ERA UNIVERSITY

ERA COLLEGE OF NURSING

SEMINAR
ON
Critical Thinking and Problem Solving
(SUBJECT: NURSING EDUCATION)

Submitted To: Submitted By:

Ms. Swastika Das Jyoti sunar
Assistant professor MSc (N) 1st YEAR
Era College of Nursing Era College of Nursing
Lucknow Lucknow

Submitted on: / /
INTRODUCTION:

Critical Thinking is reasonable reflective thinking focused on deciding what to believe or do. It is a
complex process that involves purposeful and informed reasoning and also reflection' and contem
plation about thinking that drives problem solving and decision making. Clinical judgment, clinical
decision making, and clinical reasoning involve critical thinking when providing care for clients.

DEFINITION:

Thinking: Thinking is a special human characteristic that involves organization of new information
and the reorganization of previously learned material into forms leading to new responses that can
then be generalized to new situations.

Critical thinking: Critical thinking is a term used to describe an improved process of thinking that
changes the methods of the thinking process to ensure that the conclusions are self-correctable,
reasonable, informed, and precise.

COGNITIVE PROCESSES USED IN CRITICAL THINKING

They include:

 The scientific process

 Decision making
 Problem solving.

1. SCIENTIFIC PROCESS: In the scientific method a thinker defines a problem, collects data
about the problem, formulates a hypothesis to examine the problem, tests the hypothesis and
evaluates the results of the study to determine if the hypothesis was proved or disproved.

2. DECISION MAKING: In decision making the decision maker builds on the scientific process
to identify a problem, assess all options, weigh each option, test possible options, consider the
consequences of a decision, and then make the final decision.

3. PROBLEM SOLVING: With problem solving the problem solver identifies a problem, selects
pertinent information for solution of the problem, considers the consequences of each solution,
selects the best solution for problem resolution, and evaluates the solution over time to be sure the
solution is still effective.

 In the nursing process, the nurse assesses the client, identifies the nursing diagnosis or client
problem, prioritizes the problems, establishes goals or a plan of actions, provides interventions to
improve the status of the client, and evaluates the client to see if the interventions were
 appropriate and helpful. This, similar to other cognitive processes, is a cyclical or circular
process.

CRITICAL THINKING IN NURSING PRACTICE:

 The decisions that nurses make affect client outcomes. Making the best decisions requires the
use of critical thinking and a problem-solving or decision making process that integrates a
systematic search and critical appraisal of the relevant evidence, ones' own clinical expertise,
and the preferences and values of the client.
 Professional nurses make multiple decisions involving clients, family members, and the
health care team in a variety of situations.
 In every clinical situation it is important for the nurse to think critically, apply knowledge,
and make sound judgments so that clients receive the best care possible.
 To make the situation more challenging, most clients have health problems for which there
are no clear textbook solutions.
 Each client's problem is unique and a product of many factors, including the client's physical
and emotional health, lifestyle choices, cultural background, economic circumstances, religious
beliefs, relationship with family and friends, and life experiences.
 This requires the nurse to assess, question, recall previously learned knowledge and
experiences, and be self directed in investigating various alternatives for action. Because of the
complexity of clinical care, a completely linear process of thinking can lead to erroneous
conclusions.
 To avoid biased or erroneous conclusions, processes used in critical thinking are helpful
because, once learned and called upon, the thinker is challenged to look at a problem from all
aspects.

CRITICAL THINKING AND EVIDENCE-BASED PRACTICE

 Once the problem has been identified, the interventions to provide needed care will follow.
These interventions must be based on a solid foundation of all the science.
 Critical thinking is the basis of evidence-based practice (EBP).
 The University of Minnesota describes evidence based nursing practice (EBNP) as the
process by which nurses make clinical decisions using the best available research evidence,
clinical expertise, and client preferences.
 Several steps are necessary for solving clinical problems encountered by nurses. The
following steps are:
 Clearly identifying clinical problems in practice
 Searching the literature for relevant research and the best evidence
  Evaluating and critically appraising the literature using established criteria regarding
scientific merit
 Integrating the evidence from the literature into practice with specific nursing
interventions
 Evaluating the effect of the change or interventions on client outcomes.

CRITICAL THINKING AND DECISION MAKING IN NURSING ADMINISTRATION:

 The goal of an institution outlines the common direction for all its operational sections or
divisions.
 Alongside this aspect, nurse administrators promote patient safety and quality initiatives
through a practice within the framework of professionalism.
 Productivity and cost concerns remain important; however, there is an equal if a not greater
focus on safety, quality relationships, and healing environments.
 Hence, the nurse administrator’s expertise in critical thinking and shared decision-making are
essential for creating healthy work environments where quality and efficient care can be
delivered.
 The vision, mission, goals, values, and objectives of the facility influence nursing
administration by setting the foundation for the establishment of the processes, programs/
interventions, guidelines, and innovations in the nursing unit.
 Admittedly, nurse executives should manage their operations within the gamut of the
institution’s image. The figure also reveals that the development of cognitive skills and the
imbuement of internal motivation to involve the self in critical thinking are influenced by
organizational politics, priorities, preferences, and leadership and management styles.
 Decisions made by the nurses are expected to lean towards the promotion of the objectives
and goals, and ultimately, the attainment of the organization’s vision.
 A two-way affiliation is shown between critical thinking and nursing administration. The
former element improves nursing management while the latter component provides the
environmental context in critical thinking.
 In the same hierarchy, decision-making as a product of the critical thinking process impacts
significantly nursing administration and vice versa.

