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Critical Thinking And The Nursing Process. Dr. Belal Hijji, RN, PhD December 5, 2010. Learning Outcomes. At the end of this lecture, students will be able to:
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Critical Thinking And The Nursing Process Dr. Belal Hijji, RN, PhD December 5, 2010
Learning Outcomes At the end of this lecture, students will be able to: • Discuss the nature of critical thinking, its relationship with decision making and problem solving, as well as the standards of critical thinking. • Recognise how to apply critical thinking to an example of nursing process. • Identify approaches to problem solving, define decision making, its phases, and its styles.
Critical Thinking • Critical thinking in nursing practice is a discipline specific, reflective reasoning process that guides a nurse in generating, implementing, and evaluating approaches for dealing with client care and professional concern. • Nurses use critical thinking to solve client problems and make better decisions. Critical thinking, problem solving, and decision making are interrelated processes, with creativity enhancing the result. • Creativity is thinking that results in the development of new ideas and products. • Creativity in problem solving and decision making is the ability to develop and implement new and better solutions.
Standards of Critical Thinking • How can one know whether one’s thinking is critical thinking? • Clarity: What is an example of this? • Accuracy: How can I find out if this is true? • Relevance: How does this help me with the issue? • Logicalness: Does that follow from evidence? • Breadth: Do I need to consider another view? • Precision: Can I be more specific • Which of those facts is most important? • Completeness: Have I missed any important aspects? • Fairness: Am I considering the thinking of others? • Depth: What makes this a difficult problem?
Applying Critical Thinking to Nursing Practice • Nurses function effectively some part of a day without thinking critically. For example when they select the uniform to wear or taking a particular route to work. • Psychomotor skills in nursing often involve minimal thinking. Higher order skills of critical thinking are put into play when a new idea is encountered or less than routine decision needs to be made. • The nursing process is a systematic, rational method of planning and providing nursing care. It has five phases of assessment, diagnosis, planning, implementation, and evaluation. • The next 3 slides will show the phases of the nursing process and clinical examples of critical thinking. Later on, the talk will focus on decision making and problem solving and the use of critical thinking.
Phases of the Nursing Process and Clinical Examples of Critical Thinking • Assessment: Data: A 45-year old Latino male complains of severe headache. He is overweight; BP 180/95 mmHg. He said that he takes his BP pills when he has headache. He lives with his family and has 4 children. A critical thinker is aware that more data need to be collected about the client’s cultural health values and reason of stated behaviour. Failure to do so will result in inaccurate diagnosis and interventions. • Goal setting: Goal: To increase compliance with medication regimen in order to relieve headache and prevent CVA. A critical thinker will try to determine the client’s gaols and to agree to mutual goals.
Diagnosis: The critical thinker recognises that the client’s erratic use of the prescribed medication may have multiple causes (side effects, belief that illness is due to God’s will) and will not infer a diagnosis with etiology until more data are obtained. Failure to think critically can lead to interpretations that are irrelevant, inadequate, and superficial (e.g an erroneous interpretation that the client’s problem is lack of knowledge). • Planning: The critical thinker uses concepts about motivation and change theory to understand the client’s behaviour and motivation to change. Failure to think critically can lead to reliance on a simplistic concept such as knowledge creates change.
Implementation: The critical thinker considers the consequences of selected nursing interventions before implementing plans of care. These plans, including goals and outcomes, are based on ongoing assessments of the client’s needs. Failure to think critically may lead to ineffective interventions, such as client teaching that focuses on resolving a knowledge deficit about the prescribed medication. The critical thinker recognises that a knowledge deficit may or may not be one of several problems. • Evaluation: The critical thinker bases evaluation of client’s outcome and the effectiveness of nursing interventions on measurable criteria and considers whether outcomes have been validated. Failure to think critically may lead to client noncompliance and an inference that the client did not learn effectively and needs further instruction.
Problem Solving • In problem solving, the nurse obtains information that clarifies the nature of the problem and suggests solutions. Then the solutions are evaluated carefully and the best one is selected to implement. • The nurse does not discard other solutions but hold them in reserve in the event that the first solution is ineffective. Therefore, problem solving in one situation contributes to the nurse’s body of knowledge for problem solving in another similar situation. • There are 3 approaches to problem solving and these are described next.
Approaches to Problem Solving • Trial and Error: In this approach, a number of approaches are tried until a solution is found. This method in nursing care can be dangerous because the client may suffer harm if an approach is inappropriate. • Intuition: This is the understanding or learning of things without the conscious use of reasoning. As a problem-solving approach, some consider intuition 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.
Research process: This process is a formalised, logical, and systematic approach to solving problems. For example, if the problem is about nurses’ hand decontamination practices, we may be able to solve this problem by implementing a ward-based educational intervention and see if nurses changed their behaviour.
Decision Making Definition Is a purposeful and goal directed effort that uses a systematic process to choose among options. Phases • Defining objectives • Generating options • Identifying advantages and disadvantages of each option • Ranking the options • Selecting the most appropriate option • Implementation • Evaluation
Styles • Autocratic • Participative Factors Influencing Decision-Making • Internal • Physical and emotional state • Philosophy & Personal bias • Values – ethical stance • Interests & attitudes • Experience & knowledge • External – time, resources & environment
Group Decision Making • Effective decision making meets two primary criteria. These are: • The decision must be of high quality • Those implementing the decision must accept it • High-quality decisions are more likely to result if groups are involved in the problem-solving and decision-making process. • Multidisciplinary teams should be used in the decision-making process, especially if the issue, options, or outcome involve other disciplines
Groups are more likely to be effective if members are actively involved, the group is cohesive, communication is encouraged, and members have some knowledge of group dynamics. • Groups should have the proper size and composition • Too small or too large groups should be avoided • Heterogeneous (غير المتجانسة) groups may be more successful in problem solving • The leader of a group should carefully select members on the basis of their knowledge and skills in decision making and problem solving • Aggressive, authoritarian, self oriented individuals should be avoided • The leader should provide a nonthreatening and positive environment which enhances participation
Group decision making offers a number of advantages. • Two heads are better than one • More ideas (options) can be generated by groups than by an individual • Implementing solutions becomes easier when individuals were actively involved in the decision-making process • Group decision-making, however, has some advantages. • It requires more time. In crisis situation where prompt decisions are required, group decision-making may not be appropriate. • Unequal power among group members. Dominant members may influence more passive or powerless ones to conform to their points of view.
