Critical Thinking and The Nursing Process

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Critical Thinking and The Nursing Process

• Raquel D. Esguerra RN, MAN, CCRN

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What is critical thinking?(general definition)

• intellectually disciplined process.
• based on observation, experience, reflection,
  reasoning /or communication.
• analyzing, synthesizing, conceptualizing,
  applying, /or evaluating information.
• produces a belief or action.

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What is critical thinking?(in the context of
nursing)

• entails purposeful, informed, outcome-focused
  thinking that requires careful identification of
  key problems, issues and risks involved.
• is driven by patient, family and community needs.
• is based on principles of nursing process and
  scientific method.
• use both logic and intuition, based on knowledge,
  skills and experience.
• is guided by professional standards and ethic
  codes.
• is constantly re-evaluating, self-correcting and
  striving to improve.

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Why focus on critical thinking?

• Things arent what they used to be, or what they
  will be.
• Patients are sicker, with multiple problems.
• More consumer involvement (patients and
  families).
• Nurses must be able to move from one setting to
  another.
• Rapid change and information explosion require us
  to develop new learning and workplace skills.
• 5 Consumers and payers demand to see evidence of
  benefits, efficiency and results.

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Why focus on critical thinking?

• Todays progress often creates new problems that
  can not be solved by old ways of thinking.
• Redesigning care delivery and nursing curricula
  is useless if students and nurses dont have the
  thinking skills required to deal with todays
  world.
• It can be done-it doesnt have to be that
  difficult.
• 1 Your ability to focus your thinking to get the
  results you need can make the difference between
  whether you succeed or fail in this fast-paced
  world

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CREATIVITY

• a major component of critical thinking
• thinking that results in development of new ideas
  and products
• required when a nurse encounters a new situation
  or a client situation in which traditional
  interventions are not effective
• Requires knowledge of the problem to come up with
  a creative solution

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With creativity, nurses - - -

• Are generally flexible and natural
• Generate many ideas rapidly
• Create original solutions to problems
• Tend to be independent and self-confident, even
  when under pressure
• Demonstrate individuality

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How Nurses Use Critical Thinking

• Use knowledge from multiple subjects and fields.
• Deal with change in stressful environments.
• Make important, life impacting decisions.

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Critical Analysis
Skills in Critical Thinking
Inductive Reasoning
Deductive Reasoning
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Critical Analysis

• The application of set of questions to a
  particular situation or idea to determine
  essential information and ideas and discard
  superfluous information and ideas
• Socratic questioning
• Box 15-1, Text p. 246
• Can be used during end-of-shift report, planning
  care, discussing a clients care with colleagues

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Inductive reasoning

• Generalizations are formed from a set of facts or
  observations
• Example
• Symptoms dry skin, poor turgor, sunken eyes,
  dark amber urine
• What do you think is wrong with this client?

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Deductive reasoning

• Reasoning from general to specific
• Example the nurse starts from a conceptual
  framework (Maslows Hierarchy of Needs) and makes
  descriptive interpretations of clients condition
• Given a medical diagnosis, the nurse makes
  nursing diagnoses

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Give an Example of

• A fact
• An inference
• A judgment
• An opinion

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Attitudes that foster Critical Thinking

• Independent thinking
• Fair-Mindedness
• Insight into Egocentricity vs. Sociocentricity
• Intellectual Humility Suspension of Judgment
• Intellectual Courage

• Integrity
• Perseverance
• Confidence in Reason
• Interest in Exploring Thoughts and Feelings
• Curiosity

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When do Nurses Use Critical Thinking?

• To prioritize nursing actions
• To resolve conflict
• To implement change
• To analyze situations
• To solve problems
• To make decisions

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The Nursing Process

• systematic
• rational
• method for planning and provision of
  individualized nursing care

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How do you solve problems?

• Trial and error?
• Intuition?
• Research process and scientific method or
  modified scientific method?

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Decision making process

• Identify the purpose
• Set the criteria
• Weigh the criteria
• Seek alternatives
• Examine alternatives
• Project
• Implement
• Evaluate the outcome

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Developing Critical-Thinking Attitudes and Skills

• Self-Assessment
• Think about a decision you made that you later
  regretted. Analyze the attitudes you had at that
  time and your thinking process. What could you
  have adjusted in your thinking that would have
  achieved a better outcome?

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Tolerating Dissonance and Ambiguity

• Nurses should increase their tolerance for ideas
  that contradict previously held beliefs, and they
  should practice suspending judgment (tolerating
  ambiguity for a time)
• Need to say I dont know and be comfortable
  with it until further information is available or
  known

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Seeking Situations Where Good Thinking is
Practiced

• Nurses should attend conferences in clinical or
  educational settings that support open
  examination of all sides of the issue and respect
  for opposing viewpoints

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Creating Environment that Support Critical
Thinking

• Nurse leaders should actively create a
  stimulating environment that encourages
  differences of opinion and fair examination of
  ideas and options
• As leaders, nurses should encourage colleagues to
  examine evidence carefully before they come to
  conclusions, and to avoid group think, the
  tendency to defer unthinkingly to the will of the
  group