the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process.
involves the interpretation of a patient’s needs, concerns, or health problems and whether to act, not act, modify, or improvise approaches on the basis of a patient’s response.
Critical thinking/Clinical Judgement involves
- continual inquiry
Critical thinking/clinical judgement is acquired through
experience, commitment, active curiosity toward learning
Steps to Critical Thinking
- recognize that an issue (patient problem) exists
- analyze the information (clinical data about the patient)
- evaluate the info. (reviewing assumptions & evidence)
- Make conclusions
When making conclusions, consider
- ethical principles
- informed decisions
- patient preferences
- evidence based knowledge from research & clinical experience
What separates RN’s from technicians?
clinical decision making
What do professional nurses do that technical personnel don’t do?
- assesses for changes in a patient’s condition
- recognized potential problems
- identifies new problems as they arise
- takes immediate action when a clinical condition worsens
follow directions in completing aspects of care.
purposeful thinking back or recalling a situation to discover its purpose or meaning.
What kinds of questions do you ask yourself during reflection?
What did I notice before? How did I act? What could I have done differently? What went really well? What should I do next time in the same situation?
collect and clarify data (nursing diagnosis)
What should you take into consideration when doing analysis?
be open-minded as you look at data.
Do not make assumptions-is data true or are there options?
- look at meaning and significance
- does the data confirm a problem exists?
look objectively. Use criteria such as expected outcomes.
- support your findings and conclusions.
- use knowledge & experience to choose strategies to use in the care of patients
- reflect on our experiences.
- identify ways to improve performance.
Nursing Practice Applications:
Critical Thinking Behavior includes
- seek the true meaning of a situation.
- be honest and objective when asking questions
- be tolerant of different views.
- be sensitive to your own prejudices.
- respect the rights of others with differing opinions.
- analyze problematic situations.
- anticipate results or consequences
- use evidenced based knowledge.
be organized, focused
trust your own reasoning process
be eager to acquire knowledge
reflect on your own judgements; cognitive maturity
What are the levels of critical thinking?
- Basic Critical Thinking
- Complex Critical Thinking
What happens during Basic Critical Thinking?
- the learner trusts that the experts have the right answers for every problem.
- thinking is concrete
What does it mean when they say “thinking is concrete”?
ex. ) referring to hospital policy and procedure for guidelines in inserting a foley catheter
- may not be able to modify for patients with unique needs.
What happens during Complex Critical Thinking?
- begin to separate yourself from experts.
- begin to analyze and examine choices more independently
- thinking ability and initiative to look beyond expert opinion begins to change
- learns alternative and perhaps conflicting solutions exist
- each solution has benefits and risks.
What happens during the Commitment level of Critical Thinking?
- a person anticipates when to make choices w/out assistance from others and accepts accountability for decisions made
- choosing an action or belief based on the available alternatives and support it.
Sometimes an action is
to NOT act or to delay an action
- uses reasoning
- systemic and orderly approach to gathering data and solving problems
- verifies that a set of facts agrees with reality
Five Steps of the Scientific Method
- identifying the problem
- collecting data
- formulating a question or hypothesis
- testing the question or hypotheses
- evaluating the results of the test or study
when a problem arises, you obtain info. and use it plus what your already know to find a solution (everyday problems)
- focuses on problem resolution.
- following a set of criteria helps make a thorough and thoughtful decision.
Diagnostic Reasoning and Inference
- Drawing conclusions from related pieces of evidence & previous experience with the evidence (Inference).
- Analytical process for determining a patient’s health problems.
- Begins with patient interaction or while making physical or behavioral observations.
- Accurate recognition of a patient’s problems is necessary before deciding on solutions and implementing actions.
Clinical Decision Making
Requires careful reasoning in choosing the best options for the best patient outcomes on the basis of the patient’s condition and priority of problems.
the nursing process allows nurses to
help patients meet agreed-on outcomes for better health
The purpose of the nursing process is to diagnose and treat human responses to actual or potential health problems including:
- patient symptoms
- physiological and psychological reactions to treatment
- need for knowledge
- patient’s ability to cope with loss
Eleven Critical Thinking Attitudes
- thinking independently
- responsibility and accountability
- risk taking
Standards for Critical Thinking
intellectual standards and professional standards
- knowledge base in nursing and related sciences
- critical thinking (precise, specific, accurate, relevant, consistent and logical)
ethical criteria for nursing judgements
professional standards focus on
- patient values and beliefs
- using EBP for clinical decisions. (clinical decision guidelines, standards of treatment, assessment criteria)
What are ways to help develop critical thinking skills?
- reflective journaling
- meeting with colleagues
- concept mapping
reflective journaling (reflection)
- the process of purposefully thinking back or recalling a situation to discover its purpose or meaning.
- thinking, analyzing, learning from your work.
Meeting with colleagues
- discuss and examine work experiences
- questions, differing viewpoints, shared experiences
visual representation of a patients problems, interventions and their relationship to each other.
What are things that makes nursing stressful?
- enduring 12 hour shifts
- enduring patient suffering: disease, painful treatments
- fast-paced work settings
Read key points and review questions