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RNs are responsible for making accurate and appropriate clinical decisions or judgments.
Nurses must learn to question, wonder, and explore different perspectives and interpretations to find a solution that benefits the patient.
Take advantage of learning opportunities
Working closely with experienced nurses
Analyzing situations in which appropriate nurse actions are not obvious or clear-cut.
Knowledge or deep understanding - theoretical knowledge about patient population, relevant physiology and pathophysiology, potential nursing interventions.
Learn to recognize patterns - Ex. patient w/septic shock will likely display a pattern of elevated heart rate, poor perfusion, decreased O2 sat., low BP & a left shift on WBC count differential. (knowing this pattern alerts the student nurse to note what s/s may be present or absent to determine an appropriate response.)
Apply concepts in nursing practice - search for opportunities to learn about patient care concepts; the compare and contrast present invarious patterns in order to see patterns.
Skillful responding - setting priorities and modifying them as the situation changes. Pay attention to how RN preceptors prioritize patient care. (Consider the facts they use to make decisions about planning and replanning their shift. Discuss prioritization of care as a part of your daily routine.)
Reflective Practice - helps students to process and consolidate learning about caregiving situations. Reflect on both successful and unsuccessful interventions.
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Terms in this set (155)
for the nurse, critical thinking provides a framework for
reflection on judgements and actions that result in positive outcomes, increasing the accuracy of clinical decisions
critical thinking involves
the application of knowledge and experience to identify patient problems and to direct, clinical judgements and actions that result in positive patient outcomes
clinical reasoning
uses critical thinking, knowledge, and experience to develop solutions to problems and make decisions in a clinical setting
in nursing education and practice, the term critical thinking is often used synonymously with
problem-solving, decision making, reasoning, or judgement
problem-solving
systematic, analytic approach to finding a solution to a problem
decision making
choosing a solution or answer from among different options; often considered a step in the problem-solving process
reasoning
logical thinking that links thoughts, ideas, and facts together in a meaningful way; used in scientific inquiry and problem solving
judgement
the result or decision related to the process of thinking and reasoning
critical thinking is a way to improve the quality of thought process through
analysis, assessment, and reconstruction
the interaction of these concepts is central to the development of critical thinking
-reflection
-evidence
-standards
-attributes or traits
reflection
the results of deliberate thinking are used to guide further thinking
evidence
identification and use of evidence is necessary to guide analysis of situations and decision making
standards
critical thinking needs to be assessed and evaluated according to standards to ensure quality of thinking
attributes or traits
personal characteristics associated with critical thinking, including fairness, responsibility, and empathy, are examples of traits the care
the critical thinking model of Alfaro LeFevre has been specifically applied to nursing practice and includes
four overlapping and integrated concepts; critical thinking characteristics, theoretical and experimental knowledge, interpersonal skills and technical competencies
Alfaro LeFevre model: to develop critical thinking, the nurse needs to develop a critical thinking character, which includes
maintaining high standards and developing critical-thinking qualities such as honesty, fair-mindedness, creativity, patience, persistence and confidence
the second step in LeFevre's Model in the development of critical thinking includes
taking responsibility for personal learning and seeking needed experiences that can provide the necessary knowledge on which to base the thinking
the last step in LeFevre's Model is
technical competency
Starting at the top and going clock-wise around, here's what you need to develop your ability to critically think
1. develop a critical thinking character
2. take responsibility and seek out learning experiences to help you get the theoretical and experimental knowledge needed to think critically
3. gain interpersonal skills such as teamwork, resolving conflict, and being an advocate
4. practice related technical skills
intellectual standards of critical thinking
clarity
precision
depth
logic
accuracy
relevance
breadth
significance
fairness
clarity
being easily understood of precise in thought and style; considered a gateway standard because a statement because a statement cannot be evaluated for accuracy or precision if it is ambiguous
accuracy
representing something in a true and correct way
precision
providing sufficient detail to understand exactly what was meant
relevance
focusing on facts and ideas directly related and pertinent to the topic
depth
getting beneath the surface of topic or problem to identify and manage related complexities
breadth
considering a topic, problem, or issue from every relevant viewpoint
logic
using a mutually supportive and sensible combination of thoughts and facts to form a conclusion
significance
concentrating on the most important information when considering an issue
fairness
thinking or acting in accord with reason and without bias
baseline knowledge
includes content learned in prerequisite courses, nursing-specific courses, and specialty information about specific populations
collaboration and delegation
- critical thinking guides delegation of tasks
- critical thinking
guides interdisciplinary decisions about discharge planning, end-of-life decisions, and other ethical issue
-critical thinking guides preoperative plans of care
- critical thinking guides preoperative plans of care
- critical thinking guides communication and promotes team-oriented decision making
