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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.

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Chapter 1

Chapter 1

Critical Thinking and the Nursing Process

Copyright 2002, Delmar, A division of Thomson Learning


Competencies
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.

Copyright 2002, Delmar, A division of Thomson Learning


Art of nursing
Art of Nursing

  • Incorporate aspects of caring and sharing into practice.

  • Role of intuition, “intuitive links”

Copyright 2002, Delmar, A division of Thomson Learning


Science of nursing
Science of Nursing

  • Analytical thinking

  • Based on scientific principles and research data

  • Reflective thinking: art and science

Copyright 2002, Delmar, A division of Thomson Learning


Critical thinking
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

Copyright 2002, Delmar, A division of Thomson Learning


Clinical reasoning
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)

Copyright 2002, Delmar, A division of Thomson Learning


Clinical reasoning1
Clinical Reasoning

  • Key elements (Paul & Elder, 2000)

  • Purposeful

  • Problem-solving strategy

  • Based on assumptions

(continues)

Copyright 2002, Delmar, A division of Thomson Learning


Clinical reasoning2
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

Copyright 2002, Delmar, A division of Thomson Learning


Components of critical thinking
Components of Critical Thinking

  • Interpretation

  • Analysis

  • Inference

  • Explanation

  • Evaluation

  • Self-regulation

Copyright 2002, Delmar, A division of Thomson Learning


Interpretation
Interpretation

  • Decode hidden messages

  • Clarify the meaning of information

  • Categorize information

Copyright 2002, Delmar, A division of Thomson Learning


Analysis
Analysis

  • Examines ideas and data

  • Identifies discrepancies

  • Reflects on reasons for discrepancies

Copyright 2002, Delmar, A division of Thomson Learning


Inference
Inference

  • Speculates

  • Derives

  • Reasons

  • Skill developed with experience

Copyright 2002, Delmar, A division of Thomson Learning


Explanation
Explanation

  • Requires that conclusions drawn from inferences are correct and can be justified

  • Scientific and nursing literature serve as basis for clinical justification

Copyright 2002, Delmar, A division of Thomson Learning


Evaluation
Evaluation

  • Examines the validity of the information

  • Leads to final conclusion that can be implemented

Copyright 2002, Delmar, A division of Thomson Learning


Self regulation
Self-Regulation

  • Reflects on critical thinking skills and determines what techniques were effective and which were problematic

Copyright 2002, Delmar, A division of Thomson Learning


Universal intellectual standards for critical thinking
Universal Intellectual Standards for Critical Thinking

  • Clarity

  • Accuracy

  • Precision

  • Depth

  • Breadth

  • Logic, applied to clinical reasoning

Copyright 2002, Delmar, A division of Thomson Learning


Nursing process
Nursing Process

  • Assessment

  • Diagnosis

  • Planning

  • Outcome identification

  • Implementation

  • Evaluation

Copyright 2002, Delmar, A division of Thomson Learning


Assessment
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

Copyright 2002, Delmar, A division of Thomson Learning


Health history
Health History

  • Gathers subjective data from the patient

  • Information may or may not be validated by physical assessment findings

(continues)

Copyright 2002, Delmar, A division of Thomson Learning


Health history1
Health History

  • Possible sources of information

    • Patient

    • Family

    • Neighbors

    • Friends

    • Bystanders

    • Old charts

    • Medical records

Copyright 2002, Delmar, A division of Thomson Learning


Physical assessment
Physical Assessment

  • Objective data

  • Observable, measurable data

  • Possible approaches—body systems, head to toe, or functional health patterns

Copyright 2002, Delmar, A division of Thomson Learning


Diagnostic and laboratory data
Diagnostic and Laboratory Data

  • Objective data

  • May include items such as: blood and urine studies, cultures, X rays, and diagnostic procedures

Copyright 2002, Delmar, A division of Thomson Learning


Diagnosis
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

Copyright 2002, Delmar, A division of Thomson Learning


Collaborative problem
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

Copyright 2002, Delmar, A division of Thomson Learning


Planning
Planning

  • Third step in nursing process

  • Prioritization of nursing diagnoses

  • Framework to assist prioritization

    • Maslow’s hierarchy of needs

Copyright 2002, Delmar, A division of Thomson Learning


Outcome identification
Outcome Identification

  • Fourth step in the nursing process

  • Establish patient goals

  • Develop patient outcomes

    • Short-term

    • Long-term

Copyright 2002, Delmar, A division of Thomson Learning


Intervention selection
Intervention Selection

  • Independent nursing interventions

  • Collaborative interventions

Copyright 2002, Delmar, A division of Thomson Learning


Implementation
Implementation

  • Fifth step in nursing process

  • Nurse executes the interventions that were devised during the planning stage

  • Dynamic process

Copyright 2002, Delmar, A division of Thomson Learning


Evaluation1
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

Copyright 2002, Delmar, A division of Thomson Learning


Critical pathways
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

Copyright 2002, Delmar, A division of Thomson Learning


Documenting the nursing process
Documenting the Nursing Process

  • Methods

    • SOAPIER

      • Subjective

      • Objective

      • Assessment

      • Plan

      • Implementation

      • Evaluation

      • Revision

(continues)

Copyright 2002, Delmar, A division of Thomson Learning


Documenting the nursing process1
Documenting the Nursing Process

  • PIO

    • Problem

    • Intervention

    • Outcome

(continues)

Copyright 2002, Delmar, A division of Thomson Learning


Documenting the nursing process2
Documenting the Nursing Process

  • DAR

    • Data

    • Action

    • Response

  • PIE

    • Problem

    • Intervention

    • Evaluation

(continues)

Copyright 2002, Delmar, A division of Thomson Learning


Documenting the nursing process3
Documenting the Nursing Process

  • CBE

    • Charting by exception

  • Focus

    • Specific to client’s primary diagnosis

Copyright 2002, Delmar, A division of Thomson Learning


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