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Stack #153401

Critical Thinking

Critical Thinking: The Foundation for Nursing Process Use a systematic way to think: Identify the Problem, Collect Data, Form a concept about the relationship between the data and the problem, implement a plan of action, analyze the effect of action, evaluate the plan of action
Intuition: comes after years of practice, can indicate a problem before clinical signs are evident
Blended Skills Cognitive, Technical, Interpersonal, Ethical
Cognitive Skills Gives scientific rationale and ability for select "best-match" interventions
Technical Skills Allows Competent, comfortable use of technical equipment
Interpersonal Skills Affirms worth of clients, elicits client goals and strengths, allows for collaboration with healthcare team
Ethical Skills allows for client centered practice which is accountable and consistent with standards of practice
Analysis Examine all elements, Think through alternative strategies, Identify options in a patient situation, Prioritize
Reflection Involves self evaluation -- How you handle a situation, what you would change next time; Connection between theory and nursing practice; demonstrate through sharing in post conference and writing
Attributes of Critical Thinkers Adequate knowledge; purposeful, disciplined; independent thinker, courageous; fair, humble; personal integrity; curious, creative; confident
Clinical Judgment Critical thinking supports clinical judgment: -- identifies and challenges assumptions; considers wht is important in a situation; explores alternatives; applies logic and reasoning, makes an informed decision;
Clinical Judgment is required in nursing practice
Critical Thinking/Clinical Judgment Purposeful, informed, outcome-focused; driven by patient, family and community needs; judgments based on evidence; uses both intuition and logic; guided by professional standards; ongoing re-evaluation and striving for improvement
Nursing Process Framework for Nursing practice; framework for critical thinking; determine client needs; intervene to resolve or meet the need; determine whether need is met
Five Steps of Nursing Process Assessing; Diagnosing; Planning; Implementing; Evaluating
Assessment: Gathering data Subjective; Objective
Assessment: Sources of data Patient, family, significant others; Records; Health care Team
Data Clustering Human response to health problem; Cohort data/body systems
Example #1 of Data Clustering RR 32, accessory muscles, "I can't get enough air!" diminished breathing sounds bilaterally
Example #2 of Data Clustering Abdominal incision is red and has some bloody draining, T 100.8, P 92, BP 112/84
Analysis/Diagnosis Phase Analyze: interpret, validate and clustered data; select diagnosis from a list developed by NANDA
Example of Nursing Diagnosis ineffective breathing pattern; shortness of breath; elevated respiratory rate (34); Use of accessory muscles; Aleration of O2, CO2 ratio
Nursing Diagnosis Clinical judgment about individual, family or community responses to actual or potential health problems; Provides basis for selection of nursing interventions to achieve outcomes; Common language for nurse communication
Part 1 of Nursing Diagnosis: Human Response
Part 2 of Nursing Diagnosis: Related factors
Part 3 of Nursing Diagnosis: Defining characteristics: evidence that supports the conslusion of a problem
Types of Nursing Diagnosis Actual, Risk, Possible, Wellness
Actual Diagnosis has a health care need/problem
Risk Diagnosis High potential for developing a health care need/problem
Possible Diagnosis suspicion that there could be problem under the right circumstances but not enough data to confirm it
Wellness Diagnosis Transition to a higher level of functioning building on client's strengths
Example of Actual Diagnosis Assessment data: No stool in 5 days, low fiber diet; Human Response (NANDA) constipatiaon; Related to: r/t low fiber diet; As evidenced by: a.e.b. no stool in 5 days; Nursing Dx: Constipation r/t low fiber diet a.e.b. no stool in 5 days
Example of Risk Diagnosis Assessment data: Head injury, poor gag reflex, oriented x1; Problem/human response: potential for aspirataion; Related to: diminished gag reflex; Nursing Dx: Potential for aspiration r/t diminished gag reflex
