CRITICAL. THINKING. AND. NURSING. PROCESS. "Study without reflection is a waste of time; reflection Critical thinking is a component relationship skills. Key Words: Critical Thinking, Nursing Process, Critical Thinking in Nursing Process . about the nursing process, define educational objectives in relation. Lynda Hall coined the term Nursing Process in Examining the relationship between critical-thinking skills and decision-making ability.
It is, thus, a set of criteria to rationalize an idea where one must know all the questions but to use the appropriate one in this case 8. The Socratic Method, where the question and the answer are sought, is a technique in which one can investigate below the surface, recognize and examine the condition, look for the consequences, investigate the multiple data views and distinguish between what one knows and what he simply believes. This method should be implemented by nurses at the end of their shifts, when reviewing patient history and progress, planning the nursing plan or discussing the treatment of a patient with colleagues 9.
The Inference and Concluding justification are two other critical thinking skills, where the justification for inductive generalizations formed from a set of data and observations, which when considered together, specific pieces of information constitute a special interpretation In contrast, the justification is deduced from the general to the specific.
So, the nurse who uses drawing needs categorizes information and defines the problem of the patient based on eradication, nutrition or need protection. In critical thinking, the nurses still distinguish claims based on facts, conclusions, judgments and opinions.
The assessment of the reliability of information is an important stage of critical thinking, where the nurse needs to confirm the accuracy of this information by checking other evidence and informants The concepts are ideas and opinions that represent objects in the real world and the importance of them. Each person has developed its own concepts, where they are nested by others, either based on personal experience or study or other activities.
For a clear understanding of the situation of the patient, the nurse and the patient should be in agreement with the importance of concepts. People also live under certain assumptions. Many believe that people generally have a generous nature, while others believe that it is a human tendency to act in its own interest. The nurse must believe that life should be considered as invaluable regardless of the condition of the patient, with the patient often believing that quality of life is more important than duration.
Critical thinking skills in the nursing diagnosis process
Nurse and patient, realizing that they can make choices based on these assumptions, can work together for a common acceptable nursing plan Independence of Thought Individuals who apply critical thinking as they mature acquire knowledge and experiences and examine their beliefs under new evidence.
Impartiality Those who apply critical thinking are independent in different ways, based on evidence and not panic or personal and group biases.
The nurse takes into account the views of both the younger and older family members. Perspicacity into Personal and Social Factors Those who are using critical thinking and accept the possibility that their personal prejudices, social pressures and habits could affect their judgment greatly.
So, they try to actively interpret their prejudices whenever they think and decide. Humble Cerebration and Deferral Crisis Humble intellect means to have someone aware of the limits of his own knowledge. So, those who apply critical thinking are willing to admit they do not know something and believe that what we all consider rectum cannot always be true, because new evidence may emerge.
Spiritual Courage The values and beliefs are not always obtained by rationality, meaning opinions that have been researched and proven that are supported by reasons and information. The courage should be true to their new ground in situations where social penalties for incompatibility are strict.
In many cases the nurses who supported an attitude according to which if investigations are proved wrong, they are canceled.Nursing Process Steps (CRITICAL THINKING)
Integrity Use of critical thinking to mentally intact individuals question their knowledge and beliefs quickly and thoroughly and cause the knowledge of others so that they are willing to admit and appreciate inconsistencies of both their own beliefs and the beliefs of the others. Perseverance The perseverance shown by nurses in exploring effective solutions for patient problems and nursing each determination helps to clarify concepts and to distinguish related issues despite the difficulties and failures.
Using critical thinking they resist the temptation to find a quick and simple answer to avoid uncomfortable situations such as confusion and frustration.
Confidence in the Justification According to critical thinking through well motivated reasoning leads to reliable conclusions.
Using critical thinking nurses develop both the inductive and the deductive reasoning. The nurse gaining more experience of mental process and improvement, does not hesitate to disagree and be troubled thereby acting as a role model to colleagues, inspiring them to develop critical thinking.
