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Copy of Critical thinking

How and why we use critical thinking in nursing
by

Sondae Stevens

on 9 August 2013

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Transcript of Copy of Critical thinking

COLLECTING DATA
Nurses are great data collectors
Eventually we must start making clinical judgments based on the data we collect
NUR 101 And 102
What did you learn?
Now we build upon that knowledge
Technical skills mean nothing, unless you know why you do them, what are your responsibilities after you do them, who do you do them for, when do you and don’t you do them?
Nursing Diagnoses
Analyze data
Identify health problems, risks and strengths
Formulate the diagnoses
Nursing Diagnosis for Acute respiratory distress syndrome (ARDS):
Ineffective airway clearance
Ineffective breathing pattern
Activity intolerance
Anxiety (specify level: mild, moderate, severe, panic)
Disturbed gas exchange
Risk for aspiration
Implement
Am I the only one to implement the plan?
Who else is involved?
What do I need to implement the plan?
Carry out the plan with the patient’s involvement.
DOING
After I think now I have to do something
Nursing interventions
Independent
Recheck the B/P
Check orthostatic B/Ps
Interdependent
Report B/P to physician
Check the MD orders for parameters regarding treatment of B/P
“NURSING SHOULD HAVE LITTLE ADHERENCE TO LINEAR THINKING”
DUCHSHER
http://www.robotnine.com/2009/04/skulls-created-from-living-human.html
ASSESSMENT
More than your physical exam
Very important
Your nursing history should guide your assessment
When to do
Focused
Is it different?
How do you know?
What else do you include?
Plan
What do I do now?
How do I know what to do?
What does the patient think my role is?
Is the patient involved in the plan development?
Patient oriented Expected outcomes with time frames- should be aimed at diagnosis.
Nursing interventions- should be aimed at meeting expected outcomes.
Incorporate xrays, labs, meds into meeting the expected outcomes.
Evaluate
Have we met our goals?
Why?
Why not?
What do we need to change?
Do we need to add, subtract or start all over again?
ANTICIPATE TO PREVENT
Think ahead
My patient has this
What are some potential complications of this?
What can I do to prevent these?
What nursing interventions do I need to carry out to prevent these?
Do I need help to prevent these, and do I need it now, or can it wait?
THINK


T otal recall
Remembering facts OR where to find the information you need to know
H abits
Do you look up labs prior to seeing your patient
Do you spend 5 minutes with each of your patients initially until you can speak with them more
I nquiry
In depth examination and questioning
Analyzing all of the information you collected
N ew ideas and creativity
Not afraid to try new things
Individualize things
K nowing how you think
Is it efficient, do I need to change it, do I need quiet to think efficiently, do I think better with others around me
PUT IT ALL TOGETHER
Do not miss the big picture because you are concentrating so hard on the little pieces of the puzzle
It is impossible to do nursing well without thinking
http://www.photoshopessentials.com/images/photo-effects/photoshop-puzzle/photoshop-puzzle.jpg
FOUR KEY COMPONENTS TO CRITICAL THINKING
Identify and challenge assumptions
Context is very important
Explore and imagine alternatives
Reflective scepticism
Care mapping
How does this fit into critical thinking and clinical judgement?
Why do care mapping?
Who benefits?
Will it help me see the whole picture?
Will it help me stream line my care for my patient?
Example
Carla is a 19 year old, G1P0 at 39 weeks gestation. Her pregnancy has been uneventful. Carla has taken very good care of herself by refraining from processed foods and sugars and exercising daily. Carla is 5'4" and weighs 148lbs having gained 22 pounds during the pregnancy. Carla calls her midwife's office to tell her she has had contractions for several hours. She tells the nurse that the baby has been active and that she cannot rest because of the contractions. Carla feels she is doing well. Norma has planned a natural birth with a Certified Nurse Midwife (CNM).
What questions should you ask this patient?
When should Carla go to the hospital?
What physical assessments will you do once she arrives at the hospital?
What interventions must Carla have and which ones can she decline?
How will you evaluate her labor progress?
REFERENCES
Philadelphia, Pa.Duchscher, J. E. B. (1999). Catching the wave: understanding the concept of critical thinking. Journal of Advanced Nursing 29(3), 577-583.
Rubenfeld M.G. & Scheffer, B.K. (1995). Critical thinking in nursing: an interactive approach. J.B. Lippincott company.
COLLECTING DATA
Is the data I am collecting useful in helping me care for this patient?
Too much data that is not useful will only confuse the picture.
Be efficient and accurate in your data collection.
Nurses have a lot to collect and need to know what to do with information that can be overwhelming.
Learn to cluster your data
Vital signs
Nutrition: Ht., Wt., Diet, skin and hair, I & O
oxygenation: SPO2, skin temp., mentation, ABG, skin
Now, what is missing?
CRITICAL THINKING AND CLINICAL JUDGEMENT
NUR 350
Fall 2012
Teresa Villaran MSN APRN CCRN
Full transcript