Logic and Critical Thinking

MC103NUR | MRS. MELODY CRISPINA MORALES, MSN

THE NURSING PROCESS  I MPLEMENTATION : perform sponge bath/cold compress, tell patient
 … is the diagnosis and treatment of HUMAN RESPONSES to actual to increase fluid intake, give medicine as ordered by doctor
or potential health problems (American Nurses’ Association,  E VALUATION : recheck vital signs and determine if within normal
1980) range
 Is a rational, systematic, step by step method of planning and NURSING PROCESS: ASSESSMENT PHASE
providing nursing care to patients and their families  …the first phase of the nursing process but continues throughout
 It is cyclical – it follows a logical sequence  Purposes:
 It is a series of planned actions by the nurse directed towards a  establish an initial database (initial)
particular result or goal  build and maintain the database (ongoing)
 It is a framework for nursing practice  Types:
WHY IS IT IMPORTANT?  general and comprehensive (initial)
 It individualizes patient care – leads to improved quality of care  focused (once problems are identified)
 It enables the patient to participate in his/her own care ACTIVITIES:
 It promotes continuity of care 1. DATA COLLECTION
 It provides a framework for accountability and responsibility  gathering of important, relevant and appropriate patient data or
CRITICAL THINKING AND THE NURSING PROCESS information
 CRITICAL THINKING – reasoning process by which an individual  basic human needs
REFLECTS and ANALYZES his/her own thoughts, actions and  activities of daily living
decisions and those of others  functional health patterns
 it involves using one’s mind to make conclusions, make decisions, 2. IDENTIFYING SUBJECTIVE AND OBJECTIVE DATA
draw inferences, reflect on the process and the outcomes
 helps in the critical examination of data as they complement and
CRITICAL THINKING clarify each other
 E XAMPLE : A man is walking in an unknown street. He sees a hole  SUBJECTIVE DATA – also referred to as SYMPTOMS
and walks through it. He falls. After sometime, the man walks on
 “known and experienced” only by the patient
the same street. He sees the hole…
 includes sensations, feelings, attitudes, beliefs, values,
 … if he is a CRITICAL THINKER, he avoids it
etc…
 … if he is not, then he walks through it and falls again
 OBJECTIVE DATA – also referred to as SIGNS
 E XAMPLE : In the hospital, you see a patient having chills, difficulty
 they are detected by an observer (the nurse) and can be
in breathing and in an uncomfortable condition…
measured or tested against an acceptable standard
 … if YOU are a CRITICAL THINKER, you will go to the patient,  they can be seen, felt, smelled and heard through
see what the problem is…and try to HELP observation and physical assessment
 … if YOU are NOT, then you just watch the patient undergo Example: Identifying Data
a bad hospital experience SUBJECTIVE OBJECTIVE
KEY COMPONENTS OF CRITICAL THINKING IN NURSING
 “I feel warm.”  Temp: 37.80C; warm to touch
 KNOWLEDGE BASE – includes all that the nurse has learned in her
 Report of itchiness on  scratching the face; presence of
education and training
face red marks on face
 EXPERIENCE – nursing knowledge put to the test in practice
 “My stomach makes me  vomited 3x with green-tinged
 STANDARDS – using intellectual and professional standards as
sick.” fluid; abdomen is firm and
criteria for the appropriateness of clinical decisions and distended
 “I feel afraid of the
judgements
surgery.”  patient cannot sit still; trembling
 ATTITUDES – responsibility, confidence, fairness, integrity,
or slight shaking of hands
creativity, etc…
P RACTICE E XERCISES : I DENTIFY THE FOLLOWING DATA AS OBJECTIVE OR
SUBJECTIVE
 burning sensation on urination – S UBJECTIVE
 BP = 120/70 mmHg – O BJECTIVE
 tiredness – S UBJECTIVE
 pain complaint – S UBJECTIVE
 “I am afraid of injections.” – S UBJECTIVE
 hard mass on the abdomen – O BJECTIVE
 dry mouth – O BJECTIVE
 shortness of breath –S UBJECTIVE
STEPS OF THE NURSING PROCESS
SOURCES OF DATA
A – assessment  PRIMARY– the “patient”
D – diagnosis  best source of data
P – planning  SECONDARY – sources other than patient
I – implementation  S IGNIFICANT OTHERS ( PARENTS & RELATIVES ) – good source for
E – evaluation patients who are young, unconscious or confused
 H EALTH P ERSONNEL – give information regarding changes in
C ASE : A PATIENT WITH HIGH BODY TEMPERATURE the health status since they are in close contact with
 A SSESSMENT : - check vital signs, look for signs/symptoms of patients
abnormal temperature  R ECORDS – medical and laboratory reports of past and
 D IAGNOSIS : patient is having altered body temperature (FEVER) previous illness patterns help in the plan of care
 P LAN : reduce the body temperature to normal  L ITERATURE – can provide recent trends and approaches to
the patient’s care

