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Questions and Answers
What defines critical thinking in nursing according to the National League for Nursing?
Which of the following is NOT a characteristic of critical thinking skills essential for nursing care?
What foundational knowledge is crucial for developing critical thinking in nursing?
In critical thinking for nursing, which question is most relevant for assessing the situation?
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Which of the following best defines the nursing process?
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What type of data includes observable and measurable signs?
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Which phase of the nursing process involves setting priorities of care?
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What is a nursing diagnosis primarily concerned with?
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In the context of goal/outcome identification, what characterizes a patient-centered goal?
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Which of Maslow’s hierarchy of needs would be prioritized first in nursing care?
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During assessment, who is considered the primary source of data?
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What is the first step in developing a concept map care plan?
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Which level of needs includes affection and acceptance by peers?
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How should interventions in a nursing care plan be linked?
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What is a nurse-prescribed intervention?
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What is a key purpose of concept mapping in nursing care?
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What does a significant omission in a care plan potentially impact?
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During the evaluation process, what is a variance?
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Which nursing intervention is considered to be evidence-based?
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Clinical pathways are important because they:
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What is the primary focus of self-actualization in patient care?
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What does the nursing diagnosis format require for risk nursing diagnoses?
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The clinical judgement measurement model was developed by which organization?
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Which of the following represents the correct order of the nursing process?
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What role does a knowledge base play in developing critical thinking for nursing?
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Which of the following actions is NOT a part of the critical thinking process in nursing?
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What does 'thinking with a purpose' emphasize in the context of nursing?
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What is critical thinkers' ability to connect concepts and apply them to patient scenarios indicative of?
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In critical thinking, what is the importance of considering other points of view?
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Study Notes
Critical Thinking
- Critical thinking is a discipline-specific reasoning process used by nurses to address client care and professional concerns.
- Critical thinking skills are essential for providing quality nursing care.
- Nurses use a knowledge base of facts, principles, and theories to make decisions, generate new ideas, and solve problems.
- Critical thinkers can identify and explore relationships between concepts and apply these concepts to unique patient care situations.
Knowledge Base
- Nurses develop their knowledge base by studying facts, principles, evidence-based practice guidelines, and theories.
- Knowledge of psychology, anatomy, physiology, pharmacology, and other related fields contributes to critical thinking.
- Nurses use their knowledge base to make projections about clinical situations.
Applying Critical Thinking
- When applying critical thinking, consider evidence-based practices, different perspectives, a plan of action and rationale, and evaluate the outcome.
- Critical thinkers are:
- Able to analyze information and adjust patient care accordingly.
- Aware of their limitations and biases
- Proactive in seeking information and improving their skills.
- Open to learning opportunities and recognize mistakes as learning opportunities.
Nursing
- The American Nurses Association defines nursing as the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering; diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations.
Nursing Process
- The nursing process is a systematic method that helps nurses plan and provide care for patients.
- The six dynamic and interrelated phases of the nursing process are:
- Assessment
- Diagnosis/Patient Problem Statement
- Goal/Outcome Identification
- Planning
- Implementation
- Evaluation
Assessment
- Assessment involves systematically collecting and analyzing data about a client, focusing on physiological, psychological, sociocultural, spiritual, economic, and lifestyle factors.
- The registered nurse (RN) conducts the initial assessment, and the licensed practical nurse (LPN) assists with ongoing and focused assessments.
- Assessment data comes from primary (patient) and secondary (family, medical records) sources.
- Data collection methods include biographic data and physical examination.
- Data obtained from the health history, physical examination, and diagnostic procedures is analyzed to develop a plan of care.
Diagnosis
- A nursing diagnosis is a clinical judgment about a human response to health conditions or a vulnerability for that response.
- Potential nursing diagnoses describe problems that may develop when a patient's condition changes.
- Only physicians and advanced healthcare practitioners diagnose diseases, while nurses address patient responses to health problems.
