chapter 5 critical thinking and the nursing process fundamentals of nursing: standards &...
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Copyright 2002 by Delmar, a division of Thomson Learning 5-3 Components of Critical Thinking Mental operations Knowledge AttitudesTRANSCRIPT
Chapter 5Critical Thinking and the Nursing Process
Fundamentals of Nursing: Standards & Practices, 2E
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Critical ThinkingCritical thinking is “…reasonable
reflective thinking that is focused on deciding what to believe or do” (Ennis, 1987).
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Components of Critical ThinkingMental operationsKnowledgeAttitudes
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Phases of Critical ThinkingTrigger eventAppraisal of the eventExplorationIntegration
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Promoting Development & Application of Critical Thinking Identify goals Determine what knowledge is required Assess the margin for error Determine the amount of time available
for decision making Identify available resources Recognize factors that may influence
decision making
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Critical Thinking SkillsInterpretationAnalysisInfluenceExplanationEvaluationSelf-regulation
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Critical Thinking and Creativity Critical thinkers are also creative
thinkers. Creative thinking is the foundation for
individualizing client care. A major block to creativity is groupthink. It takes intellectual courage to think
something different from one’s peers and then act on those thoughts.
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Critical Thinking and Problem Solving Critical thinkers avoid pitfalls of problem
solving by defining a problem, analyzing the data, understanding the causes, and creating new ideas that will lead to problem resolution.
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Critical Thinking and Decision Making Nurses exercise clinical judgment by making
sound decisions. Clinical judgment is viewed as critical thinking
applied in clinical situations. Nursing judgments are formed after collecting
and examining assessment data. Nursing judgments occur in every phase of the
nursing process.
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Nursing ProcessThe nursing process “…provides the
basis for critical thinking in nursing” (Alfaro-LeFavre, 1998).
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Historical Perspective Lydia Hall (1955) first referred to nursing
as a “process”. Yura and Walsh (1967) identified four
steps in the nursing process: assessing, planning, implementing, and evaluating.
In 1974, Gebbin and Lavin added nursing diagnosis to the above steps.
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Overview of the Nursing Process
A process is a series of steps or acts that leads to accomplishment of some goal or purpose.
The purpose of the nursing process is to provide individualized, holistic, effective, and efficient care to clients.
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Steps in the Nursing ProcessAssessment
• Collecting data from a variety of sources
• Validating the data• Organizing data• Categorizing or identifying patterns in
data
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• Making initial inferences or impressions
• Recording or reporting data• Types of data
Primary data source Secondary data source Subjective data Objective data
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Diagnosis• Diagnosis involves analysis and synthesis of
the data that have been collected.• Formulation of the list of nursing diagnoses
is the outcome of this process.• Nursing diagnoses provide the basis for
client care delivered through the remaining steps of the nursing process.
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• Types of nursing diagnoses Actual nursing diagnosis Risk nursing diagnosis Possible nursing diagnosis Wellness nursing diagnosis
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Outcome Identification and Planning
• Formulate guidelines that establish the proposed course of nursing action in the resolution of nursing diagnoses
• Develop the client’s plan of care• Planning can begin once the nursing
diagnoses have been developed and client strengths have been identified.
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• The planning phase involves several tasks The list of nursing diagnoses is prioritized. Client-centered long- and short-term goals
are written. Specific interventions are developed. The entire plan of care is recorded in the
client’s record.
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• Goals are broad statements that describe the intended change in the client’s behavior.
• Expected outcomes are specific objectives related to the goals and are used to evaluate the nursing interventions.
• Nursing interventions are activities that the nurse will execute to enable accomplishment of the goals.
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Implementation includes• the execution of the nursing plan of care• nursing activities that have been planned to
meet the goals set with the client• assessment skills, psychomotor skills, and
interpersonal skills• reporting and documentation
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Evaluation• determines if the client goals have
been met, partially met, or not met• is an ongoing process• Nurses continually evaluate data in
order to make informed decisions during other phases of the nursing process.