Chapter 4: The Nursing Process, Critical Thinking, and Clinical Judgment

Chapter 4 The Nursing Process, Critical Thinking, and Clinical Judgment Fundamental Concepts and Skills for Nursing, 7th edition 2025 1 Learning Objectives (1 of 3) Theory 1. Explain the use of the nursing process. 2. Identify the components of the nursing process. 3. Compare and contrast the terms critical thinking, clinical reasoning, and clinical judgment. 4. Describe the Clinical Judgment Measurement Model. 5. Compare the nursing process with the Clinical Judgment Measurement Model. 6. Identify the steps of the problem-solving process. 2 Learning Objectives (2 of 3) Theory (cont’d.) 7. List the steps used in making decisions. 8. Identify ways to improve clinical reasoning and clinical judgment. 9. Apply the critical thinking process to a real-life problem. 10. Discuss the use of critical thinking and clinical judgment in nursing. 11. Explain the principles of setting priorities for nursing care. 12. List factors to be considered when setting priorities. 3 Learning Objectives (3 of 3) Clinical Practice 1. Apply the nursing process to a patient care assignment. 2. Use clinical judgment to prioritize the care of a patient assignment. 4 The Nursing Process      A way of thinking and acting based on the scientific method Used as a tool identify patients’ problems and an organized method to meet patients’ needs Nurses are taught to use this method in everything they do. It’s the 1st step to “thinking like a nurse” Consist of 5 components. Some steps often overlap, bc were continually assessing and evaluating our patients. This process helps construct a plan of care for the patient. RNs are the only ones to initiating care plans, BUT LPNs assist with every aspect of the care plan to ensure patient outcomes are met. ➢ LPNs primary responsible for data collection to assist RN with assessment phase. 5 The Nursing Process  Components of the nursing process F4.1 & B4.1 Assessment (data collection) ➢ Analysis/problem identification (nursing diagnosis) ➢ Planning ➢ Implementation ➢ Evaluation Mnemonic : “ADPIE” A-Assess D-Diagnosis (NURSING DX, NOT MEDICAL DX) P-Plan I-Implementation E-Evaluation ➢ 6 Assessment    Collecting, organizing, documenting, and validating a patient’s health data Ex: Current Complaint or feelings, Medical History, meds, V/S, I&O, Height and Weight, data gathering, neuro assessment, lab results, information obtained family, other Healthcare professionals. BE THE NOSEY NURSE!!! 7 Nursing Diagnosis     Sorting and analyzing the assessment data to identify potential health problems Problems identified during the process are specific nursing diagnoses Nursing diagnoses prioritized and entered into the nursing plan of care RN does this but we are going to show you the NANDA DX and how to formulate a care plan bc you will be assisting the RN to ensure the POC is being achieved. 8 ND Statement Example:  MUST include 3 Parts: ✓ {Problem} + Related to {Etiology} + as evidences by {Signs and symptoms} ✓ Problem: A Nanda Diagnosis, List provided on blackboard ✓ ✓ Etiology: Probable cause of the problem ✓ ✓ Ex: Impaired Physical mobility Ex: Muscle weakness Signs and symptoms: ✓ Ex: Difficulty moving independently Final ND Statement: Impaired physical mobility related to muscle weakness as evidenced by difficulty moving independently. 9 Planning    A series of steps in which the nurse and the patient set priorities and goals to eliminate, diminish, or control identified problems Goals should be stated with specific outcomes and measurable! Ex: pain, v/s and wounds. Nurse and patient collaborate to choose specific interventions to enable the patient to meet the specific outcomes listed in the plan of care 10 Implementation   Carrying out nursing interventions prioritized during the planning process Some interventions may be delegated or carried out by other members of the health care team 11 Evaluation    Assessing the patient to evaluate his or her response to the nursing interventions Responses compared with expected outcomes to evaluate whether outcomes have been met Based on results from the evaluation process, the nursing plan of care may need to be changed 12  What activities do you do that would use this process of thinking and accomplishing things? 13 Critical Thinking (1 of 2)    Required to use the nursing process successfully Means requiring careful judgment Directed, purposeful mental activity by which ideas are evaluated, plans are constructed, and desired outcomes are decided 14 Critical Thinking (2 of 2)  Problem solving and decision making First define the problem clearly ➢ Second, consider all possible alternatives as solutions ➢ Third, consider outcomes for each alternative ➢ Fourth, predict likelihood of each outcome occurring ➢ Finally, choose alternative with best chance of success and fewest undesirable outcomes ➢ 15 Skills for Critical Thinking     Effective reading: Pick the main ideas & relevant information Effective writing: Writing thoughts clearly Attentive listening: Focusing on the topic at hand Effective communicating: Think about what you'll say before you'll say it. 16 Critical Thinking in Nursing (1 of 3)    Requires skills and experience as well as knowledge Influenced by professional standards and codes of ethics Evidence-based practice- problem solving approach to healthcare 17 Critical Thinking in Nursing (2 of 3)  Critical thinking and the nursing process Assessment: organized and systematic; includes gathering and recording data ➢ Nursing diagnosis requires analysis of data gathered, clustering related information, identifying problem areas, and choosing appropriate nursing diagnoses ➢ Planning involves determining specific desired outcomes for each nursing diagnosis ➢ 18 Critical Thinking in Nursing (3 of 3)  Critical thinking and the nursing process (cont’d) Implementation involves preparing for and performing the interventions ➢ Evaluation involves gathering data to determine whether expected outcomes have been achieved ➢ 19 Question 1 Which of the following is an example of a nurse’s statement that reflects using the scientific method in the nursing process? 1) 2) 3) 4) “I believe that this patient is getting depressed.” “The patient doesn’t look right to me; I think something is wrong.” “The patient’s husband told me that she is feeling very uncomfortable.” “The patient reports more pain than yesterday, and her blood pressure is elevated.” 20 Lesson 4.2 Setting Priorities 21 Priority Setting and Work Organization  Priority setting (prioritizing): placing nursing diagnoses/interventions in order of importance High priority: life-threatening problems- Things that can KILL my patient. Breathing, Bleeding, Anaphylactic shock. ➢ Medium priority: problems that threaten health or coping ability ➢ Low priority: problems that do not have a major effect on the person if not attended to that day or week ➢ 22 Organizing Workload   Priorities change as patient conditions change To maintain an organized workload, you must: Write out a worksheet; list major tasks to accomplish ➢ Be flexible and frequently reorder your tasks ➢ Evaluate and reprioritize work plan at least every 2 hours ➢ Know when to ask for help and when to delegate a task to others ➢ 23 Application of Problem Solving and Critical Thinking    Goal is to avoid having your decision cause injury to anyone With critical thinking skills, you can weigh many factors and skillfully solve problems, making good decisions a majority of the time Operating in critical thinking mode while pursuing nursing studies helps develop clinical judgment needed to practice safe nursing 24 Question 2 Which of the following nursing actions is the best example of problem solving? 1) Requesting the IV team to start an antibiotic drip on a patient with a history of being a difficult stick 2) Offering to call the kitchen to provide an alternate breakfast for a patient who does not like cooked cereal 3) Trying several difficult wound dressings to determine which one the patient can apply the most effectively 4) Calling for another pain medication order when the current drug results in the patient experiencing nausea 25