critical thinking and the nursing process：批判性思维与护理过程

CRITICALTHINKINGANDTHENURSINGPROCESSNRS101UnitIIISession3CriticalThinkingandNursingJudgmentHowdowemakedecisions?Howdonursesmakedecisionsaboutpatientcare?Whatdowerelyontohelpusindecisionmaking?CriticalThinkingandNursingJudgmentNotalinearstepbystepprocessProcessacquiredthroughhardwork,commitment,andanactivecuriositytowardlearningDecisionmakingistheskillthatseparatestheprofessionalnursefromtechnicalorancillarystaffCriticalThinkingandNursingJudgmentGoodproblemsolvingskillsNotalwaysacleartextbookanswerNursemustlearntoquestion,lookatalternativesHowdonurse'saccomplishthis?LearnstobeflexibleinclinicaldecisionmakingReflectonpastexperiencesandpreviousknowledgeListentootherspointofviewIdentifythenatureoftheproblemSelectthebestsolutionforimprovingclient’shealthDefinitionofCriticalThinkingCognitiveprocessduringwhichanindividualreviewsdataandconsiderspotentialexplanationsandoutcomesbeforeforminganopinionormakingadecision“Criticalthinkinginnursingpracticeisadisciplinespecific,reflectivereasoningprocessthatguidesthenurseingenerating,implementing,andevaluatingapproachesfordealingwithclientcareandprofessionalconcerns.”NLN2000CriticalThinkinginNursingPurposeful,outcome-directedEssentialtosafe,competent,skillfulnursingpracticeBasedonprinciplesofnursingprocessandthescientificmethodRequiresspecificknowledge,skills,andexperienceNewnursesmustquestionCriticalThinkinginNursingGuidedbyprofessionalstandardsandethiccodesRequiresstrategiesthatmaximizepotentialandcompensateforproblemsConstantlyreevaluating,self-correcting,andstrivingtoimproveFormulaforCriticalThinkingStartThinkingWhyAskWhyAsktheRightQuestionsAreyouanexpert?AspectsofCriticalThinkingReflectionLanguageIntuitionLevelsofCriticalThinkingBasicComplexCommitmentCriticalThinkingCompetenciesScientificmethodProblemSolvingDecisionMakingDiagnosticReasoningandInferencesClinicalDecisionMakingNursingProcessDevelopingCriticalThinkingAttitudes/SkillsNoteasyNot“eitheror”Self-assessmentToleratingdissonanceandambiguitySeekingsituationswheregoodthinkingpracticedCreatingenvironmentsthatsupportcriticalthinkingNursingProcessSystematicapproachthatisusedbyallnursestogatherdata,criticallyexamineandanalyzethedata,identifyclientresponses,designoutcomes,takeappropriateaction,thenevaluatetheeffectivenessofactionInvolvestheuseofcriticalthinkingskillsCommonlanguagefornursesto“thinkthrough”clinicalproblemsNursingProcessThinkingandLearningLifelongprocessFlexible,openprocessLearntothinkandtoANTICIPATEWhat,why,howquestionsLookbeyondtheobviousReflectonpastexperienceNewknowledgechallengesthetraditionalwayComponentsOfCriticalThinkingScientificKnowledgeBaseExperienceCompetenciesAttitudesStandardsAttitudesThatFoster

CriticalThinkingIndependenceFair-mindednessInsightintoethnocentricityIntellectualhumilityIntellectualcouragetochallengestatusquoIntegrityPreserveranceConfidenceCuriosityProfessionalStandardsEthicalcriteriaforNursingjudgment-CodeofEthicsCriteriaforevaluation-StandardsofcareStandardsofprofessionalresponsibilitythatnursesstrivetoachievearecitedinNursePracticeActs,TJCguidelines,institutionalpolicyandprocedure,ANAStandardsofNursingPracticeCriticalThinkingSynthesisReasoningprocessbywhichindividualsreflectonandanalyzetheirownthoughts,actions,&decisionsandthoseofothersNotastepbystepprocessNursingProcessTraditionalcriticalthinkingcompetency5Stepcircular,ongoingprocessContinuousuntilclientshealthisimproved,restoredormaintainedMustinvolveassessmentandchangesinconditionWhenusingtheNursingProcessIdentifyhealthcareneedsDeterminePrioritiesEstablishgoals&expectedoutcomesProvideappropriateinterventionsEvaluateeffectivenessNursingProcess

