Nursing Case Study Critical Thinking

Introduction

• Critical thinking is a daily activity, even if not realized
• Every day choices, like changing clothes, reflect critical thinking, preparing for possibilities
• Critical thinking is the ability to think clearly and rationally
• Nurses use critical thinking to make decisions daily
• Nursing students and graduates need demonstrated critical thinking skills

Components of Critical Thinking

1- Mental Operations

• Includes decision-making and reasoning
• Used to create meaning
• Results in creative, appropriate problem-solving
• Other critical thinking components include planning and evaluating one's thinking

2- Knowledge

• Nursing curricula teach specific nursing and patient care facts
• Students should understand the reasoning behind facts, not just memorize them
• Knowledge includes information from other disciplines (science, psychology, philosophy)
• Nurses apply this knowledge to patient situations

3- Attitudes

• Certain attitudes help to think critically
• A sense of curiosity is very important for a critical thinker
• Critical thinkers can accept that not all answers are known. They should have the ability to be tolerant, open-minded, and non-judgmental.
• Intellectual courage allows examining other perspectives, dealing with uncertainty,
• Self-confidence is important in critical thinking
• Nurses need to evaluate themselves constantly

Clinical Decisions in Nursing Practice

• Nurses are responsible for clinical decisions
• Professional nurses use clinical decision-making
• Nurses recognize potential problems and take immediate action when a patient's condition changes
• Critical decision-making is a sign of a professional nurse

Clinical Decisions in Nursing Practice (continued)

• Most patients have unique health problems without clear solutions
• Critical thinking is needed for each unique patient
• Nurses gather information about patients
• Nurses examine, consider, and interpret scientific principles
• Nurses create an approach to care specific to each patient

Critical Thinking Defined

• Evidence-based knowledge and clinical expertise are crucial for informed critical thinking
• Nurses with critical thinking skills see the broader picture with multiple perspectives
• Learning to think critically allows nurses to advocate for patients and make informed choices about their care
• Critical thinking is essential for better choices in patient care

Levels of Critical Thinking in Nursing

• Critical thinking ability develops with nursing knowledge
• Expert nurses are more likely to think critically automatically
• Beginner nursing students will use basic critical thinking skills
• Critical thinking levels are:
  • Basic (trusting experts)
  • Complex (separating from experts and making independent decisions)
  • Commitment (predicting and making decisions independently, showing accountability)

Basic Critical Thinking

• Learners trust experts have the right answers for every problem
• This level is based on rules or principles from protocols or manuals
• Using procedure manuals to check steps

Complex Critical Thinking

• Critical thinkers separate themselves from experts
• They analyze and evaluate other choices independently
• A complex critical thinker examines and analyzes different solutions in a problem

Complex Critical Thinking (continued)

• Nurses learn that different solutions have different benefits and risks
• They consider different options in routine procedures when complex situations develop
• Nurses evaluate patient options (like opioids vs heat therapy for pain)

Commitment Critical Thinking

• At this level, a person predicts when to make choices without assistance
• Nurses take responsibility and accountability for decisions
• Sometimes nurses may delay acting and evaluate the situation carefully
• They understand when it's time to respond, or to wait for a better time

Commitment Critical Thinking (Example)

• Recognizing a change in urine color as a sign of infection
• Implementing stricter hygiene and increased fluids before contacting the doctor
• Clearly explaining observations and recommendations to the doctor

Problem

• Patient scheduled for a pacemaker procedure
• Patient was supposed to receive blood before procedure
• Oxygen levels dropped
• Oxygen levels remained low

Critical Thinking and Solution

• The nurse analyzed the situation, considering medical history, lab values and patient's condition
• Recognizing a potential problem and acting promptly
• Nurse's analysis suggests the patient needed fluid released for better oxygen flow
• Giving lasix relieved patient's problem

Critical Thinking Competencies: Problem Solving – Trial and Error

• Testing any number of solutions until one works is trial and error
• An inefficient way to solve problems in patient care
• Trial and error can be dangerous for patients
• Therefore, nurses do not rely solely on this method

