Critical Thinking in Nursing

Critical Thinking & Clinical Judgement

• Critical thinking and clinical judgment are vital skills in nursing practice.
• A significant percentage of graduate nurses lack the necessary clinical reasoning skills for complex patient care.
• Patients may improve or deteriorate when complications arise; nurses need to recognize relevant data and respond appropriately.
• Adverse outcomes, including death, can be prevented by nurses demonstrating effective clinical judgment by identifying and responding to complications early.

Student Learning Outcomes

• Students should understand the relationship between critical thinking and clinical judgment in nursing practice.
• The value of applying a clinical judgment model in nursing practice should be understood.
• Recognizing attitudes and skills needed to develop critical thinking is important for safe, effective, and professional nursing care.
• The clinical judgment model's relevance in various healthcare settings should be understood.
• Professional standards' influence on clinical nursing decisions should be clear.
• The relationship between the nursing process and critical thinking should be established.
• Subjective and objective data should be differentiated using the patient's story.
• The correlation between goals of care, expected outcomes, and evaluative measures in nursing care should be clear.

Readings

• Fundamentals of Nursing, Potter & Perry, 11th ed., Chapter 15.
• Nursing Care Plans, Gulanick, Chapter 1 (optional).
• Clinical Judgement and Test Taking Strategies, Preface and pages 2-31.

Critical Thinking

• Critical thinking is a daily cognitive process.
• Nursing practice requires sorting information, recognizing changes, and making appropriate clinical decisions.

Clinical Judgement

• Clinical judgment is the observed outcome of critical thinking and decision-making in nursing.
• It is a process utilizing nursing knowledge, experience, and critical thinking.
• Clinical decision-making distinguishes nurses from other healthcare personnel, such as technicians.
• An example of clinical decision-making is blood glucose testing, where technicians perform the test but nurses determine actions based on results (e.g., insulin administration).

Nursing Process

• Nurses utilize the nursing process in clinical decision-making.
• The nursing process' cognitive skills are interconnected.

Six Cognitive Skills for Clinical Judgement

• Recognize cues
• Analyze cues
• Prioritize hypotheses
• Generate solutions
• Take action
• Evaluate outcomes

Recognize Cues

• Identify relevant information from various sources (history, vital signs, labs, etc.).
• Determine if something warrants immediate attention.
• Identify what is and isn't relevant information.

Analyze Cues

• Organize recognized cues and connect them to possible conditions.
• Determine why a cue is a concern.
• Identify patterns from subjective and objective assessment data.
• Compare client data to normal values to recognize deviations.

Prioritize Hypotheses/Problems

• Evaluate and rank problems by importance (urgency, likelihood, risk).
• Prioritize problems that could result in harm if left untreated.

Generate Solutions

• Set priorities and identify desired outcomes.
• Determine interventions to achieve those outcomes.
• Identify actions to avoid.
  • Use SMART goals (Specific, Measurable, Achievable, Realistic, Time-bound)

Interventions/Actions

• Independent interventions are based on scientific rationale, requiring no orders.
• Dependent interventions necessitate orders from healthcare providers.

Take Action

• Implement the nursing interventions.
• Reassess the patient after implementing interventions.
• Collect new data and modify the plan if needed.

Evaluate Outcomes

• Compare observed outcomes with expected outcomes.
• Identify if patient condition improves, worsens, or remains unchanged.
• Determine if interventions were effective or if other interventions would be more beneficial.

Additional Information

• Specific pages and figure references are provided for various topics.
• The NCSBN Clinical Judgment Measurement Model is a significant concept presented.
• Knowledge base is determined by education, experience, and evidence-based practice.
• The environment influences nurses' ability to effectively execute clinical judgment.
• Critical thinking involves specific attitudes like confidence, fairness, and intellectual integrity.
• Various learning models and concepts like "SMART goals" are presented. Examples like blood glucose testing and situations like abdominal surgeries are presented to understand clinical judgment.

Scenario/Information

• Mr. Lawson, a 68-year-old patient, underwent abdominal surgery.
• He experiences pain (7/10) after surgery.
• He's had hypertension and GERD.
• Vital signs and assessment findings should inform a comprehensive nursing plan.

Additional Instructions

• Use the worksheet and available resources (EMR, care plans, book, etc.) for clinical application.