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The Nursing Process: Critical Thinking

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Title: The Nursing Process: Critical Thinking


1
The Nursing ProcessCritical Thinking
Assessment
  • Amy C. Chavarria, RN, MSN, MBA, HCM, CCE

2
Thinking Critically, Making Decisions, Solving
Problems
3
Critical Thinking Skills
  • Critical analysis
  • Inductive and deductive reasoning
  • Making valid inferences
  • Differentiating facts from opinions
  • Evaluating the credibility of information sources
  • Clarifying concepts
  • Recognizing assumptions

4
Critical Thinking Attitudes
  • Independence
  • Fair-mindedness
  • Insight
  • Intellectual humility
  • Intellectual courage
  • Integrity
  • Perseverance
  • Confidence
  • Curiosity

5
Significance of Developing Critical Thinking
  • Essential for safe, competent, skillful nursing
    practice
  • Rapid and continuing growth of knowledge
  • Make complex and important decisions
  • Draw meaningful information from other subject
    areas
  • Work in rapidly changing, stressful environments
  • Recognize important cues, respond quickly, and
    adapt interventions

6
Top 10 Reasons to Improve Thinking
  • Things change
  • Sicker clients
  • More consumer involvement
  • Need to move from one setting to another
  • Need for new learning and workplace skills
  • Requirement for evidence of benefits, efficiency,
    and results
  • New problems cant be solved with old ways of
    thinking
  • Thinking skills needed to deal with todays world
  • Possible to improve thinking
  • Difference between success and failure

7
Critical Thinking and Nursing
  • Critical thinking underlies each step of the
    nursing, problem-solving, and decision-making
    processes

8
The Nursing Process
  • Method of planning and providing individualized
    care
  • Modified problem-solving process
  • Assess, diagnose, plan, implement, evaluate

9
Problem-Solving Process
  • Clarify the nature of a problem and suggests
    possible solutions
  • Evaluate solutions and choose best one to
    implement
  • Commonly used approaches
  • Trial and Error
  • Intuition
  • Research process
  • Scientific method

10
Decision-Making Process
  • Choosing the best actions to meet a desired goal
  • Identify purpose
  • Set and weigh criteria
  • Seek and examine alternatives
  • Project, implement, and evaluate outcome

11
Ways of Demonstrating Critical Thinking
  • Rigorous personal assessment
  • Reflection
  • Analysis of thinking processes and attitudes
  • Cultivation of critical thinking abilities
  • Attendance at conferences
  • Awareness of own thinking-while thinking
  • Create environments that support critical thinking

12
Mind Map
13
NURSING PROCESSASSESSMENT
14
Historical Development
  • Nursing Process is synonymous with the
    __________________ solving approach.
  • Before Nursing Process, proof of care was loosely
    structured and unorganized.
  • Nursing Process introduced in 1955 by Lydia Hall
    but wasnt used extensively until the
    ___________s.

15
  • Started with a _____ step process.
  • Social Policy Statement (1980) The ANA
    identified diagnosis of ______________ and
    potential health problems as part of nursing
    practice.
  • The actual development of nursing process as a
    _____ step model, which is used today, was
    introduced by the ANA in 1991 and includes
    Outcomes.

16
  • Your text has a 5 step (phase) model.
  • Is one better than the other?
  • Why different models?
  • What did the leave out?

17
6 Steps (Phases) Model
  • Assessment
  • Diagnosis
  • Outcome Identification
  • Planning
  • Implementation
  • Evaluation

18
KE Identifies 5 Steps Or Phases
  • Assessing
  • Diagnosing
  • Planning
  • Implementing
  • Evaluating

19
Comparison of both model
  • 6 STEP
  • Assessment
  • Diagnosing
  • Outcome Identification
  • Planning
  • Implementation
  • Evaluation
  • 5 STEP
  • Assessment
  • Diagnosing
  • Planning
  • Implementation
  • Evaluation

20
What Is Nursing Process?
  • ______________________ problem-solving approach
    to giving individual nursing care.
  • It is a model used to make decisions about client
    ______________.
  • Serves as a ______________ for professional
    nursing practice.
  • It requires ________________ thinking skills.

