Critical Thinking - Think like a Nurse

 

Mr. Komala Sesha Kumar¹, Mrs. M. Shanthi²

¹Tutor, ESIC College of Nursing, Indira Nagar, Bangalore.

²Professor cum Vice Principal, Rajalakshmi College of Nursing, Thandalam, Chennai.

 

ABSTRACT:

Thinking like a nurse is finely based on critical thinking, until a nurse Think critically there is no solution for the problem. Here the word critical indicates not the difficult or danger or risk. It is taking the risk, which means to solve the problem. Critical thinking is the process of searching, obtaining, evaluating, analyzing, synthesizing and conceptualizing information as a guide for developing one’s thinking with self-awareness, and the ability to use this information by adding creativity and taking risks.

 

 

INTRODUCTION:

For decades, critical thinking has been widely regarded as a concept and process of central importance in the practice of nurses and in their education. The attention given to critical thinking in nursing parallels a reform movement that has had an impact on virtually all fields. Close attention to the ways in which critical thinking is addressed in nursing, however, reveals a starkly delimited view of its meaning within the discipline¹.

 

Critical thinking is “The ability to focus your thinking to get the results you need” (Alfaro Le Fevre, 2009). The term “Critical Thinking” is used in many different ways. The definition above provides you with two key factors in critical thinking:

·       Focus

·       Results.

 

If you focus on getting the results you need, you are successfully using critical thinking².

 

The term “thinking like a nurse” was introduced by Dr. Christine Tanner in 2006. To think like a nurse, critical thinking and clinical reasoning must be defined and understood. Critical thinking is the process of intentional higher level thinking to define a client’s problem, examine the evidence-based practice in caring for the client, and make choices in the delivery of care. Clinical reasoning is the cognitive process that uses thinking strategies to gather and analyze client information, evaluate the relevance of the information, and decide on possible nursing actions to improve the client’s physiological and psychosocial outcomes³.

 

Also, Critical thinking is the process of searching, obtaining, evaluating, analyzing, synthesizing and conceptualizing information as a guide for developing one’s thinking with self-awareness, and the ability to use this information by adding creativity and taking risks⁴.

 

PURPOSES OF CRITICAL THINKING:

Critical thinking involves the differentiation of statements of fact, judgment, and opinion. The process of critical thinking requires the nurse to think creatively, use reflection, and engage in analytical thinking (Alfaro-LeFevre, 2013).

 

Critical thinking is an essential skill needed for the identification of client problems and the implementation of interventions to promote effective care outcomes (Bittencourt and Crossetti, 2012). The process of providing feedback and reflection is vital to the improvement of nursing practice. According to Scheffer and Rubenfeld (2010), critical thinking is a metaphorical bridge between information and action. Critical thinking in nursing involves habits of the mind and requires the implementation of cognitive skills. In 2000, Scheffer and Rubenfeld conducted a landmark study in which internationally diverse expert nurses from nine countries defined ten habits of the mind (affective components) and seven skills (cognitive components) of critical thinking in nursing. The ten affective components are confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection.

 

Fig:1: Scheffer and Rubenfeld were defined above Ten affective components

 

The seven skills are analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge.

 

Fig:2: Scheffer and Rubenfeld were defined above Seven cognitive components

 

APPLYING CRITICAL THINKING TO NURSING PRACTICE:

When a nurse uses intentional thinking, a relationship develops among the knowledge, skills, and attitudes that are ascribed to critical thinking and clinical reasoning, the nursing process, and the problem- solving process.

 

NURSING PROCESS:

Implementation of the nursing process provides nurses with a creative approach to thinking and doing to obtain, categorize, and analyze client data and plan actions that will meet the client’s needs. The nursing process is a systematic, rational method of planning and providing individualized nursing care. It begins with assessment of the client and use of clinical reasoning to identify client problems. The phases of the nursing process are assessing, diagnosing, planning, implementing, and evaluating.

 

PROBLEM SOLVING:

Problem solving is a mental activity in which a problem is identified that represents an unsteady state. It requires the nurse to obtain information that clarifies the nature of the problem and suggests possible solutions. Throughout the problem-solving process the implementation of critical thought may or may not be required in working toward a solution (Wilkinson, 2012). The nurse carefully evaluates the possible solutions and chooses the best one to implement. The situation is carefully monitored over time to ensure that its initial and continued effectiveness returns the client to a steady state. The nurse does not discard the other solutions, but holds them in reserve in the event that the first solution is not effective. Therefore, problem solving for one situation contributes to the nurse’s body of knowledge for problem solving in similar situations. Commonly used approaches to problem solving include trial and error, intuition, and the research process.

