Clinical judgement is complex because the nurse is required to have prior training in order to develop further understanding of the subject. You recognized that Ms. George’s lethargy was unusual, and the location and timing of her pain was of concern. • Tend to store knowledge in a highly organized and structured manner, making recall of information easier. Paul and Elder (2012) go on to describe a “well-cultivated critical thinker” as one who does the following: Critical Thinking, Clinical Judgment, and the Nursing Process Educators and philosophers struggled with definitions of critical thinking for several decades. The patient’s available financial or material resources also need to be assessed and recorded in a standard format; each institution usually has a slightly different method of recording assessment data. Lack knowledge gained from actually doing (e.g., listening to breath sounds). This paper will focus on critical thinking and clinical judgment in nursing. Sometimes incongruent data reveal something about the patient’s concerns and fears. Essential are a culture and leadership that permit and encourage critique without recrimination. ______ Willing to revise judgment when new evidence warrants All of these changes have emphasized the need for professional nurses to think critically in order to provide safe and effective client care to diverse populations. Data collection centers on the use of multiple sources and types of data, a variety of data collection techniques, and the use of reliable and valid measurement instruments. The variety of definitions helps provide insight into the myriad dimensions of critical thinking. Upper Saddle River, NJ: Prentice-Hall. The “community of scholars” type of environment to which top educational institutions aspire should, by definition, be conducive to critical thinking. The Nursing Process Is autonomous • Explain the differences between independent, interdependent, and dependent nursing actions. Contrast the characteristics of “novice thinking” with those of “expert thinking.”. In clinical settings, time to engage in deliberative critical thinking is even more difficult to attain. The focus in the care sphere is the body, including assessment and evaluation of the client’s ability to perform basic functions and activities of daily living. Critical Thinking in Nursing • Differentiate between nursing orders and medical orders. The nursing process was first described in the literature in 1955 by Lydia Hall. Critical thinking isn't a new concept. These data are measurable, such as pulse rate and blood pressure, and include observable patient behaviors. Data Collection Techniques The five-step nursing process consists of the following elements: • Assessment—gathering and validating client health data, strengths, risks, and concerns, • Analysis/diagnosis—processing client data and identifying appropriate nursing diagnoses, • Planning—designing strategies to solve identified problems and build on client strengths, • Implementation—delivering and documenting the planned care, • Evaluation—determining the effectiveness of the care delivered. Box 8-4 summarizes these characteristics and offers an opportunity for you to evaluate your progress as a critical thinker. You measure her O2 saturation with a pulse oximeter, and it is 91%. Nurses must be sensitive to the patient’s need for confidence in the nurse’s trustworthiness. Reflective thinking is an active process valuable in learning and changing behaviors, perspectives, or practices. She instructs you to have Ms. George force fluids to the extent that she can tolerate it, and to take mild pain medication for postoperative pain. Although you are wary of the surgeon’s reaction, you call the hospitalist (a physician who sees inpatients in the absence of their attending physician), who orders a chest x-ray study. • Tend to organize knowledge as separate facts. According to Allen, Rubenfeld, and Scheffer (2004), the dimensions of creativity, intuition, and transforming knowledge that are so crucial to effective clinical practice were not included in the Delphi Report definition. An expert nurse would realize that the family may be a source of distraction from the pain or may be a source of comfort in ways that the nurse may not be able to provide. That study resulted in the identification of 17 dimensions of critical thinking and agreement on the definition of critical thinking for nursing as: data and rationales. (American Philosophical Association, 1990). Share it with at least one person, and report on progress weekly. Certainly the nursing process can be taught, learned, and used in a rigid, mechanistic, and linear manner. Data may include physiological, psychological, sociocultural, developmental, spiritual, and environmental information. An excellent website on critical thinking can be found at philosophy.hku.hk/think/ (OpenCourseWare on critical thinking, logic, and creativity). Regardless of the format, the nursing database should include the following categories of information (Edelman & Mandle, 1994): Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Critical Thinking, Clinical Judgment, and the Nursing Process. Observation provides a variety and depth of data that may be difficult to obtain by other methods. Phase 1: Assessment The nurse uses critical thinking throughout the nursing process, by sorting and categorizing data; identifying patterns in the data; drawing inferences; developing hypotheses that are stated in the form of outcomes; testing these hypotheses as care is delivered; and making criterion-based judgments of effectiveness. Are you SUPER confused on what critical thinking means in nursing school? Analyzing and integrating information across an increasing number of sources of knowledge requires that you have flexible intellectual skills. You may be wondering at this point, “How am I ever going to learn how to make connections among all of the data I have about a patient?” This is a common response for a nursing student who is just learning some of the most basic psychomotor skills in preparation for practice. It was hard work, but invigorating. 