Goal/Outcome Identification
- The nurse and patient work together to develop measurable, patient-centered goals that do not interfere with the medical plan of care, are realistic, and include a time frame for reevaluation.
Planning
- In the planning phase, priorities of care are established, and nursing interventions are selected to address the nursing problem statement and achieve goals.
- Maslow's hierarchy of needs helps determine priorities, with lower-level needs requiring resolution before higher-level needs.
- Planning includes physician-prescribed and nurse-prescribed interventions.
Implementation
- The nurse and care team put the established plan into action using evidence-based interventions.
- Nursing interventions include teaching, monitoring, providing, counseling, delegating, and coordinating.
Evaluation
- Evaluation determines the extent to which established outcomes have been achieved.
- The nurse reviews established goals, reassesses the patient, and compares actual outcomes with desired outcomes.
- A variance occurs when a goal is not met and requires evaluation to understand the reasons.
Clinical Judgement
- The National Council of State Boards of Nursing (NCSBN) defines clinical judgement as the observed outcome of critical thinking and decision making.
- The NCSBN has developed a model to measure how well nurses make patient care decisions.
- While content knowledge is important, it does not always translate to clinical judgement skills.
Chief Complaint / Pathophysiology
- Medical diagnosis should be explained using student's own words to demonstrate understanding.
- Pathophysiology should reflect comprehension of the diagnosis and etiology based on the patient's condition.
Assessment
- All pertinent subjective and objective data should be collected and recorded accurately, with any omissions adequately explained.
- Additional data should be obtained through inquiry, leveraging knowledge about the patient's disease and circumstances.
Nursing Diagnosis
- The selected nursing diagnoses should accurately reflect the interpretation of analyzed data.
- Subjective and objective data should be presented appropriately as supporting evidence for the diagnoses.
- All nursing diagnoses should use NANDA terminology, with actual diagnoses in a 3-part format, risk diagnoses in a 2-part format, and syndrome diagnoses in a 1-part format.
Planning (Goal Setting)
- Recorded data should confirm, clarify, and guide patient care, with two measurable criteria for each goal.
Implementation with Rationale for Interventions
- Specific interventions should be linked to specific outcomes.
- Interventions should be realistic and appropriate for the patient's current status.
- Rationales should provide comprehensive scientific reasoning for each selected intervention.
Evaluation
- Appropriate subjective and objective data should be selected through review of interventions and ongoing assessment.
- Data measuring outcomes should be collected and analyzed accurately.
- Partially achieved or unmet goals should include revisions and new evaluation dates/times.
Concept Map Care Plan
- Concept mapping visually represents patient problems, supporting data, interventions, and evaluations.
- Concepts are analyzed to organize patient data, identify relationships, and provide a holistic view of the patient's situation.
- Critical thinking and clinical reasoning are used to formulate clinical judgments and decisions about nursing care.
Steps in Concept Map Care Planning
- The first step is to gather clinical data through review of the patient's chart, including medical history, physical assessment findings, medications, diagnostic measures, and treatments.
- The Patient Data Base form can be used to collect this information.
Step 1: Develop a Basic Skeleton Diagram
- The central circle at the top of the page represents the patient's reason for admission (usually a medical diagnosis).
- The boxes below the medical diagnosis contain the top five patient problems, formulated as nursing diagnoses.
Step 2: Analyze and Categorize Data
- Analyze and categorize collected data to support the medical diagnosis and nursing diagnoses.
- Group important data related to the medical diagnosis, including past medical history, in the top circle.
Nursing Diagnosis Map
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Purpose: The nursing diagnosis map is a tool designed for organizing and visualizing patient data related to nursing diagnoses. It facilitates a holistic understanding of the patient through data analysis and linking related concepts.
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Steps:
- Step 1: Collect patient data related to potential nursing diagnoses. This includes clinical assessment data, treatments, medications, diagnostic data, and medical history.
