Richard Paul's definition of critical thinking is adopted and the theoretical framework underlying the approach to learning is described. Critical thinking questions are designed to highlight important thought processes used to learn about caring for patients with the specific problems discussed in each chapter. Introductory Chapters: Includes a discussion of critical thinking and the elements of thinking, as well as step-by-step instructions on how to use the classroom preparation guidelines.
Revisitedsections for Critical Thinking: End each chapter and allow students to evaluate their own critical thinking skills. Quite unexpectedly, she noted that the method I used to teach undergraduate medical-surgical nursing reminded her of Richard Paul's published work on critical thinking. I would also like to acknowledge here other students, including Kirsten Boyd, Oni Cooper, Lucy Leete, Erin Molito, and Melissa Skehan, who saw the value of using critical thinking as a tool to learn about adult nursing.
I would like to thank Joanne DaCunha, editor, for recognizing that this book can contribute to the evolution of critical thinking in nursing.
Critical Thinking: Patient Problems 27 Chapter 3 Respiratory Problems 29
Chapter Outline 30
Learning Outcome Goals 30
Medical Nursing Care: Practice in Critical Thinking: Acute Care Situations 31
Medical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 43
Thinking: Acute Care Situations 54 Case Study: Lung Cancer 54
Critical Thinking Revisited 65 Suggested Readings/Resources 66
Cardiovascular Problems 67
Chapter Outline 68
Learning Outcome Goals 69
Medical Nursing Care: Practice in Critical Thinking Acute Care Situations 69
Medical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 79
Surgical Nursing Care: Practice in Critical Thinking: Acute Care Situations 90
Surgical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 99
Thinking: Acute Care Situations 102 Case Study: Peripheral Vascular Disease 102
Suggested Readings/Resources 114
Hematologic Problems 115
Chapter Outline 116
Learning Outcome Goals 116
Medical Nursing Care: Practice in Critical Thinking: Acute Care Situations 117
Medical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 127
Critical Thinking Revisited 138 Suggested Readings/Resources 140
Gastrointestinal Problems 141
Chapter Outline 142
Learning Outcome Goals 143
Medical Nursing Care: Practice in Critical Thinking: Acute Care Situations 143
Medical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 153
Surgical Nursing Care: Practice in Critical Thinking Acute Care Situations 163
Surgical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 174
Critical Thinking Revisited 185 Suggested Readings/Resources 187
Liver, Biliary, and Exocrine Pancreatic Problems 189
Chapter Outline 190
Learning Outcome Goals 191
Medical Nursing Care: Practices in Critical Thinking: Acute Care Situations 191
Thinking: Chronic Care Situations 203 Case Study: Pancreatitis 203
Surgical Nursing Care: Practice in Critical Thinking: Acute Care Situations 212
Surgical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 222
Critical Thinking Revisited 224 Suggested Readings/Resources 226
Endocrine Problems 227
Chapter Outline 228
Learning Outcome Goals 229
Medical Nursing Care: Practice in Critical Thinking: Acute Care Situations 229
Medical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 238
Surgical Nursing Care: Practice in Critical Thinking: Acute Care Situations 240
Surgical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 251
Critical Thinking Revisited 264 Suggested Readings/Resources 267
Reproductive Problems 269
Chapter Outline 270
Learning Outcome Goals 271
Medical Nursing Care: Practice in Critical Thinking: Acute Care Situations 271
Medical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 281
Surgical Nursing Care: Practice in Critical Thinking: Acute Care Situations 292
Critical Thinking Revisited 314 Suggested Readings/Resources 316
Immunologic Problems 317
Chapter Outline 318
Learning Outcome Goals 318
Medical Nursing Care: Practice in Critical Thinking: Acute Care Situations 319
Medical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 329
Surgical Nursing Care: Practice in Critical Thinking: Acute Care Situations 339
Surgical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 348
Critical Thinking Revisited 350 Suggested Readings/Resources 353
Musculoskeletal Problems 355
Chapter Outline 356
Learning Outcome Goals 357
