10 Critical Thinking and Nursing Practice

Directory Classroom Response System Questions Lecture Note Presentation

Classroom Response System Questions

Question 1 A client with diarrhea has a physician’s order for a bulk laxative daily. The nurse, not realizing bulk laxatives can solidify some types of diarrhea, concludes, “The physician does not know the client has diarrhea.” This statement is an example of: A fact An inference A judgment An opinion

Question 1 Answer A fact An inference A judgment An opinion

Question 1 Rationales The prescription and the diarrhea are facts; the nurse’s conclusion is an inference. Correct. The nurse has inferred and concluded something that is beyond the available information (and in this case may not be accurate). It would be judgment and opinion if the nurse stated that the laxative would make the diarrhea worse and should not be given. It would be judgment and opinion if the nurse stated that the laxative would make the diarrhea worse and should not be given. (Note: Critical thinking will cause this nurse to examine the assumptions made and gather more data before acting.)

Question 2 A client reports feeling hungry but does not eat when food is served. Using critical-thinking skills, the nurse should perform which of the following? Assess why the client is not ingesting the food provided Continue to leave the food at the beside until the client is hungry enough to eat Notify the primary care provider that tube feeding may be indicated soon Believe the client is not really hungry

Question 2 Answer Assess why the client is not ingesting the food provided Continue to leave the food at the beside until the client is hungry enough to eat Notify the primary care provider that tube feeding may be indicated soon Believe the client is not really hungry

Question 2 Rationales Correct. The nurse recognizes that many assumptions (beliefs) could interfere with the client eating–such as that the food presented is not culturally appropriate. These assumptions must be clarified. Option B is an intervention not supported by the facts. Option C reaches conclusions not supported by the facts. In option D, the nurse has made a judgment or has an opinion that may not be accurate. Also, the nurse is acting without assessment. Implementation should be preceded by assessment.

Question 3 One nurse expresses that the manager prepared the holiday work schedule unfairly. The manager states that it is the same type of schedule used in the past and other nurses have no problems with it. Which response indicates the nurse is displaying an attitude of critical thinking? Accepting the preferences of the other nurses since there are several of them Recognizing that the nurse must have reached a false conclusion Considering going to a higher authority than the manager for an explanation Continuing to query the manager until the nurse understands the explanation

Question 3 Answer Accepting the preferences of the other nurses since there are several of them Recognizing that the nurse must have reached a false conclusion Considering going to a higher authority than the manager for an explanation Continuing to query the manager until the nurse understands the explanation

Question 3 Rationales Giving in violates desirable attitudes of integrity, intellectual courage, and confidence in reason. Overquestioning self or poor trust in one’s own beliefs violates desirable attitudes of integrity, intellectual courage, and confidence in reason. Bypassing normal routes of authority violates desirable attitudes of integrity, intellectual courage, and confidence in reason. Correct. The critical-thinking approach should include perseverance until a reasonable solution or answer is determined.

Question 4 The client who is short of breath benefits from the head of the bed being elevated. Because this position can result in skin breakdown in the sacral area, the nurse decides to study the amount of sacral pressure occurring in other positions. This decision is an example of The scientific method The trial-and-error method Intuition The nursing process

Question 4 Answer The scientific method The trial-and-error method Intuition The nursing process

Question 4 Rationales Correct. The scientific method uses a research study-based approach to problem solving. Trial and error would involve unstructured approaches resulting in less predictable results. Intuition would involve unstructured approaches resulting in less predictable results. The nursing process generally uses application of known interventions, previously determined by the scientific (research) process.

Question 5 In the decision-making process, the nurse sets and weighs the criteria, examines alternatives, and performs which of the following before implementing the plan? Reexamines the purpose for making the decision Consults the client and family members to determine their view of the criteria Identifies and considers various means for reaching the outcomes Determines the logical course of action should intervening problems arise

Question 5 Answer Reexamines the purpose for making the decision Consults the client and family members to determine their view of the criteria Identifies and considers various means for reaching the outcomes Determines the logical course of action should intervening problems arise

Question 5 Rationales The purpose for the decision should have been clear enough at the outset as to not require re-examination at this point. Clients and families should be consulted early–in the purpose-setting and criteria-setting steps. Criteria should not be set until all significant participants have an opportunity to present their point of view. Considering various means for reaching the outcomes is the same as examining alternatives. Correct. It is important to project what problems might interfere with the plan and have appropriate responses prepared to prevent the interferences.

Lecture Note Presentation

Learning Outcomes Describe the significance of developing critical-thinking abilities in order to practice safe, effective, and professional nursing care. Explore ways of demonstrating critical thinking in clinical practice.

Learning Outcomes (cont’d) Discuss the skills and attitudes of critical thinking. Discuss the relationships among critical thinking, the problem-solving process, and the decision-making process.

Critical Thinking An intentional higher level reasoning process Essential component of professional accountability and quality nursing care Generated from a triad of professional, socioeconomic, and ethical/moral needs

Critical Thinking (cont’d) Uses clinical reasoning and clinical decision making to practice safe and effective nursing care to improve clinical systems to decrease errors in clinical judgment

Critical Thinking Skills Analyzing Applying standards Discriminating Information seeking Logical reasoning Predicting Transforming knowledge

Figure 10-1 Alfaro-LeFevre’s 4-Circle Critical Thinking Model Figure 10-1 Alfaro-LeFevre’s 4-Circle Critical Thinking Model. Adapted with permission from Critical Thinking Indicators, by R. Alfaro-LeFevre, 2008. Retrieved from http://www.alfaroteachsmart.com/cti.htm 25

Techniques in Critical Thinking Critical analysis Socratic questioning Inductive reasoning, deductive reasoning Making valid inferences Differentiating facts from opinions

Techniques in Critical Thinking (cont’d) Evaluating the credibility of information sources Clarifying concepts Recognizing assumptions

Attitudes that Foster Critical Thinking Independence Fair-mindedness Insight into self Intellectual humility Intellectual courage

Attitudes that Foster Critical Thinking (cont'd) Integrity Perseverance Confidence Curiosity

Box 10-2 Personal Critical Thinking Indicators: Behaviors Demonstrating CT Characteristics and Attitudes 30

Critical Thinking and Nursing Critical thinking underlies each step of the nursing process, problem-solving process, and decision-making process

The Nursing Process Systematic, rational method of planning and providing individualized care Assessing Diagnosing Planning Implementing Evaluating

Problem-Solving Process Clarify the nature of a problem and suggest possible solutions One situation contributes to the nurse’s body of knowledge for problem solving in similar situations Commonly used approaches Trial and error Intuition Research process

Decision-Making Process Choosing the best actions to meet a desired goal Value decisions (e.g., keeping client information confidential) Time management decisions (e.g., take clean linens in at the same time as giving medications)

Decision-Making Process (cont'd) Choosing the best actions to meet a desired goal Scheduling decisions (e.g., bathing clients before visiting hours) Prioritizing decisions (e.g., most urgent ones and ones that can be delegated)

Developing Critical Thinking Attitudes and Skills Self-assessment Tolerating dissonance and ambiguity Creating environments that support critical thinking

Figure 10-2 Mind map for critical thinking in nursing Figure 10-2 Mind map for critical thinking in nursing. From University of New Mexico College of Nursing. Retrieved from http://hsc.unm.edu/consg/critical/what_ct.shtml 37

Box 10-5 Types of Concept Maps 38

Figure 10-3 Types of concept maps: A, hierarchical; B, spider; C, flowchart; D, systems. 39

Concept Mapping Graphic depiction of connections Linear and nonlinear relationships Visual aid to critical thinking process