- critical thinking supports positive patient outcomes
inductive reasoning
uses specific facts or details to make conclusions and generalizations; it proceeds from specific to general
deductive reasoning
involves generating facts or details from a major theory, generalization, or premise
the terms thinking and reasoning are often used synonymously, although
reasoning is more formal because it usually is aimed at finding answers, providing explanations, and forming conclusions
nurses use clinical reasoning to monitor patients through
ongoing assessment and evaluation and to guide decision making
inferences
intellectual acts that involve a conclusion being made on the basis of something else
- intuition
- interpretation
intuition
the feeling that you know something without specific evidence
interpretation
-examination of how information is organized and given meaning
- differs from facts and evidence
- is based on personal concept, experience, perspective
the accuracy of an inference is directly related
to the accuracy on which the inference is based
nurses use intuition to facilitate problem solving because
their hunches (most likely intuition) is based on experiential knowledge
validation
the process of gathering information to determine whether the information or data collected
are factual and true
- to find support or findings or data
- ensuring competence of nurses
subjective data are often validated with objective data; for instance,
a patient complains of severe itching, and the nurse validates this subjective finding when observing scratch marks and a rash
attitudes necessary for critical thinking
confidence
fairness
risk
taking
perseverance
curiosity
thinking independently
humility
discipline
creativity
integrity
responsibility and accountability
make critical thinking essential in nursing
the rapid rate of change and increasing complexity of health care and information technology make critical thinking essential in nursing
the application of knowledge requires
development of a questioning attitude, this process is sometimes, referred to as thinking like a nurse
point-of-care testing POCT
allows certain laboratory tests to be performed in patient care units
standards for POCT include
routine assessment of sampling practices, standardized evaluations of controls used in assessing the samples, and review of quality of testing procedure
critical thinking in the nursing process
interpretation
analysis
inference
explanation
self-regulation
clinical decision making
interpretation
nurses use this skill to understand and explain meaning of data
analysis
investigation plans of action on the basis of examination of subjective and objective data is an example
evaluation
relevance is important in evaluation of new information, also when determining whether the desired outcome for an intervention was achieved
critical thinkers skilled in inference make
accurate conclusions that are based on sound reasoning
explanation
the ability to explain conclusions is an important critical-thinking skill
self-regulation
similar to reflection, self-regulation requires monitoring of thinking, with specific emphasis on reflecting on the rationale for the conclusion drawn and action taken
clinical decision making
for nurses, the consistent use of the essential skills of critical thinking guides clinical decision making
thinking errors to avoid
-bias
-illogical thinking
- lack of information
- closed mindedness
- erroneous assumptions
bias
a tendency to favoritism or partiality
erroneous assumptions
-asking questions for clarification before implementing patient care is essential to ensuring patient safety and providing patient-centered care
- actively listening to patients enhances a nurse's ability to communicate patient needs, values, and preferences to other members
of the health care team
bias may be related to a preconceived
notion or prejudice
it is important for nurses to examine
personal biases because they can negatively impact care
often making hasty generalizations and assumptions that do not consider the evidence
the illogical thinker may jump to conclusions
another trait associated with illogical thinking is
an appeal to tradition
- if nurses do not stay current, illogical thinking can occur, causing care to compromised
knowledge deficit (lack of knowledge) is particularly relevant to the increased numbers of
medications that nurses administer and the possible interactions with other medications and foods
the close-minded nurse may ignore that
the individual needs and values of the patient
erroneous assumptions can lead to
safety issues in the clinical setting
it is the nurses responsibility before administering medications to understand the
reason that a medication is prescribed, the expected patient response, potential adverse reactions, and drug interactions
references are available for
point-of-care, hand held devices and in the health care facility electronic health record. if new medication is not references in either of these places, requesting information from the pharmacist is recommended
methods for improving critical thinking skills
-discussion with colleagues
- audible verbalization of thoughts
- literature review
- intentional application of knowledge
- concept maps
- stimulation
- role playing
- written work
reflection of one's thinking is an important exercise to facilitate
critical thinking skills
nurses can verify their assessments and diagnoses through
discussion with colleagues to enhance clarity, precision, and accuracy
the nurse who can recognize and verbalize what is unknown is better equipped to
seek what is often a more creative answer or solution
strategies that focus on improving critical thinking through written work include
reviewing and rewriting study or lecture notes, noting key facts while reading, identifying knowledge gaps while reading, and journaling
reflection and critical thinking are essential for
providing competent and caring nursing care
research indicated that caring encourages
nurses to think critically while developing patient-centered plans of care
combined competence and caring lead to
more positive patient outcomes
continuing education, certification, and The Joint Commission- required
