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CHAPTER 1

CRITICAL THINKING AND

THE NURSING PROCESS

AUDIO CASE STUDY

Jane and the Nursing Process

1. Assessment/data collection, diagnosis, planning, implementation, and evaluation.

2. Jane was exhausted, failed a test, and was pulled in too

many directions.

3. Jane’s resources included a good friend, sick time from

work, and wasted time between classes that she could

better utilize. Your resources will be different, but they’re

there!

VOCABULARY

Nursing Process

Definition: An organizing framework that links thinking with

nursing actions. Steps include assessment/data collection,

nursing diagnosis, planning, implementation, and evaluation.

Critical Thinking

Definition: The use of those cognitive (knowledge) skills or

strategies that increase the probability of a desirable outcome.

Also involves reflection, problem-solving, and related thinking skills.

Assessment

Definition: Gathering subjective and objective data to plan care.

Objective Data

Definition: Factual information obtained through physical assessment and diagnostic tests. Objective data are observable

or knowable through the health care worker’s five senses.

Referred to as signs.

Subjective Data

Definition: Information that is provided verbally by the

patient and referred to as symptoms.

Nursing Diagnosis

Definition: Per NANDA International, a nursing diagnosis is

a “clinical judgment concerning a human response to health

conditions/life processes, or a vulnerability for that response,

by an individual, family, group or community. A nursing diagnosis provides the basis for selection of nursing interventions

to achieve outcomes for which the nurse has accountability”

(from www.nanda.org/glossary-of-terms).

Evaluation

Definition: Examination of outcomes and interventions to determine progress toward desired outcomes and effectiveness of

interventions.

Vigilance

Definition: The act of being attentive, alert, and watchful.

SUBJECTIVE AND OBJECTIVE DATA

1. Subjective (symptom)

2. Subjective (symptom)

3. Objective (sign)

4. Objective (sign)

5. Subjective (symptom)

6. Objective (sign)

7. Subjective (symptom)

8. Objective (sign)

9. Subjective (symptom)

10. Subjective (symptom)

11. Objective (sign)

12. Objective (sign)

13. Subjective (symptom)

14. Objective (sign)

15. Objective (sign)

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CRITICAL THINKING

This is just one possible way to complete a cognitive map.

2 Chapter 1 Answers

Could it be low

blood sugar?

Am I diabetic? Frontal area

Sometimes feel

sick to stomach

Mother is

diabetic

Patient's

perception

Where is it?

Useful other

data

"Sick" feeling Hard

Quality

Severity Timing

7–8 on 0–10

scale

Lasts 1–2 hours

once starts

Early in the

morning

Before meals

Food helps

Tylenol helps Hunger makes

it worse

Aggravating and

alleviating factors

Headache

REVIEW QUESTIONS—CONTENT REVIEW

The correct answers are in boldface.

1. (3) is a nursing diagnosis. (1, 2, 4) are medical diagnoses.

2. (1) is a medical diagnosis. (2, 3, 4) are nursing diagnoses.

3. (1) is correct. The nurse who keeps trying until the problem is solved is exhibiting perseverance. (2, 3, 4) are

incorrect.

4. (3, 4, 5, 1, 2) is the correct order.

5. (1) is the best definition. (2, 3, 4) do not define critical

thinking but are examples of good thinking.

REVIEW QUESTIONS—TEST PREPARATION

The correct answers are in boldface.

6. (4) is correct. Evaluation determines whether goals are

achieved and interventions effective. (2) is the role of the

physician. (1, 3) encompass data collection and implementation, which are earlier steps in the nursing process.

7. (1) is correct. The licensed practical nurse/licensed vocational nurse can collect data, which includes taking vital

signs; assessment is the first step in the nursing process.

(2, 3, 4) are all steps in the nursing process, for which

the registered nurse is responsible; the licensed practical

nurse/licensed vocational nurse may assist the registered nurse with these.

8. (1, 4, 5) can be observed through use of the five senses.

(2, 3) are subjective data that the patient must report.

9. (2) indicates that the patient is concerned about freedom

from injury and harm. (1) relates to basic needs such as

air, oxygen, and water. (3) relates to feeling loved. (4) is

related to having positive self-esteem.

10. (4) is objective, realistic, and measurable with a time

frame. (1, 2, 3) are all good outcomes, but they relate to

airway clearance, nutrition, and strength, not directly to

swallowing.

