Critical Thinking & Clinical Judgement Flashcards
Are essential processes for safe, effecient, and skillful nursing intervention
critical thinking and clinical judgement
The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process
Critical thinking
Aim to focus on the important issues in any clinical situation and make decisions that produce desired patient outcomes
Critical thinking
Enables you to face each new experience and problem involving a patient’s care with open-mindness, confidence, and continual inquiry
Sound clinical judgement
It is a process mastered only through experience, commitment, and an active curiosity toward learning
Sound clinical judgement
Partly relies on “knowing the patient” and the patient’s typical pattern of responses, as well as engaging with patients about their concerns
Sound clinical judgement
Are responsible for making accurate and appropriate clinical decisions that ensure patients receive safe, appropriate, timely, and effective nursing interventions
Registered Nurses (RN)
Defined by the national council of state boards of nursing (NCSBN) as the observed outcome of critical thinking and decision making
Clinical judgement
Is a conclusion about a patient’s needs or health problems that leads to taking or avoiding action, using or modifying standard approaches, or creating new approaches based on the patient’s response
Clinical judgement
It is a process that uses nursing knowledge, experience, and critical thinking to observe and assess presenting situations, identify a prioritized patient concern, and generate the best possible evidence-based solutions to make the decisions needed to deliver safe patient care
Clinical judgement
Are influenced more by nurse’s experience and knowledge than by the objective data about the situation at hand
Clinical judgement
Are influenced by the context of clinical situations and the culture of patient care settings
Clinical judgement
The format of this process is unique to the discipline of nursing and provides a common language and process for nurse to “think through” patient’s clinical problems
Clinical judgement
Requires a nurse to use general and specific critical thinking competencies
Clinical judgement
Separates proffessional nurses from technicians or other assistive personnel (AP
Clinical decision making
She described the research-based model of clinical judgement
Dr. Christine Tanner
Helps to explain concepts
Model
This model explains the many variables involved as you make decisions and clinical judgements about your patients
Clinical judgement model
Offers a valuable conceptual approach to understanding the nature of nursing practice
Clinical judgement model
Components of critical thinking in nursing judgement
Critical thinking competence
Knowledge base
Environment
Experience
Attitude
Standard
Guide nurses in making sound clinical judgements necessary for relavant and appropriate clinical decisions
Components of critical thinking
Described by the American nurses association (ANA) as the framework nurses use to apply critical thinking in nursing practice for making clinical decisions
Nursing process
A process described by ANA as having six steps: assessment, diagnosis, outcome identification, planning, implementation, and evaluation
Nursing process
The purpose of this is to diagnose and treat human responses to patient’s health problems
Nursing process
It encompasses significant actions taken by RNs and forms the foundation of the nurse’s clinical decision making
Nursing process
Allows nurses to help patients meet agreed-on outcomes for better health
Nursing process
Enables nurses to apply the nursing process in clinical decision making
Cognitive skills
6 (six) cognitive skills
- Recognize cues
- Analyze cues
- Prioritize problems/diagnoses
- Generate solutions
- Take actions
- Evaluate outcomes
Are the cognitive processes a nurse uses to make judgements about the clinical care of patients. These include general critical thinking, specific critical thinking in clinical situations, and specific critical thinking in nursing
Critical thinking competencies
Are not unique to nursing; they include the scientific method, problem solving, and decision making
General critical thinking
Include diagnostic reasoning and clinical decision making
Specific critical thinking competencies
Is the nursing process, which incorporates each of the specific critical thinking competencies
Specific critical thinking competency in nursing
Is a methodical way to solve problems by using reasoning
Scientific method
It is a systematic, ordered approach to gather data and solve problems
Scientific method
Healthcare researchers, including nurse scientists use this method when testing research questions
Scientific method
5 (five) steps of scientific method
- Identify problem
- Collect data
- Formulate a question or hypothesis
- Test the question or hypothesis
- Evaluate results of the test or study
Is an unsettled state
Problem
An action for a problem
Solution
Requires you to obtain information that clarifies the nature of problem, suggest possible solutions, and try the solution over time
to evaluate that it is effective
Problem-solving
Is one problem-solving approach that relies on one’s inner sense
Intuition
It is the ability to understand something immediately, without the need for conscious reasoning
Intuition
Often perceived as being a form of guessing and thus inappropriate when making nursing decisions; viewed by others as a legitimate approach to making clinical judgements
Intuition
Is commonly invoked for well-structured and familiar decision tasks
Intuitive thinking
Is triggered for ill-structured and unfamiliar decision tasks
Analytic thinking
Is a form of decision making that involves being able to understand and think through clinical problems, gather information about the problem, analyze clues and or individual cues, understand the meaning of evidence, and know when there is enough information (pattern of data) to make an accurate diagnosis
Diagnostic reasoning
The national academies of sciences, engineering, and medicine (2015) reports that the right ___ is a key aspect of healthcare because it explains a patient’s health problems and informs subsequent health care decisions
