Critical Thinking and Clinical Reasoning in Nursing: Techniques and Applications, Lecture notes of Medicine

Download Critical Thinking and Clinical Reasoning in Nursing: Techniques and Applications and more Lecture notes Medicine in PDF only on Docsity! CRITICAL THINKING AND CLINICAL REASONING Chapter -10 (NURS 210) 1-Identify of critical thinking & its purpose. 2-Discuss techniques in critical thinking 3-Describe application of critical thinking in problem solving 4-Identify components of clinical reasoning and its integration with critical thinking. 5-Identify integration of critical thinking and clinical reasoning 6-Identify concept mapping. Learning Outcomes Students after this lecture will be able to: Techniques in critical thinking 1-Critical analysis: Is the application of set of questions to a particular situation or idea to determine essential information and ideas and discard unimportant information and ideas.  The questions are not sequential steps; rather they are a set of criteria for judging an idea.  Socrates was a Greek philosopher who developed the method of posing questions and seeking an answer . Socratic questioning is a technique one can use to look beneath the surface, recognize and examine assumptions, search for inconsistencies, examine multiple points of view , and differentiate what one knows from what one merely believes. Socratic Questions QUESTIONS ABOUT THE DECISION (OR PROBLEM)  Is this question clear, understandable, and correctly  identified?  Is this question important?  Could this question be broken down into smaller parts?  How might _____________ state this question? QUESTIONS ABOUT ASSUMPTIONS  You seem to be assuming _____________; is that so?  What could you assume instead? Why?  Does this assumption always hold true? Socratic Questions QUESTIONS ABOUT POINT OF VIEW  You seem to be using the perspective of _____________.  Why?  What would someone who disagrees with your  perspective say?  Can you see this any other way? Techniques in critical thinking 3-Statements differentiation: Example Statement Description Blood pressure is affected by blood volume. Facts: Can be verified through investigation If blood volume is decreased (e.g., in hemorrhagic shock), the blood pressure will drop. Inferences: Conclusions drawn from the facts; going beyond facts to make a statement about something not currently known It is harmful to the client’s health if the blood pressure drops too low. Judgments Evaluation of facts or information that reflects values or other criteria; a type of opinion Nursing interventions can assist in maintaining the client’s blood pressure within normal limits. Opinions Beliefs formed over time; include judgments that may fit facts or be erroneous Information Inference Assumption 1. You see a man with a black eye 2. A police officer trails your car for several blocks 3. During class, a student asks “is this going to be on the test?” 4. You see a child crying next to her mother in a grocery store 5. You see a man in tattered clothes sitting on a curb with a paper bag in his hand He has been hit by someone People who have black eyes have been hit He is trying to catch me breaking the law Anytime a police officer trails you he is trying to catch you breaking the law This student is not interested in learning the subject Students who ask questions like: “Is this going to be on the test?” are not interested in learning the subject The mother has hurt the child Whenever a child is crying next to her mother she has been hurt by her mother He must be a bum All men in tattered clothes sitting on curbs with paper bags in their hands are bums (situation) Techniques in critical thinking 4-Evaluating the credibility of information sources: is an important step in critical thinking. We cannot always believe what we read or are told.  The nurse must ascertain the accuracy of information by checking other documents or with other informants. Hence, the expanding need for evidence-based nursing practice. 5-Clarifying concepts:To comprehend a client situation clearly, the nurse and the client must agree on the meaning of terms. For example, if the clients says to the nurse “I think I have a tumor,” the nurse needs to clarify what the word means to the client—the medical definition of a tumor (a solid mass) or the common lay meaning of cancer—before responding. Applying critical thinking to nursing practice  Problem Solving Problem solving: Process used when a gap is perceived between an existing state (what is occurring)& a desired state of what should be occurring. Throughout the problem-solving process the implementation of critical thought may or may not be required in working toward a solution (Wilkinson, 2012). The nurse carefully evaluates the possible solutions and chooses the best one to implement. Commonly used approaches to problem solving include trial and error, intuition, and the research process Applying critical thinking to nursing practice  trial and error:  In trial and error, a number of approaches are tried until a solution is found.  