Post on 12-May-2015
Critical Thinking in Nursing
Author: Marisa Tapia MSN, RN ACNS-BC
Critical Thinking
Nursing Education views or requires critical thinking as an educational outcome
As a result of this outcome or EVALUATION there is new thinking or new processes or new ideas
What outcomes are generated?› New ways of thinking› New ideas› New questions› New decisions› New conclusions› New results
Critical Thinking Is:
Systematic Habit forming A method or process to promote
thinking regarding the thinking about new thinking that promotes an action on the new insight as it generates more thinking
Is that clear as mud?
Why Critically Think? To make a critical analysis of factors
associated with a problem Nurses need critical thinking skills to be:
› Safe › Competent › Skillful and Confident› Aware and Ethical› Generate and promote new ideas and
knowledge in the Art and Science of Nursing
What is Critical Thinking?
Is there such a thing?
Haven’t we been doing it all along?
How do we define it?
Defining Critical Thinking
Method of Reasoning Problem Solving approach to finding an
answer Reasonable reflective thinking that
focuses on deciding what to do or what is to be done yet setting out to find alternatives within the answer
Characteristics of Critical Thinking
Being rational and reflective Creative thinking (many ways to skin a
cat) Healthy and constructive skepticism Autonomy “building your own
algorithm” Fair and equitable thinking Focusing on what the belief is and act
on it
4 Stages in the Critical Thinking Process
Preparation Incubation Insight Verification
Stage 1: Preparation
Creative thinker gathers information related to a problem or concern
How do we do this?
Stage 1: Preparation-How?› Questioning
Patient interview
› Gathering information/data Assessment data
› Identifying the Nursing Diagnosis based on the assessment findings either real or potential clinical problems
Stage 2: Incubation-Planning
Thinking about the thinking:Formulating a plan of action to accompany
the assessment finding applying the plan
(implementation) in order for your patient to meet his or her goals thus ensuring success which Evaluates the plan and implementation as achieving the goal ensuring a postive patient experienceOutcome
Stage 3: Insight: Plan and Implementation
Plan is put into place Solutions Emerge Solutions are developed Solutions are identified through a
thoughtful process Once the solution is indentified it is
then implemented
Stage 4: Verification
Implementation phase begins Evaluation of the implemented
solution is established Effectiveness of the implemented
solution is established Outcome measured as successful or
finding opportunities to improve
New approach to Critical Thinking and the Nursing Process
T.H.I.N.K.
T.H.I.N.K. incorporates the critical thinking piece to the nursing process and promotes positive outcomes in regards to nursing care
T.H.I.N.K. T: Total Recall: correlating a fact to
experience H: Habits: forming habits facilitates
thinking while the habit is undertaken
I: Inquiry: Being curious. Questioning the obvious to promote more inquiry
N: New ideas and creativity: teaching new things to different patients
K: Knowing how you think: Recognizing that you know or do not know
something and how you go about learning and teaching.
Critical Thinking:
According to LeFevre (2002)Critical thinking is the process of
figuring out what to believe or do about a situation, problem or controversy for which no single definitive answer or solution exists, but what is the proper way to deal with the situation at hand
How do we critically think? Thinking about the thinking while we
are thinking Constant and consistent analysis of the
doing Anticipating the needs of the patient or
situation or process in order to make the outcome better
In Nursing:
Nurses need to stay ahead of the situation, it may be that we have to stop and think….
Questions to Ask
How will my anticipating of the needs better the patient and the outcome?
Questioning the Question
What we may think is the right thing to do at that time may not be the correct way of handling the situation in the end
In Nursing: We should use systematic reasoning to clarify problems…
Anticipate the needs Step back and think of all the
possibilities to the resolution Explore different avenues to obtain the
same positive effect (Outcome) Be confident in your choice of solutions
and be assertive
Critical Thinking:
Critical thinking in Nursing is an essential component of professional accountability and quality nursing care
Who are the critical thinkers?
