1. NR 104 Role Transition Theory/Clinical Instructor:
Sasha Alexis Rarang, MSN, CCM, RN
Gilda Ilano-Teal, MSN, RN
CTA: Leah Buscho, BSN, RN
Rosita Quizon, BSN, RN
Class Hour:
Theory & Clinical: Thursdays and Fridays,

2. Week 1 – Module 1 Module 1 – Critical Thinking and Information Competency  

3. Critical Thinking in clinical decision making:
Define critical thinking and its components and discuss methods of searching for nursing information
Critical Thinking in clinical decision making:
To think smart in facing each new experience and problem as a nurse involving client’s care with:
Open-mindedness
Creativity
Confidence
Intellectual wisdom

4. Critical Thinking in Clinical Decision Making or Nursing Problem-Solving:
Nurses : responsible for making accurate and appropriate clinical decisions.
Clinical decision making separates professional nurses from technical personnel.
It is the professional nurse who takes immediate action when a client’s clinical condition worsens, who decides if client is having complications that call for notification of the HCP or who decide if a teaching plan for a client is ineffective.

5. Critical Thinking in Clinical Decision Making or Nursing Problem-Solving:
Benner describes clinical decision making as judgment that include critical and reflective thinking and action and application of scientific and practical logic.
Nurse should learn to question, wonder, and explore different perspective and interpretations to find a solution that benefit the client.
With experience the nurse will learn to creatively seek knowledge, act quickly when events change and make quality decision for client’s well-being

6. Critical Thinking Defined:
Thinking and learning are related process.
Critical thinking emphasized logic and reasoning (DiVito-Thomas, 2005).
It is an active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others (Chaffee, 2002).

7. Critical Thinking It involves:
Recognizing that an issue exist (Clinical problem
Analyzing an information about the issue (Clinical data about the client), and
Evaluating information ( reviewing assumption and evidence) and making conclusion.
The critical thinker considers what is important in situation, imagines and explore alternatives, considers ethical principles, and then make informed decision.

8. Critical Thinking
When the nurse care for the client, critical begins by asking the following questions:
What do I really need to know about this client situation?
How do I know it?
What are the option available to me?

9. Case Scenario
Mr. Jacobs is a 58-year old client who had a radical prostatectomy for prostate cancer yesterday. His nurse Tonya, finds the client lying supine in bed with arms extended along his sides, but tensed. When Tonya checks the client’s surgical wound and drainage device, she noticed the client winces when she gently palpates over the incisional area.
She ask the client when he last turned into his side and he responds, “ Not since last night some time,” Tonya ask Mr. Jacobs if he is having incisional pain, and he nods yes, saying, “It hurts too much to move.”

10. Case Scenario
Cont. Tonya considers the information she has observed and learned from the client to determine he is in pain and he has reduced mobility because of it. She decides that she needs to take action to relieve Mr. Jacobs’ pain so that she can turn him more frequently and begin to get him out of bed for his recovery.

11. Critical Thinking Interpretation
In Sonya’s review of the case she knew that pain was likely going to be a problem because the client had extensive surgery.
Review of observation confirms occurrence of pain.
Her options include giving Mr. Jacobs an analgesic and then waiting until it takes effect so that she is able to reposition and make the client more comfortable.

12. Evidence-Based Practice
The use of evidence-based practice or knowledge based on research or clinical expertise makes a nurse informed critical thinker.
Crtical thinking requires not only cognitive skills but a person’s habit to ask questions, to remain well informed, to be honest in facing personal biases ands always willing to reconsider and think clearly about issues.

13. Critical Thinking: What Is IT?
It is a term that is used with the beginning student nurse and is a process used daily by the professional nurse in the health care setting.
The process of critical thinking involves problem solving, creativity and decision making.
Critical thinking is a skill that is perfected over time, it is a process that involves logic and reasoning.
In critical thinking the nurse will examine assumptions about the situation, interpret information available, and evaluate arguments presented and reach a new conclusion.
In other words, critical thinking will help the professional nurse examine aspects of specific issues, and look for new and exciting ways to solve a problem.

14. Critical Thinking Skills pg. 217
Interpretation – be orderly in data collection.
Analysis – Be open minded as you look at information
about a client.
Inference – Look at the meaning and significant of the
findings.
Evaluation – Look at all situations objectively. Use criteria (expected outcomes, pain characteristics learning objectives)
Explanation – Support your findings and conclusions.
Self- regulation – Reflect your own experience.