- Step 2: Organize the gathered data into the appropriate nursing diagnosis boxes, grouping related information.
- Step 3: Formulate measurable goals for each nursing diagnosis.
- Step 4: Outline nursing interventions to achieve these goals.
- Step 5: Evaluate the effectiveness of the interventions, noting data supporting goal achievement or identifying areas for revision. Connect related nursing diagnoses using dotted lines, showcasing their interrelationship.
Data Organization and Linking
- Data Organization: Place relevant patient data, including assessments, treatments, medication, diagnostics, and medical history, within the corresponding nursing diagnosis boxes.
- Uncertain Data: If unsure about the appropriate placement of specific data, list it separately and seek clarification from peers or an instructor.
- Multiple Relevance: Repeat data when it is relevant to more than one nursing diagnosis.
- Data Linking: Use dotted lines to connect nursing diagnoses that influence one another, highlighting their interconnectedness.
Goal Setting and Interventions
- Goal Setting: For each nursing diagnosis, establish achievable and measurable goals that can be accomplished within the clinical experience timeframe.
- Interventions: Develop 4-6 nursing interventions designed to achieve the established goals. Interventions can include assessments, teaching, therapeutic communication, or other relevant interventions.
Goal Evaluation
- Evaluation: After implementing interventions, assess their effectiveness and evaluate goal achievement. Include supporting data to justify progress or areas requiring attention.
- Revisions: Identify any necessary adjustments or modifications to the plan to achieve the desired outcomes.
Holistic View of Patient
- Holistic Approach: The comprehensive nursing diagnosis map promotes a holistic understanding of the patient through analyzing interconnected concepts and utilizing critical thinking
Critical Thinking in Nursing
- Critical Thinking: A complex process, defined as a discipline-specific, reflective reasoning process used to address client care and professional concerns.
- Critical Thinking Skills: Essential for quality nursing care, analyze all variables, apply knowledge to make decisions, generate new ideas, and solve problems.
Importance of Knowledge Base
- Building Knowledge Base: Study facts, principles, evidence-based practice guidelines, and theories.
- Related Fields: Knowledge of psychology, anatomy, physiology, pharmacology, and other related subjects help build a strong knowledge base for critical thinking.
- Connecting Concepts: Exploring relationships between concepts and applying them to patient care scenarios.
Developing Critical Thinking Skills
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Reflection & Analysis: Questions to ask:
- Are there evidence-based practice guidelines?
- Have I considered other points of view?
- What should I do first and why?
- Why am I doing this procedure in this way?
- Did my actions achieve the desired result?
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Characteristics of Critical Thinkers:
- Analyze information and adjust patient care accordingly.
- Recognize their limitations and biases.
- Seek clarification and ask questions to improve knowledge.
- Embrace learning opportunities from every experience.
The Nursing Process
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Nursing Process Components: Organized framework for nursing practice, involves six dynamic and interrelated phases:
- Assessment: Gathering and analyzing information from primary and secondary sources.
- Diagnosis/Patient Problem Statement: Clinical judgment of a patient's response to health conditions, using NANDA terminology.
- Goal/Outcome Identification: Collaborative process with the patient to develop measurable, specific, realistic goals with a time frame for reevaluation.
- Planning: Prioritizing care, selecting interventions based on Maslow’s Hierarchy of Needs, and establishing physician-prescribed and nurse-prescribed interventions.
- Implementation: Putting the plan into action using evidence-based interventions, and including teaching, monitoring, providing, counseling, delegating, and coordinating.
- Evaluation: Determining the extent to which outcomes have been achieved by comparing actual outcomes with desired outcomes.
National Council of State Boards of Nursing (NCSBN)
- Clinical Judgment: Observed outcome of critical thinking and decision-making, using nursing knowledge to observe, assess, prioritize concerns, and generate solutions for safe client care.