Medical Nursing Care: Practice in Critical Thinking: Acute Care Situations 357
Medical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 367
Surgical Nursing Care: Practice in Critical Thinking: Acute Care Situations 377
Thinking: Chronic Care Situations 387 Case Study: Amputation 387
Critical Thinking Revisited 399 Suggested Readings/Resources 402
Renal Problems 403
Chapter Outline 404
Learning Outcome Goals 405
Medical Nursing Care: Practice in Critical Thinking: Acute Care Situations 405
Medical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 417
Surgical Nursing Care: Practice in Critical Thinking: Acute Care Situations 428
Surgical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 438
Critical Thinking Revisited 451 Suggested Readings/Resources 453
Neurological Problems 455
Chapter Outline 456
Learning Outcome Goals 456
Medical Nursing Care: Practice in Critical Thinking: Acute Care Situations 457
Surgical Nursing Care: Practice in Critical Thinking: Acute Care Situations 488
Critical Thinking Revisited 499 Suggested Readings/Resources 501
Sensory Problems 503
Chapter Outline 504
Learning Outcome Goals 504
Medical Nursing Care: Practice in Critical Thinking: Acute Care Situations 505
Medical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 516
Surgical Nursing Care: Practice in Critical Thinking: Acute Care Situations 526
Surgical Nursing Care: Practice in Critical Thinking Chronic Care Situations 535
Critical Thinking Revisited 544 Suggested Readings/Resources 546
Integumentary Problems 547
Chapter Outline 548
Learning Outcome Goals 548
Medical Nursing Care: Practice in Critical Thinking: Acute Care Situations 549
Class activity: Nursing care for persons recovering from the treatment of burns with skin grafting 561 Surgical nursing care: practice in critical conditions.
Thinking: Acute Care Situations 561 Case Study: Malignant Melanoma 561
Surgical Nursing Care: Practice in Critical Thinking: Chronic Care Situations 570
Suggested Readings/Resources 575
Critical Thinking: Complex Patient Problems 577
Complex Nursing Care Situations: Implications of Potential Trajectories of Illnesses 579
Chapter Outline 580
Learning Outcome Goals 580
Critical Thinking Revisited 617 Suggested Readings/Resources 619
Critical Thinking: The Foundation
Critical Thinking: A Theoretical Basis
Critical Thinking: Applying It to Practice
Critical Thinking
A Theoretical Basis
Is critical thinking a tool for students to deepen and expand their knowledge of nursing when.
Is critical thinking a tool that students can use to deepen and broaden their knowledge of nursing care as they
Chapter Outline
Learning Outcome Goals
To learn the definition of critical thinking used in this workbook 2. To understand how creative and critical thinking are related
To know the theoretical underpinnings and concepts of Paul’s framework of critical thinking
To understand the rationale for learning critical thinking skills in nursing today
A Definition of Critical Thinking
Creativity and Critical Thinking
Critical Thinking and Case Studies
Paul’s Theoretical Framework of Critical Thinking
Critical thinkers are able to clearly show the purpose of their thinking in relation to a situation or problem. Critical thinkers identify purposes and goals that are worthwhile, significant, and achievable as opposed to those that are insignificant, trivial, or unrealistic. Critical thinkers consistently articulate points of view other than their own, knowing that another person's point of view may be different, especially regarding issues that are controversial.
Critical thinkers are aware of the key concepts and ideas they are using and can distinguish between those that are relevant and those that are not in their writing. Critical thinkers are able to explain the meaning and application of the concepts and ideas they use. Critical thinkers make assumptions that are clear, reasonable, and consistent and do not contradict each other.
Critical thinkers identify and articulate a number of important implications and consequences of their reasoning.
The Traits of a Critical Thinker
Critical thinkers state information and evidence clearly, fairly, and coherently, drawing conclusions only to the extent that they have supporting data. Thinking about an issue using reasoning requires a critical thinker to understand the implications and consequences that flow from it. They are able to look for the negative and positive implications of their reasoning and anticipate the likelihood of unexpected consequences.
