Critical Thinking, Clinical Reasoning, Clinical Judgment, Clinical Decision and Nursing Process PDF

Critical Thinking, Clinical Reasoning, Clinical Judgment, Clinical Decision Making and Nursing Process ATI Nurse Logic: Knowledge and Clinical Judgment; Nursing Concepts; Priority Setting Framework ATI Engage Fundamental Module: Clinical Judgment Process CMS F...

Critical Thinking, Clinical Reasoning, Clinical Judgment, Clinical Decision Making and Nursing Process ATI Nurse Logic: Knowledge and Clinical Judgment; Nursing Concepts; Priority Setting Framework ATI Engage Fundamental Module: Clinical Judgment Process CMS Fundamental Book: Chapters 7, 8  Objectives Define Critical Thinking, clinical reasoning, clinical judgment and clinical decision-making. Describe the significance of developing critical thinking abilities in order to practice safe, effective and professional nursing care. Identify skills and attitudes of critical thinking. Discuss the relationships among critical thinking, problem solving process and the decision making process. Describe the nursing process and it’s phases. Discuss the relationship of the nursing process to critical thinking. Explain how professional standards influence a nurse’s clinical decisions. Define and describe the concept of clinical judgment. Discuss the attributes of clinical judgment. Identify the ways that nurses make judgments.  Some thoughts regarding the study of Nursing Fundamentals…………………………. Simple to complex Principles Evidence-based practice Conceptual frameworks Concept Maps *Benner’s 5 Stages of Nursing Competence Why do I need critical thinking as a nurse? DO NO HARM, essential for safe, competent, skilled nursing practice Need to apply knowledge from other subjects Manage change, deal with stressful situations, recognize patterns to clarify problems, recognize changes, and make appropriate decision under pressure Improves patient outcomes Critical Thinking is essential for data collection, data interpretation, problem solving, decision making  The Process Critical Thinking→ Clinical Reasoning→ Clinical Judgment→ Clinical Decision  Levels of Critical Thinking Basic Complex Commitment  Developing Critical Thinking Attitudes/Skills Self-assessment Tolerance of ambiguity Seek situations where good thinking is practiced Create environments that support critical thinking  Critical Thinking Attitudes Confidence Independence Fairness Responsibility Risk-taking Discipline Perseverance Creativity Curiosity Integrity Humility  Creativity Question, wonder, explore, be inquisitive, pro-active Cultivate Creativity in self and others Creativity in Nursing  Critical Thinking Skills Interpretation: Recognize, understand and describe Analysis: Examine, organize, validate, categorize/prioritize Evaluation: Creditability of sources of information, strength of evidence, relevance, significance or value of information Inference: Draw conclusions based on evidence, differentiate between conclusions/hypotheses, identify knowledge gaps or needs Explanation: Clarify the assumptions and reasoning processes, justify one’s reasoning and conclusions.  Key component to clinical decision making is……. KNOW your patient!!  Client admitted to the hospital for fever, cough, sore throat and body aches, and dehydration. Interpretation: recognize, understand, and explain the meaning of a situation. Analysis: Examine findings in relation to the situation and gather additional data as needed to validate the findings. Evaluation: Assess the relevance, significance or applicability of the findings to the situation. Inference: Draw conclusions that are based on evidential data and are logical given the client situation Explanation: Justify the reasoning/conclusions drawn in relation to the evidence and contextual considerations.  Critical Thinking Model - NCSBN Recognize Cues Analyze Cues Prioritize Hypotheses Generate Solutions Take Action Evaluate Outcomes  ATI Nursing Competence Concepts Client-centered Care Interdisciplinary Collaboration Evidence-based Practice Quality Improvement Informatics Safety Professionalism Leadership Priority Setting  Standards for Critical Thinking Universal Intellectual Standards Clear, Precise, Specific, Accurate, Relevant, Plausible, Consistent, Logical, Deep, Broad, Complete, Significant, Adequate for purpose, Fair.  “I thought we’d be talking about how to give shots and change dressings and stuff like that, not THIS stuff!!!” How can I become a critical thinker? Becoming a critical thinker…….  Reflective Thinking and Journaling  Talk with colleagues  Concept Mapping  Mentors  How do nurses APPLY critical thinking and clinical decision making in practice? By using…  The five step process  Unique to Nursing  It is a common language and process  Enabling nurses to “think through” clinical problems The NURSING PROCESS…..  Applying Critical Thinking to the Nursing Process NP is systematic, rational method of PLANNING and PROVIDING care 5 phases CT is used in every phase CT is used in every decision For example: What do I need to do first? Why? What happens if I do something else first? The Nursing Process is the American Nurses Association Standards of Care.  