Critical thinking and nursing judgement
· Critical thinking: thinking and learning
· Competencies, attitudes for critical thinking, levels of critical thinking in nursing
Critical thinking is active organized, cognitive process used to carefully examine one’s thinking and the thinking of others.
A critical thinker identifies and challenges assumptions, considers what is important in a situation, imagines and explores alternatives, considers ethical principles, applies reason and logic and thus makes informed decisions.
Critical Thinking and Nursing Judgment
· Process acquired through hard work, commitment, and an active curiosity toward learning.
· Decision making is the skill of professional nurse
· Good problem solving skills
· Not always a clear textbook answer
· Nurse must learn to question, look at alternatives
Thinking and learning:
· Learning is a lifelong process.
· Intellectual and emotional growth involve acquiring new knowledge and refining the ability to think, solve the problems and make judgments.
· To learn, person must be flexible and always open to the new information.
· Learning and thinking are inseparable.
· As we gain the new experiences apply the knowledge gained.
Components of critical thinking:
There are five components of critical thinking that leads to make the clinical judgments necessary for safe and effective nursing practice.
1. Scientific knowledge base
3. Critical thinking competencies
Critical thinking competencies:
A. General critical thinking
B. Specific critical thinking in clinical situation
C. Specific critical thinking in nursing
A. General critical thinking
General critical thinking competencies are not unique to nursing.
They are used in other disciplines and non clinical situation.
General critical thinking process includes:
1. Scientific method
2. Problem solving method
3. Decision making
It is one approach to reasoning that is used in nursing, medicine and variety of other disciplines.
Nurse researchers use scientific method when testing the research questions in nursing practice situations.
Five steps are
Collecting the data
Formulating a question or hypothesis
Test the question or hypothesis
Evaluating results of the test or study
Clients routinely present problems in nursing practice.
Effective problem solving also involves evaluating the solution overtime to be sure that it is still effective.
Decision making is a end point of critical
thinking that is focused on resolving the problem.
Following a set of criteria helps to make a thorough and thoughtful decision.
Like- personal, organizational policy, professional standard
Examples of decision making
Determining which patient care priority requires the first response
Choosing a type of dressing for a patient with a surgical wound
Selecting the best teaching approach for a family caregiver who will assist a patient who is returning home after a stroke.
Specific critical thinking in clinical situation include:
A. Diagnostic reasoning
B. Clinical inferences
C. Clinical decision making
A. Diagnostic reasoning:
It is the process of determining the clients health status by observing their behavior, physical signs and symptoms.
Diagnostic reasoning is a series of clinical judgment and formal diagnosis.
B. Clinical inference
Part of diagnostic reasoning is clinical inference, the process of drawing conclusions from related pieces of evidence and previous experience with the evidence.
An inference involves forming patterns of information from data before making a diagnosis
C. Clinical decision making:
· Nurse makes the clinical decision all the times
· To make improvement in clients health or maintain wellness.
· Clinical decision making is a problem solving activity that focuses on defining a problem and selecting an appropriate action.
· In clinical decision making a nurse identifies a patients problem and selects a nursing intervention.
· Identify nursing and collaborative problems of each patients.
· Analyze patients problems and decide which problems are most urgent on the basis of basic needs.
· Consider how to involve the clients as decision makers and participants in care. Consider the time it will take to care for clients, whose problems are of higher priority.
· Decide how to combine activities to resolve more than one client problem at a time.
Attitudes for critical thinking:
Attitudes determine how you must approach the problem to be a successful critical thinker.
When a patient complains of anxiety before a diagnostic procedure, the curious nurse explores possible reasons for the patients concerns.
The nurse shows discipline in collecting a thorough assessment to find an ability to recognize that problems exist and that there is a need for evidence to support the truth in what you think is true.
Attitudes for critical thinking
2. Thinking independently
4. Responsibility and accountability
5. Risk taking
When you are confident, you feel certain about accomplishing a task or goal a such as performing a procedure or making a diagnostic decision. Confidence builds a trust between you and your patients. Eg: how to perform procedure?
2. Thinking independently
as you gain a new knowledge you learn to consider a wide range of ideas and concepts before forming an opinion or making a judgment. Eg: why do your patients not get pain relief?
A critical thinker deals with situations impartially. This means that bias or prejudice does not enter into a decision. Eg: regardless of how you feel about obesity, you do not allow personal attitudes to influence the way you care for a patient who is overweight.
4. Responsibility and Accountability
When caring for patients you are responsible tor correctly performing nursing care activities based on standards of practice. Eg: you do not take shortcuts (failing to identify a patient.
prepare medication doses for multiple patients at the same time) when administering medications.
5. Risk taking
Persons often associate taking risks with danger. Driving 30 miles an hour over the speed limit is a risk that sometimes results in injury to the driver and an unlucky pedestrian. When taking a risk, consider all options, follow safety guidelines. Eg: when planning for different approaches to skin, wound care, pain Mx.
A disciplined thinker misses few details and follows an orderly or systematic approach when collecting information, making decisions or taking action.
Eg: you have pa patient who is in pain. instead of only asking the patient how severe is your pain on a scale of 0-10 can ask like where it hurts etc.
A critical thinker is determined to find effective solutions to patient care problems. Eg: patient who is unable to speak following throat surgery poses challenge for nurse for communicating. Nurse can try different techniques like message boards or alarm bells
Creativity involves original thinking. This means that you find solutions outside of the standard routines of care. A home care nurse has to find a way to help an older patients with arthritis have greater mobility in the home (use wooden blocks to elevate)
A critical thinkers favorite question is why. In any clinical situation you learn a great deal of information about a patient. Question family, consult with a physician or review the scientific literature etc.
Critical thinkers question and test their own knowledge and beliefs. Your personal integrity as a nurse builds trust from your coworkers. Nurse must be honest and willing to admit to mistakes or inconsistencies in his or her own behaviour, ideas and beliefs.
It is important for you to admit to any limitations in your knowledge and skill. Critical thinkers admit what they do not know and try to find the knowledge needed to make proper decisions.
Eg: a patients safety and welfare are at risk if you do not admit your inability to deal with a practice problem
Levels of Critical thinking:
The individual depend on experts to find the right answer for every problem.
Thinking is concrete and based on set of rules or principles.
Eg: as a nursing student you use a hospital procedure manual to confirm how to insert a Foley catheter. You likely to follow the procedure step by step without adjusting it to meet a patients unique needs (positioning to minimize the patients pain or mobility restrictions)
A person begins to detach from experts and analyze and examine alternatives more independently.
In complex critical thinking each solution has benefits and risks that you weigh before making a final decision.
Mr. Rosen, 36 yr old man who had hip surgery, is refusing to take analgesic. Nurse is concerned that the patient will not progress as planned, delaying rehabilitation. While discussing the importance with team members, nurse realizes that patient is unable to meditate at hospital so he was refusing medications.
The individual anticipates the need to make choices without assistance from others and then assumes accountability for them.
As a nurse you do more than just consider the complex alternatives that a problem poses.
At the commitment level you choose an action or belief based on available alternatives and supports it.