Potter & Perry
Chapter 12: Critical Thinking (Jeremy)
Critical Thinking Defined
Critical Thinking
- An active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others
- A critical thinker identifies and challenges assumptions, considers key aspects of a situation, imagines and explores alternatives, considers ethical principles, applies reason and logic and thus makes informed decisions.
- Must ask questions to gain a better understanding of client/situation
- 3 important aspects of critical thinking:
o Reflection
o Language
o Intuition
Reflection
- The process of purposefully thinking back or recalling a situation to discover its purpose or meaning
- Requires adequate knowledge and is necessary for self-evaluation when viewing one’s successes or opportunities for improvement
- However, emphasizing reflection can deter thinking in a clinical situation due to the second-guessing it can create
- With reflection, a nurse seeks to understand the relationships between concepts learned in the classroom and real-life clinical situation
- Allows a nurse to judge personal performance while also judging whether standards of nursing practice were followed
Language
- The ability to use language is closely associated with the ability to think meaningfully
- To think critically, a nurse must be able to use language precisely and clearly, where vague and inaccurate language reflects sloppy thinking
- Clear communication with clients, families and health care professionals is crucial; Requires framing of one’s thoughts so that the focus and message are clear
Intuition
- The direct understanding of particulars in a situation without conscious deliberation
- Develops as one’s clinical experience increases
- Can act as a trigger, sparking an analytical process that leads nurses in a conscious search to acquire data that confirm their sense of change in a client’s status
- Nurses should trust their intuition as a ‘red flag’ or signal that something is not quite right, but they should not take intuition as an automatic truth
Thinking and Learning
- To learn, one must be flexible and open to new information
- Thinking cannot become routine or standardized
- Nursing practice is always changing. As new knowledge becomes available, nurses must challenge traditional ways of doing things and discover those interventions that are most effective, have scientific relevance and result in better client outcomes
Levels of Critical Thinking in Nursing
- Basic
- Complex
- Commitment
Basic Critical Thinking
- A learner trusts that experts have the right answers for every problem
- Thinking is concrete and based on a set of rules or principles
- For basic critical thinkers, answers to complex problems are either right or wrong and one right answer usually exists for each problem
- Despite the tendency to be governed by others, a person gradually learns to accept the diverse opinions and values or experts
Complex Critical Thinking
- A person begins to detach from authorities and analyze and examine alternatives more independently at the complex level of critical thinking
- A nurse realizes that alternative, and perhaps conflicting solutions exist
- There is a willingness to consider deviations from standard protocols or policies when complex situations develop
Commitment
- The individual anticipates the need to make choices without assistance from others and then assumes accountability for them
- The nurse chooses an action or belief based on the alternatives available and stands by it
Critical Thinking Competencies
- Critical thinking competencies are the cognitive processes a nurse uses to make judgments
- These competencies include: general critical thinking, specific critical thinking in clinical situations and specific critical thinking in nursing
General Critical Thinking Competencies
- Applying the Scientific Method
o An approach to reasoning that is used in nursing, medicine and other disciplines
o Nurses use it when testing hypotheses or research questions in nursing practice situations
o Refer to Table 11-2 for Steps of the Scientific Method
- Problem Solving
o Involves evaluating the solution over time to be sure that it is still effective
o Having solved a problem in one situation adds to the nurse’s practice experience and allows the nurse to apply that knowledge in future client situations
- Decision Making
o An end point of critical thinking that one hopes will lead to problem resolution
o Involves a series of steps:
§ Recognizing and defining the problem
§ Assessing options
§ Weighing each option against a set of criteria
§ Testing possible options
§ Considering the consequences of the decision
§ Making a final decision
Specific Critical Thinking Competencies
- Diagnostic Reasoning
o The nurse gathers data by assigning meaning to the behaviours, physical signs, and symptoms presented by the client to logically determine the client’s health status
- Inference
o Part of diagnostic reasoning is inference, which is the process of drawing conclusions from related pieces of evidence
- Clinical Decision Making
o Requires careful reasoning so that the options for the best client outcomes are chosen on the basis of the client’s condition and the priority of the problem
o Refer to Box 11-3 for Clinical Decision Making for Groups of Clients
o Decision-making Criteria
§ What needs to be achieved?
