Critical Thinking and clinical judgment
Is a conclusion about a patient’s needs or health problems that leads to a decision to take or avoid action, use or modify standard approaches or create new approaches based on the patient’s response
What is clinical judgement?
Mr. Davis tells the nurse that he has been experiencing more frequent episodes of indigestion. The nurse asks if the indigestion is associated with meals or a reclining position and asks what relieves the indigestion. This is an example of which interview technique. Takes information provided in the patient’s story and then more fully describes and identifies specific problem areas.
What is problem seeking?
a. pathophysiological (biological or psychological)
b. treatment – related
c. situational (environmental or personal)
d. maturational
What are related factors into four groups?
Specific, Measurable, Attainable, Realistic, Timed
and
Treatments performed through interactions with patients.
Treatments performed away from the patient but on behalf of the patient.
What is a smart goal?
What are direct care and indirect care?
a. Helping role
b. Teaching–coaching function
c. Diagnostic and patient-monitoring function
d. Effective management of rapidly changing situations
e. Administering and monitoring therapeutic interventions and regimens
f. Monitoring and ensuring the quality of health care practices
g. Organizational and work role competencies
What is the domain of nursing practice when intervening with patients?
Knowledge based on research or clinical expertise.
What is Evidence-based knowledge?
a. Subjective data include patients’ verbal descriptions of their health problems (feeling, perceptions, and self-reported symptoms).
b. Objective data include observations or measurements of a patient’s health status (see, hear, and touch).
What is subjective and objective data?
Avoid inaccurate or missing data, be thorough in your collection of data.
Insufficient cluster of cues, premature or early closure, incorrect clustering
Inaccurate interpretation, failure to consider conflicting cues, insufficient number of cues, invalid cues, failure to consider cultural influences
What are errors in data collection, data clustering, and interpretation and analysis of data?
a. Desired patient outcomes
b. Characteristics of the nursing diagnosis
c. Research base knowledge for the intervention
d. Feasibility for doing the intervention
e. Acceptability to the patient
f. Your own competency
What are six factors to select nursing interventions for a specific patient?
a. Review the set of all possible nursing interventions for a patient’s problem
b. Review all possible consequences associated with each possible nursing action
c. Determine the probability of all possible consequences
d. Judge the value of the consequence to the patient
What is activities for making decisions during implementation?
These questions are questions to ask.
a. Why does the patient have this condition?
b. How does the condition normally affect a patient physically and psychologically?
c. Are the signs and symptoms shown by the patient what I would expect for the condition or situation?
d. Are the signs and symptoms associated with worsening of the condition?
e. What do I really know about this patient’s situation?
f. What other ways can I collect data to help me understand the problem more fully?
g. Do I require more information?
h. What care options do I have?
and
a. What did I learn from the experience?
b. Did I respond appropriately in this situation?
c. What were the consequences of my actions?
d. How might I act differently in the future?
e. Was I working from tradition or evidence-based practices?
and
Reflective journaling which helps to clarify concepts
b. Meeting with colleagues to discuss and examine work experiences and validate decisions
c. Concept mapping is a visual representation of patient problems and interventions that show their relationships to one another.
What is building critical thinking when in clinical situation?
What is self-evaluation?
What is that help to clarify concepts?
A. Health perception–health management pattern
b. Nutritional–metabolic pattern
c. Elimination pattern
d. Activity–exercise pattern
e. Sleep–rest pattern
f. Cognitive–perceptual pattern
g. Self-perception–self-concept pattern
h. Role–relationship pattern
i. Sexuality–reproductive pattern
j. Coping–stress tolerance pattern
k. Value–belief pattern
What is Gordon's 11 functional health patterns?
