critical thinking ethical decision making and the nursing process

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 3

Critical Thinking, Ethical Decision Making, and the

Nursing Process

Chapter 3

Critical Thinking, Ethical Decision Making, and the

Nursing Process


Definition of Critical ThinkingDefinition of Critical Thinking

• Multidimensional skill, cognitive or mental process, set of procedures

• Critical thinking involves reasoning, purposeful systematic, reflective, rational, outcome–directed thinking based upon body of knowledge, examination of all available information, ideas


Characteristics of Critical ThinkingCharacteristics of Critical Thinking

• Systematic

• Organized

• Conscious

• Outcome oriented


Alofaro-LeFevre (2008) SaysAlofaro-LeFevre (2008) Says

• Critical thinkers are

– Active thinkers, fair-minded, open-minded, persistent, empathic, independent in thought, good communicators, honest, organized and systematic, proactive, flexible, realistic, humble, cognizant of rules of logic, curious and insightful, creative, committed to excellence


Critical-Thinking SkillsCritical-Thinking Skills

• Interpretation

• Analysis

• Evaluation

• Inference

• Explanation

• Self-regulation


Critical Thinking in ActionCritical Thinking in Action


QuestionQuestion

• What is the least effective decision-making process used in critical thinking?

A.Analyzing the information

B.Maintaining an inflexible attitude

C.Formulating decisions

D.Considering available options


AnswerAnswer

• B. Maintaining an inflexible attitude.

• Rationale: It is important to maintain a flexible attitude that allows the facts to guide thinking. Analyzing the information to determine what it means and to see whether it forms clusters or patterns that point to certain conclusions, formulating decisions that reflect creativity and independent decision making, and considering available options and examining each in terms of its advantages and disadvantages are effective decision-making processes used in critical thinking.


Ethics and Morality in NursingEthics and Morality in Nursing

• Ethics: formal systematic study of moral beliefs

• Morality: individual’s adherence to informal personal value systems

• Nursing ethics: form of applied ethics that addresses moral situations specific to nursing profession, patient care


Basic Ethical PrinciplesBasic Ethical Principles

• Autonomy

• Beneficence

• Confidentiality

• Fidelity

• Double effect

• Justice

• Nonmaleficence

• Paternalism

• Respect for persons

• Sanctity of life

• Veracity


Ethical Problem SolvingEthical Problem Solving

• ANA (American Nurse’s Association) Nursing’s Social Policy Statement (2003): supports claim that nurses must be actively involved in decision-making processes surrounding health care, human responses

• American Nurses Association Code of Ethics for Nurses

• Steps of ethical analysis


QuestionQuestion

• Tell whether the following statement is true or false:

• Individual patient rights regarding freedom of choice and the right to privacy are included under the ethical principle of fidelity.


AnswerAnswer

• False.

• Rationale: Individual patient rights regarding freedom of choice and the right to privacy are included under the ethical principle of autonomy. Autonomy includes individual rights, privacy, and choice. It entails the ability to make a choice free from external constraints.


Ethical DilemmasEthical Dilemmas

• Ethical dilemmas: occur when there is clear conflict between two or more competing moral principles or claims

– Example: Ethical dilemma occurs when nurse wishes to be truthful with patient but family, physician wishing to spare patient distress prohibit informing patient about his condition


Steps of an Ethical AnalysisSteps of an Ethical Analysis

• Assess ethical/moral situations of problem

• Collect information

• List alternatives

– Compare alternatives with applicable ethical principles, professional code of ethics

• Decide, evaluate decision


Ethical TheoriesEthical Theories

• Deontologic or formalist theory: ethical theory maintaining that ethical standards or principles exist independent of ends or consequences

• Teleologic theory or consequentialism: theoretical basis of ethics, focuses on ends or consequences of actions, such as utilitarianism


Nursing ProcessNursing Process

• Assessment

• Diagnosis

• Planning

• Implementation

• Evaluation


The Nursing Process (cont’d)The Nursing Process (cont’d)


Collaborative ProblemsCollaborative Problems

• Certain physiologic complications that nurses monitor to detect onset or changes in status (Carpenito-Moyet, 2008)


Differentiating Nursing Diagnosis and Collaborative ProblemsDifferentiating Nursing Diagnosis and Collaborative Problems


Critical Thinking in Nursing ProcessCritical Thinking in Nursing Process

• Critical thinking goes beyond basic problem solving

– Results in comprehensive plan of care for patient

• Decision making, problem solving in nursing: increasingly complex, require critical thinking as part of process

• Critical thinking is at center of process of clinical reasoning, clinical judgment (Jackson, 2004)

• Nurses must use critical thinking to plan, provide nursing care


QuestionQuestion

• Assessment begins with initial patient contact. Which nursing activity is included during this component of the nursing process?

A.Interviewing and obtaining a nursing history

B.Choosing a nursing diagnosis

C.Establishing expected outcomes

D.Determining nursing actions


AnswerAnswer

• A. Interviewing and obtaining a nursing history

• Rationale: Choosing a nursing diagnosis is included during the diagnosis component of the nursing process. Establishing expected outcomes and determining nursing actions are included during the planning component of the nursing process.

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critical thinking ethical decision making and the nursing process