Introduction to Medical-Surgical Nursing, 6th ed.
12
Lesson Plans for
The Nursing Process and Critical Thinking
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 12.1:
2. Explain the role of the LPN/LVN in the nursing process.
4. Describe the relationship between the nursing process and critical thinking.
Lesson 12.2:
6. Describe how critical thinking skills are used in clinical practice.
7. Describe principles of setting priorities for nursing care.
CHAPTER TEACHING FOCUS
• In this chapter, students will be introduced to the components of the nursing process, including the
formats for North American Nursing Diagnosis Association (NANDA) diagnoses and the role of the
licensed practical nurse in that process.
• Furthermore, students will have the opportunity to examine the proper documentation of the nursing
process.
• Students will also have the opportunity to review the relationship between the nursing process and
critical thinking, including the characteristics of critical thinkers and the use of critical thinking tools in
clinical practice.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Care Competencies
• Concept: Communication
• Exemplar: Subjective Data: Health History Interview, p. 152
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) A systemic approach to providing patient care is known as __________.
a) assessment
b) implementation
c) the nursing process
d) care planning
2) The third step in the nursing process is __________.
a) assessment
b) implementation
c) evaluation
d) planning
3) Which of the following is a role of the LVN in the nursing process?
a) Collecting assessment data
b) Developing nursing diagnoses
c) Evaluating and changing the plan of
care
d) Developing interventions
4) An example of objective data is a __________.
a) patient complaining of pain
b) patient reporting diarrhea
c) blood pressure of 128/72 mm Hg
d) patient reporting feelings of depression
5) The use of touch to assess various parts of the body is known as __________.
a) auscultation
b) palpation
c) inspection
d) observation
6) Which of the following is true regarding nursing diagnosis?
a) It is used to determine the etiology of a health problem.
b) It is what controls patient care.
c) It is based on the medical diagnosis.
d) It focuses on the response of the whole person to a health problem.
7) Nursing diagnoses are written in the PES format in which S stands for __________.
a) signs
b) significance
c) symptom
d) signal
8) Which of the following is a complete and correctly stated NANDA–approved nursing diagnosis?
a) Impaired skin integrity related to immobility as evidenced by a 4-cm pressure ulcer on the coccyx
b) Impaired skin integrity related to open area on buttocks
c) Poor skin integrity related to poor care at home as evidenced by pressure ulcer
d) Skin problems related to bed-bound status
9) During which part of the nursing process should evaluation occur?
a) When the patient is being discharged
b) Throughout the nursing process
c) When an intervention is developed
d) When the physician needs a status report
10) A person who looks at all of the parts to make up a whole is demonstrating which characteristic of a
critical thinker?
a) Curious
b) Self-confident
c) Analytical
d) Mature
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
5) b
10) c
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What is involved in the assessment phase of the nursing process? What are two examples of
ways to collect data during the assessment process?
Answer: The assessment phase of the nursing process involves collecting data about the health status of
Question: What is the function of nursing diagnoses? What is included in a nursing diagnosis? Provide
an example.
Answer: Nursing diagnoses are the basis for planning nursing interventions that can help prevent,
4 Chapter 12 The Nursing Process and Critical Thinking ___________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 12.1
Instructor Preparation
Textbook Objectives Covered
2. Explain the role of the LPN/LVN in the nursing process.
4. Describe the relationship between the nursing process and critical thinking.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying the nursing process and critical thinking, including:
• Components of the nursing process
• Documentation formats for NANDA, NIC, and NOC
• The role of the licensed practical nurse (LPN/LVN)
• Proper documentation of the nursing process
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• assessment (p. 151)
• auscultation (p. 155)
• critical thinking (p. 163)
• evaluation (p. 151)
• evidence-based practice (p.
