Week 1 CJM & Critical Thinking Sp 25 - Tagged PDF

CRITICAL THINKING & CLINICAL JUDGEMENT Mrs. Sipes 3125 Fundamentals of Nursing STUDENT LEARNING OUTCOMES Critical Thinking & The Clinical Thinking Model/Clinical Judgment Model: Explain the relationship between critical thinking and clinical judgement in nursing pract...

CRITICAL THINKING & CLINICAL JUDGEMENT Mrs. Sipes 3125 Fundamentals of Nursing STUDENT LEARNING OUTCOMES Critical Thinking & The Clinical Thinking Model/Clinical Judgment Model: Explain the relationship between critical thinking and clinical judgement in nursing practice Interpret the value of applying a clinical judgement model in nursing practice Understand the attitudes and skills needed to develop critical thinking. Demonstrate critical thinking in order to practice safe, effective, and professional nursing care. Understand the Clinical Judgement Model and how it is relevant to nursing problems in a variety of healthcare settings. Understand how professional standards influence a nurse's clinical decisions. Understand the relationship of the nursing process to critical thinking. STUDENT LEARNING OUTCOMES Care Planning: Differentiate subjective and objective data utilizing the "patient's story". Understand the relationship among goals of care, expected outcomes, and evaluative measures when evaluating nursing care. READINGS Fundamentals of Nursing, Potter & Perry, 11th ed., Chapter 15 Nursing Care Plans, Gulanick, Chapter 1-optional Clinical Judgement and Test Taking Strategies, Preface and pages 2-31 WELCOME!! What would you like from me….your instructor?? What would you like from each other?? What do I want from you??? LET’S START WITH WHY WE NEED TO TALK ABOUT THIS….. 23% of graduate nurses enter practice possessing the clinical reasoning skills that lead to correct clinical judgment. They are not prepared for challenges of caring for complex, acutely ill pts. Kavanaugh & Szweda, 2017 NURSES FAIL TO RESCUE… Pts. do not stay static; they improve or can deteriorate when a complication appears. Nurses fail to recognize relevant clinical data of a complication then fail to respond appropriately. RECOGNIZE & RESPOND APPROPRIATELY… Adverse outcomes (including death) can be prevented if the nurse exercises correct clinical judgment by recognizing & responding appropriately to a complication before it needlessly progresses. Clarke & Aiken, 2003 ARE YOU READY TO You have an entire class DIVE IN?? devoted to Assessment CRITICAL THINKING Something you do every day! In Nursing it will become embedded into your practice Sort Information Recognize changes Make appropriate clinical decisions More to come on this!! CLINICAL JUDGEMENT Defined as: the observed outcome of critical thinking and decision making A process that uses nursing knowledge, experience, and critical thinking Clinical decision making separates professional nurses from tech’s or other assistive personnel  For ex. Blood glucose testing  The tech may collect the sample, perform the test, but the nurse has to make the clinical decision about the results  Does the patient need insulin, how much etc. https://www.youtube.com/watch?v=A4qzvchJT-k  The cognitive processes a nurse uses to make judgements about the clinical care of clients CRITICAL Includes: THINKING General Critical Thinking COMPETE Scientific Process, Problem Solving, Decision Making NCIES Specific Critical Thinking Diagnostic Reasoning and Clinical Decision Making PROBLEM SOLVING Obtain Information Suggest Possible solutions Try solutions over time Evaluate solutions SPECIFIC CRITICAL THINKING Diagnostic Reasoning involves understanding and thinking through clinical problems, gathering information, analyze cues, make an accurate diagnosis-what caused the problem? Decide on interventions to meet the needs of the client Accurate problem recognition is necessary before choosing solutions and implementing action SPECIFIC CRITICAL THINKING Involves Inductive(general) and Deductive(specific) Reasoning Skilled clinical decision making occurs through knowing the client  Spend time with client  Identify trends and patterns  Listen to your client  Care for the client over time CLINICAL JUDGEMENT 6 Components of Critical Definition Thinking The outcome of critical thinking Competence through the application of the nursing process Knowledge Experience Environment Attitudes Standards KNOWLEDGE BASE Varies according to educational experience  Degree, continuing education, additional college degrees Evidence Based Knowledge-knowledge based on research This improves nurses’ critical thinking  Application of client data  Obtained through direct exam, interviews with client and family, medical records and diagnostic data EXPERIENCE You will understand clinical situations, begin to anticipate and recognize patient cues You will begin to apply past experiences and knowledge to current situations ENVIRONMENT Attention to making clear decisions can be threatened; you must act in a timely manner to prevent a client from deteriorating Setting-is it noisy? Are there frequent interruptions? Lots of visitors? Task-simple vs complex Complexity-clients