Critical Thinking in Nursing - PDF

- CRITICAL THINKING AND THE NURSING PROCESS - P R O B L E M S O LV I N G D R. S E R P İ L TO P Ç U 1  INRODUCTION Every day you think critically without realizing it If it’s hot outside, you take off a sweater If you decide to wal...

- CRITICAL THINKING AND THE NURSING PROCESS - P R O B L E M S O LV I N G D R. S E R P İ L TO P Ç U 1  INRODUCTION Every day you think critically without realizing it If it’s hot outside, you take off a sweater If you decide to walk, you change to a pair of walking shoes. These examples involve critical thinking as you face each day and prepare for all possibilities 2  INRODUCTION Critical thinking is the ability to think clearly and rationally Every day, nurses make decisions that are derived through critical thinking Critical thinkers have the ability to think beyond the obvious and make connections between ideas Nursing students and graduates must demonstrate critical thinking skills 3  COMPONENTS OF CRITICAL THINKING 1- Mental Operations Mental operations include activities such as decision-making and reasoning that are used to find or create meaning The result of these mental operations is creative, appropriate problem solving Other cognitive operations involved in critical thinking are planning and evaluating one’s thinking 4  COMPONENTS OF CRITICAL THINKING 2- Knowledge Nursing curricula assist the student in learning specific facts about nursing and the delivery of quality care Nursing students are not expected to merely repeat facts that have been memorized but instead to understand the reasoning behind the knowledge. 5  COMPONENTS OF CRITICAL THINKING 2- Knowledge In order to think critically, to solve problems, and to make decisions, nurses must develop a broad base of knowledge. This knowledge base includes information from other disciplines such as science (anatomy, physiology, biology), psychology, and philosophy +nursing field courses Nurses apply this knowledge to specific client situations through critical thinking 6 COMPONENTS OF CRITICAL THINKING 3- Attitudes Certain attitudes enhance a person’s ability to think critically One of the most important attitudes needed by a critical thinker is a sense of curiosity/ interest 7  COMPONENTS OF CRITICAL THINKING 3- Attitudes ATTITUDES OF CRITICAL THINKERS Tolerance, open-mindedness, nonjudgmental mind-set Curiosity Entellectual courage Respect for others’ perspectives Dealing with uncertainty Intellectual humility (knowing that one does not have all the answers) Self-confidence 8  CLINICAL DECISIONS IN NURSING PRACTICE Nurses are responsible for making accurate and appropriate clinical decisions Clinical decision making separates professional nurses from technical personnel!!! For example; A professional nurse observes for changes in patients ↔ recognizes potential problems ↔identifies new problems as they arise ↔ and takes immediate action when a patient’s clinical condition worsens (or before) 9  CLINICAL DECISIONS IN NURSING PRACTICE Most patients have health care problems for which there are no clear textbook solutions. Each patient’s problems are unique Because no two patients’ health problems are the same, you always apply critical thinking differently. Observe patients closely, gather information about them, examine ideas and inferences about patient problems, recognize the problems, consider scientific principles relating to the problems, and develop an approach to nursing care. 10  CRITICAL THINKING DEFINED The use of evidence-based knowledge, or knowledge based on research or clinical expertise, makes you an informed critical thinker Nurses who apply critical thinking in their work are able to see the big picture from all possible perspectives Learning to think critically helps you care for patients as their advocate, or supporter, and make better-informed choices about their care «Critical thinking is more than just problem solving» 11 LEVELS OF CRITICAL THINKING IN NURSING Your ability to think critically grows as you gain new knowledge in nursing practice. An expert nurse thinks critically almost automatically. As a beginning student at first you apply the critical thinking model at the basic level. 12  LEVELS OF CRITICAL THINKING IN NURSING Basic Critical Thinking In this level a learner trusts that experts have the right answers for every problem!!!!. Thinking is based on a set of rules or principles. For example, as a nursing student you use a hospital procedure manual to confirm how to insert a Foley catheter 13  LEVELS OF CRITICAL THINKING IN NURSING Basic Critical Thinking Basic critical thinking is an early step in developing reasoning A basic critical thinker learns to accept the diverse opinions and values of experts (e.g., instructors and staff nurse role models). 