critical thinking ethical decision making and the nursing process

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critical thinking ethical decision making and the nursing process

  1. 1. Chapter 3Critical Thinking, EthicalDecision Making, and the Nursing Process Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  2. 2. Definition of Critical Thinking• Multidimensional skill, cognitive or mental process, set of procedures• Critical thinking involves reasoning, purposeful systematic, reflective, rational, outcome–directed thinking based upon body of knowledge, examination of all available information, ideas Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  3. 3. Characteristics of Critical Thinking• Systematic• Organized• Conscious• Outcome oriented Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  4. 4. Alofaro-LeFevre (2008) Says• Critical thinkers are – Active thinkers, fair-minded, open-minded, persistent, empathic, independent in thought, good communicators, honest, organized and systematic, proactive, flexible, realistic, humble, cognizant of rules of logic, curious and insightful, creative, committed to excellence Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  5. 5. Critical-Thinking Skills• Interpretation• Analysis• Evaluation• Inference• Explanation• Self-regulation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  6. 6. Critical Thinking in Action Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  7. 7. Question• What is the least effective decision-making process used in critical thinking?A.Analyzing the informationB.Maintaining an inflexible attitudeC.Formulating decisionsD.Considering available options Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  8. 8. Answer• B. Maintaining an inflexible attitude.• Rationale: It is important to maintain a flexible attitude that allows the facts to guide thinking. Analyzing the information to determine what it means and to see whether it forms clusters or patterns that point to certain conclusions, formulating decisions that reflect creativity and independent decision making, and considering available options and examining each in terms of its advantages and disadvantages are effective decision- making processes used in critical thinking. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  9. 9. Ethics and Morality in Nursing• Ethics: formal systematic study of moral beliefs• Morality: individual’s adherence to informal personal value systems• Nursing ethics: form of applied ethics that addresses moral situations specific to nursing profession, patient care Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  10. 10. Basic Ethical Principles• Autonomy • Nonmaleficence• Beneficence • Paternalism• Confidentiality • Respect for persons• Fidelity • Sanctity of life• Double effect • Veracity• Justice Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  11. 11. Ethical Problem Solving• ANA (American Nurse’s Association) Nursing’s Social Policy Statement (2003): supports claim that nurses must be actively involved in decision-making processes surrounding health care, human responses• American Nurses Association Code of Ethics for Nurses• Steps of ethical analysis Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  12. 12. Question• Tell whether the following statement is true or false:• Individual patient rights regarding freedom of choice and the right to privacy are included under the ethical principle of fidelity. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  13. 13. Answer• False.• Rationale: Individual patient rights regarding freedom of choice and the right to privacy are included under the ethical principle of autonomy. Autonomy includes individual rights, privacy, and choice. It entails the ability to make a choice free from external constraints. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  14. 14. Ethical Dilemmas• Ethical dilemmas: occur when there is clear conflict between two or more competing moral principles or claims – Example: Ethical dilemma occurs when nurse wishes to be truthful with patient but family, physician wishing to spare patient distress prohibit informing patient about his condition Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  15. 15. Steps of an Ethical Analysis• Assess ethical/moral situations of problem• Collect information• List alternatives – Compare alternatives with applicable ethical principles, professional code of ethics• Decide, evaluate decision Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  16. 16. Ethical Theories• Deontologic or formalist theory: ethical theory maintaining that ethical standards or principles exist independent of ends or consequences• Teleologic theory or consequentialism: theoretical basis of ethics, focuses on ends or consequences of actions, such as utilitarianism Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  17. 17. Nursing Process• Assessment• Diagnosis• Planning• Implementation• Evaluation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  18. 18. The Nursing Process (cont’d) Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  19. 19. Collaborative Problems• Certain physiologic complications that nurses monitor to detect onset or changes in status (Carpenito-Moyet, 2008) Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  20. 20. Differentiating Nursing Diagnosis andCollaborative Problems Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  21. 21. Critical Thinking in Nursing Process• Critical thinking goes beyond basic problem solving – Results in comprehensive plan of care for patient• Decision making, problem solving in nursing: increasingly complex, require critical thinking as part of process• Critical thinking is at center of process of clinical reasoning, clinical judgment (Jackson, 2004)• Nurses must use critical thinking to plan, provide nursing care Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  22. 22. Question• Assessment begins with initial patient contact. Which nursing activity is included during this component of the nursing process?A.Interviewing and obtaining a nursing historyB.Choosing a nursing diagnosisC.Establishing expected outcomesD.Determining nursing actions Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  23. 23. Answer• A. Interviewing and obtaining a nursing history• Rationale: Choosing a nursing diagnosis is included during the diagnosis component of the nursing process. Establishing expected outcomes and determining nursing actions are included during the planning component of the nursing process. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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