Example of Possible Diagnosis Assesment data: Post-operaive patient with mild SOB; Hman response/nursing diagnosis: Possible ineffective airway clearance; Possible alteration in gas exchange
Nursing Diagnosis is: Actual, Potential, Possible & Wellness
Actual Nursing Diagnosis Human Response (NANDA), etilogy, and supporting data
Potential Nursing Diagnosis Human Response (NANDA) and etiology
Possible Nursing Diagnosis Human Response (NANDA)
Writing Nursing Diagnoses Write in Terms of the client response, not the nursing need; Avoid use of value judgments; Two parts of the diagnosis should not mean the same thing; Avoid reversing the parts; Write the problem and related factors in terms that can be changed; State the
Planning Phase Establish client goals to prevent, reduce or resolve the problems identified in the nursing diagnosis; Identify nursing interventions/actions that will assist the client to achieve their goals
Elements of the Planning Phase Priority setting; Goals and/or outcomes; Nursing interventions; Written nursing care plan; Ongoing
What Determines the Priority Setting? Maslow's Heirachy
Priority Setting What is most important to do, Often what must be accomplished first; How do we determine priorities? Who determines Priorities? Actual vs potential problems
Nursing Diagnosis: A Blueprint for Care Outcome Interventions Evaluation: 1. Problem; 2. Related to (r/t); 3. Defining characteristic
Mutual Goals What we (the nurse and the patient) want to achieve
Short-Term Goals realistic, measrable and able to achieve
Long-Term Goals Later e.g. end of shift or by discharge
Is there a relationship between Long and Short Term Goals? Yes, they have to be related
Purpose of Goals Select nursing actions; evaluate patient's progress
Characteristics of Goals Be measurable, not general or vague; Be objective, not subjective; be realistic, be attainable; Complement the nursing diagnosis; Have a time frame
Guidelines for Writing Goals/Outcomes Subject, Verb, Criteria, Common verbs
Subject of Goals/Outcomes Usually the patient, family or community
Verb of Goals/Outcomes Action to be performed
Criteria for Writing Goals/Outcomes Expected patient behavior in observable, measurable terms
Common Verbs for Goals/Outcomes Define, Identify, List, state, describe, verbalize, select, demonstrate, explain, design, prepare, choose, apply
Nursing Interventions Activities performed to meet the client's needs and reach teh client's goals; Nursing interventions are identified in the planning stage; Nursing interventions are performed in the implementation stage of the nursing process; Consist of nursing orders
Nursing orders the written instructions for performing the nursing interventions; Continuity of care; nursing orders: nursing interventions = nursing actions
Difference between Expected Outcome and Nursing Order EO: Patient Behaviors; NO: Nursing activities or actions
Independent Nursing Actions Positioning, Vital signs monitoring, fluids, moniiring I & O, Assisting/providing in Self Cre, Assuring rest/sleep, Nutritional monitoring, Health education, Reassurance/support
Implementation Phase Actions are performed to carry out the plan of care; includes all aspects of care, assist patients to achieve health goals, promote wellness, prevention of disease and restoration of health, facilitate coping with altered functioning
Carrying Out The Plan of Care Implement the independent, dependent and collaborative nursing orders; Continual assessment; Accountable for: evidence based practice, standards of care: HCC, agency and professional
Documentation of Care Nursing interventions; Patient responses
Evaluation Measure Outcomes; Identify Contributing Factors, Document Evaluative Statement; Decide whether to terminate, continue or modify the plan of care
Document Evaluative Statement Did the actions work? Were they effective? Did the patient achieve expected outcome?
Measure outcomes Collect evaluative data; Compare expected outcomes to actual
Human Response Represents pattern of related cues; The problem; Nanda
Related factors Etiology or cause of the problem; related to (r/t)
Defining characteristics: evidence that supports the conslusion of a problem Assessment data or signs & symptoms; As evidenced by (a.e.b.)
Created by: howardccnurs