Critical Thinking in Nursing Practice, Nursing Assessment

CRITICAL THINKING Critical thinking is an active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others Recognize that an issue exists Analyzing information about the issue Evaluating information Making conclusions

Critical Thinking Requires… Cognitive skills Ask questions Remain well-informed Be honest in facing personal biases Be willing to reconsider and think clearly about issues

So why learn about critical thinking? Nurses need to make critical decisions all the time Nurses are the ones with the patients all day and night, unlike doctors who usually only spend a few minutes with patients (sometimes from the doorway) Nurses are the ones who are most likely to pick up on slight changes in patient conditions and then decide what to do… Who to call?Call the doctor? Watch & wait?What to do first?

Critical thinking Successful organizations are staffed by people who think, not just follow orders The biggest threat to critical thinking is just focusing on tasks to be done or “putting out fires” and not thinking about what you are doing and why

Critical thinking & assessment Data collection is not an end in itself- it isn’t done just to get the forms filled out and assignments completed Assessments are done so that the findings can be analyzed and problems can be identified

Autonomy Patients have the right to self-determination That means that they have the right to decide for themselves about their health and treatment options Patients have the right to refuse treatment or medication even if they may die without it If the patient is a minor, parents are expected to make these decisions If an adult patient is unable to make decisions for himself, decisions are made by the family members or a court- appointed legal guardian

Delegation RNs may delegate tasks to other members of the health care team Licensed practical nurses (LPNs) Nursing assistants (NAs) Do not delegate tasks that require nursing assessment or judgment Formulating nursing diagnoses Notifying doctors of changes in a patient’s condition Changing plan of care for a patient Advanced nursing procedures & interventions

Delegation So what might you delegate? Bed baths and bedpans Changing incontinent patients Feeding patients Taking vital signs Walking patients in the hall Getting patient up in the chair Making beds Bringing ice water to patients

But there’s a catch… You have to use your nursing judgment to know if a particular tasks should be delegated! For instance… Your elderly patient just had a stroke and has difficulty swallowing. Since there is a good chance that the patient might choke on his food, it would not be a good idea to have the nursing assistant feed this patient If your patient is very unstable (going into shock, perhaps!) you would want to take the vital signs yourself to make sure that they are accurate

Nursing Process (ADPIE) Assessment Nursing Diagnosis Planning Implementation/Intervention Evaluation

Assessment The deliberate and systematic collection of data to determine a client’s current and past health status and functional status and to determine the client’s present and past coping patterns. Collection and verification of data Primary source = patient Secondary source = family, medical record Analysis of data

Data Collection Subjective Patient states Objective Observations or Measurements Vitals Inspection of a wound

Assessment Data Subjective Data Objective Data Sources of Data Methods of Data Collection- Interview Interview initiates nurse-client relationship Use open-ended questions Nursing health history

Methods of Data Collection Interview Helps clients relate their own interpretation and understanding of their condition Three phases Orientation Begin a relationship Understand client’s primary needs Working Gather information about the client’s health status Termination

Types of Interventions Nurse-Initiated Physician-Initiated Collaborative Interventions

Nursing Care Plans vs Concept Maps NCPConcept/Mind Map