评判性思维和护理临床决策精选文档.ppt

评判性思维和护理临床决策本讲稿第一页，共三十四页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?本讲稿第二页，共三十四页本讲稿第三页，共三十四页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Everybody thinks all the day and all the time.本讲稿第四页，共三十四页Scenario：Its Tuesday.Youre on the way to classroom and these thoughts are going though your mind:“I have so much to doanatomy(解剖)test on Wednesday,Physiology(生 理 学)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 thinking本讲稿第五页，共三十四页本讲稿第六页，共三十四页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本讲稿第七页，共三十四页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（the National League for Nursing，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v One of the core competencies v One of the hot topics本讲稿第八页，共三十四页Bandman(1988):“the rational examination of ideas,inferences,assumptions,principles,arguments,conclusions,issues,statements,beliefs,and actions.”“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。”本讲稿第九页，共三十四页 Kozier 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 form a mental picture of(image),to reason.“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。本讲稿第十页，共三十四页 Kozier et al（2000）:Critical thinking:“a purposeful mental activity in which ideas are produced and evaluated,plans made,and desired conclusions determined.”“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。”本讲稿第十一页，共三十四页 Alfaro-LeFevre(1999):Entails purposeful,outcome-directed(results-oriented)thinking.Is driven by patient,family,and community needs.Is based on principles of nursing process and scientific method.Requires knowledge,skills and experience.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；本讲稿第十二页，共三十四页 Alfaro-LeFevre(1999):Is guided by professional standards and ethics codes.Requires strategies that maximize human potentialand compensate for problems created by human nature.Is constantly reevaluating,self-correcting,and striving to improve.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。本讲稿第十三页，共三十四页 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（rational reasoning）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 本讲稿第十四页，共三十四页 General critical thinking Critical thinking in clinical situationsSpecific critical thinking in nursing 本讲稿第十五页，共三十四页 Specific Knowledge Base(专业基础知识)Experience（经验）Skills in Critical Thinking（思维技能）Attitudes for Critical Thinking(态度倾向)本讲稿第十六页，共三十四页Skills in Critical ThinkingIs the core component.Critical analysis Inductive reasoning Deductive reasoning本讲稿第十七页，共三十四页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 归纳法（induction）general principles particular facts or instances本讲稿第十八页，共三十四页Case：A patient underwent a partial gastrectomy operation this morning.The surgeon prescribed as follows:1.Following nursing interventions for the patients undergoing general anesthesia2.演绎法（deduction）the generalthe specificinferencereasoning本讲稿第十九页，共三十四页Skills in Critical ThinkingSix critical thinking cognitive skills：interpretation,analysis,evaluation,inference,explanation and self-regulationAmerican Philosophical Association(APA,1990)本讲稿第二十页，共三十四页1.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 Thinking本讲稿第二十一页，共三十四页Commitment LevelComplex LevelBasic Level尽职层次复杂层次基础层次本讲稿第二十二页，共三十四页 Strader(1992):“the process of establishing criteria by which alternative courses of action are developed and selected.”Smith H.and Donald(2002):A problem solving activity that focuses on defining client problems and selecting appropriate treatment interventions.本讲稿第二十三页，共三十四页 Roche(2002):A complex process in which nurses combine theoretical knowledge with practical experience to make judgments regarding client care.Kozier et al(2000):A critical thinking process for choosing the best actions to meet a desired goal.本讲稿第二十四页，共三十四页 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。本讲稿第二十五页，共三十四页 Ethical decision making护理伦理决策 Clinical decision making护理临床决策 Managerial decision making in nursing 护理管理决策 The classification is not absolutely!本讲稿第二十六页，共三十四页 Identify/Define the Problem 确定 问题 State the Goals/Identify the Objectives 陈 述目 标 Seek Alternatives and Make Choices 寻求备择方案并做出决策 Implement the Solutions 实 施方案 Evaluate and Feedback 评价和反馈本讲稿第二十七页，共三十四页Personal Factors/Individual Factors Values Past Experience Knowledge Base Individual Preference and Risk Way of Thinking Emotional Intelligence Personal Characteristics 本讲稿第二十八页，共三十四页Environmental Factors The physical environmental factors The social environmental factors 本讲稿第二十九页，共三十四页Situational Factors Anxiety,Stress,Fatigue Freedom,Rationality,and Voluntarily Related Information Risks Involved Time Limitations Complexity of Decision Making Task 本讲稿第三十页，共三十四页What major outcomes/results do I hope to achieve?What problems or issues must be addressed to achieve the major outcomes?What are the circumstances(what is the context)?What knowledge is required?How much room is there for error?How much time do I/we have?What resources can help?Whose perspectives must be considered?What is influencing thinking?本讲稿第三十一页，共三十四页学而不思则罔思而不学则殆知识实践思维 专业成长本讲稿第三十二页，共三十四页千 里 之 行知识实践思维始 于 足 下本讲稿第三十三页，共三十四页Have a break！本讲稿第三十四页，共三十四页