Critical Thinking in Nursing

Introduction

• Critical thinking is a daily process, even in seemingly simple actions
• Taking off a sweater when it is hot, or changing into walking shoes, involves critical thinking
• Critical thinking is the ability to think clearly and rationally
• Nurses use critical thinking in daily decision-making
• Nursing students and graduates must demonstrate critical thinking skills

Components of Critical Thinking

1- Mental Operations

• Mental operations include decision-making and reasoning to find or create meaning
• These lead to creative and appropriate problem-solving
• Other cognitive operations involved in critical thinking include planning and evaluating one's thinking

2- Knowledge

• Nursing curricula aim to teach specific facts about nursing and care delivery
• Nursing students should understand the reasoning behind the facts, not just memorize them
• A broad knowledge base (science, psychology, philosophy, and nursing courses) is crucial for critical thinking
• Nurses apply this knowledge to specific client situations

3- Attitudes

• Certain attitudes enhance critical thinking
• Curiosity and interest are vital components of critical thinking
• Critical thinking requires tolerance, open-mindedness, a non-judgmental mindset
• Intellectual courage, respecting others' perspectives, and dealing with uncertainty are essential attitudes.
• Intellectual humility (awareness of one's knowledge limitations), and self-confidence are important.

Clinical Decisions in Nursing Practice

• Nurses are responsible for accurate clinical decisions
• Clinical decision-making distinguishes professional nurses from technical staff.
• A professional nurse will observe changes in patient conditions, recognize potential problems, and take immediate action
• Patients have unique health problems
• Nurses use critical thinking to gather information, form inferences, and choose a nursing approach using scientific principles

Critical Thinking Defined

• Evidence-based knowledge or knowledge from research and clinical experience leads to informed critical thinking
• Skilled nurses can see the bigger picture of patient situations from various perspectives
• Critical thinking facilitates care for patients and supports informed decisions

Levels of Critical Thinking in Nursing

• Critical thinking ability develops with nursing knowledge and experience
• An expert nurse thinks critically automatically
• A beginning student uses a critical thinking model at the basic level

Basic Critical Thinking

• Learners trust experts' solutions for each problem
• Based on rules and principles (using a procedure manual)

Complex Critical Thinking

• Critical thinkers examine choices and options independently
• They analyze and evaluate choices autonomously, separating themselves from dependence on experts
• An important aspect of complex critical thinking is considering various treatment options for patients with various consequences

Complex Critical Thinking (continued)

• Nurses realize that different solutions for patient care have benefits and risks
• Consider all the possible solutions
• Willingness to consider varied options in complex situations

Complex Critical Thinking (continued)

• If a patient experiences severe post-operative pain, the nurse evaluates various options (e.g., increasing opioid medication or using heat therapy).
• Each option has benefits and potential risks
• The best option depends on patient-specific needs

Commitment Critical Thinking

• Nurses decide when to make a choice without help from others, taking responsibility
• Some actions are delayed due to experience and knowledge

Commitment Critical Thinking (continued)

• Example: A nurse observes a change in urine color (cloudiness and foul odor) during catheter care.
• The nurse assesses the situation and suspects a urinary tract infection
• The nurse recommends actions to reduce the infection risk (e.g., increased fluid intake, strict hygiene protocols) and monitors patient symptoms before contacting the doctor
• The nurse advocates for the patient by clearly communicating observations, taken actions, and suggestions to the doctor

Problem

• A patient needing a pacemaker was scheduled for 09:00 and required two units of blood prior
• Oxygen levels dropped and stabilized with 2L oxygen, fluctuating in the low 90s

Critical Thinking and Solution

• The nurse analyzed the patient's medical history and condition
• Recognized that the low oxygen levels could be related to fluid buildup in the lungs
• Recommended an intervention to address the fluid buildup, a dose of IV lasix
• The patient's oxygen levels improved.

Trial-and-Error Problem Solving

• This approach entails trying numerous solutions until a successful one is found
• It is generally inefficient and risky for patient care

Critical Thinking Competencies

Scientific Method

• The scientific method is a problem-solving tactic using reasoning
• Identifying problems, collecting data, formulating questions/hypotheses, testing, and evaluating results are the five key steps

Intuitive Problem Solving

• Intuition plays a role in clinical decisions
• Nurses frequently apply intuitive thinking to save patients' lives
• Intuition is linked to identifying situations where there are no clear signs but there are underlying issues

Intuitive Problem Solving (continued)

• Example: A nurse notices subtle changes in a post-operative patient, like decreased alertness and a slight drop in blood pressure.
• The nurse uses intuition to assess and alerts the doctor, which could prevent complications

Critical Thinking Competencies

• Nurses make decisions and choices every day—these decisions have implications
• Skilled decision-making in nursing is critical

General Critical Thinking- Decision Making

• Decision-making in nursing is a critical thinking process involving selecting the appropriate course of action from various options
• Determining priorities and resolving conflicts are a part of decision-making
• Example: When determining if wound care or respiratory distress is the priority for a patient

Potential Errors in Decision Making

• Biases: Favoring first received information, avoiding contradicting opinions, choosing a singular solution, or supporting past choices are some examples of biases.
• Failure to consider the full situation: Using inaccurate data, not properly ordering problems in importance, setting unrealistic goals are some examples
• Impatience: Not identifying all potential solutions, not applying appropriate resources, or implementing decisions incorrectly are examples

Specific Critical Thinking: Diagnostic Reasoning and Inference

• Expert nurses consider the context when diagnosing issues, such as observing and interpreting symptoms of hypoglycemia in a diabetic patient
• A nurse uses observation skills, gathers data, and checks for supporting symptoms (e.g., blurred vision, dizziness, weakness, tremors), to determine possible causes and offer solutions.

The Nursing Process as a Competency

• Nurses use the nursing process to evaluate, diagnose, implement, and assess a treatment or plan for better patient health
• This process helps to diagnose and treat actual or potential health issues
• The nursing process leads to improved health outcomes.

A Critical Thinking Model- Clinical Decision Making

I. Specific Knowledge Base

• Understanding medical knowledge, and patient's issues helps to understand patient needs appropriately.

II. Experience

• Clinical experience supports clinical decisions
• Nurses use experience to interpret clinical situations and determine the significance of symptoms

III. Attitudes

• Confidence: Nurses should be confident and informed in their knowledge
• Independence: Critical thinkers form opinions and ideas without relying on others
• Responsibility & Accountability: Nurses are responsible for carrying out tasks appropriately and take accountability for outcomes and decisions
• Risk-Taking: Risk-taking is crucial in nursing while ensuring safety guidelines and patient health
• Discipline: Using systematic thinking and accurate interventions
• Creativity: Thinking innovatively
• Curiosity: Encouraging inquiry
• Integrity: Being genuine and honest in actions and decisions
• Humility: Recognizing the limitations in knowledge and proactively seeking the needed information