in this lecture we will be discussing critical thinking and nursing practice nurses use critical thinking skills in a variety of ways critical thinking skills are essential from making clinical decisions as a nurse why is critical thinking important patient outcomes improve when the nurse uses critical thinking failure to employ critical thinking results in wasted time and energy poor quality patient outcomes frustration and anxiety nurses must be able to process both previously learned and newly acquired information about their patients the work environment resources at hand in the work environment or in the community as well as applicable evidence that is related to the care of the patient the nurse must be able to prioritize this information quickly and efficiently clinical judgment or clinical decision-making is a process that nurses used in the clinical setting to evaluate and select the best actions to meet the desired goals nurses use clinical decision-making whenever choices are available even when they evaluate a situation and decide not to act in some cases decisions are required in situations that neither have clear answers standard procedures or they have conflicting forces that add to complexity but other times decisions are considered routine clinical decision making applies across the continuum of nursing care from direct patient care at the bedside to professional behaviors and accountability that is inherent to the profession of Nursing the nurse must evaluate each patient's needs and preferences as well as time constraining activities to make appropriate decisions for each patient to make these decisions the nurse must use critical thinking to choose among alternatives that support the best patient outcomes for all of their patients critical thinkers question see and examine information for answers and deeper meanings in order to understand their patients critical thinking is a way of thinking about clinical situations by asking questions in using critical thinking and clinical judgment skills we must understand interpretation analysis inference evaluation explanation and self-regulation as nurses we are going to be collecting data about about our patients so we need to understand if there are different patterns that are developing from this data collection be able to categorize the data and formulate nursing diagnoses and then gather additional data and clarify any data that we have questions about when we analyze the data we need to be open-minded as we look for information about our patient we cannot make assumptions based on what we think could be the problem we must actually find out the true answer as to what the problem is when we talk about inference we need to look at the meaning and the significance of our findings and see if there are any relationships that are common among the findings in evaluation we need to look at all of the situation's objectively we need to use expected outcomes pain characteristics learning objectives so that we can determine if the results of our nursing actions were appropriate when we explenation we're going to support our findings and our conclusions we use our knowledge and our experience to choose strategies that we're going to use in the care of our patients and lastly self-regulation this is where you're going to reflect on the experience we need to make sure that our actions are connecting with the outcomes and then identify ways that we can improve upon our own performance what do you think that we could do to make you more successful in this situation we also need to look at some of the concepts of a critical thing so a critical thinker should be truth-seeking so they should find the true meaning of any situation that's gonna entail being courageous honest and objective about asking questions they need to be open-minded they need to be tolerant of different views be sensitive to the possibility of our own prejudices and respect the right of others to have different opinions they need to be analytical they're gonna have to look at potentially problematic situations and anticipate possible results or Consequences using evidence-based knowledge they need to be systematic so you need to be organized focus and work hard when you're performing any sort of inquiry self-confidence is going to be the ability to trust in your own reasoning experiences and this is going to happen as your gain as you encounter different patient situations in nursing you will continually gain self confidence they need to be inquisitive so you need to make sure that you are able to acquire knowledge and learn from explanations you need to value learning and lastly maturity so this is going to be the part where you're reflecting on your own judgments and you're able to manage multiple solutions and learn from these situations to develop this maturity reflection is going to be the action of retrospectively making sense of occurrences experiences situations or decisions and learning from them it is the process of figuring out what worked and what didn't work what could you have done differently to achieve better outcomes what was done well what necessary resources were available and so forth to reflect on an experience the nurse needs to learn to observe the significant factors of an experience that need to be included in reflective thinking evidence shows that debriefing or reflective thinking after a simulation scenario or clinical learning experience encourages reflective learning this is a process that can help transfer the book knowledge to practical application and complex situations your ability to think critically grows as you gain new knowledge and experience in nursing practice in this critical thinking model you will see three different levels basic complex and commitment beginning nursing students are task oriented as they focus on performing skills and organizing their nursing care activities this is okay you're at the basic level of critical thinking and you have to learn how to have or find the right answer for every problem your thinking is concrete and it's based on the set of rules or principles as you move into complex critical thinking you begin to rely less on the experts and you begin to trust your own decisions more this is going to enhance as you begin to encounter different patient situations so rather than jumping to finding the answer and a procedure module and just keep repeating that same approach you're going to be able to take that knowledge that you have from clinical situation and examine choices that you have to make you more independent in your practice the last level of commitment is going to be where you begin you anticipate when to make choices without assistance from others and accept accountability for the decisions that you make so as a nurse you may do more than just consider