nursing process & critical thinking cld

Nursing Health Assessment

Maria Carmela L. Domocmat, MSN, RN
Instructor, Nursing Health Assessment
School of Nursing
Northern Luzon Adventist College

• Review of the Nursing Process

• Critical Thinking

Maria Carmela L. DOmocmat. RN, MSN

Nursing Process: A Review

• What is the nursing process and why
learn about it?


Nursing Process

• Nursing Process and Maslow are the
main frameworks for the local board
and the NCLEX Exams.

• Remember ONLY the RN can assess,
develop a plan of care, evaluate and
educate clients.

Nursing Process cont.

• is the framework for professional
nursing practice.



• Is a systematic, dynamic way of giving
systematic,
nursing care

• Promotes humanistic, outcome-focused,
humanistic, outcome-focused,
cost-
cost-effective care



• Pushes nurses to continually examine
what they are doing and to study how it
can be done better.

• Consists of five interrelated steps


1. Assessment
2. Diagnosis
3. Planning
4. Implementing
5. Evaluating


Nursing Process

• Why systematic?

• Why dynamic?

• Why humanistic?

• Why outcome-focused?
outcome-

• Why cost-effective
cost-


Systematic

• Like a problem-solving method
problem-

• It consists of five steps during which
you take deliberate steps to maximize
efficiency and attain long-term
long-
beneficial results.


Dynamic

• As you gain more experience, you’ll
find yourself moving back and forth
between the steps, sometimes
combining activities, yet getting the
same end result.


Dynamic cont.

• For example, new nurses often need to
methodically assess a patient for quite some
time before coming to a diagnosis, whereas
experienced nurses often immediately
suspect a diagnosis, then assess the patient
more closely to see of they are correct.

Humanistic

• The nursing process involves looking at the
whole patient at all times.

• It personalizes the patient.

• As nurses, we deal with the body, mind and
spirit.

• He is not "the CVA in bed # 5."

Humanistic
• We strive to understand each individual’s health
problems and the corresponding impact on one’s
sense of well-being and ability to do daily
well-
activities.


Humanistic
• The process provides a
roadmap that ensures good
nursing care and improves
patient outcomes.


Outcome-
Outcome-focused

• Result-oriented
Result-

• The steps of the nursing process are
designed to keep the focus on
determining whether people seeking
health care are getting the best results
in the most efficient way.

Why learn about it?

• The nursing process provides the basis
for the board exams –you need to be
thoroughly familiar with it to think
your way to through the questions.


Why learn about it?

• It help you think critically in the clinical
setting—
setting—you must master the principles
behind the nursing process.


Why learn about it?

• Using the nursing process complements
what other health care professionals do by
focusing on both the medical problems and
human response –how the person responds to
medical problems, treatment plans, and
changes in activities of daily life.

Comparison
Physician’s data Nurse’s data
• Disease focus Wholistic focus –
considering their
problems and their
effect on the
person’s ability to
function
independently.


Physician’s data

• Mrs. Garcia has pain and swelling in all
joints. Diagnostic studies indicate that she
has rheumatoid arthritis. We will start her
in a course of anti-inflammatories to treat
anti-
the rheumatoid arthritis.

• (Focus is on treating the arthritis)
arthritis)

Nurse’s data

• Mrs. Garcia has pain and swelling in all
joints, making it difficult to dress herself. She
has voiced that it’s difficult to feel worthwhile
when she can’t even feed herself. She states
that she is depressed because she misses
seeing her two small grandchildren.

Nurse’s data
• We need to develop a plan to help her
pain, to assist with her feeding and
dressing, to work through feelings of low
self-
self-esteem, and for special visitations
with the grandchildren.

• (Focus is on Mrs. Garcia)

WHAT IS CRITICAL
THINKING IN NURSING?

Maria Carmela L. Domocmat, RN, MSN

Critical Thinking


Critical Thinking

• Unlike the mindless thinking
we do when we do our daily
routine, critical thinking is
careful, deliberate, outcome-
outcome-
focused (results-oriented)
(results-
thinking.

What is critical thinking in
nursing?
Critical thinking in nursing:

• Entails purposeful, outcome-oriented
outcome-
(results-
(results-oriented) thinking.

• Is driven by patient, family, and
community needs.



• Is based on principles of nursing
process and scientific method

• Requires knowledge, skills and
experience

• Is guided by professional standards and
ethics codes.


• The ability to:

• identify a problem

• analyze it

• develop a response

• follow through



• Requires strategies that maximize
human potential (e.g., using individual
strengths) and compensate for
problems created by human nature (e.g.,
the powerful influence of personal
perspectives, values and beliefs.)


