NR222 Chp 15

Diagnostic reasoning

Analytical process for determining a patient's health problems and selecting proper therapies

Clinical decision making requires the nurse to:

Answer: 4. Establish and weigh criteria in deciding the best choice of therapy for a patient Rationale: Involves recognizing an issue exists, analyzing information, evaluating information, and making conclusions

Which of the following is not one of the five steps of the nursing process?

Answer: 4. Hypothesis testing Rationale: The five steps are assessment, diagnosis, planning, interventions, and evaluation

Three levels of critical thinking in nursing have been identified. Briefly describe each.

Basic: In 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 or principles. Complex: In complex critical thinking, learners begin to separate themselves from experts and analyze and examine choices more independently. Commitment: In commitment, learners anticipate the need to make choices without assistance from others and accept accountability.

Perseverance

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

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

Diagnostic reasoning

Determining a patient's health status after you have assigned meaning to the behaviors and symptoms presented

Integrity

Do not compromise nursing standards or honesty in delivering nursing care

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

Critical thinking involves:

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

Fairness

Listen to both sides in any discussion

Creativity

Look for different approaches if interventions are not working

Problem solving

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

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 appraoch to gathering data and solving problems

Discipline

Take time to be thorough, and manage your time effectively

Identify the two components of "knowing the patient."

a. A nurses understanding of a specific patients b. A nurses subsequent selection of interventions

The clinical thinking model includes five elements of critical thinking in nursing judgment; identify them and give an example:

a. Competence (problem-solving and decision-making ability): the use of the nursing process and the ability to perform nursing skills proficiently. b. Knowledge: basic nursing education, continuing education courses, additional college degrees. c. Experience is necessary to acquire clinical decision-making skills. d. Attitudes: confidence, independence, fairness, responsibility, risk-taking, discipline, perseverance, creativity, curiosity, intellectual integrity, humility. e. Standards: intellectual standards is a guideline or principle for rational thought; professional standards refer to the ethical criteria for nursing judgments and criteria for professional responsibility.

As you care for a patient, you need to reflect after the caring by asking what specific questions?

a. How did I act? b. Why did I choose such an action? c. What could I have done differently? d. Were the results what I expected? e. What should I do in a similar situation in the future?

Identify some ways the nurse may better manage stress

a. Nurses should take advantage of educationl and self-help programs for stress management b. Exercises on grieving and coping with the demands of dying pateints c. Learn assertive communciation, conflcit resolution, and problem-solving startegies

List ways that you can start developing critical thinking skills

a. Reflective journaling which helps to clarify concepts b. Meeting with colleagues to discuss and examine work experiences and validate decisions. c. Concept mapping is a visual representation of patient problems and interventions that show their relationships to one another.

List the tips suggested to foster knowing your patient

a. Spend more time during initial patient assessment to observe behavior and measure physical findings. b. Listen to their accounts of their experiences with illness. c. Consistently check on patients to assess and monitor problems. d. As to have the patient assigned to you over consecutive days. e. Social conversation and continuity.

Case Study You are removing your patient's food tray and notice that the food is still on the tray. When you assess the patient, he states he feels hungry but does not eat his food when it is served a. Using critical thinking skills, the nurse would perform what? b. What specific questions could I ask this patient to better understand the issue?

a. The Nurse needs to recognize that many assumptions (beliefs) could interfere with the patient eating; such as the food presented is not culturally appropriate. These assumptions must be clarified. The aim of critical thinking is the ability to focus on the important issues at hand( not eating his food) and make decisions that produce desired outcomes. b. Knowing the patient is central to individualizing nursing care so a patient feels cared for and cared about. Specific questions to ask: Why is the patient not eating the food that is given to him? What do I really know about this patient's dietary habits? What options do I have?

Define evidence-based knowledge:

knowledge based on research or clinical expertise

Inference

the process of drawing conclusions from related pieces of evidence and previous experience with the evidence