Fortunately, as nursing has become more truly professional and nurses have functioned with increasing autonomy in increasingly complex situations, critical thinking has become a most important and valued competency. What elements converge to produce a good critical thinker? It seems to me that there are several requisites, not the least of which is intelligence.
However, even though intelligence is a necessary condition, critical thinking is not guaranteed to occur without training and a nourishing environment as well. We assume that critical thinking is something that can be learned; hence we address it at all levels of nursing curricula. Based on my experience, I believe that two essential types of learning provide the basis for critical thinking. The first is substantive. It is impossible to think truly critically about something you do not understand or about which you possess only partial information.
Mastery of the theory and research findings that relate to the problem or issue to be addressed is critical, but this is not something that nurses always take time to achieve.
Unfortunately, we have been less successful than other professions namely, medicine in socializing our practitioners to value learning as a career-long pursuit; yet pursuit of the most state-of-the-science information is an essential ingredient of critical thinking.
The second type of learning involves the process of critical thinking itself. The skills of raising questions, using logic, and comprehensively considering alternative perspectives, explanations, and courses of action can often best be learned experientially within a structure that encourages and, in fact, mandates that kind of thoughtful consideration. The model that comes to mind is the daily medical rounds in which physicians-in-training are challenged to present cases and to lay out their diagnostic reasoning clearly for others to critique.
Equally valid as an environment for cultivating critical thinking is that found in many of the social sciences and humanities, where freewheeling debate and open challenge of ideas are encouraged. At first frightened by that kind of candor during my doctoral studies in sociology, I later came to value greatly the critical input of my peers. For me, the groundwork for critical thinking was laid early in my education. Fortunately, the faculty responsible for the BSN program I attended were forward-thinking and highly committed to the emerging definition of nursing as a true profession, with the requisite obligation to base action on scientific knowledge and clear and logical thinking.
Without labeling the goal as such, we were consistently encouraged, groomed, and enabled to be critical thinkers. We were continually challenged by being asked to provide rationales for our decisions, to make explicit all of the alternative approaches and explanations we had considered and rejected, and to explain why.
Not inconsequentially, the school was in a small liberal arts institution, where we were exposed on a daily basis to a wide range of points of view and disciplinary perspectives and assumptions. I wrestled more than once with how in the world assignments such as dissecting the symbolism in Moby Dick might be relevant to my career in nursing, but I now appreciate the mind-expanding contribution that such activities made to my ability to think critically.
Downsizing, high proportions of nonprofessional personnel, high levels of acuity, and high productivity requirements may discourage critical thinking. That means every effort must be made to counter the tendency to let critical thinking slide and, instead, to encourage, nurture, and reward it, even if that means bucking the tide and incurring some additional short-term costs.
Nevertheless, even in those settings, time and energy to engage in deliberation, to exchange ideas, and to critique those ideas openly are scarce, and the kind of culture that encourages such scholarly dialogue is relatively rare. When it is in place, it is wonderful. We drew on what we knew substantively about nursing, science, philosophy, and the disciplines of our respective doctoral degrees none of which were in nursing.
It was hard work, but invigorating. The ground rules were that no idea was to be belittled or rejected out of hand; all perspectives were heard and considered. We were given time to think with minimal interruption and maximal flexibility; accordingly, the end product was excellent and the process truly energizing.
Essential are a culture and leadership that permit and encourage critique without recrimination. In clinical settings, time to engage in deliberative critical thinking is even more difficult to attain.
Rather, critical thinking seems to be expected to occur routinely without much cultivation. However, I assert that the level of critical thinking displayed by clinical experts needs to be developed deliberately and strategically.
The clinical environment in which I have seen critical thinking encouraged most effectively was one in which the expectations were explicit, critical thinking was measured routinely in the practice context, relevant learning and growth opportunities were provided, and critical thinking was taken into account in performance evaluation. In other words, the nursing leadership in that academic medical center truly valued critical thinking and was willing to assign it priority. Nursing has reached the point in its evolution in which a consistent and continuous pattern of critical thinking by its practitioners is a mandate—a sine qua non.
The assurance that critical thinking will be truly woven into the fabric of our profession will depend on our ability to recruit and retain intelligent, interested, and committed nurses; to provide challenging educational opportunities that develop the requisite competencies; and to provide and sustain the kinds of environments in which critical thinking is valued and demanded.
The ability to process information from multiple sources and make decisions is a fundamental ability of professional nursing practice. All of these changes have emphasized the need for professional nurses to think critically in order to provide safe and effective client care to diverse populations. To function effectively in complex, rapidly changing health care environments, nurses must use higher-order thinking skills and apply content knowledge to clinical practice.
The critical thinking process provides nurses with the ability to use purposeful thinking and reflective reasoning to examine ideas, assumptions, principles, conclusions, beliefs, and actions in the context of professional nursing practice Brunt, Professional nurses must think critically to process complex data from multiple sources and make intelligent decisions in planning, managing, delivering, and evaluating the health care of their clients.
To become a critical thinker, a nurse must understand the concept of critical thinking; possess or acquire the essential knowledge, skills, and attributes required to think critically; and deliberately apply critical thinking principles in making clinical judgments.
This chapter covers both classical and current sources to examine critical thinking, clinical judgment, and the nursing process. Critical thinking, as a concept, has been examined and presented from a variety of perspectives.