Critical Thinking Competencies: Problem Solving-Scientific

• A systematic process-like the nursing process
• Involved steps, like identification, data collection, forming hypotheses, testing, evaluation

Critical Thinking Competencies: Problem Solving- Intuitive

• Nurses rely on intuition sometimes
• Internal prompts can lead to helpful actions
• Nurses should still be careful and seek more information while using intuition

Quick Assessment of Intuitive Response

• Checking patient vital signs and recognizing slight drops in blood pressure
• Elevating heart rate
• Immediately alerting the doctor for a more detailed evaluation
• Suggesting additional tests

Critical Thinking Competencies: Decision Making

• Making decisions is about choosing among possible options
• Nurses face tough decisions every day, with consequences
• Prioritizing patient care is crucial

Critical Thinking Competencies: Potential Errors in Decision Making

• I-Bias: Overemphasizing the first information, avoiding disagreement, sticking to single solutions
• 2-Failure to consider the total situation: Poor data use, not recognizing issues, unrealistic goals
• 3-Impatience: Not exploring multiple options or using available resources

Critical Thinking Competencies: Specific Critical Thinking- Diagnostic Reasoning and Inference

• Expert nurses understand the context of patient situations
• Identifying clues from symptoms and medical history
• Nurse accurately diagnoses problems
• Offering a solution to the problem

Nursing Process as a Competency

• The nursing process is used for diagnosing and treating patient needs
• The nursing process is a clinical decision-making approach
• It includes assessment, diagnosis, planning, implementation, and evaluation
• Nurses use the nursing process to help patients meet care goals

A Critical Thinking Model for Clinical Decision Making: Specific Knowledge Base

• Knowledge is crucial for anticipating and understanding patient problems

A Critical Thinking Model for Clinical Decision Making: Experience

• Clinical experiences are essential to improve clinical decision-making skills
• Experience improves a nurse's interpretative abilities
• Knowledge and experience together help critical thinking

A Critical Thinking Model for Clinical Decision Making: Attitudes

• Nurses should always be aware of what they know and don't know
• Nurses should not attempt procedures without confidence and knowledge

A Critical Thinking Model for Clinical Decision Making: Thinking Independently

• Critical thinkers do not blindly accept ideas from others
• Independent thought is crucial for improving nursing practice

A Critical Thinking Model for Clinical Decision Making: Responsibility and Accountability

• Nurses must perform duties accurately and use nursing standards as minimum performance
• Shortcuts in patient care are not acceptable.

A Critical Thinking Model for Clinical Decision Making: Risk Taking

• Risk-taking can be necessary, but must be done with careful consideration and adhering to safety guidelines
• Potential dangers to patients must be evaluated

A Critical Thinking Model for Clinical Decision Making: Discipline

• Nurses must make accurate problem identifications
• Choosing appropriate interventions helps ensure proper care
• Specific questions can help nurses accurately identify patient pain problems

A Critical Thinking Model for Clinical Decision Making: Creativity

• Innovative thinking is a key quality for approaching nursing
• Thinking of creative solutions can help improve patient care

A Critical Thinking Model for Clinical Decision Making: Curiosity

• Nurses should be curious and seek additional information
• Use resources such as talking to physicians, reading literature, and consulting with other nurses

A Critical Thinking Model for Clinical Decision Making: Integrity

• Nurses make mistakes, admitting and learning from them is crucial
• Integrity requires honesty in their actions

A Critical Thinking Model for Clinical Decision Making: Humility

• Recognizing limitations in knowledge is crucial for good critical thinking
• Nurses should always seek to improve knowledge bases

Critical Thinking Synthesis

• Knowledge and experience, standards and attitudes work together with the nursing process, to create critical thinking competency

This quiz evaluates your understanding of critical thinking in nursing practice based on a specific case study. You will answer questions related to patient assessment, intervention strategies, and the importance of clinical decision-making. Test your knowledge on how nursing professionals utilize critical thinking in patient care scenarios.