FUNDAMENTALS OF NURSING
(Problem Solving Process)
Prepared by:
DANAN, MAE ANN P.
BSN 1-E
Instructor:
[Link] Garcia
Critical Thinking
the ability to objectively analyze information, identify biases, and form reasoned judgement,
rather than simply accepting information without questionning
solve problems effectively, encompassing skills like evaluating arguments, recognizing
assumptions, , and drawing logical conclusions.
Critical Thinking Defined
Critical Thinking Defined
It is the ability to think in a systematic and logical manner with openness to question and
reflect on the reasoning process.
* It involves open-mindedness,
continual inquiry, and perseverance, combined with a
willingness to look at each patient situation and determine which identified assumptions are true and relevant.
* It considers what is important in each clinical situation, imagines and explores alternatives, considers ethical
principles, and makes informed decisions about the care of patients.
• It involves the use of evidence- based knowledge, or knowledge based on research or clinical expertise.
* It requires cognitive skills and the habit of asking questions, staying well informed, being honest in facing personal
biases, and always being willing to reconsider and think clearly about issues (Facione, 1990).
It requires reflection.
Reflection involves purposeful thinking back or recalling a situation to discover its purpose or meaning. It is like
instant replay. Research has shown that, when nurses reflect on past experiences, they perceive that their knowledge
increase and their critical thinking moves to a higher level (Kaddoura, 2013)
• Critical Thinking and Clinical Judgment Skills
SkillNursing
.•Be orderly in collecting data about patients.
• Apply reasoning while looking for patterns to emerge.
Categorize the data (e.g., nursing diagnoses)
•Gather additional data or clarify any data
about which you area uncertain.
Interpretation
•Be open-minded as you look at information about a patient.
•Do not make careless assumptions. Does the data reveal a
problem or trend that you believe is true, or are there other
options?
Analysis
•Look at the meaning and significance of the findings. Are
there relationships about the findings? Does the data about the
patient help you see that a problem exists?
Inference
•Look at all situations objectively.
•Use criteria (eg., expected outcomes, pain characteristics,
learning objectives)
Evaluation determine results of nursing actions.
Reflect on your own behavior.
•Support your findings and conclusions.
•Use knowledge and experience to choose
strategies to use in the care of patients.
Explanation
•Reflect on your experiences.
Self-Regulatio •Be responsible for connecting your actions with outcomes.
•Identify the ways you can improve your own performance.
What will make you believe that you have been successful?
• Concepts for a Critical Thinker
SkillNursing
Seek the true meaning of a situation. Be courageous, honest
and objective about asking questions.
Trufh Seeking
Be tolerant of different views; be sensitive to the possibility
of your own prejudices; respect the right of others to have
Open mindedness different
Analyze potential problematic situations; anticipate possible
results or consequences; value reason; use evidence-based
Analycity
Be organized, focused; work hard in any
Sustematicity
Self Confidence Trust in your own reasoning processes.
Be eager to acquire knowledge and learn Inquisitiveness
explanations even when applications of the knowledge are
Inquisitiveness not immediately clear. Value learning for learning's sake.
Multiple solutions are acceptable. Reflect on your own
judgments; have cognitive maturity.
Maturity
Levels of Critical Thinking in Nursing Commitment.
The three levels of critical thinking in Nursing are as follows: (I) Basic, (2) Complex, (sy
1. Basic Critical Thinking
•At the basic level of critical thinking a learner trusts that experts have the right answers for
every problem.
•Thinking is concrete and based on a set of rules or principles.
2. Complex Critical Thinking
•Complex critical thinkers begin to separate themselves from experts.
•The nurse analyzes the clinical situation and examine choices more independently. v A person's thinking abilities and initiative
to look beyond expert opinion begin to change.
3. Commitment
• At this level of critical thinking the nurse anticipates when to make choices withs assistance from others and accepts
accountability for decisions made.
• The nurse do more than just consider the complex alternatives that a problems poses.
Critical Thinking Competencies
1. General Critical Thinking
o Scientific Method
o Problem Solving
o Decision Making
2. Specific Critical Thinking
In clinical Situation
o Diagnostic Reasoning and Inference
o Clinical Decision Making
3. Specific Critical Thinking
In Nursing
• Nursing Process
Critical thinking competencies are the cognitive processes a nurse uses to make judgments about
the clinical care of patients.
1. General Critical Thinking
a. Scientific Method
•It is a methodical way to solve problems using reasoning.
•It is a systematic ordered approach to gathering data and solving problems.
This approach looks for the truth and verifies that a set of facts agrees with reality.
The scientific method has five steps:
1. Identify the problem.
2. Collect data.
3. Formulate a question or hypothesis.
4. Test the question or hypothesis.
5. Evaluate results of the test or study.
b. Problem Solving
•Effective problem solving involves evaluating a situation and trying a solution over time to make sure it is effective.
If a problem recurs, it becomes necessary to try different options.
•Having solved a problem in one situation adds to a nurse's experience in practice, whit allows the nurse to apply that knowledge
in future patient situations.
c. Decision Making
•Is a product of critical thinking that focuses on problem resolution.
