Ch. 14 - Critical Thinking in Nursing Practice
Terms
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- An active, organized, cognitive process used to carefully examine one's thinking and the thinking of others.
- Critical Thinking
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Interpretation
Analysis
Evaluation
Inference
Explanation
Self-Regulation - Critical Thinking Skills
- Being systematic in data collection, looking for patterns to categorize data.
- Interpretation
- Being open minded as one looks at information about a client while not making careless assumptions. Asking whether data reveals what one believes is true, or are there other options?
- Analysis
- Looking at all situations objectively, using criteria (e.g., expected outcomes, pain characteristics, learning objectives) to determine results of nursing actions. Reflect on one's own behavior.
- Evaluation
- Looking at the meaning and significance of findings. Are there relationships b/w findings? Does the data about the client help to determine that a problem exists?
- Inference
- Supporting findings and conclusions. Using knowledge to select strategies used in care of clients.
- Explanation
- Reflecting on own experiences. Identifying in what way I can improve my own performance. What will make me feel that I have been successful?
- Self-Regulation
- The process of purposefully thinking back or recalling a situation to discover its purpose or meaning.
- Reflection
- This ability is closely associated with the ability to think meaningfully.
- Precise and clear language.
- The direct understanding of particulars in a situation without conscious deliberation.
- Intuition
- Involves our intellectual and emotional growth when acquireing new knowledge and refining the ability to think, problem solve, and make judgements.
- Thinking and Learning
- Levels of Critical Thinking
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Basic Critical Thinking
Complex Critical Thinking
Commmitment - When a learner trusts that experts have the right answers for every problem. (Right or Wrong, concrete thinking)
- Basic Critical Thinking
- When a person begins to detach from authorities and analyze and examine alternatives more independently. (More "It depends" way of thinking)
- Complex Critical Thinking
- When individual anticipates the need to make choices without assistance from others and then assumes "accountability" for them.
- Commitment
- General Critical Thinking Processes
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Scientific method
Problem solving
Decision making - Specific Critical Thinking in Clinical Situations
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Diagnostic Reasoning
Clinical Inference
Clinical Decision Making - Specific Critical Thinking in Nursing
- Nursing Process
- Approach to seeking the truth or verifying that a set of facts agrees with reality
- Scientific Method
- Obtaining information and then using the information plus what we already know to find a solution, then later evaluating the solution to be sure that it is still effective.
- Problem Solving
- An end point fo critical thinking that hopefully leads to problem resolution.
- Decision Making
- Decision Making Process
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1. Recognize and define the problem or situation
2. Assess all options
3. Weigh each option against a set of criteria.
4. Test possible options
5. Consider the consequences of the decision.
6. Then make a final decision. - A process of determining a client's health status after the nurse assigns meaning to the behaviors, physical signs, and symptoms presented by the client.
- Diagnostic Reasoning
- The process of drawing conclusions from related pieces of evidence. Ex: Forming a nursing diagnosis
- Inference
- Requires careful reasoning so that the options for the best client outcomes are chosen on the basis of the client's condition and the priority of the problem.
- Clinical Decision Making Process
- Clinical Decision Making Criteria
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1. What needs to be achieved?(Ex: healing of skin, a safe home environment)
2. What needs to be preserved? (Ex: mobility, nutritions, comfort, and safety)
3. What needs to be avoided? (Ex: further tissue injury or infection and further falls) - 5 Steps of the Nursing Process
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1. Assessment
2. Diagnosis
3. Plan
4. Implementation
5. Evaluation - Purpose of Nursing Process
- To diagnose and treat human responses to actual or potential health problems.
- Use of the Nursing Process
- Allows nurses to help clients meet agreed-upon outcomes for better health
- What the nursing process provides:
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1. Systematic approach for gathering client data.
2. Syst. appr. for critically examining and analyzing the data.
3. Sys. appr. for identifying the client's response to a health problem
4. Sys. appr.for determining priorities.
5. Sys. appr. for establishing goals and expected outcomes of care.
6. Sys. appr. for taking action.
7. Sys. appr. for evaluation whether the action is effective. - Components of critical thinking:
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1. Specific Knowledge Base
2. Experience
3. Competencies
4. Attitudes
5. Standards - Includes basic nursing education, continuing education courses, and additional college degrees.
- Specific Knowledge Base
- The practice of using what a nurse learns from observing, sensing, talking with clients and families, and then reflecting actively on all of this.
- Experience
- Nursing Process
- Critical Thinking Competency
- Defines how a person approaches a problem in order to be a successful critical thinker.
- Attitudes
- List Attitudes for Critical Thinking:
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1.Confidence
2.Thinking Independently
3.Fairness
4.Responsiblity and Accountability
5.Risk Taking
6.Discipline
7.Perserverance
8.Creativity
9.Curiosity
10.Integrity
11.Humility - Application of Confidence in Practice
- Learn how to introduce yourself to a client. Speak with conviction when you begin a treatment or procedure. Don not lead a client to thingk that you are uncertain of being able to perform care safely. Always be prepared before performing a nursing activity.
- Application of Thinking Independently in Practice
- Read the nursing literature, espectially when there are different views on the same subject. Talk with clooeagues and share ideas about nursing interventions.
- Applications of Fariness in Practice
- Listen to both sides in any discussion. If a client or family memeber complains about a colleague, listen to the story and the nspeak with the colleague as well. Weigh all facts.
- Application of Responsibility and Authority in Practice
- Ask for help if youare uncertain about an aspect of client care. Report any problems immediately. Follow standards of practice in your care.
- Application of Risk Taking in Practice
- Ifyour knowledge causes you to questiona physician's order, do so. Be willing to recommend alternative approaches to nursing care when colleagues are having little success with clients.
- Application of Discipline in Practice
- Be thorough in whatever you do. Use known scientific and practice-based criteria for activities such as assessment and evaluation. Take time to be thorough, and manage your time effectively.
- Application of Perseverance in Practice
- Be wary of an easy answer. if colleagues give you information about a client, and some fact seems to be missing, go clarify info. or talk to the client directly. If problems of the same type continue to occur on a nursing division, bring colleagues together, look for apattern, and find a solution.
- Application of Creativity in Practice
- Look for different approaches if interventions are not woking. A client may need a different postitioning technique or a different instructional approach that will suit his or her unique needs.
- Application of Curiosity in Practice
- Always ask why. A clinical sign or symptom can indicate a variety of problems. Explore and learn more about the client so as to make appropriate clinical judgements.
- Application of Integrity in Practice
- Recognize when your opinions may conflict with those of a client; review your postition, and decide how best to proceed to reach mutually beneficial outcomes. Don not compromise nursing standards or honesty in delivering nursing care.
- Application of Humility in Practice
- REcognize when you need more info. to make a decision. When you are newly assigned to a clinical division and you are unfamiliar with the clients, ask to be oriented to the area. Ask RNs regularly assigned to the area for assistance. Read the professional journals regularly to keep updated on new approaches to care.
- Fifth Component of Critical thinking model and includes intellectual and professional standards
- Standards for Critical Thinking
- Standards such as preciseness, accuracy, and consistency to ensure that all data is available for making sound clinical decisions.
- Intellectual Standards
- Ethical criteria for nursing judgements, scientific and practice-based criteria used for evaluation
- Professional standards in critical thinking.
- The process of determing health status after analysis of data that explains a clinical judgement
- Diagnotic Reasoning