Jen Ch 15 Flashcards
critical thinking
Active, purposeful, organized, cognitive process used to carefully examine one’s thinking and the thinking of other individuals. (“Why?”, “What am I missing?”, “What do I really know about this patient’s situation?”, and “What are my options?”)
evidenced based knowledge
knowledge based on research or clinical expertise, makes you an informed critical thinker.
critical thinking skills
- Interpretation
- Analysis
- Inference
- Evaluation
- Explanation
- Self regulation
Concepts for critical thinkers
- Truth seeking
- Open-mindedness
- analyticity
- systematicity
- self-confidence
- inquisitiveness
- Maturity
Interpretation
Critical Thinking Skill: Look for patterns to categorize data (e.g., nursing diagnoses. Clarify any data you are uncertain about.
analysis
Critical Thinking Skill: Be open-minded as you look at information about a patient. Do not make careless assumptions. Do the data reveal what you believe is true, or are there other options?
Inference
Critical thinking skill: Look at the meaning and significance of findings. Are there relationships between findings? Do the data about the patient help you see that a problem exists?
evaluation
critical thinking skill: Look at all situations objectively. Use criteria (e.g., expected outcomes, pain characteristics, learning objectives) to determine results of nursing actions. Reflect on your own behavior.
explanation
critical thinking skill: Support your findings and conclusions. Use knowledge and experience to choose strategies to use in the care of patients.
self-regulation
critical thinking skill: Reflect on your experiences. Identify the ways you can improve your own performance. What will make you believe that you have been successful?
truth-seeking
critical thinking concept: Seek the true meaning of a situation. Be courageous, honest, and objective about asking questions.
open-mindedness
critical thinking concept: Be tolerant of different views; be sensitive to the possibility of your own prejudices; respect the right of others to have different opinions.
analyticity
critical thinking concept: Analyze potentially problematic situations; anticipate possible results or consequences; value reason; use evidence-based knowledge.
systematicity
critical thinking concept: Be organized, focused; work hard in any inquiry.
self-confidence
critical thinking concept: Trust in your own reasoning processes.
inquisitiveness
critical thinking concept: Be eager to acquire knowledge and learn explanations even when applications of the knowledge are not immediately clear. Value learning for learning’s sake.
maturity
critical thinking concept: Multiple solutions are acceptable. Reflect on your own judgments; have cognitive maturity.
basic critical thinking
learner trusts that experts have the right answers for every problem. Thinking is concrete and based on a set of rules or principles
Complex critical thinking
analyze and examine choices more independently. The person’s thinking abilities and initiative to look beyond expert opinion begin to change.
commitment
third level of critical thinking - a person anticipates when to make choices w?o assistance from others and accepts accountability
scientific method
1 Identifying the problem
2 Collecting data
3 Formulating a question or hypothesis
4 Testing the question or hypothesis
problem solving
Methodical, systematic approach to explore conditions and develop solutions, including analysis of data, determination of causative factors, and selection of appropriate actions to reverse or eliminate the problem.
decision making
Process involving critical appraisal of information that results from recognizing a problem and ends with generating, testing, and evaluating a conclusion. Comes at the end of critical thinking..
diagnostic reasoning
Process that enables an observer to assign meaning to and classify phenomena in clinical situations by integrating observations and critical thinking.
inference
process of drawing conclusions from related pieces of evidence and previous experience with the evidence. An inference involves forming patterns of information from data before making a diagnosis.
clinical decision making
Problem-solving approach that nurses use to define patient problems and select appropriate treatment.
nursing process
lem-solving method by which nurses individualize care for each patient. The five steps of the nursing process are:
- assessment,
- diagnosis,
- planning,
- implementation, and
- evaluation.
Clinical Decision Making for Groups of Patients
• Identify the nursing diagnoses and collaborative problems of each patient
- Analyze patients’ diagnoses/problems and decide which are most urgent on the basis of basic needs, the patients’ changing or unstable status, and problem complexity (see Chapter 18).
