CNP Final 2

Critical thinking in nursing

A process and set of skills using logic open-mindedness creativity confidence and wisdom to make accurate judgments and decisions

Steps of critical thinking

Recognize the issue → Analyze information → Evaluate information → Draw conclusions

Tool nurses use to apply critical thinking

The Nursing Process ADPIE

Levels of critical thinking

Basic rule-following Complex independent weighing of options Commitment responsible accountable decisions

5 components of critical thinking

Knowledge base Experience Competencies Attitudes Standards

Knowledge base

Includes information and theory from sciences humanities behavioral sciences and nursing

Experience in critical thinking

Learning from patients families and reflection adapting safely admitting knowledge limits

General competencies in critical thinking

Scientific method Problem solving Decision making

Clinical competencies in critical thinking

Diagnostic reasoning determine health status Clinical inference draw conclusions from evidence

Attitudes in critical thinking

Knowing when more info is needed spotting misleading info recognizing limits and biases

Standards in critical thinking

Intellectual thoroughness precision accuracy consistency and Professional ethics evidence responsibility

Strategies to develop critical thinking

Case-based learning Reflective journal writing Concept mapping

Critical thinking in Mr Pham’s case

Recognize ethical issues analyze perspectives evaluate evidence make informed patient-centered decisions

Leadership vs Management in nursing

Leadership equals vision values relationships Management equals day-to-day delivery of care resources

CNA statement on nursing leadership

Every nurse provides leadership by articulating vision enabling others encouraging and taking initiative

Unregulated Care Providers UCPs

Frontline personnel without standardized qualifications such as HCAs PCAs aides

Traditional models of care

Team nursing Primary nursing Case management

Intraprofessional vs Interprofessional teams

Intraprofessional equals nursing only Interprofessional equals multiple health disciplines

Decentralized participatory management

Decision-making at staff level with greater responsibility for quality of care

4 As of professional responsibility

Autonomy freedom of choice Authority right to act Accountability answerable for actions Responsibility duties activities

5 elements of clinical care coordination

Clinical decisions Priority setting Time management Evaluation Delegation

Delegation in nursing

Transferring responsibility for a task while retaining accountability for the outcome

Role of CPSI

Canadian Patient Safety Institute advocates catalysts integrators brokers promoters for safe healthcare

ADPIE

Assessment Diagnosis Planning Implementation Evaluation

Subjective vs Objective data

Subjective equals client’s verbal description Objective equals measurable observable signs

Sources of data

Primary client Secondary family team records Tertiary literature nurse’s experience

Nursing diagnosis

Clinical judgment about client’s response to health problem

Types of nursing diagnoses

Actual Risk Health promotion Wellness

Components of a nursing diagnosis

Diagnostic label Related factors Definition Risk factors Support of statement

Phases of planning

Initial Ongoing Discharge

Priority classifications

High Intermediate Low

Types of goals

Client-centred Short-term Long-term

Guidelines for writing goals

Singular Observable Measurable Time-limited Mutual Realistic

Implementation in nursing

Initiation or completion of planned actions interventions

Types of nursing interventions

Nurse-initiated independent Physician-initiated dependent Collaborative interdependent

Factors guiding intervention selection

Nursing diagnosis Goals outcomes Evidence base Feasibility Client acceptability Nurse competency

Levels of NIC

Domains broad Classes 30 categories Interventions 514 linked to NANDA

Purposes of NIC

Standardize language Expand nursing knowledge Support teaching decision-making

Steps of implementation process

Reassess client Review revise care plan Organize resources Anticipate prevent complications Identify assistance Apply skills cognitive interpersonal psychomotor

Examples of direct care

ADLs teaching counselling physical care life-saving measures

Examples of indirect care

Documentation delegation infection control safety management shift reports

5 elements of evaluation

Identify criteria Collect data Interpret summarize Document Revise continue terminate plan

Difference between goals evaluative measures expected outcomes

Goals broad aim Evaluative measures how you check Expected outcomes specific measurable changes