Critical Thinking in Nursing Practice

Critical Thinking in Nursing Practice

• Critical thinking is the ability to think clearly, logically, and independently, considering all aspects of a situation to make informed decisions.
• Critical thinking involves:
  • Thinking clearly and logically: understanding information, evaluating it, and making sound decisions.
  • Asking questions: asking "why," "what if," and "how" to better understand a situation.
  • Considering all sides: looking at a situation from all angles before making a decision.
• Critical thinking is important in nursing because it leads to:
  • Safe patient care: making the best decisions to keep patients safe.
  • Effective problem-solving: handling unexpected situations effectively.
  • Better patient outcomes: using critical thinking leads to better results for patients.
• To practice critical thinking, nurses should:
  • Observe details
  • Reflect on what is happening and why
  • Decide on the best course of action for the patient.
• Critical thinking is like a muscle–the more you use it, the stronger it gets.

Key Questions for Nurses

• "Why?" (Example: Patient's vital signs are stable, but anxious. Why is the patient anxious?)
• "What am I missing?" (Example: Patient with diabetes reports dizziness. What else could be causing the dizziness?)
• "What do I really know about this patient's situation?" (Example: Reviewing a patient's allergies and current medications before administering a new medication.)
• "What are my options?" (Example: Patient in pain but allergic to the prescribed pain medication. What alternative pain management strategies are available?)

A Critical Thinker Must

• Identify what is important in each clinical situation. (Example: In a code situation, maintaining airway and circulation is crucial.)
• Imagine and explore alternatives. (Example: If a wound isn't healing, explore different dressings or therapies.)
• Consider ethical principles. (Example: Respecting a patient's wish to refuse treatment, even if it conflicts with the nurse's personal beliefs.)
• Make informed decisions about patient care. (Example: Weighing the risks and benefits of an early discharge for a patient, considering both the patient's health status and support system at home.)

General Critical Thinking Competencies

• Scientific Method: A structured, step-by-step approach to problem-solving (Example: A nurse investigating why patients who drink more water have fewer headaches).
• Problem Solving: Identifying a problem, generating potential solutions, selecting the best option, and implementing it (Example: Student struggling to manage a busy study schedule).
• Decision Making: Choosing the best course of action among different possible options, considering available information, goals, and priorities (Example: Choosing whether to attend a professional workshop or cover a work shift).

Specific Critical Thinking Competencies

• Diagnostic Reasoning: Analyzing patient data, recognizing patterns, and making inferences to identify underlying problems or diagnoses (Example: A patient experiencing shortness of breath, chest pain, and fatigue might suggest a possible cardiac issue).
• Clinical Decision Making/Clinical Judgment: Choosing the best action or intervention for patient care based on the diagnosis and current clinical situation (Example: After diagnosing a post-operative patient with shortness of breath and suspected pulmonary embolism, deciding on immediate actions such as administering oxygen and notifying the healthcare provider).

Levels of Critical Thinking in Nursing

• The levels of critical thinking are represented as a pyramid, with increasing commitment, complexity, and base knowledge.

A Critical Thinking Model for Clinical Decision Making

• The diagram illustrates how critical thinking forms the foundation of the nursing process
• The cycle includes assessment and analyzing patient needs, clinical judgment, and translating judgments into planned decisions.
• Each step builds upon the previous ones in a continuous cycle

A Critical Thinking Model for Clinical Decision Making: Knowledge & Experience

• Nurses must be adept at gathering and interpreting patient data to make informed decisions.
• Basic and nursing sciences, along with specific nursing knowledge, form the basis of decisions.
• Knowledge of various nursing theories and models can guide clinical practice, e.g., Orem's self-care deficit theory.
• Personal experiences, including caregiving or illness experiences, can influence critical thinking and clinical judgment.
• Hands-on clinical practice creates opportunities to develop critical thinking skills and refine clinical judgment.

A Critical Thinking Model for Clinical Decision Making: The Nursing Process

• This model outlines critical thinking steps in the nursing process (assessment, diagnosis, planning, implementation, evaluation).

A Critical Thinking Model for Clinical Decision Making: Critical Thinking Attitudes

• Attitudes like confidence, independence of thought, fairness, accountability, risk-taking, discipline, perseverance, creativity, curiosity, integrity, and self-awareness are essential.

A Critical Thinking Model for Clinical Decision Making: Environment & Standards

• Time pressure, setting, complexities of tasks, and interruptions can influence the practice of critical thinking.
• Effective critical thinking involves applying intellectual standards (accuracy, clarity etc.) to the decisions.
• Professional standards, such as ethical guidelines, evidence-based practices, and agency policies, guide the decisions.
• Patient-centered care is paramount.

Clinical Judgment in Nursing Practice

• Clinical judgment is the practical application of critical thinking in a healthcare setting
• It is directly related to patient care and informed by observations, knowledge, and experience.
• Example: A nurse notices a patient's condition worsening and uses clinical judgment to decide on immediate intervention.

Evaluation of Clinical Judgment

• Reflective journaling helps in expressing clinical experiences in one's own words.
• Meeting with colleagues and discussing experiences strengthens decision-making abilities.
• Concept mapping visualizes patient problems and intervention relationships.

Managing Professional Stress

• The demanding nature of the nursing profession can lead to stress.
• Prolonged or extreme stress can negatively impact decision-making abilities and communication effectiveness.