Critical Thinking & Nursing Judgement

Definition

• Nursing process is defined as a cyclical & ongoing process with a systematic problem solving approach that guides the nursing care using the fundamental principles of critical thinking, client-centered approaches to treatment, goal-oriented tasks, evidence-based practice (EDP) recommendations, and nursing intuition.

Critical Thinking and Nursing judgement

• Critical Thinking
  Critical thinking in nursing involves applying knowledge and experience to identify patient problems and directing clinical judgments by selecting from alternatives, weighing evidence, using intuition, and by pattern recognition. It includes questioning, data collection, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, creativity, and verification.
• Nursing Judgement
  Nursing judgment is the culmination of education, experience, and insight that allows nurses to execute the best action possible on behalf of patients. A Nurse relies on nursing judgment for making decisions to protect and enhance patient well-being & to render effective patient care.

CRITICAL THINKING-THINKING

• Critical Analysis
  • Critical analysis is the application of a set of questions to a ideas and discard unimportant information and ideas. The questions are not sequential steps; rather they are a set of criteria for judging an idea. Not all questions will need to be applied to every situation, but one should be aware of all of the questions in order to choose those questions appropriate to a given particular situation.
• Socratic Questioning
  • Socratic questioning is a technique one can use to look beneath the surface, recognize and examine assumptions, search for inconsistencies, examine multiple points of view, and differentiate what one knows from what one merely believes. Nurses should employ Socratic questioning when reporting about a client’s condition and current status, reviewing a client’s history and progress notes, and planning care.
• Inductive & Deductive Reasoning:

. In inductive reasoning, generalizations are formed from a set of facts or observations. When viewed together, certain bits of information suggest a particular interpretation. Inductive reasoning moves from specific examples (premises) to a generalized conclusion.

• Deductive reasoning, by contrast, is reasoning from general premise to the specific conclusion. Nurses use critical thinking to help analyze situations and establish which premises are valid.

CRITICAL THINKING-LEARNING

• Distinguishing Facts & opinions

• In critical thinking, the nurses still distinguish claims based on facts, conclusions,
judgments and opinions. The assessment of the reliability of information is an
important stage of critical thinking, where the nurse needs to confirm the
accuracy of this information by checking other evidence and informants.

• Clarifying Concepts
  • Each person has developed its own concepts, where they are nested by others, either based on personal experience or study or other activities. For a clear understanding of the situation of the patient, the nurse and the patient should be in agreement with the importance of concepts.
• Recognising Conditions
  • The nurse must believe that life should be considered as invaluable regardless of the condition of the patient, with the patient often believing that quality of life is more important than the condition. Nurse and patient, realizing that they can make choices based on these assumptions, can work together for a common acceptable nursing plan.

COMPETENCIES OF CRITICAL THINKING

• Continual Learning
  • Nurses can gain the necessary expertise by engaging in self-reflective and collegial dialogue about professional practice, volunteering on committees and task forces, and attending continuing education opportunities, conventions, and conferences. It requires commitment and motivation to develop the core cognitive skills central to critical thinking.
• Professional Accountability
  • Professional accountability as being “answerable to oneself and others for one’s own actions.” Not only do we hold high clinical practice and ethical standards for ourselves, but we must also be willing to accept professional responsibility when or if deviations from care standards occur.
  • To meet the growing healthcare needs of patients who are living longer with chronic illnesses and complex disease processes, we must be professionally accountable for expanding our clinical skill set and consistently implementing gold standard evidence-based practice findings to guide our nursing interventions.
• Independent & Interdependent Decision Making
  • Patients are diverse; their clinical presentations are unique. Nurses must be capable of making rational clinical decisions independently & also interdependent with other health care professionals in order to provide safe, high-quality care.
• Creative Problem Solving
  • Though nurses rely on clinical expertise and experience in a variety of situations, those with problem-solving skills are better equipped to serve their patients. By thinking creatively, asking the right questions and considering multiple options, nurses will be able to solve problems much more effectively.
  • Nurses using problem-solving skills see problems not as obstacles but as opportunities to improve their patients’ health and well-being.

ATTITUDES FOR CRITICAL THINKING

• Independence
  • Critical thinkers consider seriously a wide range of ideas, learn from them, and then make their own judgments about them. Nurses are open-minded about considering different methods of performing technical skills—not just the single way they may have been taught in school. Nurses should not ignore what other people think, but they should consider a wide range of ideas, learn from them, and then take the time to build their own judgments.
• Fair-mindedness
  • Fair-mindedness helps one to consider opposing points of view and to try to understand new ideas fully before rejecting or accepting them. Critical thinkers strive to be open to the possibility that new evidence could change their minds. The nurse listens to the opinions of all members of a family, young and old. Sometimes the traditional approach will emerge as the most effective strategy, whereas at other times a new and possibly unproven approach should be tried. In every case, the nurse must be able to provide the rationale for any action taken.
• Intellectual Humility
  • Intellectual humility means having an awareness of the limits of one’s own knowledge. Critical thinkers are willing to admit what they do not know; they are willing to seek new information and to rethink their conclusions in light of new knowledge.
• Integrity
  • Intellectual integrity requires that individuals apply the same rigorous standards of proof to their own knowledge and beliefs as they apply to the knowledge and beliefs of others. Critical thinkers question their own knowledge and beliefs as quickly and thoroughly as they challenge those of another. They are readily able to admit and evaluate inconsistencies between their own beliefs and those of another.
• Perseverance
  • Because critical thinking is a lifelong endeavor, nurses who are critical thinkers show perseverance in finding effective solutions to client and nursing problems. This determination enables them to clarify concepts and sort out related issues, in spite of difficulties and frustrations. Confusion and frustration are uncomfortable, but critical thinkers resist the temptation to find a quick and easy answer.
• Confidence
  • Critical thinkers believe that well-reasoned thinking will lead to trustworthy conclusions. Therefore, they cultivate an attitude of confidence in the reasoning process and examine emotion-laden arguments using the standards for evaluating thought, by asking questions such as these: Is that argument fair? Is it based on sufficient evidence? etc.
• Curiosity
  • The mind of a critical thinker is filled with questions: Why do we believe this? What causes that? Does it have to be this way? Could something else work? What would happen if we did it another way? Who says that is so? The curious nurse may value tradition but is not afraid to examine traditions to be sure they are still valid.

LEVELS OF CRITICAL THINKING

• Interpretation
  • Interpretation is clarifying the client’s data that includes determining the significance of laboratory values, vital signs, and physical assessment data as well as understanding the meaning of a patient’s behavior or statements.
• Analysis
  • It is determining the patient’s problems based on assessment data. At times, the actual problem cannot be validated initially, but several predicting relationships can be identified.
• Evaluation
  • It is identifying expected nursing care outcomes and assessing whether or not they are met. If not met, the nurse ascertains the reason, allowing for the revision of actions and goals.
• Inference
  • It is deducting the Information. For example, the nurse uses careful monitoring to determine when a patient’s health status improves or declines. Inferences are created through the concepts and assumptions the nurse does by critical thinking
• Explanation
  • It is the ability to justify actions. Explanation includes the application of nursing theories and models, an appropriate ethical framework, and research-based knowledge from nursing and the sciences which the nurse implements in practice.
• Self Regulation
  • Self-regulation is the process of assessing one’s practice and adjusting or improving it as necessary. Nurses must be able to plan, execute, monitor, and evaluate their learning and develop an awareness of their abilities.