critical thinking

Kataoka-Yahiro and Saylor critical thinking model

1 BASIC- based on rules 2 COMPLEX - analyze and examine choices more independently. risks and benefits 3 COMMITMENT At this level you anticipate when to make choices without assistance from others and accept accountability for decisions made

Critical thinking - Professional standards (3)

1. Ethical criteria for nursing judgment 2. Criteria for evaluation 3. Professional responsibility

scientific method 5 steps

1. Identify the problem. 2. Collect data/research the problem 3. Formulate a question or hypothesis. 4. Test the question or hypothesis. 5. Evaluate results of the test or study.

An elderly debilitated patient is confined to bed. The patient has reduced libido, is unable to eat, and is incontinent of urine. Which intervention would be the priority for this patient? A improve skin integrity B Improve libido C Better nutrition D Reduce incontinence

A improve skin integrity

Which behavior indicates the nurse's understanding of integrity? Select all that apply. One, some, or all responses may be correct. A Following the highest standards of practice B Questioning own knowledge and beliefs C Always having a sense of curiosity about the patient's condition D Being honest about and willing to accept own mistakes or inadequacies E Continually looking for more resources until a successful approach is found

A, B , D Rationale In critical thinking, integrity means the nurse should follow the highest standards of practice. Nurses should be open- minded and, if need arises, should question themselves. Nurses should be honest and accept their own mistakes or inadequacies. Having curiosity about the patient's condition is not part of integrity. Perseverance involves looking for more resources until a successful approach is found, pp. 205-206

The nurse is new to a postoperative ward. The nurse finds it difficult to care for the immediate needs of a patient. Which measure would the nurse take to improve caregiving? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected A Spend more time in initial assessment. B Request an assignment to another unit. C Provide nonspecific interventions to the patient. D Observe the patient's behavior and measure physical findings. E Constantly assess and monitor patients for health needs.

A, D. E Rationale The nurse should improve clinical decision-making skills by spending more time in initial assessment; this helps better assess the patient's needs. Observing the patient's behavior and measuring physical findings promotes better assessment and formulation of nursing diagnoses. The nurse should constantly assess and monitor the patients so the care plan can be modified as needed. Transferring the nurse to a less demanding position may bring learning to a halt. Providing nonspecific interventions is not ethically acceptable.

The nurse has instructed the assistive personnel (AP) on the tasks that need to be performed, including getting patient A out of bed, collecting a urine specimen from patient B, and checking vital signs on patient C, who is scheduled to go home. Which scenario is an example of successful delegation? Select all that apply. One, some, or all responses may be correct. A The nurse explains to the AP the approach to use in getting the patient up and why the patient has activity limitations. B The nurse is asked by a patient to help her to the bathroom; the nurse leaves the room and directs the AP to assist the patient instead. C The nurse sees the AP preparing to help a patient out of bed, goes to assist, and thanks the AP for her efforts to get the patient up early. D The nurse is in patient B's room to check an intravenous (IV) line and collects the urine specimen while in the room. E The nurse offers support to the AP when needed but allows her to complete patient care tasks without constant oversight.

A. C E Rationale Nurses demonstrate successful delegation by communicating clearly and explaining tasks, showing respect and appreciation, showing initiative, and having confidence in other staff members. The nurse shows a lack of initiative by directing the AP to assist the patient after the patient asked the nurse for help getting to the bathroom. Delegation is, ineffective if the registered nurse (RN) fails to carry out proper supervision and evaluation of care. Following through on tasks is necessary but not constant oversight.

The nurse who is working on a surgical unit is caring for four different patients. Patient A will be discharged home and is in need of instruction about wound care. Patients B and C have returned from the operating room within an hour of each other, and both require monitoring of their vital signs and intravenous (IV) lines. Patient D is resting after physical therapy. Which activity by the nurse represents use of clinical decision-making for these patients? Select all that apply. A Consider how to involve patient A in deciding whether to involve the family caregiver in wound care instruction. B Think about past experience with patients who develop postoperative complications. C Decide which activities can be combined for patients B and C. D Carefully gather any assessment information and identify patient problems. E Discuss physical therapy progress with patient D

A. and C. Examples of clinical decision-making for groups of patients include considering how to involve patients in decisions and how to combine nursing activities to be more organized and allow for resolving more than one problem at a time. Thinking about past experiences is an example of reflection, an approach to strengthen critical thinking skills. Gathering assessment information and identifying patient problems is part of the process of diagnostic reasoning, which should be applied to 'each patient.