2, Philadelphia, 1999, Saunders. Regretfully, today’s employment picture in nursing is typically one with precious little time for contemplation. We were given time to think with minimal interruption and maximal flexibility; accordingly, the end product was excellent and the process truly energizing. You ask her to consider delaying her discharge home, but she refuses. Interpretation A critical thinker gives reasoned consideration to evidence, context, theories, methods, and criteria to form a purposeful judgment. Clinical skills in nursing are obviously important, but critical thinking is at the core of being a good nurse.. Critical thinking skills are very important in the nursing field because they are what you use to prioritize and make key decisions that can save lives. ______ Self-informed/finds own answers • Know when it is safe to skip steps or do two steps together. Definitions of Critical Thinking Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Presenting arguments • Assess and consider different options for intervening before acting The interactive nature of the model with its feedback mechanism permits the nurse to reenter the nursing process at the appropriate stage to collect additional data, restructure nursing diagnoses, design a new plan, or change implementation strategies. The American Nurses Association (ANA), in its publication Nursing: Scope and Standards of Practice (2004), parallels the steps of the nursing process and supports its use. Regardless of the format, the nursing database should include the following categories of information (Edelman & Mandle, 1994): • Surgical and (if appropriate) obstetrical history, Only gold members can continue reading. Know when it is safe to skip steps or do two steps together. Two days after a surgery for a large but benign abdominal mass, Mr. Stevens has not yet been able to tolerate solid food and has diminished bowel sounds. Measurement may require the use of specialized equipment (e.g., stethoscope, thermometer) or specialized assessment tools (e.g., pain scale, depression scale) to assess functional, behavioral, social, or cognitive domains. Critical thinking in nursing is undergirded by the standards and ethics of the profession. The development of critical thinking skills is crucial as you provide nursing care for patients with increasingly complex conditions. These communication techniques are discussed in chapter 8. They believe that the nursing process contributes to linear thinking and stymies critical thinking. Critical thinking is something you’ll do every day as a nurse and honestly you probably do it in your regular non-nurse life as well. Most authors agree that the critical thinking processes are not discipline specific but, rather, are generalizable (Ennis, 1987; Facione, 1990; Paul, 1992; Watson & Glaser, 1964). Her temperature remains at 37.8° C, and her pulse is 120. Critical thinking skills provide you with a powerful means of determining patient needs, interpreting physician orders, and intervening appropriately. Incongruent objective and subjective data require further careful assessment to ascertain the patient’s situation more completely and accurately. To complete a comprehensive assessment, objective and subjective data are obtained. It seems to me that there are several requisites, not the least of which is intelligence. The current model closely resembles the Yura and Walsh model, but with the addition of a diagnostic component. Subjective data can be very private. These critical thinking cognitive skills and subskills are listed in Box 9-1. But you have wanted to see this band since you were 15, and you do not know when you will have another chance. We were given time to think with minimal interruption and maximal flexibility; accordingly, the end product was excellent and the process truly energizing. You then realize that with such a good grade on this exam, you will have much less pressure when studying for the final exam at the end of the semester. In the assessment phase, the nurse deliberately and systematically collects data to determine the client’s health, functional status, strengths, and risk factors (Carpenito, 2008). Critical thinking: it’s recognizable when someone does it well and certainly evident when it is not happening. • Analyzing the meaning of terms It is important to collect both objective and subjective data to complete a comprehensive assessment. Ms. George has to wait 3 hours for her husband to drive her home, and you note that she continues to lie on the bed passively, and her lethargy is increasing. Her surgeon does not respond to your page, so you call the nursing supervisor, explaining to him that you are concerned with Ms. George’s impending discharge. The Delphi project produced the following consensus definition from its panel of experts: We understand critical thinking (CT) to be purposeful, self-regulatory, judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based. Nurses just beginning to pay attention to their thinking processes may ask these questions after nurse–patient interactions have ended. Meyers (1991) and McPeck (1990) believe that mastery of basic terms, concepts, and methodologies must occur before critical thinking skills can be developed. Although she describes herself as “not feeling well at all,” the physician writes the order for discharge and you, as the nurse who does postoperative discharge planning for the surgery practice, prepare Ms. George to go home with her