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Critical Thinking in Nursing: Tips to Develop the Skill

4 min read • February, 09 2024

Critical thinking in nursing helps caregivers make decisions that lead to optimal patient care. In school, educators and clinical instructors introduced you to critical-thinking examples in nursing. These educators encouraged using learning tools for assessment, diagnosis, planning, implementation, and evaluation.

Nurturing these invaluable skills continues once you begin practicing. Critical thinking is essential to providing quality patient care and should continue to grow throughout your nursing career until it becomes second nature. 

What Is Critical Thinking in Nursing?

Critical thinking in nursing involves identifying a problem, determining the best solution, and implementing an effective method to resolve the issue using clinical decision-making skills.

Reflection comes next. Carefully consider whether your actions led to the right solution or if there may have been a better course of action.

Remember, there's no one-size-fits-all treatment method — you must determine what's best for each patient.

How Is Critical Thinking Important for Nurses? 

As a patient's primary contact, a nurse is typically the first to notice changes in their status. One example of critical thinking in nursing is interpreting these changes with an open mind. Make impartial decisions based on evidence rather than opinions. By applying critical-thinking skills to anticipate and understand your patients' needs, you can positively impact their quality of care and outcomes.

Elements of Critical Thinking in Nursing

To assess situations and make informed decisions, nurses must integrate these specific elements into their practice:

• Clinical judgment. Prioritize a patient's care needs and make adjustments as changes occur. Gather the necessary information and determine what nursing intervention is needed. Keep in mind that there may be multiple options. Use your critical-thinking skills to interpret and understand the importance of test results and the patient’s clinical presentation, including their vital signs. Then prioritize interventions and anticipate potential complications. 
• Patient safety. Recognize deviations from the norm and take action to prevent harm to the patient. Suppose you don't think a change in a patient's medication is appropriate for their treatment. Before giving the medication, question the physician's rationale for the modification to avoid a potential error. 
• Communication and collaboration. Ask relevant questions and actively listen to others while avoiding judgment. Promoting a collaborative environment may lead to improved patient outcomes and interdisciplinary communication. 
• Problem-solving skills. Practicing your problem-solving skills can improve your critical-thinking skills. Analyze the problem, consider alternate solutions, and implement the most appropriate one. Besides assessing patient conditions, you can apply these skills to other challenges, such as staffing issues . 

How to Develop and Apply Critical-Thinking Skills in Nursing

Critical-thinking skills develop as you gain experience and advance in your career. The ability to predict and respond to nursing challenges increases as you expand your knowledge and encounter real-life patient care scenarios outside of what you learned from a textbook. 

Here are five ways to nurture your critical-thinking skills:

• Be a lifelong learner. Continuous learning through educational courses and professional development lets you stay current with evidence-based practice . That knowledge helps you make informed decisions in stressful moments.  
• Practice reflection. Allow time each day to reflect on successes and areas for improvement. This self-awareness can help identify your strengths, weaknesses, and personal biases to guide your decision-making.
• Open your mind. Don't assume you're right. Ask for opinions and consider the viewpoints of other nurses, mentors , and interdisciplinary team members.
• Use critical-thinking tools. Structure your thinking by incorporating nursing process steps or a SWOT analysis (strengths, weaknesses, opportunities, and threats) to organize information, evaluate options, and identify underlying issues.
• Be curious. Challenge assumptions by asking questions to ensure current care methods are valid, relevant, and supported by evidence-based practice .

Critical thinking in nursing is invaluable for safe, effective, patient-centered care. You can successfully navigate challenges in the ever-changing health care environment by continually developing and applying these skills.

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Chapter 15 Critical Thinking in Nursing Practice

Published by Meredith Franklin Modified over 8 years ago

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Presentation on theme: "Chapter 15 Critical Thinking in Nursing Practice"— Presentation transcript:

1 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 20 Supervising and Evaluating the Work of Others.

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Happy semester with best wishes from all nursing staff Dr Naiema Gaber.

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CHAPTER 3 ~~~~~ INFORMAL ASSESSMENT: SELECTING, SCORING, REPORTING.

Critical Thinking and The Nursing Process

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CRITICAL THINKING AND THE NURSING PROCESS

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Critical Thinking in Nursing. Definition  Critical thinking is an active, organized, cognitive process used to carefully examine one’s thinking and the.

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CRITICAL THINKING in Nursing Practice: chapter 14 “…active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others.”

