CRITICAL THINKING AND THE NURSING PROCESS
Critical Thinking and Safe Care
Outline:
A. Critical Thinking Attitudes
1. Intellectual Humility
2. Intellectual Courage
3. Intellectual Empathy
4. Intellectual Integrity
5. Intellectual Perseverance
6. Faith in Reason
7. Intellectual Sense of Justice
B. Knowledge Base
Concern for Patient Safety
C. Critical Thinking Skills
Problem Solving
Other Critical Thinking Skills
Introduction
Think critically; means the use of knowledge and skills to make the best decisions
possible in patient care situations.
“Critical thinking is the use of those cognitive [knowledge] skills or strategies that
increase the probability of a desirable outcome.”
Critical thinking is sometimes called directed thinking because it focuses on a goal.
Other terms used include reasoning, common sense, analysis, and inquiry.
Good thinking requires:
9 Critical thinking attitudes and skills
9 Good knowledge base
Critical Thinking Attitudes
1- Intellectual Humility
People with intellectual humility have the ability to say, “I am not sure about that…. I need
more information.” Certainly, we want our patients to think we are smart and know what we
are doing, but patients also respect nurses who can say, “I do not know; let me find out.” It is
unsafe to care for patients when you are not sure of what you need to do.
2- Intellectual Courage
Intellectual courage allows you to look at other points of view even when you do not agree
with them at first. Maybe you really believe that 8-hour shifts are best for nurses, and have a
lot of good reasons for your belief. But if you have intellectual courage, you will be willing to
really listen to the arguments for changing to 12-hour shifts. Maybe you will even be
convinced. Sometimes you have to have the courage to say, “Okay, I see you were right after
all.”
3- Intellectual Empathy
Consider the patient who snaps as you enter her room, “I’ve been waiting all morning for my
bath. If you do not help me with it right now I am going to call your supervisor.” The first
response that comes into your head is, “I have five other patients; you are lucky I am here
now!” But, if you have intellectual empathy, you will be able to think, “If I were this patient,
who is in chronic pain and is tired of being in the hospital, how would I feel?” It might change
how you respond.
4- Intellectual Integrity
Your patient seems to ask a hundred questions when you bring her a medication that has been
newly prescribed for her high blood pressure. But later you notice she is taking an herbal
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remedy from her purse. Someone with intellectual integrity would want the same kind of
proof that both types of medications are safe and effective before using them.
5- Intellectual Perseverance
Do not give up. Consider this scenario. You have concerns about some side effects you have
noticed when you administer a new drug to your patients. You mentioned it to the physician
and he said not to worry about it, but you are still concerned. If you have intellectual
perseverance, you might do some research on the web, then go to your supervisor or the
pharmacist to discuss your concerns.
6- Faith in Reason
If you have faith in reason, you believe in your heart that good thinking, and reason, will
indeed result in the best outcomes for your patients. And if you really believe, you will be
more likely to attend a seminar or read an article on critical thinking skills.
7- Intellectual Sense of Justice
One of your co-workers wants to change the medication administration schedule on your unit.
She says it is because it will be better for the patients, but you think it might be because it fits
her break schedule better. If you have an intellectual sense of justice, you will be sure that
your thinking is not biased by something that you just want for yourself, like your co-worker
seems to be doing. You should examine your own motives as well as those of others when
you are making decisions.
So, what does this all mean to you as a nursing student?
Knowledge Base
Nurses must have a good knowledge base in order to safely care for their patients.
The best knowledge upon which to base your practice comes from research. Nurse researchers
try new methods for taking care of patients and compare them with traditional methods to
determine what works best.
When nursing care is based on good, well-designed research studies, it is called evidence
based practice. As nurses, we need to use as many interventions as we can that have been
researched. Other interventions, until they are validated by research, have to be based on our
best critical thinking skills. Some expert organizations are beginning to “bundle” best practice
strategies together to increase their use. Bundles are groups of interventions that, when used
together, have been shown to improve patient outcomes. To find more information on
bundles, go to http://www.ihi.org/ihi and type “bundles” in the search window.
Concern for Patient Safety
9 Health-care providers are being held accountable for safe care by society.
9 As a result, guidelines to reduce errors in health care and improve patient outcomes
have been developed.
9 The Joint Commission on Accreditation of Hospitals and Organizations 2006 patient
safety goals can be found at http://www.jcipatientsafety.org.
These goals are throughout the book to increase awareness and understanding of them. They
address important areas of concern such as:
9 Using medications safely
9 Correctly identifying patients
9 Identifying operative sites correctly
9 Improving communication
9 Reducing fall injuries
9 Reducing risk for infections
Critical Thinking Skills
Problem Solving
Problem solving is one type of critical thinking skill. Nurses solve problems on a daily basis.
However, a problem can be handled in a way that may or may not help the patient. For
instance, consider Mr. Frank, who is in pain and requests pain medication.
An alternative approach is to use a standard problem-solving method:
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1. Gather data.
Decide to use a pain-rating scale on which the patient rates pain on a scale of 0 (no pain) to
10 (the greatest pain possible).
You check his history and find he has compression fractures of his spine.
You next go to the medication record and find that he has no alternative pain medications
ordered.
2. Identify the problem. Here you use your knowledge base to draw the conclusion that
Mr. Frank is in acute pain, and the current medication orders are not sufficient to provide pain
relief.
3. Decide what outcome (sometimes called a goal) is desirable. The outcome should be
determined by you (the nurse) and the patient working together.
In this case you talk to Mr. Frank and determine that he needs pain relief now; he cannot wait
until the next scheduled dose of medication. He states that he is able to tolerate a pain rating
of 3 or less on a 10-point scale.
4. Plan what to do. Formulate and evaluate some alternative solutions. For example, tell
Mr. Frank that he has to wait 40 minutes; giving the medication early might relieve his pain,
you could decide to try some non–drug pain-control methods, such as relaxation,
distraction, or imagery. Another alternative is to report to the physician that Mr. Frank’s
pain is not controlled with the current pain-control regimen. Once you have several alternative
courses of action, decide which will best help the patient. Then you can discuss those options
with the registered nurse (RN) and together decide the best thing to do; in this case, you might
decide to have the RN contact the physician while you work with the patient on relaxation
exercises.
You might decide to ask Mr. Frank if he would like to listen to some of the music his wife
brought in for him. You can also tell Mr. Frank that the physician is being contacted.
5. Implement the plan of care. The RN enters the room and informs you and the patient that
the physician has changed the analgesic orders. You obtain and administer the first dose of the
new analgesic, being sure to explain its effects and side effects to Mr. Frank. The RN also
informs Mr. Frank that the physician has ordered a consultation with the pain clinic.
6. Evaluate the plan of care. Did the plan work? As you reassess Mr. Frank 30 minutes later,
he rates his pain level at 2. You think back to the desired outcome, compare it with the
current data collected, and determine that your interventions were successful.
Other Critical Thinking Skills
Problem solving is just one critical thinking skill. There are many others that are beyond the
scope of this book.
Following are a few questions to ask yourself as you continue to develop your critical
thinking. There are many more questions you might ask. These are not in any order, nor
would they all be asked for a given situation. They are just some ideas to get you started.
Have I thought this through?
What information do I need?
How do I know?
Is someone influencing my thinking in ways I am not aware of?
What conclusions can I draw from the information I have?
Am I basing this decision on assumptions that may or may not be true?
Am I thinking creatively about this, or am I in a rut?
Is there an expert I can consult that can help me think through this?
Is there any research or evidence that this is true?
Am I too stressed or tired to think carefully about this right now?
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