Conclusions that can be made, for example, since this has been shown, therefore it is possible. All reasoning involves inferences by which we make sense of data and arrive at a conclusion. Critical thinkers draw conclusions that are clear and deep, rather than superficial, and that come from evidence and are consistent with each other.
Using Critical Thinking as a Learning Tool in Nursing
Summar y and Conclusions
Applying It to Practice
How does the method work?
To develop critical thinking skills through learning how to use the Prepa- ration for Class Guidelines and the elements of thought for each Prepara-
FACTS
NURSING CARE ISSUES AND CONCERNS (INCLUDE THOSE RELATED TO AGING) 4. ASSESSMENT AND TENTATIVE NURSING DIAGNOSES
NURSING INTERVENTIONS a. Nursing diagnosis (retained)
Directions for Using the Preparation for Class Guidelines
- EVALUATION OF OUTCOMES a. Nursing diagnosis (retained)
- HEALTHCARE PROFESSIONALS AND MEDICAL CARE NEEDED 10. ADDITIONAL QUESTIONS ABOUT THIS PATIENT’S NURSING CARE
- ELIMINATION 4. ACTIVITY-EXERCISE
- COGNITIVE-PERCEPTUAL
Are the inferences I have made in raising issues and concerns supported by the facts and information I have found in the literature and/or in the textbook? Usually, the information nurses have about the patients they care for is incomplete or not as recent and current as they would like. In formulating these nursing diagnoses, the information I focused on clearly and accurately related to the individuals in the situation.
Are the concepts, theories, or principles clearly connected based on the facts and information I found in the literature or textbook. Are modifications needed in this person's environment to enable the person to function in the hospital. Make decisions about the tentative nursing diagnoses you have listed, based on the level of priority of each, to the situation of the individual in the case study.
Do the results match the information I have about the problem in this person's situation?
Applying the Preparation for Class Guidelines to a Case Study
In the emergency room, an X-ray of Mr Ryder's hip showed that the head of the right femur had been fractured. Casts, splints, braces, types of traction, and nursing care related to each are included in the following sections. Students may assume that Mr. Ryder's care must be similar to that described in the textbook.
Generic physiologic nursing diagnoses that relate to the care of any patient with a hip fracture have already been identified in the manual care plan. Ryder's situation depends on the information they find in the medical-surgical textbook and the nursing diagnosis book. In the postoperative period he is given pain medication with medications that are suitable for the elderly patient.
In the immediate postoperative period, impaired physical mobility related to hip precautions and acute pain related to the surgical procedure are the highest priority problems.
Classroom Activities
Answers will vary based on the students' experiences and what each remembers from reading as they prepare for class. Given the information you have, what do you think happens in the new situation. The classroom activities require discussion and each group reporting its decisions and solutions to the class.
Critical Thinking: How to design instruction so that students master content in a deep and thoughtful way. Paper presented at the 14th International Critical Thinking Conference, Sonoma State University, Rohnert Park, CA. Paper presented at the 14th Annual International Conference on Critical Thinking and Educational Reform, Sonoma State University, Rohnert Park, CA.
Paper presented at the 15th Annual International Conference on Critical Thinking and Educational Reform, Sonoma State University, Rohnert Park, CA.
Patient Problems
Respiratory Problems
How do problems of oxygenation from respirator y dysfunction show themselves in the patterns of an
To use reasoning skills to learn about the care of patients with respiratory dysfunction
To apply principles related to the disruption of gas exchange when caring for individuals with respiratory problems
How do oxygenation problems appear from respiratory dysfunction y in models of a. The case studies in this chapter are divided into medical and surgical management of acute and chronic diseases. In both acute and chronic care situations, your knowledge of anatomy, physiology, and pathophysiology is the basis for learning about the care of individuals with these problems, and you are required to apply intellectual standards to the elements of reasoning when learning about the care of these individuals. .
Do you have all the facts you need to start planning care for someone with similar problems to the individual in the case study. Are you aware of your position in this situation and why you have that position. Are you aware of the consequences of the interventions you recommend when planning your care?
