critical-thinking-in-the-nursing-process-lakesumter-：在護理過程中的批判性思考湖薩姆特課件

1、Critical Thinking in The Nursing ProcessSeparating the Professional from the TechnicalCritical Thinking in The Nursi“the active, organized, cognitive process used to examine ones own thinking and the thinking of others”Using reflection, intuition, and previous experiences to make sound decisions Req

2、uires a habit of asking questions, remaining well informed, a willingness to reconsider, and avoiding premature decision makingAspects of Critical Thinking“the active, organized, cognitKnowledge baseTheoretical ExperientialExperiencePractice making decisionsTechnical Skills & CompetenciesAttitudes a

3、nd behaviorsComponents of Critical ThinkingKnowledge baseComponents of CrSelf awareGenuine / authenticEffective communicatorCurious & inquisitiveAlert to contextAnalytical & insightfulLogical and intuitiveConfident & resilientHonestResponsible & autonomousCareful & prudentOpen & fair mindedSensitive

4、 to diversityCreativeRealistic and practicalReflective & self-correctiveProactiveCourageousPatient & persistentFlexibleImprovement orientedCritical Thinking Indicators R. Alfaro-LeFevreSelf awareCareful & prudentCriThe Nursing Process: a systematic problem solving approach consisting of;AssessmentDi

5、agnosisPlanningImplementationEvaluationNursing involves both thinking and doingNursing deals with complex issuesSpecific Critical Thinking in NursingThe Nursing Process: a systemBrings togetherCritical thinkingNursing processNursing knowledgePatient situationSynthesis of Critical Thinking & Nursing

6、ProcessSynthesis of Critical ThinkingTypes of AssessmentComprehensiveFocusedSpecial needs Initial OngoingStep 1 of Nursing Process AssessmentTypes of AssessmentStep 1 of NTypes of DataSubjectiveObjectiveSources of DataPrimary dataClientSecondary dataFamilyHealth RecordsHealth Team MembersNursing Ass

7、essmentTypes of DataNursing AssessmenMethods of collectionObservationUse all 5 sensesPhysical assessmentInterviewHealth historyNursing AssessmentMethods of collectionNursing APerformed after nursing historyCollection of objective dataHt., Wt., V.S.General SurveyHead to toe examInspectionPalpationPer

8、cussionAuscultationOlfactionPhysical Assessment Performed after nursing historBiographical DataReason for Seeking Health Care / Chief complaint Clients Expectations History of Present IllnessPast Health HistoryFamily History / social historyMedications Review of body systemsNursing Health HistoryBio

9、graphical DataNursing HealtTo ensure data is accurateCompleteFactualAnd you are not jumping to conclusionsWhen to validateSubjective and objective data do not agreePatients statements differ at different timesData falls outside normal rangeValidating DataTo ensure data is Validating DSystematic Usua

10、lly controlled by agency formsBody systems frameworkMaslows Hierarchy of NeedsGordons functional patternsOrems Self care modelRoy Adaptation ModelNANDA nursing diagnosis Taxonomy IIOrganizing DataSystematic Organizing DataOrganizing data into meaningful clustersA set of signs or symptoms grouped tog

11、ether into logical orderGroupings of associationsHelps you recognize significant cuesData ClusteringOrganizing data into meaningfuUtilizes critical thinking to Judge the value or significance of the dataValidate and verify assumptions with client and other health care team membersData Interpretation

12、Utilizes critical thinking to Identify patterns in data and draw conclusions about clients statusDescribes clients actual or potential response to a health problemA statement of client health that nurses can identify, prevent, or treat independentlyStated in terms of unique human responses to diseas

13、es, injuries, or stressorsMust be accurate because it provides direction for nursing careStep 2 of the Nursing ProcessNursing DiagnosesStep 2 of the Nursing ProcessActual (3-part statement)Presently existsRisk (2-part statement)Likely to develop in vulnerable patientPossible (2 or 3- part statement)

14、Suspect on intuition but dont have enough data yetSyndrome (1 part statement)Collection of nursing diagnoses that occur togetherWellness (1-part statement)Not a health problem, wants to move to higher level of wellnessTypes of Nursing DiagnosesActual (3-part statement)TypeDiagnostic Label (title or

15、name)Approved by NANDARelated FactorsEtiology must be in nurses domain to interveneDont use medical diagnoses Defining CharacteristicsCues from assessment data must support diagnosisEg. Impaired mobility R/T lack of peripheral sensation AEB inability to walk from bed to chair.Nursing Diagnosis State

16、mentDiagnostic Label (title or naData collectionOmitted, incomplete, inaccurate, disorganizedData analysis & interpretationInaccurate interpretation of cues, conflicting cues, incorrect judgments of inferencesData clusteringIncorrectly clustered or not clustered at allDiagnostic StatementProblem & e

