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Chapter 1What is evidence based practice? What does it involve? Why is it important to the
practice of nursing?
❖ In professional nursing today, there is an increasing emphasis on evidence-based
practice (EBP). Almost all of the currently used nursing theories address this issue in
some way. Simply stated, EBP is the practice of nursing in which interventions are based
on data from research that demonstrates that they are appropriate and successful. It
involves a systematic process of uncovering, evaluating, and using information from
research as the basis for making decisions about and providing client care.
❖ Many nursing practices and interventions of the past were performed merely because
they had always been done that way (accustomed practice) or because of deductions
from physiological or pathophysiological information. Clients have become more adept in
the use of information technology, and as a result, many now have a higher level of
knowledge about their illnesses than in the past. This increase in knowledge levels, use
of online health-care information, and demand for higher-quality care constitute one of
the driving forces behind the use of EBP.
❖ The development of information technology has made EBP in nursing a reality. In the
past, nurses relied primarily on units within their own facilities for information about the
success of treatments, decisions about health care, and outcomes for clients. Nursing
education now requires nursing students to perform research for papers and projects so
that by the time of graduation, they feel comfortable accessing a wide range of the best
and most current information through electronic sources. Of course, one of the key
limiting factors of EBP is the quality of the information on which the practice is based.
Evaluating the quality of information on the Internet can be difficult at times.
❖ The first step in developing an EBP is to identify exactly what the intervention is
supposed to accomplish. Once the goal or client outcome is identified, the nurse needs
to evaluate current practices to determine whether they are delivering the desired client
outcomes. If the current practices are unsuccessful or if the nurse feels they can be
more efficient with fewer complications, research sources need to be collected. These
can be from published journal articles (either electronic or hard copy) and from
presentations at research or practice conferences, which often present the most current
information. Then a plan should be developed to implement the new findings. This
process can be applied to changing policy and procedures or developing training
programs for facility staff. The most current research data should always be used when
initiating new practices or modifying old ones.
Know the definition and difference between critical reasoning, critical thinking, critical
judgement and think- in- action.
❖ Critical reasoning: a broad term—refers to reasoning both inside and outside of the
, clinical setting.
❖ Clinical reasoning and decision-making:specific terms, refer to the process you use to
think about patient problems in the clinical setting
➢ for example, deciding how to prevent and manage mobility issues. For reasoning
about other clinical issues (e.g., teamwork, collaboration, and streamlining
workflow), nurses usually use the term critical thinking.
❖ Clinical judgment aka critical judgment: refers to the result (outcome) of critical thinking,
clinical reasoning, and decision-making—the conclusion, decision, or opinion you make
after analyzing information
❖ Think-in action: by thinking-in-action, we mean the patterns and habits of thought and
actions directly tied to responding to patients and families and to the nature of the
situation, such as staff availability, other urgent demands on nurses and other members
of the health care team
Other:
Critical thinking in nursing—which includes clinical reasoning, decision-making, 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 regulations).
• Is driven by patient, family, and community needs, as well as nurses’ needs to give competent
and efficient care (e.g., streamlining charting to free up nurses for patient care).
• Is based on principles of the nursing process, problem-solving, and the scientific method
(requires forming opinions and making decisions based on evidence).
• Focuses on safety and quality, constantly re-evaluating, self-correcting, and striving to improve
personal, professional, and system practices.
• Carefully identifies the key problems, issues, and risks involved and includes patients, families,
and key stakeholders in decision-making early in the process. Stakeholders are the people who
will be most affected (patients and families) or from whom requirements will be drawn (e.g.,
caregivers, insurance companies, third-party payers, and health care organizations).
• Uses logic, intuition, and creativity and is grounded in specific knowledge, skills, and
experience.
• Calls for strategies that make the most of human potential and compensate for problems
created by human nature (e.g., preventing errors by using technology).
Box 1-4 in (Critical Thinking book)
How Other Authors Describe Critical Thinking Traits
Scheffer and Rubenfeld’s Habits of the Mind:
• CONFIDENCE: Assurance of one’s reasoning abilities.
,• CONTEXTUAL PERSPECTIVE: Consideration of the whole situation, including relationships,
background, and environment relevant to some happening.
• CREATIVITY: Intellectual inventiveness used to generate, discover, or restructure ideas. Imagining
alternatives.
