Critical Thinking and the Nursing Process

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LECTURE 1

• Critical Thinking and the Nursing Process

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Competencies

• Describe how nursing is both an art and a
  science.
• Discuss the components of critical thinking.
• Apply the Universal Intellectual Standards to the
  critical thinking process.

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Competencies

• Define the nursing process.
• Describe the six steps of the nursing process.
• Explain the distinctions among actual, risk, and
  wellness nursing diagnoses.

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Art and Science of Nursing

• Nursing is a blend of art and science.
• Skills in both areas develop with experience.

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Art of Nursing

• Incorporates aspects of caring and sharing into
  practice
• Recognizes role of intuition, intuitive links

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Science of Nursing

• Analytical thinking
• Based on scientific principles and research data
• Analytical thinking skills can be learned

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Critical Thinking

• Purposeful, goal-directed thinking process that
  strives to resolve patient care issues through
  the use of clinical reasoning
• Combines logic, intuition, and creativity
• Essential to nursing practice

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Clinical Reasoning

• Disciplined, creative, and reflective approach
• Used concurrently with critical thinking
• Purpose to establish potential strategies for
  patients to reach their desired health goals

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Clinical Reasoning

• Essential to nursing practice
• Key elements
• Purposeful
• Problem-solving strategy
• Based on assumptions

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Clinical Reasoning

• Conducted from some point of view
• Based on data, information, and evidence
• Expressed through, and shaped by, concepts and
  ideas
• Implications and consequences

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Components of Critical Thinking

• Interpretation
• Analysis
• Inference
• Explanation
• Evaluation
• Self-regulation

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Interpretation

• Decodes hidden messages
• Clarifies the meaning of information
• Categorizes information

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Analysis

• Examines ideas and data
• Identifies discrepancies
• Reflects on reasons for discrepancies

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Inference

• Speculates, derives, or reasons to a specific
  premise based on information and assumptions
  obtained from patient
• Skill develops with experience

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Explanation

• Requires that conclusions drawn from inferences
  be correct and justifiable
• Scientific and nursing literature serve as basis
  for clinical justification

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Evaluation

• Examines the validity of the information
• Leads to final conclusion that can be implemented

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Self-Regulation

• Reflects on critical thinking skills and
  determines which techniques were effective and
  which were problematic

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Universal Intellectual Standards for Critical
Thinking

• Clarity
• Accuracy
• Precision
• Relevance

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Universal Intellectual Standards for Critical
Thinking

• Depth
• Breadth
• Logic (applied to clinical reasoning)

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Nursing Process

• Assessment
• Nursing diagnosis
• Outcomes identification
• Planning
• Implementation
• Evaluation

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Assessment

• First step in nursing process
• Purpose is to identify
• Patients current health status
• Actual and potential health problems
• Areas for health promotion

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Assessment

• Sources of information
• Health history
• Physical assessment
• Diagnostic and laboratory data
• Dynamic phase

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Health History

• Gathers subjective data from patient
• Information may or may not be validated by
  physical assessment findings

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Health History

• Possible sources of information
• Patient
• Family
• Neighbors
• Friends
• Bystanders
• Old charts
• Medical records

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Physical Assessment

• Objective data
• Observable, measurable data
• Possible approaches body systems, head to toe,
  or Functional Health Patterns

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Diagnostic and Laboratory Data

• Objective data
• May include items such as blood and urine
  studies, cultures, X rays, and diagnostic
  procedures

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Diagnosis

• Second step in nursing process
• North American Nursing Diagnosis Association
  (NANDA) is leader in identifying diagnoses

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Diagnosis

• Provides the basis for selection of nursing
  interventions to achieve outcomes for which the
  nurse is accountable

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Nursing Diagnosis Formulation

• Collecting information
• Interpreting information
• Clustering information
• Naming a cluster, or problem formulation

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Types of Nursing Diagnoses

• Actual nursing diagnoses
• Risk nursing diagnoses
• Wellness nursing diagnoses

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Writing the Nursing Diagnosis

• Descriptor or qualifier
• Label or human response
• Related factors
• Defining characteristics, or risk factors

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Outcome Identification

• Third step in the nursing process
• Establish patient goals
• Develop patient outcomes
• Short-term
• Long-term

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Planning

• Fourth step in nursing process
• Prioritization of nursing diagnoses
• Framework to assist prioritization
• Maslows Hierarchy of Needs

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Intervention Selection

• Planned strategies to help patient meet the
  patient outcomes
• Independent nursing interventions
• Collaborative interventions

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Implementation

• Fifth step in nursing process
• Nurse executes the interventions that were
  devised during the planning stage
• Dynamic process

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Evaluation

• Sixth and final step in nursing process
• Determine patients progress in achieving
  outcomes
• Continual and dynamic process

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Evaluation

• Evaluate each outcome separately
• Document whether outcome was achieved or not
  achieved
• May result in revising the plan of care

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Evidence-Based Practice

• Growing trend toward basing practices on evidence
• Uses outcomes of well-designed and executed
  scientific studies
• Results disseminated through computer research,
  clinical conferences, and expert testimony

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Critical Pathways

• Show the outcome of predetermined patient goals
  over a period of time
• State what activity patient should be capable of
  completing daily

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Critical Pathways

• Delineates critical incidents and crucial nursing
  interventions
• Recognizes variances early

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Documenting the Nursing Process

• Methods
• SOAPIER
• Subjective data
• Objective data
• Analysis of data
• Plan
• Intervention/implementation
• Evaluation
• Revision

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Documenting the Nursing Process

• Methods (contd)
• PIO
• Problem
• Intervention
• Outcome
• CBE
• Charting by exception
• Focus charting

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Documenting the Nursing Process

• Methods (contd)
• DAR
• Data
• Action
• Response/revision
• PIE
• Problem
• Intervention
• Evaluation