1
NR224 Fundamentals – Skills
Exam 1 Material
Chapter 15 Critical Thinking in Nursing Practice
Critical Thinking
- Need to sort out the information into patterns to clarify problems, recognize
changes, and make appropriate care decisions under pressure
- Essential process for safe, efficient, and skillful nursing intervention
Clinical Judgement in Nursing Practice
- Conclusion about a patient’s needs or health problems
- Influenced by a nurse’s experience and knowledge
Critical Thinking – ability to think in a systematic and logical manner
- A continuous process characterized by open-mindedness, continual inquiry, and
perseverance, combined with a willingness to look at each unique patient situation
and determine which identified assumptions are true and relevant
- Evidence-based knowledge
Levels of Critical Thinking in Nursing
1. Level 1 – basic
2. Level 2 – complex
3. Level 3 – commitment
Components: Specific knowledge base, experience, competencies, attitudes, and standards
Nursing Process Competency
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation
Haphazardly – use of diagnostic reasoning involves this rigorous approach to clinical practice
and demonstrates that critical thinking cannot be done
Chapter 16 Nursing Assessment
Five Step Nursing Process
1. Assess – gather information about the patient’s condition
2. Diagnose – identify the patient’s problems
3. Plan – set goals of care and desired outcomes and identify appropriate nursing actions
4. Implement – perform the nursing actions identified in planning
5. Evaluate – determine if goals and expected outcomes are achieved
,2
Critical Thinking in Assessment
Two Stages:
- Collection of information from a primary source (a patient) and secondary sources
- The interpretation and validation of data to determine whether more data is needed,
or the database is complete
Knowledge – underlying disease process, normal growth and development, normal physiology
and psychology, normal assessment findings, health promotion, assessment skills, and
communication skills
Standards – ANA Scope of Standards of Nursing Practice, specialty standards of practice, and
intellectual standards of measurement
Attitudes – perseverance, fairness, integrity, confidence, and creativity
Experience – previous patient care experience, validation of assessment findings, and
observation of assessment techniques
Types of Assessments
- Patient-centered interview – conducted during nursing history
- Periodic assessments – conducted during ongoing contact with patients
- Physical examination – conducted during a nursing history and at any time a
patient presents a symptom, head-to-toe assessment
Types of Data
- Subjective – patients’ verbal descriptions of their health problems, including
patients’ feelings, perceptions, and self-reported symptoms
- Objective – findings resulting from direct observation, when collecting, apply
critical thinking intellectual standards so that you can correctly interpret your
findings
Assessment Data Sources
- Patient
- Family caregivers and significant others
- Health care team
- Medical records
- Other records and the scientific literature
- Nurse’s experience
Cultural Considerations
- Cultural Competence – involves self-awareness, reflective practice, and knowledge of
a patient’s core cultural background
Data Documentation
- Record any subjective information by using quotation marks
, 3
Assessment Process
1. Data collection – use information about a patient’s needs to adapt your data collection
2. Interpretation – critically interpret assessment data to determine whether
abnormal findings are present, cues and references
3. Validation – comparison of data with another source to determine data accuracy
Cues for Discomfort
- Lies still with arms along sides and very tense
- States has not turned for some time
- Reports pain a 7 on a scale of 0 to 10
Inferences for Discomfort
- Pain is severe
- Pain limits patient’s ability to move and reposition self
Chapter 28 Infection Prevention and Control
Scientific Knowledge Base
Nature of Infection
- Infection – results when a pathogen invades tissues and begins growing within a host
(ABSCESS – strep, staph, more invasive, gets into the tissue, once it is in the
bloodstream and your septic = it is bad)
- Colonization – presence and growth of microorganisms within a host without tissue
invasion or damage (Flora, opportunistic infections, bacteria, colonized by microbiome,
if its normally living, it is a colonizer)
Chain of Infection
1. Infectious agent
2. Reservoir – food, oxygen, water, temperature, pH, and light
3. Portal of exit – skin and mucous membranes, respiratory tract, urinary tract,
gastrointestinal tract, reproductive tract, and blood
4. Mode of
transmission 5. Portal of
entry
6. Host
The Infectious Process
Defenses against Infection
- Normal floras (ex. respiratory, gut, or vaginal [yeast] floras)
- Body system defenses
- Inflammation (vascular and cellular responses, inflammatory exudate, tissue repair)
Health Care – Associated Infections (HAIs)
Occur because of:
- Invasive procedures
- Antibiotic administration
- Multidrug-resistant organisms (MDROs)
- Breaks in infection prevention and control activities