An early definition, proposed by Watson and Glaser , described critical thinking as the combination of abilities needed to define a problem, recognize stated and unstated assumptions, formulate and select hypotheses, draw conclusions, and judge the validity of inferences. Alfaro-LeFevre presented critical thinking for nursing as informed, purposeful, and outcome-focused thinking that requires the ability to identify problems, issues, and risks and make judgments based on evidence.
Conclusions are drawn as a result of this reasoning process. In nursing practice, the desired outcome of this reasoning is effective action. Conflicting viewpoints exist regarding whether critical thinking is subject specific or generalizable U. Department of Education, The same critical thinking skills of interpretation, analysis, inference, and evaluation are applied in different subjects.
However, the difference lies in how the critical thinking processes are applied to specific disciplines. For example, professional nurses apply critical thinking skills to client care situations in order to make sound clinical judgments, whereas engineers apply critical thinking skills to business or industrial situations in order to make sound decisions.
Meyers and McPeck believe that mastery of basic terms, concepts, and methodologies must occur before critical thinking skills can be developed.
Ennis agrees that some familiarity with subject matter is necessary for the development of critical thinking; however, some principles of critical thinking bridge many disciplines and can transfer to new situations.
An attempt to define critical thinking by consensus was begun in the late s, and the results became known as the Delphi Report. The Delphi research project used an expert panel of theoreticians representing several disciplines from the United States and Canada to develop a conceptualization of critical thinking from a broad perspective Facione, The resulting work described critical thinking in terms of cognitive skills and affective dispositions.
A critical thinker gives reasoned consideration to evidence, context, theories, methods, and criteria to form a purposeful judgment.
At the same time, the critical thinker monitors, corrects, and improves the judgment. The Delphi project produced the following consensus definition from its panel of experts:.
We understand critical thinking CT to be purposeful, self-regulatory, judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based. American Philosophical Association, The Delphi participants identified core critical thinking skills as interpretation, analysis, inference, evaluation, and explanation.
These critical thinking cognitive skills and subskills are listed in Box Scheffer and Rubenfeld replicated the Delphi 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:. 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. According to Allen, Rubenfeld, and Scheffer , 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. Although a universally accepted definition of critical thinking has not emerged, agreement exists that it is a complex process.
The variety of definitions helps provide insight into the myriad dimensions of critical thinking. Commonalities in definitions include an emphasis on knowledge, cognitive skills, beliefs, actions, problem identification, and consideration of alternative views and possibilities Daly, The definitions presented earlier are summarized for comparison in Table , and characteristics of critical thinking are listed in Box From Wilkinson, J.
Nursing process: A critical thinking approach 2nd ed. The activities involved in the process of critical thinking include appraisal, problem solving, creativity, and decision making.
This text is suitable for nursing students as an introduction to nursing process, or for use in the continuing education of professionals who may need refresher information and practice. This text can be used for independent study and for distance learning, but it is in no way limited to that approach.
It can be used as a text to supplement lectures, either in a separate course or when the nursing process is integrated in the curriculum. This text makes clear that nursing process and a written plan of care are not one and the same. The terms client and patient are used throughout the book.
Nursing,Medicine, and Multidisciplinary Practice 5. Nursing in Wellness and Illness 6. Relationship to Nursing and Caring Purpose and Characteristics Organization: Phases of the Nursing Process Relationship to Problem-Solving Process Cognitive Intellectual Skills Creativity and Curiosity Nursing Process Practice Critical Thinking Practice: Self-Knowledge Nursing Is an Applied Discipline Nursing Draws on Knowledge from Other Fields Nurses Deal with Change in Stressful Environments Some Definitions of Critical Thinking Characteristics of Critical Thinking Types of Nursing Knowledge Intellectual Humility Intellectual Integrity Intellectual Perseverance Intellectual Curiosity Interest in Exploring Thoughts and Feelings Believing and Knowing Judging and Evaluating Critical Thinking Practice:Using Language Purpose of Nursing Assessment Relationship to Other Phases of the Nursing Process Critical Thinking in Assessment Subjective and Objective Data Primary and Secondary Data Sources Initial Versus Ongoing Assessment Comprehensive Versus Focus Assessment Use of Computers in Assessment Data Collection Methods Home Care and Functional Assessment Spiritual Assessment Community Assessment Critical Thinking Practice: Believing and Knowing History of Nursing Diagnosis Importance of Nursing Diagnosis Use of Nursing Models Labeling and Recording Diagnoses Health Promotion: Diagnosing Wellness Avoiding Diagnostic Errors Critical Thinking Practice: Analysis and Synthesis Classification Systems The Need for Uniform Nursing Language Existing Nursing Taxonomies How to Choose a Label Actual Nursing Diagnoses Potential Risk Nursing Diagnoses Possible Nursing Diagnoses Wellness Diagnoses Format Collaborative Problems Unrealistic Expectations Effect on Holistic Perspective Ethical Considerations Cultural Considerations Initial Versus Ongoing Planning Computerized Care Plans Comprehensive Nursing Care Plans Multidisciplinary Care Plans Critical Pathways Purpose of the Outcome Statement Writing Outcome Statements Family and Home Health Outcomes Outcomes for Wellness Diagnoses Patient Teaching Outcomes Guidelines for Judging the Quality of Outcome.
Ethical Considerations in Planning Legal Issues in Planning Spiritual Planning and Outcomes Cultural Considerations in Planning Critical Thinking Practice: Classifying Types of Interventions Theory-Based Planning Nursing Interventions and Problem Status How to Generate and Select Nursing.
Computerized Planning
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