The use of trial- and-error methods in nursing care can be dangerous because the client might suffer harm if an approach is inappropriate.  However, nurses often use trial and error in the home setting due to logistics, equipment, and client lifestyle .  For example, when teaching a client to perform a colostomy irrigation, bent coat hanger hung on the shower curtain rod pervades an appropriate height to perform the irrigation.  Intuition  Is a problem-solving approach that relies on a nurse’s inner sense. It is a legitimate aspect of a nursing judgment in the implementation of care.  Intuition is the understanding or learning of things without the conscious use of the reasoning. It I also known as sixth sense, hunch, instinct, feeling, or suspicion. Applying critical thinking to nursing practice Components of clinical reasoning  Clinical reasoning is the analysis of a clinical situation as it unfolds or develops. It requires the nurse to use 1-cognitive and metacognitive:  processes. Cognitive processes are the thinking processes based on the knowledge of aspects of client care. Cognitive skills are learned through reading and applying health-related literature.  Metacognitive: include reflective thinking and awareness of the skills learned by the nurse in caring for the client.  The nurse reflects on the client’s status, and through the use of critical thinking skills determines the most effective plan of care. Components of clinical reasoning 2-Setting Priories:  The nurse must know what assessments, tasks, and concerns need to be completed first.  Priories setting flexible because the clinical environment can change quickly, requiring changes in priories. Beginning nursing students often view everything as being of equal importance. They are often task oriented and focused on what needs to be done and not necessarily on what is most important. As they gain more clinical experience, they start to determine which data are most relevant and important to each client’s situation. Components of clinical reasoning 3-Developing Rationales:  After assessing the data and determine what is relevant to client’s condition and concerns, the nurse identifies interventions and sets priorities for most urgent needs.  Being able to state the rationale, based on nursing knowledge, acts as a check for potential errors, justifies the nurse’s actions, contributes to client safety, and helps the beginning nursing student learn how a nurse thinks in practice. Components of clinical reasoning 6-Clinical Reasoning-in-Transition:  Clinical reasoning-in-transition is the ability to recognize subtle changes in a client’s condition over time. It includes the evaluation of nursing interventions and the trending of relevant assessment data.  Nurses need to develop a sense of what is most important in each changing clinical situation and remember that the primary focus is on the client’s well- being. Components of clinical reasoning 7-Reflection:  is a key to success of clinical reasoning. Though reflection the nurse identifies factors that improved client care and those the required changing elimination. It is important to reflect on whether the client was assessed accurately and in a timely manner. The nurse think back on the interventions implemented and whether they were effective. Most importantly , reflection includes information on the outcome of care. Components of clinical reasoning 8-Responding to Changes in the Client’s Condition: Nurses spend more time with clients than do other health care providers. Clinical reasoning involves an understanding and assessment of the client’s relevant history and current condition and how it may be changing. By closely monitoring and comparing any changes from previous assessment data, the nurse is able to recognize a change in status that may prevent an adverse outcome. Integration of critical thinking and clinical reasoning  Logical reasoning is a critical thinking skill that closely aligns with clinical reasoning. In the planning of care, nurses must question whether knowledge they possess about the care of the client is consistent with the most current evidence-based practice. The nurse must review the most current nursing and health- related literature prior to implementing care. Concept mapping  Concept mapping:  Concept mapping is a technique that uses a graphic depiction of nonlinear and linear relationships to represent critical thinking. Also known as mind mapping, concept maps are context dependent and can be used to develop analytical skills.  Concept maps provide an opportunity to visualize things in your own way.  The concept map allows the nurse to map words on a page and focus on concepts and relationships. Concept mapping  Types of Concept Maps:  Hierarchical maps—concept and attributes arranged in a hierarchical pattern and typically constructed in a descending order of importance. Relationships are identified between and among a concept and its attributes. Concept mapping  Systems maps—inputs and outputs illustrate relationships among the concept and its attributes. Any Questions?