21
Characteristics
  • The nursing process has unique characteristics
    that enable responsiveness to the
    __________________ health status of the client.
  • Cyclic (____________ itself) and dynamic (ever
    ______________________)
  • Client ________________ using client strengths
    not nurse or physician centered

22
Characteristics (cont.)
  • Focuses on problem solving and decision making
  • In every ________________ of the process
  • Allowing nurses to be creative and use all their
    skills and ________________________
  • This facilitates ________________________ of
    client care

23
Characteristics (cont.)
  • Interpersonal and collaborative -- involves
    communication with
  • ________________________
  • ________________________
  • Others in the health care team

24
Characteristics (cont.)
  • Universal applicability
  • Appropriate throughout _______________
  • Can be used in ___________ settings
  • Use of critical thinking
  • See page 261 of text TABLE 16-2

25
Characteristics (cont.)
  • Looks at _________________ person
  • ___________________ AND SYSTEMATIC
  • Framework for CARE to individuals, families and
    communities

26
Interactive Nature
  • Each phase interacts and is influenced by
    _____________ phases.
  • As condition ________________, the nurse gathers
    and incorporates information into __________ plan
    of care.

27
Skills Requirements
  • ________________ knowledge based of basic
    sciences and humanities.
  • Ability to communicate in _________________.
  • Ability to ______________.

28
Nursing Process And Nursing Practice
  • Professional Relevance
  • Systematic, organized way of providing nursing
    care for any client in ____________ situation
  • Focuses on clients unique problems
  • Recognized as a ____________________ of care

29
Nursing Process And Nursing Practice
  • Professional Relevance (cont.)
  • Recognized _________________________ as method of
    practicing nursing
  • ________________ bound to use NP by Nurse
    Practice Act
  • Ensures __________________ nursing care

30
  • Professions require a sound scientific base
  • Nursing requires a __________________ system to
    provide a structure for nursing practice.
  • Our system is the Nursing Process

31
ASSESSMENT
32
Assessment
  • Is the _____________________, organizing,
    validating, and documenting of client data.
  • It is systematic and ___________________
  • What is data? _______________________
  • You assess throughout the entire nursing process
    (all the phases/steps)
  • All phases of the NP depend on accurate and
    ___________________ data collection.

33
Purpose Of Assessment
  • To establish a database about the clients
  • ___________________ to health concerns or
    illness.
  • Their ability to manage health care
    _______________.

34
Activities of Assessment
  • Establish a database
  • Obtain a nursing health _____________________.
  • Conduct a _____________________ assessment.
  • Review client ______________________.
  • Review nursing __________________________.
  • Consult ___________________________ persons.
  • Consult health professionals.

35
Activities of Assessment (cont.)
  • Update data as ____________________.
  • ___________________ data.
  • ____________________ data.
  • Communicate/____________________ data.

36
Texas Nurse Practice Act 217.11 3
  • States (the professional nurse will) _________
    (a) systematic approach to provide
    individualized, __________-directed nursing care
    by performing a __________________ assessment
    regarding health status of the client.

37
4 types of Assessments
  • _____________ assessment
  • Problem-_________________ assessment
  • __________________ assessment
  • _______________-lapsed reassessment

38
Types Of Assessments
  • Initial - 1st client _____________________
  • Comprehensive nursing history physical exam.
  • Performed within specified time after
    ______________________.
  • Purpose is to establish a complete database for
    problem identification, reference, and future
    _________________.

39
Types Of Assessments (cont.)
  • Problem focused assessment - ____________ scope
  • Ongoing process integrated with nursing care
  • Purpose
  • To determine the status of a ________________
    problem identified in an earlier assessment.
  • To identify _________ or overlooked problems.
  • Such as
  • Hourly assessment of clients IO in and ICU.
  • Assessment of clients ability to perform ADLs.

40
Types Of Assessments (cont.)
  • Time lapsed - ongoing assessment
  • Done several months ______________ initial
    assessment.
  • Purpose is to compare the clients current status
    to _____________________ data previously
    obtained.
  • Such as reassessment of a clients functional
    health patterns in a
  • Home care setting
  • Outpatient setting
  • Hospital setting
  • Shift change

41
Types Of Assessments (cont.)
  • Emergency - may be initial for ____________-threat
    ening problems
  • Done during any physiologic or psychologic
    ______________ of the client.
  • Purpose is to identify life-threatening problems.
  • Such as
  • Rapid assessment of a persons airway, breathing
    status, and circulation during a cardiac arrest.
  • Assessment of suicidal tendencies or potential
    for ______________________.

42
Types of Data
  • Subjective
  • Also called ______________ or covert data.
  • Only things the client can ______________ that we
    cannot test or see.
  • Clients sensations, feelings, values, beliefs,
    attitudes, and perception of personal health
    status and life situation.

