Chapter 2: Critical Thinking And Nursing Process

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CriticalThinking:

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is "the art of thinking about your thinking whileyou are thinking in order to make your thinking better: more clear, moreaccurate, or more defensible." We should reflect on the thinking processthat we are using to figure something out: "why did I ask those particularquestions? Do I have enough information to decide, or have I jumped to aconclusion? Have I considered all the possibilities. Critical thinking is a combination of reasoned thinking, openness toalternatives, an ability to reflect, and a desire to seek truth. It is acomplex concept and people think about it in different ways - none of them are"wrong". Any situation that requires critical thinking is likely tohave more than one "right" answer. You need critical thinking toproblem solve important decisions. Criticalthinking skills refer to thecognitive (intellectual) processes used in complex thinking operations such asproblem-solving and decision making.

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NursingProcess:

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It consists of six phases: assessment, diagnosis,planning outcomes, planning interventions, implementation, and evaluation. (pg.38 & 39) Assessment - the first phase - the data-gathering stage. You will obtain information from many sources: the client via history or physical exam, the client record, lab or test results, other health professionals, the client's family or support system, and the professional literature. In this phase your purpose is to gather data that you will use to draw conclusions about the patients health status. Diagnosis - the second phase. In this step you will identify the patients health needs (usually state in the form of a problem) based on careful review of your assessment data. You need to analyze all of your data, synthesize and cluster information, and hypothesize about your patients health status. The term diagnosis has been thought of as being medical, such as a diagnosis of cancer or diabetes. However, nursing diagnoses reflect the patient's responses to actual or potential health problems and are different from medical diagnoses. Planning - The third and fourth steps of the nursing process both involve planning. Planning can be divided into two phases: planning (predicting) outcomes and planning interventions. In the planning outcomes step you work with the patient to decide goals for care – that is, the patient outcomes you want to achieve through your nursing activities. These outcomes will drive your choice of interventions. (I.e. - nutritional status will improve as evidenced by a weight to gain of 3 pounds by July 1). In the planning interventions phase you develop a list of possible interventions based on your nursing knowledge and then choose those most likely to help the patient to achieve the stated goals. The best interventions are evidence-based; that is, supported by sound research. Implementation - this is the action phase. During implementation you will carry out or delegate the actions that you previously planned. You may delegate an action to another member of the healthcare team only if it is an action that may safely and legally be carried out by that team member. In the implementation phase, you are also document your actions in the patient's responses to them. Evaluation - The final phase of nursing process is evaluation. In this phase you determine whether the desired outcomes have been achieved, and judge whether your actions have successfully treated or prevented the patient's health problems. You then modify the care plan as needed. (I.e.– if a problem has been resolved, you delete it from your care plan; if outcomes have not been achieved, you determine why. It may be that a new intervention is needed. If so, you add it). You can see that evaluation step requires you to begin again using all the other steps. You will find that you go back and forth between the steps, especially as you gain nursing experience. In addition to being cyclical, the steps may be concurrent. That means that some of the steps may occur at the same time. For example, while inserting a urinary catheter (implementation step), the nurse also observes the urine that returns through the tube (assessment step). KEY POINT: notice thatthe nursing process is not intended to be linear (one step rigidly followinganother). Instead it is a cyclical process that follows a logical progression.

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Comorbidities:

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morethan one health problems occurring at the same time. (I.e.- if a healthy9-year-old fell and broke his right arm, he would experience pain anddiscomfort. However, with proper casting of the arm and time to heal, the childwould recover. While recovering, he may have to eat using his left hand orlimit the use of his injured arm. The child would likely be discharged homefrom the emergency department or clinic in the care of his parents orguardians. The nurse's primary interventions would be to teach the homecaregivers the care needed by the child. The adjustments would be quitedifferent for an older adult who has had a stroke (a comorbidity) that limitsthe use of his left arm. With decreased function in the left arm, a right armfracture would severely affect the older persons ability to care for himself.The nurse would need to evaluate whether the adult requires care in thehospital or in a skilled-care facility and what support services he will needas he convalesce. In the inpatient setting, nursing interventions mightinitially include assisting the client with eating, bathing, and toileting.

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IntellectualEmpathy:

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It is one of thecritical-thinking attitudes. Critical thinkers try to understand the feelingsand perceptions of others. They try to see a situation as the other person seesit.

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Model:

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is a set ofinterrelated concepts that represents a particular way of thinking aboutsomething - much in the same way that the lens affects what you see. Forexample, you would look through a telescope to view a distant star. Looking atthe star through reading glasses or magnifying glass would give adifferent view. The mode organizes critical thinking in to 5 major categories:

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Contextual Awareness

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One of the first things you need to consider is yourusual response to new experiences. How do you react to change? What other tasksfor assignments do you have that will dictate the timing of your preparation?Have you had any previous experiences that will aid or hamper you in yourpreparation? As you consider these questions, you're addressing the star pointof contextual awareness.

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Using credible sources

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you need to gather information about the clinical experience. It is important to use inquiry based on credible sources as you gather data. For example, you may ask your instructor for guidance on how to best prepare. Or you might consult a student who has successfully completed the same course. You will need to obtain accurate information about patients who have been assigned to you for care. You could use the patient's chart and your textbooks to prepare. Use only knowledgeable, reliable sources of information – for example, nursing textbooks and nursing journals, not popular (non-scholarly) magazines (such as parents magazine) or searching the Internet sites. After you have more information, you should go back and analyze your response to the situation. You may find that you are feeling less anxious already! All of this is part of inquiry. Anotherway to describe nursing is to say nursing involves thinking, doing and caring.

