NU226 - Ch15 (Crt Thinking in Nsng)

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critical thinking

Active, organized, cognitive process used to carefully examine one's thinking and the thinking of others.

database

Information about a client's level of health, health practices, past illnesses, present illnesses, and physical examination combined to serve as the basis for the plan of care.

decision making

Process involving critical appraisal of information that results from recognition of a problem and ends with the generation, testing, and evaluation of a conclusion.

problem solving

Methodical, systematic approach to explore conditions and develop solutions and that includes analysis of data, determination of causative factors, and selection of appropriate actions to reverse or eliminate the problem.

reflection

Process of thinking back or recalling an event or discovering the meaning and purpose of that event.

evidence-based knowledge

Knowledge that comes from scientific investigation or knowledge that is based on clinical expertise

prognosis

A prediction of the probable outcome of a disease or condition of a client and the usual course of the disease as observed in similar situations

clinical decision making

The use of critical thinking skills throughout the nursing process to obtain relevant information about the client and to plan and provide effective care and measure the outcomes of the care provided. Clinical decision making may occur alone or in collaboration with other health care providers.

diagnostic reasoning

Process that enables an observer to assign meaning and to classify phenomena in clinical situations by integrating observations and critical thinking.

scientific method

Codified sequence of steps used in the formulation, testing, evaluation, and reporting of scientific ideas.

inference

Taking one proposition as a given and guessing that another proposition follows.

nursing process

Systematic problem-solving method by which nurses individualize care for each client. The five steps of the nursing process are assessment, diagnosis, planning, implementation, and evaluation.

concept map

Visual representation of client problems and interventions that shows their relationships to each other. Metacognitive tool that assists learners in developing a self-appraisal of their own individual thinking processes and in considering the context of nursing practice in the conceptualization of client problems.

Key Concepts

Critical thinking is a process acquired through experience, commitment, and active curiosity towards learning

clinical decision-making involves judgment that includes critical and reflective thinking and action and application of scientific and practical logic

nurses who apply critical thinking and their work focus on options for solving problems and making decisions, rather than rapidly and carelessly forming quick, single solutions

following a procedure step-by-step without adjusting to a client's unique needs is an example of basic critical thinking

and complex critical thinking in nurse learns that alternative, and perhaps conflicting, solutions do exist

when you face a clinical problem or situation and choose a course of action from several options, you are making a clinical decision

in diagnostic reasoning, you collect client data and then logically explain a clinical judgment, such as nursing diagnosis

you improve your clinical decision-making by knowing your clients

the nursing process is a blueprint for client care that involves both general and specific critical thinking competencies in a way that focuses on a particular client's unique needs

the critical thinking model combines and nurses knowledge base, experience, competence in the nursing process, attitudes, and standards to explain how nurses make clinical judgments that are necessary for safe, effective, nursing care

clinical learning experiences are necessary for you to acquire clinical decision-making skills

reflective journaling gives you the opportunity to define and express the clinical experience in your own words

critical thinking attitudes help you to know when more information is necessary, when information is misleading, and to recognize your own knowledge limits

the use of intellectual standards during assessment ensures a complete database of information

professional standards for critical thinking refer to ethical criteria for nursing judgments, evidence-based criteria for evaluation, and criteria for professional responsibility

1. During the change-of-shift report the night nurse states that a client mentioned having a bad experience with surgery in the past. The nurse was called away and was unable to continue the conversation with the client. The nurse tells the day shift nurse about the comment and notes that the client appears anxious. When the day shift nurse visits the client to clarify the client's bad experience with surgery, the nurse is exhibiting which aspect of critical thinking?

Discipline!

Discipline includes completing the task at hand, including assessments (which were not completed on the previous shift). Integrity includes recognizing when one's opinions conflict with those of others and finding a mutually satisfying solution. Confidence is demonstrated in one's presentation and belief in one's knowledge and abilities. Perseverance helps the critical thinker to find effective solutions to client care problems, especially when they have been previously unresolved.

A client tells the nurse, "I'm not happy with the way the patient care technician did my bath. He just seemed to be in a hurry and did not wash my back like I asked." The nurse decides to go talk with the technician to learn his side of the story as well. This is an example of:

Fairness

Fairness involves analyzing all viewpoints to understand the situation completely before making a decision.

Curiosity gives the critical thinker the motivation to continue to ask questions and learn more.

Risk taking involves trying different ways to solve problems.

The surgical unit has initiated the use of a pain rating scale to assess the severity of clients' pain during their postoperative recovery. The nurse assigned to a client can look at the pain flow sheet to see the client's pain scores over the last 24 hours. Use of the pain scale is an example of adherence to which intellectual standard?

Consistency

Using the same pain scale for all clients and ratings promotes consistency—each nurse has the same measurement scale to compare assessments.

