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1、S M M U评判性思维和-护理临床决策S M M US M M U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.S M M UScenario：Its Tuesday.Youre on the way to classroom and
2、these thoughts are going though 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 thi
3、nkingS M M US M M U2020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S M M U8080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
4、审护理学院的必须标准。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护理科学的理论基础和哲学基础vOne of the core competencies vOne of the hot topicsS M M UBandman(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、问对思想、推理、假设、原则、争议、结论、问题
5、、说明、信念和行动的理性检验。题、说明、信念和行动的理性检验。”S M M UKozier 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，
6、而是指“仔细地、正确地判断能力仔细地、正确地判断能力”；“思维思维”是指有思想、是指有思想、有反思、有回忆、有设计发明、有想象和有推理。有反思、有回忆、有设计发明、有想象和有推理。S M M UKozier 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，制制定定计划和确定理
7、想结论的智力活动过程。计划和确定理想结论的智力活动过程。”S M M UAlfaro-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维
8、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；S M M UAlfaro-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-corr
9、ecting,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。S M M U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一种观念、一种意识是一种观念、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）和和推推理理（ration
10、al reasoning）是是评评判性思维的实质过程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 S M M UGeneral critical thinkingCritical thinking in clinical situationsSpecific critical thinking in nursing S M M USpecific Knowledge Base(专业基础知识专业基础知识)Experience（经验）（经验）Skills in Critical Thinkin
11、g （思维技能）（思维技能）Attitudes for Critical Thinking(态度倾向态度倾向)S M M USkills in Critical ThinkingIs the core component.Critical analysisInductive reasoningDeductive reasoningS M M UCase：With the caring experience of 35 children undergoing maxillary surgery,several conclusions of peri-operational interventio
12、ns for maxillary surgery patients are drawn as follows:123 归纳法（归纳法（induction）general principles particular facts or instancesS M M UCase：A patient underwent a partial gastrectomy operation this morning.The surgeon prescribed as follows:1.Following nursing interventions for the patients undergoing ge
13、neral anesthesia2.演绎法演绎法（deduction）the generalthe specificinferencereasoningS M M USkills in Critical ThinkingSix critical thinking cognitive skills：interpretation,analysis,evaluation,inference,explanation and self-regulationAmerican Philosophical Association(APA,1990)S M M U1.Confidence.2.Independe
14、nce 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 ThinkingS M M UCommitment LevelComplex LevelBasic Level尽职层次尽职层次复杂层次复杂层次基础层次基础层次S M M UStrader(1992):“the process of establish
15、ing 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.S M M URoche(2002):A complex process in which nurses combine theoretical know
16、ledge 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.S M M U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问问题题，从从所所拟拟定定的的若若干干个个可供选择的方案中做出决断并付诸实施的过程。可供选择的方案中做出决断并付诸实施的过程。S M
17、 M UEthical 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!S M M UIdentify/Define the Problem确定确定问题State the Goals/Identify 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
18、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S M M UPersonal Factors/Individual Factors Values Past Experience Knowledge Base Individual Preference and Risk Way of Thinking Emotional Intelligence Personal Characteristics S M M UEnvironmental Factors The physical environmental f
19、actors The social environmental factors S M M USituational Factors Anxiety,Stress,Fatigue Freedom,Rationality,and Voluntarily Related Information Risks Involved Time LimitationsComplexity of Decision Making Task S M M UWhat major outcomes/results do I hope to achieve?What problems or issues must be
20、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?S M M U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S M M U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S M M UHave a break！S M M U此课件下载可自行编辑修改，仅供参考！此课件下载可自行编辑修改，仅供参考！感谢您的支持，我们努力做得更好！谢谢感谢您的支持，我们努力做得更好！谢谢