Chapter 10 Amoroso

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CHAPTER 10

Critical Thinking and

the Nursing Process

SUBMITTED BY:

Jhun Harald C. Amoroso

BSN II-BLK 2

SUBMITTED TO:MRS. PALTENG


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Art of Nursing Incorporate aspects of caring and

sharing into practice.

Role of intuition, intuitive links


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Science of Nursing Analytical thinking

Based on scientific principles and

research data

Reflective thinking: art and science


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Critical Thinking Purposeful, goal-directed thinking

process that strives to problem solve

patient care issues through the useof clinical reasoning

Combines logic, intuition, and

creativity Essential to nursing practice


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Clinical Reasoning Disciplined, creative, and reflective

approach

Used concurrently with criticalthinking

Purposeestablish potential

strategies for patients to reach theirdesired health goal

Essential to nursing practice(continues)


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Clinical Reasoning Key elements (Paul & Elder, 2000)

Purposeful

Problem-solving strategy

Based on assumptions

(continues)


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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


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Components of

Critical Thinking Interpretation

Analysis

Inference

Explanation

Evaluation

Self-regulation


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Interpretation Decode hidden messages

Clarify the meaning of information

Categorize information


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Analysis Examines ideas and data

Identifies discrepancies

Reflects on reasons for

discrepancies


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Inference Speculates

Derives

Reasons

Skill developed with experience


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Explanation Requires that conclusions drawn

from inferences are correct and can

be justified Scientific and nursing literature

serve as basis for clinical

justification


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Evaluation Examines the validity of the

information

Leads to final conclusion that can beimplemented


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Self-Regulation Reflects on critical thinking skills

and determines what techniques

were effective and which wereproblematic


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Universal Intellectual

Standards for CriticalThinking

Clarity Accuracy

Precision

Depth Breadth

Logic, applied to clinical reasoning


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Nursing Process Assessment

Diagnosis

Planning

Outcome identification

Implementation

Evaluation


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Assessment First step in nursing process

Purpose

Identifies the patients 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


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Health History Gathers subjective data from the

patient

Information may or may not bevalidated by physical assessment

findings

(continues)


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Health History Possible sources of information

Patient

FamilyNeighbors

Friends

Bystanders

Old charts

Medical records


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Physical Assessment Objective data

Observable, measurable data

Possible approachesbody

systems, head to toe, or functional

health patterns


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Diagnostic and

Laboratory Data Objective data

May include items such as: blood

and urine studies, cultures, X rays,and diagnostic procedures


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Collaborative Problem Requires the nurse to work

jointly with the physician and

other members of the healthcare team in monitoring,

planning, and implementing

patient care


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Planning Third step in nursing process

Prioritization of nursing diagnoses

Framework to assist prioritization

Maslows hierarchy of needs


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Outcome Identification Fourth step in the nursing process

Establish patient goals

Develop patient outcomes

Short-term

Long-term


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Intervention Selection Independent nursing interventions

Collaborative interventions


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Implementation Fifth step in nursing process

Nurse executes the interventions

that were devised during theplanning stage

Dynamic process


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Evaluation Sixth step in nursing process

Determine patients progress in

achieving outcomes Continual and dynamic process

Evaluate each outcome separately

Document if outcome achieved ornot achieved

May result in revising the plan ofcare


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Critical Pathways Show the outcome of predetermined

patient goals over a period of time

State what activity the patientshould be capable of completing on

a daily basis

Critical incidents Variance


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Documenting

the Nursing Process PIO

Problem

InterventionOutcome

(continues)


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Documenting

the Nursing Process DAR

Data

ActionResponse

PIE

Problem

Intervention

Evaluation

(continues)


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Documenting

the Nursing Process CBE

Charting by exception

FocusSpecific to clients primary diagnosis

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Chapter 10 Amoroso