NURSING PROCESS AND CRITHICAL THINKING

1. Chapter 1
Critical Thinking and the Nursing
Process

2. Objectives
 Define critical thinking.
Identify critical thinking tools to use in
nursing practice.
Explain how to integrate the nursing
process with critical thinking.
Apply critical thinking processes to solve
patient care situations.

3. What IS Critical Thinking?
Critical thinking is “The ability to focus your
thinking to get the results you need” (Alfaro
LeFevre, 2009).
The term “Critical Thinking” is used in many
different ways. The definition above provides
you with two key factors in critical thinking:
• Focus
• Results

4. Alfaro-LeFevre describes critical thinking as:
A. The process in which you discover your inner self-
worth.
B. A priority-setting mechanism to accomplish all your
goals.
C. The ability to focus your thinking to achieve the desired
results.
Test Yourself
The correct answer is C. Critical thinking is “The ability
to focus your thinking to get the results you
need” (Alfaro-LeFevre, 2014).

5. Critical Thinking – WHY USE
IT?
• 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
• USED TO IMPROVE THE QUALITY OF PATIENT CARE.
• It Allows You to Ensure Patient Safety

6. Clinical Reasoning
• Clinical reasoning, is The process by
which nurses collect signs, process the
information, come to an understanding
of a patient problem or situation, plan
and implement interventions, evaluate
outcomes, and reflect on and learn from
the process.
(continues)

7. Clinical Reasoning
• Key elements (Paul & Elder, 2000)
• Purposeful
• Problem-solving strategy
(continues)

8. Components of Critical
Thinking
• critical thinking involves the use of several
concepts, including:
• exploring,
• analyzing,
• prioritizing,
• explaining,
• deciding, and
• evaluating

9. Components of Critical
Thinking
• Exploring encourages you to identify all the variables
within a situation.
• Analyzing is the process of studying each variable to
understand its meaning and its relationship to the
other variables.
• Prioritizing requires you to weigh the relative
importance of each variable to the others, at a given
point in time.
• Priority setting can be defined as the ordering of
nursing problems using notions of urgency and/or
importance, in order to establish a preferential order
for nursing actions.

10. Components of Critical
Thinking
• Explaining the variables involves the exercise of
amplifying each variable to understand its meaning in the
situation and to the involved parties.
• Deciding means to choose a specific course of action.
• Evaluating requires the thinker to assess how correct the
thinking process was, and if further action is needed.

11. Personal Factors that
influence Critical Thinking
• Moral development
• Age
• Personal dislikes, and prejudices
• Self-confidence
• Past experiences

12. • Knowledge of problem solving, decision
making, nursing process and research
principles
• Effective Interpersonal relationship skills
• Early evaluation
• Effective writing and learning skills
Personal Factors that
influence Critical Thinking

13. Situational Factors that
influence Critical Thinking
• Anxiety, stress and fatigue
• Awareness of risks
• Knowledge of related factors
• Awareness of resources
• Positive reinforcement
• Environmental distractions

14. Barriers to Thinking
Critically
• Self focusing
• My way is better
• Choosing only one
• Face saving
• Resistance to change
• Self deception (short, sharp look in to some our
most important ego)

15. Exercise # 1
• Mrs. Vernon, a 67-year old patient who suffers from
Chronic obstructive pulmonary disease (COPD) has
been admitted to your unit from another facility. Upon
admission you note her to be alert, oriented and
appropriate.
• She provides you with information to complete her
history. After completing & charting your assessment,
you leave her to see to your other patients. An hour
later when you return, you note that Mrs. Vernon does
not seem as alert, and appears to be confused. On each
of the 5 components of critical thinking, write down
what could be going on with your patient.

16. Mrs. Vernon
• Exploring: what could be causing this
previously alert woman to be so suddenly
confused?
• Hypoxia
• Hypotension
• Fatigue
• Infection
• Medications
• Unfamiliar Surroundings
• Stroke

17. Mrs. Vernon
• Analyzing: what other information can I
gather to help me narrow down the possible
causes of her confusion?
• Vital Signs
• Oxygen Saturation/ ABG
• Medications taken & last dose time
• Further assessment of confusion level
• Previous history of confusion?
• Potential infection sites & their appearance

18. • Prioritizing/Deciding: is this change
significant to this patient, and do I need to even
look further? This also includes the decision
that is made whether to inform the physician of
the change in their patient’s status. What would
you say?
• Considering that Mrs. Vernon is a new patient,
and that this is a sudden change, it is
potentially clinically significant, and should be
investigated thoroughly, and reported to the
Physician right away.
Mrs. Vernon

19. • Evaluating: after reporting the alteration to the
patient’s Physician, he orders the following:
• STAT ABG & STAT Portable CXR
• Blood Cultures
• Urine & Sputum Cultures
• Head CT in the morning if confusion doesn’t resolve
• Discontinue all medications that could cause confusion
• At this point, the Physician’s orders indicate to you that
he is thinking along the same lines as you did, and
your thinking process was complete
Mrs. Vernon

20. • Now the next time you have a patient who
suddenly presents with confusion, you have a
“history” with that experience, and have a
knowledge base to draw from.
Mrs. Vernon

21. Other Concepts
• The other concepts of deciding and evaluating also
take part in your assessment of the situation!
• As you started this exercise, and every critical
thinking episode, you start with your existing
knowledge base. Each time you are faced with a
new situation, you identify from it what you
already know.

22. Case Study: PCA Pump
• Your patient, Mr. J is using the PCA pump to self-
administer morphine. You count his respirations at six
breaths per minute and find that he is difficult to arouse.
Is there a problem here? If so, what is it?
• Yes, the problem is morphine toxicity.
What will you do?
Per organization policy, administer naloxone (Narcan®)
Monitor the patient’s response
Continue to assess and manage pain
Report and document per facility policy
Investigate the cause:
o Pump malfunction?
o Need for further teaching?

23. Why?
 Classic symptoms of morphine toxicity include respiratory
depression
o Without reversal, respiratory arrest is likely
o Naloxone reverses morphine
• You are held legally accountable for following organization
policy
• You are legally accountable for questioning orders that may
be inappropriate for a given patient
How do you know what action is indicated?
Experience
Education
Knowledge of organization’s policy