- NCSBN Clinical Judgement Measurement Model: Evaluates how well nurses make decisions regarding patient care.
Nursing Diagnosis
- NANDA Terminology: Used to define and classify nursing diagnoses.
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Types of Nursing Diagnoses:
- Actual Nursing Diagnoses: Three-part statements: problem, related to, as evidenced by.
- Risk Nursing Diagnoses: Two-part statements: problem, related to.
- Syndrome Nursing Diagnoses: One-part statement.
Concept Map Care Planning
- Concept Mapping: A visual representation of patient problems, supporting data, interventions, and evaluations.
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Steps in Concept Map Care Planning:
- Step 1: Develop a Basic Skeleton Diagram: Start with the patient's medical diagnosis and then identify the top 5 problems, formulating nursing diagnoses.
- Step 2: Analyze and Categorize Data: Group the most important data related to the patient's medical diagnosis and nursing diagnoses.
Nursing Diagnosis Map
- Purpose: A tool for organizing and analyzing patient data to develop a holistic care plan.
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Steps:
- Step 1: Gather data about the patient.
- Step 2: Categorize the data into appropriate areas within the nursing diagnosis map.
- Step 3: Formulate measurable goals for each nursing diagnosis and identify interventions.
- Step 4: Evaluate the effectiveness of the interventions and revise the plan as needed.
- Step 5: Connect the nursing diagnoses to demonstrate their interconnectedness.
Using the Nursing Diagnosis Map
- Data Organization: Group data related to each nursing diagnosis, including clinical assessments, treatments, medications, diagnostic information, and medical history.
- Uncertain Data: Place uncertain data outside the boxes and seek clarification from peers or instructors.
- Overlapping Data: Repeat data in different boxes if it's relevant to multiple diagnoses.
- Goal Setting: Create realistic, measurable goals for each nursing diagnosis.
- Intervention Selection: Choose 4-6 nursing interventions that directly support achieving the stated goals.
- Intervention Types: Include key assessment areas, therapeutic interventions, teaching, and therapeutic communication.
- Evaluation: Assess whether interventions were successful in achieving the goal.
- Revise and Recommend: Adjust the intervention plan based on the patient's response and suggest any needed modifications.
Holistic View
- Linking diagnoses with dotted lines reveals interrelationships, providing a comprehensive understanding of the patient's needs.
Critical Thinking
- The nursing diagnosis map promotes critical thinking by prompting the clinician to analyze and synthesize patient information to tailor care.
Critical Thinking
- Critical thinking is a complex process with no simple definition
- Critical thinking for nursing is a reflective reasoning process guiding nurses in generating, implementing, and evaluating approaches to client care and professional concerns
- Critical thinking skills are essential to providing quality nursing care
- Critical thinking involves assessing all variables and using knowledge to make decisions, generate new ideas, and solve problems
- Critical thinking helps guide decision-making
- Critical thinking begins with a knowledge base and grows by studying facts, principles, evidence-based practices, and theories
- A knowledge base includes understanding of psychology, anatomy, physiology, pharmacology, and other related subjects
- Critical thinkers explore relationships between concepts and ideas.
Thinking with a Purpose
- When developing and applying critical thinking, ask yourself:
- Are there evidence-based practices?
- Have you considered multiple points of view?
- What should be done first and why?
- Why is a procedure being done in a specific way?
- Did the actions achieve the desired result?
