Download - nursing process & critical thinking cld
Nursing Health AssessmentNursing Health Assessment
Maria Carmela L. Domocmat, MSN, Maria Carmela L. Domocmat, MSN, RNRN
Instructor, Nursing Health Assessment Instructor, Nursing Health Assessment
School of NursingSchool of Nursing
Northern Luzon Adventist CollegeNorthern Luzon Adventist College
•• Review of the Nursing ProcessReview of the Nursing Process
•• Critical Thinking Critical Thinking
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Nursing Process: A ReviewNursing Process: A Review
•• What is the nursing process and why What is the nursing process and why
learn about it? learn about it?
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Nursing ProcessNursing Process
•• Nursing Process and Maslow are the Nursing Process and Maslow are the
main frameworks for the local board main frameworks for the local board
and the NCLEX Exams.and the NCLEX Exams.
•• Remember ONLY the RN can assess, Remember ONLY the RN can assess,
develop a plan of care, evaluate and develop a plan of care, evaluate and
educate clients.educate clients.Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Nursing Process Nursing Process cont.cont.
•• is the framework for professional is the framework for professional
nursing practice.nursing practice.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Nursing Process Nursing Process cont.cont.
•• Is a Is a systematicsystematic,, dynamicdynamic way of giving way of giving
nursing carenursing care
•• Promotes Promotes humanistichumanistic, , outcomeoutcome--focusedfocused, ,
costcost--effectiveeffective carecare
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Nursing Process Nursing Process cont.cont.
•• Pushes nurses to continually examine Pushes nurses to continually examine
what they are doing and to study how it what they are doing and to study how it
can be done better.can be done better.
•• Consists of five interrelated stepsConsists of five interrelated steps
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Nursing Process Nursing Process cont.cont.
1.1. AssessmentAssessment2.2. DiagnosisDiagnosis3.3. PlanningPlanning4.4. ImplementingImplementing4.4. ImplementingImplementing5.5. EvaluatingEvaluating
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Nursing ProcessNursing Process
•• Why systematic?Why systematic?
•• Why dynamic?Why dynamic?
•• Why humanistic? Why humanistic?
•• Why outcomeWhy outcome--focused? focused?
•• Why costWhy cost--effectiveeffective
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Systematic Systematic
•• Like a problemLike a problem--solving methodsolving method
•• It consists of five steps during which It consists of five steps during which
you take deliberate steps to maximize you take deliberate steps to maximize
efficiency and attain longefficiency and attain long--term term
beneficial results. beneficial results.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
DynamicDynamic
•• As you gain more experience, you’ll As you gain more experience, you’ll
find yourself moving back and forth find yourself moving back and forth
between the steps, sometimes between the steps, sometimes
combining activities, yet getting the combining activities, yet getting the
same end result.same end result.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Dynamic Dynamic cont.cont.
•• For example, new nurses often need to For example, new nurses often need to
methodically assess a patient for quite some methodically assess a patient for quite some
time before coming to a diagnosis, whereas time before coming to a diagnosis, whereas
experienced nurses often immediately experienced nurses often immediately
suspect a diagnosis, then assess the patient suspect a diagnosis, then assess the patient
more closely to see of they are correct. more closely to see of they are correct. Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
HumanisticHumanistic
•• The nursing process involves looking at the The nursing process involves looking at the
whole patient at all times. whole patient at all times.
•• It personalizes the patient. It personalizes the patient.
•• As nurses, we deal with the body, mind and As nurses, we deal with the body, mind and
spirit.spirit.
•• He is not "the CVA in bed # 5."He is not "the CVA in bed # 5."Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
HumanisticHumanistic
•• We strive to understand each individual’s health We strive to understand each individual’s health
problems and the corresponding impact on one’s problems and the corresponding impact on one’s
sense of wellsense of well--being and ability to do daily being and ability to do daily sense of wellsense of well--being and ability to do daily being and ability to do daily
activities. activities.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
HumanisticHumanistic
•• The process provides a The process provides a
roadmap that ensures good roadmap that ensures good
nursing care and improves nursing care and improves nursing care and improves nursing care and improves
patient outcomes.patient outcomes.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
OutcomeOutcome--focusedfocused
•• ResultResult--orientedoriented
•• The steps of the nursing process are The steps of the nursing process are
designed to keep the focus on designed to keep the focus on
determining whether people seeking determining whether people seeking
health care are getting the best results health care are getting the best results
in the most efficient way. in the most efficient way. Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Why learn about it?Why learn about it?
