Critical Thinking in Nursing

Author: Marisa Tapia MSN, RN ACNS-BC

Critical Thinking

Nursing Education views or requires critical thinking as an educational outcome

As a result of this outcome or EVALUATION there is new thinking or new processes or new ideas

What outcomes are generated?› New ways of thinking› New ideas› New questions› New decisions› New conclusions› New results

Critical Thinking Is:

Systematic Habit forming A method or process to promote

thinking regarding the thinking about new thinking that promotes an action on the new insight as it generates more thinking

Is that clear as mud?

Why Critically Think? To make a critical analysis of factors

associated with a problem Nurses need critical thinking skills to be:

› Safe › Competent › Skillful and Confident› Aware and Ethical› Generate and promote new ideas and

knowledge in the Art and Science of Nursing

What is Critical Thinking?

Is there such a thing?

Haven’t we been doing it all along?

How do we define it?

Defining Critical Thinking

Method of Reasoning Problem Solving approach to finding an

answer Reasonable reflective thinking that

focuses on deciding what to do or what is to be done yet setting out to find alternatives within the answer

Characteristics of Critical Thinking

Being rational and reflective Creative thinking (many ways to skin a

cat) Healthy and constructive skepticism Autonomy “building your own

algorithm” Fair and equitable thinking Focusing on what the belief is and act

on it

4 Stages in the Critical Thinking Process

Preparation Incubation Insight Verification

Stage 1: Preparation

Creative thinker gathers information related to a problem or concern

How do we do this?

Stage 1: Preparation-How?› Questioning

Patient interview

› Gathering information/data Assessment data

› Identifying the Nursing Diagnosis based on the assessment findings either real or potential clinical problems

Stage 2: Incubation-Planning

Thinking about the thinking:Formulating a plan of action to accompany

the assessment finding applying the plan

(implementation) in order for your patient to meet his or her goals thus ensuring success which Evaluates the plan and implementation as achieving the goal ensuring a postive patient experienceOutcome

Stage 3: Insight: Plan and Implementation

Plan is put into place Solutions Emerge Solutions are developed Solutions are identified through a

thoughtful process Once the solution is indentified it is

then implemented

Stage 4: Verification

Implementation phase begins Evaluation of the implemented

solution is established Effectiveness of the implemented

solution is established Outcome measured as successful or

finding opportunities to improve

New approach to Critical Thinking and the Nursing Process

T.H.I.N.K.

T.H.I.N.K. incorporates the critical thinking piece to the nursing process and promotes positive outcomes in regards to nursing care

T.H.I.N.K. T: Total Recall: correlating a fact to

experience H: Habits: forming habits facilitates

thinking while the habit is undertaken

I: Inquiry: Being curious. Questioning the obvious to promote more inquiry

N: New ideas and creativity: teaching new things to different patients

K: Knowing how you think: Recognizing that you know or do not know

something and how you go about learning and teaching.

Critical Thinking:

According to LeFevre (2002)Critical thinking is the process of

figuring out what to believe or do about a situation, problem or controversy for which no single definitive answer or solution exists, but what is the proper way to deal with the situation at hand

How do we critically think? Thinking about the thinking while we

are thinking Constant and consistent analysis of the

doing Anticipating the needs of the patient or

situation or process in order to make the outcome better

In Nursing:

Nurses need to stay ahead of the situation, it may be that we have to stop and think….

Questions to Ask

How will my anticipating of the needs better the patient and the outcome?

Questioning the Question

What we may think is the right thing to do at that time may not be the correct way of handling the situation in the end

In Nursing: We should use systematic reasoning to clarify problems…

Anticipate the needs Step back and think of all the

possibilities to the resolution Explore different avenues to obtain the

same positive effect (Outcome) Be confident in your choice of solutions

and be assertive

Critical Thinking:

Critical thinking in Nursing is an essential component of professional accountability and quality nursing care

Who are the critical thinkers?

Attributes: Habits of the Mind Confidence competence creativity, flexibility, inquisitiveness integrity, intuition, open-mindedness

perseverence and reflection

Skills in Creative Thinking

Critical Analysis Questioning:

Examining many points of view

Play devil’s advocate: search for inconsistencies

Differentiate what you know from what you believe

Inductive reasoning Deductive reasoning Evaluating the

credibility of sources Clarifying concepts

Attitudes of Creative Thinkers

Independence of thought

Fair-mindedness Insight into

egocentricity and socioentricity

Intellectual Humility

Suspension of judgment

Intellectual courage Integrity PerseverenceConfidence in Reason

Attributes of Creative Thinkers

Attributes: Skills Analyzing Applying standards Discriminating (recognizing

differences) Information seeking Logical reasoning Predicting Transforming knowledge

Concept of Independence of Thought

Think for yourself Serious consideration is taken to a wide

array of ideaslearn from themand make your own judgments based on this insight (deductive and inductive reasoning)

Concept of Fair-mindedness

Assess all points of view with the same standards and not basing the judgment on personal prejudices or personal opinions but rather on factual knowledge

