Systematic and comprehensive assessment. Detection of bias and determination of information credibility. Identification of assumptions and inconsistencies. Development of reasonable conclusions based on evidence.
Determination of individual outcomes with a focus on results. Risk management; priority setting. Effective communication. Individualization of interventions. Nurses also need to possess personal CTIs that support the critical thinking characteristics. The four domains of critical thinking are elements of thought, abilities, affective dimensions, and intellectual standards. Critical thinking involves the use of cognitive skills and working through dispositions or the way a person approaches life and living.
One way that psychiatric-mental health nurses use critical thinking as a framework for clinical decision making is to answer a structured series of questions either through individual reflection or in consultation with other nurses. Reflecting on and answering these questions can promote critical thinking involving cognitive skills and dispositions when a psychiatric-mental health nurse is engaged in the interpersonal relationship and faces a clinical problem in delivering care.
One example of psychiatric-mental health nurses using critical thinking skills to solve patient care problems may include situations that involve the need to alter a noneffective plan of care after a nurse—patient interaction.
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Another example may occur when the nurse requests clinical supervision to better understand how personal feelings may be influencing the nurse—patient relationship. Thus, the nursing process integrates critical thinking skills and clinical decision making.
Nurses use the nursing process to deliver safe, effective therapeutic nursing care regardless of the setting.
The challenge for psychiatric-mental health nurses is to integrate the specialized focus of their work with patients—the therapeutic use of self within the interpersonal relationship—with their nursing process skills. Both the nursing process and the interpersonal relationship reflect a problem-solving approach to providing care. Their integration is important because it is the foundation for sound clinical decision making in psychiatric-mental health nursing.
Recall from Chapter 2 that Peplau identified four phases of the interpersonal relationship: orientation, identification, exploitation, and resolution. These phases closely parallel the stages of the nursing process. Figure depicts the correlations among critical thinking, clinical decision making, the interpersonal relationship, and the nursing process.
Psychiatricmental health nurses integrate the nursing process and the interpersonal relationship for sound clinical decision making in psychiatricmental health nursing. The first stage of the nursing process is assessment, which involves the collection of patient data through a patient history and physical assessment. For the psychiatric-mental health patient, a mental status examination and psychosocial assessment are essential components. This data collection process is ongoing, with the nurse continuously updating and validating the information.
In some clinical situations, a psychiatric-mental health nurse will have information about the patient before meeting him or her. This information may come from a variety of sources. The nurse uses observation skills to gather clinical information that can guide nursing interventions in the orientation and identification phases of such a relationship.
Nursing Fundamentals DeMYSTiFieD: A Self-Teaching Guide
A nurse might encounter a psychiatric patient in a hospital unit day room after an angry outburst in which the patient threatens to harm himself or herself. Figure Interrelationship among critical thinking, clinical decision making, the interpersonal relationship, and the nursing process. Information that a psychiatric-mental health nurse has before meeting the patient, whether it is historical in nature or immediately in the here and now, can trigger a range of reactions for the nurse.
The psychiatric nurse needs to develop self-awareness about how either a stereotypically biased reaction e.
How Would You Respond? The assessment stage begins when the patient and nurse meet, often for the first time. Whether this is an encounter where the nurse meets the patient for the first time or the patient is known to the nurse from a previous therapeutic relationship and has now returned for further help, the assessment stage and the orientation and identification phases set the stage for how the nursing process and interpersonal relationship will unfold. Anxiety for both the nurse and the patient is common during this time because each has preconceptions about the other as well as uncertainty about how and if help can be provided.
The nurse collects biopsychosocial clinical assessment data using the formats specific to the setting, for example, the hospital unit, emergency department, community agency, residential setting, or home health care setting. This clinical assessment occurs within the nurse—patient relationship. Make your own flashcards that can be shared with others.
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