Interesting Thoughts and Feelings for Research Nurses need to recognize, examine and inspect or modify the emotions involved with critical thinking. So, if they feel anger, guilt and frustration for some event in their work, they should follow some steps: To restrict the operations for a while to avoid hasty conclusions and impulsive decisions, discuss negative feelings with a trusted, consume some of the energy produced by emotion, for example, doing calisthenics or walking, ponder over the situation and determine whether the emotional response is appropriate.
After intense feelings abate, the nurse will be able to proceed objectively to necessary conclusions and to take the necessary decisions. Curiosity The internal debate, that has constantly in mind that the use of critical thinking is full of questions. So, a research nurse calculates traditions but does not hesitate to challenge them if you do not confirm their validity and reliability.
Thus, higher critical thinking skills are put into operation, when some new ideas or needs are displayed to take a decision beyond routine. The nursing process is a systematic, rational method of planning and providing specialized nursing The steps of the nursing process are assessment, diagnosis, planning, implementation, evaluation.
The health care is setting the priorities of the day to apply critical thinking Problem Solving Problem solving helps to acquire knowledge as nurse obtains information explaining the nature of the problem and recommends possible solutions which evaluate and select the application of the best without rejecting them in a possible appeal of the original.
Also, it approaches issues when solving problems that are often used is the empirical method, intuition, research process and the scientific method modified Experiential Method This method is mainly used in home care nursing interventions where they cannot function properly because of the tools and equipment that are incomplete Intuition Intuition is the perception and understanding of concepts without the conscious use of reasoning.
As a problem solving approach, as it is considered by many, is a form of guessing and therefore is characterized as an inappropriate basis for nursing decisions. But others see it as important and legitimate aspect of the crisis gained through knowledge and experience.
The clinical experience allows the practitioner to recognize items and standards and approach the right conclusions. Despite the fact that the intuitive method of solving problems is recognized as part of nursing practice, it is not recommended for beginners or students because the cognitive level and the clinical experience is incomplete and does not allow a valid decision Health professionals working in uncontrolled situations need to implement a modified approach of the scientific method of problem solving.
With critical thinking being important in all processes of problem solving, the nurse considers all possible solutions and decides on the choice of the most appropriate solution for each case The Decision The decision is the selection of appropriate actions to fulfill the desired objective through critical thinking. Decisions should be taken when several exclusive options are available or when there is a choice of action or not.
The nurse when facing multiple needs of patients, should set priorities and decide the order in which they help their patients. Even nurses make decisions about their personal and professional lives. The contribution of critical thinking in decision making Acquiring critical thinking and opinion is a question of practice. Critical thinking is not a phenomenon and we should all try to achieve some level of critical thinking to solve problems and make decisions successfully 19 - It is vital that the alteration of growing research or application of the Socratic Method or other technique since nurses revise the evaluation criteria of thinking and apply their own reasoning.
So when they have knowledge of their own reasoning-as they apply critical thinking-they can detect syllogistic errors 22 — The nurses will also be applied to investigate the views of people from different cultures, religions, social and economic levels, family structures and different ages.
Scriven M, Paul R. The frequency of the cited critical thinking skills thought to be utilized in the nursing diagnosis shown in Figure 1. Based on the participant's justifications regarding the use of specific critical thinking skills in the nursing diagnosis process, the identified characteristics are presented in Chart 1. The three critical thinking skills most often cited included analysis, technical and scientific knowledge and logical reasoning, as shown in Figure 1. Analysis, according to the participants, is an essential critical thinking skill in the nursing diagnosis process because it enables an evaluation and detailing of the clinical history from the observation and relating of the patient data to justify the identification of health problems.
This analysis requires the grouping of main signs and symptoms to comprehend the priority health needs of the patient. The application of technical and scientific knowledge is considered fundamental to critical thinking skills as it assists in the knowledge of pathophysiology to comprehend and relate signs and symptoms, favoring the comparison of clinical situations with data from the literature to evaluate the clinical manifestations.