14 LEVELS OF CRITICAL THINKING IN NURSING Complex Critical Thinking Complex critical thinkers begin to separate themselves from experts. They analyze and examine choices more independently. 15  LEVELS OF CRITICAL THINKING IN NURSING Complex Critical Thinking A nurse learns that alternative solutions. In complex critical thinking each solution has benefits and risks that before making a final decision. The complex critical thinker is willing to consider different options from routine procedures when complex situations develop 16 Complex Critical Thinking A patient experiences severe post-operative pain. The nurse considers two options: increasing opioid medication or trying non-pharmacological methods like heat therapy. The nurse evaluates: Opioids: Effective for pain relief but risk of side effects or dependence. Heat therapy: Non-invasive, but may not fully relieve severe pain. 17  LEVELS OF CRITICAL THINKING IN NURSING Commitment Critical Thinking At this level a person predict when to make choices without assistance from others and accepts accountability for decisions made As a nurse ; Sometimes an action is to not act or to delay an action until a later time You choose to delay or act as a result of your experience and knowledge 18  Commitment Critical Thinking Example: Situation: A nurse notices a change in urine color (cloudiness and foul odor) while performing catheter care on a patient. Commitment Approach: Assessing the situation: The nurse suspects a urine infection and recognizes that this is a sign. Making independent decisions: Before contacting the doctor, the nurse recommends that the patient increase fluid intake, implements stricter hygiene protocols to reduce the risk of infection, and asks the patient to monitor symptoms carefully. Advocating for action: Clearly states observations, actions taken, and recommendations when reporting the situation to the doctor. 19  PROBLEM I had a patient that was scheduled to go to get a pacemaker placed at 09.00. The physician wanted the patient to get 2 units of blood before going downstairs to the procedure. I administered it per protocol. About 30 minutes after that second unit got started, I noticed his oxygen went from 95% down to 92% down to 90%. I put 2L of O2 on him and it came up to 91%. But it just sort of hung around the low 90’s on oxygen. 20  CRITICAL THINKING AND SOLUTION I stopped. And thought. What is going on? I looked at his history. «Congestive heart failure». I looked at his intake and output. He was positive 1.5 liters. I thought about how he’s got extra fluid in general, and because of his CHF he can’t really pump out the fluid he already has, let alone this additional fluid. Maybe I should listen to his lungs. His lungs were clear earlier. I heard crackles throughout both lungs. OK, so he’s got extra fluid that he can’t get out of his body.What do I know that will get rid of extra fluid and make him pee? Maybe some lasix? I ran over my thought process with a coworker before calling the doctor. They agreed. I called the doctor and before I could suggest anything, he said. “Give him 20 mg IV lasix one time. I’ll put the order in.” I gave the lasix. And he was off of oxygen before he went down to get his pacemaker. 21  CRITICAL THINKING COMPETENCIES General Critical Thinking- Scientific Method The scientific method is a way to solve problems using reasoning. The scientific method has five steps: 1. Identifying the problem 2. Collecting data 3. Formulating a question or hypothesis 4. Testing the question or hypothesis 5. Evaluating results of the test or study 22  PROBLEM I had a patient that was scheduled to go to get a pacemaker placed at 09.00. The physician wanted the patient to get 2 units of blood before going downstairs to the procedure. I administered it per protocol. About 30 minutes after that second unit got started, I noticed his oxygen went from 95% down to 92% down to 90%. I put 2L of O2 on him and it came up to 91%. But it just sort of hung around the low 90’s on oxygen. 23  CRITICAL THINKING AND SOLUTION I stopped. And thought. What is going on? I looked at his history. «Congestive heart failure». I looked at his intake and output. He was positive 1.5 liters. I thought about how he’s got extra fluid in general, and because of his CHF he can’t really pump out the fluid he already has, let alone this additional fluid. Maybe I should listen to his lungs. His lungs were clear earlier. I heard crackles throughout both lungs. OK, so he’s got extra fluid that he can’t get out of his body.What do I know that will get rid of extra fluid and make him pee? Maybe some lasix? I ran over my thought process with a coworker before calling the doctor. They agreed. I called the doctor and before I could suggest anything, he said. “Give him 20 mg IV lasix one time. I’ll put the order in.” I gave the lasix. And he was off of oxygen before he went down to get his pacemaker. 