43
Types of Data (cont.)
  • Objective
  • Also called ______________ or overt data.
  • You can see, smell, heart, taste, feel, or
    _______________.
  • Such as
  • Wound size, color and drainage
  • Blood pressure, temperature, _________

44
Sources Of Data
  • Primary source - the ______________
  • Secondary sources -
  • Family-significant others (____________ people)
  • Past and current health ______________
  • _______ test and diagnostic procedures
  • Reports from other health members
  • Reviewing literature

45
Setting And Environment
  • Should be scheduled so client is not
    _____________, hungry or in pain.
  • Should provide ___________________.
  • Allow family to ___________ if client desires.

46
Conducting The Assessment
  • Reviewing general information - primary and
    secondary data.
  • Considering _______________ language, beliefs,
    values
  • ____________________ the client and environment.
  • _________________ for seeking healthcare.

47
Conducting The Assessment
  • What types of things are we going to assess?
  • ______________
  • Activity and Exercise
  • Nutrition and Metabolism
  • Elimination
  • _____________ and rest

48
Conducting The Assessment
  • What types of things are we going to assess?
    (cont.)
  • ________________ and perception
  • Self-perception and self-_______________
  • Roles and relationships
  • ___________________ and stress tolerance
  • Sexuality and reproduction
  • Values and __________________

49
Assessment Skills
  • Observation using your _____________
  • Vision
  • Smell (body or breath odor)
  • ____________________
  • Touch

50
Assessment Skills (cont.)
  • Overall appearance
  • Body ____________
  • General ___________________
  • Posture
  • ________________________

Observation Vision
51
Assessment Skills (cont.)
  • Signs of distress or discomfort
  • ____________ and body gestures
  • ____________ color or lesions

Observation Vision
52
Assessment Skills (cont.)
  • Abnormalities of ________________
  • _________-verbal demeanor
  • Signs of anger or anxiety

Observation Vision
53
Assessment Skills (cont.)
  • ________________ or cultural artifacts
  • Books
  • Icons
  • Candles
  • Beads
  • Pictures

Observation Vision
54
Assessment Skills (cont.)
  • Lung and heart ________________
  • _________________ sounds
  • Ability to communicate
  • Language spoken

Observation Hearing
55
Assessment Skills (cont.)
  • Ability to ______________ when spoken to
  • __________________ to time, place and person
  • Thoughts and feelings
  • About self, others and health status

Observation Hearing
56
Assessment Skills (cont.)
  • Skin temperature and ____________
  • ____________ strength hand grips
  • Pulse rate, rhythm, and __________
  • Palpatory lesions lumps, masses, nodules

Observation Touching
57
Assessment Skills (cont.)
  • Interviewing - planned or conversation with a
    purpose
  • 2 approaches
  • _________________
  • Structured
  • Gets _________________ information
  • _______________ controls the purpose
  • Non-direct-
  • ___________________ building interview
  • _______ controls the purpose, topic and pace

58
Assessment Skills (cont.)
  • Interviewing continued
  • Types of interview questions
  • Close-ended
  • Answer with ____________ words
  • Used in directive interviews
  • Restrictive or blocking to conversation
  • Usually beings with when, where, who,
    what, does or is
  • Highly ______________ or people who have
    difficulty communicating like close-end questions

59
Assessment Skills (cont.)
  • Interviewing continued
  • Types of interview questions (cont.)
  • Open-ended
  • Used with nondirective interview
  • Invites client to ________________ on thoughts,
    feeling or information
  • Invites ________________ answers
  • Begin with what or how or tell me
  • See BOX 16-2 on page 267 of text.

60
INTERVIEWING PHASES
  • Maintenance Phase
  • Keep focused
  • Encourage client to talk
  • Concluding Phase
  • Explain action to client
  • Review goals and plans for action
  • Preparatory Phase
  • Review chart
  • Evaluate Data
  • Assess your own feelings
  • Plan for quiet time
  • Introductory Phase
  • When nurse and client meet
  • Establish rapport

61
Planning the Interview Setting
  • Time when
  • Client is _______________________
  • There will be ________ interruptions
  • When the client will feel comfortable and
    unhurried.

62
Planning the Interview Setting
  • Place
  • Well-_______________, well-ventilated
  • Moderate size room
  • ____________ of noise, movement and interruption
  • A place where others cannot overhear or
    ______________ the client is desirable

63
Planning the Interview Setting
  • Setting
  • Without barriers between nurse and client
  • Nurse __________ client on same eye level
  • Sit at a ______ degree angle to clients bed
  • Dont
  • Sit on their bed
  • ___________ and look down at the client
  • Stand at the ___________ of the bed

64
Planning the Interview Setting
  • Distance
  • Neither too _____________ or too far
  • Most people feel comfortable with a distance of
    __________ feet
  • _______________ will dictate appropriate distance

65
Personal Space Variables
  • Accepted distance between individual in
    conversation varies with ethnicity.
  • About 8-12 inches in Arab countries
  • _______ inches in the US
  • _______ inches in Britain
  • _______ inches in Japan

66
Personal Space Variables (cont.)
  • Men of all cultures usually require ____________
    space than women.
  • Anxiety increases the need for ________________.

