Nursing 200: Critical Thinking for the Registered Nurse
Week 1: Critical Thinking Skills and Strategies Arranged Using Tanner's Model
Notice
Identifying Signs and Symptoms
An ability to identify signs and symptoms indicating a situation is different, changed, and
not of a normal state. For example, there are signs that indicate food in the refrigerator is no
longer fresh. Nurses learn about signs and symptoms of diseases, side effects of drugs, and a
host of other factors that indicate a situation differs from normal functioning or what is expected
in a situation.
Gathering Complete and Accurate Data
When assessing any situation it is important to gather complete and accurate data.
Gathering complete and accurate data is fundamental to critical thinking. Data are collected
from all sources available to the nurse. The data are then used as the basis for identifying
issues, problems, and concerns; solving problems; and making decisions. It is important that
data collection is complete and accurate.
Assessing Systematically and Comprehensively
Assessing systematically and comprehensively is an approach used to ensure that data
gathering is complete and accurate. Using a systematic approach is a critical thinking strategy
applied to all areas of nursing practice. To assess patients, nurses use a systematic method
such as a body-systems or a head-to-toe approach, or a focused assessment, so no areas are
forgotten.
A systematic and comprehensive approach is also used when collecting data during a
shift report. Most nurses use a specific format for gathering patient data to ensure that all
important areas of information are noted.
Predicting and Managing Potential Complications
Predicting and managing potential complications requires critical thinking. Nurses must
look at the big picture to predict potential complications that may exist for individual patients.
The starting point is to know common complications related to a patient’s condition, then
consider individual differences that may produce additional concerns for the patient.
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, Nursing 200: Critical Thinking for the Registered Nurse
Week 1: Critical Thinking Skills and Strategies Arranged Using Tanner's Model
For example, all surgical patients are at risk for atelectasis and pneumonia. Interventions
such as deep breathing and coughing exercises, early ambulation, and the use of an incentive
spirometer are planned. However, an 18-year-old athlete in excellent physical condition who has
undergone a laparoscopic appendectomy is at much less risk for these complications than a 60-
year-old obese patient with a history of cigarette smoking who has undergone a colon resection.
The nurse's assessment must consider these potential complications and gather patient
assessment data related to these complications.
Identifying Assumptions
Making assumptions refers to taking something for granted or hastily arriving at a
conclusion without supporting evidence. For example, people may assume that the elderly
typically need help with many areas of their lives when, in fact, most older people do not require
assistance in their everyday life and activities. It is important to make decisions based on the
best available evidence, both about the patient and how to approach care for that patient.
Collecting data during the patient assessment is critical to prevent making assumptions that
may not be correct. You must engage in the noticing step of thinking without assumptions or
prejudices.
Interpret
Compare and Contrast Data
Comparing and contrasting details of information about two similar situations provides
practice with determining nuances between the cases. Nuances refer to subtle differences in
situations. Patients with the same medical diagnosis may appear the same, but subtle
differences in their individual presentation may require different interventions. The nurse is able
to detect these subtle differences more expeditiously with more experience with similar
situations.
Clustering Related Information
Clustering related information refers to grouping together information with a common
theme. This is the process used when determining patient issues, problems, or concerns
(concepts) that require action by the nurse. Related signs and symptoms are clustered together
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