Lesson 2.1

Chapter 2

Lesson 2.1

Chapter 2

Critical Thinking and Nursing Process

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Learning ObjectivesLearning Objectives

Theory

1. Explain what critical thinking is in your own words.

2. Describe how critical thinking affects clinical judgment.

3. Discuss why nurses in all programs must learn to think critically.

4. Clarify your role in nursing process according to your state’s nurse practice act.

5. Explain three fundamental beliefs about human life as the basis for nursing process.

6. Identify the source for LPN/LVN standards for nursing process.

Clinical Practice

1. Explain how factors that influence critical thinking are experienced by you during patient care.

2. Provide a clinical example of how nursing process is used in the care of medical-surgical patients.

3. Provide an example of each of the following techniques of physical examination: inspection and observation, olfaction, auscultation, and percussion.

4. Prepare a list for beginning-of-shift assessment for a specific patient.

5. Write an example of a patient goal that is realistic, measurable, and time referenced.

6. Differentiate between nursing orders and medical orders.

7. Explain the value of identifying the patient’s actual problems that lead to nursing diagnoses.

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Critical ThinkingCritical Thinking

• A problem-solving method

• Incorporates the scientific method

• Always asks, “Is there a better way?”

• A lifelong process

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Critical Thinking and Clinical Judgment

(Alfaro-Lefevre, 2004) Critical Thinking and Clinical Judgment

(Alfaro-Lefevre, 2004)

• Purposeful, informed, and outcome-focused

• Requires careful identification of patient problems, issues, and risks

• Makes accurate decisions about what is happening, what needs to be done, and prioritization of patient care

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Critical Thinking and Clinical Judgment

(Alfaro-Lefevre, 2004) Critical Thinking and Clinical Judgment

(Alfaro-Lefevre, 2004)

• Driven by patient, family, and community health care needs

• Based on principles of nursing process and the scientific method

• Uses logic, intuition, knowledge, skills, and experience of the LPN/LVN

• Guided by standards and ethical codes

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Critical Thinking and Clinical Judgment (Alfaro-Lefevre, 2004)

Critical Thinking and Clinical Judgment (Alfaro-Lefevre, 2004)

• Calls for strategies that make the most of human potential

• Compensates for problems created by human nature

• Means constantly reevaluating, self-correcting, and striving to improve (Hill and Howlett, 2005).

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Consider the Following When Receiving Report

Consider the Following When Receiving Report

• Do I understand what is being said?

• What will I be expected to do?

• What are the priorities of nursing care?

• What areas need further clarification?

• What procedures will require instructor supervision?

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Critical Thinking Is Based On Science

and Scientific Principles Critical Thinking Is Based On Science

and Scientific Principles

• Collecting data in an organized way

• Verifying data in an organized way

• Looking for gaps in information

• Analyzing the data

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Factors that Influence Critical Thinking and Nursing Care

Factors that Influence Critical Thinking and Nursing Care

• Attitude

• Communication skills

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Fundamental Beliefs: The Basis for Nursing Process

Fundamental Beliefs: The Basis for Nursing Process

• Every person is endowed with worth and dignity.

• Every person has basic needs.

• Meeting one’s basic human needs may require assistance.

• Every person has the right to high-quality service.

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Fundamental Beliefs: The Basis for Nursing Process

Fundamental Beliefs: The Basis for Nursing Process

• Patients and their families prefer a patient-centered approach.

• The focus of nursing should be on maintaining health, preventing disease, and helping the sick and injured.

• The nurse who engages in the nursing process will continue to work toward his/her own self-fulfillment.

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The Nursing ProcessThe Nursing Process

NCSBN and the LVN/LPN in medical-surgical nursing:

1. Assessment (data collection)

2. Nursing diagnosis

3. Planning

4. Implementation

5. Evaluation

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Assessment (Data Collection)Assessment (Data Collection)

• Data collection

• Subjective data

• Objective data

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Sources of InformationSources of Information

• Review of admission forms

• Interview:– Primary source – Secondary source

• Medication reconciliation form

• Physical assessments

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Figure 2-3Figure 2-3

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Physical Assessments Physical Assessments

• Inspection and observation

• Olfaction

• Palpation

• Auscultation

• Percussion

• Practical daily assessment (data collection)

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Chart ReviewChart Review

• History, physical examination, progress notes, and results of diagnostic tests

• Medication profile sheets or medication administration record

• Nursing documentation and patient chart information

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Legal & Ethical Considerations 2-1: Protected Health Information

Legal & Ethical Considerations 2-1: Protected Health Information

• Any protected health information that the student collects from a patient’s chart must be carefully guarded to avoid violating the confidentiality component of the HIPAA.

• Information that is retained by the student for educational purposes must be devoid of identifying information.

• Student preparation paperwork that contains protected health information must be destroyed following the policies and procedures of the facility.

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Commonly Ordered Tests Commonly Ordered Tests

• WBCs

• RBCs

• Hemoglobin

• Hematocrit

• Platelets

• Glucose

• Hemoglobin A1C

• Thyroid-stimulating hormone

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Analysis and Nursing Diagnosis:

Patient’s Response to Health Condition Analysis and Nursing Diagnosis:

Patient’s Response to Health Condition

• Based on available patient data• Nursing diagnosis and medical diagnosis• Complete nursing diagnosis includes:

– The problem (NANDA stem) – The etiology (related causes of the problem) – The signs and symptoms (evidence of the

problem)

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Nursing Diagnosis: Actual or Potential Problems

Nursing Diagnosis: Actual or Potential Problems

• Actual problems are currently exhibited and include all three components of the diagnosis statement

• Potential problems do not currently exhibit evidence, but the data demonstrate that these could occur

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PlanningPlanning

• Setting priorities of care:– Maslow’s Hierarchy of Needs

• Goals and expected outcomes:– Outcome statements are derived from the

signs and symptoms included in the nursing diagnosis statement

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Figure 2-5Figure 2-5

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Characteristics of Outcome Statements

Characteristics of Outcome Statements

• Realistic

• Measurable

• Time-referenced

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Writing Expected Outcomes Writing Expected Outcomes

• Subject

• Action verb

• Conditions or modifiers

• Criterion (standard) for desired performance

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Nursing InterventionsNursing Interventions

• Nursing actions to achieve the goals and expected outcomes

• Independent nursing interventions

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ImplementationImplementation

• LPN/LVN scope of practice

• Staff communication regarding care

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EvaluationEvaluation

• Comparison of actual outcomes to the expected outcomes

• Interdisciplinary (collaborative) care plan