have multiple medical diagnoses, multiple medications Interruptions-phones, call lights etc. CRITICAL ATTITUDES Confidence Discipline Independence Perseverance Fairness Creativity Responsibility Curiosity Risk taking Intellectual Integrity Humility WE JUST REVIEWED THE CRITICAL THINKING AND Let’s move on…. CLINICAL JUDGEMENT NURSING PROCESS Nurses apply the nursing process in clinical decision making The cognitive skills interact CLINICAL JUDGEMENT MODEL SIX COGNITIVE SKILLS NEEDED TO MAKE APPROPRIATE CLINICAL DECISIONS Recognize Cues Analyze Cues Prioritize Hypotheses Generate Solutions Take Action Evaluate Outcomes RECOGNIZE CUES Identify relevant and important information from different sources History, VS, labs, medication record, assessment Is there something urgent to address?  What is relevant?  What is of immediate concern? ANALYZE CUES REFER TO PAGE 246 Organizing and linking the recognized cues to the client’s clinical presentation What client conditions are consistent with the cues? Why is a cue cause for concern? From your assessment data(subjective and objective) look for patterns Compare client data with information that is consistent with normal, healthy patterns and accepted norms(lab values, vital signs, and normal physiological limits) PRIORITIZE HYPOTHESES/PROBLEM REFER TO PAGE 251 PRIORITIZATION SECTION Evaluating and ranking according to priority High Intermediate or low in importance Urgency, likelihood, risk etc. A problem that when left untreated resulting is harm to the client will have the highest priority GENERATE SOLUTIONS PAGES 260-261, 263,TABLE 18.1 Involves Setting Priorities Identifying expected outcomes/goals What are the desirable outcomes? What interventions can achieve those outcomes? What should be avoided?  GRAB YOUR GEAR, YOU’RE ABOUT TO TAKE ACTION AND INTERVENE… The best ways to provide your nursing care… Make sure it’s evidence-based Don’t go it alone, check out the Nursing Care Plan book Your pt.’s picture won’t be there, but you will find info to prime your pump on the best way to intervene! How should the intervention be accomplished? INTERVENTIONS/ACTIONS Page 265 Independent  Autonomous actions based on scientific rationales  Nurse initiates without supervision, direction, or orders Dependent  Requires an order from a health care provider  As a nurse you intervene by carrying out the health care provider’s written or verbal orders  Insert a catheter, initiate IV fluids, administer medications, dressing changes etc TAKE ACTION “Carry out” the specific, individualized, jointly agreed-on interventions in the plan of care. Often, the interventions implemented are focused on symptom management, which is alleviating symptoms so that the client’s able to function at their highest level. Performance at its finest! You always reassess your patient after taking action/initiating interventions  Collect new data  Does this provide any new clues that you would need to alter your plan of care? AND FINALLY EVALUATE OUTCOMES Compare observed outcomes Recall your SMART goal: against expected outcomes  Be specific  Make it measurable What signs point to  And achievable improving/declining/unchanged  Relevant status  Time frame Would other interventions have been more effective  Did your plan work?? REVIEW: SIX COGNITIVE SKILLS NEEDED TO MAKE APPROPRIATE CLINICAL JUDGMENTS…. Recognize Cues Analyze Cues Prioritize Hypotheses Generate Solutions Take Action Evaluate Outcomes LET’S APPLY WHAT WE HAVE LEARNED!! SCENARIO/INFORMATION Mr. Lawson is a 68-year-old who had abdominal surgery for a colon resection and removal of a tumor yesterday. He is retired, lives with his wife of 40 years. He has a history of hypertension and GERD. NKDA. His most recent VS are: Temp 98.6, HR 108, RR 24, BP 160/90, O2 sat 93% on RA. You find him lying supine in bed with his arms held tightly over his abdomen. His facial expression is tense. You check his surgical wound, observing the condition of the dressing. The dressing is midline with a small amount of serosanguinous drainage. The dressing is due to be changed when the physician rounds. There is also a Jackson Pratt drain device in place draining red secretions. SCENARIO/INFORMATION You note he winces when you place your hands to palpate around the incision. You ask when he last turned onto his side, and he responds “Not since last night.” You ask, “Show me where you are having pain.” He points to his incision and says, “It hurts too much to move.” You assess him using a pain-rating scale. He rates his pain at 7 on a scale of 0-10. You refer the electronic health record, noting he received the last analgesic 5 hours ago. You consider the information observed and gathered. Refer to pages 225 238 Figure 16.5 and figure 16.7 Page 246 Data clustering Page 248 Figure 17.4 Page 251 Prioritization 260-263 Page 262 Table 18.1 Take the Clinical Judgement Worksheet and begin to apply the information Once you are in clinical you will have access to the EMR for PMH, lab, VS, Intake and output, medications etc. For rationales on interventions refer to the care plan book or text. WELCOME TO NURSING!