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Critical Thinking and Decision-making in Nursing

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  1. Critical Thinking and Decision-making in Nursing Wang Juan

  2. Objectives 【master】 1.Concept, composition and feature of critical thinking; 2.Application of critical thinking in the nursing care; 3.Definition of clinical nursing decision; 4.Types and modes of clinical nursing decision; 5.Steps of clinical nursing decision; 6.Clinical nursing decision and evidence-based nursing.

  3. 【comprehend】 1.Measure for ability of nursing critical thinking; 2.Factors influencing clinical nursing decision; 3.Strategies to develop ability of clinical nursing decision. 【understand】 Layers and standards of critical thinking.

  4. Section 1 Critical Thinking

  5. Critical thinking is a complex cognitive process • Critical analysis allows the nurse to make better decision • Why?

  6. When nurses must make decisions about client care and about the distribution of limited resources, they will be forced to use critical thinking to think and act on areas where there are neither clear answers nor standardized procedures and where conflicting forces make decisions complex.

  7. Definitions of Critical Thinking • Different conceptualization of critical thinking should be developed in relation to the different domains in which it is practiced. • The definition of critical thinking originates principally from philosophy and education.

  8. Definitions of Critical Thinking • APA: to be purposeful and self-regulatory judgment • Chaffee: to be the active, organized cognitive process • Kozier: to be a purposeful mental activity

  9. Definitions of Critical Thinking • A whole definition of critical thinking in nursing developed by Lefevre are developed as follows: (1)Entail purposeful, outcome-directed thinking; (2)Is driven by patient, family, and community needs; (3)Is based on principles of nursing process and scientific method;

  10. Definitions of Critical Thinking (4)Requires knowledge, skills and experience; (5)Is guided by professional standards and ethics codes; (6)Requires strategies that maximize human potential and compensate for problems created by human nature; (7)Is constantly reevaluating, self-correcting, and striving to improve.

  11. Types of Critical Thinking Competencies • General Critical Thinking • Specific Critical Thinking in Clinical Situations • Specific Critical Thinking in Nursing

  12. General Critical Thinking • General critical thinking processes include the scientific method, problem solving, and decision making. This are not unique to nursing but are used in other disciplines and in other situations.

  13. General Critical Thinking 1、Scientific Method It is one approach to reasoning and one formal way to approach a problem, plan a solution, test the solution, and then come to a conclusion. It is a process that moves from observable facts of experience to reasonable explanations of those facts. It is an approach to verify that a set of facts agrees with reality.

  14. General Critical Thinking A nurse researcher might observe a problem that terminally ill clients in a hospice program often have difficulty in communicating their feelings to family members. Then she will use scientific method to identify the problem, find the cause, and design a study that involves formal instruction in communication skills to help family members practice and apply skills.

  15. General Critical Thinking 2、Problem Solving It is the process used when there is a gap between what is occurring and what should be occurring. It involves obtaining information and using information to reach acceptable solutions.

  16. General Critical Thinking In problem solving, the nurse obtains information that clarifies the nature of the problem and suggests possible solutions. The nurse then carefully evaluates the possible solutions, chooses the best one to implement, and then carefully monitors the situation over time to ensure its initial and continued effectiveness.

  17. General Critical Thinking 3、Decision Making In decision making, a person is faced with a problem or situation where a choice must be made as to a course of action. Decision making is an end point of critical thinking that leads to problem resolution.

  18. Specific Critical Thinking in clinical situations • Specific critical thinking competencies in clinical situations include diagnostic reasoning, clinical inferences, and clinical decision making. These competencies are widely used by physicians, social workers, nurses, and other health care professionals in deciding about the clinical care and support of clients.

  19. Specific Critical Thinking in clinical situations 1、Diagnostic Reasoning and Inferences It is a process of determining a client’s health status, which begins when a nurse receives information about a client in a particular clinical situation.

  20. Specific Critical Thinking in clinical situations • Most clients have problems for which there are no clear solutions. Nurse must learn to question, to retrieve knowledge regarding symptoms, and then to reason in a direct and precise way to determine the nature of the client’s problem.

  21. Specific Critical Thinking in clinical situations • Diagnostic reasoning enables the nurse to assign meaning to the behaviors, physical signs, and reported client symptoms. The process of diagnostic reasoning involves a series of clinical judgments made during and after data collection, resulting in an informal judgment or formal judgment. • An example of diagnostic reasoning is the formulation of a nursing diagnosis.

  22. Specific Critical Thinking in clinical situations 2、Clinical Decision Making The clinical decision making process requires thoughtful reasoning so that the best options for the client are chosen on the basis of the client’s condition and the priority of the problem.

  23. Specific Critical Thinking in Nursing • The specific critical thinking competency in nursing is the nursing process. • The nursing process incorporates general and specific critical thinking competencies in a manner that focus on a particular client’s unique needs.

  24. In fact, the three types of critical thinking competencies are often incorporated in the nursing practice situations. • A nurse may use all the critical thinking competencies, such as the scientific method and the diagnostic reasoning, with the format for the nursing process, making clinical decisions to resolve the client’s problems in one practice situation.

