The Nursing Process and Critical Thinking

Objectives Give a definition of the nursing process  Explain each component of the nursing process with an example of each.  Define a system of patient acuity and how it relates to the nursing process. 

What is Nursing? 

In 1980, The American Nurses’ Association (ANA) defined nursing as: “The diagnosis and treatment of HUMAN RESPONSES to actual or potential health problems.”

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In 2003 that definition had evolved:  “Nursing

is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations.”

What is nursing process? Systematic method of providing care  Problem solving approach  Organized, scientific  All personnel take part in the process  Ongoing 

Just 5 Small Steps Assessment  Diagnosis  Planning  Implementation  Evaluation 

Assessment

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This is the data collection step. Assessment involves taking vital signs, performing a head to toe assessment, listening to the patient's comments and questions about his health status, observing his reactions and interactions with others. It involves asking pertinent questions about his signs and symptoms, and listening carefully to the answers. Once you have collected the data, the process moves on to analysis of the data to determine the health status, the patient's coping mechanisms or lack thereof, his ability to use these mechanisms and to identify his problems related to his health status

Types of Data 

Subjective  From

the patient and/or pt’s family  Verbal statements  Can only be collected from patient 

Objective  Observable  Measurable  Can

be recorded

Sources of Data Direct observation  Patient  Family/ friends  Medical records  Diagnostic procedures  Other members of the healthcare team 

Methods of Data Collection  

Interview Physical examination

Physical Examination     

Inspection Palpation Percussion Auscultation Smell

Objective or Subjective?         

Temperature 102.9F “I feel hot.” Pain 9/10 Nausea Anxiety Slurred speech Emesis 50 mL green Skin warm and dry Drinks wine only at meals

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Pounding headache BP 178/89 K+ 3.5 Bilateral pulmonary infiltrates Wet cough Can’t get enough air SaO2 88% Didn’t sleep all night

Diagnosis Nurses only make nursing diagnoses. Once you have identified the patient's problems related to his health status, you formulate a nursing diagnosis for each of them. You will also prioritize the problems in formulating your plan and goals.

Nursing vs Medical Diagnosis Medical diagnosis: Physicians are licensed to make a medical diagnosis. They are specific and related to a pathologic disease process. They are relatively uniform and treated fairly much the same way in all patients.  Nursing diagnosis: Based on the patient’s physical, sociocultural, emotional, and spiritual response to illness or disease. 

Nursing Diagnoses Describes the patient’s response to disease  May be actual or potential  Can even be a problem that relates to his family rather then to him alone  Most patients have more than one nursing diagnosis 

Medical or Nursing?         

Knowledge deficit Anxiety Impaired circulation Alzheimer’s Pneumonia Impaired cognitive abilities Impaired coping Altered body image Heart failure

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Impaired circulation Bowel obstruction Constipation Diabetes Impaired mobility Grief Fear Acute alcohol poisoning Left hip fracture Impaired gas exchange

Planning 

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Setting goals to improve the outcomes for the patient is a primary focus of the nursing process. Based on the nursing diagnoses, what are the expectations for this patient? This not about nursing goals. They are patient goals. This is about improving the health status and quality of life for your patient. This is about what your patient needs to do to improve his health status and/or better cope with his illness. Planning also involves making plans to carry out the necessary interventions to achieve those goals. The use of formal care plans or care maps and protocols is highly advised

Implementation 

Implementation is setting your plans in motion and delegating responsibilities for each step. Communication is essential to the nursing process. All members of the health care team should be informed of the patient's status and nursing diagnosis, the goals and the plans. They are also responsible to report back to the RN all significant findings and to document their observations and interventions as well as the patient's response and outcomes.

Evaluation 

The nursing process is an ongoing process. Evaluation involves not only analyzing the success (or failure) of the current goals and interventions, but examining the need for adjustments and changes as well.  The evaluation process incorporates all input from the entire health care team, including the patient. Evaluation leads back to Assessment and the whole process begins again

The Whole Patient 

The nursing process involves looking at the whole patient at all times. It personalizes the patient. He is Mr. Jones, not "the CVA in 214B." It also forces the health care team to observe and interact with the patient, and not just become the task they are performing such as a dressing change (the dressing change in 317A), or a bed bath. In so doing, the process provides a roadmap that ensures good nursing care and improves patient outcomes.

Critical Thinking in the Nursing Process 

Critical thinking is: 

“…purposeful, informed, outcome-focused thinking that requires careful identification of key problems, issues, and risks involved.”

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“…careful, goal-oriented, purposeful thinking that involves many mental skills, such as determining which data are relevant, evaluating the credibility of sources, and making inferences.”

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Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness.

Why be a Critical Thinker? 

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Is the information you have received from the patient, the outgoing nurse, the ex-mother-in-law reliable? Is the information, goal, intervention appropriate in the current situation? What does the data mean? How can I apply the data? How does what I know impact patient care? Should I just be “a good soldier” and simply do what I’m told, or would a different course be more appropriate?

Characteristics of the Critical Thinker       

Curiosity Systematic thinking Analytical Open-minded Self-confident Maturity Truth-seeking

Tools of Critical Thinking Interpretation  Analysis  Evaluation  Inference  Explanation  Self-Regulation 

And if all else fails…..