Study Guide for Critical Thinking and Nursing Process
1.
2.
Review the outlines given in class.
Define and differentiate between critical thinking, problem-solving, decision
making, and clinical judgment.
Critical thinking
The active, organized, cognitive process used to carefully examine
one’s thinking and the thinking of others. It requires the nurse to:
observe, decide what is important, look for patterns &
relationships, identify the problem, transfer the knowledge from
one situation to another, apply knowledge, and evaluate according
to criteria.
Problem solving
A systematic approach resulting in formation of a solution.
Decision Making
The process of choosing among alternatives; does not have to be
related to a problem.
Clinical Judgment
The ability to safely and competently care for clients, “the process
by which the nurse decides on data to be collected about a client,
makes an interpretation of the data, arrives at a nursing diagnosis
and identifies appropriate nursing actions: this involves problem
solving, decision making, and critical thinking”
3.
Clarity
What are the standards of critical thinking? Give examples of each.
Thinking clearly is central to understanding. Can you explain clearly
what you learned?
EX: Abbreviations may lead to error
Accuracy
Using reliable resources and evidence-based practice. Accurate
interpretation of evidence and data.
EX: Medication calculations
Precision
Exactness and details.
EX: Errors in patient care occur when the nurse takes short cuts.
Relevance
Discriminate between pertinent and non-pertinent information. The mind
becomes cluttered with irrelevant facts.
EX: Which patient symptoms/observations are important and which are
not
Depth
Go beyond the surface – recognize the complexities and visualize
relationship among various aspects.
Ex. Using FORM model, care for patient as a person
F – Family
O – Occupation
R – Recreation
M – Message (more willing to listen)
Breadth
Thinking from several different points of view (POV) and considering
different POV before making a decision.
EX: Differing POV occur frequently in health care.
Logic
Significance
Fairness
Maturity
Conclusion is based on evidence and assumptions must be valid. Ask
yourself, does this make sense?
EX: Nursing procedures need to be performed in a logical order.
Determining which facts are most important and what information is
critical to the situation.
Being open to others’ ideas or information, and avoiding bias. Allowing
biases can compromise the integrity of the thinking process.
EX: Listen to both sides in any discussion. If a patient or family member
complains about a co-worker, listen to the story and then speak with the
co-worker as well. If a staff member labels a patient uncooperative,
assume the care of that patient with openness and a desire to meet that
patient’s needs.
Putting focus on the client, not self (develops over time).
4.
What are the pitfalls in critical thinking?
Illogical process: “Obviously” “It is true because it is so.”
Appeal to tradition: “We’ve always done it this way.”
Hasty generalizations without considering all the evidence.
Bias: can cause errors in care
Close-mindedness: limits care
Jumping to conclusions.
5.
Differentiate between critical pathways, algorithms and the nursing process.
- Critical pathways: Step by step plan of care. It’s patient care
management plans that provide the multidisciplinary health care team with
the activities and tasks to be put into practice over time; their main
purpose is to deliver timely care in each phase of the care process for a
specific type of patient.
-Algorithms: Question with yes or no – it narrows focus, and helps one
come up with an answer.
-Nursing process:
Decisions have consequences and ignoring a problem is a decision and has a
consequence.
Name and define the five problem-solving strategies.
 Do it yourself
 Combine Knowledge
 Influence others
 Do nothing
 Delegation
What are the non-systematic methods of problem solving?
 Tradition/habit
 Authority
 Trial and error
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13.
Define the nursing process. Remember the nursing process is used to develop
nursing care plans (NCP) whose major purpose is to identify nursing actions
to be delivered to clients.
 The nursing process is a scientific problem-solving method that assists
the nurse in using theoretical knowledge to diagnose the nursing care
needs of persons and to plan interventions to be implemented to attain,
maintain, and promote optimal biopsychosocial functioning.
What are the components of the nursing process?
 Provides a way to identify health – strengths and needs
 Framework for nursing practice
 Utilizes nursing standards (what you can/cannot do)
What is the first step of the nursing process and what is involved in this step?
1) Assessment
 Collect and validate data through…
o Interview
o Physical exam
o Use of instruments
o Health history
o Physical assessment
o Psychosocial assessment
o Observation of the environment
o Functional health assessment
 Being to cluster clues and identify patterns
Identify and give example of objective and subjective data.
 Subjective: symptoms and “I” messages
 “I am having pain”
 “Pain level 5/10”
 “I ate well”
 Family member states “Patient is 66.”
 Objective: Information obtained by clinical observation, examination, and
diagnostic studies.
 Diet recall: 25% of meat, 25% of vegetables, and 100% of fruit
 Patient grimacing when he turns to left side.
Define the analysis step of the nursing process.
 Analysis is continuing to cluster clues and identifying patterns and
additionally reviewing data and clusters, identifying relevant data,
knowing “normal,” looking at patterns. It is defined as the cognitive
process of breaking down information into component parts and
identifying relationships among them.
 List all problems identified for patient.
 EX: surgical pain, fever, fluid deficit, immobility, and constipation
 Set priorities – what comes first?
 Maslow’s Hierarchy
 ABC
 Eliminate the most stable and see least stable first.
14.
What is the nursing diagnosis? Differentiate this from a medical diagnosis.
Defines the parts of the nursing diagnosis and the PES system. What do the
letters stand for? Give examples of each.
 Nursing diagnosis: promotes individualized care, professional
accountability, and autonomy by defining and describing the independent
area of nursing practice. It is the conclusion a nurse reaches after
collecting and analyzing data about a patient’s health status.
