1. Chapter 5 Critical Thinking and the Nursing Process Fundamentals of Nursing: Standards & Practices, 2E

2.  Copyright 2002 by Delmar, a division of Thomson Learning 5-2 Critical Thinking  Critical thinking is “…reasonable reflective thinking that is focused on deciding what to believe or do” (Ennis, 1987).

3.  Copyright 2002 by Delmar, a division of Thomson Learning 5-3 Components of Critical Thinking  Mental operations  Knowledge  Attitudes

4.  Copyright 2002 by Delmar, a division of Thomson Learning 5-4 Phases of Critical Thinking  Trigger event  Appraisal of the event  Exploration  Integration

5.  Copyright 2002 by Delmar, a division of Thomson Learning 5-5 Promoting 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  Identify available resources  Recognize factors that may influence decision making

6.  Copyright 2002 by Delmar, a division of Thomson Learning 5-6 Critical Thinking Skills  Interpretation  Analysis  Influence  Explanation  Evaluation  Self-regulation

7.  Copyright 2002 by Delmar, a division of Thomson Learning 5-7 Critical Thinking and Creativity  Critical thinkers are also creative thinkers.  Creative thinking is the foundation for individualizing client care.  A major block to creativity is groupthink.  It takes intellectual courage to think something different from one’s peers and then act on those thoughts.

8.  Copyright 2002 by Delmar, a division of Thomson Learning 5-8 Critical Thinking and Problem Solving  Critical thinkers avoid pitfalls of problem solving by defining a problem, analyzing the data, understanding the causes, and creating new ideas that will lead to problem resolution.

9.  Copyright 2002 by Delmar, a division of Thomson Learning 5-9 Critical Thinking and Decision Making  Nurses exercise clinical judgment by making sound decisions.  Clinical judgment is viewed as critical thinking applied in clinical situations.  Nursing judgments are formed after collecting and examining assessment data.  Nursing judgments occur in every phase of the nursing process.

10.  Copyright 2002 by Delmar, a division of Thomson Learning 5-10 Nursing Process  The nursing process “…provides the basis for critical thinking in nursing” (Alfaro-LeFavre, 1998).

11.  Copyright 2002 by Delmar, a division of Thomson Learning 5-11 Historical Perspective  Lydia Hall (1955) first referred to nursing as a “process”.  Yura and Walsh (1967) identified four steps in the nursing process: assessing, planning, implementing, and evaluating.  In 1974, Gebbin and Lavin added nursing diagnosis to the above steps.

12.  Copyright 2002 by Delmar, a division of Thomson Learning 5-12 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.

13.  Copyright 2002 by Delmar, a division of Thomson Learning 5-13 Steps in the Nursing Process  Assessment Collecting data from a variety of sources Validating the data Organizing data Categorizing or identifying patterns in data

14.  Copyright 2002 by Delmar, a division of Thomson Learning 5-14 Making initial inferences or impressions Recording or reporting data Types of data  Primary data source  Secondary data source  Subjective data  Objective data

15.  Copyright 2002 by Delmar, a division of Thomson Learning 5-15  Diagnosis Diagnosis involves analysis and synthesis of the data that have been collected. Formulation of the list of nursing diagnoses is the outcome of this process. Nursing diagnoses provide the basis for client care delivered through the remaining steps of the nursing process.

16.  Copyright 2002 by Delmar, a division of Thomson Learning 5-16 Types of nursing diagnoses  Actual nursing diagnosis  Risk nursing diagnosis  Possible nursing diagnosis  Wellness nursing diagnosis

17.  Copyright 2002 by Delmar, a division of Thomson Learning 5-17  Outcome Identification and Planning Formulate guidelines that establish the proposed course of nursing action in the resolution of nursing diagnoses Develop the client’s plan of care Planning can begin once the nursing diagnoses have been developed and client strengths have been identified.

18.  Copyright 2002 by Delmar, a division of Thomson Learning 5-18 The planning phase involves several tasks  The list of nursing diagnoses is prioritized.  Client-centered long- and short-term goals are written.  Specific interventions are developed.  The entire plan of care is recorded in the client’s record.

19.  Copyright 2002 by Delmar, a division of Thomson Learning 5-19 Goals are broad statements that describe the intended change in the client’s behavior. Expected outcomes are specific objectives related to the goals and are used to evaluate the nursing interventions. Nursing interventions are activities that the nurse will execute to enable accomplishment of the goals.

20.  Copyright 2002 by Delmar, a division of Thomson Learning 5-20  Implementation includes the execution of the nursing plan of care nursing activities that have been planned to meet the goals set with the client assessment skills, psychomotor skills, and interpersonal skills reporting and documentation

21.  Copyright 2002 by Delmar, a division of Thomson Learning 5-21  Evaluation determines if the client goals have been met, partially met, or not met is an ongoing process Nurses continually evaluate data in order to make informed decisions during other phases of the nursing process.