Chapter 15 Critical Thinking in Nursing Practice Critical thinking is not a simple step-by-step linear process that is learned in a short period of time. Critical thinking is acquired through experience, commitment, and active curiosity. You will soon learn that critical thinking and the nursing process are interwoven. One does not exist without the other. When caring for clients and their family members, nurses need to think smart in order to make sensible judgments so the client can receive appropriate nursing care.

Clinical Decision in Nursing Practice Clinical decision-making skills separate professional nurses from technical and ancillary staff. Clients have problems for which no textbook answers exist. Nurses need to seek knowledge, act quickly, and make sound clinical decisions. Critical thinking challenges you to think creatively, search for the answer, collect data, make inferences, and draw conclusions.

Critical Thinking Defined Chaffee (2002) An active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others Settersten and Lauer (2004) Recognizing an issue exists, analyzing information, evaluating information, and making conclusions Thinking and learning are related processes. Nurses will use observations and judgments to make choices. You will always want to ask “why” and “how” when caring for clients. The use of evidence-based knowledge (Chapter 5) helps you become a critical thinker. Table 15-1 further discusses critical thinking skills.

Thinking and Learning Learning is a lifelong process. Intellectual and emotional growth involves learning new knowledge, as well as refining the ability to think, solve problems, and make judgments. In Chapter 1 we talked about the attributes of a profession. One of them was having a knowledge base. The science of nursing continues to grow. Nurses need to be flexible and open to new information.

Levels of Critical Thinking Kataoka-Yahiro and Saylor (1994) Critical Thinking Model Basic critical thinking Complex critical thinking Commitment At the basic level, students think concretely on the basis of a set of rules or principles, following a step-by-step process without deviation from the plan. Complex critical thinking analyzes and examines choices independently. Students learn to think beyond and synthesize knowledge. Commitment is the third level of critical thinking. Students (soon to be future nurses) anticipate needs and make choices without assistance from others.

Critical Thinking Competencies Scientific method Problem solving Decision making Diagnostic reasoning and inference Clinical decision making Nursing process as a competency These critical thinking competencies are cognitive processes. Critical thinking processes are not unique to nursing, but are used in everyday life in many situations. These include scientific method, problem solving, and decision making. Specifically in nursing we use diagnostic reasoning and inference, clinical decision making, and nursing processes.

Critical Thinking Model for Decision Making Models serve to explain concepts and help nurses 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.

Five Components of Critical Thinking Knowledge base Experience Nursing process competencies Attitudes Standards Box 15-2 presents the components of critical thinking. A nurse’s knowledge base is drawn from nursing school education as well as from knowledge obtained from basic sciences, humanities, and behavioral science. Experience is obtained from clinical situations, actually working with clients and their families. The nursing process will be discussed specifically in the following chapters Chapter 16: Assessment Chapter 17: Nursing Diagnosis Chapter 18: Planning for Nursing Care Chapter 19: Implementing Nursing Care Chapter 20: Evaluation There are 11 attitudes a new nurse needs when thinking critically. Table 15-3 discusses these attitudes. Finally, there are two standards to consider when thinking critically: intellectual and professional. An intellectual standard is a guideline or principle for rationale thought. Professional standards refer to ethical criteria for nursing judgments, evidence-based criteria used for evaluation, and criteria for professional responsibility.

Critical Thinking Attitudes Independence of thought Fair-mindedness Insight Intellectual humility and suspension of judgment Courage Integrity Perseverance Confidence in reason Interest in exploration Curiosity

Developing Critical Thinking Skills Reflective journaling A tool used to clarify concepts through reflection by thinking back or recalling situations Concept mapping A visual representation of client problems and interventions that illustrates an interrelationship When you use critical thinking, you need to connect knowledge and theory. This can be done through reflective journaling and concept mapping.

Critical Thinking Synthesis A reasoning process used to reflect on and analyze thoughts, actions, and knowledge Requires a desire to grow intellectually Requires the use of nursing process to make nursing care decisions Critical thinking and the nursing process are inseparable. As a new nurse, you will rely on the nursing process to guide your practice. The next five chapters thoroughly discuss nursing process and application to client care.