•• The nursing process provides the basis The nursing process provides the basis
for the board exams for the board exams ––you need to be you need to be
thoroughly familiar with it to think thoroughly familiar with it to think
your way to through the questions.your way to through the questions.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Why learn about it?Why learn about it?
•• It help you think critically in the clinical It help you think critically in the clinical
settingsetting——you must you must mastermaster the principles the principles
behind the nursing process. behind the nursing process.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Why learn about it?Why learn about it?
•• Using the nursing process complements Using the nursing process complements
what other health care professionals do by what other health care professionals do by
focusing on both the medical problems and focusing on both the medical problems and
human response human response ––how the person respondshow the person responds to to
medical problems, treatment plans, and medical problems, treatment plans, and
changes in activities of daily life.changes in activities of daily life.Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
ComparisonComparison
Physician’s dataPhysician’s data•• Disease focusDisease focus
Nurse’s dataNurse’s dataWholisticWholistic focus focus ––
considering their considering their problems and their problems and their problems and their problems and their effect on the effect on the person’s ability to person’s ability to function function independently. independently.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Physician’s dataPhysician’s data
•• Mrs. Garcia has pain and swelling in all Mrs. Garcia has pain and swelling in all
joints. Diagnostic studies indicate that she joints. Diagnostic studies indicate that she
has rheumatoid arthritis. We will start her has rheumatoid arthritis. We will start her
in a course of antiin a course of anti--inflammatoriesinflammatories to treat to treat
the rheumatoid arthritis. the rheumatoid arthritis.
•• (Focus is on treating the arthritis(Focus is on treating the arthritis) ) Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Nurse’s dataNurse’s data
•• Mrs. Garcia has pain and swelling in all Mrs. Garcia has pain and swelling in all
joints, making it difficult to dress herself. She joints, making it difficult to dress herself. She
has voiced that it’s difficult to feel worthwhile has voiced that it’s difficult to feel worthwhile
when she can’t even feed herself. She states when she can’t even feed herself. She states
that she is depressed because she misses that she is depressed because she misses
seeing her two small grandchildren. seeing her two small grandchildren. Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Nurse’s dataNurse’s data
•• We need to develop a plan to help her We need to develop a plan to help her
pain, to assist with her feeding and pain, to assist with her feeding and
dressing, to work through feelings of low dressing, to work through feelings of low dressing, to work through feelings of low dressing, to work through feelings of low
selfself--esteem, and for special visitations esteem, and for special visitations
with the grandchildren.with the grandchildren.
•• (Focus is on Mrs. Garcia)(Focus is on Mrs. Garcia)
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
WHAT IS CRITICAL WHAT IS CRITICAL THINKING IN NURSING?THINKING IN NURSING?
Maria Carmela L. Domocmat, RN, MSNMaria Carmela L. Domocmat, RN, MSN
Critical Thinking Critical Thinking
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Critical Thinking Critical Thinking
•• Unlike the mindless thinking Unlike the mindless thinking
we do when we do our daily we do when we do our daily
routine, critical thinking is routine, critical thinking is
careful, deliberate, outcomecareful, deliberate, outcome--
focused (resultsfocused (results--oriented) oriented)
thinking. thinking. Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
What is critical thinking in What is critical thinking in nursing?nursing?
Critical thinking in nursing:Critical thinking in nursing:
•• Entails purposeful, outcomeEntails purposeful, outcome--oriented oriented
(results(results--oriented) thinking.oriented) thinking.
•• Is driven by patient, family, and Is driven by patient, family, and
community needs.community needs.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Critical thinking in nursing:Critical thinking in nursing:
•• Is based on principles of nursing Is based on principles of nursing
process and scientific methodprocess and scientific method
•• Requires knowledge, skills and Requires knowledge, skills and
experienceexperience
•• Is guided by professional standards and Is guided by professional standards and
ethics codes.ethics codes.Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Critical thinking in nursing:Critical thinking in nursing:
•• The ability to:The ability to:
•• identify a problemidentify a problem
••analyze itanalyze it
••develop a responsedevelop a response
•• follow throughfollow through
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Critical thinking in nursing:Critical thinking in nursing:
•• Requires strategies that maximize Requires strategies that maximize
human potentialhuman potential (e.g., using individual (e.g., using individual
strengths) and compensate for strengths) and compensate for
problems created by problems created by human naturehuman nature (e.g., (e.g.,
the powerful influence of personal the powerful influence of personal
perspectives, values and beliefs.)perspectives, values and beliefs.)Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Critical thinking in nursing:Critical thinking in nursing:
•• Is constantly reIs constantly re--evaluating, selfevaluating, self--
correcting, and striving to improve. correcting, and striving to improve.
