BIOL 1040 Chapter 11 Flashcards: Developing Nursing Judgment Through Critical Thinking

A set of 127 question-and-answer study flashcards covering Chapter 11 on developing nursing judgment through critical thinking, reflective practice, the nursing process, and the NCJMM.

What is the main purpose of critical thinking in nursing?

To assess a patient’s needs, make sound clinical decisions, and prioritize care.

Why is a nurse's ability to use a reliable, consistent cognitive approach important?

To identify patient care priorities and make sound clinical decisions based on those priorities.

How does the chapter describe critical thinking?

A complex, purposeful, disciplined process guided by nursing standards and ethics to improve patient outcomes.

What is critical thinking according to the Paul-Elder Critical Thinking Framework?

A way of thinking that improves thinking quality by applying intellectual standards to the thinking process.

Why does the chapter say critical thinking should not simply be memorized?

Because critical thinking requires complex reasoning, not simple memorization.

What are the major intellectual characteristics of a well-cultivated critical thinker described by Paul and Elder?

Asks questions, gathers and evaluates information, interprets ideas, reaches and tests conclusions, stays open-minded, and considers alternative perspectives and consequences.

What does a critical thinker do with questions and problems?

The critical thinker raises questions and problems and formulates them clearly and precisely.

What does a critical thinker do with information?

The critical thinker gathers and assesses relevant information, using abstract ideas for interpretation.

How does a critical thinker handle conclusions and solutions?

The thinker arrives at conclusions and solutions that are well-reasoned and tests them against relevant standards.

What does open-mindedness mean in critical thinking?

Being open-minded means assessing assumptions, implications, and consequences and recognizing alternative ways of viewing problems.

What is the relationship between critical thinking and nursing judgment?

Critical thinking supports the reasoning and decision-making nurses use to make sound clinical judgments and provide effective patient care.

What does the chapter say about critical thinking and simply stating an opinion?

Critical thinking is not the same as being critical or simply stating an opinion. The nurse must be able to explain how conclusions were reached and support decisions with explicit data and rationale.

Why is experience related to becoming an excellent critical thinker?

The chapter states that becoming an excellent critical thinker is significantly related to increased years of work experience and higher education level.

What is reflective practice?

Reflective practice is the application of reflective thinking to one's professional experiences, actions, and decisions so that practice can improve.

What did Maria do in the Mr. Peterson example that demonstrates reflective practice?

She internally reviewed the events leading to his rapid decline, identified what went well and areas for improvement, considered her decisions and feelings, and developed an action plan for improving her recognition of deterioration.

What did Maria identify as areas for improvement after Mr. Peterson's deterioration?

She recognized the need for earlier recognition of subtle changes in patient condition, clear communication with the nursing leadership and interprofessional team, continuous education on emergency protocols, and further training.

What is the purpose of reflective practice?

It helps nurses learn from experiences, improve clinical skills, and provide better care for future patients.

What is a key difference between novice and expert thinking?

Novices tend to rely more on separate facts, resources, clear rules, and step-by-step procedures, whereas experts organize knowledge in a highly structured way, recognize subtle changes, use experience, and consider flexible options.

How do novice nurses tend to organize knowledge?

They tend to organize knowledge as separate facts and rely heavily on resources such as notes, preceptors, and listening to breath sounds.

How do expert nurses tend to organize knowledge?

They tend to store knowledge in a highly organized and structured manner, making recall of information easier, including experiential knowledge.

How do novices approach assessment before acting?

Novices may focus so much on actions that they may not fully assess before acting.

How do experts approach assessment before acting?

Experts assess and consider different options for interventions before acting.

How do novice nurses view rules?

They often need clear-cut rules and tend to follow step-by-step procedures and policies rigidly.

How do expert nurses use rules?

They know which rules are flexible and when it is appropriate to bend the rules.

How can anxiety affect novice thinking?

Novices may be hindered by anxiety and lack of self-confidence.

How does confidence differ between novice and expert nurses?

Experts are usually more self-confident and less anxious, so they can focus more on the patient's needs.

How do novices tend to focus on procedures?

They tend to focus on performing procedures correctly rather than on the patient's response to the procedure.

How do experts focus on procedures?

Experts are comfortable with rethinking a procedure when the patient's needs require modification.

How does knowledge of suspected problems differ between novices and experts?

Novices have limited knowledge of suspected problems and may collect data superficially or in a less focused way; experts have a larger storehouse of experiential knowledge and recognize subtle changes.

How do novices learn?

They learn more readily when matched with a supportive, knowledgeable preceptor or mentor.

How do experts respond to novice questions?

