4Sabiduría Knowledge vs. Wisdom Knowledge: Wisdom Gaining information, understanding conceptsWisdomCollected meaning and significance gained from knowledgeSpanish word for the two sides of learning
5What is thinking?Asking questions Move towards answers
6Is there such a thing as a “bad question”? Yesterday I was at my local COSTCO buying a large bag of Purina dog chow for my loyal pet, Jake, the Wonder Dog and was in the check-out line when a woman behind me asked if I had a dog.
7Is there such a thing as a “bad question”? What did she think I had an elephant?So since I'm retired and have little to do, on impulse I told her that no, I didn't have a dog, I was starting the Purina Diet again.I added that I probably shouldn't, because I ended up in the hospital last time, but that I'd lost 50 pounds before I awakened in an intensive care ward with tubes coming out of most of my orifices and IVs in both arms.
8Is there such a thing as a “bad question”? I told her that it was essentially a Perfect Diet and that the way that it works is, to load your pants pockets with Purina Nuggets and simply eat one or two every time you feel hungry.The food is nutritionally complete so it works well and I was going to try it again.(I have to mention here that practically everyone in line was now enthralled with my story.)
9Is there such a thing as a “bad question”? Horrified, she asked if I ended up in intensive care, because the dog food poisoned me.I told her no, I stepped off a curb to sniff a poodle and a car hit me.I thought the guy behind her was going to have a heart attack he was laughing so hard.
10“Only students who have questions are really thinking and learning” Ask questions that stimulate thought.Ask students – do you believe it?
11“The difference between good science and great science is the quality of the questions posed.” ~ William Hunter
12You want to get an A in your anatomy class Use questions to analyze:What do I need to memorize this week?What multiple pathway to learning is my strength?Come up with creative ideas:What are different ways to study using my strength?Apply practical solutionsWhat ways can I study my anatomy to memorize the body systems?When will I use these study skills?(Analyze)How bad is my money situation?(Creative) What ways can I earn money?(Practical) How do I get a job on campus?Analyitical: What does it take to be a nurse? Get a nursing degree? What field do I want to work in?Creative:
13Know your purpose! What are you trying to accomplish? Are your questions leading you towards that purpose?
14Can you get smarter?“As jogging is to the body, thinking is to the brain.” ~ Nob Yoshigahara (puzzle master)
15January 5, 2010 Puzzles and Alzheimer's A new study adds to a growing body of evidence that mentally challenging activities like word games, playing cards, reading and writing may delay the rapid memory loss that occurs with Alzheimer’s disease.The study involved 488 people who were in their 70s and 80s. All were free from Alzheimer’s at the start. Each participant filled out questionnaires about how often they participated in six leisure-time activities: reading books, magazines or newspapers, writing, doing crossword puzzles, playing board or card games, participating in group discussions or playing music.“The effect of these activities in late life appears to be independent of education,” Dr. Hall said. “These activities might help maintain brain vitality.”For each activity, those who took part every day of the week were rated at seven points; several days a week was rated at four points; and once-a-week participation was rated at one point.Researchers studied them for about five years, performing regular checks to look for signs of memory loss and other symptoms of Alzheimer’s disease. During that time, 101 developed Alzheimer’s or another form dementia. The findings appeared in Neurology, the medical journal of the American Academy of Neurology.Among those who developed dementia, the more activity points someone had, the longer they went without showing obvious signs of memory loss and other symptoms. The researchers found that for every additional activity a person participated in, the onset of rapid memory loss was delayed by about two months.“The point of accelerated decline was delayed by 1.29 years for the person who participated in 11 activities per week compared to the person who participated in only 4 activities per week,” said study author Charles B. Hall, Ph.D., of Albert Einstein College of Medicine in New York.The results remained valid even after researchers factored in the education level of the participants. Having many years of formal schooling has been shown to reduce the risk of Alzheimer’s in old age. “The effect of these activities in late life appears to be independent of education,” Dr. Hall said. “These activities might help maintain brain vitality.”The findings are consistent with earlier reports that mentally challenging activities may help to build up so-called cognitive reserve, or the ability of the brain to function normally despite showing signs of damage from Alzheimer’s disease. So while participating in these mentally stimulating tasks did not prevent the onset of Alzheimer’s altogether, it did delay the onset of memory loss and thinking problems.