the complex alternatives you're going to choose an action or a belief that is based on the available alternatives and then you're going to support it critical thinking competencies are the cognitive processes a nurse uses to make judgments about the clinical care of their patients they include general critical thinking specific critical thinking in clinical situations and specific critical thinking and nursing as far as general critical thinking we've all heard of the scientific method at some point in your student career you have participated in some sort of science fair you've used this method to identify a problem you've collected data on your problem you've had to formulate your hypothesis you've had to test out your hypothesis and then evaluate the results to determine if your hypothesis was true or false we've also used problem-solving and decision-making in our everyday life when we talk about specific critical thinking diagnostic reasoning is going to be a form of decision-making that involves being able to understand and think through clinical problems as a nurse we're going to look for clues we have to understand the meaning of the evidence and know when there is enough information to make an accurate nursing diagnosis or consider different causes of the problem and lastly we're going to select interventions that best meet the needs of our patients decision making or clinical decision making is a popular term lately and nursing this is going to be a product of critical thinking that focuses on resolving a patient's problem such as a nursing diagnosis in using clinical decision making the nurse is going to use inductive reasoning so they are going to review specific data to make an inference which is where you form a conclusion relate it to the pieces of evidence deductive reasoning is where you move from the general to the specific nurses applied the nursing process as a competency when delivering patient care the American Nurses Association or AMA standards provide the framework necessary for critical thinking in the application of the five-step nursing process these steps include assessment diagnosis planning implementation and evaluation the purpose of the nursing process is to diagnose and treat human responses such as patient symptoms or the need for knowledge use of the process allows nurses to help patients meet upon agreed outcomes so that they can improve their health the nursing process requires a nurse to do the general and specific critical thinking competencies described earlier and focus on the patient's unique needs the format for the nursing process is unique to the discipline a nursing and it provides a common language and process for nurses to think through the patient's clinical problems as a nurse it does take time to develop these critical thinking skills as a nursing student you can start now by actively engaging in your patients that you're assigned to as part of your clinical rotation you can apply the principles that you have learned of the critical thinking and the nursing process model to help develop these skills there are some other actions that you can take to make yourself a more independent thinker and use the knowledge that you're gaining in nursing school and clinical practice to really hone in on those critical thinking skills reflective journaling is going to be a tool that we use to develop critical thought and reflection by clarifying the concepts that you're learning in the classroom so when you are reflective journaling this is going to allow you to define and express your clinical or your simulation experiences in your own words your writing skills will improve as you learn to identify and address concepts or situations that you in practice and it'll help you to marry the concepts that you're learning in the classroom - what you're seeing in the clinical setting another way to develop critical thinking skills is to regularly meet with colleagues such as your fellow nursing students this allows you ways that you can discuss and examine work experiences you can talk about how your learning and connect with others to get that support from other nursing students most of us are capable of learning the material but when you meet with colleagues you can critically think and discuss a little more in depth of the different concepts that we're learning or you can discuss situations that you've experienced in the clinical or in simulation and apply that to what you're learning in the classroom so this is gonna really allow you to learn from others experiences and use their perspectives to promote reflective critical thinking and then lastly concept mapping is going to be a way that we use visual representation of a patient problem and interventions and show how it's gonna have relationships to others so sometimes when we use the concept mapping we are going to use these case studies where we have a patient situation and you're gonna have to fill in what you would do for the patient so the interventions that you would apply or what type of goal you would expect to have for this patient so you're really going to look at their assessment data you're gonna look at the different nursing diagnoses that you would apply what their health needs are the different nursing interventions that you could use and then how are you gonna evaluate to make sure that the plan is actually working this is going to allow you to see a big picture of the patient and help us understand the different patients that you're going to encounter in the clinical setting now it's time for an NCLEX review so the first questions the use of diagnostic reasoning involves a rigorous approach to clinical practice and demonstrates that critical thinking cannot be done a logically be haphazardly C independently and D systematically take a minute to think of your answer and then proceed to the next slide so that you can view the correct answer and rationale so if you chose B haphazardly you would be correct the rationale is critical thinking should be done using a systematic approach using knowledge and experience to formulate an opinion for this NCLEX review question we are asking the nursing process organizes your approach while delivering nursing care to provide the best professional care to patients nurses need to incorporate nursing process and a decision making B problem solving C intellectual standards or D critical thinking skills take a minute to reflect on what would be the best answer and then proceed to the next slide for the correct answer and rationale it shows D critical thinking skills you would be correct the nursing process and critical thinking go hand in hand in providing patient-centered care the nursing process cannot be completed without critical thinking informing nursing diagnosis setting goals interventions and evaluation