critical thinking in nursing practice, nursing assessment
TRANSCRIPT
Critical Thinking in Nursing Practice, Nursing Assessment
CRITICAL THINKING
Critical thinking is an active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others Recognize that an issue exists Analyzing information about the issue Evaluating information Making conclusions
Critical Thinking Requires…
Cognitive skills Ask questions Remain well-informed Be honest in facing personal biases Be willing to reconsider and think clearly
about issues
So why learn about critical thinking?
Nurses need to make critical decisions all the time
Nurses are the ones with the patients all day and night, unlike doctors who usually only spend a few minutes with patients (sometimes from the doorway)
Nurses are the ones who are most likely to pick up on slight changes in patient conditions and then decide what to do…
Who to call? Call the doctor?
Watch & wait? What to do first?
Critical thinking
Successful organizations are staffed by people who think, not just follow orders
The biggest threat to critical thinking is just focusing on tasks to be done or “putting out fires” and not thinking about what you are doing and why
Critical thinking & assessment
Data collection is not an end in itself-
it isn’t done just to get the forms filled out
and assignments completed
Assessments are done
so that the findings can be analyzed
and problems can be identified
Autonomy Patients have the right to self-determination
That means that they have the right to decide for themselves about their health and treatment options
Patients have the right to refuse treatment or medication even if they may die without it
If the patient is a minor, parents are expected to make these decisions
If an adult patient is unable to make decisions for himself, decisions are made by the family members or a court-appointed legal guardian
Delegation
RNs may delegate tasks to other members of the health care team Licensed practical nurses (LPNs) Nursing assistants (NAs)
Do not delegate tasks that require nursing assessment or judgment Formulating nursing diagnoses Notifying doctors of changes in a patient’s condition Changing plan of care for a patient Advanced nursing procedures & interventions
Delegation
So what might you delegate?
Bed baths and bedpans Changing incontinent patients
Feeding patients Taking vital signs
Walking patients in the hall Getting patient up in the chair
Making beds Bringing ice water to patients
But there’s a catch…
You have to use your nursing judgment to know if a particular tasks should be delegated!
For instance… Your elderly patient just had a stroke and has difficulty
swallowing. Since there is a good chance that the patient might choke on his food, it would not be a good idea to have the nursing assistant feed this patient
If your patient is very unstable (going into shock, perhaps!) you would want to take the vital signs yourself to make sure that they are accurate
Nursing Process (ADPIE)
Assessment
Nursing Diagnosis
Planning
Implementation/Intervention
Evaluation
Assessment
The deliberate and systematic collection of data to determine a client’s current and past health status and functional status and to determine the client’s present and past coping patterns. Collection and verification of data
Primary source = patient Secondary source = family, medical record
Analysis of data
Data Collection
Subjective Patient states
Objective Observations or Measurements
Vitals Inspection of a wound
Assessment DataAssessment Data Subjective Data Objective Data Sources of Data Methods of Data Collection-Interview Interview initiates nurse-client
relationship Use open-ended questions Nursing health history
Methods of Data Collection
Interview Helps clients relate their own interpretation and
understanding of their condition Three phases
Orientation Begin a relationship Understand client’s primary needs
Working Gather information about the client’s health status
Termination
Types of InterventionsTypes of Interventions
Nurse-Initiated
Physician-Initiated
Collaborative Interventions
Nursing Care Plans vs Concept Nursing Care Plans vs Concept MapsMaps
NCP Concept/Mind Map