• FLEXIBILITY: Capacity to adapt, accommodate, modify, or change thoughts, ideas, and behaviors.
• INQUISITIVENESS: An eagerness to know, demonstrated by seeking knowledge and understanding
through observation and thoughtful questioning to explore possibilities and alternatives.
• INTELLECTUAL INTEGRITY: Seeking the truth through sincere, honest processes, even if the results
are contrary to one’s assumptions and beliefs.
• INTUITION: Insightful sense of knowing without conscious use of reason.
• OPEN-MINDEDNESS: A viewpoint characterized by being receptive to divergent views and sensitive to
one’s biases.
• PERSEVERANCE: Pursuit of a course with determination to overcome obstacles.
• REFLECTION: Contemplation on a subject, especially on one’s assumptions and thinking for the
purposes of deeper understanding and self-evaluation.
Facione’s Critical Thinking Dispositions
• TRUTH SEEKING: A courageous desire for the best knowledge, even if such knowledge fails
to support or undermines one’s preconceptions, beliefs, or self-interest.
• OPEN-MINDEDNESS: Tolerance of divergent views; self-monitoring for possible bias.
• ANALYTICITY: Demanding the application of reason and evidence; alert to problematic
situations; inclined to anticipate consequences.
• SYSTEMATICITY: Valuing organization; focusing; being diligent about problems at all levels of
complexity.
• CRITICAL THINKING SELF-CONFIDENCE: Trusting one’s own reasoning skills; seeing
oneself as a good thinker.
• INQUISITIVENESS: Curious and eager to acquire knowledge and learn explanations, even
when the applications of the knowledge are not immediately apparent.
• MATURITY: Prudence in making, suspending, or revising judgment; awareness that multiple
solutions can be acceptable; appreciation of the need to reach closure even in the absence of
complete knowledge.
Paul and Elder’s Intellectual Traits
• INTELLECTUAL HUMILITY: Consciousness of limits of your knowledge; willingness to admit
what you don’t know.
• INTELLECTUAL COURAGE: Awareness of the need to face and fairly address ideas, beliefs,
or viewpoints to which you haven’t given serious listening.
• INTELLECTUAL EMPATHY: Consciousness of the need to imaginatively put yourself in the
place of others to genuinely understand them.
• INTELLECTUAL AUTONOMY: Having control over your beliefs, values, and inferences; being
an independent thinker.
• INTELLECTUAL INTEGRITY: Being true to your own thinking; applying intellectual standards
to thinking; holding yourself to the same standards to which you hold others; willingness to
admit when your thinking may be flawed.
, • CONFIDENCE IN REASON: Confidence that, in the long run, using your own thinking and
encouraging others to do the same gets the best results.
• FAIR-MINDEDNESS: Awareness of the need to treat all viewpoints alike, with awareness of
vested interest.
What is the best way for nurses to gain power? What determines the amount of power
that a professional organization has?
Probably the first, and certainly the most important, way in which nurses can gain power in all
areas is through professional unity***
Join professional organization in large numbers- ex NLN or ANA
Nurses can be empowered from several sources. Empowerment can originate from:
➔ social structure of the work setting when nurses work to increase their control over the
workplace and feel more satisfied with the care they provide.
➔ Relationships are also a very strong source of empowerment by sharing power with
others, particularly those who are often viewed as having more power than nurses.
➔ Empowerment can be either a group effort or an effect of environmental change or the
individual nurse’s own efforts at self-growth and actualization.
Most commonly, it is a combination of all three factors.
➔ The most powerful groups are those that are best organized and most united. The power
that a professional organization has is directly related to the size of its membership.
According to the ANA, there are approximately 3.6 million actively practicing nurses in
the United States. It is not difficult to imagine the power that the ANA could have to
influence legislators and legislation if all of those nurses were members of the
organization rather than the approximately 300,000 who actually do belong.
Chapter 2
What event caused a nursing shortage? What incentive was used in order to encourage
more nurses to enter the military?
❖ World War II produced another nursing shortage, and in response, Congress passed the
Bolton Act, which shortened hospital-based diploma programs from 36 to 30 months.
The new Cadet Nurse Corps established minimum educational standards for nursing
programs and forbade discrimination on the basis of race, creed, or sex.Many schools
revised and improved their curricula to meet these new standards.
❖ To encourage more nurses to enter the military, the U.S. government granted women full
commissioned status and gave them the same pay as men with the same rank. By the
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