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Critical Thinking in The Nursing Process

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Presentation on theme: "Critical Thinking in The Nursing Process"— Presentation transcript:

1 Critical Thinking in The Nursing Process
Separating the Professional from the Technical

2 Aspects of Critical Thinking
“the active, organized, cognitive process used to examine one’s own thinking and the thinking of others” Using reflection, intuition, and previous experiences to make sound decisions Requires a habit of asking questions, remaining well informed, a willingness to reconsider, and avoiding premature decision making

3 Components of Critical Thinking
Knowledge base Theoretical Experiential Experience Practice making decisions Technical Skills & Competencies Attitudes and behaviors

4 Critical Thinking Indicators R. Alfaro-LeFevre
Self aware Genuine / authentic Effective communicator Curious & inquisitive Alert to context Analytical & insightful Logical and intuitive Confident & resilient Honest Responsible & autonomous Careful & prudent Open & fair minded Sensitive to diversity Creative Realistic and practical Reflective & self-corrective Proactive Courageous Patient & persistent Flexible Improvement oriented

5 Specific Critical Thinking in Nursing
The Nursing Process: a systematic problem solving approach consisting of; Assessment Diagnosis Planning Implementation Evaluation Nursing involves both thinking and doing Nursing deals with complex issues

6 Synthesis of Critical Thinking & Nursing Process
Brings together Critical thinking Nursing process Nursing knowledge Patient situation

7 Step 1 of Nursing Process Assessment
Types of Assessment Comprehensive Focused Special needs Initial Ongoing

8 Nursing Assessment Types of Data Sources of Data Subjective Objective
Primary data Client Secondary data Family Health Records Health Team Members

9 Nursing Assessment Methods of collection Observation
Use all 5 senses Physical assessment Interview Health history

10 Physical Assessment Performed after nursing history
Collection of objective data Ht., Wt., V.S. General Survey Head to toe exam Inspection Palpation Percussion Auscultation Olfaction

11 Nursing Health History
Biographical Data Reason for Seeking Health Care / Chief complaint Client’s Expectations History of Present Illness Past Health History Family History / social history Medications Review of body systems

12 Validating Data To ensure data is When to validate accurate Complete
Factual And you are not jumping to conclusions When to validate Subjective and objective data do not agree Patient’s statements differ at different times Data falls outside normal range

13 Organizing Data Systematic Usually controlled by agency forms
Body systems framework Maslow’s Hierarchy of Needs Gordon’s functional patterns Orem’s Self care model Roy Adaptation Model NANDA nursing diagnosis Taxonomy II

14 Data Clustering Organizing data into meaningful clusters
A set of signs or symptoms grouped together into logical order Groupings of associations Helps you recognize significant cues

15 Data Interpretation Utilizes critical thinking to
Judge the value or significance of the data Validate and verify assumptions with client and other health care team members

16 Step 2 of the Nursing Process Nursing Diagnoses
Identify patterns in data and draw conclusions about client’s status Describes client’s actual or potential response to a health problem A statement of client health that nurses can identify, prevent, or treat independently Stated in terms of unique human responses to diseases, injuries, or stressors Must be accurate because it provides direction for nursing care

17 Types of Nursing Diagnoses
Actual (3-part statement) Presently exists Risk (2-part statement) Likely to develop in vulnerable patient Possible (2 or 3- part statement) Suspect on intuition but don’t have enough data yet Syndrome (1 part statement) Collection of nursing diagnoses that occur together Wellness (1-part statement) Not a health problem, wants to move to higher level of wellness

18 Nursing Diagnosis Statement
Diagnostic Label (title or name) Approved by NANDA Related Factors Etiology must be in nurses domain to intervene Don’t use medical diagnoses Defining Characteristics Cues from assessment data must support diagnosis Eg. Impaired mobility R/T lack of peripheral sensation AEB inability to walk from bed to chair.