Nursing Process (5)

Assessment Diagnosis/Analysis Planning Implementation Evaluation

The postoperative patient expresses to the nursing student that he is experiencing some pain and discomfort. The nursing student examines the patient's wound. The patient also tells the nurse that another nurse visited him a while ago but was rude and did not pay any attention to him. The nursing student apologizes and assures him that his needs are fulfilled. The student speaks to the co-worker and manages the situation. Which attitude for critical thinking did the nursing student display here? A Curiosity B Fairness C Creativity D Confidence

B Fairness Rationale Faimess involves listening to both sides of the story and managing the situation without prejudice. Curiosity is characterized by exploring and desiring to learn more. Creativity involves looking for and exploring different approaches for the patient's needs. Confidence is presenting oneself with conviction and being well prepared. p.205C

Which critical thinking attitude would the nurse possess to identify new solutions to patient-related problems? A Curiosity B Creativity C Integrity D Humility

Creativity Rationale Creativity is a critical thinking attitude that helps the nurse identify new ways to help a patient when traditional techniques are not working. Curiosity is an attitude by which the nurse can explore the patient's conditions and emotions. Integrity is related to the honesty of the nurse. The nurse can show humility, but this is not an attitude that leads to new solutions. p.205

SPECIFIC CRITICAL THINKING in CLINICAL SITUATIONS includes 1 2 3

DIAGNOSTIC REASONING. Diagnostic reasoning involves being able to understand and think through clinical problems, look for clues, understand the meaning of evidence, and know when there is enough information to make an accurate diagnosis, consider different causes of the problem, and then select interventions that best meet the needs of a patient CLINICAL DECISION MAKING . when you face a clinical problem or situation with a patient and need to choose a course of action from several options, you are making a clinical decision.

For example, what does Mr. Lawson's restlessness, shortness of breath, and developing chest pain indicate? _____________________ reasoning begins when you interact with a patient or make physical or behavioral observations.

Diagnostic

5 components of critical thinking in nursing

I. Specific knowledge base in nursing /skills competence II. Experience III. Critical thinking competencies (3) A General critical thinking B Specific critical thinking C Specific critical thinking in nursing: nursing process IV. Attitudes for critical thinking (11) Confidence, independence, fairness, responsibility, risk taking, discipline, perseverance, creativity, curiosity, intellectual integrity, humility V. Standards for critical thinking A Intellectual standards (10) B professional Standards (3)

Intellectual standards for critical thinking in nursing (10)

Intellectual standards CLEAR—Plain and understandable (e.g., clarity in how one communicates). PRECISE—Exact and specific (e.g., focusing on one problem and possible solution). SPECIFIC—To mention, describe, or define in detail ACCURATE—True and free from error; getting to the facts (objective and subjective) RELEVANT—Essential and crucial to a situation (e.g., a patient's changing clinical status) PLAUSIBLE—Reasonable or probable CONSISTENT—Expressing consistent beliefs or values LOGICAL—Engaging in correct reasoning from what one believes in a given instance to the conclusions that follow DEEP—Containing complexities and multiple relationships BROAD—Covering multiple viewpoints (e.g., patient and family) COPLETEe—Thoroughly thinking and evaluating SIGNIFICANT—Focusing on what is important and not trivial ADEQUATE (for purpose)—Satisfactory in quality or amount FAIR—Being open-minded and impartial

6 critical thinking skills

Interpretation Analysis Inference Evaluation Explanation Self-Regulation

4 decision making questions

Question the PROBLEM • Is the problem clear and understandable? • Is the problem important or a priority in the patient's care? Question Your PERSPECTIVE • You are looking at the problem from the view of _____. Why? • How might someone with an opposite view see the problem? • How does your view compare with that of the patient? Questions ASSUMPTIONS • You are assuming _______. How does that affect your analysis of the problem? • What might you assume instead? Is there another option? Question EVIDENCE • What evidence supports your assumption? • Is there a reason to doubt the evidence? Does it apply to this specific situation? • What further evidence is needed?

BARKSBY REFLECTION MODEL

REFLECT R Recall the events. Review the facts about a situation and describe what happened. E Examine your responses. Think about or discuss your thoughts and actions at the time of the situation. F Acknowledge Feelings: Identify any feelings you had during the situation. L Learn from the experience: Review and highlight what you learned from the situation—for example, your patient's responses and your actions. E Explore options: Think about or discuss your options for similar situations in the future. C Create a plan of action: Create a plan for how to act in future similar situations. T Set a Time: Set a time by which your plan of action will be completed.

Facione's concepts for critical thinking

TOASSIM Truth seeking Seek the true meaning of a situation. Be courageous, honest, and objective about asking questions. Open-mindedness Be tolerant of different views; be sensitive to the possibility of your own prejudices; respect the right of others to have different opinions. AnalyticitY Analyze potentially problematic situations; anticipate possible results or consequences; value reason; use evidence-based knowledge. Systematicity Be organized, focused; work hard in any inquiry. Self-confidence Trust in your own reasoning processes. Inquisitiveness Be eager to acquire knowledge and learn explanations even when applications of the knowledge are not immediately clear. Value learning for learning's sake. Maturity Multiple solutions are acceptable. Reflect on your own judgments; have cognitive maturity.

Nursing Process purpose

The purpose of the nursing process is to diagnose and treat human responses (e.g., patient symptoms, need for knowledge) to actual or potential health problems

Critical thinking competencies

are the cognitive processes a nurse uses to make judgments about the clinical care of patients (Kataoka-Yahiro and Saylor, 1994). GENERAL CRITICAL THINKING (the scientific method, problem solving, and decision making.) SPECIFIC CRITICAL THINKING in CLINICAL SITUATIONS SPECIFIC CRITICAL THINKING in NURSING

five elements of critical thinking model in nursing judgment:

competence (e.g., problem solving and clinical decision-making ability), knowledge, experience, attitudes, and standards (intellectual and professional).