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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