评判性思维和护理临床决策ppt课件

1、S M M U第七章第七章 评判性思想和护理临床决策评判性思想和护理临床决策Critical Thinking and Decision-making in NursingNursing School of Second Military Medical UniversityS M M UMain Topics:Why and which thinking is important to nurse?What is the definition and components of critical thinking and why it is important?How to improve

2、the nurses critical thinking ability? Whats clinical decision making and how to make clinical decisions?S M M USignificance of Nursing ThinkingS M M U思想形状思想形状动作思想动作思想笼统思想直观思想笼统思想直观思想笼统思想逻辑思想笼统思想逻辑思想思想探求答案方向思想探求答案方向求异思想发散思想求异思想发散思想求同思想聚合思想求同思想聚合思想思想能否具有新颖性、独创性思想能否具有新颖性、独创性再生性思想再生性思想发明性思想发明性思想Everybod

3、y thinks all the day and all the time.思想的类型思想的类型S M M UScenario ：Its Tuesday. Youre on the way to classroom and these thoughts are going though your mind: “I have so much to doanatomy(解解剖剖) test on Wednesday, Physiology(生理学生理学) paper due on Thursday.I really wanted to get a hair cut.Do I really have

4、 to shop tomorrow?Hey, what an interesting looking m a n t h a t i s o n t h e c o r n e r. I m starvingWhat can I eat? Aimless thinkingS M M UPurposefullyDialecticallyDynamicallyCriticallyInitiativelyS M M U评判性思想评判性思想critical thinking2020世纪世纪3030年代德国法兰克福学派创建年代德国法兰克福学派创建 一种批判实际和思想方式一种批判实际和思想方式7070年代

5、开场运用于教学年代开场运用于教学 本质是反思才干和建立性批判精神本质是反思才干和建立性批判精神HistoryS M M U8080年代初，被引入护理年代初，被引入护理 护文科学的实际根底和哲学根底护文科学的实际根底和哲学根底19921992年，美国护理联盟年，美国护理联盟the National the National League for NursingLeague for Nursing，NLNNLN把评判性把评判性 思想列入评审护理学院的必需规范。思想列入评审护理学院的必需规范。 护文科学的实际根底和哲学根底护文科学的实际根底和哲学根底评判性思想评判性思想critical thinki

6、ngHistoryvOne of the core competencies vOne of the hot topicsS M M U Bandman(1988):“the rational examination of ideas, inferences, assumptions, principles, arguments, conclusions, issues, statements, beliefs, and actions. 评判性思想评判性思想critical thinkingDefinitions“对思想、推理、假设、原那么、争议、结论、问对思想、推理、假设、原那么、争议、结

7、论、问题、阐明、信心和行动的理性检验。题、阐明、信心和行动的理性检验。 S M M U Kozier et al2000: Critical: not “eager to find fault but “capable of judging carefully and accurately. Thinking: to have an opinion, to reflect on, to call to mind, to devise by thinking, to form a mental picture of (image), to reason. 评判性思想评判性思想critical t

8、hinkingDefinitions“评判性的不是指评判性的不是指“急于发现问题，而是指急于发现问题，而是指“仔细地、正确地判别才干；仔细地、正确地判别才干； “思想是指有思思想是指有思想、有反思、有回想、有设计发明、有想象和有推想、有反思、有回想、有设计发明、有想象和有推理。理。S M M U Kozier et al2000: Critical thinking: “a purposeful mental activity in which ideas are produced and evaluated, plans made, and desired conclusions deter

9、mined. 评判性思想评判性思想critical thinkingDefinitions“一个有目的的、产生思想并对其进展评价，制定一个有目的的、产生思想并对其进展评价，制定方案和确定理想结论的智力活动过程。方案和确定理想结论的智力活动过程。S M M U Alfaro-LeFevre(1999) : Entails purposeful ,outcome-directed (results-oriented) thinking. Is driven by patient, family, and community needs. Is based on principles of nurs

10、ing process and scientific method. Requires knowledge, skills and experience.评判性思想评判性思想critical thinkingDefinitions 必需是有目的的、结果导向的思想；必需是有目的的、结果导向的思想；受患者、家庭、社受患者、家庭、社区需求的驱动；区需求的驱动；以护理程序和科学方法原那么为根底；以护理程序和科学方法原那么为根底；需需求知识、技艺和阅历；求知识、技艺和阅历； S M M U Alfaro-LeFevre(1999) : Is guided by professional standard