Critical Thinkers
- Analyze information and adjust patient care
- Are sensitive to their own limitations and predispositions
- Anticipate questions, ask experts, or ask "why" to improve critical thinking skills
- Take advantage of learning opportunities, recognizing every experience, mistakes, and encounters as potential learning opportunities
- Explore relationships between concepts and ideas, applying those concepts to unique patient care situations
Nursing
- Nursing is the protection, promotion, and optimization of health
- Nursing aims to prevent illness and injury, facilitate healing, alleviate suffering through diagnosis and treatment
- Nursing advocates for individuals, families, groups, communities, and populations
Nursing Process
- The nursing process is a systematic method for planning and providing care
- The nursing process uses critical thinking skills to solve problems
- The nursing process consists of six phases: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation
Assessment
- Assessment involves gathering and analyzing data about a client
- Assessment includes physiological, psychological, sociocultural, spiritual, economic, and lifestyle factors
- The initial assessment is performed by a Registered Nurse (RN)
- Initial assessments include a review and physical examination of all body systems
- A focused assessment gathers information about a specific health problem
- Subjective data is provided by the patient (e.g., pain, fatigue, anxiety)
- Objective data is observable and measurable (e.g., capillary refill, blood pressure, edema)
- Primary data comes from the patient, considered the most accurate source
- Secondary data comes from sources other than the patient, such as family members, medical records, or diagnostic procedures
- Methods of data collection include gathering biographic data, performing a physical examination, and reviewing diagnostic procedures
- Data clustering organizes data to develop a plan of care
Diagnosis/Patient Problem Statement
- A nursing diagnosis is a clinical judgment about a human response to health conditions or life processes
- Nursing diagnoses identify vulnerabilities and serve as the basis for selecting interventions
- A potential nursing diagnosis describes a problem that may develop when a patient's condition is expected to change.
- Physicians and advanced practitioners diagnose diseases, while nurses address human responses to health problems
Goal/Outcome Identification
- Nurses and patients collaboratively develop expected outcomes for established diagnoses
- Patient-centered goals are measurable, specific, realistic, and have a time frame for reevaluation
- Goals guide nursing intervention selection and measure the effectiveness of interventions
Planning
- Priorities of care are established and nursing interventions are selected based on the problem statement and desired goals
- Priorities are determined using Maslow's Hierarchy of Needs
- Needs are structured by level, with lower levels needing to be met before higher ones can be achieved.
- Physiologic (bottom): nutrition, elimination, oxygenation, and sexuality
- Safety and security: stability, protection, security, freedom from fear and anxiety
- Love and belongingness: affection, acceptance by peers and community
- Esteem: self-respect, self-confidence, feelings of self-worth
- Self-actualization (top): full use of individual talents
- Priorities shift as patients progress through treatment.
- Physician-prescribed interventions are actions ordered by a physician
- Nurse-prescribed interventions are actions the nurse is legally able to order or begin independently
- Nursing orders must be signed, dated, and specify who will perform the intervention and its time/frequency
- Clinical pathways guide care and coordinate actions from all disciplines
Implementation
- The plan of care is put into action
- Interventions are implemented safely, timely, and using evidence-based practices
- Nursing interventions include nurse-prescribed and physician-prescribed activities, such as teaching, monitoring, providing, counseling, delegating, and coordinating
Evaluation
- The nurse determines how much the expected outcomes have been achieved
- The evaluation process involves reviewing patient goals, reassessing the patient, and comparing actual outcomes to desired outcomes
- The nurse determines if the goal was achieved, partially achieved, or not achieved
- Not achieving a goal is considered a variance; it must be evaluated to understand why the outcome wasn't met
Clinical Judgement
- Clinical judgment is the outcome of critical thinking and decision-making
- Clinical judgment uses nursing knowledge to:
- Observe and assess situations
- Identify a prioritized client concern
- Generate evidence-based solutions for safe client care
- The NCSBN has developed a clinical judgment measurement model to assess how well nurses make decisions.
