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..."