Chapter 11 Blended Skills and Critical Thinking Throughout the Nursing Process
Historical Development of the Nursing Process 1955 nursing process term used by Hall 1960s specific steps delineated 1967 Yura and Walsh published first comprehensive book on nursing process 1973 ANA Congress for Nursing Practice developed Standard of Practice 1982 state board examinations for professional nursing uses nursing process as organizing concept
Five Steps of the Nursing Process Assessing collecting, validating, and communicating of patient data Diagnosing analyzing patient data to identify patient strengths and problems Planning specifying patient outcomes and related nursing interventions Implementing carrying out the plan of care Evaluating measuring extent to which patient achieved outcomes
Question Which step of the nursing process is a nurse using when she analyzes patient data to determine her patient s strengths following a CVA? A. Assessing B. Diagnosing C. Planning D. Implementing E. Evaluating
Answer: B. Diagnosing Rationale: Answer The diagnosing step involves analyzing patient data to determine strengths and weaknesses. The assessing step refers to the collection, validation, and communication of patient data. In the planning step, the nurse determines patient outcomes and related nursing interventions, and in the Implementing step, the nurse carries out the plan. When evaluating, the nurse measures the extent to which the patient achieved outcomes.
The Steps of the Nursing Process
Question Which of the following characteristics of the nursing process describes the interaction and overlapping of steps within the process itself? A. Systematic B. Dynamic C. Interpersonal D. Universally Applicable
Answer Answer: B. Dynamic Rationale: The nursing process is dynamic in that there is much interaction and overlapping of the steps. It is systematic since it is an ordered sequence of activities. Interpersonal refers to the human being at the heart of nursing. The nursing process is universally applicable in that it is a framework for all nursing activities.
Characteristics of the Nursing Process Systematic part of an ordered sequence of activities Dynamic great interaction and overlapping among the five steps Interpersonal human being is always at the heart of nursing Outcome oriented nurses and patients work together to identify outcomes Universally applicable a framework for all nursing activities
Problem Solving and the Nursing Process Trial-and-error problem solving Scientific problem solving Intuitive thinking Critical thinking
Question Tell whether the following statement is true or false. Critical thinking occurs when a nurse directly apprehends a situation based on its similarity or dissimilarity to other situations. A. True B. False
Answer Answer: B. False Intuitive thinking occurs when a nurse directly apprehends a situation based on its similarity or dissimilarity to other situations.
Benefits of the Nursing Process Patient Scientifically based, holistic individualized patient care Continuity of care Clear, efficient, cost-effective plan of action Nurse Opportunity to work collaboratively with other healthcare workers Satisfaction of making a difference in lives of patients Opportunity to grow professionally
Four Blended Skills Cognitive skills using critical thinking; a systematic way to form and shape one s thinking Technical skills manipulating equipment skillfully to produce desired outcome Interpersonal skills promoting the dignity and respect of patients and establishing caring relationships Ethical/legal skills establishing a personal moral code and professional role responsibilities
Question A nurse s personal moral code is to assist all patients to the best of her ability. What blended skill would she use when seeking out special services for a homeless patient with a diabetic foot ulcer? A. Cognitive B. Technical C. Interpersonal D. Ethical/Legal
Answer: D. Ethical/Legal Rationale: Answer Using ethical/legal skills is the best answer as it involves following a moral code and acting professionally. Cognitive skills involve thinking through a situation to achieve outcomes. Technical skills relate to the proper use of equipment. Interpersonal skills are used to develop caring relationships.
Cognitively Skilled Nurses Offer scientific rationale for patient plan of care. Select nursing interventions most likely to yield desired outcomes. Use critical thinking to solve problems creatively. Display purpose of thinking and adequacy of knowledge. Work through potential problems and use helpful resources. Critique judgments/decisions.
Technically Skilled Nurses Use technical equipment with competence and ease to achieve goals with minimal distress to patients. Creatively adapt equipment and technical procedures to needs of patients in diverse circumstances.
Interpersonally Skilled Nurses Use interactions with patients and significant others and colleagues to promote human dignity and respect. Elicit personal strengths and abilities of patients to achieve health goals and establish caring relationships. Provide the healthcare team with knowledge about patient goals and expectations. Work collaboratively with healthcare team as respected and credible colleagues.
Ethically and Legally Skilled Nurses Are trusted to act in ways that advance interests of patients Are accountable for the practice Act as effective patient advocates Mediate ethical conflict among patient, significant others, and healthcare team
Four Domains of Critical Thinking Elements of thought basic building blocks of thinking Abilities the skills essential to higher-order thinking Affective dimensions attitudes, dispositions, passions, traits of mind essential to higher-order thinking Intellectual standards used to critique higher-order thinking
Elements of Thought: Basic Building Blocks of Thinking Purpose Question at issue or central problem Point of view Empirical dimension Concepts and ideas Assumptions Implications and consequences
Characteristics of Interpersonal Caring Promotion of dignity and respect of patients Centrality of the caring relationship Mutual enrichment of both participants in the nurse patient relationship
Developing Ethical/Legal Skills Developing accountability Reporting incompetent, unethical, or illegal practice
Steps in Concept Map Care Planning Develop a basic skeleton diagram. Analyze and categorize data. Analyze nursing diagnoses relationships. Identify goals, outcomes, and interventions. Evaluate patient s responses.
Question Tell whether the following statement is true or false. Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts. A. True B. False
Answer Answer: A. True Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts.
Critical Thinking and Clinical Reasoning Is purposeful, informed, outcome-focused thinking Is driven by patient, family, and community needs Is based on principles of nursing process and scientific method Uses both intuition and logic, based on knowledge, skills, and experience Requires strategies that make the most of human potential Is constantly reevaluating, self-correcting, and striving to improve