Critical Thinking and Nursing Practice

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The Value of Critical Thinking in Nursing

• How Nurses Use Critical Thinking
• How to Improve Critical Thinking
• Common Mistakes

Some experts describe a person’s ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as “necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation.”

“This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice,” he says.

How Do Nurses Use Critical Thinking?

Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.

Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:

“Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe.”

The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

“Nurses are at the patient’s bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider,” she explains.

Top 5 Ways Nurses Can Improve Critical Thinking Skills

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills.

In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. “What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?”

Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.

Practice Self-Reflection

Rhoads is an advocate for self-reflection. “Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help.” Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.

It’s important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

Develop a Questioning Mind

McGowan has learned that “critical thinking is a self-driven process. It isn’t something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive.”

To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .

However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient’s care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient’s mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.

Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

• Ask questions.
• Gather information.
• Implement a strategy.
• Evaluate the results.
• Consider another point of view.

These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what’s happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.

“We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care,” he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.

“Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient’s blood pressure because medication administration is a task that must be completed,” Slaughter says. “A nurse employing critical thinking skills would address the low blood pressure, review the patient’s blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld.”

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:

• Learn from their mistakes and the mistakes of other nurses
• Look forward to integrating changes that improve patient care
• Treat each patient interaction as a part of a whole
• Evaluate new events based on past knowledge and adjust decision-making as needed
• Solve problems with their colleagues
• Are self-confident
• Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.

By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient’s cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient’s overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter is a core faculty member in Walden University’s RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter’s clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.

Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.

What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

Successful nursing requires learning several skills used to communicate with patients, families, and healthcare teams. One of the most essential skills nurses must develop is the ability to demonstrate critical thinking. If you are a nurse, perhaps you have asked if there is a way to know how to improve critical thinking in nursing? As you read this article, you will learn what critical thinking in nursing is and why it is important. You will also find 18 simple tips to improve critical thinking in nursing and sample scenarios about how to apply critical thinking in your nursing career.

What is Critical Thinking in Nursing?

4 reasons why critical thinking is so important in nursing, 1. critical thinking skills will help you anticipate and understand changes in your patient’s condition., 2. with strong critical thinking skills, you can make decisions about patient care that is most favorable for the patient and intended outcomes., 3. strong critical thinking skills in nursing can contribute to innovative improvements and professional development., 4. critical thinking skills in nursing contribute to rational decision-making, which improves patient outcomes., what are the 8 important attributes of excellent critical thinking in nursing, 1. the ability to interpret information:, 2. independent thought:, 3. impartiality:, 4. intuition:, 5. problem solving:, 6. flexibility:, 7. perseverance:, 8. integrity:, examples of poor critical thinking vs excellent critical thinking in nursing, 1. scenario: patient/caregiver interactions, poor critical thinking:, excellent critical thinking:, 2. scenario: improving patient care quality, 3. scenario: interdisciplinary collaboration, 4. scenario: precepting nursing students and other nurses, how to improve critical thinking in nursing, 1. demonstrate open-mindedness., 2. practice self-awareness., 3. avoid judgment., 4. eliminate personal biases., 5. do not be afraid to ask questions., 6. find an experienced mentor., 7. join professional nursing organizations., 8. establish a routine of self-reflection., 9. utilize the chain of command., 10. determine the significance of data and decide if it is sufficient for decision-making., 11. volunteer for leadership positions or opportunities., 12. use previous facts and experiences to help develop stronger critical thinking skills in nursing., 13. establish priorities., 14. trust your knowledge and be confident in your abilities., 15. be curious about everything., 16. practice fair-mindedness., 17. learn the value of intellectual humility., 18. never stop learning., 4 consequences of poor critical thinking in nursing, 1. the most significant risk associated with poor critical thinking in nursing is inadequate patient care., 2. failure to recognize changes in patient status:, 3. lack of effective critical thinking in nursing can impact the cost of healthcare., 4. lack of critical thinking skills in nursing can cause a breakdown in communication within the interdisciplinary team., useful resources to improve critical thinking in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of critical thinking impact my nursing career, 2. usually, how long does it take for a nurse to improve their critical thinking skills, 3. do all types of nurses require excellent critical thinking skills, 4. how can i assess my critical thinking skills in nursing.

• Ask relevant questions • Justify opinions • Address and evaluate multiple points of view • Explain assumptions and reasons related to your choice of patient care options

5. Can I Be a Nurse If I Cannot Think Critically?

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Creative Ways to Enhance and Assess Critical Thinking in Nursing Students

Parker, Kimberly C.

