Nur102

nurses use critical thinking as they...

apply knowledge from other subjects and fields to nursing practice, deal with change in stressful environments, and make important decisions related to client care

what is critical reasoning

applying critical thinking ex: clustering clues to solve a problem

A nurse preparing a teaching plan for a client recently diagnosed with type 2 diabetes mellitus identifies which action as the first step in this process?

assess the clients learning needs

Which step of the nursing process is being performed when a nurse obtains a health history, vital signs, and auscultates the abdomen of a client admitted with a possible bowel obstruction?

assessment

confidence

assurance of one's reasoning abilities

A client reports severe abdominal pain. Which is the best question the nurse should ask to obtain more information about the pain?

can you please describe the pain?

flexibility

capacity to adapt, accommodate, modify, or change thoughts, ideas, and behaviors

transforming knowledge

changing or converting the condition, nature, form, or function of concepts among contexts

This statement appears on a client's care plan: "The client will ambulate in the hall without assistance within 4 days." This statement is an example of which component of the nursing process?

client outcome

leading question

closed, used in a directive interview. guides the client's answer. ex: you're nervous about the surgery, aren't you?

skills necessary for implementation

cognitive (like critical thinking) interpersonal technical (hands on)

What is the primary goal of the Assessment phase of the nursing process?

collect data

nursing audits

collecting information from nursing reports and other documented evidence about patient care and assessing the quality of care by the use of quality assurance programs.

hierarchical maps

concept and attributes arranged in a hierarchical pattern and typically constructed in a descending order of importance. Relationships are identified between and among a concept and its attributes

affective components of critical thinking

confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, reflection

reflection

contemplation upon a subject, especially one's assumptions and thinking for the purposes of deeper understanding and self-evaluation

A nurse questions the practice of administering rectal suppositories to residents in a long-term care facility at bedtime, rather than earlier in the day. When told that this is the best time for staff and that's the routine that has been practiced for a long time, the nurse continues to research whether there would be a better time, especially in the best interest of the residents. Which critical thinking attitude is this nurse demonstrating?

curiosity

spider maps

depict the interrelatedness of the concept and its attributes in the map

concept maps can be used to...

develop analytical skills and to improve nurses' critical thinking, clinical decision making, and performance.

evaluation process

did the intervention work or do new goals need to be set?

logic reasoning

drawing inferences or conclusions that are supported in or justified by evidence

Which is an independent nursing intervention?

elevating an edematous leg

perseverance

pursuit of a course with determination to overcome obstacles

discriminating

recognizing differences and similarities among things or situations and distinguishing carefully as to category or rank

guidelines for writing nursing care plans

-date and sign the plan -use category headings -use approved medical symbols/words -be specific -refer to procedure books rather than including all the steps on a written plan -make it unique to the patient, not standardized -include both restorative and preventative aspects -ongoing assessments -collaboration activities -plans for discharge and home care

components of evaluating

-deciding whether hypotheses are correct -making criterion-based evaluations

how do you develop your critical thinking?

-develop a critical thinking character -take responsibility and seek out learning experiences -gain interpersonal skills -practice related technical skills

components of diagnosing

-finding patterns and relationships among cues -making inferences -suspending judgement when lacking data -stating the problem -examining assumptions -identifying factors contributing to the problem

components of planning

-forming valid generalizations -transferring knowledge from one situation to another -developing evaluative criteria -hypothesizing -making interdisciplinary connections -prioritizing client problems -generalizing principles from other sciences

"thinking like a nurse"

-introduced by Dr.Christine Tanner in 2006 -critical thinking v clinical reasoning

components of assessing

-observing -distinguishing between important and unimportant data -validating data -organizing data -recognizing assumptions -identifying gaps in data

interviewing techniques

-use language the patient can understand -avoid using personal feelings -accept brief silence so the patient can gather thoughts -be aware of nonverbal communication like body language -ask only one question at a time and ask in a logical sequence -eye contact at a good level and angle -acknowledge patients right to view things how they view them

steps of the nursing process

1. Assessment 2. Diagnosis 3. Planning 4. Implementation 5. Evaluation

Maslow's Hierarchy of Needs

(level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization

types of data

-Subjective data- Patients' verbal descriptions of their health problems. Includes feelings, perceptions, and self-report of symptoms.Once a patient provides subjective data, explore findings further by collecting objective data. -Objective data- Observations or measurements of a patient's health status. Be clear, precise and consistent.

types of nursing diagnoses

-actual -health promotion -risk -syndrome (cluster)

components of implementing

-applying knowledge to perform interventions -testing hypotheses

Which client statement is an example of objective data?

"I feel very warm"

Gordon's Typology of 11 Functional Health Patterns

1. Health Perception-Health Management: -describes client's perceived pattern of health & well being & how health is managed 2. Nutritional-Metabolic: -describes client's pattern of food & fluid consumption relative to metabolic need & pattern indicators of local nutrient supply 3. Elimination: -describes patterns of excretory function -(bowel, bladder, & skin) 4. Activity-Exercise: -describes pattern of exercise, activity, leisure, & recreation 5. Sleep: -describes patterns of sleep & relaxation 6. Cognitive-Perceptual: -describes sensory perceptual & cognitive patterns 7. Self Perception-Self Concept: -describes client's self concept pattern & perceptions of self -(worth, body image, feeling state) 8. Role-Relationship: -describes client's pattern of role participation & relationships 9. Sexuality-Reproductive: -describes client's patterns of satisfaction & dissatisfaction with sexuality pattern -describes reproductive patterns 10. Coping-Stress Tolerance: -describes client's general coping pattern & effectiveness of pattern in terms of stress tolerance 11. Value-Belief: -describes pattern of values, beliefs, & goals that guide client's choices or decisions

inquisitiveness

An eagerness to know by seeking knowledge and understanding through observation and thoughtful questioning in order to explore possibilities and alternatives

ADPIE

Assessment Diagnosis Planning Implementation Evaluation

Which is the best example of a correctly written client outcome/ goal?

