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Chapter 1
Critical Thinking and the Nursing Process
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Competencies Describe how nursing is both an art and a
science. Discuss the components of critical
thinking. Apply the universal intellectual standards
to the critical thinking process. Define the nursing process. Describe the six steps of the nursing
process.
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Art of Nursing Incorporate aspects of caring and
sharing into practice. Role of intuition, “intuitive links”
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Science of Nursing
Analytical thinking Based on scientific principles and
research data Reflective thinking: art and science
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Critical Thinking Purposeful, goal-directed thinking
process that strives to problem solve patient care issues through the use of clinical reasoning
Combines logic, intuition, and creativity
Essential to nursing practice
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Clinical Reasoning
Disciplined, creative, and reflective approach
Used concurrently with critical thinking
Purpose—establish potential strategies for patients to reach their desired health goal
Essential to nursing practice(continues)
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Clinical Reasoning
Key elements (Paul & Elder, 2000) Purposeful Problem-solving strategy Based on assumptions
(continues)
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Clinical Reasoning
Conducted from some point of view Based on data, information, and
evidence Expressed through, and shaped by,
concepts and ideas Implications and consequences
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Components of Critical Thinking Interpretation Analysis Inference Explanation Evaluation Self-regulation
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Interpretation Decode hidden messages Clarify the meaning of information Categorize information
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Analysis Examines ideas and data Identifies discrepancies Reflects on reasons for
discrepancies
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Inference Speculates Derives Reasons Skill developed with experience
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Explanation Requires that conclusions drawn
from inferences are correct and can be justified
Scientific and nursing literature serve as basis for clinical justification
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Evaluation Examines the validity of the
information Leads to final conclusion that can be
implemented
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Self-Regulation Reflects on critical thinking skills
and determines what techniques were effective and which were problematic
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Universal Intellectual Standards for Critical Thinking Clarity Accuracy Precision Depth Breadth Logic, applied to clinical reasoning
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Nursing Process Assessment Diagnosis Planning Outcome identification Implementation Evaluation
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Assessment First step in nursing process Purpose
Identifies the patient’s current health status
Actual and potential health problems Areas for health promotion
Sources of information Health history Physical assessment Diagnostic and laboratory data
Dynamic phase
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Health History Gathers subjective data from the
patient Information may or may not be
validated by physical assessment findings
(continues)
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Health History Possible sources of information
Patient Family Neighbors Friends Bystanders Old charts Medical records
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Physical Assessment
Objective data Observable, measurable data Possible approaches—body
systems, head to toe, or functional health patterns
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Diagnostic and Laboratory Data
Objective data May include items such as: blood
and urine studies, cultures, X rays, and diagnostic procedures
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Diagnosis Second step in nursing process Describes conditions treated by
nurses North American Nursing Diagnosis
Association (NANDA) Provides the basis for selection of
nursing interventions to achieve outcomes for which the nurse is accountable
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Collaborative Problem
Requires the nurse to work jointly with the physician and other members of the health care team in monitoring, planning, and implementing patient care
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Planning Third step in nursing process Prioritization of nursing diagnoses Framework to assist prioritization
Maslow’s hierarchy of needs
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Outcome Identification
Fourth step in the nursing process Establish patient goals Develop patient outcomes
Short-term Long-term
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Intervention Selection
Independent nursing interventions Collaborative interventions
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Implementation Fifth step in nursing process Nurse executes the interventions
that were devised during the planning stage
Dynamic process
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Evaluation Sixth step in nursing process Determine patient’s progress in
achieving outcomes Continual and dynamic process Evaluate each outcome separately Document if outcome achieved or
not achieved May result in revising the plan of
care
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Critical Pathways Show the outcome of predetermined
patient goals over a period of time State what activity the patient
should be capable of completing on a daily basis
Critical incidents Variance
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Documenting the Nursing Process
Methods SOAPIER
Subjective Objective Assessment Plan Implementation Evaluation Revision
(continues)
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Documenting the Nursing Process
PIO Problem Intervention Outcome
(continues)
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Documenting the Nursing Process
DAR Data Action Response
PIE Problem Intervention Evaluation
(continues)
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