critical-thinking-in-the-nursing-process-lakesumter-：在护理过程中的批判性思考湖萨姆特课件.ppt

1、Separating the Professional from the Technical“the active,organized,cognitive process used to examine ones own thinking and the thinking of others”Using reflection,intuition,and previous experiences to make sound decisions Requires a habit of asking questions,remaining well informed,a willingness to

2、 reconsider,and avoiding premature decision makingKnowledge base Theoretical ExperientialExperience Practice making decisionsTechnical Skills&CompetenciesAttitudes and behaviorsSelf awareSelf awareGenuine/authenticGenuine/authenticEffective Effective communicator communicatorCurious&inquisitiveCurio

3、us&inquisitiveAlert to contextAlert to contextAnalytical&insightfulAnalytical&insightfulLogical and intuitiveLogical and intuitiveConfident&resilientConfident&resilientHonestHonestResponsible&Responsible&autonomous autonomousCareful&prudentCareful&prudentOpen&fair mindedOpen&fair mindedSensitive to

4、diversitySensitive to diversityCreativeCreativeRealistic and practicalRealistic and practicalReflective&self-correctiveReflective&self-correctiveProactiveProactiveCourageousCourageousPatient&persistentPatient&persistentFlexibleFlexibleImprovement orientedImprovement orientedThe Nursing Process:a sys

5、tematic problem solving approach consisting of;Assessment Diagnosis Planning Implementation EvaluationNursing involves both thinking and doingNursing deals with complex issuesBrings togetherCritical thinkingNursing processNursing knowledgePatient situationTypes of AssessmentComprehensiveFocusedSpeci

6、al needs Initial OngoingTypes of DataTypes of Data Subjective ObjectiveSources of DataSources of Data Primary data Client Secondary data Family Health Records Health Team MembersMethods of collectionObservationUse all 5 sensesPhysical assessmentInterviewHealth historyPerformed after nursing historyC

7、ollection of objective data Ht.,Wt.,V.S.General Survey Head to toe exam Inspection Palpation Percussion Auscultation OlfactionBiographical DataReason for Seeking Health Care/Chief complaint Clients Expectations History of Present IllnessPast Health HistoryFamily History/social historyMedications Rev

8、iew of body systemsTo ensure data is accurate Complete Factual And you are not jumping to conclusionsWhen to validate Subjective and objective data do not agree Patients statements differ at different times Data falls outside normal rangeSystematic Usually controlled by agency forms Body systems fra

9、mework Maslows Hierarchy of Needs Gordons functional patterns Orems Self care model Roy Adaptation Model NANDA nursing diagnosis Taxonomy IIOrganizing data into meaningful clustersA set of signs or symptoms grouped together into logical orderGroupings of associationsHelps you recognize significant c

10、uesUtilizes critical thinking to Judge the value or significance of the data Validate and verify assumptions with client and other health care team membersIdentify patterns in data and draw conclusions about clients statusDescribes clients actual or potential response to a health problemA statement

11、of client health that nurses can identify,prevent,or treat independentlyStated in terms of unique human responses to diseases,injuries,or stressorsMust be accurate because it provides direction for nursing careActual (3-part statement)Presently existsRisk (2-part statement)Likely to develop in vulne

12、rable patientPossible (2 or 3-part statement)Suspect on intuition but dont have enough data yetSyndrome(1 part statement)Collection of nursing diagnoses that occur togetherWellness(1-part statement)Not a health problem,wants to move to higher level of wellnessDiagnostic Label (title or name)Approved

13、 by NANDARelated Factors Etiology must be in nurses domain to intervene Dont use medical diagnoses Defining Characteristics Cues from assessment data must support diagnosisEg.Impaired mobility R/T lack of peripheral sensation AEB inability to walk from bed to chair.Data collection Omitted,incomplete

14、,inaccurate,disorganizedData analysis&interpretation Inaccurate interpretation of cues,conflicting cues,incorrect judgments of inferencesData clustering Incorrectly clustered or not clustered at allDiagnostic Statement Problem&etiology must be in scope of nursing to treatIdentify clients response no

