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Essential critical thinking skills

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Interpretation, analysis, evaluation, inference, explanation, self-regulation & clinical decision-making

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Interpretation

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use to understand & explain data. Drawn on baseline knowledge and used to apply CT. Used to consider possible causes and implications of observed data, events and actions

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When in ADPIE is interpretation most often used?

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Assessment, diagnosis & evaluation

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Analysis

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used by nurses for considering the advantages, disadvantages & consequences of all possible nursing actions or decisions and for deciding on the best possible course of action for the patient

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When in ADPIE is Analysis most often used?

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Diagnosis, planning & evaluation

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Evaluation

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determine reliability, credibility & bias of information sources. Relevance is important in new information.

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When in ADPIE is Evaluation most often used?

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Planning, implementation & evaluation

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Inference

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make accurate conclusions based on sound reasoning. Gather relevant baseline data and compare it to other information

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When in ADPIE is Inference most often used?

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Assessment, diagnosis & evaluation

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Explanation

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ability to explain conclusions is frequently used & important. Intellectual standards of clarity, accuracy and precision are important for this skill. Provide sound rationale for thoughts and actions

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When in ADPIE is Explanation most often used?

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Planning, implementation & evaluation

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Self-regulation

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similar to self-reflection, requires monitoring of one's own thinking with specific emphasis on reflecting the rationale for the conclusion drawn and the actions taken. Assess personal thinking, decision making and actions

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When in ADPIE is Self-regulation most often used?

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Used in ALL steps of ADPIE

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Clinical decision making

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Guided by consistent use of critical thinking

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When in ADPIE is Clinical Decision Making most often used?

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Diagnosis, planning & implementation

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Common Negative influences on Critical thinking, reasoning & decision making?

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Bias, illogical thinking, lack of information, close-mindedness, erroneous assumptions

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What may be related to common negative influences on CT?

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past-experiences, cultural beliefs, emotions, state of mind, other interpersonal & intrapersonal causes

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Improving Critical Thinking in Nursing Process

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discussion w/ colleagues, audible verbalization of thoughts, literature review, intentional application of knowledge, concept maps, simulation, role playing & written work

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Discussion with colleagues

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enhances clarity, precision, accuracy of thoughts. Helps correct erroneous assumptions and catch biases

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Audible verbalization of thought

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Verbally talks through data, assumptions & plans, helps with accuracy and relevance. Incorporated reflective thinking, may uncover knowledge gaps or areas of illogical thinking.

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Literature Review

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Fosters critical thinking by addressing knowledge deficits. Be accurate, clear and precise when approaching literature.

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Intentional application of knowledge

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intentionally apply new concepts

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Concept maps

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visual representations of critical thinking process. Represent clinical manifestations, treatment modalities & nursing care.

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Simulation

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increase confidence and competence in clinical reasoning and judgement. Debriefs require nurse to explore thinking & reflect on assumptions, inferences and decisions made

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Role playing

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facilitates critical thinking with assigned roles

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Written work

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reviewing and rewriting study or lecture notes, identifies knowledge gaps

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Which critical thinking component is the nurse using when considering the pros and cons of different types of dressings for a patient's wounds?

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Analysis

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During which steps of the nursing process do nurses use interpretive skills most frequently?

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Assessment, Diagnosis & evaluation

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During which steps of the nursing process do nurses use evaluation skills most frequently?

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Planning, implementation & evaluation

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During which steps of the nursing process do nurses use Analysis skills most frequently?

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Diagnosis, planning & implementation

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During which steps of the nursing process do nurses use Inference skills most frequently?

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Assessment, diagnosis & evaluation. Same as interpretation!

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During which steps of the nursing process do nurses use Explanation skills most frequently?

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Planning, implementation and evaluation. Same as evaluation!!

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During which steps of the nursing process do nurses use Self-regulation skills most frequently?

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Used in ALL the steps

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During which steps of the nursing process do nurses use Clinical Decision Making skills most frequently?

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Diagnosis, planning & implementation. Same as Analysis!

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The critical thinking intellectual standard of relevance is of primary importance in which step of the Nursing Process?

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Evaluation

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The critical thinking intellectual standard of breadth is of primary importance in which step of the Nursing Process?

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Planning

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The critical thinking intellectual standard of Implementation is of primary importance in which step of the Nursing Process?

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Planning

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Which TWO critical thinking intellectual standard of logic and significance are of primary importance in which step of the Nursing Process?

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Diagnosis

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Using the argument that, "I have always done it this way" to defend one's actions is an example of which common thinking error?

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Illogical thinking

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The charge nurse accuses a PCA of being incompetent because a crib rail was left down. The PCA explained that a family member may have done so. But the charge nurse continues to accuse the PCA. Which thinking errors might this represent?

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Erroneous assumptions, close-mindedness & bias

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Engaging in continuing education activities helps prevent which common thinking error?

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Lack of information

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Which exercise can facilitate the nurse's critical thinking ability?

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Reflecting on one's thinking

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Which strategy used to improve critical thinking involves a visual representation of a thought or idea?

