评判性思维和护理临床决策优秀课件.ppt

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1、评判性思维和护理临床决策第1页，本讲稿共34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?第2页，本讲稿共34页第3页，本讲稿共

2、34页思维形态思维形态动作思维动作思维形象思维（直观思维）形象思维（直观思维）抽象思维（逻辑思维）抽象思维（逻辑思维）思维探索答案方向思维探索答案方向求异思维（发散思维）求异思维（发散思维）求同思维（聚合思维）求同思维（聚合思维）思维是否具有新颖性、独创性思维是否具有新颖性、独创性再生性思维再生性思维创造性思维创造性思维Everybody thinks all the day and all the time.第4页，本讲稿共34页Scenario：Its Tuesday.Youre on the way to classroom and these thoughts are going th

3、ough your mind:“I have so much to doanatomy(解解剖剖)test on Wednesday,Physiology(生生理理学学)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第5页，本讲稿共34页第6页，本讲稿共34页20

4、20世纪世纪3030年代德国法兰克福学派创立年代德国法兰克福学派创立 一种批判理论和思维方式一种批判理论和思维方式7070年代开始运用于教学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质是反思能力和建设性批判精神第7页，本讲稿共34页8080年代初，被引入护理年代初，被引入护理 护理科学的理论基础和哲学基础护理科学的理论基础和哲学基础19921992年，美国护理联盟（年，美国护理联盟（the National the National League for NursingLeague for Nursing，NLNNLN）把评判性）把评判性 思维列入评审护理学院的必须标准。思维列入评审

5、护理学院的必须标准。护理科学的理论基础和哲学基础护理科学的理论基础和哲学基础vOne of the core competencies vOne of the hot topics第8页，本讲稿共34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、对思想、推理、假设、原则、争议、结论、问题、说明、信念和行动的理

6、性检验。说明、信念和行动的理性检验。”第9页，本讲稿共34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.“评判性的评判性的”不是指不是指“急于发现问题急于发现问题”，而是指，而是指“仔细仔细地

7、、正确地判断能力地、正确地判断能力”；“思维思维”是指有思想、有反思、是指有思想、有反思、有回忆、有设计发明、有想象和有推理。有回忆、有设计发明、有想象和有推理。第10页，本讲稿共34页Kozier et al（2000）:Critical thinking:“a purposeful mental activity in which ideas are produced and evaluated,plans made,and desired conclusions determined.”“一一个个有有目目的的的的、产产生生思思想想并并对对其其进进行行评评价价，制制定定计计划和确定理想结论

8、的智力活动过程。划和确定理想结论的智力活动过程。”第11页，本讲稿共34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.必必须须是是有有目目的的的的、结结果果导导向向的的思思

9、维维；受受患患者者、家家庭庭、社社区区需需要要的的驱驱动动；以以护护理理程程序序和和科科学学方方法法原原则则为为基基础础；需需要要知识、技能和经验；知识、技能和经验；第12页，本讲稿共34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,sel

10、f-correcting,and striving to improve.受受职职业业标标准准和和伦伦理理规规范范的的指指导导；需需要要一一定定的的策策略略，如如：运运用用个个人人力力量量来来发发挥挥人人类类最最大大潜潜能能的的策策略略，弥弥补补人人性性弱弱点点的的策策略；略；需要不断地再评估、自我修正并努力改进。需要不断地再评估、自我修正并努力改进。第13页，本讲稿共34页评评判判性性思思维维首首先先是是一一种种理理性性思思维维，护护理理运运用用强强调调的的是是一一种种观观念、一种意识念、一种意识 评判性思维理论是一个完整体系评判性思维理论是一个完整体系 反反思思（Reflection）和和

11、推推理理（rational reasoning）是是评评判判性性思维的实质过程思维的实质过程 临床决策是护理评判性思维的核心目的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护理程序是评判性思维的应用工具 第14页，本讲稿共34页General critical thinkingCritical thinking in clinical situationsSpecific critical thinking in nursing 第15页，本讲稿共34页Specific Knowledge Base(专业基础知识专业基础知识)Experience（经验）（经验）Skill

12、s in Critical Thinking （思维技能）（思维技能）Attitudes for Critical Thinking(态度倾向态度倾向)第16页，本讲稿共34页Skills in Critical ThinkingIs the core component.Critical analysisInductive reasoningDeductive reasoning第17页，本讲稿共34页Case：With the caring experience of 35 children undergoing maxillary surgery,several conclusions

13、of peri-operational interventions for maxillary surgery patients are drawn as follows:123 归纳法（归纳法（induction）general principles particular facts or instances第18页，本讲稿共34页Case：A patient underwent a partial gastrectomy operation this morning.The surgeon prescribed as follows:1.Following nursing interven

14、tions for the patients undergoing general anesthesia2.演绎法演绎法（deduction）the generalthe specificinferencereasoning第19页，本讲稿共34页Skills in Critical ThinkingSix critical thinking cognitive skills：interpretation,analysis,evaluation,inference,explanation and self-regulationAmerican Philosophical Association

15、(APA,1990)第20页，本讲稿共34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第21页，本讲稿共34页Commitment LevelComplex LevelBasic Level尽职层次尽职层次复杂层次复杂层次基础层

16、次基础层次第22页，本讲稿共34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.第23页，本讲稿共34页Roche(200

17、2):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.第24页，本讲稿共34页护护理理临临床床决决策策就就是是护护士士在在临临床床护护理理实实践践过过程程中中，对对面面临临的的现现象象或或

18、问问题题，从从所所拟拟定定的的若若干干个个可可供供选选择的方案中做出决断并付诸实施的过程。择的方案中做出决断并付诸实施的过程。第25页，本讲稿共34页Ethical decision making护理伦理决策护理伦理决策Clinical decision making护理临床决策护理临床决策Managerial decision making in nursing 护理管理决策护理管理决策 The classification is not absolutely!第26页，本讲稿共34页Identify/Define the Problem确定确定问题State the Goals/Ident

19、ify the Objectives陈述目述目标Seek Alternatives and Make Choices 寻求备择方案并做出决策寻求备择方案并做出决策Implement the Solutions实施方案施方案Evaluate and Feedback 评价和反馈评价和反馈第27页，本讲稿共34页Personal Factors/Individual Factors Values Past Experience Knowledge Base Individual Preference and Risk Way of Thinking Emotional Intelligence P

20、ersonal Characteristics 第28页，本讲稿共34页Environmental Factors The physical environmental factors The social environmental factors 第29页，本讲稿共34页Situational Factors Anxiety,Stress,Fatigue Freedom,Rationality,and Voluntarily Related Information Risks Involved Time LimitationsComplexity of Decision Making Ta

21、sk 第30页，本讲稿共34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?第31页，本讲稿共34页学学而而不不思思则则罔罔思思而而不不学学则则殆殆知识知识实践实践思维思维 专专业业成成长长第32页，本讲稿共34页千千 里里 之之 行行知识知识实践实践思维思维始始 于于 足足 下下第33页，本讲稿共34页Have a break！第34页，本讲稿共34页