11、s and ethics codes. Requires strategies that maximize human potentialand compensate for problems created by human nature. Is constantly reevaluating, self-correcting, and striving to improve. 评判性思想评判性思想critical thinkingDefinitions 受职业规范和伦理规范的指点；受职业规范和伦理规范的指点；需求一定的战略，如：需求一定的战略，如：运用个人力量来发扬人类最大潜能的战略，弥补

12、人性弱点的战运用个人力量来发扬人类最大潜能的战略，弥补人性弱点的战略；略；需求不断地再评价、自我修正并努力改良。需求不断地再评价、自我修正并努力改良。 S M M U 评判性思想首先是一种理性思想，护理运用强调的评判性思想首先是一种理性思想，护理运用强调的是一种观念、一种认识是一种观念、一种认识 评判性思想实际是一个完好体系评判性思想实际是一个完好体系 反思反思ReflectionReflection和推理和推理rational reasoningrational reasoning是评判性思想的本质过程是评判性思想的本质过程 临床决策是护理评判性思想的中心目的临床决策是护理评判性思想的中心目

13、的 护理程序是评判性思想的运用工具护理程序是评判性思想的运用工具 评判性思想评判性思想critical thinkingDefinitionsS M M U General critical thinking Critical thinking in clinical situations Specific critical thinking in nursing 评判性思想评判性思想critical thinkingTypesS M M U Specific Knowledge Base(专业根底知识专业根底知识) Experience 阅历阅历 Skills in Critical Thi

14、nking 思想技艺思想技艺 Attitudes for Critical Thinking(态度倾向态度倾向)Critical thinking in nursingComponentsS M M USkills in Critical ThinkingIs the core component.Critical analysisInductive reasoningDeductive reasoningCritical thinking in nursing-ComponentsS M M UCase：With the caring experience of 35 children un

15、dergoing maxillary surgery, several conclusions of peri-operational interventions for maxillary surgery patients are drawn as follows:123 归纳法归纳法inductiongeneral principles particular facts or instancesS M M UCase：A patient underwent a partial gastrectomy operation this morning. The surgeon prescribe

16、d as follows: 1. Following nursing interventions for the patients undergoing general anesthesia2.演绎法演绎法deductionthe generalthe specificinferencereasoningS M M USkills in Critical ThinkingSix critical thinking cognitive skills：interpretation, analysis, evaluation, inference, explanation and self-regu

17、lationAmerican Philosophical Association(APA,1990) Critical thinking in nursing-ComponentsS M M U1.Confidence.2. Independence of thought.3.Fairness.4.Integrity.5.Responsibility and Accountability.6. Curiosity.7.Risk Taking and courage.8.Creativity.9.Perseverance. 10.Humility. Attitudes for Critical

18、ThinkingCritical thinking in nursing-ComponentsS M M UCommitment LevelComplex LevelBasic LevelLevels of Critical Thinking in Nursing尽职层次尽职层次复杂层次复杂层次根底层次根底层次S M M U Strader (1992): “the process of establishing criteria by which alternative courses of action are developed and selected. Definitions Cli

19、nical decision making in nursing Smith H. and Donald (2002): A problem solving activity that focuses on defining client problems and selecting appropriate treatment interventions. S M M U Roche (2002): A complex process in which nurses combine theoretical knowledge with practical experience to make

20、judgments regarding client care. Definitions Clinical decision making in nursing Kozier et al (2000) : A critical thinking process for choosing the best actions to meet a desired goal. S M M U 护理临床决策就是护士在临床护理实际过程护理临床决策就是护士在临床护理实际过程中，对面临的景象或问题，从所拟定的假设干中，对面临的景象或问题，从所拟定的假设干个可供选择的方案中做出决断并付诸实施的过个可供选择的方案中

21、做出决断并付诸实施的过程。程。 Definitions Clinical decision making in nursingS M M U Ethical decision making 护理伦理决策护理伦理决策 Clinical decision making 护理临床决策护理临床决策 Managerial decision making in nursing 护理管理决策护理管理决策Classifications Decision making in nursing The classification is not absolutely! S M M U Identify/Define

22、 the Problem 确定问题确定问题 State the Goals/Identify the Objectives 陈说目的陈说目的 Seek Alternatives and Make Choices 寻求备择方案并做出决策寻求备择方案并做出决策 Implement the Solutions 实施方案实施方案 Evaluate and Feedback 评价和反响评价和反响Process stepsDecision making in nursingS M M UPersonal Factors/Individual Factors Influencing Factors Clin

23、ical Decision making in nursing Values Past Experience Knowledge Base Individual Preference and Risk Way of Thinking Emotional Intelligence Personal Characteristics S M M UEnvironmental Factors Influencing Factors Clinical Decision making in nursing The physical environmental factors The social environmental factors S M M USituational Factors Influencing Factors Clinical Decision