new dietary guidelines and encouragement for her successful weight loss. In the practice of nursing, the, In 1973, the National Group for the Classification of Nursing Diagnosis published its first list of nursing diagnoses. Process of self-disciplined, self-directed, rational thinking that verifies what we know and clarifies what we do not know Clinical judgment is an ambiguous term that is synonymous with the term decision‐making. A stark example of incongruent subjective and objective data well-known to labor and delivery nurses is when a pregnant woman in labor describes ongoing fetal activity (subjective data); however, there are no fetal heart tones (objective data), and the infant is stillborn. BOX 8-3   NOVICE THINKING COMPARED WITH EXPERT THINKING. Dramatic changes in the health care system and the practice of nursing have occurred during the past decade as a result of an aging population, cost containment efforts, technological advances, increased complexity of clients’ health care needs, decreased average hospital length of stay, and a shift from acute care to community-based care. We understand critical thinking (CT) to be purposeful, self-regulatory, judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based. Role transition to patient care management. Two decades ago, the American Philosophical Association published an expert consensus statement (Box 8-1) describing critical thinking and attributes of the ideal critical thinker. • Formulating and clarifying value judgments A nurse who is exercising critical thinking asks the following questions: “What assumptions have I made about this patient?” “How do I know my assumptions are accurate?” “Do I need any additional information?” and “How might I look at this situation differently?” Mastery of the theory and research findings that relate to the problem or issue to be addressed is critical, but this is not something that nurses always take time to achieve. Upper Saddle River, NJ: Prentice-Hall.) Critical thinking in nursing A less prescriptive definition was offered by Ennis (1989), who characterized critical thinking as “reasonable reflective thinking focused on deciding what to believe or do” (p. 4). An example of objective data that a nurse might gather includes the observation that the patient, who is lying in bed, is diaphoretic, pale, and tachypneic, clutching his hands to his chest. Critical thinking, the nursing process, and clinical judgment Objective data are the other types of data that the nurse will collect through observation, examination, or consultation with other health care providers. Types of data That study resulted in the identification of 17 dimensions of critical thinking and agreement on the definition of critical thinking for nursing as: … an essential component of professional accountability and quality nursing care. • Evaluating the soundness of conclusions • Making and checking inferences based on data Currently, NANDA-I has more than 200 diagnoses approved for clinical testing and has recently added 16 new diagnoses and 8 revised diagnoses. Keep in mind that this is a process, that progression through the process may not be linear, and that it is a tool to use, not a road map to follow rigidly. Ennis (1987) agrees that some familiarity with subject matter is necessary for the development of critical thinking; however, some principles of critical thinking bridge many disciplines and can transfer to new situations. An excellent website on critical thinking can be found at philosophy.hku.hk/think/ (OpenCourseWare on critical thinking, logic, and creativity). This model is consistent with the concept of critical thinking as a continuous reflective process. For individuals outside the profession, nursing is commonly and simplistically defined in terms of tasks nurses perform. Rather, blind, noncritical obedience is the order of the day. We were continually challenged by being asked to provide rationales for our decisions, to make explicit all of the alternative approaches and explanations we had considered and rejected, and to explain why. To function effectively in complex, rapidly changing health care environments, nurses must use higher-order thinking skills and apply content knowledge to clinical practice. The Delphi research project used an expert panel of theoreticians representing several disciplines from the United States and Canada to develop a conceptualization of critical thinking from a broad perspective (Facione, 1990). Your critical thinking skills and willingness to advocate for your patient prevented an even worse postoperative course. The critical thinking process provides nurses with the ability to use purposeful thinking and reflective reasoning to examine ideas, assumptions, principles, conclusions, beliefs, and actions in the context of professional nursing practice (Brunt, 2005). • Current and past medical problems Currently, NANDA-I has more than 200 diagnoses approved for clinical testing and has recently added 16 new diagnoses and 8 revised diagnoses. They are concerned that the nursing process format, and rigid faculty adherence to it, encourages students to copy from published sources when writing care plans, thus inhibiting the development of a holistic, creative approach to patient care (Mueller, Johnston, and Bligh, 2002). Until then, diagnosis was considered to be within the scope of practice of physicians only. Novice nurses Informed, purposeful, and outcome-focused thinking that uses evidence to make clinical judgments • Surgical and (if appropriate) obstetrical history Almost every encounter a nurse has with a patient is an opportunity for the nurse to assist the patient to a higher level of wellness or comfort. ______ Analytic/confident in own reasoning skills, ______ Honest about personal biases/self-aware, ______ Willing to revise judgment when new evidence warrants, ______ Orderly in complex matters/organized approach to problems. It is impossible to think truly critically about something you do not understand or about which you possess only partial information. All these elements are critical to building a comprehensive database. CHAPTER 8 Critical thinking: it’s recognizable when someone does it well and certainly evident when it is not happening. Planning Examples of subjective data are statements such as, “I am in pain” and “I don’t have much energy.” The only source for these data is the patient. This model is consistent with the concept of critical thinking as a continuous reflective process. You need to understand that, just like learning to give injections safely and maintaining a sterile field properly, you can learn to think critically. Many clinical areas have developed nursing history and physical forms specific to the type of agency and the clients served. That means every effort must be made to counter the tendency to let critical thinking slide and, instead, to encourage, nurture, and reward it, even if that means bucking the tide and incurring some additional short-term costs. It results from critical thinking and clinical reasoning. Self-examination A more detailed discussion of nursing diagnosis is located in the next section of this chapter. You measure her O, Your critical thinking skills and willingness to advocate for your patient prevented an even worse postoperative course. Defining “critical thinking” is a complex task that requires an understanding of how people think through problems. Nurses can also learn to examine their thinking processes during an interaction as they learn to “think on their feet.” This is a characteristic of expert nurses. Overview of Critical Thinking Throughout the Nursing Process Conflicting viewpoints exist regarding whether critical thinking is subject specific or generalizable (U.S. Department of Education, 1995). Mar 21, 2017 | Posted by admin in NURSING | Comments Off on Critical thinking, the nursing process, and clinical judgment. The nursing process is a method of critical thinking focused on solving patient problems in professional practice. Key aspects of clinical reasoning are also present in this model including the importance of identifying RELEVANT clinical data and then INTERPRETING the significance of what this data represents. Directions: Listed below are 15 characteristics of critical thinkers. • Tend to organize knowledge as separate facts. ], St. Louis: Mosby.) The definitions presented earlier are summarized for comparison in Table 9-1, and characteristics of critical thinking are listed in Box 9-2. Distinguishing relevant from irrelevant data You demonstrated excellent clinical judgment in measuring her O2 saturation. Secondary sources of data include written records, other health care providers, and significant others (e.g., family members, friends). ______ Focused on inquiry FIGURE 9-2 The interactive nursing process model. • Seeking reasons, criteria, and principles that justify value judgments Have a large storehouse of experiential knowledge (e.g., what abnormal breath sounds sound like, what subtle changes look like). Clarifying meaning Therefore critical thinking can distinguish between fact and fiction, providing a rational basis for clinical judgments and the delivery of nursing care. The nursing process is a method of critical thinking focused on solving patient problems in professional practice. The outcome was a definition of critical thinking as the process of purposeful, self-regulatory judgments: an interactive, reflective reasoning process (Facione & Facione, 1996). Scheffer and Rubenfeld (2000) replicated the Delphi study with a panel of 55 nurse educators to obtain a consensus definition of critical thinking for nursing. The primary source of data is the client, whether the client is defined as the individual, the family, or the community. Your exam counts 35% of your final grade. Critical thinking in nursing— which includes clinical reasoning and clinical judgment — is purposeful, informed, outcome-focused thinking that: Is guided by standards, policies, ethics codes, and laws (individual state practice acts and state boards of nursing). In recent years, some nursing leaders have questioned the use of the nursing process, describing it as linear, rigid, and mechanistic. One of my most exciting opportunities to engage in intense and prolonged critical thinking occurred when a group of four colleagues and I were “freed up” from many of our routine responsibilities to plan a doctoral program “from scratch.” In weekly full-day sessions we argued, debated, challenged, cajoled, compromised, and created. The second type of learning involves the process of critical thinking itself. They proposed a four-step nursing process model that consisted of assessing, planning, implementing, and evaluating. A thorough understanding of the nursing process reveals that critical thinking is indeed an integral part of its most effective use. This is known as reflective thinking. Making inferences Even within the profession, the intellectual basis of nursing practice was not articulated until the 1960s, when nursing educators and leaders began to identify and name the components of nursing’s intellectual processes. More creative use of the nursing process may occur by expert nurses who have a greater repertoire of interventions from which to select. • Learn more readily when matched with a supportive, knowledgeable preceptor or mentor Having sound critical thinking, clinical reasoning, and clinical judgment skills makes the difference between keeping patients safe and putting them in harm’s way. OBJECTIVES If anything, the nursing students were the “oddballs” whose pragmatism and