- Consider the time it will take to care for patients whose problems are of high priority (e.g., do you have the time to restart a critical intravenous (IV) line when medication is due for a different patient?).
- Consider the resources you have to manage each problem, nursing assistive personnel assigned with you, other health care providers, and patients’ family members.
- Consider how to involve the patients as decision makers and participants in care.
- Decide how to combine activities to resolve more than one patient problem at a time.
- Decide which, if any, nursing care procedures to delegate to assistive personnel so you are able to spend your time on activities requiring professional nursing knowledge.
- Discuss complex cases with other members of the health care team to ensure a smooth transition in care requirements.
Yahiro and Saylor model: critical thinking components
- knowledge base,
- experience,
- critical thinking competencies (with emphasis on the nursing process),
- attitudes, and
- standards.
The elements of the model combine to explain how nurses make clinical judgments that are necessary for safe, effective nursing care
Specific Knowledge Base
knowledge base includes information and theory from the basic sciences, humanities, behavioral sciences, and nursing
experience
Clinical learning experiences are necessary to acquire clinical decision-making skills. knowledge combined with clinical expertise from experience defines critical thinking.
Critical Thinking Attitudes and Applications in Nursing Practice
- Confidence
Learn how to introduce yourself to a patient; speak with conviction when you begin a treatment or procedure. Do not lead a patient to think that you are unable to perform care safely. Always be well prepared before performing a nursing activity. Encourage a patient to ask questions.
- Thinking independently
Read the nursing literature, especially when there are different views on the same subject. Talk with other nurses and share ideas about nursing interventions.
- Fairness
Listen to both sides in any discussion. If a patient or family member complains about a co-worker, listen to the story and then speak with the co-worker as well. If a staff member labels a patient uncooperative, assume the care of that patient with openness and a desire to meet that patient’s needs.
- Responsibility and authority
Ask for help if you are uncertain about how to perform a nursing skill. Refer to a policy and procedure manual to review steps of a skill. Report any problems immediately. Follow standards of practice in your care.
- Risk taking
If your knowledge causes you to question a health care provider’s order, do so. Be willing to recommend alternative approaches to nursing care when colleagues are having little success with patients.
- Discipline
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.
- Perseverance
Be cautious of an easy answer. If co-workers give you information about a patient and some fact seems to be missing, clarify the information or talk to the patient directly. If problems of the same type continue to occur on a nursing division, bring co-workers together, look for a pattern, and find a solution.
- Creativity
Look for different approaches if interventions are not working for a patient. For example, a patient in pain may need a different positioning or distraction technique. When appropriate, involve the patient’s family in adapting your approaches to care methods used at home.
- Curiosity
Always ask why. A clinical sign or symptom often indicates a variety of problems. Explore and learn more about the patient so as to make appropriate clinical judgments.
- Integrity
Recognize when your opinions conflict with those of a patient; review your position, and decide how best to proceed to reach outcomes that will satisfy everyone. Do not compromise nursing standards or honesty in delivering nursing care.
- Humility
Recognize when you need more information to make a decision. When you are new to a clinical division, ask for an orientation to the area. Ask registered nurses (RNs) regularly assigned to the area for assistance with approaches to care.
Reflective Journaling questions
1 Which experience, situation, or information in your clinical experience seems confusing, difficult, or interesting?
2 What is the meaning of the experience? What feelings did you have? What feelings did your patient have? What influenced the experience? Which guesses or questions developed with the first connection in question 1? Give examples.
3 Do the feelings, guesses, or questions remind you of any experience from the past or present or something that you think is a desirable future experience? How does it relate? What are the implications/significance?
4 What are the connections between what is being described and what you have learned about nursing science, research, and theory? What are some possible solutions? Which approach or solution would you choose and why? How is this approach effective?
concept map
a visual representation of patient problems and interventions that shows their relationships to one another. It offers a nonlinear picture of a patient that can then be used for comprehensive care planning
