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Critical Thinking Skills OR

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Aaron Fasser

on 23 April 2013

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Transcript of Critical Thinking Skills OR

Little experience and skills learning by rote.
Advanced Beginner
Can perform adequately with some judgement, usually upon graduation.
Able to foresee long range goals and are mastering skills. Still lack experience to make decisions based on intuition. Most nurses take up to 1 year to reach this stage.
View situation as a whole.
Intuition and decision making are instant, takes at least 5 years to reach. Assessing, Analyzing information and Ideas Unknowns In Perioperative Environment
How many patients are scheduled?
What types of surgery will be performed?
What instruments,supplies, and technology will be required to support the cases?
What urgent/emergent cases will have to be done?
What are the Doctor's pre-op orders or patient presentation that will require additional resources or change in plan of care?
What family/significant other needs must be met?
What post operative needs must be planned for and met? Asks pertinent questions
The nurse understands that all patients must have correct surgical site verification and asks the patient to relate the proposed procedure, site and side. They may also ask for allergies. Critical Thinking is required to deliver safe patient care because safe care requires teamwork and care tailored to the individual patient.
Perioperative nurse should act according to the terms of agreement between the patient and the nurse.
The development and refinement of critical thinking skills (from Novice to Expert) is affected by: the nurse's level of knowledge and experience; clinical narratives, simulation, questioning; partnering with proficient nurses.
Perioperative nurses need to be able to: anticipate, recognize a problem, know what/when/how to do it and why, thus becoming a professional nurse. Leticia Cortez-Fasser
RN, BScN, CPN(C) Attributes of Critical Thinking during Preoperative Process Independent Thinker
Recognizes doctor's standing orders or patient presentation that require an additional assessment and/or change in the careplan.
Evaluates Evidence and Facts
During surgical site verification, the patient relates the wrong surgical side. The nurse reviews the surgical schedule, history and physical and consent. Intraoperative Care Priorities include:
Supporting the patient during induction of anesthesia.
Participating in safe patient positioning.
Instituting"Surgical Safety Check list Phases" process for the entire team to pause and reflect on patient care plan.
Initiating appropriate skin preparation to prevent infection.
Maintaining asepsis during the procedure.
Completing instrument and sharps count at appropriate intervals.
Carefully documenting the procedure, including relevant safety and infection control measures. Thinking Critically An Essential Skill An active persistent and careful consideration of the evidence supporting a decision.

A skill in applying the methods of logical inquiry and thoughtful reasoning. Definition of Critical thinking "Critical Thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, synthesizing and/or evaluating information gathered, or generated by observation, experience, reflection, reasoning, or communication as a guide to belief and action" (Jenicek,2006)
An abstract concept developed since Socrates. Explore consequences before making decision or taking action

Although a patient maybe second in line on the schedule, the nurse realizes that the patient breach on NPO status (i.e. chewing bubble gum) may require repriotizing on the schedule.

Evaluate Policy
The nurse recognizes that although visitors are generally not permitted in the OR, the patient's language barrier might require a family member present for the induction of the patient Displays curiosity

Between cases the nurse follows up with PACU nurses to check on status of patient who was difficult intubation.

Rejects Incorrect information

Despite the fact that the parents claim the child has had nothing to eat or drink since before midnight the nurse understands from the child she had a few sips of juice that morning. Operating Room Preparation
A Peri-op Nurse responsibility in collaboration with the surgical team and ensures supplies, implants, appropriate equipment, technology, instruments, medications and personnel and are all coordinated. Perioperative Environment:

A place of unknowns requiring nursing staff to display unique qualities and high levels of critical thinking both as an individual and part of a team. Confident in decisions
The surgeon questions nurse about patient positioning before surgery. The nurse shares patient history and protocol that contraindicates surgeon's preference. Displays curiosity
Between cases the nurse follows up with PACU nurses to check on status of patient who was difficult intubation
Rejects incorrect information
Despite the fact that the parents claim the child was NPO before midnight, the nurse understands from the child she had a few sips of juice that morning. Operating Room Preparation

A Perioperative Nurse responsibility in collaboration with the surgical team.
Accountable for ensuring that the appropriate equipment, technology, supplies, implants, instruments, medications, personnel and outside vendors are all coordinated to support the case.
Accountable for making sure that individual surgeon preferences and needs are planned for to ensure smooth case flow. Independent Thinker
Recognize the need to substitute a prep agent based on patient's allergy. Evaluates Evidence and Facts
Notes that decreased HCT and expected blood loss from surgery may mean blood transfusion. Explores consequences before taking action
Does not open implants until needed and verified, as the implant maybe needed for a later case. Evaluate Policy
Make sure that surgeon's credentials cover all the surgical procedures for the case
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