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CLINICAL DECISION MAKING & THE NURSING PROCESSNRS 110
Critical Thinking Revisited
• Knowledge
• Experience
• Reflection
• Intuition
Components of Critical Thinking in Nursing
• Specific Knowledge Base• Experience• Critical Thinking Competencies• Diagnostic Reasoning• Clinical Decision Making• Nursing Process• Critical Thinking Attitudes• Critical Thinking Standards• Intellectual Standards• Professional Standards
Clinical Decision Making
• Critical thinking process for choosing the best actions to meet a desired goal
• To act or not to act, that is the question!
• Criteria used to make decisions
• Collaboration
• Problem Identification
• Who is responsible for making the decision?
Level of Critical Thinking
• Basic
• Complex
• Commitment
NURSING PROCESS
• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation
The nursing process in action
Step One: Assessment
• Collect data (Types of data, Sources of data, Methods of data collection)
• Organize data
• Validate the data
• Record & report
Step 2: Diagnosis
• Analysis of assessment data leads to problem identification
• NANDA list• Types of nursing dx.
Anatomy of a Nursing Diagnosis
• Problem (Diagnostic label)
• Etiology (Related factors and Risk factors)
• Defining Characteristics
• Differentiating Nursing Diagnoses from Medical Diagnoses
• Differentiating Nursing Diagnoses from Collaborative Problems
The Diagnostic Process
• Analyzing data: Compare data against standards, cluster data, identify gaps and inconsistencies in data
• Identify health problems, determine problems and risks, determine strengths
Formulating Diagnostic Statements
Step 3: Planning
• Set priorities• Apply standards• Identify goals &
outcomes• Select interventions• Record the plan
(nursing care plan)
What are the priorities?
Maslow’s Hierarchy of Basic Human Needs
Guidelines for Writing Goal Statements
• Write goals in terms of client responses
• Be sure the desired outcomes are realistic and compatible with ordered therapies
• Make sure that each goal is derived from only one nursing diagnosis
• Use observable, measurable terms for outcomes
• Involve the client in the process
CONCEPT MAP Ineffective Airway Clearance (Gas Exchange)
Step 4: Implementation
• Put your plan into action
• Perform the interventions
• Note patient response to interventions
• Record & report
Types of Interventions
• Independent (nurse initiated)
• Dependent (physician initiated)
• Collaborative
Step 5: Evaluation
• Did the plan work?• Was goal achieved?• What was the
outcome of the care provided.
• Stated in measurable terms.
• It’s all about outcomes!
Case Scenario
• A.A. is an 28 y.o. female who was admitted with pneumonia. She presents with complaint of cold x 2 weeks, dyspnea on exertion, , orthopnea, decreased oral intake. Assessment of patient reveals:
• T 103F, P 92, R 22 shallow, BP 122/80• Dry mucous membranes, hot pale skin• Decreased breath sounds, inspiratory crackles• Ineffective cough-coughing up thick pink
sputum• Lethargic, c/o being weak
Now lets write the plan down!
Concept Map Steps
• Place your main issue/problem in the middle• Determine key problems/concepts that have
a direct relationship to the main problem• Add clinical data to appropriate problem
boxes• Draw lines between related problems. Label
with a nursing diagnosis• Identify goals/outcomes• Add interventions• Evaluate patient response to interventions
CONCEPT MAP Ineffective Airway Clearance (Gas Exchange)