Critical Thinking in Nursing: Clinical Judgment and the Nursing Process - Elsevier

Chapter 2 Critical Thinking, Clinical Judgment, and the Nursing Process  Lesson 2.1 Critical Thinking and the Nursing Process Theory Objectives (1 of 2)  Illustrate how critical thinking affects clinical judgment.  Explain what characteristics are necessary to think...

Chapter 2 Critical Thinking, Clinical Judgment, and the Nursing Process  Lesson 2.1 Critical Thinking and the Nursing Process Theory Objectives (1 of 2)  Illustrate how critical thinking affects clinical judgment.  Explain what characteristics are necessary to think critically.  Correlate how problem solving and decision making are a part of critical thinking.  Theory Objectives (2 of 2)  Discuss the LPN/LVN standards for medical- surgical nursing practice.  Explain three fundamental beliefs about human life as the basis for nursing process.  Distinguish how critical thinking, clinical reasoning, and clinical judgment are applied to the nursing process. Clinical Practice Objectives (1 of 2)  Select factors that influence critical thinking during patient care.  Provide a clinical example of how nursing process is used in the care of medical-surgical patients.  Demonstrate each of the following techniques of physical examination: inspection and observation, olfaction, auscultation, and percussion. Clinical Practice Objectives (2 of 2)  Include the patient in formulation of the nursing care plan.  Use clinical reasoning to prioritize care for a specific patient.  Prepare a prioritized list for beginning-of-shift assessment for a specific patient.  Critical Thinking  A method for solving problems  Evaluate ideas, construct plans, and determine desired outcomes  Incorporates the scientific method and uses clinical reasoning to make reliable observations and to draw sound conclusions from obtained data  Clinical judgment is the result of critical thinking applied to clinical situations.  Critical Thinking and Clinical Judgment (1 of 2)  Purposeful, informed, and outcome focused  Principles of nursing process and the scientific method  Expanding thinking beyond the obvious  Critical Thinking and Clinical Judgment (2 of 2)  Critical thinking is at its best when the brain is purposefully engaged.  While listening to a shift report, pay attention to what the nurse is saying and think about how you will apply the information you have gained.  Factors That Influence Critical Thinking and Nursing Care  Attitude  Communication skills  Problem solving and decision making Integrating Critical Thinking and the Nursing Process  Critical thinking, clinical reasoning, and clinical judgment are integral to use of the nursing process.  Essential to know the boundaries of the role of the LPN/LVN in your state  LPN/LVN scopes of practice stipulate a directed role under the supervision of an RN.  Scopes of practice differ in the areas of care planning, assessment, intravenous therapy, teaching, and delegation from state to state.  Nursing Process  Provides a way to make changes in patient care if progress is not being made  Builds on a patient’s strengths  Creates a partnership between nurse and patient  An orderly way to assess a patient’s response to current health status and to plan, implement, and evaluate patient responses to nursing care  The goal is to alleviate, minimize, or prevent real or potential health problems.  Applying Standards in Medical- Surgical Nursing  Five basic steps in the nursing process:  Assessment  Nursing diagnosis  Planning  Implementation  Evaluation  A Complete Database  Includes a thorough health history, physical assessment, psychosocial assessment, and cultural- spiritual assessments  Includes subjective and objective data  Subjective data—data that the patient gives that cannot be seen or felt by another, such as pain  Objective data—data that can be verified by sight, smell, touch, or sound  Sources of Information for the Database  Admission forms, history, and physical  Focused assessments  Interview  Social assessment  Physical assessment  Focused assessment  Beginning of shift assessment  Chart review  Audience Response Question 1 The nurse notes that the patient is on long-term anticoagulant therapy. What patient statement(s) would strongly correlate with excessive anticoagulant therapy? (Select all that apply.) 1. “I have noticed some blood streaking in my bowel movements.” 2. “I have been embarrassed by constant, uncontrollable gassiness.” 3. “My urine has been cloudy with occasional clots.” 4. “I bruise easily whenever I bump into anything.” 5. “Flossing my teeth has been painful and bloody.”  Diagnostic Test Results  White blood cell count  Red blood cell count  Hemoglobin  Hematocrit  Platelet count  Glucose  Hemoglobin A1c  Thyroid-stimulating hormone  Analysis and Nursing Diagnosis  General statements that label patient problems. They are linked with the etiology (cause) and evidence (signs and symptoms) of the problem  Standard stems are published by the North American Diagnosis Association International (NANDA-I)  Nursing Diagnoses and Medical Diagnoses  The physician is concerned with health problems that can be treated with surgery, medications, and other forms of therapy provided or prescribed by the physician.  Nursing diagnoses identify the patient’s response to an illness or a health condition.  Priority Setting From Williams P: deWit’s Fundamental concepts and skills for nursing, ed. 5, St. Louis, 2018, Elsevier.. Louis, 2014, Elsevier.  Audience Response Question 2 What is considered critical in assessing sleep disturbance of the patient? (Select all that apply.) 1. Family history of sleep disorders 2. Rituals associated with sleep 3. Feelings of restfulness 4. Diet choices 5. Urinary habits  Setting Priorities of Care  Prioritizing includes identifying tasks that are urgent and tasks that can wait  Nursing Interventions  Nursing actions and patient activities chosen to achieve the goals and expected outcomes  Independent nursing interventions can be initiated and implemented without a provider's order.  Dependent actions are ordered by the provider.  Prioritizing Delivery of Care  After you receive your assignments:  Review the patient’s chart.  Look up required drug information.  List focused assessments.  List procedures.  Attend report and make additional notes and question what you do not understand.  Make rounds.  Staff Communication Regarding Care  Interstaff communication  Charting and electronic health record  Report  Privacy and Protected Health Information  Health Insurance Portability and Accountability Act (HIPAA)  Any protected health information from a patient’s chart must be carefully guarded  Interdisciplinary (Collaborative) Care Plans  Medical diagnosis  Shared observations  Problem list  Shared care plan  Team approach  Progress reporting