KOZIER ERBS Fundamentals of NURSING NINTH EDITION Concepts

KOZIER & ERB’S Fundamentals of NURSING NINTH EDITION Concepts, Process, and Practice CHAPTER 10 Critical Thinking and Nursing Practice Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Directory • Classroom Response System Questions • Lecture Note Presentation Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Classroom Response System Questions Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 1 A client with diarrhea has a physician’s order for a bulk laxative daily. The nurse, not realizing bulk laxatives can solidify some types of diarrhea, concludes, “The physician does not know the client has diarrhea. ” This statement is an example of: A. A fact B. An inference C. A judgment D. An opinion Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 1 Answer A. B. C. D. A fact An inference A judgment An opinion Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 1 Rationales A. The prescription and the diarrhea are facts; the nurse’s conclusion is an inference. B. Correct. The nurse has inferred and concluded something that is beyond the available information (and in this case may not be accurate). C. It would be judgment and opinion if the nurse stated that the laxative would make the diarrhea worse and should not be given. D. It would be judgment and opinion if the nurse stated that the laxative would make the diarrhea worse and should not be given. (Note: Critical thinking will cause this nurse to examine the assumptions made and gather more data before acting. ) Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 2 A client reports feeling hungry but does not eat when food is served. Using critical-thinking skills, the nurse should perform which of the following? A. Assess why the client is not ingesting the food provided B. Continue to leave the food at the beside until the client is hungry enough to eat C. Notify the primary care provider that tube feeding may be indicated soon D. Believe the client is not really hungry Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 2 Answer A. Assess why the client is not ingesting the food provided B. Continue to leave the food at the beside until the client is hungry enough to eat C. Notify the primary care provider that tube feeding may be indicated soon D. Believe the client is not really hungry Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 2 Rationales A. Correct. The nurse recognizes that many assumptions (beliefs) could interfere with the client eating–such as that the food presented is not culturally appropriate. These assumptions must be clarified. B. Option B is an intervention not supported by the facts. C. Option C reaches conclusions not supported by the facts. D. In option D, the nurse has made a judgment or has an opinion that may not be accurate. Also, the nurse is acting without assessment. Implementation should be preceded by assessment. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 3 One nurse expresses that the manager prepared the holiday work schedule unfairly. The manager states that it is the same type of schedule used in the past and other nurses have no problems with it. Which response indicates the nurse is displaying an attitude of critical thinking? A. Accepting the preferences of the other nurses since there are several of them B. Recognizing that the nurse must have reached a false conclusion C. Considering going to a higher authority than the manager for an explanation D. Continuing to query the manager until the nurse understands the explanation Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 3 Answer A. Accepting the preferences of the other nurses since there are several of them B. Recognizing that the nurse must have reached a false conclusion C. Considering going to a higher authority than the manager for an explanation D. Continuing to query the manager until the nurse understands the explanation Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 3 Rationales A. Giving in violates desirable attitudes of integrity, intellectual courage, and confidence in reason. B. Overquestioning self or poor trust in one’s own beliefs violates desirable attitudes of integrity, intellectual courage, and confidence in reason. C. Bypassing normal routes of authority violates desirable attitudes of integrity, intellectual courage, and confidence in reason. D. Correct. The critical-thinking approach should include perseverance until a reasonable solution or answer is determined. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 4 The client who is short of breath benefits from the head of the bed being elevated. Because this position can result in skin breakdown in the sacral area, the nurse decides to study the amount of sacral pressure occurring in other positions. This decision is an example of A. The scientific method B. The trial-and-error method C. Intuition D. The nursing process Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 4 Answer A. The scientific method B. The trial-and-error method C. Intuition D. The nursing process Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 4 Rationales A. Correct. The scientific method uses a research study-based approach to problem solving. B. Trial and error would involve unstructured approaches resulting in less predictable results. C. Intuition would involve unstructured approaches resulting in less predictable results. D. The nursing process generally uses application of known interventions, previously determined by the scientific (research) process. