•Your challenge is to draw four straight lines which go through the middle of all of the

dots without taking the pencil off the paper.

•If you were using a pencil, you must start from any position and draw the lines one
after the other without taking your pencil off the page.
•Each line starts where the last line finishes
Thinking is the hardest work there
is, which is probably why so few
engage in it.
-Henry Ford
Lessons Learned from the Puzzle
• Look beyond the current definition of
the problem

• Investigate the boundaries

• Hard work is not the solution

Are you thinking right now?
What is CRITICAL THINKING?
The process of actively and skillfully conceptualizing,
applying, analyzing, synthesizing, & evaluating
information to reach an answer or conclusion

It is thinking that is purposeful, reasoned, and goal

directed

It is searching, plotting, making associations,

explaining, analyzing, probing for multiple angles,
justifying, scrutinizing, making decisions, solving
problems, and investigating

It is literally thinking about something from many

angles
 Why be CRITICAL ???
It fosters understanding of issues

It enables you to quickly find answers to

difficult questions.

It enhances your ability to identify

patient’s needs.

It also enables you to use sound clinical

decision making and to determine which
nursing actions best meet a patient’s
needs.
Developing critical thinking skills Part of being
a critical thinker
Always asking questions and is asking the right
questions and
learning digging to find the
right answers

“What’s the patient’s diagnosis?”

• What are the signs and symptoms?
• What’s the usual cause?
• What complications can occur?
• What are the patient’s physical examination
findings?
• What laboratory and diagnostic tests are
necessary?
• Does the patient have any risk factors? If so, are
they significant? What interventions would minimize
those risk factors?
Developing critical thinking skills Part of being
a critical thinker
Always asking questions and is asking the right
questions and
learning digging to find the
right answers

• What are the possible complications? What type of

monitoring is needed to watch for complications?
• What are the usual medications and treatments for
the patient’s condition?
• What are the patient’s cultural beliefs? How can you
best address the patient’s cultural concerns?
Step 1: Assessment

To obtain assessment data:

• ask relevant questions
• validate evidence or data that has been
collected
• identify present and potential concerns.

Then be sure to analyze the assessment

data and determine the nursing diagnoses.
Step 2: Planning

During the planning stage, critical thinking

skills come in handy when considering
how the patient is expected to achieve goals.

During this stage, consider the consequences

of planned interventions. This is also the
time to set priorities of care for the patient.
Step 3: Implementation
During the implementation stage, use critical thinking to involve
the patient and other members of the health care team in
implementing
the care plan.

Step 4: Evaluation
During the evaluation stage, use critical thinking to continually
reassess, modify, and individualize care. Evaluation enables you
to assess the patient’s responses and determine whether
expected outcomes have been met.
a workout for the mind. Applying the nursing process
requires critical thinking
It’s a workout for
the mind. Applying
the nursing
process requires
CRITICAL
THINKING.
 Fact Vs Opinion Exercise

• Is each statement below a fact or an opinion?

1. If made into law, the Lokpal bill would be the best in
terms of anti corruption law in India.
2. Anna Hazare started a Satyagraha movement by
commencing an indefinite fast in New Delhi to
demand the passing of the bill.
3. “Gandhi” is the best movie ever made.
4. Lincoln was the best president to ever head the
United States.
5. All MBA students will get a good placement
PATIENT ASSESSMENT

• Know : medical history, social history, medical interventions

• See : airway patency, pallor, sweating, mental state, posture, facial
expression, general condition
• Find : respiratory care, adequacy of oxygenation, pulse, blood
pressure, urine output, conscious level, monitor for changes in any of
the above

( Norman & Cook, 2000)

CRITICAL CARE NURSING

• Constant and rapid assessment: close monitoring and respond to

treatment
• Providing appropriate nursing interventions
• Documenting and reporting
• Observing mental state of family state
• Maintaining a spiritual attitude
A, B, C, D, E MODELS

• Airway: patent
• Breathing: respiratory rate
• Circulation: pallor, hemorrhage
• Disability:altered conscious level
• Expose to examine: unseen haemorrhage, wound leakage
( Smith, 2000)
PATIENT MONITORING

• Information from monitoring equipment

• Accuracy of equipment
• Compare with manual recordings
• Assess ,record and analyze findings frequently / continuously
PATIENT SAFETY

• errors due to hectic and complex environment

• compromised physiologic interventions
• multiple technologic and pharmacologic interventions, care provider
• Work at a fast pace
IMMEDIATE CARE

• Administer oxygen via face mask

• Maintain client safety
• Maintain fluid replacement
• Monitor cardiac instability
• Monitor urine output hourly
• Arterial blood gas analysis
• Referral to critical care
INVESTIGATIONS

• Haematology
• Biochemistry
• X-ray
SUBSEQUENT CARE

• Monitor continuously
• Position : upright
• Conscious level
• Intravenous therapy
• Medication :Analgesia and antibiotics
• Nil by mouth blood sugar levels
• Oral and tube feeding
• Document client’s response
ETHICAL ISSUES

• ethnic and religious doctrines that limit treatment options

• allocation of resources that may limit admission or promote
premature discharge
• Use of critical care beds for terminally ill clients
• Discontinuation of resuscitation or life support measures
ETHICAL ISSUES
Ethical issues in acute care commonly occur when the nurse is
caught in the middle between clients, physicians, administrators,
and Other nurses and feels powerless to change the situation.
Ethical distress can lead to negative consequences for everyone
involved.
Nurses are often called on to assist families in making informed
decisions about client care, and they must be familiar with
ethical, legal, economic, and emotional factors that affect the
family's decision.
LEGAL ISSUES

Nurses have more responsibility today than in the past.

Expanded roles open the doors to greater legal risk.
The nurse's employer is obligated to carry malpractice insurance
for its employees.
You should know what is covered in the policy.
In addition, you should consider carrying individual malpractice
insurance.
LEGAL ISSUES
PROPER DOCUMENTATION is crucial to serve asevidence of the
quality of nursing care provided.
The court still assumes that if something was not noted in a chart, it
was not done.
Be specific, and document nursing actions taken and the client's
response (e.g., pain reduction).
If unusual events occur, complete an incident report.
The benefit of incident reports is that they allow analysis of adverse
client events.
CLINICAL MAPPING
24 hour Individualized Plan
assessment
Collaborative care

medication CRITICALLY ILL CLIENT

Monitoring
evaluation

intervention
CONCLUSION

• the experience of critical illness has a profound effect on the client,

family and nurses
• Nurses and family interventions played an important role in the
recovery of client
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