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 LOGIC AND CRITICAL THINKING
METHODS of DATA COLLECTION  Personal knowledge and integration of physiology, psychology,
 OBSERVATION – gathering of data using the 5 senses sociology, etc…
 it is a conscious, deliberate skill that is developed only 2. G ENERATE TENTATIVE HYPOTHESES ( MEANINGS ) FROM DATA CLUSTERS
through effort and an organized approach  Example:
 INTERVIEW – a planned communication or conversation with a  A patient complaints of abdominal pain, he is grimacing and
purpose holding his abdomen and reports passing loose stools. The
 makes use of open and closed ended questions to facilitate stools are greenish-brown with foul smell.
gathering of data  Hypotheses:
 EXAMINATION – a systematic data collection method that uses  ** The patient is having diarrhea.
observation to detect health problems and validate initial cues  ** The patient ingested contaminated food.
and clues MAKE DECISIONS BASED ON THE DATA:
 cephalocaudal in approach and makes use of inspection, a. Are the data within the normal range for the patient’s age group?
palpation, percussion and auscultation b. Is the functioning described by the patient typical of her previous
ACTIVITIES: patterns?
3. ORGANIZING AND CLUSTERING DATA c. What relationships exist between pieces of data?
 a process of determining relationships in the data and finding d. What specific behavior patterns contribute to the health and
patterns in the facts well-being of the client?
E XAMPLE : e. What are the strengths, resources and limitations of the patient?
 A patient complaints of abdominal pain (subjective interview PROBLEM IDENTIFICATION
data), he is grimacing and holding his abdomen (objective  From the analyzed data, what are the problems of the patient?
observation) and reports passing loose stools (subjective  Which areas of health require nursing interventions?
interview data). Color of the stools is greenish brown with  Which among these problem areas need IMMEDIATE ACTION or
foul smell (objective observation). Laboratory investigation intervention?
shows he has eaten contaminated food. FORMULATION OF THE NURSING DIAGNOSIS
4. VALIDATING THE DATA  The nurse formulates CAUSAL RELATIONSHIPS between the health
problems and the factors related to them
 the nurse checks that the data is:  Causal factors may be environmental, sociologic, psychologic,
a) F ACTUAL – data is accurate and not based on assumptions physiologic, or spiritual
or misunderstandings ACTUAL NURSING DIAGNOSIS
b) C OMPLETE – the nurse looks for gaps, missing data or
inconsistencies  refers to a situation existing in the here and now
5. RECORDING AND REPORTING  it must be resolved so that complications and potential problems
may be prevented
 writing data according to specified format E XAMPLE :
 reporting of abnormal findings to proper personnel  A patient has fever due to an infection. He has a body
temperature of 39 0C. The fever needs to be resolved so that
the patient will not suffer from seizure (fits), damage to vital
organs and maintain his comfort.
POTENTIAL NURSING DIAGNOSIS
 refers to a problem which may develop in the future if actual
nursing problems are not resolved
 identification of such will prevent the problem or lessen the
consequences
E XAMPLE :
 A patient has fever due to an infection. He has a body
temperature of 39 0C. The fever needs to be resolved so that
the patient will not suffer from seizure (fits), damage to vital
organs and maintain his comfort.
DIAGNOSIS E XERCISE : D EVELOP NURSING DIAGNOSES OUT OF THE FOLLOWING
 The phase of the nursing process in which the nurse focuses on SCENARIO :
3 main tasks: An 18 year old student nursing student was seen at the Out-
 Analyzing the data gathered from assessment Patient Department of St. Paul Hospital due to complaints of
 Identifying problem areas for the patient difficulty in sleeping for the past 5 days . She said: “I can not sleep
 Stating the patient’s problem in the form of a NURSING because I am worried about my exams next week.” She used to
DIAGNOSIS sleep 8 hrs. but now, she barely sleeps for 4 hrs. because she
keeps on thinking. Her conjunctivae are pale, with dark circles
around the eyes. She also complained of dizziness and feeling
tired all the time.
N URSING D IAGNOSIS :
 P ROBLEM : difficulty of sleeping
 N URSING D IAGNOSIS : Sleep Pattern Disturbance
 E TIOLOGY : worrying and thinking about exams
DATA ANALYSIS  S IGNS /S YMPTOMS :
HOW DOES THE NURSE ANALYZE THE DATA?  S UBJECTIVE : patient stated: “I can’t sleep because I am
1. COMPARE DATA AGAINST STANDARDS worried about my exams next week.”; patient
 Normal vital signs verbalized sleeping only for 4 hrs.; complained of
 Normal health patterns dizziness and feeling tired all the time
 Laboratory values  O BJECTIVE : pale conjunctivae with dark circles around
 Growth and development the eyes

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 LOGIC AND CRITICAL THINKING