Critical Thinking: The Development of an Essential Skill for Nursing Students
Thus, it was comprehended that the base of technician-scientific knowledge favors the development of the nursing diagnosis process by allowing the nurse to understand the relation of signals and symptoms to establish problems and care. Based on the perception of the participants, the use of logical reasoning was observed at the moment of relating of the objective and subjective patient data, aimed at understanding the relationship of the identified data with the health problem of the patient.
Thus, logical reasoning can provide the organization of the data obtained to then proceed to the grouping of the data that will support the identification of the nursing diagnosis. Clinical experience, as the second critical thinking skill most often cited in this study, provides nurses with knowledge derived from their clinical practice. Clinical experience, according to the participants, helps to identify the priority nursing diagnosis due to experience in similar clinical cases enabling perception and observation of data from similar clinical cases.
Knowledge about the patient and the application of standards are the third most-cited skills mentioned by participants.
Knowledge about the patient, according to participants, is critical in gathering data for in the nursing diagnosis process, as it is a comprehension of the symptoms of the patient - subjective analysis, that accounts for data related to the personal and family contexts.
Critical Thinking: The Development of an Essential Skill for Nursing Students
When establishing a nursing diagnosis, it is considered essential to have knowledge of the clinical history of the patient and their family context. Regarding the application of standards, the participants cited this as an important critical thinking skill required in the nursing diagnosis process because it enables a clinical evaluation based on the literature. In addition to this evaluation, the application of standards facilitates the grouping of data based on standards and evidence from the literature.
Discernment and contextual perspective were the least cited critical thinking skills in this study. According to participants, discernment is provided in the nursing diagnosis process by enabling the reflection of clinical situations based on the evaluation of the data.
This evaluation enables the judgment of priority nursing diagnoses. Contextual perspective was considered relevant in the nursing diagnosis process due to its role in allowing an analysis of evidence from a holistic perspective. The diagnostic process is commonly understood as a series of perceptual and cognitive activities in which observations lead to inferences and, in turn, lead to more observations.
The initial conclusions raised from the observation of some data will be improved in that new observations are carried out for the naming of the problems identified 3. The direction of this process requires collecting, processing and interpreting data based on relevant theories, enabling the integration between data identified and theoretical knowledge.
Therefore, clinical experience, judgment to make decisions and critical thinking permeate the steps of the diagnostic process 8. It can be seen that this cycle of activities requires a series of critical thinking skills for the perception, recognition and classification of information in an attempt to comprehend the complexity of human responses to health problems or life situations.
Thus, it appears that the diagnostic process involves the recognition of the signs or factors that are presented by a patient. This recognition requires the collection of reliable and relevant data. When relevant data have been obtained and considered, information must then be interpreted and grouped to construct patterns that inform the development of plausible explanations, or diagnostic hypotheses related to these indications. To clarify the relationship patterns between factors and articulate diagnostic hypotheses, the use of theoretical knowledge and practical experience, common sense, ethical judgment, intuition and critical thinking are required 5.
According to the study participants, technical and scientific knowledge and clinical experience permeate all the phases of the nursing diagnosis process. Clinical experience promotes the development of specific nursing knowledge and requires theoretical knowledge to enable the nurses to compare data identified with information from the literature.
The analysis involves the application of standards and requires knowledge about the patient and their contextual perspective for the data collection. It is believed that, for the investigation and evaluation of the biopsychosocial aspects of human beings, it is necessary to compare identified data with standards in the literature, as well as knowing the specifics of the human being and their life context.
The analysis process begins with the data collection and continues with its interpretation and with its grouping based on the application of standards and logical reasoning. At this moment, logical reasoning enables the coherent evidence to be related in the determination of inferences as diagnostic hypotheses. Thus, it is understood that the judgment of these hypotheses requires logical reasoning and insight to justify the relationship between data in order to judge them, with a view to making a decision regarding the priority nursing diagnosis In the clinical case used in this study, the participants were asked to identify a priority nursing diagnosis and, explain the different diagnostic hypotheses that could be raised; however, the interest of the study was the identification of the nursing diagnosis that represented the primary health needs of the patient in the clinical case presented.