17、tiology must be in scope of nursing to treatSources of Diagnostic ErrorData collectionSources of DiagIdentify clients response not medical diagnosisOne symptom is insufficient for problem identificationNursing interventions directed at correcting etiology of problemIdentify client response to equipm

18、ent not the equipment itselfClient problems not nurse problemsDevelop in cooperation with clientAvoiding Errors in Nursing DiagnosesIdentify clients response notNursing diagnosisDefines nursing needs of clients related to the medical diagnosesMedical DiagnosisReflects specific disease, illness, or i

19、njury Goal prescribe treatmentMedical Diagnosis vs. Nursing DiagnosisNursing diagnosisMedical DiagnPlace in order of importance or urgencyMaslows Hierarchy of Human NeedsPhysiologicalSafety and securityLove and belongingSelf-esteemSelf-actualizationA,B,CsNursing ProcessPrioritizing ProblemsPlace in

20、order of importance oClient centered goals / outcomesSpecific measurable objectiveAre precise, descriptive, clearly statedReflects highest level of wellnessShould be realisticObservable client behaviorMeasurable criteria for each goalProjected time frame for goal achievementProvide a guide for selec

21、ting interventionsShort term goalsAchieve in hours or days, less than 1 weekLong term goalsAchieved over weeks or monthsStep 3 of the Nursing ProcessPlanning / OutcomesClient centered goals / outcomSubjectThe clientAction verbAction that will be performed by clientPerformance criteriaSpecific measur

22、ement to be evaluatedTarget timeWhen action should be achievedSpecial conditionsAmt. of assistance, what equipment, resources neededProperly Written Expected OutcomesSubjectProperly Written ExpecClient centeredSingular factors/ criteriaObservable factorsMeasurable factorsTime limited factorsMutual f

23、actorsRealistic factors7 Guidelines for Writing Goals/OutcomesClient centered7 Guidelines fServes as Written guidelines for client careCommunicates careEnhances continuityOrganizes information promotes efficiencyInvolves client and familyMeets requirements of accrediting agenciesCare plans help stud

24、ents learn problem solving, skills of written communication, organizational skills, and application of theory Purpose of Care PlansServes as Written guidelines fAKA Nursing ActionsMeasuresStrategiesActivitiesActions based on clinical nursing judgment and knowledge that nurses perform to achieve clie

25、nt outcomesInclude activities of observation/assessment, prevention, treatment, & health promotionStep 4 of the Nursing ProcessPlanning Nursing InterventionsAKA Nursing Step 4 of the NursIndependentNurse initiated interventionsIn realm of independent nursing practiceNo MD order requiredDependentPhys

26、ician initiated interventionsRequire MD ordersCollaborative (interdependent) interventionsCoordination of multiple professionals3 Types of InterventionsIndependent3 Types of IntervenInclude activities of Observation/assessmentPreventionTherapeutic TreatmentsHealth promotionActivities of daily living

27、TeachingDischarge planningFlow from Client goals/outcomes / ordersIndividualize standardized interventionsInterventionsInclude activities of IntervenNursing OrdersInstructions on care plan describing implementation of interventionsInclude DateSubjectAction verbTimes and limitsSignatureStanding Order

28、sProtocolsCritical PathwaysEvidence Based PracticeNursing OrdersNursing action nonspecificFail to indicate frequencyFail to indicate quantityFail to indicate methodFail to indicate person to performErrors in Writing Nursing InterventionsNursing action nonspecificErroImplementationThe action phase of

29、 the nursing processYou will perform or delegate planned interventionsImplementation ends when you record the nursing actions on chartEvolves into evaluation as you record resulting client responses5th step of Nursing ProcessImplementation & EvaluationImplementation5th step of NursCheck your knowled

30、ge and abilitiesOrganize your workPrepare the patientImplement the planCoordinate/collaborateDelegate appropriatelyRight taskRight circumstanceRight personRight directions / communicationRight supervisionPreparing for ImplementationCheck your knowledge and abiliPlannedOngoing Does not end the nursin

31、g processSystematicMake judgments aboutClients progress toward expected outcomes/goalsEffectiveness of nursing care planQuality of nursing care deliveredThe final stepEvaluation PlannedThe final stepEvaluatiOngoing evaluationAt each contact with patientIntermittent evaluationAt outcome evaluation sp

32、ecified times Terminal evaluationAt time of dischargeTypes of EvaluationOngoing evaluationTypes of EvaReview OutcomesCollect Reassessment DataJudge Goal AchievementAchieved (met)Partially achieved (partially met)Not achieved (unmet)Record evaluative statement Revise care plan if indicatedBegin with assessment data and go through entire nursing processEvaluating Patient ProgressReview OutcomesEvaluating PatiWritten evidence of interactionsHealth professionalsClientsFamiliesHealth care organizationsDiagnostic testsTreatm