Unit B - Chapter 8 - Critical Thinking and Clinical Judgment Flashcards
Nursing practice requires the application of
knowledge from biological, social, and physical sciences; knowledge of pathophysiology;
knowledge of nursing procedures and skills.
Nurses also must use multiple thinking skills—including. (6)
to make clinical judgments about problems in nursing practice.
critical thinking skills
interpretation,
analysis,
evaluation,
inference, and
explanation)—
Clinical judgments lead the nurse to choosing
Through a process called
actions or intervention
clinical reasoning.
A nursing knowledge base with 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
guides a nurse in various approaches to
making a nursing judgment
In critical thinking a nursing judgement is made by
applying knowledge
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 status, a nurse must be able to
think critically,
correctly identify problems, and
both devise and implement best solutions (interventions).
Critical thinking discourages
quick judgments that lead to single‐focused solutions.
Critical thinking requires
- lifelong learning
- 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
open-minded manner and
inquisitive 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,
intuition, .
Critical thinking evolves through how many levels
three distinct levels
as a nurse gains knowledge and experience while maturing into a competent nursing professional
Critical thinking involves 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?”
Two components of critical thinking
Language
Intuition
Language
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:
● “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 somethi ng.
Intuition should spark nurse to search data to confirm or disprove the feeling.
The nurse should ask the following:
● “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: 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: 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: 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
Competence
Cognitive processes a nurse uses to make nursing judgments.
General critical thinking
● Scientific method
● Problem-solving
● Decision-making
● Diagnostic reasoning and inference
● Clinical decision-making; collaboration
Specific critical thinking in nursing:
The nursing process
Attitudes
Mindsets that affect how a nurse approaches a problem.
Attitudes of critical thinkers include:
● Confidence:.
● Independence:.
● 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.
● 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.
List at least three critical thinking skills for each of the five steps of the nursing process.
- 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 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 with 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
