Chapter 7: Critical Thinking

Clinical Decisions in Nursing Practice Clinical decision-making skills separate professional nurses from technical and supportive staff No two patients have the identical health problems, which challenges nurses Nurses need to utilize knowledge, act quickly, and make sound clinical decisions

Critical Thinking Defined A process and set of skills Cirocco (2007), Profetto-McGraff et al (2003) An active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others Chaffee (2002) Is not memorizing a list of information Cirocco (2007) Reflective, purposeful, and self-regulating process Facione and Facione (1996)

Three Aspects of Critical Thinking Reflection Purposeful thinking Language and intuition A clear communication process and the inner sense or “gut feeling” Thinking and learning Learning is lifelong

Levels of Critical Thinking in Nursing Basic critical thinking Concrete and based on a set of rules or principles Complex critical thinking Knowledge is synthesized Choices are analyzed and examined Commitment Choices are made without assistance from others

Critical Thinking Competencies General critical thinking Not unique to nursing Specific critical thinking in clinical situations Clinical inference and diagnostic reasoning Specific critical thinking in nursing Use of the nursing process

General Critical Thinking Processes Scientific method Problem identification, collect data, formulate question, test hypothesis, evaluate results Problem solving High level of cognitive reasoning Decision-making Focuses on problem resolution

Specific Critical Thinking Competencies Clinical inference Making a tentative conclusion based on observed data Diagnostic reasoning Use of cognitive thinking and assessment of the situation Clinical decision-making Focuses on selecting the treatment after forming diagnostic conclusions

The Nursing Process as a Competency A systematic process that incorporates Diagnostic reasoning Clinical decision-making Five-step process Assessment Diagnosis Planning Implementation Evaluation

A Critical Thinking Model Models serve to explain concepts and help you make decisions and judgments about patients Kataoka-Yahiro and Saylor (1994) Define the outcome of critical thinking as nursing judgment that is relevant to nursing problems in a variety of settings

Components of Critical Thinking Specific knowledge base Experience Problem solving competence Attitudes for critical thinking Standards of critical thinking

Developing Critical Thinking Skills Learned by connecting knowledge and theory with practice Reflective journaling Reflection leads to development of judgment and skills Concept mapping A visual representation of patient problems and interventions

Practice Questions 1. The use of diagnostic reasoning involves a rigorous approach to clinical practice and demonstrates that critical thinking cannot be done: A. logically. B. haphazardly. C. independently. D. in a vacuum.

Practice Questions (continued) 2. The nursing process organizes your approach while delivering nursing care. To provide the best professional care to clients, nurses need to incorporate nursing process and which of the following? A. Decision making B. Problem solving C. Intellectual standards D. Critical thinking skills

Practice Questions (continued) 3. You are caring for a patient with an indwelling Foley catheter. You notice that there is no urine draining into the bag. You check the tubing and find it is kinked. This action is an example of which of the following? A. Decision making B. Clinical inference C. Problem solving D. Inference