2. Specific Critical Thinking
a. Diagnostic Reasoning and Inference
Diagnostic reasoning is the analytical process for determining a patient's health
problems
b. Clinical Decision Making
• It is a problem- solving activity.
•Nurses make clinical decisions to improve a patient's health or maintain wellness.
Nursing Process As a Competency
Nurses apply the nursing process as a competency when delivering patient care (Kataoka-Yahiro and Saylor 1994).
• Critical thinking is necessary in the application of the five- step nursing process: assessment,
diagnosis, planning, implementation, and evaluation.
A Critical Thinking Model for Clinical Decision Making
Thinking critically is at the core of professional nursing competence. The ability to think critically, improve clinical practice and
decrease errors in clinical judgments is an aim of nursing practice.
five components of critical thinking:
1. Knowledge base
2. Experience
3. Critical thinking competencies (with emphasis on the nursing process)
4. .Attitudes
5. Standards
These elements of the model explain how nurses make clinical judgments that are necessary for
safe, effective nursing care.
1. Specific Knowledge Base
Knowledge prepares the nurse to better anticipate and identify patient's problems by understanding their origin and nature.
• A nurse's broad knowledge base offers a physical, psychological, social, moral, ethical, and cultural view of patients and their
health care needs.
2. Experience
• Nursing is a practice discipline. Clinical learning experiences are necessary to acquire clinical decision- making skills.
• Knowledge combined with clinical expertise from experience defines critical thinking.
•In clinical situation, the nurse learns from observing, sensing, talking with patients and
families, and reflecting actively on all experiences.
With experience, the nurse begins to understand clinical situations, anticipate and recognize cues of patient's health patterns, and
interpret the cues as relevant or irrelevant.
4. Attitudes for Critical Thinking•
Eleven attitudes define the central features of a critical thinker and how a successful critical
thinker approaches a problem.
• The following are the essential attitudes for critical thinking:
• Confidence
• Perseverance
• Independence
• Creativity
• Fairness
• Curiosity
• Responsibility
• Integrity
• Risk Taking
• Humility
• Discipline
Confidence
•Is the belief in oneself, one's judgment and psychomotor skills, and one's possession of the knowledge and the ability to think
critically and draw appropriate conclusions.
•Thinking Independently. The nurse learns to consider all sides of a situation.
A critical thinker does not accept another person's ideas without question.
Fairness.
A critical thinker deals with situations justly. This means that bias or prejudice does not enter into a decision.
Responsibility and Accountability.
Responsibility is the knowledge that one is accountable for
his/her decisions, actions, and critical thinking (Etheridge, 2007).
•When the nurse is caring for patients, he/she is responsible for correctly performing nursing care activities on the basis of
standards of practice.
Risk Taking.
•People often associate taking risks with danger. But risk taking does not always have negative outcomes. Risk taking is
desirable, particularly when the result is a positive outcome.
•When taking a risk, consider all options; follow safety guidelines; analyze any potential dangers to a patient; and act in a
well-reasoned, logical, and thoughtful manner.
Discipline
•A disciplined thinker is orderly or systematic when collecting information, making decisions or taking actions and misses
few details.
Perseverance.
A critical thinker is determined to find effective solutions to patient care problems.
This is especially important when problems remain unresolved or recur. Learn as much as possible about a problem and try
various approaches to care.
Creativity
Creativity involves original thinking. This means that the nurse finds solutions outside of the standard routines of care while still
following standards of practice.
Curiosity
•A critical thinker's favorite question is "Why." In any clinical situation the nurse learns a great deal of information
about a patient.
Integrity
. Critical thinkers' question and test their own knowledge and beliefs. The nurse's personal integrity builds trust from co-workers.
Nurses face dilemmas or problems in everyday clinical practice, and everyone makes mistakes at times.
•A person of integrity is honest and willing to admit to mistakes or inconsistencies in his or her own behavior, ideas, and beliefs.
Humility
• It is important for the nurse to admit to any limitations in his or her knowledge and skill.
Critical thinkers admit what they do not know and try to find the knowledge needed to make proper decisions. It is common for a
nurse to be an expert in one area of clinical practice but a novice in another because the knowledge in all areas of nursing is
unlimited.
5. Standards for Critical Thinking
The fifth component of the critical thinking model includes:
1. Intellectual Standards
2. Professional Standards (Kataoka-Yahiro and Saylor, 1994)
a. Intellectual Standards
Paul (1993) identified 14 intellectual standards universal for critical thinking.
An intellectual standard is a principle for rational thought.
These standards are applied by the nurse during all steps of the nursing process.
•For example, when the nurse considers a patient problem, he or she applies the intellectual standards of preciseness, accuracy,
.
The intellectual standards are as follows:
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
Deep - Containing complexities and multiple relationships.
Broad - Covering multiple viewpoints (e.g., patient and family).
Complete - Thoroughly thinking and evaluating.
Significant - Focusing on what is important and not trivial.
b. Professional Standards
Professional standards for critical thinking
refer to ethical criteria for nursing judgments,
evidence - based criteria used for evaluation, and criteria for professional responsibility (Paul,)
•Professional standards promote the highest level of quality nursing care.
