(FINAL) Foundations - Critical Thinking, Nursing Process, Clinical Reasoning, Clinical DecisionMaking, & Clinical Judgment

NURSING PROCESS (ADPIE)

Assess → Diagnose/Analyze → Plan → Implement → Evaluate

Assessment phase collects what two types of data?

Subjective data (what patient reports) and Objective data (what nurse measures/observes)

Subjective data example

Patient says "my pain is a 10/10" — only the patient perceives it; cannot be directly measured

Objective data example

Blood pressure reading, nurse observes patient grimacing — directly measured or observed

Pain level on 0-10 scale: subjective or objective?

SUBJECTIVE — it is self-reported by the patient

Nurse observing a patient grimacing in pain: subjective or objective?

OBJECTIVE — the nurse directly observes it

What step comes AFTER implementing an intervention?

Evaluate — measure if the outcome was achieved

What does "Analyze/Determine" replace in the nursing process?

"Diagnose" — now called Analyze or Determine

A well-written patient outcome must be:

Measurable, time-limited, and patient-centered

Example of a POORLY written outcome

"Patient will drink more water" — not measurable, not time-limited

Example of a WELL-written outcome

"Patient will drink 60 mL water every 2 hours while awake by [date]"

CURE Hierarchy — C

Critical: emergent, life-threatening situations — see FIRST

CURE Hierarchy — U

Urgent: patient could be harmed or uncomfortable if delayed — see SECOND

CURE Hierarchy — R

Routine: standard care tasks — address THIRD

CURE Hierarchy — E

Extras: non-essential comfort tasks — address LAST

ABCs priority order

Airway → Breathing → Circulation — always prioritize in this order

Patient choking vs. patient with oozing incision — who is priority?

Choking patient — airway obstruction is life-threatening (ABCs)

Acute vs. Chronic rule

Always prioritize ACUTE/UNSTABLE over chronic/stable needs

Stable vs. Unstable rule

Choose interventions for UNSTABLE patients first; stable patients can wait

Least Restrictive principle

Always try the least invasive/restrictive intervention FIRST

Patient on bed rest needs to urinate — best action?

Offer a bedpan — least restrictive before inserting a catheter

Maslow's Hierarchy in nursing — what takes priority?

Physiological needs (airway, breathing, circulation) → Safety → then higher needs

Safety vs. psychosocial: who is priority?

Patient who is a fall risk over patient who "feels powerless" — safety first

Tanner's Clinical Judgment Model (CJM) — 4 phases

Notice → Interpret → Respond → Reflect

Noticing (Tanner CJM)

Recognizing relevant cues and abnormal findings in the patient situation

Interpreting (Tanner CJM)

Analyzing cues, identifying the problem, prioritizing hypotheses

Responding (Tanner CJM)

Generating solutions and taking action (implementing interventions)

Reflecting (Tanner CJM)

Evaluating outcomes — did the intervention work? Revise plan if needed

NCLEX Clinical Judgment Measurement Model (NCJMM) — 6 steps

1. Recognize cues → 2. Analyze cues → 3. Prioritize hypotheses → 4. Generate solutions → 5. Take action → 6. Evaluate outcomes

Recognize cues

Identify relevant, abnormal, or important patient data from the situation

Analyze cues

Connect cues to possible conditions/problems; determine what they mean

Prioritize hypotheses

Rank potential problems by urgency and risk to the patient

Generate solutions

Determine expected outcomes and identify nursing interventions to achieve them

Take action

Implement the highest-priority, appropriate nursing intervention

Evaluate outcomes

Determine if interventions were effective; revise plan as needed

Nursing Care Plan purpose

Structured, personalized plan that organizes and guides patient care decisions

Nursing diagnosis vs. Medical diagnosis

Nursing Dx = patient response to a health problem (nurse can treat); Medical Dx = disease/condition (physician diagnoses)

COPD patient on 2L O2 vs. heart failure patient on 100% O2 — who is priority?

Heart failure patient on 100% O2 — acute/unstable vs. chronic/stable (COPD is chronic)

Patient with emphysema preparing for discharge vs. new post-op admission — priority?

New post-op admission — acute/unstable takes priority over a stable discharge patient

Patient needing scheduled meds vs. patient who is blind — priority?

Patient needing scheduled medications — blind patient is a chronic/stable condition

High blood sugar needing insulin vs. incision pain — priority?

High blood sugar needing insulin — urgent metabolic need over comfort

Priority framework: Urgent vs. Non-Urgent

Always address urgent (potential harm if delayed) before non-urgent (stable/routine) needs

What are the 5 prioritization frameworks to know?

1. ABCs | 2. Maslow's Hierarchy | 3. Acute vs. Chronic / Stable vs. Unstable | 4. Least Restrictive/Invasive | 5. CURE Hierarchy

Assessment step in CJM language

Assess = Noticing (collecting and recognizing cues)

Planning step in CJM language

Plan = Prioritizing hypotheses and generating solutions

Implementation step in CJM language

Implement = Taking action / Responding

Evaluation step in CJM language

Evaluate = Reflecting on outcomes

Critical thinking in nursing means

Using knowledge from multiple disciplines to analyze information and make sound clinical decisions

What is the Tree of Inquiry?

A visual tool (concept map) used to organize and apply the nursing care plan and clinical judgment model