CRITICAL THINKING in Nursing Practice:

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CRITICAL THINKING in Nursing Practice

• active, organized, cognitive process used to
  carefully examine ones thinking and the thinking
  of others.
• Involves use of MIND
• Form conclusions
• Make decisions
• Draw inferences
• reflect

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Critical Thinking and Nursing

• The nurse identifies unique needs of each client
  and develops specific interventions to meet those
  needs.
• Creative thinkers have the intellectual courage
  and capacity to think in a new and in a different
  way.
• Without creative thinking, nursing would become
  routine and habitual.

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Critical Thinking Applied in Nursing

• Application of critical thinking is vital to each
  step of the nursing process.
• Critical thinkers develop a questioning attitude.
• No action is performed without critical
  thinking.

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Activity

• Its often said that medicine is curing and
  nursing is caring, do you agree ?
• Discussion

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BEGIN WITH

• Questions
• What do I really know about this nursing care
  situation?
• How do I know it?
• What options are available to me?

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THREE INPORTANT ASPECTS

• REFLECTION purposefully thinking back
  /recalling. Requires honest review
• LANGUAGE precise clear resulting in clear
  message
• INTUITION inner sensing that something is so

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THINKING AND LEARNING

• LIFELONG PROCESS

• NURSING PRACTICE ALWAYS CHANGING

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LEVELS OF CRITICAL THINKING IN NURSING

• BASIC CONCRETE, BASED ON SET OF RULES OR
  PRINCIPLES
• COMPLEX IT DEPENDS
• COMMITMENT CHOOSE AN ACTION STAND BY IT

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CRITICAL THINKING COMPETENCIES

• Scientific method
• Problem solving
• Decision making

• Diagnostic reasoning and inference
• Clinical decision making

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Critical Thinking and Decision Making

• Decision Making
• Considering and selecting interventions to
  facilitate achievement of desired outcomes.
• Based on reliable information and made with as
  much critical thought as possible

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Critical Thinking and Decision Making

• Critical thinking for clinical decision-making is
  the ability to think in a systematic and logical
  manner with openness to ask questions and reflect
  on the reasoning process used to ensure safe
  clinical practice and quality care.

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Activity

• You hear strange noise in the kitchen. Upon
  entering the kitchen you find that you left the
  water running and notice the kitchen floor is
  covered with water. Within your reach there are
  six (6) sponges, a mop and bucket and a covered
  floor drain. What do you do first?

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Critical Thinking and Problem Solving

• The nurse uses the nursing process to identify
  and make decisions about client needs.
• The nursing process is a systematic and
  scientifically-based process.
• The process requires the use of many cognitive
  and psychomotor skills

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NURSES DO NOT MAKE MEDICAL DIAGNOSES, BUT THEY
DO ASSESS AND MONITOR CLIENTS CLOSELY AND COMPARE
THE CLIENTS SIGNS AND SYMPTOMS WITH THOSE THAT
ARE COMMON TO A MEDICAL DIAGNOSIS.
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The Nursing Process

• A process is a series of steps or acts that leads
  to accomplishment of some goal or purpose.
• The purpose of the nursing process is to provide
  individualized, holistic, effective, and
  efficient care to clients.
• Systematic framework for providing professional,
  quality nursing care.
• Used in every practice setting and specialty.
• Derived from the scientific method of problem
  solving.

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Nursing process as a competency

• Five steps
• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation

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Components of the Nursing Process
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SYSTEMATIC APPROACH

• GATHER DATA
• CRITICALLY EXAMINE ANALYZE
• IDENTIFY RESPONSE
• DETERMINE PRIORITY
• ESTABLISH GOALS EXPECTED OUTCOMES
• TAKE ACTION
• EVALUATE

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Characteristics of Critical Thinking

• Creativity
• Logical and rational
• Cautious and information-seeking
• Systemic
• intellectual

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Critical Thinkers Ask

• What am I taking for granted?
• Did I explore all points of view?
• Do I understand the question?
• What information do I need?

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The Four Critical Thinking Skills

• Reading
• Listening
• Observing
• Analyzing

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To Improve Critical Reading

• Highlight the main ideas as you read. If most of
  the text is highlighted you are not reading
  critically.
• Join a study group and see if your main idea is
  the same as fellow group members.
• Dialogue with yourself to identify the main idea
  of your reading.
• Try to state the main idea in your own words

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To Improve Critical Listening

• Restate the points made in a discussion with
  others to see if you understand them.
• Focus on what a speaker is saying and listen for
  key points.
• While listening, make note of anything you find
  confusing, and ask about it later.

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To Improve Critical Observing

• Remove any restrictions in your mind.
• Eliminate or decrease any distraction.
• Ask yourself if you understand the most important
  points?
• Create new ways of looking at situations
• Always look from outside the situation .

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To Improve Critical Analyzing

• Maintain clear and accurate logic.
• Take all details into consideration.
• Use systematic and scientifically-based process.
• Use both cognitive and psychomotor skills.

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Reasoning

• The process of solving problems by using critical
  thinking skills.
• An attempt to figure something out, solve a
  problem, or settle a question

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.Strategies that Promote Development
Application of Critical Thinking

• Identify goals.
• Determine what knowledge is required.
• Assess the margin for error.
• Determine the amount of time available for
  decision making.
• Identify available resources.
• Recognize factors that may influence decision
  making.

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Barriers to Creative Thinking

• Resistance to change, rigid mind-set, practice
  guided by tradition, habit, routines
• Stereotypical perceptions of clients
• Fear of making mistakes
• Unwillingness to take risks or look for
  alternative strategies
• Decision making without sufficient data or
  supported by rationale
• Failure to evaluate effectiveness of nursing
  actions

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Examples

• A 6-year old girl is admitted to following
  lacrimal duct probing. She has a history of
  asthma and is receiving humidified oxygen through
  a nebulizer mask. Suddenly, her respiratory
  status changes. She is struggling for air and has
  sternal retraction. Her respirations become loud
  and crowing.
• What would you do at this time? Why?

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Examples

• On your second home visit with Mrs. B., she tells
  you , Being in this much pain isnt worth it
  anymore. I am just getting worse everyday. I can
  hardly do anything for myself. I would be better
  off dead!
• Describe three possible responses you could make
  to Mrs. B. Provide a rationale for each.
• Which response would you choose and why?
• Mr. K., a patient with asthma, was admitted
  yesterday morning. He has an order for albuterol
  treatments to be given every 4 hours around the
  clock. You enter his room at 400 a.m. and find
  him sleeping soundly.
• What would you do? Why?

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10 Key Questions that Promote Critical Thinking

1. What major outcomes (observable results) will
   drive our thinking?
2. Exactly what are the problems, issues, or risks
   that must be addressed to achieve the major
   outcomes?
3. What are the circumstances?
4. What knowledge is required?
5. How much room is there for error?

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10 Key Questions that Promote Critical Thinking

• 6. How much time do I/we have?
• What resources can help?
• Whose perspectives must be considered?
• Whats influencing thinking?
• What must we do to prevent, control, or eliminate
  the problems or issues identified in question 2
  above?

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Designed with the Assumptions that

• Critical thinking
• has to happen in our own brains.