評(píng)判性思維和護(hù)理臨床決策講解課件

1、評(píng)判性思維和護(hù)理臨床決策講解課件評(píng)判性思維和護(hù)理臨床決策講解課件Main Topics:Why and which thinking is important to nurse?What is the definition and components of critical thinking and why it is important?How to improve the nurses critical thinking ability? Whats clinical decision making and how to make clinical decisions?Main Topi

2、cs:Why and which thinSignificance of Nursing ThinkingSignificance 思維形態(tài)動(dòng)作思維形象思維（直觀思維）抽象思維（邏輯思維）思維探索答案方向求異思維（發(fā)散思維）求同思維（聚合思維）思維是否具有新穎性、獨(dú)創(chuàng)性再生性思維創(chuàng)造性思維Everybody thinks all the day and all the time.思維的類型思維形態(tài)動(dòng)作思維思維探索答案方向求異思維（發(fā)散思維）思維是否Scenario ：Its Tuesday. Youre on the way to classroom and these thoughts ar

3、e going though your mind: “I have so much to doanatomy(解剖) test on Wednesday, Physiology(生理學(xué)) paper due on Thursday.I really wanted to get a hair cut.Do I really have to shop tomorrow?Hey, what an interesting looking man that is on the corner.Im starvingWhat can I eat?” Aimless thinkingScenario ：Its

4、 Tuesday. YoureThinkPurposefullyDialecticallyDynamicallyCriticallyInitiativelyThinkPurposefullyDialectically評(píng)判性思維（critical thinking）20世紀(jì)30年代德國(guó)法蘭克福學(xué)派創(chuàng)立 一種批判理論和思維方式70年代開(kāi)始運(yùn)用于教學(xué) 本質(zhì)是反思能力和建設(shè)性批判精神History評(píng)判性思維（critical thinking）Histor80年代初，被引入護(hù)理 護(hù)理科學(xué)的理論基礎(chǔ)和哲學(xué)基礎(chǔ)1992年，美國(guó)護(hù)理聯(lián)盟（the National League for Nursing，NLN

5、）把評(píng)判性 思維列入評(píng)審護(hù)理學(xué)院的必須標(biāo)準(zhǔn)。 護(hù)理科學(xué)的理論基礎(chǔ)和哲學(xué)基礎(chǔ)評(píng)判性思維（critical thinking）HistoryOne of the core competencies One of the hot topics護(hù)理科學(xué)的理論基礎(chǔ)和哲學(xué)基礎(chǔ)評(píng)判性思維（critical tBandman(1988):“the rational examination of ideas, inferences, assumptions, principles, arguments, conclusions, issues, statements, beliefs, and actions.

6、 ”評(píng)判性思維（critical thinking）Definitions“對(duì)思想、推理、假設(shè)、原則、爭(zhēng)議、結(jié)論、問(wèn)題、說(shuō)明、信念和行動(dòng)的理性檢驗(yàn)?！?Bandman(1988):“the rational exKozier et al（2000）:Critical: not “eager to find fault” but “capable of judging carefully and accurately.” Thinking: to have an opinion, to reflect on, to call to mind, to devise by thinking, to

7、form a mental picture of (image), to reason. 評(píng)判性思維（critical thinking）Definitions“評(píng)判性的”不是指“急于發(fā)現(xiàn)問(wèn)題”，而是指“仔細(xì)地、正確地判斷能力”； “思維”是指有思想、有反思、有回憶、有設(shè)計(jì)發(fā)明、有想象和有推理。Kozier et al（2000）:評(píng)判性思維（critiKozier et al（2000）:Critical thinking: “a purposeful mental activity in which ideas are produced and evaluated, plans made,

8、 and desired conclusions determined.” 評(píng)判性思維（critical thinking）Definitions“一個(gè)有目的的、產(chǎn)生思想并對(duì)其進(jìn)行評(píng)價(jià)，制定計(jì)劃和確定理想結(jié)論的智力活動(dòng)過(guò)程?！盞ozier et al（2000）:評(píng)判性思維（critiAlfaro-LeFevre(1999) :Entails purposeful ,outcome-directed (results-oriented) thinking.Is driven by patient, family, and community needs.Is based on principl

9、es of nursing process and scientific method.Requires knowledge, skills and experience.評(píng)判性思維（critical thinking）Definitions必須是有目的的、結(jié)果導(dǎo)向的思維；受患者、家庭、社區(qū)需要的驅(qū)動(dòng)；以護(hù)理程序和科學(xué)方法原則為基礎(chǔ)；需要知識(shí)、技能和經(jīng)驗(yàn)； Alfaro-LeFevre(1999) :評(píng)判性思維（crAlfaro-LeFevre(1999) :Is guided by professional standards and ethics codes.Requires strate

10、gies that maximize human potentialand compensate for problems created by human nature.Is constantly reevaluating, self-correcting, and striving to improve. 評(píng)判性思維（critical thinking）Definitions受職業(yè)標(biāo)準(zhǔn)和倫理規(guī)范的指導(dǎo)；需要一定的策略，如：運(yùn)用個(gè)人力量來(lái)發(fā)揮人類最大潛能的策略，彌補(bǔ)人性弱點(diǎn)的策略；需要不斷地再評(píng)估、自我修正并努力改進(jìn)。 Alfaro-LeFevre(1999) :評(píng)判性思維（cr評(píng)判性思維首