About the Author Kimberly C. Parker, DNP, RN, is a clinical instructor, University of Alabama Capstone College of Nursing, Tuscaloosa, Alabama. For more information, contact her at [email protected] .

The author has declared no conflict of interest.

Nursing students should be challenged to implement critical thinking decisions regarding conclusions they implement for patient care. This article reinforces common techniques and introduces new practices to teach critical thinking. Many ways are currently recognized utilizing an assortment of techniques. The concepts from an escape room are a great way to deliver opportunities for students to practice this skill and can be provided economically and easily. Being creative in managing these concepts will offer an exciting chance to introduce critical thinking for your students.

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Critical Thinking in Nursing

Critical thinking in nursing definition critical thinking is an active, organized, cognitive process used to carefully examine one s thinking and the thinking of ... – powerpoint ppt presentation.

• Critical thinking is an active, organized, cognitive process used to carefully examine ones thinking and the thinking of others.
• Need to make accurate and appropriate clinical decisions
• Need to solve problems and find solutions
• Need to plan care for each unique client and client problem
• Need to seek knowledge and use it to make clinical decisions and problem solve
• Need to be able to think creatively when planning care for clients
• To develop into an expert critical thinker the nurse needs to use
• Basic Critical Thinking
• Complex Critical Thinking
• General critical thinking competencies used by many disciplines, in many everyday situations.
• Scientific method
• Problem solving
• Decision making
• Specific critical thinking in clinical situations used by physicians, nurses, and other health care professionals.
• Diagnostic reasoning/ Clinical inference
• Clinical decision making
• Specific critical thinking competency used in nursing practice
• Nursing Process
• Analysis (Nursing Diagnosis)
• Implementation
• The model helps to explain how nurses make clinical judgments/ decisions in their clinical practice that result in safe, effective, nursing care. There are 5 components in this model of critical thinking
• Knowledge base
• Experience in nursing
• Critical thinking competencies
• Attitudes for critical thinking
• Standards for critical thinking
• Thinking independently
• Responsibility and accountability
• Risk taking
• Perserverance
• Intellectual Standards-
• 14 intellectual standards (Paul,1993) Nurses use these when using the nursing process
• 1. Confidence 7. Perseverance
• 2. Independence 8. Creativity
• 3. Fairness 9. Curiosity
• 4. Responsibility 10. Integrity
• 5. Risk taking 11. Humility
• 6. Discipline
• Professional standards
• Sound ethical standards
• When critically thinking must have a sense of their own values, beliefs, feelings and their clients/ clients familys values, beliefs, feelings
• Scientifically based practice with standards developed by experts
• Evidenced based practice
• Standards developed as a result of evidence
• These are minimum requirements that are necessary to give quality effective care

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Critical Thinking in Nursing

Sep 06, 2012

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Critical Thinking in Nursing. Sheryl Abelew MSN RN. Chapter 4. Priority Setting. Priority Setting. Important step in the critical thinking process Includes effective time management

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Critical Thinking in Nursing Sheryl Abelew MSN RN

Chapter 4 Priority Setting

Priority Setting • Important step in the critical thinking process • Includes effective time management • Steve Covey (1989) states you should be “putting first things first”. There are three categories “must do, should do, and nice to do”. • Develop a time frame for priorities. ***Review box 4-2 Time Management Procedures

Prioritizing patient needs • Use Maslow’s hierarchy of needs • Five levels of needs • Physiologic needs • Sleep, food, water, movement, comfort • Psychological needs • Safety and security • Love and belonging • Affiliation, affection, intimacy • Self-esteem • Sense of self worth, self respect, dignity • Self-actualization • Recognition of potential growth, health, autonomy

Prioritizing Nursing Diagnosis • Place in level of priority High, Medium, and Low • High • Life threatening, threats to pt safety, pain, and anxiety, unstable or changes in condition • Medium • Problems that could result in unhealthy consequences, like emotional or physical impairment, but no threat on life • Low • Problems that can be resolved with minimal intervention and have little potential to cause dysfunction

Priority Activities • Four levels of priority according to Rubenfeld and Scheffer (1999) • Life Threatening Issues • ABC’s • Safety • Protecting the patient from injury, practicing within scope of nursing, doing no harm • Patient Priorities • Plan of care based on patient activities and condition • Nursing Priorities • Examine all the patients strengths and health concerns, moral and ethical and Maslow’s hierarchy of needs

