CLINICAL DECISION MAKING & THE NURSING PROCESS NRS 110

Critical Thinking Revisited Knowledge Experience Reflection Intuition

Components of Critical Thinking in Nursing Specific Knowledge Base Experience Critical Thinking Competencies Diagnostic Reasoning Clinical Decision Making Nursing Process Critical Thinking Attitudes Critical Thinking Standards Intellectual Standards Professional Standards

Clinical Decision Making Critical thinking process for choosing the best actions to meet a desired goal To act or not to act, that is the question! Criteria used to make decisions Collaboration Problem Identification Who is responsible for making the decision?

Level of Critical Thinking Basic Complex Commitment

NURSING PROCESS Assessment Diagnosis Planning Implementation Evaluation

The nursing process in action

Step One: Assessment Collect data (Types of data, Sources of data, Methods of data collection) Organize data Validate the data Record & report

Step 2: Diagnosis Analysis of assessment data leads to problem identification NANDA list Types of nursing dx.

Anatomy of a Nursing Diagnosis Problem (Diagnostic label) Etiology (Related factors and Risk factors) Defining Characteristics Differentiating Nursing Diagnoses from Medical Diagnoses Differentiating Nursing Diagnoses from Collaborative Problems

The Diagnostic Process Analyzing data: Compare data against standards, cluster data, identify gaps and inconsistencies in data Identify health problems, determine problems and risks, determine strengths

Formulating Diagnostic Statements

Step 3: Planning Set priorities Apply standards Identify goals & outcomes Select interventions Record the plan (nursing care plan)

What are the priorities?

Maslow’s Hierarchy of Basic Human Needs

Guidelines for Writing Goal Statements Write goals in terms of client responses Be sure the desired outcomes are realistic and compatible with ordered therapies Make sure that each goal is derived from only one nursing diagnosis Use observable, measurable terms for outcomes Involve the client in the process

CONCEPT MAP Ineffective Airway Clearance (Gas Exchange)

Step 4: Implementation Put your plan into action Perform the interventions Note patient response to interventions Record & report

Types of Interventions Independent (nurse initiated) Dependent (physician initiated) Collaborative

Step 5: Evaluation Did the plan work? Was goal achieved? What was the outcome of the care provided. Stated in measurable terms. It’s all about outcomes!

Case Scenario A.A. is an 28 y.o. female who was admitted with pneumonia. She presents with complaint of cold x 2 weeks, dyspnea on exertion, , orthopnea, decreased oral intake. Assessment of patient reveals: T 103F, P 92, R 22 shallow, BP 122/80 Dry mucous membranes, hot pale skin Decreased breath sounds, inspiratory crackles Ineffective cough-coughing up thick pink sputum Lethargic, c/o being weak

Now lets write the plan down!

Concept Map Steps Place your main issue/problem in the middle Determine key problems/concepts that have a direct relationship to the main problem Add clinical data to appropriate problem boxes Draw lines between related problems. Label with a nursing diagnosis Identify goals/outcomes Add interventions Evaluate patient response to interventions

CONCEPT MAP Ineffective Airway Clearance (Gas Exchange)