Diagnosis
It requires you to assign meaning to behaviours and physical signs and symptoms presented by a patient
Diagnosis
Is a technique for looking beneath the surface, recognizing and examining assumptions, searching for inconsistencies, examining multiple points of view and biases, and differentiating what one knows from what one merely believes
Socratic questioning
These types of questions are common when a nurse completes an end of shift or reviews a patient’s history and progress
Socratic questioning
Moves from reviewing specific data elements to making an inference by forming a conclusion about the related piece of evidence
Inductive reasoning
Moves from general to the specific
Deductive reasoning
Is an in-depth knowledge of a patient’s patterns of responses within a clinical situation and knowing the patient as a person
Knowing the patient
Offers a nurse “the big picture” and “knowing the whole person” so that suitable patient-centered decisions can be made to protect patient’s from harm
Knowing the patient
2 (two) components of knowing the patient
- Nurse’s understanding of a specific patient
- Subsequent selection of interventions
3 (three) levels of critical thinking
- Basic critical thinking
- Complex critical thinking
- Commitment
A level where a learner trusts that experts have the right answers for every problem
Basic critical thinking
A level where thinking is concrete and based on a set of rules of principles
Basic critical thinking
Answers to complex problems are perceived as either right or wrong
Basic critical thinking
A single solution usually resolves each problem
Basic critical thinking
An early step in developing critical thinking
Basic critical thinking
A level where a learner begins to rely less on experts and instead trust their own decisions
Complex critical thinking
A level where learners analyze the clinical situation and examine choices more independently
Complex critical thinking
Learn that alternative and perhaps conflicting solutions exist
Complex critical thinking
A level where thinking abilities and initiative to look beyond expert opinion begin to change
Complex critical thinking
Each solution has benefits and risks that you weigh before making a final decision. There are options. Thinking becomes more innovative
Complex critical thinking
The third level of critical thinking
Commitment
A level where you anticipate when to make choices without assistance from others and accept accountability for decisions made
Commitment
A level where you decide on an action and belief that is based on the available alternatives and support it
Commitment
Able to consider wider array of clinical alternatives for a patient’s situation
Commitment
Recognize that sometimes a proper action is the decision to not act or to delay an action until a layer time based om experience and knowledge
Commitment
Able to apply all elements of clinical judgement model almost automatically
Commitment
Requires inductive and deductive reasoning and making valid inferences
Effective clinical decision making
Requires you to use your judgement in investigating and analyzing all aspects of a clinical problem and then applying scientific and nursing knowledge to choose the best course of action
Good clinical decision making
Goes hand in hand with problem solving and and problem resolution
Basic decision making
Learns to accept the diverse opinions and values of experts
Basic critical thinker
Begin to rely less on experts and instead trust their own decisions
Complex critical thinker
Is necessary before choosing solutions and implementing actions
Accurate problem recognition
True or False
Experience is crucial to knowing how to interpret data
True
True or False
Critical thinking is crucial to knowing how to interpret data
False
True or False
Most patients have health care problems for which there are no clear textbook solutions
True
True or False
Most patients have health care problems for which there are clear textbook solutions
False
True or False
With experience you learn to creatively seek new knowledge, act quickly when events, and make good decisions for patient’s well-being
True
True or False
Nurses use a variety of reasoning approaches in combination, such as problem solving and reflection to understand patient problems and create an individualized plan of care
True
True or False
Clinical judgements made by thinking critically and making sound decisions are at the core of professional nursing competence
True
True or False
Critical thinking in nursing is complex
True
True or False
Critical thinkers question, are honest in facing personal biases, and examine information for answers and deeper meanings in order to
understand their patients
True
True or False
When core critical thinking competences are applied, the complex and continuous nature of decision making and clinical judgement become clear
True
True or False
Critical thinking is a way of thinking about clinical situations
True
True or False
Critical thinking is a way of thinking about solutions
False
True or False
Less experienced nurses, including students, may rely more heavily on analytic reasoning, whereas experienced nurses are more likely to use intuitive reasoning based on their clinical experiences with numerous patients
True
True or False
Less experienced nurses, including students, may rely more heavily on intuitive reasoning, whereas experienced nurses are more likely to use analytic reasoning based on their clinical experiences with numerous patients
False
True or False
Responding intuitively to problems enables quick action, but it must then be complemented with thoughtful reasoning and judgement to ensure the proper response has occured
True
True or False
Intuition is not recommended for beginning nurses because your cognitive level and clinical experience are incomplete and do not allow for valid intuitive decisions
True
True or False
Intuition is recommended for beginnings nurses
False
True or False
Accurate problem recognition is necessary before choosing solutions and implementing actions
True
True or False