annual competency reviews are methods used to enhance critical thinking and ensure the competence of licensed nurses
basic research
research conducted to generate theories, which help provide explanations for phenomena
applied research
testing the application of theories in different situations with different populations
clinical research
research used when testing theories about the effectiveness of interventions
the ANA standards of professional performance require that use research findings in practice. the criteria measured are twofold
- the first criterion is that nurses need to use the best available evidence, which includes research findings, to guide
their practice decisions
- the second criterion is that nurses participate in research activities that are appropriate for their position and level of education attained
in 1985, the ANA created the National Center for Nursing Research, which evolved in the Nation Institute of Nursing Research (NINR) in 1993, affording it equal status with other National Institutes of Health
- the mission of NINR is to
promote and improve the health of individuals, families, communities, and populations
- NINR supports and conducts clinical and basic research and research training on health and illness across the lifespan
bench-marking
you compare yourself against like facilities
methods of research gather
data, which are information expressed as numbers or words
quantitative research
usually results in data in the form of numbers
qualitative research
uses a constructivist philosophy, which assumes that reality is composed of multiple socially constructed realities of each person or group
quantitative research uses a
post-positivist philosophy, which assumes that reality is objective, fixed, stable, observable, measurable, and value-free
positivism assumes that
the approach is deductive in nature, and it seeks to gain knowledge through scientific and experimental research
phenomenon
is an aspect of reality that can be observed or experienced
variable
is a concept that has different values that can be measured, manipulated, or controlled in the study
deductive reasoning
takes a large amount of data and formulates a specific concept
inductive reasoning
takes a specific concept and tries to generalize
descriptive research
identifies data and characteristics about the population or phenomenon
correlational research
explores a relationship between two variables
experimental research
explores the causal relationships between variables
quasi-experimental research
examines a causal relationship between variables
experimental research examines whether on variable has a
cause-and-effect relationship with another, such as blood pressure medication having an effect on decreasing blood pressure
quasi-experimental research may not meet
the strict guidelines of experimental research
phenomenological research
explores the experiences of a specific group of people experiencing a similar event in their lives
grounded theory research
consists of deriving a theory from the data collected in the research
ethnography
focuses on the sociology of meaning through close field observation of a sociocultural phenomenon
historical research
studies historic documents to determine an accurate picture of a historical event or time period
qualitative research uses a constructvist philosophy, which
assumes that reality is composed of multiple socially constructed realities of each person or group, and thus is value laden, focusing on the beliefs, thoughts, and feelings of the person
constructivism assumes an approach that is
inductive
literature review
a critical analysis of current information on a specific subject that will be studied in the research
systematic review
of the literature provides a comprehensive, unbiased analysis through the use of a strict scientific design to select and assess each of the studies
a meta-analysis
merges statistical results from related studies for the purpose of discovering similarities and differences between the studies
hypothesis
is a statement about two or more variables and their relationship to each other
sample
includes the actual individuals in the population from whom the data will be collected
instruments
are the data collection tools used to collect the information
instruments
are the data collection tools used to collect the information
an example of an instrument is a
questionnaire, which may be created either in a Likert scale format, showing the degree of satisfaction with each item, or open-ended questions
independent variable
a concept that is thought to have an effect on another concept
dependent variable
the outcome and is affected by the independent variable
in experimental research, the independent variable is referred to as
an experimental variable or treatment variable
control group
does not receive the treatment
institutional review board
a review committee established to help protect the rights and welfare of human research subjects
human subject
a living subject
about whom an investigator conducting research obtains
1- data through intervention or interaction with the individual
2- identifiable private information
informed consent
begins when subjects are recruited and continues through-out the research process
confientiality
the assurance that information can be viewed only by those requiring access
anonymity
means that a person's identity or personal information is not known
the vulnerable subjects of research participation include
-children
-embryos or fetuses
-mentally disabled subjects
-subjects experiencing emergency situations
-subjects within hierarchical social structures who may
feel pressured to volunteer
-educationally disadvantaged subjects, who may be illiterate or unable to comprehend materials provided
-economically disadvantaged subjects, who may be influenced by monetary compensation
- members are marginalized social groups, who may not have access to the legal system
-individuals with fatal or incurable illnesses who may accept high risks in the hope of a cure even if there is no direct path
important issues in ethical, legal, and professional practice are patient rights regarding informed consent
- research participants require an explanation of the study in which they are subjects.
