评判性思维和护理临床决策.ppt

,第七章评判性思维和护理临床决策,CriticalThinkingandDecision-makinginNursing,NursingSchoolofSecondMilitaryMedicalUniversity,MainTopics:,Whyandwhichthinkingisimportanttonurse?Whatisthedefinitionandcomponentsofcriticalthinkingandwhyitisimportant?Howtoimprovethenursescriticalthinkingability?Whatsclinicaldecisionmakingandhowtomakeclinicaldecisions?,SignificanceofNursingThinking,思维形态,动作思维形象思维（直观思维）抽象思维（逻辑思维）,思维探索答案方向,求异思维（发散思维）求同思维（聚合思维）,思维是否具有新颖性、独创性,再生性思维创造性思维,Everybodythinksallthedayandallthetime.,思维的类型,Scenario：ItsTuesday.Youreonthewaytoclassroomandthesethoughtsaregoingthoughyourmind:“Ihavesomuchtodoanatomy(解剖)testonWednesday,Physiology(生理学)paperdueonThursday.Ireallywantedtogetahaircut.DoIreallyhavetoshoptomorrow?Hey,whataninterestinglookingmanthatisonthecorner.ImstarvingWhatcanIeat?”,Aimlessthinking,Think,Purposefully,Dialectically,Dynamically,Critically,Initiatively,评判性思维（criticalthinking）,20世纪30年代德国法兰克福学派创立一种批判理论和思维方式70年代开始运用于教学本质是反思能力和建设性批判精神,History,80年代初，被引入护理护理科学的理论基础和哲学基础1992年，美国护理联盟（theNationalLeagueforNursing，NLN）把评判性思维列入评审护理学院的必须标准。,护理科学的理论基础和哲学基础,评判性思维（criticalthinking）,History,OneofthecorecompetenciesOneofthehottopics,Bandman(1988):“therationalexaminationofideas,inferences,assumptions,principles,arguments,conclusions,issues,statements,beliefs,andactions.”,评判性思维（criticalthinking）,Definitions,“对思想、推理、假设、原则、争议、结论、问题、说明、信念和行动的理性检验。”,Kozieretal（2000）:Critical:not“eagertofindfault”but“capableofjudgingcarefullyandaccurately.”Thinking:tohaveanopinion,toreflecton,tocalltomind,todevisebythinking,toformamentalpictureof(image),toreason.,评判性思维（criticalthinking）,Definitions,“评判性的”不是指“急于发现问题”，而是指“仔细地、正确地判断能力”；“思维”是指有思想、有反思、有回忆、有设计发明、有想象和有推理。,Kozieretal（2000）:Criticalthinking:“apurposefulmentalactivityinwhichideasareproducedandevaluated,plansmade,anddesiredconclusionsdetermined.”,评判性思维（criticalthinking）,Definitions,“一个有目的的、产生思想并对其进行评价，制定计划和确定理想结论的智力活动过程。”,Alfaro-LeFevre(1999):Entailspurposeful,outcome-directed(results-oriented)thinking.Isdrivenbypatient,family,andcommunityneeds.Isbasedonprinciplesofnursingprocessandscientificmethod.Requiresknowledge,skillsandexperience.,评判性思维（criticalthinking）,Definitions,必须是有目的的、结果导向的思维；受患者、家庭、社区需要的驱动；以护理程序和科学方法原则为基础；需要知识、技能和经验；,Alfaro-LeFevre(1999):Isguidedbyprofessionalstandardsandethicscodes.Requiresstrategiesthatmaximizehumanpotentialandcompensateforproblemscreatedbyhumannature.Isconstantlyreevaluating,self-correcting,andstrivingtoimprove.,评判性思维（criticalthinking）,Definitions,受职业标准和伦理规范的指导；需要一定的策略，如：运用个人力量来发挥人类最大潜能的策略，弥补人性弱点的策略；需要不断地再评估、自我修正并努力改进。