a. Identify the patient’s response, not the medical diagnosis
b. Identify diagnostic statement rather than the symptom
c. Identify a related factor or risk factor treatable through nursing intervention
d. Identify the problem caused by the treatment or diagnostic study rather than the treatment or study itself
e. Identify the patient’s response to the equipment rather than the equipment itself
f. Identify the patient’s problems rather than your problems with nursing care
g. Identify the patient’s problem rather than the nursing intervention
h. Identify the patient’s need rather than the goal of care
i. Make professional rather than prejudicial judgments
j. Avoid legally inadvisable statements
k. Identify the problem and etiology to avoid a circular statement
l. Identify only one patient problem in the diagnostic statement
What is guidelines for reducing errors when formulating the diagnostic statement?
a. If untreated, result in harm to the patient or others
b. Involve nonemergent, non-life-threatening needs of the patient
c. Are not always directly related to a specific illness or prognosis but affect a patient’s well-being
What establish priorities in relation to importance and time?
a. being systematic and using criterion-based evaluation
b. collaborating with patients and healthcare professionals
c. using ongoing assessment data to revise a plan
d. communicating results to patients and families
What is the competencies for evaluation?
six cognitive skills:
a. analyze cues
c. prioritize problems/diagnoses
d. generate solutions
e. take actions
f. evaluate outcomes
and
six components:
a. Critical thinking competence – diagnostic reasoning and clinical decision-making ability
b. Specific knowledge base – patient data, basic and nursing science, nursing and healthcare theory
c. Experience personal, clinical practice, skill competence.
d. Environment – time pressure, setting, task complexity
e. Attitudes: confidence, independence, fairness, responsibility, risk taking, discipline, perseverance, creativity, curiosity, intellectual integrity, humility
f. Standards: intellectual standards is a guideline or principle for rational thought; professional standards refer to the standard of practice, ethical criteria for nursing judgments, criteria for evaluation, professional responsibility
What is the clinical decision making process?
and
What is the clinical thinking model in nursing judgement?
Courtesy
b. Comfort
c. Connection
d. Confirmation
a. Observation: Nonverbal communication
b. Open-ended: Prompts patients to describe a situation (tell their story) in more than one or two words
c. Leading question: Risky, limits information
d. Back channeling: Active listening prompts
e. Probing: Encourages a full description without trying to control the direction of the story
f. Closed-ended: Limit the patient’s answers to one or two words
What are used in an interview?
Statement of a patient response to a health problem that requires nursing intervention that provide the basis for the selection of nursing interventions to achieve outcomes for which the nurse is responsible.
What is a nursing diagnosis?
a. Identify the general problem area
b. Direct the consultation to the right professional
c. Provide the consultant with relevant information about the problem area
d. Do not prejudice against or influence the consultants
e. Be available to discuss the findings and recommendations
f. Incorporate the recommendations into the plan of care
What is six steps of the nurse's role in seeking consultation?
a. examine the outcome criteria to identify the exact desired patient behavior or response.
b. evaluate a patient’s actual behavior or response
c. compare the established outcome criteria with the actual behavior or response
d. judge the degree of agreement between outcome criteria and the actual behavior or response
e. if there is not agreement (or only partial agreement) between the outcome criteria and the actual behavior or response, what is the reason?
What are the steps to objectively evaluate the level of your patients success in achieving their outcomes of care?
Moves from reviewing specific data elements to make an inference by forming a conclusion about the related pieces of evidence.
and
Moves from reviewing specific data elements to make an inference by forming a conclusion about the related pieces of evidence.
What is Inductive reasoning and deductive reasoning?
the comparison of data with another source to determine data accuracy.
visual representation that allows you to graphically show the connections between a patient’s many health problems.
What is term data validation?
What is a concept map?
It is the patient’s actual or potential response to the health problem.
What is a correct nursing diagnosis?
The following statement appears on the nursing care plan for an immunosuppressed patient: “The patient will remain free from infection throughout hospitalization.” This statement is an example of a (an) ____ because it is an objective behavior or response that you expect a patient to achieve.
What is a short term goal?
The nurse is responsible for consistent, thorough documentation of the patient’s progress toward the expected outcomes and use of nursing diagnostic language. When documenting a patient’s response to the interventions, the nurse should describe the intervention, the evaluative measures used, the outcomes achieved, and the continued plan of care.