- procedures and the purpose of the study need to be explained
- the manner in which subject anonymity and confidentiality will be protected needs to be explained
- any potential harm, including physical or mental discomfort, needs to be revealed as well as any
possible benefits from participation
- any questions need to be answered so that participants fully understand the research and their part in the process
- all subjects need to be given time to decide on their participation
- study participants are voluntary, may withdraw at any time, or may choose not to complete tasks
data analysis
techniques are specific procedures used to summarize the words or numbers and create a meaningful result for interpretation
dissemination of outcomes
is the communication and distribution of the findings of research
application to practice
when research is conducted, the goal is to apply the findings to practice
patient education and health literacy
- patients require that research results be translated into understandable language that is practical for them
- brochures and fact sheets that provide brief but pertinent information related to different topics have the best impact on patients
- short videos are another means of relaying information regarding health practices to patients
- websites provided by the health care facility or by state or federal health care agencies can be a
source of accurate information
- public service announcements, such as antismoking campaigns based on research, are a means of education the community
evidence based practice
is an integration of the best available research evidence and the nurse's clinical expertise to make patient care decisions
research use
the application of research findings to clinical practice
EBP results in
better patient outcomes, keeps nursing practice current and increases the nurse's confidence in professional decision making
assessing the problem
- the first phase of EBR consists of assessing the need for change in practice by identifying a problem
- major
stakeholders such as staff nurses or patients are involved in the EBR process
- a stakeholder is someone who is an integral part of the process, either the end user of the process or anyone who may be affected by the process
after identifying the problem, the second phase of EBR consists of
formulating a specific research question so that the nurse can effectively search the literature databases
one specific method of formulating a research question is identified by the acronym
PICO
patient, problem, population
intervention
comparison intervention
outcomes
P (patient, population, problem)
describe the subject of the problem. the nurse determines how best to describe the group of patients on which the research is to be conducted
I (intervention)
define which intervention is being considered for the specific patient or population
C (comparison intervention)
describe a second intervention to compare to the first if appropriate. an example of such a comparison would be a traditional x ray versus an MRI
O (outcome)
define the type of outcome to assess. outcomes may be of several types. the outcome can relate to changes in a physical sign; the result of a diagnostic test, a patient response to a treatment or intervention, or the cost-effectiveness of a treatment
examples of resources for systematic reviews and practice guidelines
-systematic reviews
- cochrane
collaboration
- database of abstracts of review of effects
- clinical practice guidelines
- agency for health care research and quality
- national guideline clearinghouse
critical appraisal
is a balanced evaluation of the strengths and benefits as well as the weaknesses and flaws of the research
validity
generally refers to the strength or the degree to which a concept, conclusion, or measurement is justifiable and corresponds accurately to the real world
after identifying an article or systematic review resource that seems appropriate to question, the nurse
must critically appraise the information
nurses should not accept research without carefully reviewing the study
internal validity
examination of whether the results of the study are reasonable on the basis of how the study was conducted
external validity
a measure of whether a study can be applied to any other setting
searching for and evaluating evidence
internal validity
result analysis
external
validity
evidence based research example
1. assess the problem
2. develop a question
3. search for evidence and evaluate
4. develop the plan
5. implement the plan
6. reevaluate
nurses should understand that any single means to establishing care, even if it is an accepted method, may not
meet the complex needs of individuals patients
collaborate with colleagues to use research when caring for the same patient on
various shifts and days
collaborate with colleagues to used research on the nursing unit to influence
the clinical microsystem (the small functional unit where care is provided)
educate unlicensed assistive personnel, prior to delegating care,
on the importance of EBP for positive patient outcomes
collaborate with administrators to use research to influence
the larger practice environment
function as a participant or co-researcher in a
collaborative knowledge-generating research project
each of these qualities is present in magnet hospitals
- nurses are involved in data collection and decision making in the process of delivering patient care
- the relationship between nursing leaders and staff nurses indicates appreciation and respect and rewards them for advancing nursing practice
- the administration involves staff nurses in research-based nursing practice through
ongoing open communication and collaboration between nurses and other members of the health care team
- the hospital has an appropriate mix of personnel that allows for the best outcomes
magnet status is an award given by the american nurses credentialing center (ANCC)
an affiliate of the ANA
a magnet hospital is characterized by
excellent patient outcomes resulting from nursing, a high level of nursing job satisfaction with a low nurse turnover rate, and appropriate resolution of any grievance
the magnet recognition award
supports and evidence-based environment, which includes the nurses' autonomy to improve quality of care by using evidence
quality nursing care is the priority of
evidence-based practice
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