Relevance refers to how applicable the assessment is.

An assessment has depth when it deals with less obvious issues. Specificity refers to the ability of the assessment to provide information about the particular problem of interest.

During the day the nurse spends time instructing a client in how to self-administer insulin. After discussing the technique and demonstrating an injection, the nurse asks the client to try it. After the client makes two attempts it is clear that the client does not understand how to prepare the correct dose. The nurse discusses the situation with the charge nurse and asks for suggestions. This is an example of:

Problem Solving

This is an example of problem solving because the nurse is taking a problem to a supervisor for help in finding a different approach.

Reflection is the process of purposefully thinking back and recalling a situation to discover its purpose or meaning.

Risk taking involves trying a different approach.

Client assessment is the first step in the process of instruction.

A nurse uses an institution's procedure manual to confirm how to insert a Foley catheter. The level of critical thinking the nurse is using is

Basic Critical Thinking

At the basic level of critical thinking, a learner trusts the experts and follows a procedure step by step.

Complex critical thinkers separate themselves from authorities and analyze and examine choices more independently.

Commitment is the third level of critical thinking in which the person anticipates the need to make choices without assistance from others.

The scientific method is a process of problem solving.

A nurse refers to a client's postsurgical written plan of care, noting that the client has a drainage device collecting wound drainage. The surgeon is to be notified when drainage in the device exceeds 100 ml for the day. The nurse carefully notes the amount of drainage currently in the device. This is an example of:

Assessment

Assessment is the process of observing and collecting data.

Planning is the step in which the diagnosis is analyzed for problem resolution.

Intervention consists of the steps actually taken after planning.

Evaluation measures the effectiveness of the plan.

The nurse asks a client how she feels about impending surgery for breast cancer. Before initiating the discussion the nurse reviewed information about loss and grief in addition to therapeutic communication principles. The critical thinking component involved in the nurse's review of the literature is:

Knowledge application

The nurse sought appropriate information to be able to communicate more knowledgeably with the client. Experience is acquired through clinical learning situations. Problem solving is a series of steps to resolve a problem. Clinical decision making is a process in which critical thinking steps are followed for problem resolution.

8. Before performing a procedure for the first time at a new agency, the travel nurse:

Reads about the policy in the procedure and policy manual

Every agency has its own policies and way of performing procedures.

The charge nurse may not know how the procedure should be performed or may explain it incorrectly.

The procedure may be performed differently than in the previous agency.

If the nurse refuses to perform procedures that are covered by the Nurse Practice Act, the nurse could be fired.

Which of the following is the most accurate information to give a nurse during change-of-shift reporting?

"Client reports pain in left anterior knee"

The information in this option represents objective data that the nurse can use as part of baseline information.

"Encouraged" and "more" are vague terms. "Concern" is also vague; relating the exact concern would be more accurate.

"Client refuses to take meds" may be true, but accurate data would also report why the client refused medication.

On entering a client's room during change-of-shift rounds, the nurse notices that the client and spouse have their backs turned to each other, and both have their arms folded across their chests. The best action for the nurse to take at this time is to:

Ask them if they need some alone time.

The situation suggests that the nurse entered during a stressful time. Offering privacy would be appropriate.

Because the situation indicates tension between the couple, this is not the time to initiate teaching.

The nurse is assessing the urinary history of a middle-aged married woman. The nurse asks her if she gets up at night. She replies, "Yes." What other question should the nurse ask?

"Why do you get up at night?"

Perhaps it is the client's husband who is getting up in the middle of the night because of a prostate problem, and this is why she is awakened. The nurse should not assume nocturia without further assessment questions.

A client with diabetes mellitus who takes daily insulin injections is scheduled for surgery the next day. The client is to take nothing by mouth (NPO status) after midnight. The nurse questions whether insulin should be given the morning of surgery. This is an example of:

Scientifically Based Clinical Judgement

The nurse is demonstrating awareness of the effect of insulin, which is to lower blood glucose level. Because the client will be NPO status for a long period of time, no calories will be consumed. Giving the usual injection of insulin could cause the client to experience hypoglycemia

The client is a 65-year-old overweight woman with multiple medical diagnoses, including diabetes mellitus type 2, hypertension, and residual right-sided weakness resulting from a previous cerebrovascular accident. What tool should be used to plan her care?

Concept Map

A concept map is a visual representation of client problems and interventions that shows their relationships to each other and allows easy synthesis of data about the client.

A client newly admitted to the hospital begins to have chest pain. Before calling the physician, the nurse should gather what additional data?

The nurse should gather the data the physician will need to determine whether the chest pain represents a myocardial infarction. Family history is important in comprehensive pain assessment; however, taking time to obtain this information is inappropriate in this critical situation.

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