Fundamentals Of Nursing, Ch 15

Front 1

Nurses are responsible for making

Back 1

Accurate and appropriate clinical decisions. Clinical decisions separate professional nurses from technical personnel.

Front 2

Benner describes clinical decision making as

Back 2

judgment that includes critical and reflective thinking and action and application of scientific and practical logic. (most clients have health care problems for wh/ there are NO CLEAR textbook solutions.

Front 3

Critical Thinking

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(logic and reasoning) IS an active, organized cognitive process used to carefully examine one's thinking and the thinking of others. p217 Table 15-1

Front 4

Critical Thinking Model:
Level 1 Basic (nursing student)
Level 2 Complex
Level 3 Commitment

Back 4

1. right or wrong way to do things, not adjusting to ind. client. This nurse depends on value of experts 2. begin to separate themselves fr. authorities. More independent, thinking more creatively, views different options. 3. Need to make choices w/out assistant from others. Accountable for decisions.

Front 5

Critical Thinking Competencies

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the cognitive processes a nurse uses to make judgments about clinical care of clients. Includes general critical thinking (scientific method), spec. critical thinking in clinical situations (diagnostic reasoning), and spec. critical thinking in nursing (nursing process).

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General Critical thinking

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Scientific Method-way to solve problems using reasoning, systematic
Problem Solving-evaluating the solution over time to make sure that it is effective
Decision Making-product of critical thinking that focuses on problem resolution. Following a set of criteria helps to make a thorough and thoughtful decision.

Front 7

Diagnostic reasoning

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Begins the moment you receive info about a client, DR begins. Process of determining a client's health status after you assign meaning to the behaviors, physical signs, and symptoms presented by the client. Also begins when you enter into an interaction w/ a client or when you make physical or behavioral observations. observe themes and patterns. nurses don't make medical diagnoses but do assess and monitor clients closely and compare clients' signs and symptoms with those that are COMMON to a medical diagnosis. Use client data gathered to logically explain a clinical judgment.

Front 8

Inference

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(part of DR) process of drawing conclusions from related pieces of evidence before making diagnosis

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Clinical Decision Making

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problem-solving activity that focuses on defining client problems and selecting appropriate treatment. Choose best nursing intervention. Reducing severity of the problem or resolving the problem completely. Requires careful reasoning so that you choose the options for the best client outcomes on the basis of the client's condition and priority of the problem. Knowing clients and experience is important.

Front 10

Selection of nursing therapy (under clinical decision making)

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(prognosis - usual patterns of any diagnosed problem)

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Purpose of nursing process

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is to diagnose and treat human responses to actual or potential health problems. __involves the general and sp. critical thinking competencies, described earlier, in a way that focuses on a particular client's unique needs. Blueprint of care

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Critical thinking model for clinical decision making

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(nursing problems - ADLs, IDL, quality of life - McNeese)
Model - 5 components - knowledge base, exp., critical thinking competencies, attitudes, and standards. The elements of the model combine to explain how nurses make clinical judgments that are necessary for safe, effective nursing care. Box 15-2

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Vision of nursing practice

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to think critically, improve clinical practice, and decrease errors in clinical judgments.

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Review Attitudes

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Table 15-3

Front 15

(under professional standards)
clinical practice guidelines

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(critical thinking requires use of evidenced based criteria - based on scientifically based on research findings or Institutions QI initiatives).
_____developed by individual clinical agencies and National organizations such as the Agency for Healthcare Research and Quality (AHRQ). Standards for treatment for select clinical conditions - deep vein thrombosis

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Standards of professional responsibility that a nurse tries to achieve are those standards cited in

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Nurse Practice Acts, institutional practice guidelines, and professional orgs. standards of practice.

Front 17

Reflection (used in journalling)

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process of purposefully thinking back or recalling a situation to discover its purpose or meaning. Journalling improves observation and descriptive skills. The Circle of Meaning model adapted to nursing encourages concept clarification and a search for meaning in nursing practice.