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)