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Critical Thinking in Nursing

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Critical Thinking Problem Solving Critical Thinking in Nursing Clinical Reasoning Priority Setting Lipe, S. K. & Beasley, S., (2004). Critical Thinking in Nursing: A ... – PowerPoint PPT presentation

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Title: Critical Thinking in Nursing


1
Critical Thinking in Nursing
Critical Thinking
Problem Solving
Clinical Reasoning
Priority Setting
  • Lipe, S. K. Beasley, S., (2004). Critical
    Thinking in Nursing A cognitive skills
    workbook. Lippincott. Philadelphia, PA.

Decision Making
2
OBJECTIVES
  • Utilize critical thinking to develop treatment
    plan in both simulated and clinical situations.
  • Discuss the process of critically thinking.
  • Identify common errors in utilizing the critical
    thinking process.

3
OBJECTIVES
  • Discuss the characteristics of a critical thinker
    and standards commonly applied when critically
    thinking.
  • Explain how time management, client care
    needs/activities, multitasking, and nursing
    diagnoses are integral to the prioritizing
    processes.

4
OBJECTIVES
  • Prioritize nursing diagnoses using patient
    condition as the basis for decisions.
  • Formulate priorities for management and delivery
    of nursing care in various settings.
  • Apply critical thinking and prioritizing to
    client scenarios and NCLEX-style questions.

5
CRITICAL THINKING
  • Ennis reasonable, reflective thinking that is
    focused on deciding what to believe or do
  • Lipe Beasley (Nosich, 2001, p.2)
  • Critical Thinking is goal directed it is
    thinking with a purpose. (Lipe Beasley, 2004,
    p. 3)

6
  • Decision Making
  • Involves choosing from options
  • It is a step in the problem solving process
  • Problem Solving
  • Systematic approach resulting in formation of
    solutions

7
Characteristics of a Critical Thinker
  • Independent thinker
  • Questioning
  • Recognizes biases assumptions
  • Observant
  • Organize/cluster data
  • Prioritizes
  • Open minded
  • Open to new ideas
  • Flexible-willing to change
  • Innovative, creative
  • Analytical
  • Communicator
  • Assertive
  • Knowledgeable
  • Resourceful
  • Intuitive
  • Out of the box
  • thinker

8
Process of Critically Thinking
9
  • http//www.criticalthinking.org/CTmodel/CTModel1.c
    fm

10
6 Essential Cognitive Skills of Critical Thinking
  • Interpretation ability to explain the meaning
    of information
  • Analysis examine subjective and objective,
    advantages, disadvantages, and consequences
  • Evaluation Is info source credible? Any bias?
    Is info relevant?
  • Inference draw a conclusion based on info
  • Explanation ability to explain ones
    conclusions
  • Self-regulation reflecting on our own thinking
    Did I have all the facts? Are my assumptions
    correct/ incorrect?

11
Pitfalls in Critical Thinking
  • Illogical Process
  • Bias
  • Closed-
  • mindedness

12
SCENARIO
  • Situation Frank Fellow, a 72-year-old patient
    admitted for acute confusion presented in the
    emergency department (ED) with a history of
    hypertension, diabetes type 1, and arthritis. He
    lives in a single-family home with his wife.
  • The client is slightly confused and has an
    unsteady gait. He frequently forgets to use his
    walker and fails to call for assistance from the
    nursing staff when ambulating to the bathroom.
  • Interpretation - clarifying
  • Analysis - questioning
  • Outcomes what do you expect?
  • Inference - conclusion
  • Self Regulation what else?

13
INFLUENCING FACTORS
  • Emotions
  • Values
  • Perceptions
  • Social climate

14
Characteristics of an Effective Decision Maker
  • Self Confident
  • Assertive
  • Proactive
  • Flexibility
  • Knowledgeable
  • Ability to accept responsibility
  • Ability to focus
  • Priorities first

Are these characteristics similar to the critical
thinker?
15
Prioritizing
  • Time Management
  • Maslow Hierarchy of Needs
  • Prioritizing Nursing Diagnoses
  • Priority Activities
  • Multitasking
  • Nursing Process

16
  • The 34 yr. patient with cirrhosis is admitted
    for dehydration and needs a central line for high
    volume fluid replacement. Vital signs upon
    arrival on the unit at 2 pm were temp 99, pulse
    102, r 24, b/p 90/60. The nurse has finished
    report and the physician is on the way to the
    unit to place a central line. Which nursing
    activity is the highest priority?
  • A. Ensure consent signed
  • B. Take the patients
    vital signs
  • C. Notify the family
  • D. Listen to breath sounds
  • E. Assess urinary output

17
  • 16-year-old boy transported to the emergency
    department by ambulance following a MVA.
    Witnesses report his car slid on ice, and the
    vehicle became airborne, throwing the adolescent
    from his car. Initial assessment reveals that
    the patient has a patent airway, is responsive to
    painful stimuli, has a laceration to his left
    thigh that is covered with a dressing, and has
    contusions to the left flank area. Place the
    following activities in order of priority.
  • ___Call the parents for consent to treat
  • ___Immobilize head and neck
  • ___Assess level of consciousness and neurologic
    deficits
  • ___Assess left thigh and apply clean pressure
    dressing

18
PITFALLS IN PRIORITY SETTING
  • Inadequate Assessment and Evaluation of Client
    Needs
  • Failure to Differentiate Between Priority and
    Non-priority Tasks
  • Acceptance of Others Priorities Without
    Assessing All the Variables
  • Performance of Tasks with a First Identified,
    First Completed Approach
  • Completion of the Easiest Tasks First

19
  • The patient is resting quietly, breath sounds
    clear, respirations easy and unlabored, skin
    color pink. O2 _at_ 3 Liters, and O2 sat is 98.
    After eating dinner , the patient rings the
    nurse. The nurses assessment reveals
    respirations are 30 breaths/min and labored,
    crackles are auscultated bilaterally, skin color
    dusky, and the SpO2 82.
  • What are you the nurse going to do?

20
  • The nurse intervenes by
  • Elevating the head of the bed
  • Applying prescried O2 through a nonrebreather
  • Notify Physician

21
CALLING THE PHYSICIAN
  • Change in status
  • Pain w/o ordered mgmt strategies
  • Lack of treatment orders
  • Lab values
  • Risk to safety

22
LAB VALUES
  • Do not consider lab values in isolation
  • Evaluate data and compared to patients clinical
    status
  • Compare to age, medical diagnosis, assessment
    data, physical status, physical orders, current
    treatment, previous labs

23
  • Failure to assess, monitor, and report
  • negligence

24
  • 13. Which patient should the nurse see first?
  • A. a 40 yo 7 day postpartum female with bright
    red vaginal bleeding and a hgb of 7.0 g/dL.
  • B. A diabetic patient with a blood sugar of 400
    mg/dL and no orders for insulin coverage.
  • C. A 46 yo ESRD patient who had an AV fistula
    placement 2 days ago. No thrill or bruit noted.
  • D. A 50 yo woman, 2 days after knee replacement.
    She refuses to use CPM machine due to pain

25
Client Care
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