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 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 thinking is the objective analysis of facts to form a judgment.
The subject is complex, and several different definitions exist, which generally include the rational, skeptical, unbiased analysis, or evaluation of factual ashio-midori.comal thinking is self-directed, self-disciplined, self-monitored, and self-corrective thinking.
It presupposed . thinking than to evaluate it, the model may serve as a strong base from which to develop a model suitable for categorizing the types of critical thinking skills demonstrated by students.
thinking or, instead, a more specific focus on critical thinking while completing particular clinical chal- lenges, is a more effective use of instructional time. People remain in the ____ thinking because they live in a predominantly homogeneous environment surrounded by people who think and believe the same way they do.
Intellectual standards Critical thinkers continually evaluate their beliefs by applying ____ to asses the strength and accuracy of these beliefs. Critical Thinking. Nursing education has emphasized critical thinking as an essential nursing skill for more than 50 years.
1 The definitions of critical thinking have evolved over the years. There are several key definitions for critical thinking to consider. Critical thinking is, in short, self-directed, self-disciplined, self-monitored, and self-corrective thinking. It requires rigorous standards of excellence and mindful command of their use.
It entails effective communication and problem-solving abilities, and a commitment to overcoming our native egocentrism and sociocentrism.