goal-directedness seemed strange to the arts, sciences, and music majors. ______ Persistent Reprinted with permission. Only gold members can continue reading. Is fair In nursing, critical thinking has often been portrayed as a rational, linear process that is synonymous with clinical judgment, problem solving, and the nursing process (Ford & Profetto-McGrath, 1994; Huckabay, 2009; Jones & Brown, 1993; Kintgen-Andrews, 1991; Wilkinson, 1996). To enhance your understanding of this chapter, try the Student Exercises on the Evolve site at evolve.elsevier.com/Black/professional. The base hopefully having been laid during one’s professional education, critical thinking depends not only on training but also on an environment or context that enables, encourages, and rewards it. According to, SUMMARY OF DEFINITIONS OF CRITICAL THINKING, Although a universally accepted definition of critical thinking has not emerged, agreement exists that it is a complex process. This model can accommodate changes in the client’s health status or failure to achieve expected outcomes through a feedback mechanism. Elizabeth R. Lenz PhD, RN, FAAN Dean and Professor, College of Nursing, The Ohio State University, Columbus, Ohio. Critical thinking in nursing which includes clinical reasoning and clinical judgment is purposeful, informed, outcome-focused thinking that is guided by standards, policies, ethics codes, and laws. Scheffer and Rubenfeld (2000) replicated the Delphi study with a panel of 55 nurse educators to obtain a consensus definition of critical thinking for nursing. The skills of raising questions, using logic, and comprehensively considering alternative perspectives, explanations, and courses of action can often best be learned experientially within a structure that encourages and, in fact, mandates that kind of thoughtful consideration. Ms. George has recently undergone bariatric surgery after many attempts to lose weight over the years have failed. Educators and philosophers struggled with definitions of critical thinking for several decades. Like many frameworks for thinking through problems, the nursing process is a series of organized steps, the purpose of which is to impose some discipline and critical thinking on the provision of excellent care. Analyzing arguments This chapter explores several important and interdependent aspects of thinking and decision making in nursing: critical thinking, the nursing process, and clinical judgment. The outcome was a definition of critical thinking as the process of purposeful, self-regulatory judgments: an interactive, reflective reasoning process (Facione & Facione, 1996). Consciously developed to improve patient outcomes, critical thinking by the nurse is driven by the needs of the patient and family. • Family medical history Qualitative studies have shown that the use of intuition in making clinical nursing judgments is an important part of the critical thinking process. Reasonable reflective thinking focused on deciding what to believe or do Your diagnosis is that Mr. Stevens has dysfunctional gastrointestinal motility. • Explain the purpose and phases of the nursing process. An example of subjective data occurs when the client states that he is having pain in his right ear. The specific, detailed information that you were able to provide the hospitalist allowed him to follow a logical diagnostic path, determining that Ms. George did indeed have a significant postoperative complication. Nurses obtain two types of data about and from patients: subjective and objective. • Devise a personal plan to use in developing sound clinical judgment. Sources of Data • Tend to rely on step-by-step procedures and follow standards and policies rigidly Her approach was built around three interrelated spheres of nursing activity: care, core, and cure. You take her vital signs and note that her temperature is 37.8° C and her pulse is 115. All of these changes have emphasized the need for professional nurses to think critically in order to provide safe and effective client care to diverse populations. Nursing process: A critical thinking approach (2nd ed.). • Analyze standards and policies, looking for ways to improve them Chapter opening photo from istockphoto.com. Stating the problem We understand critical thinking (CT) to be purposeful, self-regulatory judgment that results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based. The interrelationships among these concepts are illustrated in Figure 9-1. Without labeling the goal as such, we were consistently encouraged, groomed, and enabled to be critical thinkers. In nursing practice, the desired outcome of this reasoning is effective action. Differentiate between nursing orders and medical orders. The nursing process serves as a tool for applying critical thinking to nursing practice. Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice. Observation provides a variety and depth of data that may be difficult to obtain by other methods. CRITICAL THINKING AND THE NURSING PROCESS CJ is the DOING outcome of learning and practicing NCSBN sees a need for more of this because Increasing gap between practice / academia Errors by novice nurses indicate lack in CJ Continuing growth in complexity Critical Thinking Clinical Decision Making • Childhood illnesses Humans are involved in problem solving on a daily basis. The critical thinking test predicts a job candidate’s ability to: • Planning—designing strategies to solve identified problems and build on client strengths Upper Saddle River, NJ: Prentice-Hall. Nevertheless, even in those settings, time and energy to engage in deliberation, to exchange ideas, and to critique those ideas openly are scarce, and the kind of culture that encourages such scholarly dialogue is relatively rare. The assurance that critical thinking will