Learning Outcomes

1. Describe the significance of developing critical-thinking

abilities in order to practice safe, effective, and
professional nursing care.
2. Explore ways of demonstrating critical thinking and
Clinical reasoning in clinical practice.
3. Discuss the skills and attitudes of critical thinking
4. Conduct Applying Critical Thinking to Nursing Practice
5. Discuss the Techniques of Critical Thinking:
Learning Outcomes (cont'd)

6. Discuss the relationships among critical thinking, the

problem-solving process, and the decision-making process.
7. identify Attitudes That Foster Critical Thinking
8. Explore Integration of Critical Thinking and Clinical
Reasoning
9. Compile Components of Clinical Reasoning
10. Demonstrate Concept Mapping and Enhancing Critical
Thinking and Clinical Reasoning
Most important concept to learn about
today
 Critical thinking
 Clinical reasoning
 Problem solving
 Decision making
 Mind-Mapping
Importance of clinical experiences
 Enables students to apply classroom theory and the skills learned in the
nursing learning laboratory and the simulation environment
 Educating students on clinical skills in the hospital or other clinical settings
increases their confidence and expertise.
 The practice of nursing requires critical thinking and clinical reasoning.
Critical thinking
 Is the process of intentional higher-level thinking (generally)
 critical thinking is an evaluation of one’s beliefs and actions. In critical
thinking, a nurse critiques his or her thoughts to ascertain an appropriate
outcome.
 This critique allows the nurse to make judgments, arrive at conclusions, and
offer hypotheses.
Clinical reasoning
• Cognitive process that uses thinking strategies to gather and analyze client
information, evaluate the relevance of the information, and decide on
possible nursing actions. (Specific)
• Clinical reasoning requires the integration of critical thinking in the
identification of the most appropriate interventions that will improve the
client’s condition
 Clinical reasoning combines both thinking and decision-making in the
clinical setting.
Purposes :
• Improve the client’s physiologic and psychosocial outcomes.
• Promotion of decision-making when delivering client care.
• Make the complex trade-offs between the benefits and risks of tests and
treatments
Nurses Ways to use critical thinking skills

 Nurses use knowledge from other subjects and fields.

 Nurses use critical thinking skills when they reflect on knowledge derived
from other interdisciplinary subject areas such as the biophysical and
behavioral sciences and the humanities in order to provide holistic nursing
care.

 Nurses deal with change in stressful environments.

 Critical thinking enables the nurse to recognize important cues, respond
quickly, and adapt interventions to meet specific client needs at the right
time.

 Nurses make important decisions.

 Every moment during the day, nurses use critical thinking skills and
clinical reasoning to make judgments about a client’s care.
Creativity

 Critical thinking cognitively fuels the intellectual, artistic activity of

creativity. When nurses incorporate creativity, they are able to find unique
solutions to unique problems.
 Creativity is required when the nurse encounters a new situation or a client
situation in which traditional interventions are not effective.
The use of creativity provides the nurse with the ability to:
 Generate many ideas rapidly.
 Be generally flexible and natural; that is, able to change viewpoints or
directions in thinking rapidly and easily.
 Create original solutions to problems.
 Be independent and self-confident, even when under pressure.
 Demonstrate individuality.
Box 10-2 Personal Critical Thinking
Indicators: Behaviors Demonstrating CT
Characteristics and Attitudes
Techniques of Critical Thinking:
1- Critical analysis :
is the application of a set of questions to a particular situation or
idea to determine essential information and ideas and discard
unimportant information and ideas.
2- Inductive reasoning :
Generalizations are formed from a set of facts or observations.
(Specific to general)
3- Deductive reasoning:
Is reasoning from general premise to the specific conclusion.
(General to specific)
 Applying Critical Thinking
to Nursing Practice
 Implementation of the nursing process provides nurses with a
creative approach to thinking and doing to obtain,
categorize, and analyze client data and plan actions that
will meet the client’s needs.
 Systematic, rational method of planning and providing
individualized care
 Assessing
 Diagnosing
 Planning
 Implementing
 Evaluating
Problem-Solving Process

 Is a mental activity in which a problem is identified

that represents an unsteady state.
 Clarify the nature of a problem and suggests possible
solutions
 carefully evaluates the possible solutions and chooses
the best one to implement.
 One situation contributes to the nurse’s body of
knowledge for problem solving in similar situations
 Commonly used approaches:
1- Trial and Error
2- Intuition
3- Research process
Problem-Solving Process
1 -trial and error :
- number of approaches are tried until a solution is found.
- The use of trial-and-error methods in nursing care can be dangerous
because the client might suffer harm if an approach is inappropriate.
2- intuition :
- is a problem-solving approach that relies on a nurse’s inner sense.
-It is a legitimate aspect of a nursing judgment in the implementation of care
-Experienceis important in improving intuition because the rapidity of the
judgment depends on the nurse having seen similar client situations many
times
3- research process:
Formalized, logical, systematic approach to problem-solving
The classic quantitative research process is most useful when the researcher
is working in a controlled situation.
Attitudes That Foster Critical
Thinking
 Independence: CT requires that individuals think for themselves.

 Fair-Mindedness: assess all viewpoints with the same standards and do not
base their judgments on personal or group bias or prejudice

 Insight into Egocentricity: actively try to examine their own biases and
bring them to awareness each time they think or make a decision.

