While assessing a patient, the nurse observes that the patient's intravenous (IV) line is not infusing at the ordered rate. The nurse assesses the patient for pain at the IV site, checks the flow regulator on the tubing, looks to see if the patient is lyi
problem solving
how is problem solving done
the nurse collects information and tried options until she is able to find a solution to the problem
the nurse sits down to talk to a patient who lost her sister 2 weeks ago. the patient reports she is unable to sleep, feels very tired during the day, and is having trouble at work. the use asks her to clarify the type of trouble. the patient explains she
diagnostic reasoning
how is diagnostic reasoning done
the nurse collects info about the patient, sees patterns in the data collects and makes a nursing diagnosis
the patient on a surgical unit develops sudden shortness of breath and a drop in BP. the stand response but the patient dies 30 mins later. the manager on the nursing until calls the staff involved in the emergency response together. the staff discuss wha
conducting reflective practice
a conscious process of thinking, analyzing, and learning from previous situations
the process of conducting reflective practice
A nurse has worked on an oncology unit for 3 years. One patient has become visibly weaker and states, "I feel funny." The nurse knows how patients often have behavior changes before developing sepsis when they have cancer. The nurse asks the patient quest
analyticity, self confidence
A nurse who is working on a surgical unit is caring for four different patients. Patient A will be discharged home and is in need of instruction about wound care. Patients B and C have returned from the operating room within an hour of each other, and bot
Consider how to involve patient A in deciding whether to involve the family caregiver in wound care instruction.
examples of clinical decision making for groups of patients.
Considering how to involve patients in decisions and how to combine nursing activities to be more organized and allow for resolving more than one problem at a time
The surgical unit has initiated the use of a pain-rating scale to assess patients' pain severity during their postoperative recovery. The registered nurse (RN) looks at the pain flow sheet to see the pain scores recorded for a patient over the last 24 hou
consistent
During a home health visit the nurse prepares to instruct a patient in how to perform range-of-motion (ROM) exercises for an injured shoulder. The nurse verifies that the patient took an analgesic 30 minutes before arrival at the patient's home. After dis
I understand your reluctance, but the exercises are necessary for you to regain function in your shoulder. Let's go a bit more slowly and try to relax.
The nurse cared for a 14-year-old with renal failure who died near the end of the work shift. The health care team tried for 45 minutes to resuscitate the child with no success. The family was devastated by the loss, and, when the nurse tried to talk with
Description of the efforts to restore the child's blood pressure, what was used, and questions about the child's response
A nurse has been working on a surgical unit for 3 weeks. A patient requires a Foley catheter to be inserted, so the nurse reads the procedure manual for the institution to review how to insert it. The level of critical thinking the nurse is using is:
basic critical thinking
basic critical thinking
the use trusts that the experts have the right answers for how to do something
A patient had hip surgery 16 hours ago. During the previous shift the patient had 40 mL of drainage in the surgical drainage collection device for an 8-hour period. The nurse refers to the written plan of care, noting that the health care provider is to b
evaluation
The nurse asks a patient how she feels about her impending surgery for breast cancer. Before the discussion the nurse reviewed the description of loss and grief and therapeutic communication principles in his textbook. The critical thinking component invo
knowledge application
A nurse is working with a nursing assistive personnel (NAP) on a busy oncology unit. The nurse has instructed the NAP on the tasks that need to be performed, including getting patient A out of bed, collecting a urine specimen from patient B, and checking
A nurse explains to the NAP the approach to use in getting the patient up and why the patient has activity limitations.
successful delegation is represented by what
good communication, showing respect, showing initiative
Which of the following is unique to the commitment level of critical thinking?
anticipates when to make choices without assistance
analyzing and examining choices and weighing benefits and risk are characteristics of
complex critical thinking
In which of the following examples is the nurse not applying critical thinking skills in practice?