 

TRIAL AND ERROR:

One way to solve problems is through trial and error, in which a number of approaches are tried until a solution is found. However, without considering alternatives systematically, one cannot know why the solution works. The use of trial-and-error methods in nursing care can be dangerous because the client might suffer harm if an approach is inappropriate. However, nurses often use trial and error in the home setting due to logistics, equipment, and client lifestyle.

 

INTUITION:

Intuition is a problem-solving approach that relies on a nurse’s inner sense. It is a legitimate aspect of a nursing judgment in the implementation of care (Wilkinson, 2012). Intuition is the understanding or learning of things without the conscious use of reasoning. It is also known as sixth sense, hunch, instinct, feeling, or suspicion. As a problem-solving approach, intuition is viewed by some people as a form of guessing and, as such, an inappropriate basis for nursing decisions. However, others view intuition as an essential and legitimate aspect of clinical judgment acquired through knowledge and experience. Clinical judgment in nursing is a decision-making process to ascertain the right nursing action to be implemented at the appropriate time in the client’s care. The nurse must first have the knowledge base necessary to practice in the clinical area and then use that knowledge in clinical practice. Clinical experience allows the nurse to recognize cues and patterns and begin to reach correct conclusions. Experience is important in improving intuition because the rapidity of the judgment depends on the nurse having seen similar client situations many times before. Nurses in critical care often pay closer attention than usual to a client when they sense that the client’s condition could change suddenly. Although the intuitive method of problem solving is gaining recognition as part of nursing practice, it is not recommended for novices or students, because they usually lack the knowledge base and clinical experience on which to make a valid judgment.

 

RESEARCH PROCESS:

The research process is a formalized, logical, systematic approach to problem solving. The classic quantitative research process is most useful when the researcher is working in a controlled situation. Health professionals, often working with people in uncontrolled situations, require a modified approach for solving problems. However, it is becoming increasingly important for nurses to identify evidence that supports effective nursing care. One critical source of this evidence is research³.

 

CRITICAL THINKING FOR NURSING:

Scheffer and Rubenfeld (2000) replicated the study with a panel of 55 nurse educators to obtain a consensus definition of critical thinking for nursing. That study resulted in the identification of 17 dimensions of critical thinking and agreement on the definition of critical thinking for nursing as:

 

An essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Critical thinkers in nursing practice the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting and transforming knowledge.

 

Although many areas overlap with the American Philosophical Association’s (1990) Delphi Report definition of critical thinking, some important differences also exist. According to Allen, Rubenfeld, and Scheffer (2004), the dimensions of creativity, intuition, and transforming knowledge that are so crucial to effective clinical practice were not included in the Delphi Report definition. These dimensions emerged in the consensus definition of critical thinking for nursing.

 

The activities involved in the process of critical thinking include appraisal, problem solving, creativity, and decision making. The interrelationships among these concepts are illustrated in Figure -3. These activities are embedded in the critical thinking process in both nursing education and nursing practice.

 

Fig: 3: Critical thinking model. (Modified from Strader, M. K., and Decker, P. J. [1995]. Role transition to patient care management. Upper Saddle River, NJ: Prentice-Hall.)⁵

 

Source: https://nursekey.com/critical-thinking-clinical-judgment-and-the-nursing-process/

 

REFERENCE:

1.      Cody, W.K. (2002). Critical thinking and nursing science: judgement, or vision? Nursing Science Quartely, 15, 184-189.

2.      Critical Thinking: Work Smarter Bette Case Di Leonardi, 2011. Available from: https://lms.rn.com/getpdf.php/2052.pdf

3.      Critical thinking and clinical reasoning. Available from: https://www.pearson.com/content/dam/one-dot-com/one-dot-com/us/en/higher-ed/en/products-services/course-products/berman-10e-info/pdf/CH10.pdf

4.      Belgin Yildirim Sukran, Ozkarhramano, Critical Thinking in Nursing Process and Education, International Journal of Humanities and Social Science, 2011: 1(13); 257.

5.      Benda morris, Critical thinking, Clinical judgment and the nursing process. Available from: https://nursekey.com/critical-thinking-clinical-judgment-and-the-nursing-process/

 

 

Received on 22.02.2020          Modified on 07.04.2020

Accepted on 16.05.2020    © AandV Publications all right reserved