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Exploring alternatives and analyzing assumptions

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now that you know something about the clinicalexperience, you can plan your day. You need to consider alternatives andanalyze your assumptions about the experience. What is expected of you? What doyou expect from the experience? How should you approach your patient? How willyou introduce yourself? What skills do you have? How will you apply them tocaring for patient?

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Reflecting and deciding

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after you feel that you have addressed the concerns, youneed to quickly review your preparation (reflective skepticism). Have yougathered enough information to feel comfortable in the situation? Have you leftanything out? Do you need more information? This was a demonstration of how youmight apply the critical-thinking model to a real experience. In this example,you also used theoretical, practical, personal, and ethical knowledge.

Front 10

Name 4 characteristics of critical thinking:

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(1)reasoned thinking, (2) openness to alternatives, (3) an ability to reflect, and(4) a desire to seek truth

Front 11

Listthe steps of the nursing process in correct order and give a brief example ofeach:

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It consists of sixphases: assessment, diagnosis, planning outcomes, planning interventions,implementation, and evaluation. (pg. 38 & 39) Assessment - the first phase - the data-gathering stage. You will obtain information from many sources: the client via history or physical exam, the client record, lab or test results, other health professionals, the client's family or support system, and the professional literature. In this phase your purpose is to gather data that you will use to draw conclusions about the patients health status. Diagnosis - the second phase. In this step you will identify the patients health needs (usually state in the form of a problem) based on careful review of your assessment data. You need to analyze all of your data, synthesize and cluster information, and hypothesize about your patients health status. The term diagnosis has been thought of as being medical, such as a diagnosis of cancer or diabetes. However, nursing diagnoses reflect the patient's responses to actual or potential health problems and are different from medical diagnoses. Planning - The third and fourth steps of the nursing process both involve planning. Planning can be divided into two phases: planning (predicting) outcomes and planning interventions. In the planning outcomes step you work with the patient to decide goals for care – that is, the patient outcomes you want to achieve through your nursing activities. These outcomes will drive your choice of interventions. (I.e. - nutritional status will improve as evidenced by a weight to gain of 3 pounds by July 1). In the planning interventions phase you develop a list of possible interventions based on your nursing knowledge and then choose those most likely to help the patient to achieve the stated goals. The best interventions are evidence-based; that is, supported by sound research. Implementation - this is the action phase. During implementation you will carry out or delegate the actions that you previously planned. You may delegate an action to another member of the healthcare team only if it is an action that may safely and legally be carried out by that team member. In the implementation phase, you are also document your actions in the patient's responses to them. Evaluation - The final phase of nursing process is evaluation. In this phase you determine whether the desired outcomes have been achieved, and judge whether your actions have successfully treated or prevented the patient's health problems. You then modify the care plan as needed. (I.e.– if a problem has been resolved, you delete it from your care plan; if outcomes have not been achieved, you determine why. It may be that a new intervention is needed. If so, you add it). You can see that evaluation step requires you to begin again using all the other steps. You will find that you go back and forth between the steps, especially as you gain nursing experience. In addition to being cyclical, the steps may be concurrent. That means that some of the steps may occur at the same time. For example, while inserting a urinary catheter (implementation step), the nurse also observes the urine that returns through the tube (assessment step).

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Give an example of theoretical knowledge,practical knowledge self- knowledge and ethical knowledge

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Theoretical knowledge consists of information, facts, principles, andevidence-based theories in nursing and related disciplines. Examples are: physiology and psychology. It includes researchfindings and rationally constructed explanations of phenomena. You will use itto describe your patients, understand their health status, explain yourreasoning for choosing interventions, and predict patient responses tointerventions in treatment. Practical knowledge - knowing what to do and how to do it – consistsof processes (examples: The decision process and the nursingprocess) and procedures (examples: how to give an injection), and is anaspect of nursing expertise. Self knowledge - is self understanding. To think critically, you must beaware of your beliefs, values, and cultural and religious biases. This kind ofknowledge helps you to find errors in your thinking and enables you to tune into your patients. You can game self-knowledge by developing personal awareness– by reflecting (asking yourself), "Why did I do that?" Or "howdid I come to think that?" Ethical knowledge - finally, nurses use ethical knowledge, that is,knowledge of obligation, or right and wrong. Ethical knowledge consists ofinformation about moral principles and processes for making moral decisions.Ethical knowledge helps you to fulfill your ethical obligations to patients andcolleagues.

Front 13

Howis a nursing diagnosis different from a medical diagnosis?

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Theterm diagnosis has been thought of as being medical, such as a diagnosis ofcancer or diabetes. However, nursing diagnoses reflect the patient's responsesto actual or potential health problems and are different from medical diagnoses

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Whatis the basis of the nursing diagnosis?

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Is careful reviewof your assessment data

Front 15

Whyis it important to be critical thinkers? (Need 3 reasons)

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because nurses use complex-critical thinking processes(I.e.- problem-solving, decision-making, and clinicalreasoning) in every aspect of their work(pg. 33).

Front 16

Explain the primary reason for applying the full spectrum nursing model.

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Using it as aguide when you are faced with clinical decisions or unfamiliar situations (pg.34).

Front 17

Giveat least 4 aspects of health care affected by a patient’s culture.

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Culturalbeliefs influence how people defined sickness, at what point they seekhealthcare, what type of healthcare provider they see, and the type oftreatment they consider acceptable

Front 18

List atleast 4 aspects to display caring for a patient? Not in thephysical sense but the way you treat them.

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Knowing. Striving to understand what in event (an illness) means in the life of the patient Being with. Been emotionally present for the patient (making eye contact, actively listening) Doing for. Doing what the patient would do for himself if he could (bathing) Enabling. Supporting the patient through coping with life changes in unfamiliar events, such as hospitalization Maintaining belief. Having faith in the patient's ability to get through the change or event and to find fulfillment and meaning