PREPARATION FOR CLINICAL EXPERIENCE:

 Nursing students receive an opportunity to critically think about the client and the client's
health problems in clinical rotations.
 The critically thinking process is not exclusively used by experienced nurses; novice nurse
must practice thinking in new and challenging ways to understand the client and the health
problems of the client.
 If the student is able to assess the client and read the chart before the clinical experience, it is
important that the history and physical, doctor s orders, laboratory and other diagnostic testing
results, nurses notes, and medication records be reviewed.
 Once the student has an appreciation for the reason for admission and treatments done to date,
the student should introduce him/herself to the client, explain the purpose for the visit (e.g., "I
will be assisting your nurse in your care tomorrow morning").
 A brief head-to-toe assessment may or may not be done, depending on the expectations of the
clinical faculty.
 During the time with the client, the student should observe equipment in the room in order to
review the intravenous pump, patient controlled analgesia (PCA) pump, or other technology as
needed before the clinical experience.
 The introduction also allows the student to determine what cultural factors or beliefs might be
important for the client.
 Once the student leaves the hospital, a critical review of the information collected is
performed, in order to plan for the following clinical experiences.
 Only if there is adequate preparation can the clinical experience provide the best education for
the student and the best care for the client.
 Use course notes, textbooks, and other resources to gather information or review information
about the clients primary diagnosis and co-morbidities (other conditions that may influence the
outcome such as hypertension or diabetes mellitus).
 For instance, consider what is expected during the post-operative recovery for a client
undergoing a total knee replacement procedure as well as how the client's diabetes may affect
normal wound healing.
 To do this, the student should be able to explain the normal anatomy and physiology of the
affected system, how a joint replacement Surgery is performed and how DM may interfere
with normal wound healing for a surgical client,
 Using the standards of critical thinking, the student should consider the relevance of each of
the physician's orders.
 Consider questions such as the following: "What usual response to this disease and/or
operation is being addressed by this interventions?
 For example, What is the reason a postoperative client is prescribed iron? Did the client have
an iron deficiency anemia prior to surgery? Did the client lose blood in surgery and iron is
being used to rebuild blood supply? why are the sequential compression devices used? Are
they prescribed to reduce the risk of postoperative thrombosis?
  The student should review possible procedures that may be required while providing care for
this client such as inserting a Foley catheter, scanning the bladder for residual urine,
administering blood, placing the client in a continuous passive motion (CPM) machine, and
injecting medications intravenously.
 In addition, the student should consider unexpected events, such as deep vein thrombosis
(DVT) or pulmonary embolus (PE), and the clinical manifestations and nursing interventions
required to assess and treat those complications.
 All medications ordered for the client should be reviewed so that the student determines the
following: the classification of the drug and the disorders that classification of drug may be
used to treat, the action of the drug, the side effects of the drug, assessments required to
determine if the medication should be held or administered, if the medication has been
scheduled for administration at the correct time, and the seven rights of medication
administration.

RESEARCH INPUT:

A study done by Karen L Brooks, EdD, RN; Jan M Shepherd, PhD in 1990.

A descriptive study was undertaken to investigate the relationship between clinical decision-making
skills in nursing and critical thinking abilities of senior nursing students in four types of nursing
education programs: generic baccalaureate, associate, and diploma - the basic RN programs, along
with the upper division baccalaureate (specifically RN completion) program.

50 senior students from each type of program were selected. Among the basic RN programs, the
higher level of general critical thinking ability was attained by generic baccalaureate seniors (mean
score, 61.3) compared with the associate (50.0) and diploma (51.3) seniors. The clinical decision-
making scores in nursing skills were virtually identical for the three basic programs - generic (32.2),
associate (32.2), and diploma (32.3). Performance Simulation Instrument showed no statistically
significant difference. The mean critical thinking score for the upper division baccalaureate seniors
(61.1) was comparable to that of the generic baccalaureate seniors. Clinical decision-making mean
score for the upper division seniors was significantly higher (38.0) than those of the other three
groups.

SUMMARY:

Critical thinking is a term used to describe an improved process of thinking that changes the methods
of the thinking process to ensure that the conclusions are self-correctable, reasonable, informed, and
precise. Critical thinking also plays vital role in nursing profession as it improves the quality of
nursing care and client’s satisfaction.
COCNLUSION:

The decisions that nurses make affect client outcomes. Making the best decisions requires the use of
critical thinking and a problem-solving or decision making process that integrates a systematic
search and critical appraisal of the relevant evidence, ones' own clinical expertise, and the
preferences and values of the client.

Nurse administrators who are adept at using critical thinking and have the “habits of mind” of a
critical thinker are in a good position to assume a leadership role and create the changes that will
achieve positive outcomes in health care organizations. Operating as a manager and leader requires
ongoing development of critical thinking skills and the inclination to use those skills. Critical
thinking can have a powerful influence on the decision making and problem solving that nurse
managers are faced with on a daily basis.

BIBLIOGRAPHY:

 Dr. Anita Gupta ,’Psychology FOR Nurses’, Publishers of medical and nursing books, Delhi,
page no. 80- 89.
 Black. M. Joyce, “medical surgical nursing”, volumw-1, 2009, 8 th edition, Elsevier publishers,
page no. 43- 47.
 http://article.sapub.org/10.5923.j.nursing.20180804.03.html (Lilian G. Tumapang)
 https://www.healio.com/nursing/journals/jne/1990-11-29-9/%7Ba5444df7-8d06-4e3b-b3d3-
13ce171b8fdf%7D/the-relationship-between-clinical-decision-making-skills-in-nursing-and-
general-critical-thinking-abilities-of-senior-nursing-students-in-four-types-of-nursing-programs