 Nursing diagnosis vs. medical diagnosis: the nursing diagnosis focuses on
problems the nurse can help with and the medical diagnosis focuses on the
disease process.
 PES:
 Problem: diagnostic label (positive or negative finding)
 Etiology: cause of a problem (R/T)
o Must be something nursing can do something about
o Common areas: lack of knowledge, lack of resources, lack
of compliance, lack of ability
o Can have secondary to… (may be a medical diagnosis)
 Signs and Symptoms: objective and subjective from data.
 PES:
 The problem: actual > potential
 The contributing factors (related to) (etiology)
 The signs and symptoms (as evidence by) (subjective and
objective)
 Secondary to medical
15.
What are the seven steps of the nursing process? Give an example of each.
Step
Pneumonic
Definition
Example
Assessment (A)
Angry
Data collection
“Patient grimacing when he
turns to left side.”
Analysis (A)
Alexis
- Surgical pain
-fever
-fluid deficit
-immobility
-constipation
Nursing
Diagnosis (D)
Doesn’t
Client
Outcomes (CO)
Cooperate
Cognitive process of
breaking down
information into
component parts and
identifying the
relationships among
them.
Conclusion a nurse
reaches after
collecting and
analyzing data about
a patient’s health
status.
Statements of
preferred patient
“Ineffective coughing related
to lack of knowledge of
coughing techniques.”
“Client will state five foods
that are vegetables he likes by
(Planning)
Nursing
Interventions
(NI)
(planning)
Nicely
Implementation
(I)
In
Evaluation (E)
Elevators
16.
17.
status, part of
collaborative
process, and states
outcomes and
deadlines.
What the nurse will
do to address the
problem in order to
help the client
achieve the
outcomes.
the end of the teaching session
today.”
During the clinical today the
nurse will: list 10 foods that
are vegetables, ask client to
choose 5/10 vegetables that he
likes to eat, and asses the
client in developing a 3-day
menu that includes the 5
vegetables.
Carry out or delegate “[interventions] implemented
care based on
as planned.”
priorities.
The planned
“Outcome achieved. BP is
systematic
128/78”
comparison of a
OR
client’s current
“Outcome not achieved. BP is
health status with the 92/50”
states outcomes.
Recognize the NANDA nursing diagnostic labels.
State the four etiological areas of the diagnostic statement and give an
example of each.
 Lack of Knowledge
 Does not have the information
 Does not understand the information
 EX: Does not know pickles are high in sodium.
 Lack of Resources
 Money, medication, assistive devices, people (don’t have a way to
get to the doctor)
 Ex: Does not have money to buy medication.
 Lack of Motivation
 Has knowledge, resources, and ability, yet does not do what is
needed (hardest to deal with)
 Ex: Doesn’t follow through with doctor’s appointment although
patient has a way to get there, has the ability to get there, and
knows why he should go.
 Lack of Ability
 Many clients in hospital are in this situation
 Much nursing care is needed as the client cannot do what is needed
and someone must assist.
 Ex: Patient is unable to walk after a broken hip.
18.
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20.
What are client outcomes? What parts are required when developing a client
outcome?
 Step 4: Client Outcomes
 Statement of preferred patient status
o “The patient will…”
o Use words like… “list, state, increase”
o Do not use… “understand, learn, feel”
 Part of collaborative process
o Nurse/client/other providers
 Outcomes and deadlines
o Specific and measurable
o Clear and objective
o Realistic
o Time Frame
 Short and long term goals
 Outcomes will show resolution of the etiology first and the
problem last.
 Ex: “During the clinical today, the client will take three deep breaths and
cough once forcefully.”
What are nursing interventions? What parts are required when developing
nursing interventions? What is evidence-based practice and how does it
related to nursing interventions and the nursing process?
 Step 5: Nursing Interventions
 Nursing interventions are “the nurse will…” statements. They are what the
nurse will do to address the problem in order to help the client achieve the
outcomes. The nurse will do what to or with whom, how, when, where,
and rationale (why).
 Should be based on assessment data
 Consider client resources and abilities
 What will the nurse do to help resolve the etiology of the problem?
 You need to support the interventions with evidence-based practice (EBP);
this is your rationale. Why are you doing what you’re doing?
 EBP: practices based on research findings are more likely to result
in the desired patient outcomes across various settings and
geographic locations.
What is implementation and what is included in this step?
 Step 6: Implementation
 Carrying out or delegating care based on priorities.
 Implementing interventions.
o Refers to accomplishing or fulfilling
o Actually doing what you said you will do
o Documentation of “did it” or “didn’t do it” and why.
 Priorities
o What should the nurse do first?
o Is it the right thing to do?
o What will happen to the patient?
 EX: “Implemented as planned” or “Not implemented as planned due to
blah blah blah.”
21.
What is evaluation? What are the parts of evaluation? What should be
included in the summary portion?
 Step 7: Evaluation
 The planned systematic comparison of a client’s current health status with
the stated outcomes.
 Evaluate outcomes: achieved, not achieved, partially achieved, and
how you know this.
 Summary
o Review all areas of the process - are outcomes as a whole
achieved?
o Look at the whole process, outcomes, interventions, and
implementation. Are there any changes needed?
o Where to go from here – plan for the future.
o Did it work? Document and communicate.
22.
Review the example of the nursing process. Be able to identify all parts of the
process.
“During clinic today, the nurse will instruct the patient to take three deep breaths in and
out and on the third exhalation cough forcefully. This should be done every two hours
while awake.”
This is an example of what part of the nursing process?
 assessment
 outcome
 intervention
 evaluation
Which part of the above is missing?
 who
 to whom
 what
 scientific rationale