Chapter 6Clinical Reasoning, Decisionmaking, and Action: Patricia Benner;1 Ronda G. Clinical reasoning and judgment are examined in relation to other modes of thinking used by clinical nurses in providing quality health care to patients that avoids adverse events and patient harm. The expert performance of nurses is dependent upon continual learning and evaluation of performance.
Patricia Benner;1 Ronda G. Clinical reasoning and judgment are examined in relation to other modes of thinking used by clinical nurses in providing quality health care to patients that avoids adverse events and patient harm.
The expert performance of nurses is dependent upon continual learning and evaluation of performance. Critical Thinking Nursing education has emphasized critical thinking as an essential nursing skill for more than 50 years.
There are several key definitions for critical thinking to consider. The American Philosophical Association APA defined critical thinking as purposeful, self-regulatory judgment that uses cognitive tools such as interpretation, analysis, evaluation, inference, and explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations on which judgment is based.
It presupposes assent to rigorous standards of excellence and mindful command of their use. It entails effective communication and problem solving abilities and a commitment to overcome our native egocentrism and sociocentrism.
Every clinician must develop rigorous habits of critical thinking, but they cannot escape completely the situatedness and structures of the clinical traditions and practices in which they must make decisions and act quickly in specific clinical situations.
Scheffer and Rubenfeld 5 expanded on the APA definition for nurses through a consensus process, resulting in the following definition: Critical thinking in nursing is an essential component of professional accountability and quality nursing care.
Critical thinkers in nursing exhibit these habits of the mind: This is demonstrated in nursing by clinical judgment, which includes ethical, diagnostic, and therapeutic dimensions and research 7 p. Critical thinking underlies independent and interdependent decision making. Critical thinking includes questioning, Critical thinking clinical reasoning and clinical judgment, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, and creativity 8 p.
Course work or ethical experiences should provide the graduate with the knowledge and skills to: Use nursing and other appropriate theories and models, and an appropriate ethical framework; Apply research-based knowledge from nursing and the sciences as the basis for practice; Use clinical judgment and decision-making skills; Engage in self-reflective and collegial dialogue about professional practice; Evaluate nursing care outcomes through the acquisition of data and the questioning of inconsistencies, allowing for the revision of actions and goals; Engage in creative problem solving 8 p.
Taken together, these definitions of critical thinking set forth the scope and key elements of thought processes involved in providing clinical care.
Exactly how critical thinking is defined will influence how it is taught and to what standard of care nurses will be held accountable.
Professional and regulatory bodies in nursing education have required that critical thinking be central to all nursing curricula, but they have not adequately distinguished critical reflection from ethical, clinical, or even creative thinking for decisionmaking or actions required by the clinician.
Other essential modes of thought such as clinical reasoning, evaluation of evidence, creative thinking, or the application of well-established standards of practice—all distinct from critical reflection—have been subsumed under the rubric of critical thinking.
In the nursing education literature, clinical reasoning and judgment are often conflated with critical thinking.
The accrediting bodies and nursing scholars have included decisionmaking and action-oriented, practical, ethical, and clinical reasoning in the rubric of critical reflection and thinking.
One might say that this harmless semantic confusion is corrected by actual practices, except that students need to understand the distinctions between critical reflection and clinical reasoning, and they need to learn to discern when each is better suited, just as students need to also engage in applying standards, evidence-based practices, and creative thinking.
The growing body of research, patient acuity, and complexity of care demand higher-order thinking skills. Critical thinking involves the application of knowledge and experience to identify patient problems and to direct clinical judgments and actions that result in positive patient outcomes.
These skills can be cultivated by educators who display the virtues of critical thinking, including independence of thought, intellectual curiosity, courage, humility, empathy, integrity, perseverance, and fair-mindedness. The emerging paradigm for clinical thinking and cognition is that it is social and dialogical rather than monological and individual.
Early warnings of problematic situations are made possible by clinicians comparing their observations to that of other providers.
Clinicians form practice communities that create styles of practice, including ways of doing things, communication styles and mechanisms, and shared expectations about performance and expertise of team members.
By holding up critical thinking as a large umbrella for different modes of thinking, students can easily misconstrue the logic and purposes of different modes of thinking.
Clinicians and scientists alike need multiple thinking strategies, such as critical thinking, clinical judgment, diagnostic reasoning, deliberative rationality, scientific reasoning, dialogue, argument, creative thinking, and so on.
Critical Reflection, Critical Reasoning, and Judgment Critical reflection requires that the thinker examine the underlying assumptions and radically question or doubt the validity of arguments, assertions, and even facts of the case.
Critical reflective skills are essential for clinicians; however, these skills are not sufficient for the clinician who must decide how to act in particular situations and avoid patient injury.
Available research is based upon multiple, taken-for-granted starting points about the general nature of the circulatory system. As such, critical reflection may not provide what is needed for a clinician to act in a situation.
This idea can be considered reasonable since critical reflective thinking is not sufficient for good clinical reasoning and judgment.
The powers of noticing or perceptual grasp depend upon noticing what is salient and the capacity to respond to the situation. Critical reflection is a crucial professional skill, but it is not the only reasoning skill or logic clinicians require.
The ability to think critically uses reflection, induction, deduction, analysis, challenging assumptions, and evaluation of data and information to guide decisionmaking.
Critical thinking is inherent in making sound clinical reasoning.Clinical judgment requires clinical reasoning across time about the particular, and because of the relevance of this immediate historical unfolding, clinical reasoning can be very different from the scientific reasoning used to formulate, conduct, and assess clinical experiments.
Practical strategies to promote critical thinking, clinical reasoning, and clinical judgment are incorporated along with supporting evidence as to why the strategies work.
Focus on application (or "how to") and inclusion of supporting rationales (theory) make difficult concepts easy to caninariojana.coms: *Critical thinking is one of the key factors of clinical reasoning Clinical Reasoning beakdown *The cognitive and metacognitive processes used for analyzing knowledge relative to a clinical situation or a specific patient.
Having sound critical thinking, clinical reasoning, and clinical judgment skills makes the difference between keeping patients safe and putting them in harm’s way.
This educational activity addresses the knowledge, skills, and attitudes needed for critical thinking and clinical reasoning/5(K).
Expert author Rosalinda Alfaro-LeFevre makes the concepts of critical thinking and clinical reasoning come alive, so you can start thinking like a nurse and learn essential critical thinking and clinical judgment reasoning skills for nursing practice.
Start studying Critical Thinking, Nursing Process and Clinical Judgement- Theories and Concepts. Learn vocabulary, terms, and more with flashcards, games, and .