24  CRITICAL THINKING COMPETENCIES Problem Solving- Trial-and-Error Problem Solving Trial-and-error problem solving involves testing any number of solutions until one is found that works for that particular problem. This method is not efficient for the nurse and can be dangerous to the patient; it is, therefore, not recommended as a guide for nursing practice. 25  «Consider Jermaine Byrd, the patient who has returned from vascular surgery and whose posterior tibial pulse cannot be palpated. The nurse might use trial- and-error to determine if the pulse is indeed absent or just difficult to palpate or locate. For example, the nurse might try to reposition the fingers for palpation or apply less pressure during palpation to determine if the pulse can be palpated» 26  CRITICAL THINKING COMPETENCIES Problem Solving- Scientific Problem Solving This method is commonly used by healthcare professionals as they work with patients, such as the nursing process. Scientific problem solving is a systematic, seven-step, problem-solving process that involves (1) problem identification (2) data collection (3) hypothesis formulation (4) plan of action (5) hypothesis testing (6) interpretation of results (7) evaluation 27  CRITICAL THINKING COMPETENCIES Problem Solving- Intuitive Problem Solving Today, nurses acknowledge the role of intuitive thinking in making clinical decisions Many veteran nurses can describe situations in which an “inner prompting” led to a quick nursing intervention that saved a patient’s life. When the nurse senses that something is wrong with the patient, although there are no clinical signs, careful monitoring of the patient should be initiated 28  Problem Solving- Intuitive Problem Solving Scenario: A nurse notices that a post-operative patient is quieter than usual and has a subtle change in facial expression. The patient does not complain of pain or discomfort, but the nurse senses that something might be wrong. Intuitive Approach: Quick Assessment: The nurse checks the patient’s vital signs and notices a slight drop in blood pressure and an elevated heart rate. Action: The nurse immediately alerts the doctor for a more detailed evaluation and suggests additional tests to rule out internal bleeding or other complications. Outcome: If the patient is indeed experiencing a minor bleed, this early intervention prevents the condition from worsening. 29  CRITICAL THINKING COMPETENCIES Nurses make decisions every day. Decision making is about choosing from options. All decisions have consequences. It is critical for nurses to be skilled in making decisions. 30  CRITICAL THINKING COMPETENCIES General Critical Thinking - Decision Making When you face a problem or situation and need to choose a course of action from several options, you are making a decision. Decision making is a product of critical thinking that focuses on problem resolution. Include determining which patient care priority requires the first response ( Wound care vs dispnea??) 31 CRITICAL THINKING COMPETENCIES Potential errors in decision making include; 1-Bias: Placing excess emphasis on first data received Avoiding information contrary to one’s opinion Being predisposed to a single solution Making decisions to support past choices 32 CRITICAL THINKING COMPETENCIES Potential errors in decision making include; 2-Failure to consider the total situation: Using inaccurate data Not clearly identifying the problem Failing to first things the problems in order of importance Using unrealistic goals 33  CRITICAL THINKING COMPETENCIES Potential errors in decision making include; 3-Impatience: Failing to identify multiple solutions Incorrectly implementing the decision Failing to use appropriate resources «Making quick decisions doesn't always mean you're a great critical thinker.» 34  CRITICAL THINKING COMPETENCIES Specific Critical Thinking- Diagnostic Reasoning and Inference (result) An expert nurse sees the context of a patient situation- a patient who is feeling dizziness with blurred vision and who has a history of diabetes is possibly experiencing a problem with blood glucose levels observes patterns and themes- symptoms that include weakness, hunger, and visual disturbances suggest hypoglycemia and makes decisions quickly- offers a food source containing glucose 35 NURSING PROCESS AS A COMPETENCY Nurses apply the nursing process as a competency when delivering patient care The nursing process is a five-step clinical decision-making approach: assessment, diagnosis, planning, implementation, and evaluation The purpose of the nursing process is to diagnose and treat human responses to actual or potential health problems Use of the process allows nurses to help patients meet agreed-on outcomes for better health 36  A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING 1-Specific Knowledge Base The first component of the critical thinking model is a nurse’s specific knowledge base. Knowledge prepares you to better anticipate and identify patients’ problems by understanding their origin and nature Nurses’ knowledge varies according to educational experience and includes basic nursing education, continuing education courses, and additional college degrees. 