Diagnostic reasoning begins when you interact with a patient or make physical or behavioral observations
True
True or False
Nurses do not make medical diagnosis
True
True or False
Nurses assess and monitor each patient closely and compare a patient’s signs and symptoms with those that are common to a medical diagnosis
True
True or False
To manage wide variety of problems associated with groups of patients, skillful, prioritized clinical decision making is critical
True
True or False
Beginning nursing students are tasked oriented
True
True or False
When you are a basic critical thinker, you will perform skills carefully and continuously following policy and procedure
True
Can create distraction, making it difficult to a new nurse to focus on applying the nursing process in an individualized and systematic way
Skills
Develops from getting to know a patient and building a foundation for connecting on the first day of care, to deepening understanding of the patient and being able to recognize clinical changes on subsequent days
Nurse-patient relationship
A nurse’s ___ varies according to educational experience that includes basic nursing education, continuing education courses, and additional college degrees
Knowledge base
A knowledge based on research or clinical expertises that makes nurses better informed critical thinkers
Evidence-based knowledge
The most critical source of knowledge a nurse applies in critical thinking
Patient data
Guide a nurse during assessment
Patient data
Is a practice discipline
Nursing
Is the laboratory for developing and testing approaches that you safely adapt or revise to fit the setting, a patient’s unique qualities, and the experiences you have from caring for previous patients
Clinical experience
Affects the presentation of cues or patient data, which indirectly affects the decision maker
Task complexity
Are guidelines for how to approach a problem and make the correct decision
Critical thinking attitudes
Is the belief in oneself, one’s judgement and psychomotor skills, and one’s possession of the knowledge and the ability to think critically
Confidence
True or False
Confidence grows with experience in recognizing your strengths and limitations
True
True or False
A critical thinker does not accept another person’s ideas without question
True
This is an important aspect of evidence-based practice
Thinking independently
Learning to consider a wide range of ideas and concepts before making a judgement
Thinking independently
Not letting bias or prejudice affect your decisions
Fairness
Having a sense of ____ helps you develop and attitude of fairness
Imagination
Is the knowledge that you are accountable for your decisions, actions, and critical thinking
Responsibility
Are the minimum level of performance accepted to ensure high-quality care
Standards of practice
True or False
A discipline thinker misses few details when assessing a patient, considering care options and resources, or making decisions about nursing interventions
True
True or False
A discipline thinker never misses few details when assessing a patient, considering care options and resources, or making decisions about nursing interventions
False
To keep looking for more resources until you find a successful approach
Persevering/Perseverance
True or False
A critical thinker who perseveres is not satisfied with minimal effort but works to achieve the highest quality level of care
True
True or False
A critical thinker who perseveres is satisfied with minimal effort and works to achieve the highest quality level of care
False
Involves original thinking and motivates you to think of options and unique approaches. This means that you find solutions outside the standard routine of care while still following standards of practice
Creativity
Motivates you to further investigate a clinical situation so that you get all the information you need to make a decision
Curiosity
A person of ____ is honest and willing to admit to mistakes or inconsistencies in one’s own behavior, ideas, and beliefs
Integrity
It is the act of admitting to any limitations in your knowledge and skill
Humility
2 (two) types of standards for critical thinking
- Intellectual standards
- Professional standards
Is a guideline or principle for rational thought
Intellectual standard
You apply these standards during all steps of the nursing process
Intellectual standards
Refer to ethical for nursing judgements, evidence-based criteria used for evaluation, and criteria for professional responsibility
Professional standards
These standards “raise the bar” for the responsibilities and accountabilities that a nurse assumes in guaranteeing high-quality health care to the public
Professional standards
A step in the nursing process that methodically determines if nursing care approaches were successfully led to desired or expected patient outcomes
Evaluation
Is a critical thinking component that prepares you to better anticipate and identify patient problems by understanding their origin and nature
Knowledge
Is like instant replay. It is not intuitive. It involves purposely visualizing a situation and taking the time to honestly review everything you remember about it
Reflection
It assists an individual in learning about life situations and experiences that provide a significant means for the person to learn
Reflection
Allows you to gain knowledge and raise questions about your practice
Reflection
Is a tool for developing self-evaluation skills by consciously clarifying concepts used in nursing practice
Reflective journaling
This model can be used individually or as a process shared with others
Model for reflection
Is a visual representation of patient problems and interventions that shows their relationship to one another
Concept map
It is a nonlinear picture of a patient to be used for comprehensive care planning
Concept map
Helps you synthesize relevant data about a patient, including assessment data, nursing diagnoses, health needs, nursing interventions, and evaluation measures
Concept map
Is a reasoning process by which you cognitively apply and analyze your thoughts, actions, and knowledge to make sound clinical judgement
Critical thinking