NR224 Fundamentals – Skills
Exam 1 Material
Chapter 15 Critical Thinking in Nursing Practice
Critical Thinking
- Need to sort out the information into patterns to clarify problems, recognize
changes, and make appropriate care decisions under pressure
- Essential process for safe, efficient, and skillful nursing intervention
Clinical Judgement in Nursing Practice
- Conclusion about a patient’s needs or health problems
- Influenced by a nurse’s experience and knowledge
Critical Thinking – ability to think in a systematic and logical manner
- A continuous process characterized by open-mindedness, continual inquiry, and
perseverance, combined with a willingness to look at each unique patient situation
and determine which identified assumptions are true and relevant
- Evidence-based knowledge
Levels of Critical Thinking in Nursing
1. Level 1 – basic
2. Level 2 – complex
3. Level 3 – commitment
Components: Specific knowledge base, experience, competencies, attitudes, and standards
Nursing Process Competency
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation
Haphazardly – use of diagnostic reasoning involves this rigorous approach to clinical practice
and demonstrates that critical thinking cannot be done
Chapter 16 Nursing Assessment
Five Step Nursing Process
1. Assess – gather information about the patient’s condition
2. Diagnose – identify the patient’s problems
3. Plan – set goals of care and desired outcomes and identify appropriate nursing actions
4. Implement – perform the nursing actions identified in planning
5. Evaluate – determine if goals and expected outcomes are achieved
,2
Critical Thinking in Assessment
Two Stages:
- Collection of information from a primary source (a patient) and secondary sources
- The interpretation and validation of data to determine whether more data is needed,
or the database is complete
Knowledge – underlying disease process, normal growth and development, normal physiology
and psychology, normal assessment findings, health promotion, assessment skills, and
communication skills
Standards – ANA Scope of Standards of Nursing Practice, specialty standards of practice, and
intellectual standards of measurement
Attitudes – perseverance, fairness, integrity, confidence, and creativity
Experience – previous patient care experience, validation of assessment findings, and
observation of assessment techniques
Types of Assessments
- Patient-centered interview – conducted during nursing history
- Periodic assessments – conducted during ongoing contact with patients
- Physical examination – conducted during a nursing history and at any time a
patient presents a symptom, head-to-toe assessment
Types of Data
- Subjective – patients’ verbal descriptions of their health problems, including
patients’ feelings, perceptions, and self-reported symptoms
- Objective – findings resulting from direct observation, when collecting, apply
critical thinking intellectual standards so that you can correctly interpret your
findings
Assessment Data Sources
- Patient
- Family caregivers and significant others
- Health care team
- Medical records
- Other records and the scientific literature
- Nurse’s experience
Cultural Considerations
- Cultural Competence – involves self-awareness, reflective practice, and knowledge of
a patient’s core cultural background
Data Documentation
- Record any subjective information by using quotation marks
, 3
Assessment Process
1. Data collection – use information about a patient’s needs to adapt your data collection
2. Interpretation – critically interpret assessment data to determine whether
abnormal findings are present, cues and references
3. Validation – comparison of data with another source to determine data accuracy
Cues for Discomfort
- Lies still with arms along sides and very tense
- States has not turned for some time
- Reports pain a 7 on a scale of 0 to 10
Inferences for Discomfort
- Pain is severe
- Pain limits patient’s ability to move and reposition self
Chapter 28 Infection Prevention and Control
Scientific Knowledge Base
Nature of Infection
- Infection – results when a pathogen invades tissues and begins growing within a host
(ABSCESS – strep, staph, more invasive, gets into the tissue, once it is in the
bloodstream and your septic = it is bad)
- Colonization – presence and growth of microorganisms within a host without tissue
invasion or damage (Flora, opportunistic infections, bacteria, colonized by microbiome,
if its normally living, it is a colonizer)
Chain of Infection
1. Infectious agent
2. Reservoir – food, oxygen, water, temperature, pH, and light
3. Portal of exit – skin and mucous membranes, respiratory tract, urinary tract,
gastrointestinal tract, reproductive tract, and blood
4. Mode of
transmission 5. Portal of
entry
6. Host
The Infectious Process
Defenses against Infection
- Normal floras (ex. respiratory, gut, or vaginal [yeast] floras)
- Body system defenses
- Inflammation (vascular and cellular responses, inflammatory exudate, tissue repair)
Health Care – Associated Infections (HAIs)
Occur because of:
- Invasive procedures
- Antibiotic administration
- Multidrug-resistant organisms (MDROs)
- Breaks in infection prevention and control activities
