Chapter 14

Critical Thinking in
Nursing Practice

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 Definition
• Critical thinking is an active,
organized, cognitive process used to
examine thinking.
• Aspects
– Reflection-purposefully thinking back to
discover meaning
• Adequate knowledge for self evaluation
– Language- Precision & clarity
– Intuition – understanding a situation
without conscious deliberation
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 Levels

• Basic critical thinking – experts have

answers/concrete thinking based on
principles/rules
• Complex critical thinking – “It
depends”, complexity is recognized
• Commitment – Choices based on
independent thinking assuming
accountability.

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 Processes
• Scientific method-nursing research
• Problem solving-individuals have individual
needs!
• Decision making- end point of critical
thinking with resolution?
• Diagnostic reasoning and inference
• Clinical decision making- Made to improve
client health or maintain wellness.

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 Competencies in
Nursing Practice
• Diagnostic reasoning – A process to
determine client’s health status after
assessment
• Clinical inference – conclusion based on
fact but go beyond what is presently known.
• Clinical decision making – requires careful
reasoning to select the optimal options

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 Decision Making Criteria
• What needs to be achieved?
• What needs to be preserved?
• What needs to be avoided?

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 Nursing Process
• See Figure 14-1, p, 268
• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation
• Purpose is to diagnose & treat human response
to actual/potential health problems.

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 Critical Thinking

• Model-see Figure 14-2, p269

• Components
– Knowledge base
– Experience
– Competence
– Attitudes
– Standards

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 Attitudes
• Confidence – balance of knowledge
• Thinking independently – consider all sides
• Fairness – recognize biases & prejudices
• Responsibility and accountability – standards
of practice
• Risk taking – consider potential danger to pt.
• Discipline- thorough!

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 Attitudes (cont’d)

• Perseverance- work to achieve high

level quality care
• Creativity- imagination and innovation
• Curiosity- Why?
• Integrity- Sound moral & ethical position
• Humility – admit one’s limitations!

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 Standards

• Intellectual – preciseness, accuracy , &

consistency
• Professional – ethical criteria,
scientific/practice-based criteria, and
professional responsibility.
• Box 14-4 , p. 269

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 Skills, Table 14-1
• Interpretation- collect, clarify, note patterns
• Analysis- Do not assume
• Evaluation- Be objective
• Inference – Relationships between findings
• Explanation – Knowledge base to support
strategies
• Self-regulation – How can you improve your
own performance?

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 CRITICAL THINKING FLOW
CHART
• Identify need or problem
• Goal/outcome?
• Knowledge/experience/competencies required?
• Questions that need answering
• Where to find the answers
• Answers/bad answers
• Action/further investigation
• Evaluation
• Consider outside influences: time, money,
resources, environment, people

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Mosby items and derived items © 2005 by Mosby, Inc.