Different diagnostic hypotheses were identified, yet nursing students experienced difficulties, in selecting a priority nursing diagnosis. They identified a number of nursing diagnoses and, among them, established the order of priority according to the health needs presented by the patient.
In this context, it is accepted that the nurse's decision-making process should be based on a thorough evaluation of the patient's signs and symptoms by understanding their interrelationship as well as their relevance for patient care. Observations revealed some difficulty in establishing priority nursing diagnoses within the context of theoretical and practical activities with nursing students, when they are based on the classification systems used in professional practice. Regardless of the classification system used in the clinical practice, it is believed that it is essential to develop, both in the teaching and the nursing practice, the act of questioning the differences and similarities between the diagnostic concepts and their definitions; to comprehend the relationship between the signs and symptoms observed and, overall, to evaluate the main health needs of a patient so that a nursing diagnosis, selected as the priority, guides the planning of the appropriate nursing care.
Thus, it is understood that discernment can be developed as an important critical thinking skill in the nursing diagnosis process through questions directed towards reflecting on certain clinical situations.
It follows, therefore, that the difficulty in identifying priority nursing diagnoses represents a challenge for nurses to logically asses the relationships between signs and symptoms and to delineate their capacity for discernment. These findings highlights the necessity of using strategies designed to develop critical thinking abilities, in nursing education as well as in clinical practice.
An underlying assumption of the nursing diagnosis process is that the nurse must take a questioning stance, when interpreting and categorizing to identify the diagnosis. Notably, some questions may guide the evaluation of clinical situations that are intended to identify nursing diagnoses, such as the following examples: What other sources of information are available?
Is the participation of the patient, family or other professionals necessary for the care? What nursing interventions can be planned to facilitate these results?
It is widely believed that this questioning can promote the development of cognitive skills of required for critical thinking, such the search for information, analysis, the application of standards, logical reasoning and discernment. This questioning can help both the nursing student as well as the nurse, to expand their technical and scientific knowledge and to transform the knowledge based on their clinical experience.
Furthermore, the questions can instigate the necessity to comprehend the nursing diagnosis as a way to assist the nurse in the understanding of human responses and in the planning of the nursing care with a focus on achieving efficient results.
It is also believed that the case studies associated with the development of conceptual maps can help in the development of logical reasoning and, consequently, can facilitate the discernment for decision making regarding the priority nursing diagnosis as they allow for the visualization of interrelated concepts arranged in a configuration that expresses a meaning and, therefore, contributes to the understanding of specific phenomena of the clinical practice.
The use of specific critical thinking skills at different stages of the nursing diagnosis process was observed in this study and it appears that their application, both in nursing education and in the clinical practice, facilitates the identification of accurate nursing diagnoses. Furthermore, it should be noted that accurate diagnoses are essential for directing nursing interventions aimed at achieving positive health outcomes Based on this reasoning, the development of critical thinking skills can potentially improve the accuracy of nursing diagnoses.
The priority nursing diagnosis constitutes a resultant product of the clinical judgment of the nursing students. To judge which nursing diagnosis would be given priority in the clinical situation presented, the data were highlighted in the clinical case; then they were interpreted and grouped to raise different nursing diagnoses and an order of diagnoses priority was established among these.
The critical thinking skills identified in the nursing diagnosis process consist of the following factors: Thus, we have the technical and scientific knowledge and the clinical experience function in the nursing diagnosis process as a basis for understanding clinical manifestations and establishing their interactions as they relate to the nursing diagnosis.
The skills of analysis, application of standards, knowledge about the patient and contextual perspective are interconnected and vital in the collection of data relevant. The interpretation and classification proficiency in the analysis, application of standards and logical reasoning to pose inferences that may underlie diagnostic hypotheses. Regarding clinical judgment, discernment and logical reasoning skills were reported critical in making decisions regarding priority nursing diagnoses.
This study described an established relationship between critical thinking skills and the steps of the diagnostic process in nursing. Consequently, the application of the nursing diagnosis process in education and clinical practice informs strategies that may facilitate the development of distinct critical thinking skills.
Ordem dos Enfermeiros de Portugal; Nursing process-application to the professional practice.