The nurse explains the procedure for giving a tube feeding to a second nurse who has floated to the unit to assist with care.
clinical decision making involves judgement that includes
critical and reflective thinking and action and application of scientific and practical logic
nurses who apply critical thinking in their work focus on
options for solving problems and making decisions rather than rapidly and carelessly forming quick, and single solutions
an example of basic critical thinking
following a procedure step by step without adjusting to a patients unique needs
in complex critical thinking a nurse learns that
alternative and perhaps conflicting solutions exists
in diagnostic reasoning you collect
data and analyze them to determine the patients problems
a blueprint for patient care that involves both general and specific critical thinking competencies in a way that focuses on a particular patients unique needs
the nursing process
combines a nurse's knowledge base, experience, competence in the nursing process, attitudes, and standards to explain how nurses make clinical judgements that are necessary for safe and effective nursing care.
the critical thinking model
critical thinking attitudes
help you to know when more info is necessary and when it is misleading and to recognize your own knowledge limits
the use of intellectual standards during assessment ensure
that you obtain a complete database of information
professional standards of critical thinking refer to
ethical criteria for nursing judgements, evidence base criteria for evaluation and criteria for professional responsibility
meeting regularly with colleagues allows you to
discuss anticipated and unanticipated outcomes in any clinical situation to continually learn and develop your expertise and knowledge
process used to examine ones thinking and the thinking of others
critical thinking
based on research or clinical expertise
evidence-based knowledge
seek the true meaning to a situation
truth seeking
be tolerant of different views and own prejudices
open mindedness
1. interpretation 2. analysis 3. inference 4. evaluation 5. explanation 6. self- regulation
critical thinking skills
anticipate possible results or consequences
analyticity
being organized
systematically
trust in your own reasoning process
self confidence
be eager to acquire new knowledge and value learning
inquisitiveness
reflect upon your own judgements
maturity
basic, complex, commitment
the three levels of critical thinking
begin to separate themselves authorities, makes choices more independently
complex love of critical thinking
anticipates the need to make choices without assistance from others
commitment level of critical thinking
systematic, ordered approach to gathering data and problem solving
scientific method
evaluating the solution over time to make sure it is effective
problem solving
focuses on problem resolution
decision making
determining a clients health status after you have assigned meaning to the behaviors and symptoms presented
diagnostic reasoning
drawing conclusions from related pieces of evidence
inference
careful reasoning so that the best options are chosen for the best oucomes
clinical decision making
five step clinical decision making approach
nursing process
knowledge, experience, critical thinking competencies, attitudes, standards
five components of critical thinking
speak with conviction and always be prepared to perform care safely
confidence
reads the nursing literature, considering wide range of ideas before making own conclusions
thinking independently
listen to both sides in any discussion
fairness
willing to accept an obligation and be accountable for an action or situation
responsibility
willing to recommend alternative approaches to nursing care
risk taking
take time to be thorough and manage time effectively
discipline
cautious of an easy answer, look for a pattern and find a solution
perseverance
look for different approaches if interventions are not working
creativity
explore and learn more about a client to make appropriate clinical judgements
curiosity
do not compromise nursing standards or honesty in delivering nursing care
integrity
recognize when you need more information to make a decision
humility
intellectual and professional
two standards used in the critical thinking model
a guideline or principle for rational though
intellectual as used in the critical thinking model
refers to ethical criteria for nursing judgements; evidence based used for evaluation and criteria for professional responsibility
professional as used in the critical thinking model
recalling a situation to discover its purpose meaning
reflective journaling
a visual representation of client problems and interventions that shows their relationships to one another
concept mapping
process of thinking back and recalling an event or discovering the meaning and purpose of that event
reflection
a prediction of a probable outcome of a disease or condition of a client and the usual course of the disease as observed in similar situations
prognosis
a continuous process characterized by open mindedness, continual inquiry and perseverance, combines with a willingness to look at each unique patient situation and determine which indented assumptions are true and relevant
critical thinking