19 Sources of Diagnostic Error
Data collection Omitted, incomplete, inaccurate, disorganized Data analysis & interpretation Inaccurate interpretation of cues, conflicting cues, incorrect judgments of inferences Data clustering Incorrectly clustered or not clustered at all Diagnostic Statement Problem & etiology must be in scope of nursing to treat

20 Avoiding Errors in Nursing Diagnoses
Identify client’s response not medical diagnosis One symptom is insufficient for problem identification Nursing interventions directed at correcting etiology of problem Identify client response to equipment not the equipment itself Client problems not nurse problems Develop in cooperation with client

21 Medical Diagnosis vs. Nursing Diagnosis
Defines nursing needs of clients related to the medical diagnoses Medical Diagnosis Reflects specific disease, illness, or injury Goal – prescribe treatment

22 Prioritizing Problems
Place in order of importance or urgency Maslow’s Hierarchy of Human Needs Physiological Safety and security Love and belonging Self-esteem Self-actualization A,B,C’s Nursing Process

23 Step 3 of the Nursing Process Planning / Outcomes
Client centered goals / outcomes Specific measurable objective Are precise, descriptive, clearly stated Reflects highest level of wellness Should be realistic Observable client behavior Measurable criteria for each goal Projected time frame for goal achievement Provide a guide for selecting interventions Short term goals Achieve in hours or days, less than 1 week Long term goals Achieved over weeks or months

24 Properly Written Expected Outcomes
Subject The client Action verb Action that will be performed by client Performance criteria Specific measurement to be evaluated Target time When action should be achieved Special conditions Amt. of assistance, what equipment, resources needed

25 7 Guidelines for Writing Goals/Outcomes
Client centered… Singular factors/ criteria… Observable factors… Measurable factors… Time limited factors… Mutual factors… Realistic factors…

26 Purpose of Care Plans Serves as Written guidelines for client care
Communicates care Enhances continuity Organizes information – promotes efficiency Involves client and family Meets requirements of accrediting agencies Care plans help students learn problem solving, skills of written communication, organizational skills, and application of theory

27 Step 4 of the Nursing Process Planning Nursing Interventions
AKA Nursing Actions Measures Strategies Activities Actions based on clinical nursing judgment and knowledge that nurses perform to achieve client outcomes Include activities of observation/assessment, prevention, treatment, & health promotion

28 3 Types of Interventions
Independent Nurse initiated interventions In realm of independent nursing practice No MD order required Dependent Physician initiated interventions Require MD orders Collaborative (interdependent) interventions Coordination of multiple professionals

29 Interventions Include activities of
Observation/assessment Prevention Therapeutic Treatments Health promotion Activities of daily living Teaching Discharge planning Flow from Client goals/outcomes / orders Individualize standardized interventions

30 Evidence Based Practice
Nursing Orders Instructions on care plan describing implementation of interventions Include Date Subject Action verb Times and limits Signature Standing Orders Protocols Critical Pathways Evidence Based Practice

31 Errors in Writing Nursing Interventions
Nursing action nonspecific Fail to indicate frequency Fail to indicate quantity Fail to indicate method Fail to indicate person to perform

32 5th step of Nursing Process Implementation & Evaluation
The action phase of the nursing process You will perform or delegate planned interventions Implementation ends when you record the nursing actions on chart Evolves into evaluation as you record resulting client responses

33 Preparing for Implementation
Check your knowledge and abilities Organize your work Prepare the patient Implement the plan Coordinate/collaborate Delegate appropriately Right task Right circumstance Right person Right directions / communication Right supervision

34 The final step Evaluation
Planned Ongoing Does not end the nursing process Systematic Make judgments about Client’s progress toward expected outcomes/goals Effectiveness of nursing care plan Quality of nursing care delivered

35 Types of Evaluation Ongoing evaluation Intermittent evaluation
At each contact with patient Intermittent evaluation At outcome evaluation specified times Terminal evaluation At time of discharge

36 Evaluating Patient Progress
Review Outcomes Collect Reassessment Data Judge Goal Achievement Achieved (met) Partially achieved (partially met) Not achieved (unmet) Record evaluative statement Revise care plan if indicated Begin with assessment data and go through entire nursing process

37 Documentation Written evidence of interactions Health professionals
Clients Families Health care organizations Diagnostic tests Treatments Education Client results/responses

38 Documentation Guidelines
Correct client record Client name on each page Document immediately Date and time each entry Sign each entry with name and professional credentials No space between entries Never change another’s entry Use “quotes” for client statements Chronological order

39 Elements of Documentation
Use appropriate vocabulary / terminology Only approved abbreviations / symbols Use organized and logical sequence State only factual not inferences Use correct spelling, legible writing Protect client confidentiality by not releasing records to anyone without patient permission Write neatly, legibly, & in ink Use concrete specific terms Follow agency guidelines

40 Documentation Methods
Source-Oriented Records Separate sections for each discipline Problem-Oriented Records Consists of database, problem list, plan of care, & progress notes

41 Types of Charting Narrative SOAP PIE Focus Charting by exception
Computerized


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