Ch. 8: Critical Thinking, the Nursing Process, and Clinical Judgment

critical thinking in nursing

- Begins with reflective thinking - Is a complex, purposeful, and disciplined process - Is undergirded by standards and ethics of nursing - Improves with practice and professional experience

questions involved in critical thinking

- What assumptions have I made about this patient? - How do I know my assumptions are accurate? - Do I need any additional information? - How might I look at this situation differently?

types of nursing diagnosis'

- actual - risk - wellness

nursing diagnosis

- diagnosis that focuses on the human responses to health and illness - diagnosis that addresses the patient's problems that the nurse can treat with in their scope of practice - diagnosis that can change daily and patients' comfort and alternate

implementation interventions

- monitoring - teaching - assessing - collaborating

what written patient goals require

- outcome criteria (measurable/observable) - time frames (short - long term)

info gathered in assessment phase

- patient info - subjective data - secondary sources - objective data

national group of classification of nursing diagnosis

- published the first list of nursing diagnosis - standardized nursing diagnosis to improve health care - aka north american nursing diagnosis association

what does a critical thinker do?

- raises questions/problems - arrives at conclusions/solutions - open minded/recognizes alternative views - communicates effectively - gather/asses relevant info

what clinical judgment requires

- recalling facts - recognizing patterns - forming a meaningful whole - knowing your limits - acting appropriately

critical thinking requires

- the ability to describe how you came to a conclusion - the ability to support your argument with explicit data and rationales

care plans

- written once interventions are selected - individualized - multidisciplinary framework of "critical paths"

5 phases of the nursing process

1. assessment 2. diagnosis 3. planning 4. implementation 5. evaluation

3 types of nursing interventions

1. independent 2. dependent 3. interdependent

5 components of nursing diagnosis (NANDA-1)

1. label 2. definition 3. defining characteristics (sings and symptoms) 4. risk factors 5. related factors

bloom's domain of learning

1. psychomotor 2. cognitive 3. affective

Critical Thinking

a process by which the thinker improves the quality of his or her thinking by taking charge of the structures inherent in thinking and imposing intellectual standards upon them

subjective data

aka symptoms : "my tummy hurts"

interventions

are written based on bloom's domains within the scope of nursing practice - "nursing practice"

affective domain

bloom's domain that involves emotions, feelings, values, and attitudes - patient will describe feeling more accepting of changes in physical appearance by discharge

cognitive domain

bloom's domain that involves knowledge and intellectual skills - patient will list 5 signs of illness in her baby by day of discharge

psychomotor domain

bloom's domain that involves physical movement - patient will move from bed to chair 3x without help

diagnostic statement

contains the problem, etiology, and signs&symptoms

objective data

data that is obtained through observations - aka signs - pulse is 84

signs and symptoms

defining characteristics of problems - "as evidence by..."

independent intervention

intervention that does not require supervision or direction by others - nurse initiated

interdependent intervention

intervention that requires a nurse to collaborate and/or consult with another health professional before carrying out the actions

dependent intervention

intervention that requires written orders or provision of another health professional

nursing process

is a method of critical thinking focused on solving patient problems in professional practice. - goal orientated - conceptual - flexible

clinical judgment

is the result of critical thinking

secondary source

observation, physical exam, diagnostic exam, and info from other health care providers

actual type of diagnosis

pain related to (r/t) fractures collarbone

wellness type

readiness for enhanced knowledge r/t diabetic diet

risk type of diagnosis

risk for impaired parenting r/t maternal history of substance abuse

nursing orders

the actions to assist the patient in achieving a stated goal

implementation

the actual carrying out of orders - aimed at individuals, families, and/or community

gain extensive direct patient care contact

the best means for developing expert clinical judgment

planning phase

the phase in the nursing process where the nurse and patient make goals of what is to be accomplished - derived from diagnosis - outcome criteria ID'd - time frames established (short - long term)

assessment phase

the phase of the nursing process that gathers info

diagnosis phase

the phase of the nursing process that is the analysis and ID of patient's problems and where data collected in validated

evaluation phase

the phase of the nursing process when the nurse measures the progress of patient against the goals and outcome criteria to determine whether the problem is resolved, in the process of being resolved, or unresolved - ID changes that need to be made

imperial knowledge and expertise

what informed opinions and decisions are based on in clinical judgment

etiology

what is causing or contributing to the patients' problems - "related to..."