§ What needs to be preserved?
§ What needs to be avoided?
Specific Clinical Thinking in Nursing
- Applying the Nursing Process
o Consists of five steps:
§ Assessment
§ Nursing Diagnosis
§ Planning
§ Implementation
§ Evaluation
o Provides a systematic approach for gathering client data, critically examining and analyzing the data, identifying the client’s response to a health problem, determining priorities, establishing goals and expected outcomes of care, taking appropriate action, and evaluating whether the action is effective
o This process is not linear, nurses often will move back and forth, using steps which are most appropriate to a client’s presenting situation
Critical Thinking Model
- Kataoka-Yahiro’s model of critical thinking for nursing judgement have five components of critical thinking
- Refer to Box 11-4 for further review
o Knowledge Base
o Experience
o Competencies
o Attitudes
o Standards
Specific Knowledge Base
- First component of critical thinking is a nurse’s knowledge base
- Includes the initiative a nurse shows in reading the nursing literature to remain current in nursing science
Experience
- Unless a nurse practices and make decisions about client care, critical thinking in clinical decision making will not develop
- In clinical situations, the nurse learns from observing, sensing, talking with clients and families and then reflecting actively on all experiences.
- Clinical experience is the laboratory for testing nursing knowledge
- New nursing students must value all client experiences, because they become stepping stones for building new knowledge and stimulating innovative thinking
Attitudes for Critical Thinking
- 11 attitudes that are central features of a critical thinker
- These attitudes define how a successful critical thinker approaches a problem
- Refer to Table 11-3 for further review
o Confidence- to feel certain in one’s ability to accomplish a task or goal. It grows with experience and the maturity to recognize one’s strengths and limitations
o Thinking Independently- As people mature and gain new knowledge, they learn to consider a wide range of ideas and concepts before forming an opinion or making a judgment
o Fairness- Critical thinkers are just. They recognize their own biases and prejudices and do not allow them to affect their decision.
o Responsibility and Accountability- A nurse is responsible for correctly performing nursing care activities based on standards of practice. A nurse who is accountable is reliable and willing to recognize when nursing care is ineffective
o Risk Taking- Without intellectual risk taking, knowledge cannot advance. A critical thinker is willing to take risks in trying different approaches to solving problems
o Discipline- Ensures that decisions are made systematically and in a comprehensive manner
o Perseverance- Takes on a problem with determination and diligence despite opposition. This attitude is especially important when problems remain unresolved or when they reoccur. A critical thinker who perseveres is not satisfied with minimal effort, but works to achieve the highest level of quality care
o Creativity- Involves using imaginative and innovative skills in problem solving.
o Curiosity- Drives a critical thinker to ask the question, “Why?”
o Integrity- Acts according to a sound moral and ethical position.
o Humility- Important to be humble and admit to one’s own limitations in knowledge and skills
Standards for Critical Thinking
- Intellectual Standards
o Clear
o Precise
o Specific
o Accurate
o Relevant
o Plausible
o Consistent
o Logical
o Deep
o Broad
o Complete
o Significant
o Adequate (for purpose)
o Fair
- Professional Standards
o Requires that nurses use critical thinking for the good of individuals or groups
o Promote the highest level of quality care
o Focusing on a client’s values and beliefs helps a nurse to make clinical decisions that are just, faithful to the client’s choices, and beneficial to the client’s health and well-being
Critical Thinking Synthesis
- As nurses engage in the nursing process, they are also synthesizing critical thinking knowledge, experience, competencies, standards, and attitudes
- The nursing process and critical thinking are synthesized, meaning the two come together in a manner that allows a student to become a competent professional nurse