AssessmentDiagnosisPlanningImplementationEvaluationAssessmentSystemicallycollects,verifies,analyzesandcommunicatesdataTwostepprocess-CollectionandVerificationofdata&AnalysisofdataEstablishesadatabaseaboutclientneeds,healthproblems,responses,relatedexperiences,healthpractices,values.lifestyle,&expectationsCriticalThinkingandAssessmentProcessBringsknowledgefrombiological,physical,&socialsciencesasbasisforthenursetoaskrelevantquestions.NeedknowledgeofcommunicationskillsPriorclinicalexperiencecontributestoassessmentskillsApplyStandardsofPracticePersonalAttitudesAssessmentDataSubjectiveDataObjectiveDataSourcesofDataMethodsofDataCollection-InterviewInterviewinitiatesnurse-clientrelationshipUseopen-endedquestionsNursinghealthhistoryNursingDiagnosisStatementthatdescribestheclient’sactualorpotentialresponsetoahealthproblemFocusesonclient-centeredproblemsFirstintroducedinthe1950’sNANDAestablishedin1982StepofthenursingprocessthatallowsnursetoindividualizecarePlanningforNursingCareClient-centeredgoalsandexpectedoutcomesareestablishedPrioritiesaresetrelatingtounmetneedsMaslow’sHierarchyofNeedsisausefulmethodforsettingprioritiesPrioritiesareclassifiesashigh,intermediate,orlowPurposeofGoalsandOutcomesProvidesdirectionforindividualizednursinginterventionsSetsstandardsofdeterminingtheeffectivenessofinterventionsIndicatesanticipatedclientbehaviororresponsetonursingcareEndpointofnursingcareGoalsofCare

Goal:GuidepoststotheselectionofnursinginterventionsandcriteriaintheevaluationofinterventionsWhatyouwanttoachievewithyourpatientandinwhattimeframeShorttermvs.LongtermOutcomeOfCare:Whatwasactuallyachieved,wasgoalmetornotmet

NursingInterventionsInterventionsareselectedaftergoalsandoutcomesaredeterminedActionsdesignedtoassistclientinmovingfromthepresentlevelofhealthtothatwhichisdescribedinthegoalandmeasuredwithoutcomecriteriaUtilizescriticalthinkingbyapplyingattitudesandstandardsandsynthesizingdataTypesofInterventionsNurse-InitiatedPhysician-InitiatedCollaborativeInterventionsSelectionOfInterventionUsingclinicaldecisionmakingskills,thenursedeliberates6factors:Diagnosis,expectedoutcomes,researchbase,feasibility,acceptabilitytoclient,competencyofnurseNursingCarePlansWrittenguidelinesforclientcareOrganizedsonursecanquicklyidentifynursingactionstobedeliveredCoordinatesresourcesforcareEnhancesthecontinuityofcareOrganizesinformationforchangeofshiftreportNursingCarePlansvsConceptMapsNCPConcept/MindMapImplementationofNursingInterventionsDescribesacategoryofnursingbehaviorsinwhichtheactionsnecessaryforachievingthegoalsandoutcomesareinitiatedandcompletedActiontakenbynurseTypesofNursingInterventionsStandingOrders:Documentcontainingordersfortheuseofroutinetherapies,monitoringguidelines,and/ordiagnosticprocedureforspecificconditionProtocols:Writtenplanspecifyingthep