- Clinical judgment involves multiple elements, and having knowledge does not guarantee clinical judgment skills
Chief Complaint/Pathophysiology
- Students demonstrate understanding by explaining medical diagnosis in their own words
- Pathophysiology demonstrates understanding of diagnosis and identifies etiology based on the patient’s condition
Assessment
- All subjective and objective data is collected and recorded using appropriate terminology
- Blank spaces regarding uncollected data are adequately explained
- Inquiry is used flawlessly to apply knowledge about the individual’s disease and circumstances
Nursing Diagnosis
- Nursing diagnoses reflect the accurate interpretation of subjective and objective data
- Supporting data is listed appropriately for each diagnosis
- All nursing diagnoses utilize NANDA terminology
- Actual nursing diagnoses use three-part statements
- Risk nursing diagnoses use two-part statements
- Syndrome diagnoses use one-part statements
- The correct format is used
Planning (Goal Setting)
- Recorded data is analyzed to confirm, clarify, and direct patient care with two measurable criteria
Implementation with Rationale for Interventions
- Specific interventions are easily linked to specific outcomes.
- The interventions are realistic and appropriate to the patient's current status.
- Rationales for each intervention contain comprehensive scientific reasoning that identifies why the intervention was selected.
Evaluation
- The appropriate subjective and objective data is selected through review of interventions related to ongoing assessment.
- The subjective and objective data that measures the outcome is collected and analyzed correctly.
- If the goal was partially met or not met, the plan includes a revision and/or new evaluation date/time.
Concept Map Care Plan
- A concept map care plan is a diagram of patient problems, supporting data, interventions, and evaluations.
- Concept maps organize patient data, analyze relationships within data, and provide a holistic view of the patient's situation.
- Concept mapping requires critical thinking to analyze clinical data.
- Concept mapping links medical and nursing diagnoses with relevant clinical data.
Steps in Concept Map Care Planning
- The nursing process steps (assessment, diagnosis, planning, implementation, and evaluation) are related to concept map development.
- Gathering clinical data is the initial step and corresponds to the assessment phase.
- Review the patient’s chart to identify their health problems, medical history, physical assessment findings, medications, diagnostic measures, and treatments.
Step 1: Develop a Basic Skeleton Diagram
- Create an initial diagram based on clinical impressions from the collected data.
- Write the patient's reason for admission (medical diagnosis) in the central circle.
- Identify general problems representing the patient’s responses to the diagnosis (e.g., problems breathing).
- Select the top five problems, formulate nursing diagnoses, and write them in boxes below the central circle.
- Prioritize the nursing diagnosis by writing the appropriate number in the small box above each diagnosis.
Step 2: Analyze and Categorize Data
- Analyze and categorize the collected Patient Data.
- This step provides evidence to support the medical diagnosis and nursing diagnoses.
- Organize the most important medical diagnosis-related data in the top circle (e.g., past medical history).
Nursing Diagnosis Map
- The nursing diagnosis map provides a framework to organize and analyze patient data related to nursing diagnoses.
- Data is categorized into sections: clinical assessment, treatments, medications, diagnostic data, and medical history.
- Data relevant to multiple diagnoses can be repeated in different boxes.
- A "clarification" section allows for unclear data to be documented and discussed with peers or instructors.
Goal Setting and Interventions
- Develop a measurable goal for each nursing diagnosis that is achievable within a two-day clinical experience.
- Identify 4-6 nursing interventions that will contribute to achieving the goal.
- Interventions should include assessment, therapeutic communication, and education.
- While rationales don't need to be written, be prepared to explain them verbally.
Evaluating Patient Responses
- Assess the effectiveness of the intervention plan and goal achievement.
- Provide data supporting goal attainment or non-attainment.
- Offer revisions or recommendations to improve goal achievement.
Linking Nursing Diagnoses
- Connect related nursing diagnoses with dotted lines to demonstrate their interrelatedness.
- This step emphasizes the holistic view of patient care.
- Repetitive data across diagnoses suggests their interconnectedness.
- The completed map enables comprehensive patient analysis through critical thinking.
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Description
This quiz evaluates your understanding of critical thinking as a vital component of nursing practice. It covers the knowledge base necessary for effective decision-making, problem-solving, and the application of evidence-based practices. Test your skills in identifying relationships between concepts related to client care and professional concerns.
