Critical Thinking - Answers the deliberate nonlinear process of collecting, interpreting, analyzing,
drawing conclusions about, presenting, and evaluating information that is both factually and belief
based. This is demonstrated in nursing by clinical judgment, which includes ethical, diagnostic, and
therapeutic dimensions and research
whats the order of thinking Skills - Answers -critical thinking
-clinical reasoning
-clinical judgment
-clinical decision making
Critical Thinking - Answers identifying, evaluating, and using evidence to guide decision making by
means of logic and reasoning
Clinical Reasoning - Answers the thinking process by which a nurse reaches a clinical judgment
or
a process of observing, interpreting, responding, and reflecting situated within and emerging from the
nurse's knowledge and perspective.
Clinical Decision-Making types - Answers -Analytic - requires the decision-maker to combine patient
cues to form a logical determination of intervention to address patient need
-Intuitive - based on experience and includes recognition of similarities between patient care
situations, awareness developed over time, and a process that may appear to be without rationale
Clinical Judgment - Answers the observed outcome of critical thinking and decision-making (NCSBN,
2015);
or
a conclusion nurses reach about a patient's needs or clinical problem; result of the clinical reasoning
process
Attributes of Clinical Judgment - Answers -Involves a holistic view of the patient situation
-Has a process orientation (a circular process)
-Requires reasoning and the interpretation of data
what is Reflective Practice - Answers -The ability to act on the basis of critical thinking comes with
experience.
-Turning over a subject in the mind and thinking about it seriously is reflection.
Tanner's Model - Answers -Noticing
-Interpreting
-Responding
-Reflecting
Noticing - Answers A function of the nurse's expectations and initial grasp of the situation; based on
knowledge
of the population of patients and relating the individual patient's situation.
Interpreting - Answers Narrative - how you frame your patient's "story"
Responding - Answers Applying the thinking strategies to determine the action to take and the
expected
outcomes.
Reflecting: - Answers -Reflection-in-action happens in real time while care is occurring
-Reflection-on-action happens after the patient care occurs
Five-Step Nursing Process - Answers -Assess (gather data)
-Diagnose (identify problem)
-Plan (set goals of care and desired outcomes)
-Implement (perform nursing interventions)
-Evaluate (determine if goals and expected outcomes)
Assessment stages - Answers Stage 1: Collection of information from primary (from pt) or secondary
source (family and medical record)
, Stage 2: Interpretation and validation of data to determine if more data is needed or if data base is
complete
Types of Assessments - Answers 1. Patient Centered Interview (involve pt and their wants and needs,
also medical history.)
2. Periodic Assessment (report)
3. Physical Examination (head to toe at first of shift)
Types of Data - Answers 1. Subjective= Patients' verbal descriptions of their health problems, patient
feelings, perceptions, and self-reported symptoms
2. Objective= Findings resulting from direct observation or measurement. (critical thinking intellectual
standards so that you can correctly interpret your findings.)
Assessment Data Sources - Answers -Patient
-Family caregivers and significant others
-Health care team
-Medical records
-Other records and the scientific literature
-Nurse's experience
Motivational interviewing - Answers it allows the pt to become a helper in the change process
The Patient-Centered Interview - Answers - Good communication skills
-Courtesy
-Open ended questions
-summaries
-ask at the end if there is anything else they would like you to know
Phases of the Interview - Answers Orientation: introduction and explain what you are doing
Working phase: Collect data using therapeutic communication techniques
Termination: Summaries your discussion
Cultural Considerations - Answers Cultural competence: knowledge of a patient's core cultural
background
Cultural humility: Requires you to recognize your own knowledge limitations and cultural perspective
and thus be open to new perspectives
Components of the Nursing Health History - Answers -Biographical information (admin office)
-Chief concern
-Patient expectations
-Present illness or health concerns
-Past health history
-Psychosocial history
-Family history
-Spiritual health
-Observation of patient behavior
-Diagnostic and laboratory data
The Assessment Process 1 - Answers 1. Data collection: gather all possible data
2. Interpretation: Critically interpret assessment data to determine whether abnormal findings are
present
3. Validation: Comparison of data with another source to determine data accuracy
The Assessment Process 2 - Answers Cue:
Inferences:
History of Nursing Diagnosis - Answers -First introduced in 1950
-1953, Fry proposed the formulation of a nursing diagnosis.
-1980 and 1995, the American Nurses Association (ANA) included diagnosis as a separate activity in its
publication Nursing: a Social Policy Statement.
-1982, North American Nursing Diagnosis Association (NANDA) was founded