CRITICAL THINKING in Nursing Practice:

1. CRITICAL THINKING in Nursing Practice: • “…active, organized, cognitive process used to carefully examine one’s thinking and the thinking of others.” • Involves use of MIND • Form conclusions • Make decisions • Draw inferences • reflect

2. Critical Thinking and Nursing The nurse identifies unique needs of each client and develops specific interventions to meet those needs. Creative thinkers have the intellectual courage and capacity to think in a new and in a different way. Without creative thinking, nursing would become routine and habitual. 2

3. Critical Thinking Applied in Nursing Application of critical thinking is vital to each step of the nursing process. Critical thinkers develop a questioning attitude. “No action is performed without critical thinking.” 3

4. Activity Its often said that medicine is curing and nursing is caring, do you agree ? Discussion 4

5. BEGIN WITH: Questions: • What do I really know about this nursing care situation? • How do I know it? • Whatoptions are available to me?

6. THREE INPORTANT ASPECTS • REFLECTION: purposefully thinking back /recalling. Requires honest review • LANGUAGE: precise & clear resulting in clear message • INTUITION: inner sensing that something is so

7. THINKING AND LEARNING • LIFELONG PROCESS • NURSING PRACTICE ALWAYS CHANGING

8. LEVELS OF CRITICAL THINKING IN NURSING • BASIC – CONCRETE, BASED ON SET OF RULES OR PRINCIPLES • COMPLEX: “IT DEPENDS” • COMMITMENT: CHOOSE AN ACTION & STAND BY IT

9. CRITICAL THINKING COMPETENCIES • Scientific method • Problem solving • Decision making • Diagnostic reasoning and inference • Clinical decision making

10. Critical Thinking and Decision Making Decision Making Considering and selecting interventions to facilitate achievement of desired outcomes. Based on reliable information and made with as much critical thought as possible 10

11. Critical Thinking and Decision Making Critical thinking for clinical decision-making is the ability to think in a systematic and logical manner with openness to ask questions and reflect on the reasoning process used to ensure safe clinical practice and quality care. 11

12. Activity You hear strange noise in the kitchen. Upon entering the kitchen you find that you left the water running and notice the kitchen floor is covered with water. Within your reach there are six (6) sponges, a mop and bucket and a covered floor drain. What do you do first? 12

13. Critical Thinking and Problem Solving The nurse uses the nursing process to identify and make decisions about client needs. The nursing process is a systematic and scientifically-based process. The process requires the use of many cognitive and psychomotor skills 13

14. ‘NURSES DO NOT MAKE MEDICAL DIAGNOSES, BUT THEY DO ASSESS AND MONITOR CLIENTS CLOSELY AND COMPARE THE CLIENTS’ SIGNS AND SYMPTOMS WITH THOSE THAT ARE COMMON TO A MEDICAL DIAGNOSIS.”

15. The Nursing Process A process is a series of steps or acts that leads to accomplishment of some goal or purpose. The purpose of the nursing process is to provide individualized, holistic, effective, and efficient care to clients. Systematic framework for providing professional, quality nursing care. Used in every practice setting and specialty. Derived from the scientific method of problem solving. 15

16. Nursing process as a competency • Five steps: • Assessment • Diagnosis • Planning • Implementation • Evaluation

17. Components of the Nursing Process 17

18. SYSTEMATIC APPROACH • GATHER DATA • CRITICALLY EXAMINE & ANALYZE • IDENTIFY RESPONSE • DETERMINE PRIORITY • ESTABLISH GOALS & EXPECTED OUTCOMES • TAKE ACTION • EVALUATE

19. Characteristics of Critical Thinking Creativity Logical and rational Cautious and information-seeking Systemic intellectual 19

20. Critical Thinkers Ask What am I taking for granted? Did I explore all points of view? Do I understand the question? What information do I need? 20

21. The Four Critical Thinking Skills: Reading Listening Observing Analyzing 21

22. To Improve Critical Reading Highlight the main ideas as you read. If most of the text is highlighted you are not reading critically. Join a study group and see if your main idea is the same as fellow group member’s. Dialogue with yourself to identify the main idea of your reading. Try to state the main idea in your own words 22

23. To Improve Critical Listening Restate the points made in a discussion with others to see if you understand them. Focus on what a speaker is saying and listen for key points. While listening, make note of anything you find confusing, and ask about it later. 23

24. To Improve Critical Observing Remove any restrictions in your mind. Eliminate or decrease any distraction. Ask yourself if you understand the most important points? Create new ways of looking at situations Always look from outside the situation . 24

25. To Improve Critical Analyzing Maintain clear and accurate logic. Take all details into consideration. Use systematic and scientifically-based process. Use both cognitive and psychomotorskills. 25

26. Reasoning The process of solving problems by using critical thinking skills. An attempt to figure something out, solve a problem, or settle a question 26

27. .Strategies that Promote Development & Application of Critical Thinking Identify goals. Determine what knowledge is required. Assess the margin for error. Determine the amount of time available for decision making. Identify available resources. Recognize factors that may influence decision making. 27

28. Barriers to Creative Thinking Resistance to change, rigid mind-set, practice guided by tradition, habit, routines Stereotypical perceptions of clients Fear of making mistakes Unwillingness to take risks or look for alternative strategies Decision making without sufficient data or supported by rationale Failure to evaluate effectiveness of nursing actions 28

29. Examples A 6-year old girl is admitted to following lacrimal duct probing. She has a history of asthma and is receiving humidified oxygen through a nebulizer mask. Suddenly, her respiratory status changes. She is struggling for air and has sternal retraction. Her respirations become loud and “crowing”. What would you do at this time? Why? 29

30. Examples On your second home visit with Mrs. B., she tells you , “Being in this much pain isn’t worth it anymore. I am just getting worse everyday. I can hardly do anything for myself. I would be better off dead!” Describe three possible responses you could make to Mrs. B. Provide a rationale for each. Which response would you choose and why? Mr. K., a patient with asthma, was admitted yesterday morning. He has an order for albuterol treatments to be given every 4 hours around the clock. You enter his room at 4:00 a.m. and find him sleeping soundly. What would you do? Why? 30

31. 10 Key Questions that Promote Critical Thinking What major outcomes (observable results) will drive our thinking? Exactly what are the problems, issues, or risks that must be addressed to achieve the major outcomes? What are the circumstances? What knowledge is required? How much room is there for error?

32. 10 Key Questions that Promote Critical Thinking 6. How much time do I/we have? What resources can help? Whose perspectives must be considered? What’s influencing thinking? What must we do to prevent, control, or eliminate the problems or issues identified in question 2 above?

33. Designed with the Assumptions that… Critical thinking has to happen in our ownbrains.