Copyright 2002, Delmar, A division of Thomson Learning

Copyright 2002, Delmar, A division of Thomson Learning


Chapter 1

Critical Thinking and the Nursing Process


Competencies Describe how nursing is both an art and a

science. Discuss the components of critical

thinking. Apply the universal intellectual standards

to the critical thinking process. Define the nursing process. Describe the six steps of the nursing

process.


Art of Nursing Incorporate aspects of caring and

sharing into practice. Role of intuition, “intuitive links”


Science of Nursing

Analytical thinking Based on scientific principles and

research data Reflective thinking: art and science


Critical Thinking Purposeful, goal-directed thinking

process that strives to problem solve patient care issues through the use of clinical reasoning

Combines logic, intuition, and creativity

Essential to nursing practice


Clinical Reasoning

Disciplined, creative, and reflective approach

Used concurrently with critical thinking

Purpose—establish potential strategies for patients to reach their desired health goal

Essential to nursing practice(continues)


Clinical Reasoning

Key elements (Paul & Elder, 2000) Purposeful Problem-solving strategy Based on assumptions

(continues)


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


Components of Critical Thinking Interpretation Analysis Inference Explanation Evaluation Self-regulation


Interpretation Decode hidden messages Clarify the meaning of information Categorize information


Analysis Examines ideas and data Identifies discrepancies Reflects on reasons for

discrepancies


Inference Speculates Derives Reasons Skill developed with experience


Explanation Requires that conclusions drawn

from inferences are correct and can be justified

Scientific and nursing literature serve as basis for clinical justification


Evaluation Examines the validity of the

information Leads to final conclusion that can be

implemented


Self-Regulation Reflects on critical thinking skills

and determines what techniques were effective and which were problematic


Universal Intellectual Standards for Critical Thinking Clarity Accuracy Precision Depth Breadth Logic, applied to clinical reasoning


Nursing Process Assessment Diagnosis Planning Outcome identification Implementation Evaluation


Assessment First step in nursing process Purpose

Identifies the patient’s 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


Health History Gathers subjective data from the

patient Information may or may not be

validated by physical assessment findings

(continues)


Health History Possible sources of information

Patient Family Neighbors Friends Bystanders Old charts Medical records


Physical Assessment

Objective data Observable, measurable data Possible approaches—body

systems, head to toe, or functional health patterns


Diagnostic and Laboratory Data

Objective data May include items such as: blood

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


Diagnosis Second step in nursing process Describes conditions treated by

nurses North American Nursing Diagnosis

Association (NANDA) Provides the basis for selection of

nursing interventions to achieve outcomes for which the nurse is accountable


Collaborative Problem

Requires the nurse to work jointly with the physician and other members of the health care team in monitoring, planning, and implementing patient care


Planning Third step in nursing process Prioritization of nursing diagnoses Framework to assist prioritization

Maslow’s hierarchy of needs


Outcome Identification

Fourth step in the nursing process Establish patient goals Develop patient outcomes

Short-term Long-term


Intervention Selection

Independent nursing interventions Collaborative interventions


Implementation Fifth step in nursing process Nurse executes the interventions

that were devised during the planning stage

Dynamic process


Evaluation Sixth step in nursing process Determine patient’s progress in

achieving outcomes Continual and dynamic process Evaluate each outcome separately Document if outcome achieved or

not achieved May result in revising the plan of

care


Critical Pathways Show the outcome of predetermined

patient goals over a period of time State what activity the patient

should be capable of completing on a daily basis

Critical incidents Variance


Documenting the Nursing Process

Methods SOAPIER

Subjective Objective Assessment Plan Implementation Evaluation Revision

(continues)



PIO Problem Intervention Outcome

(continues)



DAR Data Action Response

PIE Problem Intervention Evaluation

(continues)



CBE Charting by exception

Focus Specific to client’s primary diagnosis

Documents

Copyright 2002, Delmar, A division of Thomson Learning