16How can You improve your analytical thinking skills? AKA: Critical ThinkingGathering informationAnalyzing & ClarifyEvaluating for the purpose ofGaining understandingSolving a problemMaking a decision
17Gather information (Define your purpose!) Information How much do you need?How much time do you spend gathering?Is the information relevant?Writing a paper on nursing ethics:Review assignment – what are the requirements- research out relelcant informationChoose two topics, find 4-5 comprehensive pieces on eachSick patient:Diagnosis of diabetesReview in mind pathophysiology of diabetes? What might be wrong?Obtain data:-read their chart lab values, medicationsFSBSVital signsAssess urine outputAssess skin for dryness, color,
18Analyze & Clarify information Break information into partsSeparate the ideasCompare and ContrastExamine cause and effect*Look for themes, patterns and categoriesSeparate the ideasPaper:ER nurse: different types of ER nurses. Triage. Cardic monitor. Major traumaICU: CCU, Neonatal ICU(NICU) TelemetryDiabetic patient:Vital signsFSBSMedications
19Analyze & Clarify information Examine whether examples support ideasDistinguish fact from opinionSubjective InformationObjective Information
20Objective information Is observable, able to be seen, heard or touched, smelled, tastedFactualAble to be countedAble to be describedThe same from multiple reportersis verifiable. Another person can repeat the observation, you can perform some type of test, etc.
21Objective language I saw… I counted… I observed… This is what he did… This is what it sounded like…
22Subjective information Is opinion, judgment, Assumption, beliefs, rumor or suspicionVaries from person to person, day to dayInformation that can be interpreted differently by other peopleis what comes out of the patient or family's mouth.
23Subjective language I feel … Example: "I feel hot" is subjective as someone may feel hot to themselves but another might touch them and say "no, you're freezing". As opposed to: "I have a temperature of 101 degrees" - this can be measured with a thermometer and the fact remains the same no matter who is looking at the thermometer.
24Diabetes Case StudyM.G. is a 58 y/o white female who presents to her primary care physician with a complaint of “tired all the time.”Height:5’4”Weight:212 lbs.It’s been going on for several months, and she doesn’t report any concerns with nighttime sleep.She doesn’t note any new stress or other life changes, and denies depression or anxiety.Alcohol consumption is limited to one to two drinks per week, and she quit smoking over 10 years ago.BP:135/86Family history is notable for type 2 diabetes in an older sister; her mother had hypothyroidism and “heart disease.”The patient also has high cholesterol that she has been trying to treat with “weight loss and exercise.”She walks about 20 minutes three times weekly when the weather allows.Lung sounds are clearPulse regular and strongShe has been treated for about five years for hypertension with hydrocholorthiazide.No thyromegaly
25Analyze & Clarify information Examine whether examples support ideasDistinguish fact from opinionSubjective vs. ObjectiveExamine perspective & AssumptionsBiasPrejudicesEvaluate information
26Assess Analytical Thinking Skills I tend to perform well on objective tests.People say I’m a “thinker”, “brainy”, “studious”.I am not comfortable with gray areas – I prefer information to be laid out in black and white.In a group setting, I like to tackle the details of a problemI sometimes over think things and miss my moment of opportunity.Score =least like me; 5 most like me.