Purpose of Nursing Process Identify client’s health status and actual/potential care needs or problems Plans to meet patient needs Deliver specific nursing interventions to meet needs Evaluate nursing interventions *the client can be an individual, family group, community  Nursing Process Client-centered (focus is the client’s RESPONSE to health practices, diseases, alterations in body structure Decision-making involved in each phase, phases overlap, constantly in motion Interpersonal and collaborative Types of Nursing Care Plans (NCP) or Plans of Care (POC) Informal – not written Formal – written or computerized Standardized – formal plan developed for groups of patients with similar health problems Individualized – meets unique needs of client  Nursing Process: Assessment Phase Systematic, continuous collection, organization, validation and documentation of data (creation of database) All phases of NP depend on accurate, complete data collection  Assessment Phase Purpose of Assessment Phase To establish a database about the client’s response to a HEALTH (not only ILLNESS) problem Perceived needs Health problems Related experiences Health practices Health beliefs, values, lifestyle  Types of Data Subjective Data Objective Data Symptoms/covert data Detectable by the observer apparent to client Described/verified only by Can be measured, tested client against standard (seen, Includes sensations, feelings, heard, felt, smelled) perception of personal health Examples: BP reading, Examples: pain, nausea, dizziness heart beat, swelling  Sources of Data Primary : Client Secondary :  Family members (support persons), lab & diagnostic reports, other health care providers  Client records  Admission sheet  Medical records  Laboratory and diagnostic text records  Records of therapies  Analysis Phase Nurse continues to use critical thinking Purpose of Analysis Phase: Analyze assessment data Identify client strengths and problems Formulate nursing diagnosis statement(s) (NANDA) It is a clinical judgment  Priority Setting Frameworks Maslow’s Hierarchy of Needs ABC’s Safety and Risk Reduction 1. Safety risk to client 2. Greatest risk to client 3. Significance of risk compared to other risks. 4. Least restrictive 5. Least invasive Types of Nursing Diagnosis Statements NANDA-I Problem –Focused or Actual Nursing Diagnosis : Client problem present at time of assessment (will have RT “related to…” and AEB “as evidenced by…”) At Risk Nursing Diagnosis: clinical judgment that problem does not exist, but presence of risk factors indicates that a problem is likely to develop unless the nurse intervenes. May or may not have a “related to”, but will not have “as evidenced by”. Health Promotion: positive diagnoses , desire/motivation to improve health status.  Nursing, Medical, Collaborative Diagnoses Nursing Diagnosis: Statement of Nursing Judgment Refers to a condition the nurse is licensed to treat Describes client’s physical, socio-cultural, psychological, spiritual responses to health/illness problem Relates to nurse’s independent functions  Medical Diagnosis Made by a physician Refers to condition only a physician can treat, for example disease processes Prescribes therapies and treatments, the nurse is obligated to carry out (dependent nursing functions) Remember……………. There is a difference between nursing diagnosis and medical diagnosis. Independent nursing functions Dependent nursing functions Collaboration Collaborative Problems and Nursing Diagnoses Type of potential problem that the nurse manages using BOTH independent and dependent nursing interventions Usually associated with disease process or treatment regimen Example: potential complications of infection in the broken bone  Planning Phase Deliberate, systematic, involves decision making and problem solving and setting priorities (prioritize problems) Nurse reviews assessment data and diagnostic statements to determine direction for formulating plan of care (goals, outcomes will determine nursing interventions) What is the goal? What is the desired outcome?  Establish Client Goal and Outcome Client-centered: what does the client want to achieve? Goal Statement – BROAD meaning Desired Outcome –SPECIFIC Both the Goal and Outcome reflect the NURSING DIAGNOSIS Provides direction for planning nursing interventions Serves as a criteria for evaluating client progress  Implementation: Nursing Interventions and Activities Types of Nursing Interventions Independent Dependent Collaborative  Selecting Nursing Interventions to Implement Criteria Safe and appropriate (DO NO HARM) Achievable with available resources Congruent with client beliefs, values (CLIENT-CENTERED) Congruent with other therapies Based on nursing or scientific knowledge and experience (Evidence- Based) Within established standards  Process of Implementation/Interventions Reassess client Determine patient’s need for assistance Implement nursing interventions Supervise delegated care Relate nursing activities to outcomes Draw conclusions about the client’s problem status DOCUMENTATION  Evaluation Use the Outcome Statement as a guideline Draw conclusions about the client problem status Decide if the desired outcome is met, not met or partially met Is the Actual Problem resolved or does it still exist? Was the Potential Problem prevented? Does the care plan need revision, modified or discontinued? The nurse can modify interventions, but usually not the outcome or goal!