Critical Thinking in Nursing Practice PDF

CHAPTER 15 Critical Thinking in Nursing Practice CRITICAL THINKING DEFINED Definition: Critical Thinking: The ability to think in a clear, logical, and independent manner, considering all aspects of a situation to make informed decisions. What is Critical Thinking? Thinking Clearly and...

CHAPTER 15 Critical Thinking in Nursing Practice CRITICAL THINKING DEFINED Definition: Critical Thinking: The ability to think in a clear, logical, and independent manner, considering all aspects of a situation to make informed decisions. What is Critical Thinking? Thinking Clearly and Logically: It’s about understanding information, evaluating it, and making sound decisions. Asking Questions: Always ask "Why?", "What if?", and "How?" to understand the situation better. Considering All Sides: Look at a situation from all angles before making a decision. Why is it Important in Nursing? Safe Patient Care: Critical thinking helps you make the best decisions to keep patients safe. Problem-Solving: It allows you to handle unexpected situations effectively. Better Outcomes: Using critical thinking leads to better patient outcomes. How to Practice Critical Thinking: Observe: Pay attention to details—everything you see, hear, and notice matters. Reflect: Think about what’s happening and why it’s happening. 2 Decide: Use the information to make the best decision for your patient. Remember: Critical thinking is like a muscle—the more you use it, the stronger it gets! CRITICAL THINKING IN ACTION Key Questions for Nurses: “Why?” Example: A patient’s vital signs are stable, but they are suddenly very anxious. The nurse asks, “Why is the patient feeling anxious? Could it indicate something more serious?” “What am I missing?” Example: A patient with diabetes reports dizziness. The nurse checks blood sugar but also asks, “What am I missing? Could the dizziness be related to dehydration or a cardiac issue?” “What do I really know about this patient’s situation?” Example: Before administering a new medication, the nurse reviews the patient’s allergies and current medications to ensure there are no contraindications. “What are my options?” Example: A patient is in pain but allergic to the prescribed pain medication. The nurse considers alternative pain management strategies, such as different medications or non-pharmacological methods. A Critical Thinker Must: Identify what is important in each clinical situation: Example: In a code situation, the nurse prioritizes maintaining airway and circulation. Imagine and explore alternatives: Example: When a wound isn’t healing, the nurse suggests using a different dressing or therapy based on evidence-based practice. Consider ethical principles: Example: A nurse respects a patient’s wish to refuse treatment, even if it conflicts with the nurse’s personal beliefs. Make informed decisions about patient care: 3 Example: A nurse weighs the risks and benefits of an early discharge for a patient, considering both the patient’s health status and their support system at home.  GENERAL CRITICAL THINKING COMPETENCIES 1. Scientific Method: A structured, step-by-step approach used to investigate problems and find. Example: A nurse observes that patients who drink more water have fewer headaches, hypothesizes that increasing hydration reduces headaches, and tests this by encouraging some patients to drink more water while monitoring their symptoms. 2. Problem Solving: The process of identifying a problem, generating potential solutions, selecting the best option, and implementing it. Example: A nursing student is struggling to keep up with their study schedule because they have multiple assignments due at the same time. The student identifies that the issue is poor time management. They brainstorm possible solutions, such as creating a more organized study plan, setting daily goals, or prioritizing tasks based on deadlines. After considering the options, they choose to use a planner to break down large tasks into smaller, manageable chunks, allowing them to complete assignments on time without feeling overwhelmed. 3. Decision Making: This is a broad skill applicable in various situations, not limited to healthcare. Decision making involves choosing the best course of action among different options based on available information, goals, and priorities. 4 Example: A nurse decides whether to attend a professional development workshop or cover a shift at work. Both options have pros and cons, and the nurse weighs these factors to make the best choice. SPECIFIC CRITICAL THINKING Diagnostic Reasoning: COMPETENCES What It Is: Diagnostic reasoning is the process of analyzing patient data, recognizing patterns, and making inferences to identify the underlying problem or diagnosis. Focus: It primarily involves figuring out what’s wrong with the patient. Example: Noticing that a patient has shortness of breath, chest pain, and fatigue, and inferring that these symptoms could be due to a cardiac issue, prompting further tests to confirm a diagnosis like a heart attack or heart failure. Clinical Decision Making/Clinical Judgment: What It Is: Clinical decision making is the process of choosing the best action or intervention for patient care based on the diagnosis and current clinical situation. Focus: It’s about deciding what to do once you know what the problem is. Example: After diagnosing a post-operative patient with shortness of breath as likely having a pulmonary embolism, the 5 nurse must decide on the immediate steps to take, such as administering oxygen, notifying the healthcare provider, and preparing for further treatment. LEVELS OF CRITICAL THINKING IN NURSING 6 A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING The diagram shows how critical thinking provides the foundation for the nursing process. This process is used to assess and analyze patient needs, leading to clinical judgment. The judgments made are then translated into clinical decisions that address the identified needs. Each component relies on the others, creating a cycle that ensures patient care is thoughtful, evidence-based, and effective. 