CRITICAL THINGKING IN NURSING

 There are many obvious traits that people expect a nurse to have, such as compassion for others, a caring and nurturing personality, and the sincere desire to help others along with the unique ability to deal with all those things that others might find, well, stomach turning.
As a nursing program manager, I talk with hundreds of people seeking information on how they can become a nurse, including many who wonder if they have what it takes. In nursing school we can teach you how to dress a wound, give an IV, and even save a life. I tell my potential nursing students that in order to learn how to do those things, you need to develop great critical thinking skills. Do you think like a nurse? Thinking like a nurse is not the same as thinking like an accountant, a web designer, or business owner.
Critical thinkers work hard to develop their skills; essentially they think about thinking!  What this means is they spend time developing clear and rational thoughts and make decisions based on the evidence available to them. Some say that critical thinkers think at a higher level than most people! Those who master critical thinking are able to analyze information and thoughts with clarity, accuracy, and reasoning (Lee Ann Andronico).
Critical thinking skills are essential in nursing because they are the basis for learning to prioritize and make decisions. Because nurses provide care for patients 24/7, a nurse’s critical thinking skills can literally mean the difference between life and death. These skills are necessary not only to provide bedside care, but to make policy decisions.

Critical Thinking in Nursing
To become a professional nurse requires that you learn to think like a nurse. What makes the thinking of a nurse different from a dentist or an engineer? It is how we view the patient and the types of problems we deal with in practice. To think like a nurse requires that we learn the content of nursing: the ideas, concepts, and theories of nursing and develop our intellectual capacities and skills so that we become disciplined, self-directed critical thinkers. Critical thinkers strive to be clear, accurate, precise, logical, complete, and fair when they listen, speak and act. As nurses we want to eliminate irrelevant, inconsistent and illogical thoughts as we reason about patient care. Nurses use language to clearly communicate indepth information that is significant to nursing care. Nurses are not focused on the trivial or the irrelevant.

Skills of Critical Thinking
Certain skills are important for effective critical thinking. These skills are applied to patient care through the framework called the Nursing Process. The skills that are needed are:
1. Interpretation – The ability to understand and explain the meaning of information or an event.
2. Analysis – The investigation of a course of action based on objective and subjective data.
3. Evaluation – The process of assessing the value of the information obtained. Is it credible, reliable, and relevant? This skill is also applied in determining if desired outcomes have been reached. Based on the previous three steps the nurse can apply the skill of clinical reasoning to determine the problem. These decisions are based on sound reasoning.
4. Explanation – The ability to clearly and concisely explain one’s conclusions. The nurse should be able to provide sound rationale for his/her answers.
5. Self-regulation – Involves monitoring one’s own thinking. This means reflecting on the process leading to the conclusions. The individual should self-correct the thinking process as needed, being alert for biases and incorrect assumptions.

Pitfalls in Critical Thinking
Errors in the critical thinking process may result in illogical or biased thinking and incorrect conclusions. In nursing, the incorrect conclusion can lead to an incorrect action.

Illogical Process
1. Critical thinking fails as a process when logic is not used. A common fallacy arises from using a circular argument. For example, a nurse might write the nursing diagnosis “Ineffective coping, as evidenced by inability to cope.” This does not define the problem, it simply makes a circle.
2. Another illogical process is called appeal to tradition. This is the argument that we have “always done it this way.” New strategies and creative approaches are ignored.
3. Errors in logic also occur when the thinker makes hasty generalizations without considering the evidence. The critical thinker does not jump to conclusion.

Bias
1. Everyone has biases. Critical thinkers examine their biases and do not allow them to compromise the integrity of their thinking processes.
2. Biases can interfere with patient care. For example, if we believe patients with alcoholism are manipulative, when the patient complains of anxiety, we ignore their complaint and miss the signs of delirium tremens.

Closed-Mindedness
1. The close-minded individual ignores alternative points of view.
2. Input from experts, patients, and significant others is ignored.
3. This results in limited options and the decreased use of innovative ideas.
 
References 
Lipe, S.K. & Beasley, S. (2004). Critical Thinking in Nursing. Philadelphia: Lippincott
Williams & Wilkins