,评判性思维首先是一种理性思维，护理运用强调的是一种观念、一种意识评判性思维理论是一个完整体系反思（Reflection）和推理（rationalreasoning）是评判性思维的实质过程临床决策是护理评判性思维的核心目的护理程序是评判性思维的应用工具,评判性思维（criticalthinking）,Definitions,GeneralcriticalthinkingCriticalthinkinginclinicalsituationsSpecificcriticalthinkinginnursing,评判性思维（criticalthinking）,Types,SpecificKnowledgeBase(专业基础知识)Experience（经验）SkillsinCriticalThinking（思维技能）AttitudesforCriticalThinking(态度倾向),Criticalthinkinginnursing,Components,SkillsinCriticalThinking,Isthecorecomponent.CriticalanalysisInductivereasoningDeductivereasoning,Criticalthinkinginnursing-Components,Case：Withthecaringexperienceof35childrenundergoingmaxillarysurgery,severalconclusionsofperi-operationalinterventionsformaxillarysurgerypatientsaredrawnasfollows:123,归纳法（induction）,Case：Apatientunderwentapartialgastrectomyoperationthismorning.Thesurgeonprescribedasfollows:1.Followingnursinginterventionsforthepatientsundergoinggeneralanesthesia2.,演绎法（deduction）,SkillsinCriticalThinking,Sixcriticalthinkingcognitiveskills：interpretation,analysis,evaluation,inference,explanationandself-regulation,AmericanPhilosophicalAssociation(APA,1990),Criticalthinkinginnursing-Components,1.Confidence.2.Independenceofthought.3.Fairness.4.Integrity.5.ResponsibilityandAccountability.6.Curiosity.7.RiskTakingandcourage.8.Creativity.9.Perseverance.10.Humility.,AttitudesforCriticalThinking,Criticalthinkinginnursing-Components,CommitmentLevelComplexLevelBasicLevel,LevelsofCriticalThinkinginNursing,尽职层次复杂层次基础层次,Strader(1992):“theprocessofestablishingcriteriabywhichalternativecoursesofactionaredevelopedandselected.”,Definitions,Clinicaldecisionmakinginnursing,SmithH.andDonald(2002):Aproblemsolvingactivitythatfocusesondefiningclientproblemsandselectingappropriatetreatmentinterventions.,Roche(2002):Acomplexprocessinwhichnursescombinetheoreticalknowledgewithpracticalexperiencetomakejudgmentsregardingclientcare.,Definitions,Clinicaldecisionmakinginnursing,Kozieretal(2000):Acriticalthinkingprocessforchoosingthebestactionstomeetadesiredgoal.,护理临床决策就是护士在临床护理实践过程中，对面临的现象或问题，从所拟定的若干个可供选择的方案中做出决断并付诸实施的过程。,Definitions,Clinicaldecisionmakinginnursing,Ethicaldecisionmaking护理伦理决策Clinicaldecisionmaking护理临床决策Managerialdecisionmakinginnursing护理管理决策,Classifications,Decisionmakinginnursing,Theclassificationisnotabsolutely!,Identify/DefinetheProblem确定问题StatetheGoals/IdentifytheObjectives陈述目标SeekAlternativesandMakeChoices寻求备择方案并做出决策ImplementtheSolutions实施方案EvaluateandFeedback评价和反馈,Processsteps,Decisionmakinginnursing,PersonalFactors/IndividualFactors,InfluencingFactors,ClinicalDecisionmakinginnursing,ValuesPastExperienceKnowledgeBaseIndividualPreferenceandRiskWayofThinkingEmotionalIntelligencePersonalCharacteristics,EnvironmentalFactors,InfluencingFactors,ClinicalDecisionmakinginnursing,ThephysicalenvironmentalfactorsThesocialenvironmentalfactors,SituationalFactors,InfluencingFactors,ClinicalDecisionmakinginnursing,Anxiety,Stress,FatigueFreedom,Rationality,andVoluntarilyRelatedInformationRisksInvolvedTimeLimitationsComplexityofDecisionMakingTask,Whatmajoroutcomes/resultsdoIhopetoachieve?Whatproblemsorissuesmustbeaddressedtoachievethemajoroutcomes?Whatarethecircumstances(whatisthecontext)?Whatknowledgeisrequired?Howmuch