Critical Thinking Exercise

Critical Thinking Exercise

Critical Thinking Exemplar Describe one example where you applied critical thinking skills (may include teaching).

I took care of Mrs. R.C. today and noted that she was very tired and did not want to ambulate. After further questioning, she told me that her muscles felt weak and her vision wasn’t what it used to be. Later when giving meds, I noted that she was on Lanoxin and Lasix. Her K supplement was not reordered postop. The last digoxin (dig) level was 1.8 three days ago. Last K level was 4.1 five days ago. Mrs. R.C. said her vision was blurry and that she was seeing “halos” and yellow/green lights. After the M.D. called back, he ordered a STAT dig level, and the results were 2.2 (she was dig toxic!!!) I felt pleased to have alerted the nurse to this situation. Inductive Reasoning Use the following exercise to evaluate your critical thinking exemplar & your critical thinking skills.

  1. Problem/Issue Client tired, vision impaired?
  2. Identified Facts Client on Lanoxin and Lasix. K supplement was not reordered postop. Doses of Lanoxin and Lasix were adjusted postop. 3 days ago, K level 4.1 & dig level 1.8.
  3. Assumptions I can assume that lab was drawn correctly; lab values are correct; lab values may be different since they were last drawn; client has received all scheduled medications.
  4. Inferences I can infer that her K level will be low since she is not on K replacement and has been getting Lasix & that her dig level may be up since she has continued to receive Lanoxin.
  5. Applicable Nursing Concepts Client safety Client assessment Nursing responsibility Interpretation of lab values Pharmacological effects Pathology
  6. Applicable Research Findings A client receiving Lanoxin and Lasix is prone to dig toxicity, especially if K level is low. The client’s renal function can affect clearance of Lanoxin and cause dig serum levels to climb.
  7. Synthesis/Analysis/Conclusions Client is at risk for dig toxicity. Client is experiencing possible s/sxs of dig toxicity.
  8. Implications for Nursing Care Monitor urine output, K levels, dig levels. Report last dig level. Teach client the s/sxs of dig toxicity. Report no K supplement. Monitor for s/sxs of dig toxicity. Place on cardiac monitor (if applicable). Report/record appropriate findings and follow up orders received.

 

Definitions

analysis—separation of a whole into its parts to identify patterns and relationships

assumption—an idea or concept that is taken for granted; assumptions may be true or false inductive reasoning—specific details or facts gathered to arrive at a conclusion

inferences—your judgment of what the data mean; believed to be true after careful consideration of the evidence

synthesis—parts or elements combined into a single new entity (over) revised Fall 12/ss/RevisedSpring

 

Follow rubric

 

Describe One example where you applied critical thinking skills.

Inductive Reasoning

Use the following rubric to evaluate your critical thinking exemplar & you critical thinking skills

Critical Thinking Indicators Insufficient

 

Beginning

 

Developing

 

Competent

 

Accomplished

 

Problem/Issue

Describe clearly the problem and contributing factors.

10 points

No relevant data, contributing factors presented with inaccuracies, omissions, and in part.

(0 points)

Relevant data, contributing factors presented with inaccuracies, omissions, and in part. (1-3 pts) Relevant data, contributing factors presented with minimal inaccuracies and omissions.

(4-6 pts)

Relevant data, contributing factors presented in correct and appropriate format.

(7-8 pts)

Relevant data, contributing factors presented and precisely.

(9-10pts)

Identified Facts

Who, what, where, how (use medical Dx, Hx, significant clinical manifestations & diagnostic tests, medications (pertinent to the identified problem) or another medical Tx involved?

10 points

No identified facts presented with inaccuracies, omissions, and in part.

(0 points)

Identified Facts presented with inaccuracies, omissions, and in part.

(1-3 pts)

Identified Facts presented with minimal inaccuracies and omissions.

(4-6 pts)

Identified Facts presented in correct and appropriate format.

(7-8 pts)

Identified Facts presented and precise.

(9-10pts)

Assumptions

Based on prior knowledge or assessment of occurrence

5 points

No assumptions based on limited prior knowledge and assessment of occurrence.

