NURS 205 Critical Thinking in Nursing
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Transcript NURS 205 Critical Thinking in Nursing
Sheryl Abelew MSN RN
Chapter 4
Important
step in the critical thinking
process
Includes effective time management
Steve Covey (1989) states you should be
“putting first things first”. There are three
categories “must do, should do, and nice to
do”.
Develop a time frame for priorities.
***Review box 4-2 Time Management
Procedures
Use
Maslow’s hierarchy of needs
Five levels of needs
Physiologic needs
Psychological needs
Affiliation, affection, intimacy
Self-esteem
Safety and security
Love and belonging
Sleep, food, water, movement, comfort
Sense of self worth, self respect, dignity
Self-actualization
Recognition of potential growth, health, autonomy
Place
Low
High
in level of priority High, Medium, and
Life threatening, threats to pt safety, pain, and
anxiety, unstable or changes in condition
Medium
Problems that could result in unhealthy
consequences, like emotional or physical
impairment, but no threat on life
Low
Problems that can be resolved with minimal
intervention and have little potential to cause
dysfunction
Four
levels of priority according to Rubenfeld
and Scheffer (1999)
Life Threatening Issues
Safety
Protecting the patient from injury, practicing within
scope of nursing, doing no harm
Patient Priorities
ABC’s
Plan of care based on patient activities and condition
Nursing Priorities
Examine all the patients strengths and health
concerns, moral and ethical and Maslow’s hierarchy of
needs
Setting
priorities is not linear
Addresses multiple concerns at the same
time
Learning to take charge and make efficient
use of time is key in time management
Making a to do list will help with multitasking
Assessment
Analysis
Select diagnosis and activities
Implementation
Have measureable goals based on Maslow, and prioritize
diagnosis
Plan
Prepare list of needs and diagnosis
Outcome Identification
Obtain complete information and sort and ID problems
Perform immediate actions to prevent harm first.
Highest priority to lowest priority
Evaluation
May require reevaluation and/or adjustments
Priorities
may change
Inadequate assessment of clients needs
Failure to differentiate priority and non
priority tasks
Accepting others priorities without seeing
the big picture
Performing tasks that were identified first vs.
those that are a priority
Completing the easiest task first instead of
the priority
Chapter 5
“Nursing
Process is considered to be a
specialized form of systematic inquiry or
problem solving process used in drawing
conclusions about the patient’s problems and
the corresponding nursing actions to resolve
problems.” Saucier, Stevens * Williams
(2002).
Allows
for a consistent use of standards and
standardized language providing for a way to
measure and quantify the effects of nursing
care and interventions
In order to keep terms consistent, ANA
recognizes NANDA as the official language of
nursing diagnosis, NIC for interventions
classification, and NOC for outcomes
classifications
Assessment
Analysis
(Diagnosis)
Outcome Identification
Plan
Implementation
Evaluation
Collect
data
Identify pertinent data
Recognize deviations from normal
Validate data
Sort and Organize data in a logical order
Identify patterns in the data
Examine
for unmet needs and strengths and
health concerns
Focus on problems the nurse can change
Develop diagnosis based on facts
Validate the diagnosis
Establish priorities
Establish
outcomes
Realistic
Achievable
Measureable
Collaborate
to review goals to meet needs
How
to develop your strategies for meeting
nursing interventions
Use NIC for nursing interventions
Write plan of care using standardized
language
Collaborate for planning delivery of care
Initiate
actions to accomplish goals
Manage care in order of priority
Delegate care based on caregiver, acuity,
needs and plan of care
Intervene as necessary
Document interventions and response
Compare
actual vs. expected outcomes
Communicate findings
Record attainment of goal
Review and modify POC based on needs
Written
documentation of the nursing
process
See
Box 5-3 for care plan formation
See
Table 5-5 for sample care plan scenario
Chapter 6
Transferring
tasks to a competent individual
Used most commonly with a skill mix based
on scope of practice
Consider job description when delegating
Right
Task
Right Circumstance
Right Person
Right Direction and Communication
Right Supervision and Evaluation
Delegator
reluctant to take the risk and give
up control
Subordinate fails to take responsibility
Workplace issues
Assessment
List patients need and assessment findings
Analysis
Level of care and acuity
Outcome
identification
Establish priorities
Plan
Nurse specifies nature of tasks and skill required
Implementation
Delegation of tasks
Evaluation
Compare outcomes with the POC
Chapter 7
Three
Social
Interactions for building relationships
Therapeutic
levels of Communication
Nurse listens to patient problems and focuses on needs
Collegial
Enhancing relationships with colleagues, improved pt
care, and better documentation
Nursing
Personnel
Delegating
Report
Interdisciplinary
Conflict resolution
Physician notification
Receiving phone calls
Documentation
One way to validate critical thinking
Keep confidential
Accurate and objective
Performed promptly
Chapter 8
Goal
directed based on rationale thought
processes
Involves critical thinking
Approached analytically
4
areas must be assessed
What the patient needs to learn
Characteristics of the patient
Patients preferred learning style
Whether patient is ready/willing to learn
Conduct
a learning needs assessment
Assess cultural background
Developmental stage consideration
Literacy
Analyzing
Validate with the patient
Outcome
identification
ID goals, clear objectives
Planning
needs
the lesson
Instructional methods
Traditional i.e. lecture, discussion
Non traditional i.e. role-playing, simulations, etc
Implementing
educational session
Evaluating the educational process
Chapter 9
When
processing data, continually evaluate
reasoning
Examine the evidence to determine what
else is needed
Obtain and clarify data
Examine logic and give reasons for
conclusions
Review the consequences of possible actions
and draw conclusions if desired outcome can