 Intellectual Humility: having an awareness of the limits of one’s own

knowledge. are willing to admit what they do not know; they are willing to seek
new information and to rethink their conclusions in light of new knowledge.

 Intellectual Courage to Challenge the Status Quo and Rituals

comes from recognizing that beliefs are sometimes false or misleading
Attitudes That Foster Critical Thinking
 Integrity: apply the same rigorous standards of proof to their own
knowledge and beliefs as they apply to the knowledge and beliefs of others.

 Perseverance: Persistent and tempted to find effective

solutions to client and nursing problems

 Confidence: Critical thinkers believe that well-reasoned thinking will lead

to trustworthy conclusions. The critical thinker develops skill in both inductive
reasoning and deductive reasoning. As the nurse gains greater awareness of the
thinking process and more experience in improving such thinking, confidence
in the process will grow

 Curiosity: The mind of a critical thinker is filled with questions: Why do we

believe this? What causes that? Does it have to be this way? Could something
else work?
Components of Clinical Reasoning
Clinical reasoning describes the thinking and decision-making processes associated
with clinical practice”
Clinical reasoning is the analysis of a clinical situation as it unfolds or develops. It
requires the nurse to use cognitive and metacognitive processes.
A. Cognitive processes :
1. thinking processes based on the knowledge of aspects of client care.
2. learned through reading and applying health-related literature
3. enhanced by using critical thought to understand and apply content the nurse
has previously learned.
B. Metacognitive processes :include reflective thinking and awareness of the skills
learned by the nurse in caring for the client.
- The nurse reflects on the client’s status, and through the use of critical thinking
skills determines the most effective plan of care.
Components of Clinical Reasoning

1. Setting Priorities
2. Developing Rationales
3. Learning How to Act
4. Clinical Reasoning-in-Transition
5. Responding to Changes in the Client’s Condition
6. Reflection
Components of Clinical Reasoning

1. Setting Priorities
 the nurse must know what assessments ,tasks, requests, and concerns need to be
completed first.
 Priority setting needs to be dynamic or flexible, because the clinical environment
can change quickly, requiring changes in priorities.
2. Developing Rationales
 This is when nursing knowledge transferred to the clinical situation to justify the
plan of care.
 Nursing students are often asked to explain the “why” of their priority setting
and subsequent interventions.
 Being able to state the rationale, based on nursing knowledge, acts as a check for
potential errors, justifies the nurse’s actions, contributes to client safety, and
helps the beginning nursing student learn how a nurse thinks in practice.
Components of Clinical Reasoning

3. Learning How to Act :

 The nurse must know how and when to respond in a clinical situation by recognizing
what is most urgent or significant.
 To take action, the nurse needs to understand the relevant medical and nursing
information and translate this knowledge into a plan of care (Benner et al., 2010).
4. Clinical Reasoning-in-Transition:
 ability to recognize subtle changes in a client’s condition over time.
 It includes the evaluation of nursing interventions and the trending of relevant
assessment data.
 Components of Clinical Reasoning

5. Responding to Changes in the Client’s Condition;

 Nurses spend more time with clients than do other healthcare providers.
 As a result, an important aspect of nursing practice and the nurse’s
responsibility is to detect changes in the client’s condition, recognize a need
to change priorities, adjust nursing care, and alert the primary care provider
when appropriate.
6. Reflection:
 is a key to the success of clinical reasoning.
 Through reflection the nurse identifies factors that improved client care and
those that required changing or elimination.
Integration of Critical Thinking
and Clinical Reasoning
• Nurses use critical thinking and clinical reasoning skills when
making decisions about client care.
• The decision-making process includes:
1. Prioritizing care
2. Assisting clients to make decisions.
3. Decide if the client’s condition can be managed in the home or
requires hospitalization in the home care setting.
4. Consider the client’s cultural and religious background because
both influence the outcomes of care.
Integration of Critical Thinking
and Clinical Reasoning

 In the planning of care , nurses must question whether

knowledge they possess about the care of the client is
consistent with the most current evidence-based practice
by review most current nursing and health-related
literature prior to implementing care.
Concept Mapping (mind mapping)

 technique that uses a graphic depiction of nonlinear and

linear relationships to represent critical thinking.
 A general benefit of these maps is that they are quicker
than note taking and highlight key ideas
(Alfaro-LeFevre, 2016).
Concept Mapping and Enhancing Critical
Thinking and Clinical Reasoning

 In planning the care delivered to clients and their families, it is important to

plan and organize nursing care (Schuster, 2016).

 Concept mapping provides nurses with a link between existing nursing

knowledge and new information
E.g. :
 Concept maps often begin with the client’s principle physiologic or
psychosocial problem.
 The nursing student learns to establish a diagram of signs and symptoms that
interrelate to those physiologic and psychosocial problems.
 The assessment data gathered by the nurse or nursing student also are
interrelated concepts that contribute to the development of the concept map.
Box 10-5 Types of Concept Maps
Hierarchical maps

—concept and attributes

arranged in a hierarchical
pattern and typically constructed
in a descending order of
importance.
Relationships are identified
between and among a concept
and its attributes
Spider maps

—depict the interrelatedness of the

concept and its attributes in the map
Flowchart maps

—linear diagrams demonstrating

sequence or cause-and-effect
relations
Systems maps

—inputs and outputs illustrate

relationships among the concept
and its attributes.