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 5 In the decision-making process, the nurse sets and weighs the criteria, examines alternatives, and performs which of the following before implementing the plan? A. Reexamines the purpose for making the decision B. Consults the client and family members to determine their view of the criteria C. Identifies and considers various means for reaching the outcomes D. Determines the logical course of action should intervening problems arise Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 5 Answer A. Reexamines the purpose for making the decision B. Consults the client and family members to determine their view of the criteria C. Identifies and considers various means for reaching the outcomes D. Determines the logical course of action should intervening problems arise Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Question 5 Rationales A. The purpose for the decision should have been clear enough at the outset as to not require re-examination at this point. B. Clients and families should be consulted early–in the purpose-setting and criteria-setting steps. Criteria should not be set until all significant participants have an opportunity to present their point of view. C. Considering various means for reaching the outcomes is the same as examining alternatives. D. Correct. It is important to project what problems might interfere with the plan and have appropriate responses prepared to prevent the interferences. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Lecture Note Presentation Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Learning Outcomes 1. Describe the significance of developing critical-thinking abilities in order to practice safe, effective, and professional nursing care. 2. Explore ways of demonstrating critical thinking in clinical practice. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Learning Outcomes (cont’d) 3. Discuss the skills and attitudes of critical thinking. 4. Discuss the relationships among critical thinking, the problem-solving process, and the decision-making process. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Critical Thinking • An intentional higher level reasoning process • Essential component of professional accountability and quality nursing care • Generated from a triad of professional, socioeconomic, and ethical/moral needs Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Critical Thinking (cont’d) • Uses clinical reasoning and clinical decision making – to practice safe and effective nursing care – to improve clinical systems – to decrease errors in clinical judgment Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Critical Thinking Skills • • Analyzing Applying standards Discriminating Information seeking Logical reasoning Predicting Transforming knowledge Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Figure 10 -1 Alfaro-Le. Fevre’s 4 -Circle Critical Thinking Model. Adapted with permission from Critical Thinking Indicators, by R. Alfaro-Le. Fevre, 2008. Retrieved from http: //www. alfaroteachsmart. com/cti. htm Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Techniques in Critical Thinking • • • Critical analysis Socratic questioning Inductive reasoning, deductive reasoning Making valid inferences Differentiating facts from opinions Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Techniques in Critical Thinking (cont’d) • Evaluating the credibility of information sources • Clarifying concepts • Recognizing assumptions Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Attitudes that Foster Critical Thinking • • • Independence Fair-mindedness Insight into self Intellectual humility Intellectual courage Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Attitudes that Foster Critical Thinking (cont'd) • • Integrity Perseverance Confidence Curiosity Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Box 10 -2 Personal Critical Thinking Indicators: Behaviors Demonstrating CT Characteristics and Attitudes Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Critical Thinking and Nursing • Critical thinking underlies each step of the nursing process, problem-solving process, and decision-making process Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

The Nursing Process • Systematic, rational method of planning and providing individualized care – Assessing – Diagnosing – Planning – Implementing – Evaluating Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Problem-Solving Process • Clarify the nature of a problem and suggest possible solutions • One situation contributes to the nurse’s body of knowledge for problem solving in similar situations • Commonly used approaches – Trial and error – Intuition – Research process Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Decision-Making Process • Choosing the best actions to meet a desired goal – Value decisions (e. g. , keeping client information confidential) – Time management decisions (e. g. , take clean linens in at the same time as giving medications) Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Decision-Making Process (cont'd) • Choosing the best actions to meet a desired goal – Scheduling decisions (e. g. , bathing clients before visiting hours) – Prioritizing decisions (e. g. , most urgent ones and ones that can be delegated) Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Developing Critical Thinking Attitudes and Skills • Self-assessment • Tolerating dissonance and ambiguity • Creating environments that support critical thinking Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Figure 10 -2 Mind map for critical thinking in nursing. From University of New Mexico College of Nursing. Retrieved from http: //hsc. unm. edu/consg/critical/what_ct. shtml Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Box 10 -5 Types of Concept Maps Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Figure 10 -3 Types of concept maps: A, hierarchical; B, spider; C, flowchart; D, systems. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Concept Mapping • Graphic depiction of connections • Linear and nonlinear relationships • Visual aid to critical thinking process Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.