1. Critical Thinking and The Nursing Process
Chapter 10
Critical Thinking and The Nursing Process

2. Critical Thinking
Critical thinking is a multifaceted and complex concept “based on reason and reflection, knowledge, and instinct derived from experience.” (Catalano, 2000)
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

3. Characteristics of Critical Thinking
Creativity
Logical, rational, reflective processes
Inquisitive, cautious, truth-seeking
Systematic, mature, reflective
Intellectual humility
Independent thinking
Willingness to take risks
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

4. Characteristics of Critical Thinking
Action-oriented, goal directed
Pro-active: takes initiative, anticipatory
Expertise based on experience and knowledge
Recognizes patterns in phenomena
Blends logic and intuitive feelings
Able to work collaboratively
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

5. Development of Critical Thinking Skills
A gradual process of enhancing one’s ability to suspend judgment until the data have been collected
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

6. Strategies that Promote Development & Application of Critical Thinking
Identify goals.
Determine what knowledge is required.
Assess the margin for error.
Determine the amount of time available for decision making.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

7. Strategies that Promote Development & Application of Critical Thinking
Identify available resources.
Recognize factors that may influence decision making.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

8. Critical Thinking and Creativity
The nurse identifies unique needs of each client and develops specific interventions to meet those needs.
Creative thinkers have the intellectual courage to think something new and different.
Without creative thinking, nursing would become routine and habitual.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

9. Critical Thinking Skills
Interpretation
Analysis
Inference
Explanation
Evaluation
Self-Regulation
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10. Barriers to Creative Thinking
A major block to creativity is groupthink.
Independent thinking is a hallmark of persons who think critically and creatively.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

11. Barriers to Creative Thinking
Resistance to change, rigid mind-set, practice guided by tradition, habit, routines
Stereotypical perceptions of clients
Fear of making mistakes
Unwillingness to take risks or look for alternative strategies
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

12. Barriers to Creative Thinking
Decision making without sufficient data or supported by rationale
Failure to evaluate effectiveness of nursing actions
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

13. Critical Thinking and Problem Solving
The nurse uses the nursing process to identify and make decisions about client needs.
The nursing process is a systematic and scientifically-based process.
The process requires the use of many cognitive and psychomotor skills.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

14. Critical Thinking and Decision Making
Considering and selecting interventions to facilitate achievement of desired outcomes.
Based on reliable information and made with as much critical thought as possible.
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15. The Nursing Process
Systematic framework for providing professional, quality nursing care.
Used in every practice setting and specialty.
Derived from the scientific method of problem solving.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

16. Historical Perspective
Lydia Hall (1955) first referred to nursing as a “process.”
Yura and Walsh (1967) identified four steps in the nursing process.
Gebbie and Lavin (1974) added nursing diagnosis as a distinct step.
Standards of Practice first published (1973).
Outcome identification added to the planning phase (1991).
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

17. The Nursing Process
The nursing process is now included in the conceptual framework of all nursing curricula.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

18. Overview of the Nursing Process
A process is a series of steps or acts that leads to accomplishment of some goal or purpose.
The purpose of the nursing process is to provide individualized, holistic, effective, and efficient care to clients.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

19. Components of the Nursing Process
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20. Outcome Identification and Planning
The planning phase involves several tasks:
List of nursing diagnoses is prioritized.
Long- and short-term goals and outcomes are identified.
Specific interventions are developed.
Entire plan of care is recorded in the client’s record.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

21. Outcome Identification and Planning
Goals
Expected Outcomes
Nursing Interventions
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

22. Outcome Identification and Planning
Goals are broad statements that describe the intended change in the client’s behavior.
Goal statements refer to the problem statement.
Client-centered goals assure that nursing care is individualized.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

23. Outcome Identification and Planning
Expected outcomes are specific objectives related to the goals and are used to evaluate the nursing interventions.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

24. Outcome Identification and Planning
Nursing interventions are activities that the nurse executes for and with the client to enable accomplishment of the goals.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

25. Implementation
Performance of nursing activities planned to meet client goals.
Continued use of assessment skills, psychomotor skills, and interpersonal skills.
Critical thinking skills used to make decisions about what needs to be done.
Reporting and documentation.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

26. Evaluation
Determines if the client goals have been met, partially met, or not met.
An ongoing process in which nurses continually evaluate data in order to make informed decisions.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

27. Critical Thinking Applied in Nursing
Application of critical thinking is vital to each step of the nursing process.
Critical thinkers develop a questioning attitude.
“No action is performed without critical thinking.” (Rubenfeld & Scheffer, 1999)
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.