163)
• palpation (p. 155)
• percussion (p. 155)
• planning (p. 151)
• problem-oriented medical
record (POMR) (p. 161)
• standard of care (p. 152)
• subjective data (p. 152)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 12.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 151-161)
REVIEW
• Figure 12-1: Inspection (p. 153)
• Figure 12-2: Palpation (p. 155)
• Figure 12-3: The striking hand in percussion (p. 155)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1-4 (p. 166)
ANSWER – Study Guide
• Part IA: 1-10 (p. 57)
• Part IB: 1-12 (p. 58)
• Part IC: 1-4 (p. 58)
• Part IE: 1-5 (pp. 59-60)
• Part IIG: 1, 2, 4, 6, 8-10 (pp. 59–60)
• Part IIIH: 6, 8 (p. 61)
2
READ – Textbook (pp. 151-161)
3
READ – Textbook (pp. 161-163)
REVIEW
• Figure 12-5: Hypertension concept map (p. 162)
ANSWER – Text
ANSWER – Study Guide
• Part IIIH: 1-5 (p. 60)
4
READ – Textbook (pp. 163-165)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6 (p. 166)
ANSWER – Study Guide
• Part ID: 1-6 (p. 58)
• Part IIG: 3, 5 (pp. 59-60)
• Part IIIH: 7 (p. 61)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 12.1
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 12
The Nursing Process and Critical Thinking
Components of the Nursing Process
• Assessment
1
&
2
Slide 3
Assessment
• Collection of data about the health status of the patient
• A registered nurse must perform the initial admission assessment for each patient
• The LVN/LPN collects data through surveillance and monitoring and performs focused
nursing assessments
TALKING POINTS:
• A focused nursing assessment is defined as “an appraisal of the patient’s status and
situation at hand that contributes to ongoing data collection.”
• What does the word data mean?
Assessment (cont.)
• Subjective data
• Information reported by patient and family in a health history
TALKING POINTS:
• Subjective data usually are documented in the patient’s own words and include
information such as previous experiences and sensations or emotions that only the
patient can describe.
Slide 5
Physical Examination
• Inspection
• Purposeful observation of the person as a whole and then systematically from head to
toe
TALKING POINTS:
• When does inspection of the patient begin?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 12.1
Slide 6
Physical Examination (cont.)
• Palpation
• Uses touch to assess various parts of the body and helps confirm findings that are
noted on inspection
TALKING POINTS:
• The hands, especially the fingertips, are used to assess skin texture, moisture, and
temperature or the presence of swelling, lumps, masses, tenderness, or pain.
Slide 7
Physical Examination (cont.)
• Percussion
• Tapping on the skin to assess the underlying tissues
TALKING POINTS:
• What are the most common areas for percussion?
• Short, sharp strokes elicit sounds and subtle vibrations that are characteristic of
underlying organs and certain conditions.
• To percuss:
Slide 8
Physical Examination (cont.)
• Auscultation
• Listening to sounds produced by the body
TALKING POINTS:
• Auscultation is performed with a stethoscope.
• What is the difference between the diaphragm and the bell of a stethoscope?
Nursing Diagnosis
• Derived from data gathered during the assessment
TALKING POINTS:
• Nursing diagnoses provide a basis for planning nursing interventions that can help
prevent, minimize, or alleviate the problem.
• What is a medical diagnosis?
8 Chapter 12 The Nursing Process and Critical Thinking ___________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 12.1
Slide 10
Nursing Diagnosis (cont.)
• North American Nursing Diagnosis Association International (NANDA-I)
• Develops and revises nursing diagnoses
• Table 12-1: list of accepted nursing diagnoses
• Written in a PES format
• S = signs and symptoms of the problem
TALKING POINTS:
• The PES format helps make the general nursing diagnosis fit a specific patient care
problem.
• What is an example of a nursing diagnosis?
Slide 11
Planning
• Develop a nursing care plan for the patient based on nursing diagnoses
• Nursing care plans a form of communication with other health care professionals which:
• Improve continuity of care
TALKING POINTS:
• Who is responsible for initiating the plan of care?
Slide 12
Planning (cont.)
• Steps in planning nursing care
• Determine priorities from the list of nursing diagnoses
• Set long-term and short-term goals to determine outcomes of care
• Develop objectives to reach the goals
• Write nursing orders to direct care to meet the goals
• Priorities established according to the most immediate needs of the patient
TALKING POINTS:
• What are the steps in planning nursing care usually based on?
