Copyright 2002, Delmar, A division of Thomson Learning

Chapter 1 Critical Thinking and the Nursing Process

Copyright 2002, Delmar, A division of Thomson Learning 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. Define the nursing process. Describe the six steps of the nursing process.

Copyright 2002, Delmar, A division of Thomson Learning Art of Nursing Incorporate aspects of caring and sharing into practice. Role of intuition, “intuitive links”

Copyright 2002, Delmar, A division of Thomson Learning Science of Nursing Analytical thinking Based on scientific principles and research data Reflective thinking: art and science

Copyright 2002, Delmar, A division of Thomson Learning Critical Thinking Purposeful, goal-directed thinking process that strives to problem solve patient care issues through the use of clinical reasoning Combines logic, intuition, and creativity Essential to nursing practice

Copyright 2002, Delmar, A division of Thomson Learning Clinical Reasoning Disciplined, creative, and reflective approach Used concurrently with critical thinking Purpose—establish potential strategies for patients to reach their desired health goal Essential to nursing practice (continues)

Copyright 2002, Delmar, A division of Thomson Learning Clinical Reasoning Key elements (Paul & Elder, 2000) Purposeful Problem-solving strategy Based on assumptions (continues)

Copyright 2002, Delmar, A division of Thomson Learning 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

Copyright 2002, Delmar, A division of Thomson Learning Components of Critical Thinking Interpretation Analysis Inference Explanation Evaluation Self-regulation

Copyright 2002, Delmar, A division of Thomson Learning Interpretation Decode hidden messages Clarify the meaning of information Categorize information

Copyright 2002, Delmar, A division of Thomson Learning Analysis Examines ideas and data Identifies discrepancies Reflects on reasons for discrepancies

Copyright 2002, Delmar, A division of Thomson Learning Inference Speculates Derives Reasons Skill developed with experience

Copyright 2002, Delmar, A division of Thomson Learning Explanation Requires that conclusions drawn from inferences are correct and can be justified Scientific and nursing literature serve as basis for clinical justification

Copyright 2002, Delmar, A division of Thomson Learning Evaluation Examines the validity of the information Leads to final conclusion that can be implemented

Copyright 2002, Delmar, A division of Thomson Learning Self-Regulation Reflects on critical thinking skills and determines what techniques were effective and which were problematic

Copyright 2002, Delmar, A division of Thomson Learning Universal Intellectual Standards for Critical Thinking Clarity Accuracy Precision Depth Breadth Logic, applied to clinical reasoning

Copyright 2002, Delmar, A division of Thomson Learning Nursing Process Assessment Diagnosis Planning Outcome identification Implementation Evaluation

Copyright 2002, Delmar, A division of Thomson Learning Assessment First step in nursing process Purpose  Identifies the patient’s current health status  Actual and potential health problems  Areas for health promotion Sources of information  Health history  Physical assessment  Diagnostic and laboratory data Dynamic phase

Copyright 2002, Delmar, A division of Thomson Learning Health History Gathers subjective data from the patient Information may or may not be validated by physical assessment findings (continues)

Copyright 2002, Delmar, A division of Thomson Learning Health History Possible sources of information  Patient  Family  Neighbors  Friends  Bystanders  Old charts  Medical records

Copyright 2002, Delmar, A division of Thomson Learning Physical Assessment Objective data Observable, measurable data Possible approaches—body systems, head to toe, or functional health patterns

Copyright 2002, Delmar, A division of Thomson Learning Diagnostic and Laboratory Data Objective data May include items such as: blood and urine studies, cultures, X rays, and diagnostic procedures

Copyright 2002, Delmar, A division of Thomson Learning Diagnosis Second step in nursing process Describes conditions treated by nurses North American Nursing Diagnosis Association (NANDA) Provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable

Copyright 2002, Delmar, A division of Thomson Learning Collaborative Problem Requires the nurse to work jointly with the physician and other members of the health care team in monitoring, planning, and implementing patient care

Copyright 2002, Delmar, A division of Thomson Learning Planning Third step in nursing process Prioritization of nursing diagnoses Framework to assist prioritization  Maslow’s hierarchy of needs

Copyright 2002, Delmar, A division of Thomson Learning Outcome Identification Fourth step in the nursing process Establish patient goals Develop patient outcomes  Short-term  Long-term

Copyright 2002, Delmar, A division of Thomson Learning Intervention Selection Independent nursing interventions Collaborative interventions

Copyright 2002, Delmar, A division of Thomson Learning Implementation Fifth step in nursing process Nurse executes the interventions that were devised during the planning stage Dynamic process

Copyright 2002, Delmar, A division of Thomson Learning Evaluation Sixth step in nursing process Determine patient’s progress in achieving outcomes Continual and dynamic process Evaluate each outcome separately Document if outcome achieved or not achieved May result in revising the plan of care

Copyright 2002, Delmar, A division of Thomson Learning Critical Pathways Show the outcome of predetermined patient goals over a period of time State what activity the patient should be capable of completing on a daily basis Critical incidents Variance

Copyright 2002, Delmar, A division of Thomson Learning Documenting the Nursing Process Methods  SOAPIER  Subjective  Objective  Assessment  Plan  Implementation  Evaluation  Revision (continues)

Copyright 2002, Delmar, A division of Thomson Learning Documenting the Nursing Process  PIO  Problem  Intervention  Outcome (continues)

Copyright 2002, Delmar, A division of Thomson Learning Documenting the Nursing Process  DAR  Data  Action  Response  PIE  Problem  Intervention  Evaluation (continues)

Copyright 2002, Delmar, A division of Thomson Learning Documenting the Nursing Process  CBE  Charting by exception  Focus  Specific to client’s primary diagnosis