Chapter 7: Critical Thinking

Chapter 7: Critical Thinking
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some material previously published. Slide 1
Clinical Decisions in Nursing
Practice
 Clinical decision-making skills separate
professional nurses from technical and
supportive staff
 No two patients have the identical health
problems, which challenges nurses
 Nurses need to utilize knowledge, act quickly,
and make sound clinical decisions
Critical Thinking Defined
 A process and set of skills
 Cirocco (2007), Profetto-McGraff et al (2003)
 An active, organized, cognitive process used to
carefully examine one’s thinking and the thinking
of others
 Chaffee (2002)
 Is not memorizing a list of information
 Cirocco (2007)
 Reflective, purposeful, and self-regulating
process
 Facione and Facione (1996)
Three Aspects of Critical
Thinking
 Reflection
 Purposeful thinking
 Language and intuition
 A clear communication process and the inner
sense or “gut feeling”
 Thinking and learning
 Learning is lifelong
Levels of Critical Thinking
in Nursing
 Basic critical thinking
 Concrete and based on a set of rules or principles
 Complex critical thinking
 Knowledge is synthesized
 Choices are analyzed and examined
 Commitment
 Choices are made without assistance from others
Critical Thinking Competencies
 General critical thinking
 Not unique to nursing
 Specific critical thinking in clinical situations

 Clinical inference and diagnostic reasoning
 Specific critical thinking in nursing

 Use of the nursing process
General Critical Thinking
Processes
 Scientific method
 Problem identification, collect data, formulate
question, test hypothesis, evaluate results
 Problem solving
 High level of cognitive reasoning
 Decision-making
 Focuses on problem resolution
Specific Critical Thinking
Competencies
 Clinical inference
 Making a tentative conclusion based on observed
data
 Diagnostic reasoning
 Use of cognitive thinking and assessment of the
situation
 Clinical decision-making
 Focuses on selecting the treatment after forming
diagnostic conclusions
The Nursing Process
as a Competency
 A systematic process that incorporates
 Diagnostic reasoning
 Clinical decision-making
 Five-step process
• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation
A Critical Thinking Model
 Models serve to explain concepts and help
you make decisions and judgments about
patients
 Kataoka-Yahiro and Saylor (1994)

 Define the outcome of critical thinking as nursing
judgment that is relevant to nursing problems in a
variety of settings
Components of Critical Thinking
 Specific knowledge base
 Experience
 Problem solving competence
 Attitudes for critical thinking
 Standards of critical thinking
Developing Critical Thinking
Skills
 Learned by connecting knowledge and theory
with practice
 Reflective journaling
 Reflection leads to development of judgment and
skills
 Concept mapping
 A visual representation of patient problems and
interventions
Practice Questions
 1. The use of diagnostic reasoning involves
a rigorous approach to clinical practice and
demonstrates that critical thinking cannot be
done:
 A. logically.
 B. haphazardly.
 C. independently.
 D. in a vacuum.
Practice Questions (continued)
 2. The nursing process organizes your
approach while delivering nursing care. To
provide the best professional care to clients,
nurses need to incorporate nursing process
and which of the following?
 A. Decision making
 B. Problem solving
 C. Intellectual standards
 D. Critical thinking skills
Practice Questions (continued)
 3. You are caring for a patient with an indwelling
Foley catheter. You notice that there is no urine
draining into the bag. You check the tubing and find
it is kinked. This action is an example of which of the
following?
 A. Decision making
 B. Clinical inference
 C. Problem solving
 D. Inference

Chapter 7: Critical Thinking

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Chapter 7: Critical Thinking

 Specific critical thinking in clinical situations

 Specific critical thinking in nursing

 Kataoka-Yahiro and Saylor (1994)

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