1. CLINICAL DECISION MAKING & THE NURSING PROCESS
NRS 110

2. Critical Thinking Revisited
Knowledge
Experience
Reflection
Intuition

3. Components of Critical Thinking in Nursing
Specific Knowledge Base
Experience
Critical Thinking Competencies
Diagnostic Reasoning
Clinical Decision Making
Nursing Process
Critical Thinking Attitudes
Critical Thinking Standards
Intellectual Standards
Professional Standards

4. Clinical Decision Making
Critical thinking process for choosing the best actions to meet a desired goal
To act or not to act, that is the question!
Criteria used to make decisions
Collaboration
Problem Identification
Who is responsible for making the decision?

6. Level of Critical Thinking
Basic
Complex
Commitment

7. NURSING PROCESS Assessment Diagnosis Planning Implementation
Evaluation

8. The nursing process in action

9. Step One: Assessment
Collect data (Types of data, Sources of data, Methods of data collection)
Organize data
Validate the data
Record & report

13. Step 2: Diagnosis
Analysis of assessment data leads to problem identification
NANDA list
Types of nursing dx.

14. Anatomy of a Nursing Diagnosis
Problem (Diagnostic label)
Etiology (Related factors and Risk factors)
Defining Characteristics
Differentiating Nursing Diagnoses from Medical Diagnoses
Differentiating Nursing Diagnoses from Collaborative Problems

17. The Diagnostic Process
Analyzing data: Compare data against standards, cluster data, identify gaps and inconsistencies in data
Identify health problems, determine problems and risks, determine strengths

18. Formulating Diagnostic Statements

21. Step 3: Planning Set priorities Apply standards
Identify goals & outcomes
Select interventions
Record the plan (nursing care plan)

22. What are the priorities?

23. Maslow’s Hierarchy of Basic Human Needs

27. Guidelines for Writing Goal Statements
Write goals in terms of client responses
Be sure the desired outcomes are realistic and compatible with ordered therapies
Make sure that each goal is derived from only one nursing diagnosis
Use observable, measurable terms for outcomes
Involve the client in the process

28. CONCEPT MAP Ineffective Airway Clearance (Gas Exchange)

29. Step 4: Implementation Put your plan into action
Perform the interventions
Note patient response to interventions
Record & report

30. Types of Interventions
Independent (nurse initiated)
Dependent (physician initiated)
Collaborative

31. Step 5: Evaluation Did the plan work? Was goal achieved?
What was the outcome of the care provided.
Stated in measurable terms.
It’s all about outcomes!

33. Case Scenario
A.A. is an 28 y.o. female who was admitted with pneumonia. She presents with complaint of cold x 2 weeks, dyspnea on exertion, , orthopnea, decreased oral intake. Assessment of patient reveals:
T 103F, P 92, R 22 shallow, BP 122/80
Dry mucous membranes, hot pale skin
Decreased breath sounds, inspiratory crackles
Ineffective cough-coughing up thick pink sputum
Lethargic, c/o being weak

34. Now lets write the plan down!

35. Concept Map Steps Place your main issue/problem in the middle
Determine key problems/concepts that have a direct relationship to the main problem
Add clinical data to appropriate problem boxes
Draw lines between related problems. Label with a nursing diagnosis
Identify goals/outcomes
Add interventions
Evaluate patient response to interventions

36. CONCEPT MAP Ineffective Airway Clearance (Gas Exchange)