Multitasking • Setting priorities is not linear • Addresses multiple concerns at the same time • Learning to take charge and make efficient use of time is key in time management • Making a to do list will help with multitasking

Prioritizing within the nursing process • Assessment • Obtain complete information and sort and ID problems • Analysis • Prepare list of needs and diagnosis • Outcome Identification • Have measureable goals based on Maslow, and prioritize diagnosis • Plan • Select diagnosis and activities • Implementation • Perform immediate actions to prevent harm first. Highest priority to lowest priority • Evaluation • May require reevaluation and/or adjustments

Pitfalls in priority setting • Priorities may change • Inadequate assessment of clients needs • Failure to differentiate priority and non priority tasks • Accepting others priorities without seeing the big picture • Performing tasks that were identified first vs. those that are a priority • Completing the easiest task first instead of the priority

Chapter 5 Nursing Process Applications

Nursing process • “Nursing Process is considered to be a specialized form of systematic inquiry or problem solving process used in drawing conclusions about the patient’s problems and the corresponding nursing actions to resolve problems.” Saucier, Stevens * Williams (2002).

Role of Nursing Process • Allows for a consistent use of standards and standardized language providing for a way to measure and quantify the effects of nursing care and interventions • In order to keep terms consistent, ANA recognizes NANDA as the official language of nursing diagnosis, NIC for interventions classification, and NOC for outcomes classifications

Steps of the nursing process • Assessment • Analysis (Diagnosis) • Outcome Identification • Plan • Implementation • Evaluation

Assessment • Collect data • Identify pertinent data • Recognize deviations from normal • Validate data • Sort and Organize data in a logical order • Identify patterns in the data

Analysis • Examine for unmet needs and strengths and health concerns • Focus on problems the nurse can change • Develop diagnosis based on facts • Validate the diagnosis • Establish priorities

Outcome Identification • Establish outcomes • Realistic • Achievable • Measureable • Collaborate to review goals to meet needs

Plan • How to develop your strategies for meeting nursing interventions • Use NIC for nursing interventions • Write plan of care using standardized language • Collaborate for planning delivery of care

Implementation • Initiate actions to accomplish goals • Manage care in order of priority • Delegate care based on caregiver, acuity, needs and plan of care • Intervene as necessary • Document interventions and response

Evaluation • Compare actual vs. expected outcomes • Communicate findings • Record attainment of goal • Review and modify POC based on needs

Care Plan • Written documentation of the nursing process • See Box 5-3 for care plan formation • See Table 5-5 for sample care plan scenario

Chapter 6 Delegation

Delegation • Transferring tasks to a competent individual • Used most commonly with a skill mix based on scope of practice • Consider job description when delegating

5 Rights of delegation • Right Task • Right Circumstance • Right Person • Right Direction and Communication • Right Supervision and Evaluation

Obstacles of delegation • Delegator reluctant to take the risk and give up control • Subordinate fails to take responsibility • Workplace issues

Delegation Procedure • Assessment • List patients need and assessment findings • Analysis • Level of care and acuity • Outcome identification • Establish priorities • Plan • Nurse specifies nature of tasks and skill required • Implementation • Delegation of tasks • Evaluation • Compare outcomes with the POC

Chapter 7 Communication

Levels of Communication • Three levels of Communication • Social • Interactions for building relationships • Therapeutic • Nurse listens to patient problems and focuses on needs • Collegial • Enhancing relationships with colleagues, improved pt care, and better documentation

Collaboration • Nursing Personnel • Delegating • Report • Interdisciplinary • Conflict resolution • Physician notification • Receiving phone calls

Written Communication • Documentation • One way to validate critical thinking • Keep confidential • Accurate and objective • Performed promptly

Chapter 8 Patient Teaching

Applying the nursing Process • Goal directed based on rationale thought processes • Involves critical thinking • Approached analytically

Learning needs assessment • 4 areas must be assessed • What the patient needs to learn • Characteristics of the patient • Patients preferred learning style • Whether patient is ready/willing to learn • Conduct a learning needs assessment • Assess cultural background • Developmental stage consideration • Literacy

Processes • Analyzing needs • Validate with the patient • Outcome identification • ID goals, clear objectives • Planning the lesson • Instructional methods • Traditional i.e. lecture, discussion • Non traditional i.e. role-playing, simulations, etc • Implementing educational session • Evaluating the educational process

Chapter 9 Applying clinical reasoning to various practice settings

Reasoning • When processing data, continually evaluate reasoning • Examine the evidence to determine what else is needed • Obtain and clarify data • Examine logic and give reasons for conclusions • Review the consequences of possible actions and draw conclusions if desired outcome can be obtained