11. (2) is correct. The three parts of a diagnosis include the

problem (from the NANDA International [NANDA-I]

list), etiology (“related to”), and symptoms (“as evidenced by”). (1) does not include symptoms. (3) is a

medical diagnosis. (4) is not a NANDA-I diagnosis,

and the evidence is not related to dyspnea.

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CHAPTER 2

EVIDENCE-BASED PRACTICE

AUDIO CASE STUDY

Marie and Evidence-Based Practice

1. Thirdhand smoke is the dangerous toxins of smoke that

linger on hair, clothing, furniture, and other surfaces in

an area after a cigarette is put out. Marie learned that

exposure to these toxins can be neurotoxic to children

and can trigger asthma attacks in sensitive people.

2. Evidence-based practice is considered the gold standard

of health care.

3. Step 1: Ask the burning question. Step 2: Search and

collect the most relevant and best evidence available.

Step 3: Think critically. Appraise the evidence for

validity, relevance to the situation, and applicability.

Step 4: Measure the outcomes before and after instituting

the change. Step 5: Make it happen. Step 6: Evaluate the

practice decision or change.

4. Combination therapy with a nicotine patch and nicotine

lozenges worked best, although bupropion (Zyban) and

nicotine lozenges worked well, too. A Cochrane Review

found that advice and support from nursing staff can

increase patients’ success in quitting smoking, especially

in a hospital setting.

VOCABULARY

1. Evidence-based practice: A systematic process that uses

current evidence in making decisions about patient care.

2. Evidence-informed practice: Consideration of patient factors along with the use of evidence for shared decisionmaking between the health care provider and the patient.

3. Randomized controlled trials: True experimental studies

in which as many factors as possible that could falsely

change the results are controlled.

4. Research: Scientific study, investigation, or experimentation to establish facts and analyze their significance.

5. Systematic review: A review of relevant research using

guidelines.

6. Health literacy: Degree to which a person has the capacity to obtain, process, and understand basic health information and services to make the best-informed health

decisions.

EVIDENCE-BASED PRACTICE

1. proof

2. context

3. quality

4. care

5. randomized

6. outcomes

7. gold

8. nursing

9. patient’s

10. information

CRITICAL THINKING

1. By questioning the existing way of doing things to ensure that the patient receives the best care possible.

2. A thorough search of the literature in the area of music

therapy.

3. Cumulative Index to Nursing and Allied Health Literature (CINAHL) Database, Joanna Briggs Institute

evidence-based resources, Cochrane Reviews,

Medline/PubMed.

4. Measure patient outcomes before instituting the evidence-based change in practice so comparisons can

be made after implementation to determine if the

intervention worked.

5. Evaluate the results to determine whether the change

made a significant difference and if it was worthwhile

in terms of cost and time.

REVIEW QUESTIONS—CONTENT REVIEW

The correct answers are in boldface.

1. (2) is Level I evidence. (1, 3, 4) are not examples of the

best evidence.

2. (1) is a nursing database. (2, 3, 4) are primarily medical

databases.

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3. (3) is the website for the Joint Commission, where you

can find the National Patient Safety Goals. (1, 2, 4) are

incorrect.

4. (2) is the definition of a randomized clinical trial.

(1, 3, 4) are incorrect.

5. (1) is correct. Evidence-based practice begins with a

burning question designed to solve a clinical problem.

(2, 3, 4) are incorrect.

REVIEW QUESTIONS—TEST PREPARATION

The correct answers are in boldface.

6. (2, 3, 4, 5, 6) are all independent nursing interventions

because no health care provider’s order is required. (1) is

a dependent function because it requires a health care

provider’s order.

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7. (1, 5) are Level I research. (2, 3, 4) are not systematic

reviews of randomized controlled trials.

8. (1, 3, 5, 6) because the evidence-based practice process

involves “ASKMME!”: ask, search, think, measure,

make it happen, and evaluate. (2, 4) are not steps in the

process.

9. (2, 3, 5) are correct, as they have been found to be best

practice for oral care. (1, 4) do not remove plaque and

only freshen the mouth.

10. (4) is correct. The search should be narrowed to include

the focus on the question. (1, 2, 3) do not focus on the

question being asked.

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