1. Chapter 7: Critical Thinking

2. 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

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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

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

11. 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

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

14. 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

15. 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.

16. 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

17. 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