Guidelines for decision making • Use professional standards as guidelines to decision making when evaluating patient circumstances, and then consider the textbook data, current diagnostic test findings, and assessments of the nurse • Nurses need to follow the regulations set forth according to scope of practice and standards of practice as well as the code of ethics for nurses when making decisions • Review box 9-2 pg 199

Application of cognitive skills • Nurse collects information and uses skill of interpretation to define what the patient is presenting as • Nurse establishes expected outcomes for interventions to determine if the problem will be resolved • After implementation, nurse will evaluate on an ongoing basis progress towards goals • After recognizing effects from intervention, nurse will offer rationale for the result • Lastly, nurse will reexamine thinking

Clinical Reasoning applications • Quality implies evaluation • Evaluation requires standards which define the acceptable levels of care • Nurse must evaluate actions to the professional practice standards from the ANA

Evaluating the workload • Indicators that identify impossible workload • Failure to monitor when indicated by patients condition • Inadequate treatment for circumstances • Excessive delay of treatments • Failure to provide ongoing care and treatments • Lack of time to provide patient teaching

Monitoring patient condition • Use clinical reasoning to monitor patients change of condition and respond with the appropriate intervention • Two examples of monitoring the patients condition • Calling the physician • When there is a change in condition • Pain without ordered meds that manage the pain • Acute elimination problems • Lab values that require orders • Risk to safety • Interpreting lab values • Are the findings abnormal and expected • Are the findings abnormal and unexpected • Are the findings normal

Pitfalls in clinical reasoning • Failure to use appropriate decision making skills • Failing to assess, report, or omissions • Failure to assess for changing of condition • Nurse fails to perform duties appropriately results in negligence

Chapter 10 Ethical decision making

Ethics • Ethics deals with the principles of right and wrong • Foundation of ethics is standards of conduct and moral judgment • Nurses must be aware of their own value system

Model of ethics • Choosing • Allows for free choice identifying alternatives and selecting alternatives • Prizing • Individual satisfaction with choice of verbalization to others • Acting (Internalization and repetition)

Ethical Guides Ethical Principles • Autonomy • Right to self-determination • Nonmaleficence • Directs the nurse does no harm • Beneficence • Doing good on the patients behalf • Justice • Moral obligation to treat people fairly and equally • Fidelity • Keeping your word and acting in the patient’s best interest • Veracity • Telling the truth

American Nurses code of ethics • ANA as developed a code of ethics • Nine statements define this code • Review pg 233 Box 10-3

Ethical decision making process • Assessment • Analysis • Outcome Identification • Plan • Implementation • Evaluation **

Assessment • Gather information to determine the facts that will have the most affect on the situation • Develop sensitivity to recognize ethical situation and its essence to nursing • Identify risks to the patients

analysis • Determine the values in conflict • Become aware of the relevant information • Values clarification • Generate multiple alternatives and rank in order of what is right and wrong • Explore emotional, social and physical risks to patient and staff

Outcome identification • Providing safe nursing care • Expected outcome should serve as a guide in making decisions • Use clearly stated outcomes for success to be measureable

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REGISTERED NURSE (Ambulatory Care Services Cardiac Rehab/ Cardiovascular Medicine Domino Farms)

Mission statement.

Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

Responsibilities*

• Provide complex nursing support to an extensive outpatient cardiac rehabilitation program.  
• Complete cardiopulmonary assessments, provide recommended treatment options, and respond to urgent./emergent situations
• Facilitate the intake process for cardiac rehabilitation and metabolic fitness. 
• Integrate with exercise physiologists, physicians, advanced practice providers, physical therapists, nutritionists, and other consulting services to provide high-quality patient care for inpatients and outpatients.
• Provide education on disease processes and cardiac rehab expectations. 
• Provide in-clinic support for cardiology, hyperlipidemia and hypertension patients.
• Utilize protocols to provide tele-management to cardiology patients, including but not limited to general cardiology, hypertension and hyperlipidemia patient populations. 
• Support Echocardiogram Lab through patient monitoring, facilitating dobutamine stress testing and contrast injections. 
• Assist in referral management through triage and ordering labs per protocol. 
• Participate in quality improvement and research initiatives.