Elements of Critical Thinking Applied to Nursing Assumptions Information Concepts Purpose of thinking Points of view

Questions regarding an issue

Interpretation and inference

Implications Consequences

Assumptions

Nursing applies scientific knowledge to caring for a patient

Utilizes the caring components of human interaction while applying scientific knowledge base to facilitate wellness for the individual

Information

Assessment data› History (medical, surgical, family etc)› Physical› Labs/Procedures› Subjective and objective findings from the

patient

Concepts Theories Definitions Principles Examples:

› Lab values and their meanings› AORN Standards and recommended

practices› Adult learning principles

Purpose of Thinking: Analysis and Synthesis

Making decisions regarding the data being collected

Diagnose problems and make clinical judgments

Determining the goals and outcomes

Question of the Issue

Determining the nature of the problem To identify the legal and ethical issues

that are present within the nursing situation

Examples:› 90 y/o with COPD, O2 sats of low 80’s on

BiPap and a fractured ankle

Points of View

The nurse patient relationship The collaborative efforts among the

multidisciplinary team and the patient The overall perception of the care

being provided

Interpretation and Inference

Determining diagnosis Putting the pieces together Formulating a plan of care Identifying interventions

Implications and Consequences

Patient outcomes Modification of the plan of care

dependant on the patient outcomes

Characteristics of Critical Thinkers

Active Thinkers: Double check information for reliability and interpretation› Knowledgeable about their biases and

limitations “Intellectual humility”› Know weaknesses and strengths

Fair-minded: Aware of their own perceptions, values and beliefs but seek to treat all viewpoints alike

Characteristics of Critical Thinkers:

Good communicators: Not methodical in relaying information and consistently ask for ideas to solutions.

Mutuality of exchanging of ideas: is essential for positive outcomes and

understanding the facts first and then finding the best solutions (Intellectual Empathy)

Characteristics of Critical Thinkers

Open-minded: be aware of others values before disrupting harmony and making changes that may seem right at the moment but not positive in the long run (Positive Outcome)

Independent thinkers: think for themselves › Curious and insightful (the need to know)

Characteristics of Critical Thinkers

Humility: Know your limitations and know when you are stepping way out of your league…

Know the difference between the benefits of the “here and now” vs the effects of the “down the road implications”….the OUTCOMES

Know that you will make mistakes Good listeners

Crucial in Critical Thinking: Honesty is Integrity

Be honest with yourself: this assists you in knowing yourself first and then assisting in the steps to critically think something through

When your integrity is lost in the eyes of others, honesty is lost and rarely regained thus any decision made will be viewed doubtful or negative

First Glance to Start Critically Thinking

Be proactive Be organized Be flexible Be cognizant of rules of logic (weigh the

risks and benefits of the long run versus the here and now)

Be realistic Be a team player (Commit to excel)

How we do it in Nursing:

Analyze Apply standards Differentiate practice Seek information Logical Reasoning Predicting and transforming knowledge

How Do We Become Better Critical Thinkers:

We learn to synthesize and analyze information that leads us to a better understanding of the end result

We improve our personal development

How? Like what?

Areas of Personal Development

View of knowledge: what you know and how you utilize what you know in daily working condition to make things better

Approach to learning: Everyday we learn something new because everyday is different and every new day brings on new events that challenge us to learn more

Areas of Personal Development (continued)

Dealing with uncertainty: can be topic specific, interpersonal skills, and/or professionally specific.

Ways to facilitate uncertainties: Know your subject matter (Do your

homework) Know your limitations and address them on

a personal level…again…Do your homework…find ways for self-improvement to further develop your critical thinking skills

Creativity in Critical Thinking in Nursing

Professional Development Commitment to professional

development: Take every opportunity to learn more,

this in turn facilitates better critical thinking skills because you are “doing your homework” and this further develops your skills as a professional nurse

Scholarship and Leadership

By learning more we become more aware of our professional and personal surroundings

This in turn assures us in the anticipation of needs of the situation

When we anticipate we “think better” When we “think better” we lead better

Role of Experience

When we learn more we become better at doing what it is that we do best

Experience leads to success Success in nursing is critical in assuring

positive patient outcomes With this in mind our critical thinking

skills are further enhanced

Very Important!!!!!

If we want to develop nurses to excel, we need our nurses to be cognitively equipped to deal with difficult situations associated with patient care decisions, interpersonal decisions and moral/ethical decisions, thus, we need to build on our professional development skills to enhance our critical thinking

Putting it all together

Ask: What-if questions What-else questions Think out loud, write it down Compare and contrast Play Devil’s Advocate Organize and reorganize information Look for flaws in YOUR thinking Anticipate Ask an expert to listen to your thinking and

see where your thoughts are and synthesize and analyze the process

Any questions?

References

Harkreader, H. (2004) Fundamentals of Nursing: Caring and Clinical Judgment. Philadelphia: W.B.Saunders.

LeFevre, R. (2002). Critical thinking in nursing: A practical approach.

Philadelphia: W.B. Saunders.