Critical Thinking in Nursing Education

Introduction

• Critical thinking is a daily activity, even if not recognized
• Examples include changing clothes for the weather, choosing appropriate shoes for walking
• Critical thinking prepares one for everyday challenges and possibilities

Components of Critical Thinking

1- Mental Operations

• Mental operations include activities like decision-making and reasoning, used to find or create meaning
• The result of these operations is creative and appropriate problem-solving
• Other cognitive operations include planning and evaluating one's thinking

2- Knowledge

• Nursing curricula teach specific facts about nursing and care delivery
• Nursing students are expected to understand the reasoning behind facts, not just memorize them
• Knowledge in nursing draws from other disciplines, such as science (anatomy, physiology, biology), psychology, and philosophy
• This knowledge is then applied to specific patient situations via critical thinking

3- Attitudes

• Certain attitudes can enhance a person's ability to think critically
• Curiosity is a key attitude for critical thinkers
• Other essential attitudes include tolerance, open-mindedness, non-judgmental mind-set and intellectual courage
• Respect for others' perspectives and dealing with uncertainty are crucial for critical thinking
• Intellectual humility (knowing you don't have all the answers) and self-confidence are also important

Clinical Decisions in Nursing Practice

• Nurses are accountable for accurate and appropriate clinical decisions
• Clinical decision-making differentiates professional nurses from technical personnel
• A professional nurse observes changes in patient condition, recognizes potential problems, and takes immediate action
• Nurses examine patient situations using critical thinking, considering each patient's unique health care needs

Critical Thinking Defined

• Critical thinking integrates evidence-based knowledge or research-based knowledge
• Nursing practice and clinical expertise refine critical thinking
• Critical thinkers have a broad perspective

Levels of Critical Thinking in Nursing

• Critical thinking ability improves with experience as nursing knowledge increases
• Expert nurses tend to use it automatically
• Beginning students will initially implement basic critical thinking models
• Basic critical thinking involves trusting experts and using rules or principles
• Complex critical thinking includes separating oneself from experts and examining options independently
• Complex critical thinking also involves analyzing and understanding benefits and risks of different solutions, not just routine procedures
• Commitment critical thinking encompasses making choices independently and taking responsibility for those choices

Problem Solving Techniques

Problem Solving- Trial and Error Problem Solving

• This technique involves testing various solutions until one works
• It is considered inefficient and potentially dangerous for patients, not a recommended approach for practice

Problem Solving- Scientific Problem Solving

• Scientific problem-solving is a systematic technique with seven steps
• Steps include problem identification, data collection, hypothesis formulation, plan of action, hypothesis testing, interpretation of results, and evaluation

Problem Solving- Intuitive Problem Solving

• Intuitive problem-solving includes observations of patient behaviors and subtle changes, and using this intuition to understand/make decisions that solve health issues
• If a nurse senses something is wrong with a patient, even if there are no clinical signs, close monitoring of the patient is required

Problem Solving and Decision Making

• Nurses make daily decisions that have consequences
• Decision making is choosing from available options
• Determining patient care priorities requires considering different factors - e.g., wound care vs. respiratory distress

Potential Errors in Decision Making

• Potential errors include biases, placing excessive emphasis on initial data, avoiding conflicting information, and being predisposed to a single solution
• Failure to consider the total situation is another potential error, which can involve using inaccurate data, incorrectly identifying problems, failing to prioritize problems by importance, and employing unrealistic goals.
• Impatience can also be an error in decision-making, including failing to consider all possible solutions, improperly implementing decisions, and not utilizing available resources

Specific Critical Thinking-Diagnostic Reasoning and Inference

• Expert nurses utilize context to identify patient problems
• They consider the patient's health history and current symptoms
• They assess patterns and themes to understand the issue, e.g., patient with dizziness, blurred vision and diabetes history may have a blood glucose issue

Nursing Process as a Competency

• The nursing process is a competency; it is a five-step clinical decision-making approach
• Steps involve assessment, diagnosis, planning, implementation, and evaluation
• Nurses diagnose and treat human responses to actual or potential health problems using the nursing process

A Critical Thinking Model for Clinical Decision Making

• The model has three components: knowledge base, experience, and attitudes (confidence, responsibility and accountability, independence, humility, and discipline)

I- Specific Knowledge Base

• Knowledge is critical for nurses to anticipate/identify patient issues appropriately
• It includes basic nursing education, continuing education, and additional college degrees

II- Experience

• Clinical experience is vital for clinical decision-making
• Nurses use experience to refine their knowledge, understand clinical situations, and recognize/interpret patients' conditions

III- Attitudes

• Nurses should be confident and aware of their knowledge limits
• If a nurse has any questions about procedures, they should seek clarification from qualified personnel
• Patient safety is always paramount- nurses should feel confident before performing procedures
• Nurses should think independently, not simply following others' ideas without question
• Responsibility and accountability are crucial to professional nursing conduct
• Risk taking can be valuable, but needs to be done safely
• Discipline in decision-making helps nurses avoid problems
• Creativity empowers nurses to offer unique approaches in clinical situations
• Curiosity drives nurses to explore issues and seek necessary information
• Integrity is critical for nurses to admit mistakes/inadequacies
• Humility involves accepting limitations in knowledge