15. Concepts for a Critical Thinker
Critical Thinking Behavior
Truth Seeking
Seek the true meaning of a situation. Be honest and objective
about asking questions.
Open-mindedness
Be tolerant of different views, be sensitive to the possibility for your own prejudices, respect the rights of others.
Analyticity
Analyze potential problematic situations
Systematically
Be organized, focused, work hard in any inquiry
Self –Confidence
Trust in your own reasoning processes
Inquisitiveness
Be eager to acquire knowledge and learn explanation even when applications of the knowledge are not immediately clear.
Maturity
Multiple solutions are acceptable; Reflect upon your own judgment.

16. Levels of Critical thinking in Nursing
Critical thinking Model
Kataoka-Yahiro and Saylor’s model (1994) also, identifies three levels of critical thinking in nursing.
Basic - the learner assumes the authorities have the answer for every problem.
Complex - a person continues to recognize the diversity of individual outlook and perception. Experience helps the individual gain the ability to detach from authorities and analyze and examine alternatives more independently and systematically.
Commitment - is able to anticipate the need to make critical choices after analyzing the merits of other alternatives.

17. Critical Thinking Competencies
Scientific Method
Problem Solving
Decision Making
Diagnostic Reasoning and Inference
Clinical decision Making
Nursing Process as competency

18. Model of Critical thinking
Kataoka-Yahiro and Saylor (1994) developed a model of critical thinking for nursing judgment. The model proposes there are five components of critical thinking.
1. Specific Knowledge Base - This will vary according to the basic nursing education program from which the nurse graduated, additional continuing education, and any advanced degrees that the nurse may purse.
2. Experience - A nurse must have an opportunity to practice and make decisions for critical thinking to develop. A wealth of information can be learned from observing, sensing, talking and the reflection activity on the experience.
3. Competencies-
General competencies - include the scientific method, problem solving, and decision-making.
Specific competencies in clinical situations- include diagnostic reasoning, clinical inferences, and clinical decision making.
Specific competency in nursing- this is the nursing process.
At the basic level, students think concretely on the basis of a set of rules or principles, following a step-by-step process without deviation from the plan.
Complex critical thinking analyzes and examines choices independently. Students learn to think beyond and synthesize knowledge.
Commitment is the third level of critical thinking. Students (soon to be future nurses) anticipate needs and make choices without assistance from others.

19. Model of Critical thinking
4. Attitudes for Critical Thinking:
Accountability - to be answerable for whatever decision is made.
Thinking Independently - to challenge traditional ways of thinking, and look for rational and logical answers to problems.
Risk Taking - have the courage to look at alternative ways to deliver nursing care without compromising quality.
Humility - to admit one’s own limitations.
Integrity - quickly willing to admit and evaluate any inconsistencies in his of her own ideas and beliefs.
Perseverance - determined to find effective solutions to problems.
Creativity - to find solutions outside of what is traditionally done.

20. Model of Critical thinking
5. Standards for Critical Thinking- This includes intellectual and professional standards. These standards express the goals and values of the nursing profession. An example is the ANA’s code for nurses.

21. Five step Nursing Process Model
The nursing process is goal-oriented method of caring that provides a framework to nursing care. It involves five major steps:
A - Assess (what data is collected?)
D - Diagnose (what is the problem?)
P - Plan (how to manage the problem)
I - Implement (putting plan into action)
E - Evaluate (did the plan work?)

22. The Nursing Process
The nursing process is used by nurses every day to help clients improve their health. It is a form of problem solving. The nursing process is made up of a series of stages that are used to achieve the objective - the health improvement of the client. The nursing process can stop at any stage as deemed necessary or can repeat as needed. This process is inclusive of physical health as well as the emotional aspects of patient health.

23. The Nursing Process
Nursing knowledge is used throughout the process to formulate changes in approach to the client's changing condition. During the process, nurses use this knowledge to identify problems and changes that are occurring to the patient.
Caring for a patient requires the nurse to communicate with the patient to determine how they are feeling and gain the results of implemented care from the patient.
Phases of the nursing process include:
Assessment of the patient's needs
Diagnosis of client response needs that nurses can deal with (NANDA)
Planning of patient's care
Implementation of care
Evaluation of the success of the implemented care

24. Critical Thinking Model for Decision Making
Models serve to explain concepts and help nurses make decisions and judgments about patients.
Kataoka-Yahiro and Saylor (1994)
Define the outcome of critical thinking as nursing judgment that is relevant to nursing problems in a variety of settings.

25. Critical Thinking Synthesis
A reasoning process used to reflect on and analyze thoughts, actions, and knowledge
Requires a desire to grow intellectually
Requires the use of nursing process to make nursing care decisions.