• Is constantly re-evaluating, self-
re- self-
correcting, and striving to improve.

(Source: Alfaro-LeFevre (1999). Critical thinking in nursing:
Alfaro-

A practical approach. Philadelphia: W. B. Saunders. )


How to Become a Critical
Thinker

Critical thinking is like any other skill:
if you practice it, it becomes more
automatic.


• Take a few moments to look at the list
of the characteristics of critical thinkers,
and evaluate your current habits of
thinking

• Check each characteristics and ask
yourself, “Is this me?”

• Put a mark next to the ones you want to
develop or improve.

Characteristics of Critical Thinkers
Critical Thinkers are:

• Aware of their strengths and
capabilities:
capabilities: They’re confident that they
can reason to find answers and make
good decision.


• Sensitive to their own limitations and
predispositions:
predispositions: They know their
weaknesses, values, and beliefs and
recognize when these may hamper their
ability to assess a situation or solve a
problem.

• Open minded: They listen to new ideas
minded:
and viewpoints and consider the
situation from many perspectives.


• Humble: They overcome their own
Humble:
tendency to feel that they should have
all the answers.


• Creative: They are constantly looking
Creative:
for better ways to get things done. They
follow recommended procedures;
however, they continually examine
whether these are the best way to meet
the goals and objectives.

The Client in Context

• Proactive: they accept
Proactive:

responsibility and

accountability for their

actions. They study situations, anticipate
problems, and find ways to avoid them
before they happen.

• Flexible: They recognize the
Flexible:
importance of changing priorities and
interventions when planned
approaches don’t seem to be getting
results.


• Aware that errors are stepping-stones
stepping-
to new ideas: They turn mistakes into
ideas:
learning opportunities, reflecting on
what went wrong and identifying ways
to avoid the same mistake in the future.


• Willing to persevere: They know that
persevere:
sometimes there are no easy answers
and that there may be time-consuming
time-
struggles to find the best answer.


• Cognizant to the fact that we don’t live
in a perfect world:
world:
• They realize that sometimes the best answer
may not be the perfect answer.
answer.


• Introspective:
Introspective:
• They evaluate and correct
their own thinking.


Critical Thinkers also:

• Maintain questioning attitude:
attitude:
• They ask questions like: “What’s going on
here?”; “What does it mean?”; and “What
else could it mean, and how else could it be
interpreted?”


• Ask for clarification when they don’t
understand:
understand:
• For example, they say, “I’m not clear about
this. Can you tell me more?” or ask
questions like, “What do you mean by
better, better in what way?”


• Apply previous knowledge to new
situations:
situations:
• They see similarities and differences
between one experience and another,
between one concept and another.


• See the situation from many
perspectives:
perspectives:
• They value all viewpoints and watch that
their judgments are based on facts, not
facts,
personal feelings, views, or self-interests.
self-


• Weigh risks and benefits (advantaged
and disadvantages) before making a
decision:
decision:
• They avoid risky decisions and find ways
to reduce adverse reactions before putting
a plan into action.

• Seek help when needed.
needed.

• Put first things first:
first:
• They ask, “What is the most
important thing to do
here?”


Critical Thinkers use logic.

• They test first impressions to make
test
sure they are as they appear:
appear:
• They double-check the logic of their
double-
thinking and workability of their solutions.


• Distinguish between fact and fallacy:
fallacy:
• They take time to verify important
information to be sure it’s true.


• Distinguish fact from inference (what
they believe the fact means):
means):
• For example, they recognize that because
someone is sitting quietly in a corner may
not mean that the individual is withdrawn;
withdrawn;
It means that they are sitting quietly in a
corner and that it would be helpful to find
out why.

• Support views with evidence:
evidence:
• They wouldn’t state that the person above
is withdrawn without providing additional
supporting evidence, such as the
individual saying he wants nothing to do
with anyone.


• Determine what’s relevant and what’s
irrelevant:
irrelevant:
• They recognize what’s important for
understanding a situation and what’s
unimportant.


• Apply the concept of “cause and effect”:
effect”:
• They look for what’s causing a problem to
more fully understand the problem itself. They
anticipate responses to their actions before
performing the actions. For example, critical
thinkers would attempt to find out the cause of
pain before deciding how to treat it. They
would determine how someone might respond
to a medication before administering it.

• Withhold judgment until all the
necessary facts are in:
in:
• They realize the dangers of jumping to
conclusions.


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