Critical thinking/judgement

Why do nurses think critically?

• Solve complex problems

• Provide safe, competent, nursing care

• Make reliable observations, draw conclusion

Nursing Process: ADPIE

• Assessing: collecting data

• Diagnosing: analyzing data to identify problems

• Planning: specifying pt outcomes and nursing interventions

• Implementing: carrying out the plan

• Evaluating: measuring pt achieved outcomes

Operational Definition of Clinical judgement

• Observe and assess situation

• Identify priority concern

• Generate best possible solutions to deliver safe patient care

• Clinical reasoning - process

• Clinical judgement - making the decisions

NCJMM Clinical Judgement Model

1. Recognize cues: what matters most?

2. Analyze cues: what does it mean?

3. Prioritize hypotheses: where do I start?

4. Generate Solutions: what can I do?

5. Take action: what will I do?

6. Evaluate outcomes: did it help?

Types of Nursing Assessments

• Initial: complete database, provides reference base

• Problem-focused: ongoing process, determine status of problem, flag risks, short focused prioritized assessment

• Emergency: during physiological or psychological crisis to identify life threatening problem

• Time lapsed: occurs weeks to months after initial assessment, compare current status to baseline

Medical diagnosis vs Nursing Diagnosis

• Medical: describes disease, illness, injury, pathologic condition, remains the same, doctors

• Nursing: focuses on harmful responses to illnesses, changes as pt needs change

Types of Nursing Diagnosis

• Problem focused diagnosis- current problem

• “Risk for” nursing diagnosis - potential problem