15、t medical diagnosisOne symptom is insufficient for problem identificationNursing interventions directed at correcting etiology of problemIdentify client response to equipment not the equipment itselfClient problems not nurse problemsDevelop in cooperation with clientNursing diagnosis Defines nursing

16、 needs of clients related to the medical diagnosesMedical Diagnosis Reflects specific disease,illness,or injury Goal prescribe treatmentPlace in order of importance or urgencyMaslows Hierarchy of Human Needs Physiological Safety and security Love and belonging Self-esteem Self-actualizationA,B,CsNur

17、sing ProcessClient centered goals/outcomes Specific measurable objective Are precise,descriptive,clearly stated Reflects highest level of wellness Should be realistic Observable client behavior Measurable criteria for each goal Projected time frame for goal achievement Provide a guide for selecting

18、interventionsShort term goals Achieve in hours or days,less than 1 weekLong term goals Achieved over weeks or monthsSubject The clientAction verb Action that will be performed by clientPerformance criteria Specific measurement to be evaluatedTarget time When action should be achievedSpecial conditio

19、ns Amt.of assistance,what equipment,resources neededClient centeredSingular factors/criteriaObservable factorsMeasurable factorsTime limited factorsMutual factorsRealistic factorsServes as Written guidelines for client careCommunicates careEnhances continuityOrganizes information promotes efficiency

20、Involves client and familyMeets requirements of accrediting agenciesCare plans help students learn problem solving,skills of written communication,organizational skills,and application of theory AKA Nursing Actions Measures Strategies Activities Actions based on clinical nursing judgment and knowled

21、ge that nurses perform to achieve client outcomes Include activities of observation/assessment,prevention,treatment,&health promotionIndependent Nurse initiated interventions In realm of independent nursing practice No MD order requiredDependent Physician initiated interventions Require MD ordersCol

22、laborative(interdependent)interventions Coordination of multiple professionalsInclude activities of Observation/assessmentPreventionTherapeutic TreatmentsHealth promotionActivities of daily livingTeachingDischarge planningFlow from Client goals/outcomes/ordersIndividualize standardized interventions

23、Nursing Orders Instructions on care plan describing implementation of interventions Include Date Subject Action verb Times and limits SignatureStanding OrdersProtocolsCritical PathwaysEvidence Based PracticeNursing action nonspecificFail to indicate frequencyFail to indicate quantityFail to indicate

24、 methodFail to indicate person to performImplementationImplementationThe action phase of the nursing processYou will perform or delegate planned interventionsImplementation ends when you record the nursing actions on chart Evolves into evaluation as you record resulting client responsesCheck your kn

25、owledge and abilitiesOrganize your workPrepare the patientImplement the planCoordinate/collaborate Delegate appropriately Right task Right circumstance Right person Right directions/communication Right supervisionPlannedOngoing Does not end the nursing processSystematicMake judgments about Clients p

26、rogress toward expected outcomes/goals Effectiveness of nursing care plan Quality of nursing care deliveredOngoing evaluation At each contact with patientIntermittent evaluation At outcome evaluation specified times Terminal evaluation At time of dischargeReview OutcomesCollect Reassessment DataJudg

27、e Goal Achievement Achieved(met)Partially achieved(partially met)Not achieved(unmet)Record evaluative statement Revise care plan if indicated Begin with assessment data and go through entire nursing processWritten evidence of interactions Health professionals Clients Families Health care organizatio

28、ns Diagnostic tests Treatments Education Client results/responsesCorrect client recordClient name on each pageDocument immediatelyDate and time each entrySign each entry with name and professional credentialsNo space between entriesNever change anothers entryUse“quotes”for client statementsChronolog

29、ical orderUse appropriate vocabulary/terminologyOnly approved abbreviations/symbolsUse organized and logical sequenceState only factual not inferencesUse correct spelling,legible writingProtect client confidentiality by not releasing records to anyone without patient permissionWrite neatly,legibly,&in inkUse concrete specific termsFollow agency guidelines Source-Oriented Records Separate sections for each disciplineProblem-Oriented Records Consists of database,problem list,plan of care,&progress notesNarrativeSOAPPIEFocusCharting by exceptionComputerized