37 A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING II- Experience Nursing is a practice discipline Clinical learning experiences are necessary to acquire clinical decision-making skills Knowledge combined with clinical expertise from experience defines critical thinking. With experience you begin to understand clinical situations, recognize cues of patients’ health patterns, and interpret cues as relevant or irrelevant 38  A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING III-Attitudes for Critical Thinking- Confidence Always nurses should aware of what them know and what them do not know. If you have a question about a procedure, discuss it with your nursing instructor first before attempting it on your patient !!!! Never attempt anything on your patient unless you have the knowledge base and feel confident !!!! Patient safety is of the upmost importance 39  A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING III-Attitudes for Critical Thinking-Thinking Independently. A critical thinker does not accept another person’s ideas without question!!! Independent thinking and reasoning are essential to the improvement and expansion of nursing practice When nurses ask questions and look for the evidence behind clinical problems, they are thinking independently; For example, why is one type of surgical dressing ordered over another, why do your patients not get pain relief? 40  A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING III-Attitudes for Critical Thinking- Responsibility and Accountability When caring for patients you are responsible for correctly performing nursing care activities based on standards of practice. Standards of practice are the minimum level of performance accepted to ensure high quality care. For example, you do not take shortcuts (e.g., failing to identify a patient, prepare medication doses for multiple patients at the same time) when administering medications. As a nurse you are answerable or accountable for your decisions and the outcomes of your actions. 41  A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING III-Attitudes for Critical Thinking- Risk taking Risk taking is desirable, particularly when the result is a positive outcome When taking a risk, consider all options; follow safety guidelines; analyze any potential dangers to a patient; and act in a well-reasoned, logical, and thoughtful manner 42 A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING III-Attitudes for Critical Thinking- Discipline Being disciplined helps you identify problems more accurately and select the most appropriate interventions For example, you have a patient who is in pain. Instead of only asking the patient, “How severe is your pain on a scale of 0 to 10?” you also ask more specific questions about the character of pain. For example, “What makes the pain worse? Where does it hurt? How long have you noticed it?” 43  A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING III-Attitudes for Critical Thinking- Creativity Creativity involves original thinking. Creativity motivates you to think of options and unique approaches 44  A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING III-Attitudes for Critical Thinking- Curiosity A critical thinker’s favorite question is “Why?” Having a sense of curiosity motivates you to inquire further investigate a clinical situation (e.g., question family, consult with a physician, or review the scientific literature) You can get all the information you need to make a decision 45  A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING III-Attitudes for Critical Thinking- Integrity Nurses face many dilemmas or problems in everyday clinical practice, and everyone makes mistakes at times A person of integrity is honest and willing to admit to mistakes or inconsistencies in his or her own behavior, ideas, and beliefs 46  A CRITICAL THINKING MODEL FOR CLINICAL DECISION MAKING III-Attitudes for Critical Thinking- Humility It is important for you to admit to any limitations in your knowledge and skill Knowledge in all areas of nursing is unlimited Critical thinkers admit what they do not know and try to find the knowledge needed to make proper decisions 47 CRITICAL THINKING SYNTHESIS 48