E XERCISE : D EVELOP NURSING DIAGNOSES OUT OF THE FOLLOWING  D ESIRED O UTCOME : sleeps 8 hours a day reports feeling rested
SCENARIO : and energized reports uninterrupted sleep
A 35 year old female patient is admitted in the ward. She is PURPOSE OF GOALS/DESIRED OUTCOMES
very weak and she has a low hemoglobin level of 9.1 g/dL. She is  Provide direction for planning nursing interventions
a known case of chronic iron deficiency anemia. She looks pale,  Serve as criteria for evaluating client progress
thin, and complains of breathing difficulty & dizziness whenever  Enable the client and the nurse and client to determine when the
she performs activity. She wants to take a bath but she feels very problem has been resolved
tired and her breathing becomes difficult.  Help motivate the nurse and client by providing a sense of
achievement
N URSING D IAGNOSIS :  Goals/Desired Outcomes and Nursing Diagnosis
 Activity Intolerance related to low hemoglobin level as  GOALS are derived from the client’s NURSING DIAGNOSES or
manifested by verbal report of weakness, tiredness, dizziness PROBLEM
and breathing difficulty in performing activity; pallor, thin and E XAMPLE :
hemoglobin level of 9.1 g/dl  N URSING D IAGNOSIS : Fluid Volume Deficit related to diarrhea
 Potential for Injury/Injury Risk related to weakness and  G OAL S TATEMENT : The patient will be able to maintain fluid balance
dizziness as evidenced by normal skin turgor, moist mucus membranes,
intake is equal to output measures
PLANNING  For every nursing diagnosis, the nurse must write at least ONE
 a deliberative, systematic phase of the nursing process that DESIRED OUTCOME, that when achieved, directly demonstrates
involves DECISION MAKING and PROBLEM SOLVING resolution of the problem
 it begins with the first client contact and continues until the  Questions to ask:
nurse-client relationship ends  What is the problem clause?
 occurs from client ADMISSION to DISCHARGE  What is the opposite, healthy response?
PURPOSES OF PLANNING  How will the client look or behave if the healthy response
 To determine whether the client’s health status has changed is achieved?
 To set priorities for the client’s care  What must the client do and how well must he do it to
 To decide which problems to focus on demonstrate resolution of the problem?
 To coordinate the nurse’s activities so that more than one COMPONENTS OF A GOAL/DESIRED OUTCOMES STATEMENT
problem can be addressed SUBJECT(PATIENT) + VERB (BEHAVIOR) + CONDITIONS
ACTIVITIES DURING PLANNING (MODIFIERS) + CRITERIA OF PERFORMANCE + TIME ( IF
NEEDED )
 Prioritizing problems/diagnoses
 SUBJECT – the client or patient
 Formulating goals/desired outcomes
 VERB – specifies the OBSERVABLE action or behavior that the
 Selecting nursing interventions
client is to perform
 Writing nursing orders
 CONDITIONS (modifiers) – explains the circumstances under
 The output of the PLANNING PROCESS is a NURSING CARE which behavior is to be performed
PLAN
 CRITERIA OF PERFORMANCE – indicates the standard or level
1. S ETTING PRIORITIES FOR PROBLEMS / DIAGNOSES
by which the patient will perform the behavior
 PRIORITY SETTING – process of establishing a preferential  TIME - clarifies how long it would realistically take for the patient
sequence for addressing nursing diagnoses and interventions to reach the level of functioning stated in the criteria of
 Which nursing diagnosis or problem requires performance
attention first? Which is second and which is last? Subject Verb Conditions Criteria of Time
 HIGH PRIORITY PROBLEMS – life threatening such as loss Performance Frame
of respiratory or cardiac function The will drink 2500 mL without within 8
 MEDIUM PRIORITY PROBLEMS – health threatening patient of fluid vomiting hours
problems such as acute illness, pain and decreased coping The will walk the length with a cane one day
ability patient of the after
 LOW PRIORITY PROBLEMS – those that require minimal ward surgery
nursing support corridor
 PRIORITIES CHANGE as the client’s responses, problems and The will 500-1000 after taking in the
therapies change patient urinate mL diuretics next 2-3
 It is not necessary to resolve ALL high-priority diagnoses before hours
addressing others The will reduction from a scale after 1-2
 Nurses usually use the MASLOW’s hierarchy of needs as basis for patient report in pain felt of 8 to 5 with hours
prioritizing problems administration
 Other factors to be considered: of analgesics
 Client’s health beliefs and values The will ADL such with minimal 2 days
 Client’s priorities patient perform as bathing, assistance after
 Resources available oral from nurse or surgery
 Urgency of the health problem hygiene, relative
dressing,
 Medical treatment plan
feeding
 2. Establishing Client Goals or Desired Outcomes
 these are observable client responses that the nurse hopes to
achieve by implementing nursing interventions
 Goals – broad statement about the client’s health status
 Desired Outcomes – observable and more specific criteria used
to evaluate whether the goals have been met
E XAMPLE :
 G OAL : The patient will improve sleep pattern

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