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Concept map

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Which feature of simulation promotes critical thinking?

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Participant debriefing

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What is a strategy used by nurses to integrate new ideas or insights into their thinking?

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Reflection

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Which critical thinking skills did the nurse use when verifying the latest revision date prior to using a website's patient education brochure?

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Evaluation...to determine the reliability, credibility and bias of the info.

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Which statements are correct about the critical thinking skill of self-regulation?

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Emphasis on reflecting on reasons for one's actions, enable recognition and correction of one's errors, necessitates monitoring of self-thinking and a required for all steps of the nursing process.

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Which statement describes a defining characteristic of illogical thinking?

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Jumping to conclusions

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Which strategies can nurses use to improve critical thinking skills?

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holding discussions with colleagues, engaging in verbalization of thoughts, conducting literature reviews

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Which aspects of written work improve critical thinking?

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reviewing recent lectures, noting key facts while reading, reviewing study notes, identifying knowledge gaps.

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Which statement describes the application of critical thinking to the nursing process?

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analyzing patient data, using baseline knowledge, considering alternative actions

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What is the best method for avoiding erroneous assumptions about patients?

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Asking questions to clarify info

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Which common thinking error is most likely to hinder the development of a therapeutic nurse-patient relationship

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Close-mindedness

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Which method ensures the competency of licensed nurses?

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Specialty certification

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Interpretation CT skill

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Be orderly in collecting data about patients. Apply reasoning while looking for patterns to emerge. Categorize the data (e.g., nursing diagnoses [see Chapter 17]). Gather additional data or clarify any data about which you are uncertain.

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Analysis CT skill

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Be open-minded as you look at information about a patient. Do not make careless assumptions. Does the data reveal a problem or trend that you believe is true, or are there other options?

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Inference CT skill

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Look at the meaning and significance of findings. Are there relationships among findings? Does the data about the patient help you see that a problem exists?

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Evaluation CT skill

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Look at all situations objectively. Use criteria (e.g., expected outcomes, pain characteristics, learning objectives) to determine results of nursing actions. Reflect on your own behavior.

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Explanation CT skill

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Support your findings and conclusions. Use knowledge and experience to choose strategies to use in the care of patients.

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Self-regulation CT skill

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Reflect on your experiences. Be responsible for connecting your actions with outcomes. Identify the ways you can improve your own performance. What will make you believe that you have been successful?

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Truth-seeking Concept

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seek the true meaning of a situation. Be courageous, honest & objective about asking questions

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Open-mindedness Concept

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Be tolerant of different views, be sensitive to the possibility of your own prejudices; respect the right of others to have different opinions

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Confidence CT attitude

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Learn how to introduce yourself to a patient; speak with conviction when you begin a treatment or procedure. Do not lead a patient to think that you are unable to perform care safely. Always be well prepared before performing a nursing activity. Encourage a patient to ask questions.

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Thinking independently CT attitude

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Read the nursing literature, especially when there are different views on the same subject. Talk with other nurses and share ideas about nursing interventions.

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Fairness CT attitude

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Listen to both sides in any discussion. If a patient or family member complains about a co-worker, listen to the story and speak with the co-worker as well. If a staff member labels a patient uncooperative, assume the care of that patient with openness and a desire to meet the patient's needs.

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Responsibility & authority CT attitude

answer

Ask for help if you are uncertain about how to perform a nursing skill. Refer to a policy and procedure manual to review steps of a skill. Report any problems immediately. Follow standards of practice in your care.

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Risk taking CT attitude

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If your knowledge causes you to question a health care provider's order, do so. Be willing to recommend alternative approaches to nursing care when colleagues are having little success with patients.

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Discipline CT attitude

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Be thorough in whatever you do. Use known scientific and practice-based criteria for activities such as assessment and evaluation. Take time to be thorough and manage your time effectively.

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Perseverance CT attitude

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Be cautious of an easy answer. If co-workers give you information about a patient and some fact seems to be missing, clarify the information or talk to the patient directly. If problems of the same type continue to occur on a nursing division, bring co-workers together, look for a pattern, and find a solution.

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Creativity CT attitude

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Look for different approaches if interventions are not working for a patient. For example, a patient in pain may need a different positioning or distraction technique. When appropriate, involve the patient's family in adapting your approaches to care methods used at home.

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Curiosity CT Attitude

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Always ask why. A clinical sign or symptom often indicates a variety of problems. Explore and learn more about a patient so as to make appropriate clinical judgments.

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Integrity CT attitude

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Recognize when your opinions conflict with those of a patient; review your position and decide how best to proceed to reach outcomes that will satisfy everyone. Do not compromise nursing standards or honesty in delivering nursing care.

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Humility CT attitude

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Recognize when you need more information to make a decision. When you are new to a clinical division, ask for an orientation to the area. Ask registered nurses (RNs) regularly assigned to the area for assistance with approaches to care.

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Concepts for a critical thinker

answer

truth seeking, open-mindedness, analyticity systematicity, inquisitiveness, & maturity

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