Attributes: Habits of the Mind Confidence competence creativity, flexibility, inquisitiveness integrity, intuition, open-mindedness
perseverence and reflection
Skills in Creative Thinking
Critical Analysis Questioning:
Examining many points of view
Play devil’s advocate: search for inconsistencies
Differentiate what you know from what you believe
Inductive reasoning Deductive reasoning Evaluating the
credibility of sources Clarifying concepts
Attitudes of Creative Thinkers
Independence of thought
Fair-mindedness Insight into
egocentricity and socioentricity
Intellectual Humility
Suspension of judgment
Intellectual courage Integrity PerseverenceConfidence in Reason
Attributes of Creative Thinkers
Attributes: Skills Analyzing Applying standards Discriminating (recognizing
differences) Information seeking Logical reasoning Predicting Transforming knowledge
Concept of Independence of Thought
Think for yourself Serious consideration is taken to a wide
array of ideaslearn from themand make your own judgments based on this insight (deductive and inductive reasoning)
Concept of Fair-mindedness
Assess all points of view with the same standards and not basing the judgment on personal prejudices or personal opinions but rather on factual knowledge
Elements of Critical Thinking Applied to Nursing Assumptions Information Concepts Purpose of thinking Points of view
Questions regarding an issue
Interpretation and inference
Implications Consequences
Assumptions
Nursing applies scientific knowledge to caring for a patient
Utilizes the caring components of human interaction while applying scientific knowledge base to facilitate wellness for the individual
Information
Assessment data› History (medical, surgical, family etc)› Physical› Labs/Procedures› Subjective and objective findings from the
patient
Concepts Theories Definitions Principles Examples:
› Lab values and their meanings› AORN Standards and recommended
practices› Adult learning principles
Purpose of Thinking: Analysis and Synthesis
Making decisions regarding the data being collected
Diagnose problems and make clinical judgments
Determining the goals and outcomes
Question of the Issue
Determining the nature of the problem To identify the legal and ethical issues
that are present within the nursing situation
Examples:› 90 y/o with COPD, O2 sats of low 80’s on
BiPap and a fractured ankle
Points of View
The nurse patient relationship The collaborative efforts among the
multidisciplinary team and the patient The overall perception of the care
being provided
Interpretation and Inference
Determining diagnosis Putting the pieces together Formulating a plan of care Identifying interventions
Implications and Consequences
Patient outcomes Modification of the plan of care
dependant on the patient outcomes
Characteristics of Critical Thinkers
Active Thinkers: Double check information for reliability and interpretation› Knowledgeable about their biases and
limitations “Intellectual humility”› Know weaknesses and strengths
Fair-minded: Aware of their own perceptions, values and beliefs but seek to treat all viewpoints alike
Characteristics of Critical Thinkers:
Good communicators: Not methodical in relaying information and consistently ask for ideas to solutions.
Mutuality of exchanging of ideas: is essential for positive outcomes and
understanding the facts first and then finding the best solutions (Intellectual Empathy)
Characteristics of Critical Thinkers
Open-minded: be aware of others values before disrupting harmony and making changes that may seem right at the moment but not positive in the long run (Positive Outcome)
Independent thinkers: think for themselves › Curious and insightful (the need to know)
Characteristics of Critical Thinkers
Humility: Know your limitations and know when you are stepping way out of your league…
Know the difference between the benefits of the “here and now” vs the effects of the “down the road implications”….the OUTCOMES
Know that you will make mistakes Good listeners
Crucial in Critical Thinking: Honesty is Integrity
Be honest with yourself: this assists you in knowing yourself first and then assisting in the steps to critically think something through
When your integrity is lost in the eyes of others, honesty is lost and rarely regained thus any decision made will be viewed doubtful or negative
First Glance to Start Critically Thinking
Be proactive Be organized Be flexible Be cognizant of rules of logic (weigh the
risks and benefits of the long run versus the here and now)
Be realistic Be a team player (Commit to excel)
How we do it in Nursing:
Analyze Apply standards Differentiate practice Seek information Logical Reasoning Predicting and transforming knowledge
How Do We Become Better Critical Thinkers:
We learn to synthesize and analyze information that leads us to a better understanding of the end result
We improve our personal development
How? Like what?
Areas of Personal Development
View of knowledge: what you know and how you utilize what you know in daily working condition to make things better
Approach to learning: Everyday we learn something new because everyday is different and every new day brings on new events that challenge us to learn more
Areas of Personal Development (continued)
Dealing with uncertainty: can be topic specific, interpersonal skills, and/or professionally specific.
Ways to facilitate uncertainties: Know your subject matter (Do your
homework) Know your limitations and address them on
a personal level…again…Do your homework…find ways for self-improvement to further develop your critical thinking skills
Creativity in Critical Thinking in Nursing
Professional Development Commitment to professional
development: Take every opportunity to learn more,
this in turn facilitates better critical thinking skills because you are “doing your homework” and this further develops your skills as a professional nurse
Scholarship and Leadership
By learning more we become more aware of our professional and personal surroundings
This in turn assures us in the anticipation of needs of the situation
When we anticipate we “think better” When we “think better” we lead better
Role of Experience
When we learn more we become better at doing what it is that we do best
Experience leads to success Success in nursing is critical in assuring
positive patient outcomes With this in mind our critical thinking
skills are further enhanced
Very Important!!!!!
If we want to develop nurses to excel, we need our nurses to be cognitively equipped to deal with difficult situations associated with patient care decisions, interpersonal decisions and moral/ethical decisions, thus, we need to build on our professional development skills to enhance our critical thinking
Putting it all together
Ask: What-if questions What-else questions Think out loud, write it down Compare and contrast Play Devil’s Advocate Organize and reorganize information Look for flaws in YOUR thinking Anticipate Ask an expert to listen to your thinking and
see where your thoughts are and synthesize and analyze the process
Any questions?
References
Harkreader, H. (2004) Fundamentals of Nursing: Caring and Clinical Judgment. Philadelphia: W.B.Saunders.
LeFevre, R. (2002). Critical thinking in nursing: A practical approach.
Philadelphia: W.B. Saunders.