TEST 2 - UNIT B - CH 8 - CRITICAL THINKING (Fundamentals Book) Flashcards
Nursing practice requires the application of knowledge from and a knowledge of
biological, social, and physical sciences
knowledge of pathophysiology; and knowledge of nursing procedures and skills.
Nurses also must use multiple thinking skills—including ______(5) to make clinical judgments about problems in nursing practice.
critical thinking skills (interpretation, analysis, evaluation, inference, and explanation)—
These judgments lead the nurse to
choosing actions or interventions through a process called clinical reasoning.
A nursing knowledge base w/ foundational thinking skills, including recall and comprehension, is a prerequisite to
critical thinking in nursing.
In nursing, critical thinking is an
active, orderly, well-thought‑out reasoning process that
critical thinking guides a nurse in
guides a nurse in various approaches to making a nursing judgment by
what does the nurse apply when using critical thinking
applying knowledge and experience, problem‑solving, logic, reasoning, and decision‑making.
A critical thinker
prioritizes, explores various courses of action, keeps ethics in mind, and determines appropriate outcomes. To have a positive effect on a client’s health
Critical thinking discourages
quick judgments that lead to single‑focused solutions.
● Critical thinking requires*
lifelong learning and the ability to acquire relevant experiences that can be reflected on continuously to improve nursing judgment.
● The components of critical thinking include *
knowledge, experience, critical thinking competencies, attitudes, and intellectual and professional standards.
● Critical thinking is facilitated by*
seeking truth in an open-minded manner and being inquisitive about why something is effective or ineffective.
● Critical thinking follows a*
systematic process or pattern, not jumping to conclusions but using reason to guide decisions.
● Nurses make *
inferences when making clinical decisions by pulling pieces of information together to determine a relationship between the data.
● Critical thinking incorporates*
reflection, language, and intuition, and it evolves through three distinct levels as a nurse gains knowledge and experience while maturing into a competent nursing professional.
● Reflection
Purposefully thinking back or recalling a situation to discover its meaning and gain insight into the event.
A nurse should reflect on the following:
“Why did I say that or do this?”
● “Did the original plan of care achieve optimal client outcomes?”
◯ If so: “Which interventions were successful?”
◯ If not: “Which interventions were unsuccessful?”
Language should be
Precise, clear language demonstrating focused thinking and communicating unambiguous messages and expectations to clients and other health care team members.
A nurse should ask the following: about their language
● “Did I use language appropriate for the client?”
● “Did I communicate the message clearly to the provider?”
Intuition
An inner sensing that facts do not currently support something. Intuition should spark the nurse to search the data to confirm or disprove the feeling.
The nurse should ask the following: about intuition
● “Did the vital signs reflect any changes that account for the client’s present status?”
● “When the client’s status changed in this way last month, there was a specific reason for it. Is that what is happening here?”
LEVELS OF CRITICAL THINKING
Basic critical thinking
Complex critical thinking
Commitment
Basic critical thinking
● A nurse trusts the experts and thinks concretely based on the rules.
● Basic critical thinking results from
limited nursing knowledge and experience, as well as inadequate critical thinking experience.
Example: of basic crtiical thinking
A client reports pain 1 hr after receiving a pain medication. Instead of reassessing the client’s pain, the nurse tells the client he must wait two more hours before he can receive another dose.
Complex critical thinking
● The nurse begins to express autonomy by analyzing and examining data to determine the best alternative.
● Complex critical thinking results from
an increase in nursing knowledge, experience, intuition, and more flexible attitudes.
Example: of complex crticial thinking
A nurse realizes that a client is not ambulating as often as prescribed because of a fear of missing her daughter’s phone call. The nurse assures the client that the staff will listen for and answer her phone when she is out of her room.
Commitment
● The nurse expects to make choices without help from others and fully assumes the responsibility for those choices.
● Commitment results from
an expert level of knowledge, experience, developed intuition, and reflective, flexible attitudes.
Example: of commitmeent level of critical thinking
A nurse increases the rate of an IV fluid infusion when a client’s blood pressure indicates hypovolemic shock 24 hr after surgery.
COMPONENTS OF CRITICAL THINKING
Knowledge
Experience
Competence
Attitudes
Standards
Knowledge
Information that’s specific to nursing and comes from:
Knowledge comes from
● Basic nursing education
● Use of evidence-based practice
● Continuing education courses
● Advanced degrees and certifications
Experience
Decision‑making ability derived from opportunities to observe, sense, and interact with clients followed by active reflection. A nurse:
Experience is demonstrated by
● Demonstrates an understanding of clinical situations.
● Recognizes and analyzes cues for relevance.