Expectations 

• Demonstrate critical thinking skills through use of the nursing process, excellent problem-solving skills, and demonstrated ability to set priorities.
• Demonstrate customer service, interpersonal communication skills, and the ability to build respectful relationships within and between units and individuals.
• Demonstrate adaptability to changing needs and priorities based on unit, department, and institutional goals/objectives.
• Demonstrate knowledge and skills in providing patient and family education related to chronic conditions including, but not limited to, diabetes, metabolic syndrome, and coronary artery disease.
•  Proficiency with typing and electronic health record documentation.
• Ability to manage complex clinical issues utilizing assessment skills, protocols, and evidence-based interventions.

Nursing Specific Info

Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan medicine is comprised of over 26,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.

What Benefits can you Look Forward to?

Nursing at Michigan offers a competitive salary with excellent benefits!  

Hourly range for Registered Nurses $40.18-$62.31/ hour

• Evening Shift Differential-$3.00 / hour
• Night Shift Differential- $4.00 / hour
• Day Shift Weekend Differential- $2.90 / hour
• Evening Shift Weekend Differential- $5.90 / hour
• Night Shift Weekend Differential- $6.90 / hour
• Charge Nurse Differential- $1.00 / hour

The benefit package includes: 

• Excellent medical, dental and vision coverage
• 2:1 Match on retirement savings and immediate vesting
• Generous Paid Time Off Allowances
• Robust Tuition and Certification support programs
• Large offering of no cost CEs and professional development for advancement  

Required Qualifications*

• Current licensure as a Registered Nurse in the State of Michigan
• Required Educational Requirement: The applicant must have one of the following qualifications: a bachelor's degree in nursing (BSN) OR an associate degree or diploma in nursing and a master's degree in nursing.
• Minimum of three (3) years of recent (within the last five (5) years) of RN experience in Adult Cardiology
•  Hold ACLS certification or be willing to obtain it within 6 months of hire.

In order to be considered for this position the applicant must have met or will have met all the required qualifications prior to the start date of employment.

RESUME REQUIRED (for both internal & external applicants):  You must attach a complete and accurate resume and cover letter to be fully considered for this position.

Desired Qualifications*

• Experience as a nurse in a cardiac rehab setting. 
• Certified Cardiac Rehab professional by AACVPR or other clinical exercise certification
• Five (5) years of RN experience in Adult Cardiology
• Two (2) years of recent (within the last five (5) years) ambulatory care RN experience, including telephone triage.
• Experience with starting Peripheral IV?s in the last 2 years
• Experience with echocardiogram support in the last 2 years. 
• Experience as an RN with MiChart and/or EPIC.
• Previous participation in research and/or professional cardiology organization memberships. 
• Current ACLS certification 

Work Schedule

Hours: 32 hours per week, 8 hour shifts, 4 days per week 8-5. Shift days and hours could vary and potentially include evenings, weekends, and holidays. Location: This is an onsite position at Domino Farms with potential location change to other CVM locations including but not limited to Briarwood 05 or Frankel Cardiovascular Center, 

Additional Information

We, the staff and faculty of the U-M Cardiovascular Center (CVC) team, are committed to advancing medicine and serving humanity through living and teaching our core values of Respect and Compassion; Collaboration; Innovation; and Commitment to Excellence.

Each CVC employee is expected to understand and demonstrate that in every interaction we represent our entire organization in the care we provide and in the courtesies we extend to patients, families, and each respective team member.  The CVC is dedicated to partnering with patients and families to deliver the safest and highest quality of health care.  Applicants are expected to review the following PowerPoint presentation which provides an overview of the Cardiovascular Centers philosophy and culture:

www.med.umich.edu/cvc/pdf/cvcpotentialteam.pdf

Union Affiliation

This position is covered under the collective bargaining agreement between the U-M and the Michigan Nurses Association and the U-M Professional Nurse Council union, which contains and settles all matters with respect to wages, benefits, hours and other terms and conditions of employment.

Background Screening

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings.  Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

Selection Process

Michigan Medicine seeks to recruit and retain a diverse workforce as a reflection of our commitment to serve the diverse people of Michigan and to maintain the excellence of the University. We welcome applications from anyone who would bring additional dimensions to the University’s research, teaching, and clinical mission, including women, members of minority groups, protected veterans, and individuals with disabilities. The Department of Nursing, like the University of Michigan as a whole, is committed to a policy of nondiscrimination and equal opportunity for all persons and will not discriminate against any individual because of race, color, national origin, age, marital status, sex, sexual orientation, gender identity, gender expression, disability, religion, height, weight, or veteran status.   

U-M EEO/AA Statement

The University of Michigan is an equal opportunity/affirmative action employer.