FUNDAMENTALS OF NURSING

MID-TERMS

A. Critical Thinking and Clinical Reasoning

• Critical thinking
 An intentional higher level reasoning process
• Clinical reasoning
 Cognitive process that uses thinking strategies

Purpose of Critical Thinking

• Essential component of professional accountability and quality nursing care
• Generated from a triad of professional, socioeconomic, and ethical/moral needs
• Scheffer and Rubenfeld (2010)
 Ten affective components
 Seven skills
• Nurses use critical thinking skills in a variety of ways.
 Knowledge from other subjects and fields
 Deal with change in stressful environments
 Make important decisions
• Creativity
 Thinking that results in the development of new ideas and products
• Allows nurse to:
• Generate many ideas rapidly
• Be generally flexible and natural
• Create original solutions to problems
• Be independent and self- confident
• Demonstrate individuality
 Techniques in Critical Thinking

• Critical analysis
 Application of a set of questions to a particular situation to discard unimportant ideas
• Socratic questioning
 Technique to search for inconsistencies, examine multiple points of view, separate the known from
beliefs
• Inductive reasoning
 Generalizations formed from a set of facts, observations
• Deductive reasoning
 Reasoning from general premise to specific conclusion
• Making valid inferences
• Differentiating facts from opinions
• Evaluating the credibility of information sources
• Clarifying concepts
• Recognizing assumptions
 Applying Critical Thinking to Nursing Practice

• Nursing process
 Systemic, rational method of planning, providing individualized nursing care
 Phases
• Assessing
• Diagnosing
• Planning
• Implementing
• Evaluating

Problem Solving
• Mental activity in which a problem is identified that represents an unsteady state
• Clarify the nature of a problem and suggest possible solutions
• Problem solving for one situation contributes to the nurse's body of knowledge for problem solving in similar
situations.
• Trial and error
• A number of approaches are tried until a solution is found.
• Can be dangerous because client might suffer harm if approach is inappropriate
• Intuition
• Relies on a nurse's inner sense
• Understanding or learning of things without conscious reasoning
• Clinical judgment
• Process to ascertain the right nursing action to be implemented at the appropriate time in the client's
care
• Experience important
. Research process
• Formalized, logical, systematic approach to problem solving

Attitudes that Foster Critical Thinking

• Independence
 Individuals thinking for themselves
 Being open-minded in considering different methods of performing technical skills
• Fair-mindedness
 Making impartial judgments
 Assessing all viewpoints with the same standards
• Insight into egocentricity
 Being open to the possibility that personal biases or social pressures or customs could unduly affect
thinking
• Intellectual humility
 Having awareness of the limits of one's own knowledge
• Intellectual courage to challenge the status quo and rituals
• Integrity
 Applying the same rigorous standards of proof to their own knowledge and beliefs as they apply to
knowledge and beliefs of others
• Perseverance
 Determination in finding effective solutions to client and nursing problems
• Confidence
 Believing that well-reasoning thinking will lead to trustworthy conclusions
 Examining emotion-laden arguments using the standards for evaluating thought
• Curiosity
 Being unafraid to examine traditions to be sure they are still valid
 Components of Clinical Reasoning

• Analysis of a clinical situation as it unfolds or develops

• Cognitive processes
 Thinking processes based on the knowledge of aspects of client care
• Metacognitive processes
 Reflective thinking and awareness of skills learned by the nurse in caring for the client
• Setting priorities
• Needs to be dynamic, flexible
• Difficult for beginning nursing students to determine which data are most relevant
• Preclinical preparation
• Priorities may change based on current client situation.
• Developing rationales
• Justifying the clinical plan
Explaining the "why" of priority setting and subsequent interventions
• Learning how to act
• How and when to respond in a clinical situation
• Thinking about potential complications given the client's current problems
• Clinical reasoning-in-transition
• Ability to recognize subtle changes in client's condition over time
• Responding to changes in the client's condition
• Nurse will notice change in priorities, adjust nursing care, and alert primary care provider when appropriate.
• Reflection
 Nurse identifies factors that improved client care and those that required changing or elimination.

Integration of Critical Thinking and Clinical Reasoning

• Decision-making process
 Prioritizing care when providing care to many clients
 Deciding whether client's condition can be managed in the home or requires hospitalization
. Consider client's cultural, religious background
. Logical reasoning skills
. Commitment to lifelong learning

Concept Mapping

• Graphic depiction of connections

• Linear and nonlinear relationships
• Visual aid to critical thinking process

Concept Mapping and Enhancing Critical Thinking and Clinical Reasoning

• Link between existing nursing knowledge and new information

• Foster demonstration that nurses have acquired body of knowledge, understanding of concepts pertinent to
delivery of safe and effective care
 Interrelationships among client's problems
 Care based on complexity