Critical thinking is at the core of care delivered by a nurse. Broadly speaking, critical thinking is defined as “the disciplined, intellectual process of applying skilful reasoning as a guide to belief or action” (Paul, Ennis, & Norris, 1989 in Heaslip, 1993/2008, par.2). In nursing, the definition of critical thinking is narrower: if to apply to the context of clinical decision-making, critical thinking is a nurse’s ability to think in a systematic and logical way while being open to questions and reflections on the process of reasoning. The aim of critical thinking in nurses is to ensure safe clinical practice as well as quality care (Heaslip, 1993/2008, par.2). What are skills and abilities of a nurse as a critical thinker?
First of all, as a critical thinker, a nurse should possess relevant intellectual ability. This refers to developing and continuously expanding the frames of reference and world view by acquiring new and revisiting already known concepts, theories, and ideas of nursing (Heaslip, 1993/2008, par.1, par.4). Relevant intellectual ability is also about being able to guide your thinking process so that it becomes disciplined and self-directed (Heaslip 1993/2008, par.11). Moreover, it is also about being able to use logic when thinking as well as listening, speaking, writing, and writing in clear, accurate, precise, and logically complete fashion (Heaslip, 1993/2008, par.3). Besides, it is about being able to distinguish and communicate what is important to the nursing care without focusing on irrelevant and trivial things (Heaslip, 1993/2008, par.3).
Next, as a critical thinker, a nurse should have the skills of reasoned thinking. According to Heaslip (1993/2008, par.5), reasoning in nursing includes eight basic elements of thought. The first one is trying to figure out a problem; this is possible once a critical thinker attempts to enter the mind of the other and tries to comprehend the essence of their thinking. The second one is visualizing the purpose or goal of your thinking. The third one is applying various frames of reference; the fourth one is formulating the assumptions based on frames of reference; the fifth one is checking them against theories and concepts in nursing; the sixth one is looking for the evidence to support the assumption; the seventh one is interpreting what has been found; and the eighth one is figuring out the implications that follow from the conclusions. It is also important that the nurse learns to think about her thinking and check whether he/she is sufficiently acting as a critical thinker (Heaslip, 1993/2008, par.7).
One of examples of how critical thinking was applied in practice is my workmate’s critical thinking experience. As a nurse in a surgical unit, she was asked to take blood pressure on a patient. When she saw that it was 90/60, she did not simply record it, but went on to challenge this situation by asking herself questions: is the man hypovolemic? Or maybe he is heading into shock? Could he be septic? What else should be assessed? What are some other vital signs that need to be measured (temperature, pulse, etc)? Is there any pattern in these measures? In this example, rational reasoning took place as the nurse questioned and analyzed.
- Heaslip, P. (2008). Critical thinking and nursing. The Critical Thinking Community. Retrieved from http://www.criticalthinking.org/pages/critical-thinking-and-nursing/834. (Original work published in 1993).