67
Personal Space Variables (cont.)
  • Direct eye contact ? the need for space.
  • In East Asian and Scandinavian countries, direct
    eye contact is considered __________________.
  • Physical contact is used _____________ if it has
    a therapeutic purpose.
  • Touch can be misinterpretedespecially between
    persons of opposite _______________.

68
Planning the Interview Setting
  • Language - See Practice Guidelines
    Communication during an Interview, page 268
  • Failure to communicate in language the client can
    communicate is a form of discrimination.
  • Dont using _________________ terms.
  • Interpreters (from hospital preferred) or
    Language Line (ATT 24-7)
  • Written documents-make sure client can __________

69
Physical Exam Techniques
  • Inspection - ______________ inspection of the
    client done in a methodical deliberate manner.
  • Palpation - use of ______________-fingertips and
    palms to determine size, shape and configurations
    of underlying structures.
  • Percussion - both hands used to ____________ body
    surface to produce a sound for denseness or
    hollowness.

70
Percussion
  • Uses fingers and hands to _________ on area of
    the client to produce sound
  • Resonance - The degree to which the sound
    _________________ (magnifies the sound)
  • Type of percussion tone is determined by the
    _____________ of the medium through which sound
    is traveling
  • Use fingers of both hands - requires practice and
    repetition.

71
Percussion
72
Auscultation
  • Auscultation - listening to body sounds with a
    stethoscope place on a body surface to
    ___________________ sounds
  • Listening to the sounds of ________________
    within the body
  • Stethoscope collects and transmits sounds
  • The Bell detects _________-pitched sounds
  • The Diaphragm detects _______-pitched sounds

73
What Types of Things are Listening For
  • Heart listen for moving __________
  • Lungs listen for moving ______
  • Abdomen for movement of GI ________________

74
What Types of Things are Listening For
  • Properties of sound
  • _______________ - measure of vibration
  • Intensity _____________ of the sounds
  • Quality -musical characteristics blowing,
    squeaking, ________________
  • Duration - ____________ of the sound

75
Comprehensive Assessment Includes
  • PHYSICAL- body __________________ evaluation
    (cephalocaudal)
  • PSYCHOLOGICAL - intellect self- concept
    ___________________
  • SOCIAL relationships ___________________ with
    family and friends
  • SPIRITUAL belief in a higher being personal
    interpretation of meaning of life attitudes on
    moral decisions.

76
How Do You Organize Data
  • GORDONS FUNCTIONAL HEALTH FRAMEWORK Evaluates
    persons mind, body, and environment in relation
    to their ability to perform tasks of daily
    living.
  • HEAD TO TOE FRAMEWORK System for collecting
    data in an organized manner, starting at the head
    -proceeding systematically downward to the toes.
  • BODY SYSTEMS FRAMEWORK Focuses on
    pathophysiology involved within specific body
    systems

77
Organizing Data (cont.)
  • See text pages 270-273.

78
Recording Data
  • Systematically recorded and become a
    _______________ part of the client record
  • Written
  • _________________________

79
Validating Data
  • Validating
  • Double _________________
  • _____________________ to confirm that it is
    accurate and factual

80
Validating Data (cont.)
  • Validating helps the nurse complete the following
    tasks
  • Ensure that assessment information is
    ___________________.
  • Ensure that objective and related subjective data
    _______________.
  • Obtain additional information that may have been
    overlooked.

81
Validating Data (cont.)
  • Validating tasks (cont.)
  • Differentiate between cues and inferences.
  • Cues are subjective or objective data that can be
    directly __________________ by the nurse
  • What the client says or
  • What the nurse can see, hear, feel, smell, or
    measure.
  • Inferences are the nurses _______________________
    or conclusion made based on the cues
  • Avoid jumping to conclusions and focusing in the
    _______________ direction to identify problems.

82
Validating Data (cont.)
  • Not ______ date requires validation.
  • Height, weight, birth date, and most laboratory
    studies.
  • The nurse validates when there are discrepancies
    between data obtained in the nursing interview
    and the physical examination, or when the
    clients statements ___________ at different
    times in the assessment.
  • See TABLE 16-6 in text page 274.
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