(Source: Alfaro(Source: Alfaro--LeFevreLeFevre (1999). Critical thinking in nursing: (1999). Critical thinking in nursing:
A practical approach. Philadelphia: W. B. Saunders. )A practical approach. Philadelphia: W. B. Saunders. )
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
How to Become a Critical How to Become a Critical ThinkerThinker
Critical thinking is like any other skill: Critical thinking is like any other skill:
if you practice it, it becomes more if you practice it, it becomes more if you practice it, it becomes more if you practice it, it becomes more
automatic. automatic.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Take a few moments to look at the list Take a few moments to look at the list
of the characteristics of critical thinkers, of the characteristics of critical thinkers,
and evaluate your current habits of and evaluate your current habits of
thinkingthinking
•• Check each characteristics and ask Check each characteristics and ask
yourself, “Is this me?”yourself, “Is this me?”
•• Put a mark next to the ones you want to Put a mark next to the ones you want to
develop or improve. develop or improve. Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Characteristics of Critical ThinkersCharacteristics of Critical Thinkers
Critical Thinkers are: Critical Thinkers are:
•• Aware of their strengths and Aware of their strengths and
capabilitiescapabilities: They’re confident that they : They’re confident that they capabilitiescapabilities: They’re confident that they : They’re confident that they
can reason to find answers and make can reason to find answers and make
good decision.good decision.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Sensitive to their own limitations and Sensitive to their own limitations and
predispositionspredispositions: They know their : They know their
weaknesses, values, and beliefs and weaknesses, values, and beliefs and
recognize when these may hamper their recognize when these may hamper their
ability to assess a situation or solve a ability to assess a situation or solve a
problem.problem.Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Open mindedOpen minded: They listen to new ideas : They listen to new ideas
and viewpoints and consider the and viewpoints and consider the
situation from many perspectives.situation from many perspectives.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• HumbleHumble: They overcome their own : They overcome their own
tendency to feel that they should have tendency to feel that they should have
all the answers. all the answers.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• CreativeCreative: They are constantly looking : They are constantly looking
for better ways to get things done. They for better ways to get things done. They
follow recommended procedures; follow recommended procedures;
however, they continually examine however, they continually examine
whether these are the best way to meet whether these are the best way to meet
the goals and objectives.the goals and objectives.Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
The Client in ContextThe Client in Context
•• ProactiveProactive: they accept : they accept
responsibility and responsibility and
accountability for their accountability for their
actions. They study situations, anticipate actions. They study situations, anticipate
problems, and find ways to avoid them problems, and find ways to avoid them
beforebefore they happen.they happen.Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• FlexibleFlexible: They recognize the : They recognize the
importance of changing priorities and importance of changing priorities and
interventions when planned interventions when planned
approaches don’t seem to be getting approaches don’t seem to be getting
results. results.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Aware that errors are steppingAware that errors are stepping--stones stones
to new ideasto new ideas: They turn mistakes into : They turn mistakes into
learning opportunities, reflecting on learning opportunities, reflecting on
what went wrong and identifying ways what went wrong and identifying ways
to avoid the same mistake in the future. to avoid the same mistake in the future.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Willing to persevereWilling to persevere: They know that : They know that
sometimes there are no easy answers sometimes there are no easy answers
and that there may be timeand that there may be time--consuming consuming
struggles to find the best answer. struggles to find the best answer.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Cognizant to the fact that we don’t live Cognizant to the fact that we don’t live
in a perfect worldin a perfect world: :
•• They realize that sometimes the They realize that sometimes the best answerbest answer
may not be the may not be the perfect answerperfect answer. .