Client will walk from his room to the end of the hall and back before discharge.

contextual perspective

Considerate of the whole situation including relationships, background and environment, and relevant to some happening

critical thinking (NLN)

Critical thinking in nursing practice is a discipline specific, reflective reasoning process that guides a nurse in generating, implementing, and evaluating approaches for dealing with client care and professional concerns

critical thinking (Berman)

Critical thinking is the process of intentional higher level thinking to define a client's problem, examine the evidence-based practice in caring for the client, and make the choices in the delivery of care

information seeking

Searching for evidence, facts, or knowledge by identifying relevant sources and gathering objective, subjective, historical, and current data from those sources

intellectual integrity

Seeking the truth through sincere, honest processes, even if the results are contrary to one's assumptions and beliefs

directive interview

a highly structured interview that uses closed questions to elicit specific information

Quality Improvement

a process of continuous self-review with the purpose of identifying and correcting aspects of the system that require improvement ex: how can we prevent more cases of skin breakdown? mobility order in place, movement each day, etc.

a care plan goal must have

a time frame and be measurable

open-mindedness

a viewpoint characterized by being receptive to divergent views and sensitive to one's biases

cognitive components of critical thinking

analyzing, applying standards, discriminating, information seeking, logic reasoning, predicting, transforming knowledge

predicting

envisioning a plan and its consequences

The nurse determines goal achievement during which step of the nursing process?

evaluation

Which phase of the nursing process is being used when a nurse concludes that a client's vital signs are abnormal?

evaluation

Which step of the nursing process is the nurse using when asking a client if the client's pain has been relieved after administration of pain medication?

evaluation

quality assurance

focuses on the performance of workers, urging employees to strive for "zero defects" ex: not every surg patient needs a foley catheter, so only use them on prolonged surgeries to lessen the number of infections, etc.

What should a nurse do next after collecting data about a client?

formulate a nursing diagnosis

Which step of the nursing process is a nurse using when teaching a patient to use visualization to cope with chronic pain?

implementation

What is the defining characteristic in the nursing diagnosis "Constipation related to insufficient fluid intake secondary to NPO status and abdominal surgery manifested by increased abdominal pressure"?

increased abdominal pressure

Attitudes that foster critical thinking

independence fair-mindedness insight into egocentricity intellectual humility intellectual courage to challenge the status quo/ rituals integrity perseverance confidence curiosity

nursing-sensitive indicators (12)

indicators that are recorded and used to determine whether national standards are being met ex: how many falls this year? are the right preventable measures in place?

A client who has received general anesthesia returns from surgery. Which nursing diagnosis is highest priority for this client?

ineffective airway clearance related to decreased level of consciousness

Which statement is a complete and correct 2-part nursing diagnosis statement?

ineffective airway clearance related to mucus plugs and nonproductive cough

types of nursing interventions

initial, ongoing, discharge

systems maps

inputs and outputs illustrate relationships among the concept and its attributes

intuition

insightful sense of knowing without conscious use of reason

creativity

intellectual inventiveness used to generate, discover, or restructure ideas; imagining alternatives

Which assessment technique should be used to collect subjective data from a client?

interviewing

open-ended questions

invite clients to discover and elaborate on their feelings

Which is an example of objective data?

irregular radial pulse of 50 bpm

applying standards

judging according to established personal, professional, or social rules or criteria

flowchart maps

linear diagrams demonstrating sequence or cause and effect relations

dependent nursing interventions

medications, iv fluids, dressing changes

Non-directive interview (rapport interview)

nurse allows the client to control the purpose, subject matter, and pacing.

neutral question

opened and used in non-directive interviews. ex:how do you feel about that?

components of nursing diagnoses

problem and definition, etiology, defining characteristics

closed questions

restrictive question requiring only a short answer (often yes or no)

During the planning step of the nursing process, the nurse:

selects interventions

analyzing

separating or breaking a whole into parts to discover their nature, function, and relationships

independent nursing interventions

sitting patient up, massages, breathing exercises, oral fluids, therapeutic communication, education, coping mechanisms

both independent and dependent nursing interventions will be included in the care plan

true

what exactly is the nursing process?

• A continuous and overlapping process. • Systematic, rational method of planning and providing nursing care. • Client centered. • Differentiates nurses from other health care providers. • Interpersonal and collaborative. • Requires critical thinking skills • What nurses do!

Sources of data collection

• Client • Support people • Client records • Health care professionals • Literature • gathering cues

techniques for critical thinking

• Critical Analysis • Socratic questioning • Inductive reasoning • Deductive reasoning

types of assessments

• Initial • Problem-focused • Emergency • Time-lapsed reassessment

methods of data collection

• Observing - Use the senses: vision, smell, hearing, touch. • Interviewing - Closed questions, Open-ended questions, Setting: time, place, seating arrangement, distance, language, Stages: opening, body, closing • Examining: head to toe assessment

components of clinical reasoning

• Setting Priorities • Developing Rationales • Learn to Act • Reasoning-in-transition • Responding to changes in client's condition. • Reflection

how do nurses incorporate creativity?

• generate many ideas rapidly • flexible and natural; able to change viewpoints • create original solutions to problems • be independent and self-confident • demonstrate individuality