A sputum sample obtained in the emergency room was bloody and mucous, and a chest x-ray shows bilateral multilobar consolidation.
Literature Review
Facts
Nursing Care Issues and Concerns (include those related to aging)
Assessment and Tentative Nursing Diagnoses a. Functional health patterns
Clinical Data a. Lab values
Decision Making
Nursing Interventions
Evaluation of Outcomes
Healthcare Professionals and Medical Care Needed
Additional Questions about This Patient’s Nursing Care
His skin was pale and dry, his sputum production was less than when he was first admitted, and he was dyspneic and tagynpneic. Perry did not respond as expected to the prescribed antibiotics and bronchodilators, the nurse administered prescribed nasal oxygen at a low liter flow rate and notified the physician immediately. He sat up in the emergency room with his hands and arms over a bedside table and used the muscles in his shoulders to breathe.
Preparation for class: Nursing care of a person with chronic airway limitation or chronic obstructive pulmonary disease. Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 53 On a crisp, cold fall morning in New England, Anne Brown, age 21, returned home out of breath after jogging in her neighborhood. In the emergency room, the nursing assessment included Anne's response to the dyspnea scale as a measure of her perception of her own difficulty breathing.
Beta agonists were administered intravenously and Anne finally showed the expected response to the therapies. His wife explained that he was less and less active because of his breathing problems. He was informed of the option of surgical removal of the tumor, and agreed to undergo a lobectomy.
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 61 Nursing Diagnosis (Maintained) Nursing Interventions.
Answer the chapter opening question
Answer the following questions
Did you notice that the concepts, theories and principles you used to plan care for each of the individuals in the given situations were clear and relevant. Were the implications for identifying missing information and implications for the nursing intervention relevant to the care of each individual in the situation.
Cardiovascular Problems
What are the similarities and differences in managing an individual’s problems of oxygenation due to cardiovascu-
To use reasoning skills to learn about the care of patients with cardiovas- cular dysfunction
To apply principles related to the disruption of hemodynamic and/or vas- cular function when caring for individuals with cardiovascular problems
Critical Thinking: An Interactive Tool for Learning Medical-Surgical Nursing 109 Nursing Diagnosis (Retained) Nursing Interventions.
Hematologic Problems
How are dysfunctions of the hematologic system expressed as problems of oxygenation in adults and the elderly?
To use reasoning skills to learn about the care of patients with hematologic dysfunction
To apply principles related to increased risk for infection, disruptions in clotting, and decreased oxygenation when caring for individuals with
To prepare patients for hematologic procedures, treatments, and surgery
In both acute and chronic care situations, your knowledge of anatomy, physiology, and pathophysiology is the basis for learning about the care of people with these problems, and you are asked to apply intellectual standards to the elements of reasoning when learning about the care of these people . Morgan was outside and had tears in her eyes every time her family or friends visited her in the hospital. While in the hospital, his hemoglobin ranged from 7 to 10 mg/100 mL and his bilirubin remained elevated.
Kline was admitted to the local hospital, but she wanted to wait until after her wedding, planned in the near future, for a full examination and evaluation of her problem. In addition, she complained of inflamed mucous membranes and cracks in the corners of her lips. Was the purpose or goal of providing nursing care to the individuals in the situations logical and clearly understood.
Describe the assumptions you made about the individuals in the situations, including the older adults, before you began this task. Did the information you focused on in formulating nursing diagnoses, identifying interventions, and evaluating outcomes clearly and accurately relate to individuals in given situations. Did you identify the conclusions you made in assessing, diagnosing, planning, and evaluating nursing care that were consistent with and appropriate for the priorities of care in each situation?
Was your point of view broad enough, logical and realistic when you considered each situation in the case studies.
Gastrointestinal Problems
What are the fundamental differences in the underlying pathophysiology of the various gastrointestinal problems
To use reasoning skills to learn about the care of patients with gastroin- testinal dysfunction
To apply principles related to nutritional disruptions when caring for indi- viduals with gastrointestinal problems
Class Activity: Nursing Care of Individuals with Ulcer Disease Directions: Answer each of the following.