• Goals should be stated in terms of patient outcomes.
• Nursing orders are the actions or interventions prescribed to help achieve the stated goals
and objectives.
Slide 13
Intervention (Implementation)
• Actual performance of the nursing interventions in the plan of care
• Includes:
• Direct patient care
TALKING POINTS:
• What do you think is meant by “carrying out of medical treatments”?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 12.1
Evaluation
• Ongoing process that enables you to determine what progress the patient has made in
meeting the goals for care
TALKING POINTS:
• The plan of care should be reexamined and modified where necessary.
• How can the results of an ongoing evaluation be used?
Slide 15
• Areas evaluated by the Joint Commission include the standards of nursing care used, the
Evaluation (cont.)
• Important in individual care, but also provides data on quality of care in health care
institution
• Quality assurance audits conducted by health care agencies as well as Joint Commission
on Accreditation of Healthcare Organizations
• American Nurses Association Standards of Care used to determine if nurses have carried
out the nursing process as documented in patient records
TALKING POINTS:
3
Slide 16
Clinical Pathways
• Standard care plans developed to set daily care priorities, schedule achievement of
outcomes, and reduce length of hospital stays
• Include patient outcomes and timelines for the sequence of interventions
TALKING POINTS:
• What are the benefits of clinical pathways?
• There are concerns about the potential for legal liability when there are deviations from
pathways (even when justified).
Concept Maps
• Visual plans of care that illustrate the relationships between and among pathophysiology,
TALKING POINTS:
• View hypertension concept map with students. The concept map is a visual plan that
shows the relationships among parts of the plan.
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 12.1
Slide 18
Nursing Documentation
• Helps achieve continuity of care by:
• Providing for communication among caregivers
• Recording of patient’s progress
• A legal record of care provided and a means to verify services rendered for insurance
payments
a permanent part of the patient’s medical record, which is a legal record.
Slide 19
Nursing Documentation (cont.)
• Documentation should also include:
• All treatments and care, including medications
• Procedures performed at the bedside, on the unit, or inside or outside the facility
• Patient’s reaction to procedures
Nursing Documentation (cont.)
• Should be factual, current, complete, organized, and accurate
TALKING POINTS:
• With paper charts, each page should have the patient’s name, and the date and time
Slide 21
Nursing Documentation (cont.)
• Each time an entry is made, sign with your full name and title
• Use only permanent ink, and make no erasures
• If you make an error in charting, cross out the entry and write “error” or “mistaken entry,”
followed by your initials
TALKING POINTS:
• Increasingly, patient records are entered and maintained in computerized charting
systems.
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LESSON 12.1
Slide 22
Documentation Formats
• Nurses’ notes
• Pages of narrative recordings containing assessment data, interventions carried out
by the nurse, and evaluation data collected
• Flow sheets
• May be graphs of vital signs or tables in which nurses may check or initial boxes
indicating activities or care provided
TALKING POINTS:
• What are some examples of charting approaches?
Documentation Formats (cont.)
• Problem-oriented medical record (POMR)
• Record-keeping that focuses on patient problems rather than on medical diagnoses
TALKING POINTS:
• Each health care provider involved in the care of the patient charts on the same progress
notes in the same format.
• What information provides a foundation for problems formulated in the POMR?
4
Slide 24
Critical Thinking
• Defined as “reflective and reasonable thinking that is focused on deciding what to believe
or do”
• Tools to seek and apply knowledge
TALKING POINTS:
• Nursing deals with people in states of change in an environment that is constantly
Relationship of Critical Thinking to the Nursing Process
• The nursing process is a framework for developing, implementing, and evaluating a plan
of care
Slide 26
• Why should “ready–made” care plans not be used?
Relationship of Critical Thinking to the Nursing Process (cont.)
• The nursing process does not flow smoothly from one step to the next, but it often moves
back and forth between steps
• The nursing process is a sequence of steps that should be based on critical thinking
TALKING POINTS: