FUNDS EXAM 1 OUTLINE
1. Developing critical thinking skills
● Reflective journaling
○ Allows you to reflect on the experiences you’ve had
○ Gets you to think about what you could have done differently
● Meeting with colleagues
○ Talk and collaborate
○ See ideas from new perspectives
○ Dives deeper into the thought-process amongst a group of med. professionals
● Concept mapping
○ Visual representation of patient problems and interventions that shows their
relationships to one another
○ Primary Purpose = to synthesize relevant data about a patient, including
assessment data, nursing diagnoses, health needs, nursing interventions and
evaluation measures
2. Critical thinking skills
★ Scientific method
★ Problem solving
★ Decision-making
★ Diagnostic reasoning
★ Clinical decision-making
○ Nurse applying critical thinking skills in practice:
■ Nurse uses a pain rate scale to measure a patient's pain
■ Nurse thinks back about a personal experience before administering a
med subcutaneously (reflect)
■ Nurse gathers data on a patient with a mobility limitation to identify a
nursing diagnosis
3. Attitudes for critical thinking such as humility and responsibility
- Attitudes is the fourth component of the critical thinking model
- Guidelines for approaching problems or decision-making situations
- Confidence
- Belief in oneself and own abilities
- Grows with experience in recognizing strengths and limitations
- Builds trust
- Independent thinking
- Gain wide ranges of ideas and concepts
- Considering all sides of situations
1
, - Challenge the ways others think
- Ask for questions and look for evidence behind problems
- Fairness
- No prejudice
- Considering all viewpoints
- Responsibility & Accountability*
- Accountability & responsibility for one’s own actions (standards of practice),
responses, and outcomes
- Responsible for completely performing therapies
- Risk taking
- Trying different ways to solve problems
- Willingness comes from experience
- Leads to advances in patient care
- Consider safety guidelines, potential dangers, and logical reasoning
- Discipline
- A disciplined thinker misses few details and is orderly/systematic when
collecting info, making decisions, and taking action
- Perseverance
- Keeps looking for more resources until successful approach found
- Ex: Trying different communication approaches to see what works
- Not satisfied with minimal effort
- Works to achieve highest level of quality care; especially when solutions
remain unsolved
- Creativity
- Finding solutions outside of the standard routines while still following standards
of practice
- Curiosity
- Ask “Why?” a critical thinker’s favorite question
- Motivates further inquiries (questions)
- Investigation
- Integrity
- Honest and willing to admit mistakes of own behaviors, ideas, and beliefs
- Following higher standards of practice
- Humility
- Admitting limitations of knowledge and skill
- Tries to find knowledge needed for critical decisions
QUESTION:
★ A nurse is preparing meds and checks patient’s label with name of med on doctors
order. At bedside the nurse checks patient’s name against medication order as well.
Which critical thinking attitude is the nurse displaying?
- Responsibility for making sure you’re giving the right patient the right
medication by identifying them from their ID.
4. Nursing process for decision making
2
, ★ A → Assessment
○ Gather information about the patient’s condition
★ D → Diagnosing
○ Using diagnostic reasoning to make clinical diagnoses to Identify the patient’s
problems
★ P → Planning
○ Set goals of care and desired outcomes and identify appropriate nursing actions
★ I → Implementation
○ Perform the nursing actions identified in planning
★ E → Evaluation
○ Evaluating if the nursing interventions worked well for the patient or not
5. Professional standards for clinical decision-making
- Intellectual standards
- Rational thought
- Apply during all steps of nursing process
- Logical
- Prevents haphazard critical thinking
- Professional standards
- Ethical criteria of nursing judgements
- Evidence-based criteria used for evaluation (scientifically based on research
findings or develop practice-based standards from clinical experts)
- Criteria for professional responsibility
- Consciously aware of beliefs, values, feelings, and multiple perspectives
(patients, family members, peers)
- Accurate assessments and implementations
6. Types of data
● Two types of data:
○ Subjective = patient’s verbal report of their feelings, perceptions, and symptoms
relevant to their health condition
○ Objective = reflects psychological changes; observations or measurements of a
patient’s health status
■ Should be clear, precise, and consistent
7. Establishing patient’s database
- The assessment phase of the nursing process involves data collection to complete a
thorough patient database
- First phase
8. Method of data collection
● Information during an assessment comes from:
○ Patient through interview, observations, and physical exam
○ Family members or S/Os’ reports and responses to interviews
3
, ○ Other members of the health care team
○ Medical record information
■ patient history
■ lab work
■ x-ray film results
■ Multidisciplinary consultations
○ Scientific and medical literature
■ Evidence about disease conditions, assessment techniques, and
standards
- Patient-centered interview
- Detailed information gathered through observational skills and interview
- Discover details of the patient’s concerns, expectations, and show
interest/partnership
- Review the medical record prior to the interview
- Communication skills:
- Courtesy towards patients/family members
- Confidentiality
- Comfort measures
- Privacy
- Providing pain relief
- Surroundings (temperature, lighting, etc.)