Experts are challenged by novices' questions, which can cause them to clarify their own thinking when teaching.

What are the 15 characteristics of critical thinkers listed in Box 11.4?

Inquisitive/curious/seeks truth; self-informed/finds own answers; analytical/confident in own reasoning skills; open-minded; flexible; fair-minded; honest about personal biases/self-aware; prudent/exercises sound judgment; willing to revise judgment when new evidence warrants; clear about issues; orderly in complex matters/organized approach to problems; diligent in seeking information; persistent; reasonable; focused on inquiry.

What does being self-informed mean for a critical thinker?

The person seeks information and finds their own answers rather than relying passively on others.

Why must a critical thinker be aware of personal biases?

Self-awareness of personal biases helps prevent those biases from interfering with sound reasoning and clinical judgment.

What does it mean to be willing to revise judgment?

The nurse changes a judgment when new evidence warrants changing it.

What does being fair-minded mean?

The nurse considers information and perspectives fairly rather than allowing personal preferences or biases to control judgment.

What does the nursing process represent?

It represents a universal intellectual standard by which problems are addressed and solved in professional nursing practice.

How does the chapter define the nursing process?

It is a conceptual framework that enables the student or practicing nurse to think systematically about and process information about the patient.

What does the nursing process combine?

It combines the art of nursing—creativity—with systems theory and the scientific method to produce high-level care that is interpersonal and interactive.

Why is the nursing process considered important in nursing practice?

It is an integral part of nursing education, practice, standards, and practice acts and provides a creative approach to thinking and decision-making.

What criticism of the nursing process does the chapter discuss?

Some nurses have described it as linear, rigid, and mechanistic and believe it contributes to linear thinking and stymies critical thinking.

Despite criticism, why does the nursing process remain important?

It remains the cornerstone of nursing standards, legal definitions, and practice and therefore should be understood by nurses.

What is a nursing diagnosis?

A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems of life processes that provides the basis for selecting nursing interventions to achieve outcomes.

How is a nursing diagnosis different from a medical diagnosis?

A nursing diagnosis identifies the patient's human response to an illness, injury, or threat, whereas a medical diagnosis focuses on the disease or pathologic process.

Why are nursing diagnoses not substitutes for medical diagnoses?

Nursing diagnoses address patient problems that nurses can treat within their scope of practice; the medical diagnosis becomes a platform from which nursing diagnoses are developed.

What is NANDA-I?

NANDA International is the organization associated with standardized nursing diagnoses and their development and use.

Why are accurate nursing diagnoses important?

They provide the basis for effective nursing interventions. Incorrect or poorly supported diagnoses can lead to inappropriate care.

What is the PES format?

PES stands for problem, etiology, and symptoms. It was formerly used to write the diagnostic statement.

Does NANDA-I currently use the PES format as its official format?

The text states that NANDA-I no longer uses the PES format, although publications and countries may still use it.

How should nursing diagnoses be prioritized?

They should be placed in order of priority based on the patient's situation and relative danger or importance.

What type of diagnoses generally receive the highest priority?

Life-threatening problems generally receive the highest priority.

What is the typical priority order described using the relative-danger framework?

Life-threatening problems first; problems with potential to cause harm or injury next; then problems related to overall general health.

How does Maslow's hierarchy help prioritize nursing diagnoses?

Basic physiologic needs take priority over higher-level needs such as love and belonging or self-esteem.

Why should nurses involve patients when identifying priorities?

Patients' values and cultural factors can strongly influence how problems should be prioritized, except in life-threatening or other emergency situations where immediate safety takes precedence.

What is the third phase of the nursing process?

Planning.

What happens during the planning phase?

The nurse identifies patient goals and determines ways to reach them. Goals are used to guide selection of interventions and evaluate patient progress.

What are the three domains in Bloom's taxonomy used in nursing goals?

Psychomotor, cognitive, and affective.

What does the psychomotor domain involve?

Physical movement and increasingly complex motor-skill activity.

What does the cognitive domain involve?

Knowledge and intellectual skills, ranging from simple recall to complex tasks such as synthesis and evaluation.

What does the affective domain involve?

Emotions, feelings, values, and attitudes.

Why should patient goals be developed collaboratively?

Goals should be agreed upon by the nurse and patient whenever possible because collaboration makes the patient an active partner in care.

When might collaboration with the patient be impossible?

For example, when the patient has an altered mental status, is a young child, is otherwise incapacitated, or the nurse and patient do not speak the same language.

What should a nurse do when a patient speaks another language?

Use a qualified medical interpreter rather than using family members or friends to interpret.