be truly woven into the fabric of our profession will depend on our ability to recruit and retain intelligent, interested, and committed nurses; to provide challenging educational opportunities that develop the requisite competencies; and to provide and sustain the kinds of environments in which critical thinking is valued and demanded. To get a clearer picture of the patient’s situation, the nurse should use the best communication skills he or she possesses to increase the patient’s trust, which will result in more openness. Inference Fortunately, the faculty responsible for the BSN program I attended were forward-thinking and highly committed to the emerging definition of nursing as a true profession, with the requisite obligation to base action on scientific knowledge and clear and logical thinking. A structured interview is commonly used in emergency situations when the nurse needs to gather specific information. The interactive nature of the model with its feedback mechanism permits the nurse to reenter the nursing process at the appropriate stage to collect additional data, restructure nursing diagnoses, design a new plan, or change implementation strategies. Only gold members can continue reading. Although the components of the nursing process are described as separate and distinct steps, they become an integrated way of thinking as nurses gain more clinical experience. Based on my experience, I believe that two essential types of learning provide the basis for critical thinking. It was hard work, but invigorating. Commonalities in definitions include an emphasis on knowledge, cognitive skills, beliefs, actions, problem identification, and consideration of alternative views and possibilities (Daly, 1998). Box 8-2 presents an example of the importance of critical thinking in the provision of safe care. It combines developing CT skills with nurturing those dispositions that consistently yield useful insights and that are the basis of a rational and democratic society. Unfortunately, we have been less successful than other professions (namely, medicine) in socializing our practitioners to value learning as a career-long pursuit; yet pursuit of the most state-of-the-science information is an essential ingredient of critical thinking. Purposeful, self-regulatory judgments resulting in interpretation, analysis, inference, evaluation, and explanation A structured or unstructured interview may be used to obtain information such as a health history and demographic data. The clinical environment in which I have seen critical thinking encouraged most effectively was one in which the expectations were explicit, critical thinking was measured routinely in the practice context, relevant learning and growth opportunities were provided, and critical thinking was taken into account in performance evaluation. Log In or Register to continue Use critical thinking and communication skills to develop partnerships with clients and other healthcare professionals Clinical Judgment The interpretation or conclusion about whether or not to take an action based on clinical reasoning. Log In or Register to continue Nurses obtain two types of data about and from patients: subjective and objective. Describe evaluation and its importance in the nursing process. An unstructured interview is commonly used in situations in which the nurse wishes to elicit information from the client’s perspective or gain insight to the client’s understanding of a problem. One of my most exciting opportunities to engage in intense and prolonged critical thinking occurred when a group of four colleagues and I were “freed up” from many of our routine responsibilities to plan a doctoral program “from scratch.” In weekly full-day sessions we argued, debated, challenged, cajoled, compromised, and created. Is reflective The use of selected data collection measures and instruments can assist the nurse in compiling a comprehensive database and organizing data into meaningful patterns. The Delphi Report (American Philosophical Association, 1990); Facione, Facione, and Sanchez (1994) The nursing process has sometimes been the subject of criticism among nurses. The second type of learning involves the process of critical thinking itself. Downsizing, high proportions of nonprofessional personnel, high levels of acuity, and high productivity requirements may discourage critical thinking. To complete a comprehensive assessment, objective and subjective data are obtained. Two days later, Ms. George reports that she is “feeling much better” and is walking in the hallways several times a day. Be aware that critical thinking involves far more than stating your opinion. Lack knowledge gained from actually doing (e.g., listening to breath sounds). Watson and Glaser (1964) Includes creativity Validating data The author acknowledges the important foundational work for this chapter developed by Dr. C. Fay Raines in the previous edition of this book. Subjective data can be very private. Focuses on what to believe and do Dramatic changes in the health care system and the practice of nursing have occurred during the past decade as a result of an aging population, cost containment efforts, technological advances, increased complexity of clients’ health care needs, decreased average hospital length of stay, and a shift from acute care to community-based care. Downsizing, high proportions of nonprofessional personnel, high levels of acuity, and high productivity requirements may discourage critical thinking. The focus in the, The American Nurses Association (ANA), in its publication, In the assessment phase, the nurse deliberately and systematically collects data to determine the client’s health, functional status, strengths, and risk factors (Carpenito, 2008).
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