(0 points)

Assumptions based on limited prior knowledge and assessment of occurrence.

(1pts)

Assumptions based on minimal prior knowledge and assessment of occurrence.

(2-3pts)

Assumptions based on correct knowledge and assessment of occurrence.

(4 pts)

Assumptions based on correct knowledge and assessment of occurrence. Resources cited. (Textbooks)

(5 pts)

Inferences

What can we predict client will be able, Willing to consider doing? Predict client’s issue based on something that you know is true.

5 points

No inferences listed.  Resources are not cited.      (0 points) Inferences are limited with inaccuracies and in part.  Resources are not cited. (1pts) Inferences are minimal with limited use of resources.

(2-3pts)

Inferences are correct. Resources are cited.

(4 pts)

Inferences are presented precisely.  Resources cited. (Textbooks)

(5 pts)

Applicable Nursing Concepts

Assessment, safety, communication, comfort/pain (physical, emotional, spiritual) health beliefs etc.

10 points

No use of the applicable nursing concepts.

(0 points)

Limited or inaccurate use in the applicable nursing concepts.

(1-3 pts)

Minimal use in the applicable nursing concepts.

(4-6 pts)

 

 

Applicable nursing concepts used are correct.

(7-8 pts)

Complete use of applicable nursing concepts used in the development of the nursing care plan.

(9-10pts)

Applicable Evidenced Based Nursing Research

Summarize the article, must support the final decision/ outcome of the problem.

20 points

No use of evidence-based nursing research in the development in the nursing care plan.

(0 points)

Inaccurate or limited use of evidence-based nursing research in the development in the nursing care plan.

(1-6 pts)

Minimal use of evidenced based nursing research in the development in the nursing care plan.

(7-12 pts)

Applicable evidenced based nursing practice used clearly in the development of the nursing care plan.

(13-16 pts)

Logical application of evidence-based nursing research that supports the nursing care plan.

(17-20 pts)

Synthesis/Analysis/Conclusions

Write a summary of what/how it happened, when/what caused it/resolves (alleviated) the problem, how was the outcome accomplished or not.

15 points

No synthesis/analysis/conclusion of the resolution of the problem or the outcome.

(0 points)

Inaccurate or limited synthesis/analysis/conclusion of the resolution of the problem or the outcome.

(1-4 pts)

Minimal synthesis/analysis/conclusion of the resolution of the problem or the outcome.

(5-8 pts)

Clear synthesis/analysis/conclusion of the resolution of the problem or the outcome.

(9-12 pts)

Accurate and complete synthesis/analysis/conclusion of the resolution of the problem or the outcome.

(13-15 pts)

Implications for Nursing Care

This is a nursing care plan in action.   Use Standards of Practice & guidelines.  How do they relate to clinical practice guidelines?

20 points

No development of nursing care plan. Without standards, guidelines, or evidenced based practice.

(0 points)

Inaccurate or limited development of nursing care plan. Without standards, guidelines, or evidenced based practice.

(1-6 pts)

Minimal development of nursing care plan. With minimal use of standards of practice, guidelines, and evidence-based practice.

(7-12 pts)

Correct development of the nursing care plan. Correctly uses standards of practice, guidelines, and evidenced based practice.

(13-16 pts)

Complete development of the nursing care plan.  Uses standards of practice, guidelines, and evidenced based practice.

(17-20 pts)

Professional Presentation of Work

Organized sections and logical presentation of information; Error-free; Resources cited APA format.

5 points

Unlabeled sections with more than five grammatical errors.

(0 points)

Missing sections with more than five grammatical errors.

(1 pts)

Minimal sections included with few grammatical errors.

(2-3 pts)

Information organized in appropriate sections; evidence of proofreading and attention to detail.

(4 pts)

Organized sections and logical presentations of information; Error-free.

(5 pts)

Definitions

Analysis- separation of a whole into its parts to identify patterns and relationships

Assumption- an idea or concept your take for granted; assumptions may be true or false

Inductive reasoning- begins with specific details or facts that are used to arrive at a conclusion

Inferences- your judgement of what the data mean; believed to be true after careful consideration of the evidence

Synthesis- combining parts or elements into a single new entity

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