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Lecture 5

NUR 229 Lecture Notes - Lecture 5: Critical Thinking, Nursing Process, Reflective Practice


Department
Mennonite College of Nursing
Course Code
NUR 229
Professor
Blanca Miller
Lecture
5

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Nursing 229 Notes (1/16/18)
Critical Thinking/Clinical Reasoning
Objectives
1. Explain the different levels of critical thinking
2. Explain the aspects of critical thinking
3. Explain critical thinking competencies
4. Explain the critical thinking attitudes used in clinical decision making
5. List five characteristics of the nursing process
6. Describe clinical reasoning
7. Explain QSEN competencies
Key Terms to Know
1) Decision making: purposeful, goal directed effort applied in a systematic way to make a
choice among alternatives
2) Expected outcomes: specific, measurable criteria used to evaluate whether the patient goal
has been met
3) Intuitive problem solving: direct understanding of a situation based on a background of
experience, knowledge, and skill that makes expert decision making possible
4) Nursing process: five-step systematic method for giving patient care; involves assessing,
diagnosing, planning, implementing, and evaluating
5) Scientific problem solving: systematic problem-solving process that involves 1) problem
identification, 2) data collection, 3) hypothesis formulation, 4) plan of action, 5) hypothesis
testing, 6) interpretation of results and 7) evaluation resulting in conclusion/revision of the
study
6) Trial-and-error problem solving: method of problem solving that involves testing any number
of solutions until one is found that works for that particular problem
7) Clinical judgment: refers to the result (outcome) of critical thinking or clinical reasoning; the
conclusion, decision or opinion a nurse makes
8) Clinical reasoning: a specific term usually referring to ways of thinking about patient care
issues (determining, preventing, and managing patient problems); for reasoning about other
clinical issues (ex: teamwork, collaboration, and streamlining work flow); nurses usually use
critical thinking
9) Critical thinking: a systematic way to form and shape thinking
10) QSEN: stands for Quality and Safety Education for Nurses, a project for preparing future
nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve
the quality and safety of the health care systems within which they work
11) Reflective practice: occurs when the caregiver has a profound awareness of self, and one’s
own biases, prejudgments, prejudices, and assumptions, and understands how these may
affect the therapeutic relationship
12) Person-centered care: done when you are focused and fully aware of the patient and their
needs with each visit
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Lecture Notes
1. What is Critical Thinking?
a. Systematic way to form & shape thinking
b. Requires an open mind, disciplined in way you’re thinking
2. Levels of Critical Thinking
a. Basic: learner trusts that the experts have the answers to everything, follow all
procedures “by the book”, rules are the rules
i. Ex: starting a new job and follow every rule
b. Complex: learner starts thinking by themselves and moving away from experts,
examine decisions more independently but also make benefits and risks before
making decisions
c. Commitment: nurse makes decision without any assistance and is accountable for that
decision
3. How do you develop Critical Thinking?
a. Purpose of thinking: Why are you thinking?
i. Identify goal or purpose of thinking
b. Adequacy of knowledge: Ask yourself: “Is my knowledge accurate and factual? Is it
relevant to this situation?”
c. Potential problems: Ask yourself, what problems can arise? Ex: biases
d. Resources: Look at resources that will help you learn and provide knowledge for
“client”/patient
i. Ex: if you don’t know about a specific disease, develop a plan of care and
gather knowledge about that disease
e. Critique of decision: Evaluate the choice that you made, “Did it work? What can I do
differently next time?”
4. Critical Thinking Indicators (Box 10-5): Behaviors, attitudes, and characteristics that we
want to see in critical thinkers
1. Self-aware: Identify your own learning needs, know what strengths and
weaknesses are, seek out help with weakness
2. Effective communicator: Need to make sure you are a good listener, writer,
speaker, etc.
3. Curious: Ask more questions = learn more, constantly willing to learn
4. Intuitive: “gut feeling”; feeling that something is not quite right, develops with
practice
i. Ex: Walk into a patient’s room and think something bad is going to
happen
5. Confident: Important because if you’re not confident then your patient will be
more nervous, good posture, being assertive; if you need to, give yourself a
positive self-talk but don’t be too confident (if you don’t know then just ask!)
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