- Activities
- Pay mind to tiredness of patients
- You don’t want to over-tire them
- Connection (good first impression)
- Eye contact
- Do not dominate the conversation (allow patients to speak most)
- Silence
- Confirmation
- Summarizing end of discussion
- Ask if there are any other questions/concerns they may have
- Phases of the interview:
- 1) Orientation and setting agenda
- Personal introduction
- Reason for the interview
- Best clinical interview focuses on a patient’s goals, preferences,
and concerns; not on your agenda
- 2) Working phase
- Open-ended questions; closed-ended questions
- Active listening
- Therapeutic communication techniques
- Ongoing; continues each time you interact with the patient
- Identify cues: verbal & nonverbal
- Back-channeling: “Uh-huh,” “Go on”
4
1. Developing critical thinking skills
● Reflective journaling
○ Allows you to reflect on the experiences you’ve had
○ Gets you to think about what you could have done differently
● Meeting with colleagues
○ Talk and collaborate
○ See ideas from new perspectives
○ Dives deeper into the thought-process amongst a group of med. professionals
● Concept mapping
○ Visual representation of patient problems and interventions that shows their
relationships to one another
○ Primary Purpose = to synthesize relevant data about a patient, including
assessment data, nursing diagnoses, health needs, nursing interventions and
evaluation measures
2. Critical thinking skills
★ Scientific method
★ Problem solving
★ Decision-making
★ Diagnostic reasoning
★ Clinical decision-making
○ Nurse applying critical thinking skills in practice:
■ Nurse uses a pain rate scale to measure a patient's pain
■ Nurse thinks back about a personal experience before administering a
med subcutaneously (reflect)
■ Nurse gathers data on a patient with a mobility limitation to identify a
nursing diagnosis
3. Attitudes for critical thinking such as humility and responsibility
- Attitudes is the fourth component of the critical thinking model
- Guidelines for approaching problems or decision-making situations
- Confidence
- Belief in oneself and own abilities
- Grows with experience in recognizing strengths and limitations
- Builds trust
- Independent thinking
- Gain wide ranges of ideas and concepts
- Considering all sides of situations
1
, - Challenge the ways others think
- Ask for questions and look for evidence behind problems
- Fairness
- No prejudice
- Considering all viewpoints
- Responsibility & Accountability*
- Accountability & responsibility for one’s own actions (standards of practice),
responses, and outcomes
- Responsible for completely performing therapies
- Risk taking
- Trying different ways to solve problems
- Willingness comes from experience
- Leads to advances in patient care
- Consider safety guidelines, potential dangers, and logical reasoning
- Discipline
- A disciplined thinker misses few details and is orderly/systematic when
collecting info, making decisions, and taking action
- Perseverance
- Keeps looking for more resources until successful approach found
- Ex: Trying different communication approaches to see what works
- Not satisfied with minimal effort
- Works to achieve highest level of quality care; especially when solutions
remain unsolved
- Creativity
- Finding solutions outside of the standard routines while still following standards
of practice
- Curiosity
- Ask “Why?” a critical thinker’s favorite question
- Motivates further inquiries (questions)
- Investigation
- Integrity
- Honest and willing to admit mistakes of own behaviors, ideas, and beliefs
- Following higher standards of practice
- Humility
- Admitting limitations of knowledge and skill
- Tries to find knowledge needed for critical decisions
QUESTION:
★ A nurse is preparing meds and checks patient’s label with name of med on doctors
order. At bedside the nurse checks patient’s name against medication order as well.
Which critical thinking attitude is the nurse displaying?
- Responsibility for making sure you’re giving the right patient the right
medication by identifying them from their ID.
4. Nursing process for decision making
2
, ★ A → Assessment
○ Gather information about the patient’s condition
★ D → Diagnosing
○ Using diagnostic reasoning to make clinical diagnoses to Identify the patient’s
problems
★ P → Planning
○ Set goals of care and desired outcomes and identify appropriate nursing actions
★ I → Implementation
○ Perform the nursing actions identified in planning
★ E → Evaluation
○ Evaluating if the nursing interventions worked well for the patient or not
5. Professional standards for clinical decision-making
- Intellectual standards
- Rational thought
- Apply during all steps of nursing process
- Logical
- Prevents haphazard critical thinking
- Professional standards
- Ethical criteria of nursing judgements
- Evidence-based criteria used for evaluation (scientifically based on research
findings or develop practice-based standards from clinical experts)
- Criteria for professional responsibility
- Consciously aware of beliefs, values, feelings, and multiple perspectives
(patients, family members, peers)
- Accurate assessments and implementations
6. Types of data
● Two types of data:
○ Subjective = patient’s verbal report of their feelings, perceptions, and symptoms
relevant to their health condition
○ Objective = reflects psychological changes; observations or measurements of a
patient’s health status
■ Should be clear, precise, and consistent
7. Establishing patient’s database
- The assessment phase of the nursing process involves data collection to complete a
thorough patient database
- First phase
8. Method of data collection
● Information during an assessment comes from:
○ Patient through interview, observations, and physical exam
○ Family members or S/Os’ reports and responses to interviews
3
, ○ Other members of the health care team
○ Medical record information
■ patient history
■ lab work
■ x-ray film results
■ Multidisciplinary consultations
○ Scientific and medical literature
■ Evidence about disease conditions, assessment techniques, and
standards
- Patient-centered interview
- Detailed information gathered through observational skills and interview
- Discover details of the patient’s concerns, expectations, and show
interest/partnership
- Review the medical record prior to the interview
- Communication skills:
- Courtesy towards patients/family members
- Confidentiality
- Comfort measures
- Privacy
- Providing pain relief
- Surroundings (temperature, lighting, etc.)
- Activities
- Pay mind to tiredness of patients
- You don’t want to over-tire them
- Connection (good first impression)
- Eye contact
- Do not dominate the conversation (allow patients to speak most)
- Silence
- Confirmation
- Summarizing end of discussion
- Ask if there are any other questions/concerns they may have
- Phases of the interview:
- 1) Orientation and setting agenda
- Personal introduction
- Reason for the interview
- Best clinical interview focuses on a patient’s goals, preferences,
and concerns; not on your agenda
- 2) Working phase
- Open-ended questions; closed-ended questions
- Active listening
- Therapeutic communication techniques
- Ongoing; continues each time you interact with the patient
- Identify cues: verbal & nonverbal
- Back-channeling: “Uh-huh,” “Go on”
4