11、先是一種理性思維，護(hù)理運(yùn)用強(qiáng)調(diào)的是一種觀念、一種意識(shí) 評(píng)判性思維理論是一個(gè)完整體系 反思（Reflection）和推理（rational reasoning）是評(píng)判性思維的實(shí)質(zhì)過(guò)程 臨床決策是護(hù)理評(píng)判性思維的核心目的 護(hù)理程序是評(píng)判性思維的應(yīng)用工具 評(píng)判性思維（critical thinking）Definitions評(píng)判性思維首先是一種理性思維，護(hù)理運(yùn)用強(qiáng)調(diào)的是一種觀念、一種General critical thinkingCritical thinking in clinical situationsSpecific critical thinking in nursing 評(píng)判性思維（c

12、ritical thinking）TypesGeneral critical thinking評(píng)判性思維Specific Knowledge Base(專業(yè)基礎(chǔ)知識(shí))Experience （經(jīng)驗(yàn)）Skills in Critical Thinking （思維技能）Attitudes for Critical Thinking(態(tài)度傾向)Critical thinking in nursingComponentsSpecific Knowledge Base(專業(yè)基礎(chǔ)知識(shí)Skills in Critical ThinkingIs the core component.Critical analy

13、sisInductive reasoningDeductive reasoningCritical thinking in nursing-ComponentsSkills in Critical ThinkingIs Case：With the caring experience of 35 children undergoing maxillary surgery, several conclusions of peri-operational interventions for maxillary surgery patients are drawn as follows:123 歸納法

14、（induction）general principles particular facts or instancesCase：With the caring experiencCase：A patient underwent a partial gastrectomy operation this morning. The surgeon prescribed as follows: 1. Following nursing interventions for the patients undergoing general anesthesia2.演繹法（deduction）the gene

15、ralthe specificinferencereasoningCase：A patient underwent a parSkills in Critical ThinkingSix critical thinking cognitive skills：interpretation, analysis, evaluation, inference, explanation and self-regulationAmerican Philosophical Association(APA,1990) Critical thinking in nursing-ComponentsSkills

16、in Critical ThinkingSix1.Confidence.2. Independence of thought.3.Fairness.4.Integrity.5.Responsibility and Accountability.6. Curiosity.7.Risk Taking and courage.8.Creativity.9.Perseverance. 10.Humility. Attitudes for Critical ThinkingCritical thinking in nursing-Components1.Confidence.Attitudes for

17、CrCommitment LevelComplex LevelBasic LevelLevels of Critical Thinking in Nursing盡職層次復(fù)雜層次基礎(chǔ)層次CommitmentLevels of Critical TStrader (1992): “the process of establishing criteria by which alternative courses of action are developed and selected.” Definitions Clinical decision making in nursingSmith H.

18、and Donald (2002): A problem solving activity that focuses on defining client problems and selecting appropriate treatment interventions. Strader (1992): “the process oRoche (2002): A complex process in which nurses combine theoretical knowledge with practical experience to make judgments regarding

19、client care. Definitions Clinical decision making in nursingKozier et al (2000) : A critical thinking process for choosing the best actions to meet a desired goal. Roche (2002): A complex proce護(hù)理臨床決策就是護(hù)士在臨床護(hù)理實(shí)踐過(guò)程中，對(duì)面臨的現(xiàn)象或問(wèn)題，從所擬定的若干個(gè)可供選擇的方案中做出決斷并付諸實(shí)施的過(guò)程。 Definitions Clinical decision making in nursin

20、g護(hù)理臨床決策就是護(hù)士在臨床護(hù)理實(shí)踐過(guò)程中，對(duì)面臨的現(xiàn)象或問(wèn)題Ethical decision making護(hù)理倫理決策Clinical decision making護(hù)理臨床決策M(jìn)anagerial decision making in nursing 護(hù)理管理決策Classifications Decision making in nursing The classification is not absolutely! Ethical decision makingClassifIdentify/Define the Problem確定問(wèn)題State the Goals/Identify

21、 the Objectives陳述目標(biāo)Seek Alternatives and Make Choices 尋求備擇方案并做出決策Implement the Solutions實(shí)施方案Evaluate and Feedback 評(píng)價(jià)和反饋Process stepsDecision making in nursingIdentify/Define the ProblemProPersonal Factors/Individual Factors Influencing Factors Clinical Decision making in nursingValues Past Experienc

22、e Knowledge Base Individual Preference and Risk Way of Thinking Emotional Intelligence Personal Characteristics Personal Factors/Individual FaEnvironmental Factors Influencing Factors Clinical Decision making in nursingThe physical environmental factors The social environmental factors Environmental Factors InfluencSituational Factors Influencing Factors Clinical Decision making in nursingAnxiety, Stress, Fatigue Freedom, Rationality, and Voluntarily Related Infor