Critical Thinking

Introduction

Critical thinking involves recognizing that an issue (e.g., patient problem) exists, analyzing information about the issue (e.g. clinical data about a patient), evaluating information and making conclusions.

  Thinking-Thinking is purposeful, organised process that we use to make sense of the world.

Definition

  • Critical thinking is a continuous process characterized by open-mindedness, continual enquiry combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant.         
  • Critical  Thinking is a cognitive process that involves weighing the accuracy and logic of evidence an understanding of the nature of valid abstraction and generalization.      -Miller and Malcolm                                                                            
  • Critical  thinking  is reasonable, reflective thinking that is focused on deciding what to believe or do.       -Robert Ennis      

Purpose of Critical Thinking :-

  • To solve problems and make therapeutic decisions, one must seek knowledge.
  • Making accurate and responsible clinical judgments is necessary.
  • When organizing the patient's care, the ability to think creatively is necessary.
  • Need to identify and resolve issues.
  • Planning treatment for each individual Patient and attended concern requires attention.                                   

Critical Thinking Skills 

  • Interpretation - Collect and clarify data in an orderly fashion.
  • Analysis- Be open minded and do not make imaginations.
  • Inference - Look for relationships within information you have collected.
  • Evaluation-Be objective in nursing action that need to perform.
  • Explanation- Make sure you have support in your conclusions and use experiential knowledge and scientific bases.
  • Self-regulation- Review your methods and correct any problems identified.

Levels Of Critical Thinking-The ability of nurses to think critically grows continuously as they acquire new knowledge in nursing practice. Kataoka-Yahiro and Saylor in 1994 developed a critical thinking model

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 based on a set of rules or principles.

2. Complex critical thinking:-

  • In complex critical thinking there are more than one alternative and solution.
  • In this the nurse uses more complex ways to solve a problem, knowing the risk and benefits of each solutions.
  • In it the nurse develops the ability to think creatively.

3. Commitment:-

Commitment The third level of critical thinking is commitment. At this level a person make choices without assistance from others and accepts accountability for decisions made.

  • In this stage assumes the responsibility and evaluation of the decision.
  • In this level the nurse make decision based on the alternatives.

Critical Thinking Competencies

Kataoka-Yahiro and Saylor (1994) explained critical thinking competencies as the cognitive processes a nurse uses to make decisions about the clinical care of patients. These include general critical thinking, specific critical thinking in clinical situations and specific critical thinking  in nursing. 

A. General critical thinking

  1. Scientific method-The scientific method is a way to solve problems using reasoning. It is a systematic and ordered process of gathering data and solving problems used by nurses, physicians and a variety of other healthcare professionals. steps of scientific method.
  • Identification of problem
  • Data collection
  • Formulation of question or hypothesis
  • Testing the question or hypothesis
  • Evaluating results of the test or study 

2. Problem solving-Problem solving is the process of defining a problem; determining its cause; identifying, prioritizing, and selecting amatives for a solution; and implementing a solution and evaluate the solution.

3. Decision making-Decision making is defined as a product of critical  thinking that focuses on problem resolution. Following a set of criteria helps to make a thorough and thoughtful decision.

B. Specific critical thinking competencies in clinical health care

  1. Diagnostic reasoning- It is a process of determining a client's health status after gathering data and making a clinical judgment.

    It involves the use of cognitive thinking, metacognition (thinking about thinking), & assessment skills to structure situations so you can apply knowledge).

  2. Clinical inference- Clinical inference is the process of drawing conclusions from related pieces of evidence and previous experience with the evidence. An inference involves forming patterns of information from data before making a diagnosis.
  3. Clinical decision making-Requires careful reasoning so that the options for the best client outcomes are chosen on the basis of the client's condition and the priority of the problem.

C. Specific critical thinking competency in nursing

  1. Nursing process-Specific critical thinking competency includes specialized nursing skills used by nurses for providing quality patient care. Nursing process is the specific critical thinking skill used by nurses in day-to-day practice for providing patient care.

Paul (1993) identifies 11 attitudes :-

  1. Independence
  2. Integrity
  3. Confidence
  4. Insight into ego centricity
  5. Creativity
  6. Fair-Mindedness
  7. Perseverance
  8. Curiosity
  9. Intellectual humility
  10. Risk taking
  11. Responsibility & accountability.

1. Independence:- Critical thinking requires that individual think for themselves. A critical thinker considers seriously a wide range of ideas, learn from them and then make them own judgements about them. Nurse should not ignore what other people think, but they consider a wide range of ideas.

2. Fair-Mindedness:- Critical thinkers are fair minded and make impartial judgments. They assess all view points with the same standards and do not base their judgments on personal or group bias.

3. Integrity:- Intellectual integrity requires that individual's apply the same rigours standards of proof to their own knowledge and beliefs as they apply to knowledge. Critical thinkers question their own knowledge and beliefs as quickly and thoroughly as they challenge those of anothers.

4. Perseverance:- Critical thinking is a lifelong endeavor, nurses who are critical thinkers show perseverance in finding effective solution to client and nursing problems.

Example:- The nurse in a unit have tried to establish a policy for selected clients to leave the hospital on a pass rather than have to be discharged and readmitted on the same day. The need for involvement of nursing, medical administrative and accounting staff gradually generates solutions to obstacles.

5. Confidence:-Critical thinkers believe that well-reasoned thinking will lead to trust worthy conclusions. Critical thinkers develop skill in both inductive reasoning and deductive reasoning. Nurse gain greater awareness of thinking process and more experience in improving such thinking, confidence in the process will grow. Nurse can serve as a role model to colleagues, inspiring and encouraging them to think critically as well.

6. Curiosity:- The mind of a critical thinker is filled with questions.

  • Why do we believe this?
  • What causes that?
  • What would happen if we did it another way?

A curious nurse may value traditions but is not afraid to examine traditions to be sure they are still valid.

7. Insight to Egocentricity:- Critical thinkers are open to the possibility that their personal biases or social pressure and customs could unduly affect their thinking. They actively try to examine their own biases and bring them to awareness each time they think or make a decision.

8. Intellectual Humility:- Intellectual humility means having an awareness of the limits of one's own knowledge. Critical thinkers are willing to admit what they do not know, they are willing to seek new information and to rethink their conclusions towards new knowledge.

9. Creativity:- According to Paul, is the ability to think, imagine, and generate original and innovative ideas, solutions, or expressions. Paul believes that creativity is a fundamental human trait that can be nurtured and developed.

10. Risk taking:- Risk taking, according to Paul, involves the willingness to step outside one's comfort zone and embrace uncertainty in pursuit of opportunities and personal growth. Paul believes that taking calculated risks is an essential aspect of achieving success and fulfilling one's potential.

11. Responsibility and accountability:- Accountability, according to Paul, is the act of taking responsibility for one's actions, decisions, and their consequences. Paul believes that accountability is crucial for personal growth, success, and fostering a positive work or social environment.

Use of Critical Thinking skills in Nursing :-

  • Nurse uses knowledge from other subjects and fields.
  • Nurse deals with changes in stressful environments.
  • Nurse makes important decisions.
  • Nurse provides care according to nursing process

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