Thinking Attitude: Thinking Independently

Read nursing literature and talk to other nurses and share ideas about nursing interventions

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Critical Thinking Attitude: Fairness

Listen to both sides

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Critical Thinking Attitude: Responsibility and Authority

Ask for help if uncertain about nursing skill. Report any problems and follow standards

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Critical Thinking Attitude: Risk Taking

If knowledge causes questioning physician's orders, do so. Be willing to recommend alternative approaches.

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Critical Thinking Attitude: Discipline

Be thorough in whatever you do.

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Critical Thinking Attitude: Perseverance

Be cautious of an easy answer.

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Critical Thinking Attitude: Creativity

Look for different approaches if interventions are not working.

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Critical Thinking Attitude: Curiosity

Always ask why.

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Critical Thinking Attitude: Integrity

Do no compromise nursing standards or honesty in delivering nursing care.

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Critical Thinking Attitude: Humility

Recognize when you need more information to make a decision.

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Reflection

Process of purposefully thinking back or recalling a situation to discover its purpose or meaning.

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Concept map

Visual representation of patient problems and interventions that shows their relationships to one another.

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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

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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)

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CHARACTERISTICS (concepts for critical thinking)

truth seeking
open-mindedness
analytic approach
systematic approach (nursing process)
self-confidence
inquisitiveness
maturity

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Critical thinking model CREATORS

Kataoka-Yahiro and Saylor (1994)

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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

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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

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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)

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Critical Thinking COMPETENCIES (3)

1. General Critical Thinking
2. Specific Critical Thinking in clinical situations
3. Specific Critical Thinking in Nursing: Nursing Process

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1. General Critical Thinking

Involves:
Scientific method
Problem solving
Decision making

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2.Specific Critical Thinking in clinical situations

Involves:
Diagnostic Reasoning and Inference
Clinical Decision Making

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3. Specific Critical Thinking in Nursing: Nursing Process

5 step clinical decision-making process

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The Nursing Process...

-assessment
-diagnosis
-planning
-implementation
-evaluation

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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

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Specific Knowledge Base

Prepares you to anticipate and identify patients problem by understanding their origin and nature

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Experience

Clinical learning experiences are necessary to acquire clinical decision-making skills

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The Nursing Process Competency

In your practice you apply critical thinking components during each stop of the nursing process

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Attitudes for Critical Thinking

Thinking independently
Fairness
Responsibility and Accountability
Risk Taking
Discipline
Perseverance
Creativity
Curiosity
Integrity
Humility

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Standards for Critical Thinking

1. Intellectual Standards
-follow standards and policy
-BE CLEAR
2. Professional Standards
-be non-judgemental (abortions)

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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