Chapter 1

1. Copyright 2002, Delmar, A division of Thomson Learning

2. Chapter 1 Critical Thinking and the Nursing Process Copyright 2002, Delmar, A division of Thomson Learning

3. 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

4. Art of Nursing • Incorporate aspects of caring and sharing into practice. • Role of intuition, “intuitive links” Copyright 2002, Delmar, A division of Thomson Learning

5. 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

6. 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

7. 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

8. Clinical Reasoning • Key elements (Paul & Elder, 2000) • Purposeful • Problem-solving strategy • Based on assumptions (continues) Copyright 2002, Delmar, A division of Thomson Learning

9. 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

10. Components of Critical Thinking • Interpretation • Analysis • Inference • Explanation • Evaluation • Self-regulation Copyright 2002, Delmar, A division of Thomson Learning

11. Interpretation • Decode hidden messages • Clarify the meaning of information • Categorize information Copyright 2002, Delmar, A division of Thomson Learning

12. Analysis • Examines ideas and data • Identifies discrepancies • Reflects on reasons for discrepancies Copyright 2002, Delmar, A division of Thomson Learning

13. Inference • Speculates • Derives • Reasons • Skill developed with experience Copyright 2002, Delmar, A division of Thomson Learning

14. 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

15. Evaluation • Examines the validity of the information • Leads to final conclusion that can be implemented Copyright 2002, Delmar, A division of Thomson Learning

16. 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

17. Universal Intellectual Standards for Critical Thinking • Clarity • Accuracy • Precision • Depth • Breadth • Logic, applied to clinical reasoning Copyright 2002, Delmar, A division of Thomson Learning

18. Nursing Process • Assessment • Diagnosis • Planning • Outcome identification • Implementation • Evaluation Copyright 2002, Delmar, A division of Thomson Learning

19. 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

20. 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

21. Health History • Possible sources of information • Patient • Family • Neighbors • Friends • Bystanders • Old charts • Medical records Copyright 2002, Delmar, A division of Thomson Learning

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. Intervention Selection • Independent nursing interventions • Collaborative interventions Copyright 2002, Delmar, A division of Thomson Learning

29. 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

30. 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

31. 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

32. Documenting the Nursing Process • Methods • SOAPIER • Subjective • Objective • Assessment • Plan • Implementation • Evaluation • Revision (continues) Copyright 2002, Delmar, A division of Thomson Learning

33. Documenting the Nursing Process • PIO • Problem • Intervention • Outcome (continues) Copyright 2002, Delmar, A division of Thomson Learning

34. Documenting the Nursing Process • DAR • Data • Action • Response • PIE • Problem • Intervention • Evaluation (continues) Copyright 2002, Delmar, A division of Thomson Learning

35. Documenting the Nursing Process • CBE • Charting by exception • Focus • Specific to client’s primary diagnosis Copyright 2002, Delmar, A division of Thomson Learning