What is the difference between a patient goal and an outcome criterion?

A goal is a general direction or desired accomplishment stated in terms of what the patient will do or be able to do. Outcome criteria are specific and measurable conditions describing what must occur, to what extent, and within what time frame.

How should a patient goal usually begin?

With words such as 'the patient will' or 'the patient will be able to.'

What makes a patient goal appropriate?

It should be attainable, realistic, and include an action the patient can perform.

Why is a time frame important for patient goals?

It identifies when the goal is expected to be achieved and helps make progress measurable.

What are short-term goals?

Goals attainable within hours or days. They are usually specific and are small steps toward broader, long-term goals.

What are long-term goals?

Goals representing major changes or rehabilitation that may take months or even years to accomplish.

What can happen when goals are unrealistic?

Frustration and discouragement can occur.

What is cultural congruency in nursing care?

It means developing interventions within the broad social, cultural, and demographic context of the patient's life so care is tailored to the patient's sociocultural needs and interests.

Why should nurses avoid stereotyping patients when planning care?

Patients from the same cultural group may not all have the same beliefs, responses, or preferences, so assuming they will respond the same way can make care inappropriate.

What happens after short- and long-term goals are identified?

The nurse and patient collaborate to develop a plan of care containing actions designed to help the patient achieve the stated goal.

What is a nursing intervention?

A specific action designed to assist the patient in achieving a stated goal.

What are the three basic types of nursing interventions?

Independent, dependent, and interdependent (or collaborative).

What is an independent nursing intervention?

An intervention requiring no supervision or direction by others and performed within the nurse's scope of practice.

What is an example of an independent nursing intervention?

Teaching a patient how to breastfeed a newborn infant.

What is a dependent nursing intervention?

An intervention requiring instructions, written prescriptions, or supervision of another health professional with prescriptive authority.

What is an example of a dependent nursing intervention?

Administration of medications.

What responsibility does the nurse have with dependent interventions?

The nurse must know how to administer the intervention safely, monitor its effectiveness, and question prescriptions that seem inconsistent with safe or accepted standards of care.

What is an interdependent or collaborative intervention?

An action in which the nurse must collaborate or consult with another health professional before carrying it out.

What are protocols?

Protocols define the conditions and circumstances under which a nurse is allowed to treat a patient and what treatments are permissible.

When are protocols especially useful?

They are useful when nurses need to take immediate action without consulting a physician, such as in an emergency department, critical care unit, or home setting.

What is the purpose of a written plan of care?

It documents the selected interventions and provides an organized plan for the patient's care, often in the electronic health record.

What is an advantage of standardized plans of care?

They can decrease the time spent generating a completely new plan for each patient.

How are standardized plans of care individualized?

The nurse selects from the standard plan's menus and makes choices appropriate to the particular patient.

What are critical pathways, collaborative care plans, or care maps?

They are multidisciplinary plans of care that establish a sequence of short-term daily outcomes and facilitate communication and collaboration among healthcare team members.

What is a potential disadvantage of rigidly following a critical pathway?

Following it without considering a patient's individual responses can negatively affect outcomes and may be detrimental to successful nursing care.

What is the fourth phase of the nursing process?

Implementation of planned interventions.

What occurs during implementation?

Nursing orders are carried out; the nurse performs the planned interventions and continues assessing the patient's responses.

What should nurses do while carrying out planned interventions?

They should continuously assess the patient, note responses to interventions, modify the care plan, and add nursing diagnoses as needed.

Why is documentation important during implementation?

Documentation of nursing actions is an integral part of the implementation phase.

What is the fifth and final phase of the nursing process?

Evaluation.

What happens during evaluation?

The nurse examines the patient's progress in relation to goals and outcome criteria to determine whether a problem is resolved, in the process of being resolved, or unresolved.

What can evaluation reveal about the nursing care plan?

It may show that data, the diagnosis, goals, or interventions were appropriate, or that something was incorrect, incomplete, poorly prioritized, or improperly implemented.

Why is evaluation considered a critical phase?

It is essential for determining whether care is producing the expected results and whether the plan needs to be changed.

When should a care plan be revised?

When the patient is not improving as expected, when a problem is not resolving in a timely way, or when it will not resolve at all.

Is the nursing process linear?

No. It is dynamic and nonlinear. Nurses may move among phases and may perform more than one phase at the same time.

What does it mean that the nursing process is cyclical?

The nurse continually moves from one phase to another and then begins the process again as the patient's condition changes.

Can nurses perform two or more nursing-process phases at the same time?

Yes. For example, a nurse may assess a patient while implementing an intervention and evaluating the patient's response.