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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. 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, analysis, 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 Foundation is a non-profit organization that seeks to promote essential change in education and society through the cultivation of fairminded critical thinking--thinking which embodies intellectual empathy, intellectual humility, intellectual perseverance, intellectual integrity and intellectual responsibility.
The Critical-thinking Assessment Test (CAT) was developed with input from faculty across a wide range of institutions and disciplines, with guidance from colleagues in the cognitive/learning sciences and assessment and with support from the National Science Foundation (NSF).
Critical Thinking Testing and Assessment The purpose of assessment in instruction is improvement. The purpose of assessing instruction for critical thinking is improving the teaching of discipline based thinking (historical, biological, sociological, mathematical thinking.
Learn, Do, and Think! Experience the Dillon Difference – engage your students in the assessment process!
Throughout the text, you will find a unique body system integration, case studies strategically placed three times in each chapter, and critical thinking ashio-midori.comn Delivers! Aug 21, · Critical thinking is defined as the mental process of actively and skillfully perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision for action.
In nursing education there is frequent reference to critical. The process includes five steps: assessment, diagnosis, outcomes/planning, implementation and evaluation.
“One of the fundamental principles for developing critical thinking is the nursing process,” Vest says. “It needs to be a lived experience in the learning environment.” “Critical thinking in nursing is a paramount skill.