● Incorporates experience into intuition.
Competence
Cognitive processes a nurse uses to make nursing judgments.
General critical thinking includes (5) and are part of a nurses competence
● Scientific method
● Problem‑solving
● Decision‑making
● Diagnostic reasoning and inference
● Clinical decision‑making; collaboration
Specific critical thinking in nursing: is what
The nursing process
Attitudes
Mindsets that affect how a nurse approaches a problem.
Attitudes of critical thinkers include:
● Confidence:
● Fairness:
● Responsibility:
● Risk-taking:
● Discipline:
● Perseverance:
● Creativity:
● Curiosity:
● Integrity:
● Humility:
● Confidence
- Feels sure of abilities.
● Independence
*Analyzes ideas for logical reasoning.
● Fairness
- Is objective, nonjudgmental.
● Responsibility
- Adheres to standards of practice.
● Risk-taking
Takes calculated chances in finding better solutions to problems.
● Discipline
Develops a systematic approach to thinking.
● Perseverance
Continues to work at a problem until there’s a resolution.
● Creativity
Uses imagination to find solutions to unique client problems.
● Curiosity
Requires more information about clients and problems.
● Integrity
Practices truthfully and ethically.
● Humility
Acknowledges weaknesses.
Standards
Model for comparing care to determine acceptability, excellence, and appropriateness.
● Intellectual standards ensure the
thorough application of critical thinking.
● Professional standards
◯ Nursing judgment based on ethical criteria
◯ Evaluation that relies on evidence-based practice
◯ Demonstration of professional responsibility
◯ Promotes maximal level of nursing care
● The nurse can improve their critical thinking and clinical reasoning ability through
tactics (concept mapping and reflective journaling) which allow the nurse to recognize connections and patterns among data and outcomes.
(concept mapping and reflective journaling) which allow the nurse to
recognize connections and patterns among data and outcomes.
● Mentoring and peer relationships can positively influence the nurse’s
critical thinking ability, as nurses discuss client care and learn from each other’s experiences.
Assessment/Data collection
Collect information about a client’s present health status to identify needs, and to identify additional data to collect based on findings.
Collect information about a client’s present health status to
identify needs, and to identify additional data to collect based on findings.
CRITICAL THINKING SKILLS of assessment and data collection (5)
● Observe.
● correct techniques collecting data.
● Differentiate relevant / irrelevant data, (important / unimportant data).
● Organize, categorize, validate data.
● Interpret assessment data and draw a conclusion.
Planning
Establish priorities and optimal outcomes of care to measure and evaluate. Then, select the nursing interventions to include in a client’s plan of care to promote, maintain, or restore health.
CRITICAL THINKING SKILLS for Planning
● Identify goals and outcomes for client care.
● Set priorities.
● Determine appropriate strategies and interventions for inclusion on a client’s plan of care or teaching plan.
● Take knowledge and apply it to more than one situation.
● Create outcome criteria.
● Theorize.
● Consider the consequences of implementation.
Implementation
Provide care based on assessment data, analyses, and the plan of care.
CRITICAL THINKING SKILLS for implementation
● Use knowledge base.
● Use appropriate skills and teaching strategies.
● Test theories.
● Delegate and supervise nursing care.
● Communicate appropriately in response to a situation.
Evaluation
Examine a client’s response to nursing interventions and form a clinical judgment about meeting goals and outcomes.
CRITICAL THINKING SKILLS for evauluation
● Determine accuracy of theories.
● Evaluate outcomes based on specific criteria.
● Determine understanding of teaching.
- A nurse is caring for a client who is 24 hr postoperative following an inguinal hernia repair. The client is tolerating clear liquids well, has active bowel sounds, and is expressing a desire for “real food.” The nurse tells the client, “I will call the surgeon and ask for a change in diet.” The surgeon hears the nurse’s report and prescribes a full liquid diet. The nurse used
which of the following levels of critical thinking?
A. Basic
B. Commitment
C. Complex
D. Integrity
- A. CORRECT: At the basic level, thinking is concrete and based on a set of rules (obtaining the prescription for diet progression).
B. At the commitment level, the nurse expects to have to make choices without help from others and fully assumes the responsibility for those choices. However, postoperative protocols generally involve obtaining a prescription for diet progression.
C. Advanced experience and knowledge at the complex level will prompt the nurse to request diet progression to full liquids based on active bowel sounds and the client’s tolerance of clear liquid, not solely on the client’s request.
D. Integrity is a critical thinking attitude that comes into play when the nurse’s opinion differs from that of the client. The nurse must then review their own position and decide how to proceed to help achieve outcomes satisfactory to all parties.