7 A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING: KNOWLEDGE & EXPERIENCE Knowledge Base: Patient Data: Nurses must be skilled in gathering and interpreting patient data, including medical history, physical assessment findings, and diagnostic results. This data forms the basis for clinical judgment. Basic and Nursing Science: This includes the fundamental principles of biology, chemistry, physiology, and other sciences that underpin nursing practice. It also encompasses specific nursing knowledge, such as understanding disease processes, pharmacology, and patient care techniques. Nursing and Health Care Theory: This involves understanding various nursing theories and models that guide practice, such as Orem’s Self-Care Deficit Theory or Leininger’s Cultural Care Theory. It also includes knowledge of healthcare delivery systems and policies. Experience: Personal: Personal life experiences can influence a nurse’s perspective and decision-making. For example, personal experiences with illness or caregiving can enhance empathy and understanding. Clinical Practice: Hands-on experience in a clinical setting is crucial. It allows nurses to apply theoretical knowledge, develop skills, and learn from real-world scenarios. The more clinical situations a nurse encounters, the better they become at recognizing patterns and making sound decisions. Skill Competence: Competence in clinical skills, such as wound care, medication 8 the administration, and patient communication, is essential. Mastery of these skills ensures that nurse can carry out necessary interventions safely and effectively. A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING: THE NURSING PROCESS 9  A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING: CRITICAL THINKING ATTITUDES Confidence Thinking independently Fairness Responsibility and accountability Risk taking Discipline Perseverance Creativity Curiosity Integrity Humility and self-awareness Copyright © 2017, Elsevier Inc. All Rights Reserved. 10  A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING: ENVIRONMENT & STANDARDS Environment: Time Pressure: The ability to think critically under time constraints is vital in nursing. Nurses often need to make quick decisions, especially in emergency situations. Setting: The context in which care is provided, such as a hospital, clinic, or community setting, can influence decision-making. Different settings may have varying resources, patient populations, and care protocols. Task Complexity: Nursing tasks can range from simple (e.g., taking vital signs) to complex (e.g., managing a ventilated patient). Critical thinking is required to manage these varying levels of complexity effectively. Interruptions: Nurses often face interruptions, such as phone calls, questions from colleagues, or other patients needing attention. Effective critical thinking involves maintaining focus and prioritizing tasks despite these disruptions. Standards: Intellectual Standards: These include clarity, accuracy, precision, relevance, depth, breadth, and logical consistency. Nurses must apply these standards to ensure their thinking is rigorous and their conclusions are valid. Professional Standards: These involve adhering to ethical guidelines, agency policies, evidence-based practices, and the standards of the nursing profession. Professional standards ensure that care is not only effective but also ethical and patient-centered. 11 Copyright © 2017, Elsevier Inc. All Rights Reserved. CLINICAL JUDGMENT IN NURSING PRACTICE Clinical Judgment is the specific application of critical thinking in a healthcare setting. It’s about making decisions directly related to patient care based on your observations, knowledge, and experience. Example: After noticing that a patient’s condition is worsening, you use clinical judgment to decide if they need immediate intervention, such as calling for help or adjusting their treatment. In short: Critical thinking is the tool, and clinical judgment is how you use that tool to make patient care decisions. Copyright © 2017, Elsevier Inc. All Rights Reserved. 12 EVALUATION OF CLINICAL JUDGMENT Reflective journaling Define and express clinical experiences in your own words Meeting with colleagues Signs and Symptoms Outcomes Medical Dx/ Reason for Short Term Goal Admission/history/Age Objective Discuss and examine work Age experiences and validate Past Medical History Subjective Long Term Goal decisions Concept mapping Reason for Admission Evaluation Was short-term goal met? Visual representation of Nursing Diagnosis Was long-term goal met? patient problems and Nursing Interventions/ Rationales interventions that shows their Nursing Interventions Rationales for Nursing Interventions relationships to one another Assess Assess Do Do 13 Teach Teach Ref: MANAGING STRESS The work of professional nursing is difficult as you see patients endure suffering from disease and painful therapies and as you try to manage care responsibilities in busy, fast-paced work settings. Stress over a prolonged period or when extreme can lead to poor work productivity, impaired decision making and communication, and reduced ability to cope with clinical situations. 14