29Improving creativity Shift your perspective Challenge assumptions Take a new and different lookAsk “what if” questions
30Improving creativity Set the stage for creativity Choose – or create environments that free your mindBe curiousGive yourself time to “sit” with a questionBelieve in yourself as a creative thinker
31Improving Creativity Take risks Fly in the face of convention Let mistakes be Okay
32Assess creative thinking I tend to resist rules and regulations.People say I’m “expressive,” “full of ideas,” innovative.I break out of my routine and find new experiencesIn a group setting I like to toss ideas into the ringIf you say something too risky, I’m all for it.5-12 Weak13-19: average20-25: strong
33Improving practical thinking skills Experience“Experience is the greatest teacher!”Benjamin Franklin (Poor Richard's Almanack, Nov. 1743) offered, "Experience keeps a dear school, yet fools learn in no other.“
35Practical thinking means action! Stay motivatedMake the most of your personal strengthsWhen things go wrong, accept responsibility and reject self pityFocus on the goal and avoid distractionsManage time and tasks effectivelyBelieve in yourself
36Assess practical thinking skills I can find a way around any obstaclePeople say I’m a “doer” and “go-to” person “organized”.When I have a vision, I translate it into steps from A to B to C.In a group setting, I like to set up the planI don’t like to leave loose ends dangling – I’m a finisher.
37How is this type of thinking used in Nursing? NURSING PROCESS!
38Overview of the Nursing Process Consists of 5 stepsAssessmentDiagnosisPlanningImplementationEvaluationBuild on each otherNot linear
39Nursing process is dynamic and requires creativity in its application Steps remain the sameApplication and results differentUsed throughout the life span in any care setting
40Small group questions: How many steps are in the nursing process?What are the names of each of the steps?What is the purpose of the nursing process?In what clinical setting is the nursing process used?
41Assessment Step #1 Involves Collecting data (from variety of sources) Validating the dataOrganizing the dataInterpreting the dataDocumenting the data
42Assessment Validating the Data Organizing the Data Interpreting the DataRelevant vs. irrelevantGaps?Identify patternsDocument the Data
43Small Group QuestionsWhich of the following are objective data and which are subjective data.A. NauseaB. VomitingC. Unsteady gaitD. AnxietyE. Bruises on the right arms and faceF. Temperature 101 F
44Diagnosis Step 2 in the nursing process Formulating a nursing diagnosisAnalysis and synthesis of data
45Nursing diagnosis:“A clinical judgment about individual, family or community responses to actual or potential heal problems / life processes.A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.”
46Medical vs. Nursing diagnosis Medical diagnosisNursing diagnosisIdentifies conditions the MD is licensed & qualified to treatIdentifies situations the nurse is licensed & qualified to treat
47Medical vs. Nursing diagnosis Medical diagnosisNursing diagnosisIdentifies conditions the MD is licensed & qualified to treatIdentifies situations the nurse is licensed & qualified to treatFocuses on illness, injury or disease processesFocuses on the clients responses to actual or potential health / life problems
48Medical vs. Nursing diagnosis Medical diagnosisNursing diagnosisRemains constant until a cure is effectedChanges as the clients response and/or the health problem changes
49Medical vs. Nursing diagnosis Medical diagnosisNursing diagnosisRemains constant until a cure is effectedChanges as the clients response and/or the health problem changesi.e. Breast canceri.e. Knowledge deficitPowerlessnessGrieving, anticipatoryBody image disturbanceIndividual coping, ineffective
50Diangosis Nursing diagnosis Medical diagnosis Breathing patterns, ineffectiveChronic obstructive pulmonary diseaseActivity intoleranceCerebrovascular accidentPainAppendectomyBody image disturbanceAmputationBody temperature, risk for alteredStrep throat
51Planning & Outcome identification Step Three: PlanningIdentifying outcomesGoalsAn aim, intent or end.Short term goalsHours to days (less than a week)Long term goalsWeeks to months
52Planning & Outcome identification Developing specific nursing interventionsIndependent nursing interventionsNo order neededElevate edematous legsInterdependent nursing interventionsIn conjunction with an interdisciplinary team memberAssist client with physical therapy exercisesDependent nursing interventionsRequire an orderAdministering of medications
53Prioritizing the nursing diagnosis Maslow’s hierarchy of needs