Week 2 Clinical Decision Making Maslow PDF

Clinical Decision Making CRITICAL THINKING CLINICAL JUDGMENT PRIORITY SETTING COURSE OUTCOME Describe principles of safe, patient-centered, evidence-based nursing care to adults at the basic level, guided by the Caritas philosophy. Discuss critical thinking and clinical reasoning to provide...

Clinical Decision Making CRITICAL THINKING CLINICAL JUDGMENT PRIORITY SETTING COURSE OUTCOME Describe principles of safe, patient-centered, evidence-based nursing care to adults at the basic level, guided by the Caritas philosophy. Discuss critical thinking and clinical reasoning to provide quality patient care. Describe effective communication with patients and the interprofessional collaborative practice members. Competency Discuss critical thinking strategies used when making clinical judgments. Discuss the use of critical thinking to prioritize basic elements of patient care when implementing the nursing process. CONCEPT Clinical Decision Making: A process used to examine and determine the best actions to meet desired goals; requires anticipating, noticing, recognizing and organizing patient problems to respond with urgency and/or importance in a preferential order to avoid or minimize adverse changes in a patient’s condition. UNIT OUTCOMES Discuss Maslow’s Hierarchy of basic human needs as a basis for priority setting. Discuss anticipating and preventing complications. Describe characteristics of a critical thinker. Describe the components of critical thinking and clinical decision-making. What is a critical thinker? Critical Thinking -Deliberate, nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, and evaluating information -Process of: ◦ Questioning ◦ Analysis ◦ Synthesis ◦ Interpretation ◦ Inference ◦ Inductive and deductive reasoning ◦ Intuition ◦ Application ◦ Creativity What is a critical thinker? Question Apply Analyze Creative Reflective Synthesize Infer Interpret Reason Intuition Critical Thinker Prepare for all possibilities See the big picture Nursing Example: -hold medication for low BP Critical Thinking in Nursing Practice Recognize a problem Analyze information (cues) about the problem Is there a connection between the information and problems? Urgency? Choose strategies to care for the patient Self reflect – what worked versus what did not Continuous improvement on how to apply yourself when faced with problems in patient care  Critical Thinking in Nursing Practice: Let’s practice: Patient had abdominal surgery What should be considered? Three Levels of Critical Thinking Level 1 is Basic -Nurses think concretely on the basis of a set of rules or principles -Follow a step-by-step process without deviation from the plan or adjusting to patient’s unique needs -Examples of basic critical thinking: Three Levels of Critical Thinking Level 2 is Complex -Complex critical thinking analyzes and examines choices independently -Nurses learn to think beyond and synthesize knowledge -A nurse learns that alternative and perhaps conflicting solutions exist  Three Levels of Critical Thinking Level 3 is Commitment -Commitment is the third level of critical thinking -Nurses anticipate needs and make choices without assistance from others  Levels of Critical Thinking As a beginning nurse, what level are you? Five Components of Critical Thinking Foundation to grow and learn from: ◦ Knowledge ◦ Experience ◦ Nursing process ◦ Standards ◦ Attitude  1. Knowledge base -drawn from nursing school education -knowledge obtained from basic sciences, Five Components humanities, and behavioral science of Critical Thinking 2. Experience -obtained from clinical situations working with patients and their families. 3. Nursing Process five-step clinical decision-making approach assessment analyzing data planning implementation evaluation Five Components of Critical Thinking  4. Standards Level of care that all nurses are expected to provide Five -Nurses use evidence-based scientific knowledge (research) to address each individual patient Components of Critical -The Nursing Process is used to organize a nurse’s Thinking critical thinking -Patient is the Focus of the nurse (patient-centered care) * Standards established by State Boards, professional organizations, and employers  5. Attitudes What you bring to the situation: confidence creativity Five Componen honesty ts of humility Critical integrity Thinking knowledge of self-limits ability to ask for assistance and guidance willingness to reflect and learn spirit of care and compassion Application of the 5 components of critical thinking to clinical setting  How do we start? When you receive or start to collect information about the patient -When do you start to receive information about the patient? -What does the information mean for this patient? -Do they currently have a problem? -Is there or could there be developing a problem? -You see the patient - What do they look and sound like? -Is it what you expected before you met them? What is the same/different? Clinical reasoning starts here. Analyze and identify a patient problem  Clinical Diagnostic Reasoning Your ability to clinically reason (think) will advance over time. Expert recognition of cues occurs with repeated observation of patients with similar problems ◦ You will look for patterns between and among patients with similar problems You will use data from your observations and inquiry to identify PATIENT PROBLEMS Clinical Decisions in Nursing Practice Clinical decision-making separates professional nurses from technical and ancillary staff ◦ RN identifies a change in the patient’s condition ◦ RN recognizes a possible problem ◦ RN takes immediate action when a clinical condition declines ◦ Technical person follows directions in completing a specific TASK of care the RN has identified.  Critical Thinking Develops over time Developmental Journey: Patricia Benner (Nursing Theorist) ◦ Five levels in the journey toward clinical competence ◦ Novice ◦ Advanced beginner ◦ Competent ◦ Proficient ◦ Expert Benner’s Each level builds on the previous one Skill Restarts every time you change a new Acquisitio position throughout your career n Model Time it takes you to get to each level will vary Making Decisions and Setting Priorities Could patients have more than one problem? Priority Setting Organizing nursing problems using urgency and/or importance to establish a preferential order for nursing actions. Where to start? What is most important? What is the priority? Priority Setting Maslow’s Hierarchy of Basic Human Needs Model Helps care givers to identify a patient’s individual needs, prioritizing those needs, and encouraging the patient’s individual discovery of self.  Priority Setting - Maslow Some human needs are more basic than others Physiological; oxygen, fluids, nutrition, body temperature, and elimination are most basic. Safety and security are divided into physical safety – shelter protection from injury and psychological safety – feeling of security and trust Love and belonging – support systems and relationships with others Self esteem – control, competence, acceptance, and worth Self- Actualization – hope, spiritual well-being, enhanced growth  Let’s Practice 1. A nurse is admitting a patient to the nursing unit, which information is of greatest concern to the nurse (priority). Select all that apply (one answer to all answers). 1. The patient is 45 pounds over weight 2. The patient’s temperature is 99.7 F / 37.6 C. 3. The patient is complaining that her face, tongue, and throat itch 4. The patient has red hives on her neck and face Answer: 3 and 4 Eric Erikson: Theory of Development Life has a sequence or stages of development Tasks at each stage that can be successfully completed, partially completed, or unsuccessful Nurses enhance a patient’s development Erikson believes that the environment is highly influential to development Nurses help to share the environment for patients Erikson contends that people must change and adapt to maintain control over their lives Conclusion Critical Thinking Needed in Predicting Complications/Problems Nurses must anticipate Nurses need to notice cues Nurses need to prevent Nurses need to minimize risk Nurses need to recognize urgent cues Nurses need to take action