  25. Levels of Critical Thinking in Nursing The Basic Level The Complex Level The Commitment Level

  26. Levels of Critical Thinking in Nursing 1、The Basic Level A learner trusts that experts have the right answers for every problem. Thinking is concrete and based on a set of rules or principles.

  27. This is an early step in the development of reasoning ability, which reveals that the individual hasn’t had enough experience in critical thinking. Despite the tendency to be governed by others, a person can learn and promote his critical thinking ability by accepting the diverse opinions and values of experts.

  28. Levels of Critical Thinking in Nursing 2、The Complex Level A person begins to detach from authorities and analyze and examine alternatives more independently.

  29. A nurse realizes that alternatives, perhaps conflicting, solutions do exist, and weighs each one carefully before making a final decision. Their thinking becomes more creative and innovative. When a complex situation develops, they are willing to consider deviations from standard protocols or policies.

  30. Levels of Critical Thinking in Nursing 3、The Commitment Level The individual anticipates the need to make choices without assistance from others and then assumes accountability for them.

  31. At this level the nurses do more than just consider the complex alternatives a problem poses. They choose an action or belief based on the alternatives available and stand by it . Committed critical thinkers act in support of the client and support of the professional beliefs that underlie the discipline of nursing.

  32. Components of Critical Thinking in Nursing • Specific knowledge base • Experience • Skills • Attitudes • Standards for critical thinking

  33. 1、Specific Knowledge Base A nurse’s knowledge base includes information and theory from the basic sciences, humanities, and nursing. Broader knowledge base gives the nurse a more holistic view of clients and their health care needs.

  34. 1、Specific Knowledge Base Nurses should know that it is important to judge if the knowledge available to them is accurate, complete, and relevant at the outset of critical thinking.

  35. 2、Experience Unless a nurse has the opportunity to practice and make decisions about client care, critical thinking in clinical practice will not develop. A nurse learns from observing, sensing, talking with the client, and then reflecting actively on the experience.

  36. 2、Experience Anyway, repeated experiences in clinical settings are the only way to develop the intuitive clinical knowledge for expert decision-making skill. The ‘novice’ used only rigid rules and guidelines in making decision. Therefore, the best lesson to be learned by a new nursing student is to value all client experience.

  37. 3、Skills in Critical Thinking Cognitive skills are the core component of critical thinking. Many complex thinking processes require the use of cognitive critical- thinking skills.

  38. 3、 Skills in Critical Thinking (1)Critical Analysis Four main critical analysis questions and nine sub-questions

  39. What is the central issue? • What are the underlying assumptions? • Is the evidence given valid? • Are the conclusions acceptable?

  40. Are stereotypes or clichés used? Are emotional or biased arguments used? Are the data adequate and verifiable? Are important terms clearly defined? Are the given data relevant? Is the problem or issue correctly identified?

  41. Is the conclusion accurate? Is the conclusion applicable? Is there any value conflict?

  42. 3、 Skills in Critical Thinking (2)Inductive Reasoning and Deductive Reasoning Inductive reasoning, generalizations are formed from a set of facts or observations. Deductive reasoning, is reasoning from the general to the specific.

  43. 4、 Attitudes for Critical Thinking Attitudes are the motivation to critical thinking in nursing practice. Certain attitudes are crucial to critical thinking. Such as, confidence, independence of thought, fairness, integrity, responsibility, curiosity, risking and courage, creativity, perseverance, humility

  44. 5、 Standards for Critical Thinking • Standards for critical thinking are the criteria for determining the soundness, justness, and appropriateness of criteria decisions and judgments. • These standards conclude intellectual standards and professional standards.

  45. 5、 Standards for Critical Thinking (1)Intellectual Standards Clear, Precise, Specific, Accurate Relevant, Plausible, Consistent Logical, Deep, Broad, Complete Significant, Adequate, Fair

  46. 5、 Standards for Critical Thinking (2)Professional Standards Ethical Criteria Criteria for Evaluation Criteria for Professional Responsibility

  47. Ethical Criteria • The conscientiousness and caring that nurses display in nursing practice are often a reflection of their ethical standards. • Nurses with critical thinking should also use the seven commonly cited ethical principles, such as autonomy, beneficence, justice, fidelity, veracity, confidentiality and accountability.

  48. Criteria for Evaluation • Criteria for evaluation may be based on standards of nursing care, recognized in the professional literature or developed by related clinical agencies or professional organizations.

  49. Criteria for Evaluation • It is necessary for nurses to use the evaluation criteria to set the minimum requirements in order to ensure the quality of nursing care. • Evaluation criteria also include norms those established through research in nursing practice to be used when determining the clinical status of a client.

  50. Criteria for Professional Responsibility • The standards of professional responsibility that a nurse strives to achieve derived from four main aspects:those standards cited in nurse practice acts, national regulatory and treatment guidelines, institutional practice guidelines, and professional organizations’ standards of practice.