Chapter 10: Critical Thinking and the Nursing Process Critical Thinking o Critical thinking has many definitions

the most useful one is Critical thinking in nursing practice is a discipline specific, reflective reasoning process that guides a nurse in generating, implementing and evaluating approaches for dealing with client care and professional concerns o Is essential to safe, competent, skillful nursing practice o Nurses using critical thinking in many way o Nurses use knowledge from other subjects and fields- must draw meaningful information from other subject areas in order to understand the meaning of the client data and to plan interventions o Nurses deal w/ change in stressful environments- Nurses work in rapidly changing situations like technology, medications, etc. o Nurses make important decisions-makes vital descions that often determine well being of client y Creativity is a major component of critical thinking, when incorporated into practice may be able to find unique solutions to problems y When using creativity nurses o Generate many ideas rapidly o Generally flexible and natural o Creates original solutions to problems o Independent and self confident, even under pressure o Demonstrates individuality Critical Thinking Skills y Critical analysis-application of a set of questions to a particular situation or idea to determine essential info and ideas and discard superfluous ideas and info. o Socratic questioning-technique one can use to look beneath the surface, recognize and examine assumptions, search for inconsistencies, etc. y Inductive Reasoning-generalizations are formed from a set of facts or observations. o Moves from specific examples to generalized conclusions. Ex: after touching a hot flame, we conclude that all flames are hot y Deductive Reasoning-From generalized to specific y Differentiating facts from opinions o Facts-Can be verified through investigation o Inferences-Conclusions drawn from facts, making a statement not known o Judgments-Evaluation of facts or info that reflect values or criteria o Opinions-Beliefs formed over time and include judgments that may fit facts or be errors Critical Thinking Attitudes y Independence-Critical thinking requires that individuals think for themselves. Considers a wide range of ideas, learn from them and make own judgments about them y Fair-Mindedness-Assessing all viewpoints w/ the same standards and not basing their judgments on personal bias or prejudice. This helps one consider

opposing points of view and to try to understand new ideas fully before rejecting/accepting y Insight-Open to the possibility that their personal biases or social pressures and customs could affect their thinking. Try to examine own biases and bring them to awareness each time o Nurses tend to assume that all clients are motivated and interested in their care, which is inaccurate assessment of clients desire to learn. y Intellectual Humility-Having an awareness of the limits of ones own knowledge. Willing to admit what they do not know, willing to seek new info and rethink their conclusions in light of new knowledge y Intellectual Courage-Willing to consider and examine fairly ones own ideas or views, esp. those to which one may have a strongly negative reaction y Integrity-requires that the individuals apply the same rigorous standards of proof to their own knowledge and beliefs as they apply to the knowledge and beliefs of others. Readily able to admit and evaluate inconsistencies w/i their own beliefs and b/w their own beliefs and those of another. y Perseverance-Determination enables them to clarity concepts and sort out related issues, in spite of frustrations y Confidence y Curiosity-may value tradition but is not afraid to examine traditions to be sure they are still valid Significance of Developing Critical Thinking y Essential for safe, competent, skillful nursing practice y Rapid & Continuing growth of knowledge y Makes complex and important decisions y Draw meaningful info from other subject areas y Work in rapidly, changing, stressful environments y Recognize important cues, respond quickly, and adapt interventions Top 10 Reasons to Improve Thinking 1. Things Change 2. Sicker Clients 3. More consumer involvement 4. Need to move from one setting to another 5. Requirement for evidence of benefits, efficiency and results 6. New problems cant be solved w/ old ways of thinking 7. Thinking skills needed to deal w/ todays world 8. Possibly to improve thinking 9. Need for new learning and workplace skills 10. Difference b/w success and failure Critical Thinking and Nursing y Critical thinking underlies each step of the nursing, problem solving, and decision making process y The nursing process is a systematic, rational method of planning and providing individualized nursing care. y Phases of nursing process o Assessing

o Diagnosing o Planning o Implementing o Evaluating Problem Solving Process y Problem solving-nurse obtains info that clarifies the nature of the problem and suggests possible solns. Carefully evaluates possibly solutions and chooses the best one to implement y Commonly used approaches to problem solving, trial and error, intuition, the research process and scientific/modified method. Trial and Error y Number of approaches are tried until a solution is found y Can be dangerous b/c client might suffer harm if an approach is inappropriate Intuition y Understanding or learning of things w/o the conscious use of reasoning. y Also known as sixth sense, hunch, instinct, feeling or suspicion y Experience is important in improving intuition b/c the rapidity of the judgment depends on the nurse having seen similar client situations many times. Research Process and Scientific/Modified Scientific Method y Formalized, logical, systematic approach to solving problem y Scientific is in a controlled method y Modified is in an uncontrolled- most health care professionals use this Decision Making y Critical thinking process for choosing the best actions to meet a desired goal y Nurses must make decisions and assist clients to make decisions. When faced with many clients must prioritize and decide which client to assist first y Steps to process o Identify purpose-why decision is needed and what needs to be determined o Set the criteria-Three questions must be answered: What is the desired outcome? What needs to be preserved? What needs to be avoided? o Weight the criteria-Sets priorities or ranks from least to most important o Seek alternatives-Seeks possibly ways to meet criteria o Examine alternatives o Project-applies creative thinking & skepticism to determine what might go wrong o Implement-placed into action o Evaluate the outcome Ways of Demonstrating Critical Thinking y Rigorous personal assessment-determines which attitudes the nurse already possesses and which need to be cultivated y Reflection-pauses in order to consider nurses beliefs, knowledge, values and abilities in a situation at hand y Analysis of thinking processes and attitudes

y y y y

Cultivation of critical thinking abilities Attendance at conferences-supports open examination of all sides of issues and respect for opposing view points Awareness of own thinking while thinking-easier to detect thinking errors Create environments that support critical thinking