Chapter 15 (Critical Thinking)

Identify the 2 components of "Knowing the Patient"

1) A nurse's understanding of a specific patient 2) A nurse's subsequent selection of interventions

5 Steps in the Nursing Process

1) Assessment 2) Diagnosis 3) Planning 4) Interventions 5) Evaluation

The scientific method

1) Identify Problem 2) Collect Data 3) Form Research Question 4) Test Question 5) Evaluate Results

Ways the nurse can better manage stress

1) Learn to recognize when you are feeling stressed 2) Take a time out 3) Discuss the difficult and stressful patient care experiences you are having 4) Participate in opportunities to make decisions 5) Attend a stress management class

Concepts and Behaviors of a Critical Thinker

1) Seek the true meaning of a situation 2) Be tolerant of different views and one's own prejudices 3) Anticipate possible results or consequences 4) Be organized 5) Trust in your own reasoning processes 6) Be eager to acquire new knowledge and value learning 7) Reflect on your own judgements

5 Components of Critical Thinking

1) Specific Knowledge Base 2) Experience 3) Competencies 4) Attitudes 5) Standards

Tips suggested to foster knowing your patient

1) Spend more time during initial patient assessment to observe behavior and measure physical findings 2) Listen to their accounts of their experiences with illness 3) Consistently check on patients to assess and monitor problems 4) Ask to have the patient assigned to you over consecutive days 5) Social Conversation and continuity

Tips on how to use reflection

1) Stop and think about what is going on with your patient 2) Reflect carefully on critical incidents 3) Think about your feelings and the painful experiences you sometimes have 4) Take time to reflect at the end of the day 5) Keep all written care plans or clinical notes for future resources 6) Keep a personal journal

Which action should the nurse take to best develop critical thinking skills?

Actively participate in clinical experiences.

A nurse enters a room to find the patient sitting up in bed crying. How will the nurse display a critical thinking attitude in this situation?

Ask the patient about the crying? A clinical sign or symptom (crying) often indicates a variety of problems. Explore and learn more about the patient to make appropriate clinical judgements.

A nurse is pulled from the surgical unit to work on the oncology unit. Which action by the nurse displays humility and responsibility?

Asking for an orientation to the unit. Humility and responsibility are displayed when the nurse realizes lack of knowledge and requests an orientation to the unit.

Which patient scenario of a surgical patient in pain is most indicative of critical thinking?

Asking the patient what pain-relief methods, pharmacological and non-pharmacological have worked in the past

Gathering, verifying and communicating data about the patient to establish a database is an example of which component of the nursing process?

Assessment

Perseverance

Be cautious of an easy answer; look for pattern and find a solution

Analysis

Be open-minded as you look at info. Do not make careless assumptions.

Risk Taking

Be willing to recommend alternative approaches to nursing care

Clinical Decision Making

Careful reasoning so the best options are chosen for the best outcomes

Intellectual Standards

Clear, precise, specific, accurate, relevant, plausible, consistent, logical, broad, significant, adequate and fair

A nursing instructor needs to evaluate students' abilities to synthesize data and identify relationships between nursing diagnoses. Which learning assignment is best suited for this instructors needs?

Concept Mapping

Attitudes for a critical thinker

Confidence, thinking independently, fairness, responsibility/accountability, risk taking, discipline, perseverance, creativity, curiosity, integrity, humility

Diagnostic Reasoning

Determining a patient's health status after you have assigned meaning to the behaviors and symptoms resented Determining a patient's health problems and selecting proper therapies

Integrity

Do not compromise nursing standards or honesty in delivering nursing care

Clinical Decision Making requires the nurse to

Establish and weigh criteria in deciding the best choice of therapy for a patient

Professional Standards

Ethical criteria, criteria for evaluation, professional responsibility

Curiosity

Explore and learn more about a patient to make appropriate clinical judgements

Nursing Process

Five-step clinical decision-making approach

Decision Making

Focuses on problem resolution

The patient appears to be in no apparent distress but NAP recorded an extremely low pulse. Nurse auscultates an apical pulse and asks patient whether there is any history of heart problems. The nurse is utilizing which critical thinking skill?

Interpretation Involves being orderly in data collection, looking for patterns to categorize data, and clarifying uncertain data.

Interpretation

Involves being orderly in data collection, looking for patterns to categorize data, and clarifying uncertain data.

Commitment Critical Thinking

Learners anticipate the needs to make choices without assistance from others and accept accountability

Complex Critical Thinking

Learners begin to separate themselves from experts and analyze and examine choices more independently

Fairness

Listen to both sides in any discussion

Evaluation

Look at all situation objectively. Determining the effectiveness of interventions or care provided

Creativity

Look for different approaches if interventions are not working

Problem Solving

Obtain information and then use the info plus what you already know to find a solution

Critical Thinking Involves

Open-mindedness, continual inquiry and perseverance, combined with willingness to look at each unique patient situation and determine which identified assumptions are true and relevant

Inference

Process of drawing conclusions from related pieces of evidence

Thinking Independently

Read the nursing literature

Humility

Recognize when you need more information to make a decision

Responsibility

Refer to policy and procedure manual to review steps of a skill

Confidence

Speak with conviction and always be prepared to perform care safely

Scientific Method

Systematic, ordered approach to gathering data and solving problems

Discipline

Take time to be through and manage your time effectively

Basic Critical Thinking

The learner trusts that experts have the right answers for every problem; thinking is concrete and based on a set of rules

Reflective Journaling

The process of purposefully thinking back or recalling a situation to discover its purpose or meaning

Reflection

Turning over a subject in the mind and thinking about it seriously. Involves purposeful thinking back on a situation to discover meaning

Concept Mapping

a visual representation of patient problems and interventions that shows their relationships to one another. Challenges students to synthesize data and identify relationships between nursing diagnoses.

Evidence-based Knowledge

knowledge based on research or clinical experience

Self-regulation

reflecting on experiences

Explanation

supporting findings and conclusions