- A nurse receives a prescription for an antibiotic for a client who has cellulitis. The nurse checks the client’s medical record, discovers that the client is allergic to the antibiotic, and calls the provider to request a prescription for a different antibiotic. Which of the following critical thinking attitudes did the nurse demonstrate?
A. Fairness
B. Responsibility
C. Risk-taking
D. Creativity
- A. Fairness is using a nonjudgmental, objective approach in looking at clients and situations. This attitude does not apply here.
B. CORRECT: The nurse is responsible for administering medications in a safe manner and according to standards of practice. Checking the medical record for allergies helps ensure safety.
C. Risk-taking is a calculated approach to solving a problem that is not responding to traditional methods. This attitude does not apply here.
D. Creativity is an approach that uses imagination to find solutions to unique client problems. This problem is not unique, and it requires a straightforward solution.
- A newly licensed nurse is considering strategies to improve critical thinking. Which of the following actions should the nurse take? (Select all that apply.)
A. Find a mentor.
B. Use a journal to write about the outcomes of clinical judgments.
C. Review articles about evidence-based practice.
D. Limit consultations with other professionals involved in a client’s care.
E. Make quick decisions when unsure about a client’s needs.
- A. CORRECT: Learning from the experience of peers can improve critical thinking.
B. CORRECT: Journaling about decision-making can assist the nurse with self-reflections and improve critical thinking.
C. CORRECT: Improving knowledge by learning new information about evidence-based practice improves the nurse’s ability to think critically.
D. Although nurses who have advanced critical thinking can do so independently, the nurse should talk to other professionals to share information and remain open-minded and inquisitive.
E. Quick decision-making can lead to errors. A nurse’s intuition might cause feelings of uncertainty, which should lead the nurse to ask questions about whether the plan of care makes sense and to gather more information.
- A nurse is caring for a client who has a new prescription for antihypertensive medication. Prior to administering the medication, the nurse uses an electronic database to gather information about the medication and the effects it might have on this client. Which of the following components of critical thinking is the nurse using when he reviews the medication information?
A. Knowledge
B. Experience
C. Intuition
D. Competence
- A. CORRECT: By using the electronic database, the nurse takes the initiative to increase their knowledge base, which is the first component of critical thinking.
B. The nurse has had no prior experience w/ administering this medication to this client.
C. Intuition requires experience, which the nurse lacks in administering this medication to this client.
D. Competence involves making judgments, but no one can make a judgment about how the nurse handles researching and administering this medication to this client until they perform those tasks.
- A nurse uses a head‑to‑toe approach to conduct a physical assessment of a client who will undergo surgery the following week. Which of the following critical thinking attitudes did the nurse demonstrate?
A. Confidence
B. Perseverance
C. Integrity
D. Discipline
- A. Confidence is feeling sure of one’s own abilities. The nurse might feel confident of their physical assessment skills, but choosing a particular method or sequence requires another attitude.
B. Perseverance is continuing to work at a problem until the nurse resolves it. This attitude does not apply here.
C. Integrity is a practicing truthfully and ethically. This specific attitude does not apply here.
D. CORRECT: Discipline includes using a systematic approach to thinking. Using a head-to-toe approach ensures the nurse is thorough and calculated in getting information about the client’s physical status.
List at three critical thinking skills for assessment/ data collection step of the nursing process
● Assessment/Data collection
◯ Observe.
◯ Use correct techniques for collecting data.
◯ Differentiate between relevant and irrelevant data and between important and unimportant data.
◯ Organize, categorize, and validate data.
◯ Interpret assessment data and draw a conclusion.
List at three critical thinking skills for nalysis/Data Collection step of the nursing process
● Analysis/Data Collection
◯ Identify clusters and cues.
◯ Detect inferences.
◯ Recognize an actual or potential problem or risk.
◯ Avoid making judgments.
List at three critical thinking skills for Planning step of the nursing process
● Planning
◯ Identify goals and outcomes for client care.
◯ Set priorities.
◯ Determine appropriate strategies and interventions for inclusion on a plan of care or teaching plan.
◯ Take knowledge and apply it to more than one situation.
◯ Create outcome criteria.
◯ Theorize.
◯ Consider the consequences of implementation.
List at three critical thinking skills for Implementation step of the nursing process
● Implementation
◯ Use knowledge base.
◯ Use appropriate skills and teaching strategies.
◯ Test theories.
◯ Delegate and supervise nursing care.
◯ Communicate appropriately in response to a situation.
List at three critical thinking skills for Evaluation step of the nursing process
● Evaluation
◯ Determine accuracy of theories.
◯ Evaluate outcomes based on specific criteria.
◯ Determine understanding of teaching.