be obtained
Use
professional standards as guidelines to
decision making when evaluating patient
circumstances, and then consider the
textbook data, current diagnostic test
findings, and assessments of the nurse
Nurses need to follow the regulations set
forth according to scope of practice and
standards of practice as well as the code of
ethics for nurses when making decisions
Review box 9-2 pg 199
Nurse
collects information and uses skill of
interpretation to define what the patient is
presenting as
Nurse establishes expected outcomes for
interventions to determine if the problem
will be resolved
After implementation, nurse will evaluate on
an ongoing basis progress towards goals
After recognizing effects from intervention,
nurse will offer rationale for the result
Lastly, nurse will reexamine thinking
Quality
implies evaluation
Evaluation requires standards which define
the acceptable levels of care
Nurse must evaluate actions to the
professional practice standards from the ANA
Indicators
that identify impossible workload
Failure to monitor when indicated by patients
condition
Inadequate treatment for circumstances
Excessive delay of treatments
Failure to provide ongoing care and treatments
Lack of time to provide patient teaching
Use
clinical reasoning to monitor patients
change of condition and respond with the
appropriate intervention
Two examples of monitoring the patients
condition
Calling the physician
When there is a change in condition
Pain without ordered meds that manage the pain
Acute elimination problems
Lab values that require orders
Risk to safety
Interpreting lab values
Are the findings abnormal and expected
Are the findings abnormal and unexpected
Are the findings normal
Failure
to use appropriate decision making
skills
Failing to assess, report, or omissions
Failure to assess for changing of condition
Nurse fails to perform duties appropriately
results in negligence
Chapter 10
Ethics
deals with the principles of right and
wrong
Foundation of ethics is standards of conduct
and moral judgment
Nurses must be aware of their own value
system
Choosing
Allows for free choice identifying alternatives
and selecting alternatives
Prizing
Individual satisfaction with choice of
verbalization to others
Acting
(Internalization and repetition)
Ethical Principles
Autonomy
Nonmaleficence
Moral obligation to treat people fairly and equally
Fidelity
Doing good on the patients behalf
Justice
Directs the nurse does no harm
Beneficence
Right to self-determination
Keeping your word and acting in the patient’s best
interest
Veracity
Telling the truth
ANA
as developed a code of ethics
Nine statements define this code
Review pg 233 Box 10-3
Assessment
Analysis
Outcome
Identification
Plan
Implementation
Evaluation
**
Gather
information to determine the facts
that will have the most affect on the
situation
Develop sensitivity to recognize ethical
situation and its essence to nursing
Identify risks to the patients
Determine
the values in conflict
Become aware of the relevant information
Values clarification
Generate multiple alternatives and rank in
order of what is right and wrong
Explore emotional, social and physical risks
to patient and staff
Providing
safe nursing care
Expected outcome should serve as a guide in
making decisions
Use clearly stated outcomes for success to be
measureable
Decision
maker should choose the best
options for prioritizing of needs to achieve
the desired outcome
Organize information and alternatives that
represent various moral views
Be prepared to defend your choice
Stay focused on the outcome to stay focused
on the real problem
Implement
the moral action selected to
resolve the dilemma
Follow chain of command
Support a blame free environment
Were
the actions ethical?
Did the solution generate the desired
outcome?
Can you justify the consequences?
Do the benefits outweigh the risks?
Hospitals
and long term care facilities have
groups of individuals who discuss, clarify, and
resolve issues related to patient care welfare
Goal is to support objectivity in difficult
patient care decisions
Best when whole team and patient and
families are involved
Self-Determination
Professional
Risk for injury
Usually with the demented, depression, or delirium
Inadequate staffing
Caregiver Issues
Staffing appropriate for acuity of patients
Nurses practicing out of their specialty or knowledge
base
Biomedical advances
Transplants, in vitro, etc.
Disregard
for others
Using others without considering them
Inappropriate
Making decisions that another prudent
professional would not make
Personal
gain
Having ulterior motives
Conflict
application of standards
of values
Responding to needs without concern for those
affected
Chapter 11
A
skill required in choosing how to meet the
needs of a group of patients
Requires
Problem solving
Priority setting
Decision making
Good application of the nursing process
Ability to identify variations in patients
Strong knowledge base
Sound nursing decisions
First
level priorities
Life threatening
Unstable, worsening of condition
Second
Delay may cause untoward results
Nonemergent
Scheduled meds, mental status changes, acute pain
Third
level priorities
level priorities
Deficits that can easily be resolved or do not
affect normal function
Bathing, grooming, emotional support
Review
implications if care/treatment were
to be delayed
Develop and action plan
Scheduled activities should be primary
consideration
Determine
who can do it
Consider the roles of available UAP
Evaluate competency of staff
Nurses
should not refuse because of a lack of
skill
Focus on what they can do and what they
can help with being supervised
Educational preparation is ideal
Review pg 264 Box 11-3
Review pg 264 box 11-4
If an assignment is out of scope of practice
submit an occurrence report and request
additional training
ED
nurses
Coronary intensive care nurses
Pediatric nurses
Obstetric nurses
Oncology nurses
Psychiatric nurses
Medical/surgical nurses
Consider
circumstances and need
Gender
LOC
Acuity
Special
needs
Age
Medical
dx
Staffing
Family
requests
Failure
to use nursing judgment
Inability to gather data
Inadequate decision making
Inability to prioritize
Incompetent application of cognitive skills
Failure to ID impact of action on an outcome