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• IntrospectiveIntrospective: :
•• They evaluate and correct They evaluate and correct
their own thinking. their own thinking. their own thinking. their own thinking.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Critical Thinkers also:Critical Thinkers also:
•• Maintain questioning attitudeMaintain questioning attitude: :
•• They ask questions like: “What’s going on They ask questions like: “What’s going on
here?”; “What does it mean?”; and “What here?”; “What does it mean?”; and “What here?”; “What does it mean?”; and “What here?”; “What does it mean?”; and “What
else could it mean, and how else could it be else could it mean, and how else could it be
interpreted?”interpreted?”
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Ask for clarification when they don’t Ask for clarification when they don’t
understandunderstand: :
•• For example, they say, “I’m not clear about For example, they say, “I’m not clear about
this. Can you tell me more?” this. Can you tell me more?” oror ask ask
questions like, “What do you mean by questions like, “What do you mean by
better,better, better in what way?”better in what way?”
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Apply previous knowledge to new Apply previous knowledge to new
situationssituations: :
•• They see similarities and differences They see similarities and differences
between one experience and another, between one experience and another,
between one concept and another. between one concept and another.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• See the situation from many See the situation from many
perspectivesperspectives: :
•• They value all viewpoints and watch that They value all viewpoints and watch that
their judgments are based on their judgments are based on factsfacts, not , not
personal feelings, views, or selfpersonal feelings, views, or self--interests. interests.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Weigh risks and benefits (advantaged Weigh risks and benefits (advantaged
and disadvantages) before making a and disadvantages) before making a
decisiondecision: :
•• They avoid risky decisions and find ways They avoid risky decisions and find ways
to reduce adverse reactions before putting to reduce adverse reactions before putting
a plan into action.a plan into action.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Seek help when neededSeek help when needed..
•• Put first things firstPut first things first: :
•• They ask, “What is the most They ask, “What is the most
important thing to do important thing to do
here?”here?”
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Critical Thinkers use logic. Critical Thinkers use logic.
•• They tThey test first impressions to make est first impressions to make
sure they are as they appearsure they are as they appear: :
•• They doubleThey double--check the logic of their check the logic of their
thinking and workability of their solutions.thinking and workability of their solutions.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Distinguish between fact and fallacyDistinguish between fact and fallacy: :
•• They take time to verify important They take time to verify important
information to be sure it’s true. information to be sure it’s true. information to be sure it’s true. information to be sure it’s true.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Distinguish fact from inference (what Distinguish fact from inference (what
they they believebelieve the fact means)the fact means): :
•• For example, they recognize that because For example, they recognize that because
someone is sitting quietly in a corner may someone is sitting quietly in a corner may
not mean that the individual is not mean that the individual is withdrawnwithdrawn; ;
It means that they are sitting quietly in a It means that they are sitting quietly in a
corner and that it would be helpful to find corner and that it would be helpful to find
out why. out why.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Support views with evidenceSupport views with evidence: :
•• They wouldn’t state that the person above They wouldn’t state that the person above
is withdrawn without providing additional is withdrawn without providing additional is withdrawn without providing additional is withdrawn without providing additional
supporting evidence, such as the supporting evidence, such as the
individual saying he wants nothing to do individual saying he wants nothing to do
with anyone. with anyone.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Determine what’s relevant and what’s Determine what’s relevant and what’s
irrelevantirrelevant: :
•• They recognize what’s important for They recognize what’s important for
understanding a situation and what’s understanding a situation and what’s
unimportant. unimportant.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Apply the concept of “cause and effect”Apply the concept of “cause and effect”: :
•• They look for what’s causing a problem to They look for what’s causing a problem to
more fully understand the problem itself. They more fully understand the problem itself. They
anticipate responses to their actions before anticipate responses to their actions before
performing the actions. For example, critical performing the actions. For example, critical performing the actions. For example, critical performing the actions. For example, critical
thinkers would attempt to find out the thinkers would attempt to find out the cause cause of of
pain before deciding how to pain before deciding how to treattreat it. They it. They
would determine how someone might would determine how someone might respondrespond
to a medication before to a medication before administeringadministering it. it.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
•• Withhold judgment until all the Withhold judgment until all the
necessary facts are innecessary facts are in: :
•• They realize the dangers of jumping to They realize the dangers of jumping to
conclusions.conclusions.
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
Maria Carmela L. DOmocmat. RN, MSNMaria Carmela L. DOmocmat. RN, MSN
15 minutes