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The Value of Critical Thinking in Nursing
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Updated March 16, 2023
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Some experts describe a person's ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.
Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as "necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation."
"This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice," he says.
How Do Nurses Use Critical Thinking?
Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.
Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.
Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:
"Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe."
The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.
"Nurses are at the patient's bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider," she explains.
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Top 5 ways nurses can improve critical thinking skills.
We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.
Slaughter is a fan of the case-based approach to learning critical thinking skills.
In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. "What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?"
Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.
Rhoads is an advocate for self-reflection. "Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help." Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.
This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.
It's important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.
During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?
Develop a Questioning Mind
McGowan has learned that "critical thinking is a self-driven process. It isn't something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive."
To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .
However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.
It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient's care depends on your ability to ask the right questions, you can be ready to rise to the occasion.
Practice Self-Awareness in the Moment
Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient's mental and emotional status can affect your focus and how you manage stress as a nurse .
Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.
By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.
Use a Process
As you are developing critical thinking skills, it can be helpful to use a process. For example:
- Ask questions.
- Gather information.
- Implement a strategy.
- Evaluate the results.
- Consider another point of view.
These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.
Common Critical Thinking Pitfalls in Nursing
Your brain uses a set of processes to make inferences about what's happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.
"We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care," he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.
New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.
"Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient's blood pressure because medication administration is a task that must be completed," Slaughter says. "A nurse employing critical thinking skills would address the low blood pressure, review the patient's blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld."
Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:
- Learn from their mistakes and the mistakes of other nurses
- Look forward to integrating changes that improve patient care
- Treat each patient interaction as a part of a whole
- Evaluate new events based on past knowledge and adjust decision-making as needed
- Solve problems with their colleagues
- Are self-confident
- Acknowledge biases and seek to ensure these do not impact patient care
An Essential Skill for All Nurses
Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.
By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.
Frequently Asked Questions About Critical Thinking in Nursing
How are critical thinking skills utilized in nursing practice.
Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient's cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.
How does nursing school develop critical thinking skills?
Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient's overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.
Do only nurse managers use critical thinking?
Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.
Meet Our Contributors
Crystal Slaughter, DNP, APRN, ACNS-BC, CNE
Crystal Slaughter is a core faculty member in Walden University's RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter's clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.
Jenna Liphart Rhoads, Ph.D., RN
Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.
Nicholas McGowan, BSN, RN, CCRN
Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.
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Creativity and Problem-Solving Skills in Nursing
Published On: December 12, 2019
Nursing is a profession that blends science and art, research and creativity. Though nurses rely on clinical expertise and experience in a variety of situations, those with problem-solving skills are better equipped to serve their patients. By thinking creatively, asking the right questions and considering multiple options, nurses will be able to solve problems much more effectively.
Those who use problem-solving skills see problems not as obstacles but as opportunities to improve their patients' health and well-being . Nurses who have completed an online RN to BSN program understand how to draw upon their creative abilities and critical thinking skills to improve their practice.
According to an article from the National Institutes of Health, nurses use critical thinking to evaluate, analyze and synthesize information. They take this information, and their experience, to create a plan of action. Nurses who employ problem-solving skills begin with critical thinking. When there are no clear answers or courses of action, nurses can rely on their creativity to come up with new solutions and make decisions.
Combined with creativity, critical thinking can help nurses solve specific patient problems as well as system-wide challenges. When traditional measures are not effective, creative professionals are able to generate ideas rapidly, be flexible in their approach, act with confidence without direct supervision, and react well under pressure.
The world of healthcare is becoming more varied and complex. The new role of nurses requires them to work across disciplines, incorporating more professionals into the care plan of their patients. Nurses who have completed an online RN to BSN program will be well-versed in problem-solving approaches such as evidence-based practice. By incorporating their clinical experience, knowledge and the preferences of the patient, nurses can provide the best care.
Nurses who employ evidence-based practice will see improved patient outcomes for those in their care, according to a Nursing World report. Healthcare providers who stay abreast of the most recent research increase positive outcomes for patients. This means that more patients return home sooner.
Steps to Evidence-Based Practice
The Academy for Medical-Surgical Nurses shows the steps taken by nurses who use evidence-based practice to care for patients. First, they determine the problem and formulate a question. The second step is reviewing the evidence, which helps determine what treatment is most appropriate using existing knowledge. The third is implementation, which means beginning the actual treatment. The fourth step is evaluating the plan by reassessing the patient at pre-determined intervals.
What Does This Look Like in Practice?
A key attribute for any successful healthcare practitioner is the ability to turn obstacles into opportunities for better patient care. In addition, good nurses are those who can learn from past experiences and incorporate those lessons into the care of future patients.
Highly educated nurses who have completed an online RN to BSN program have the skills to make problem-solving a more natural part of their practice. These nurses hold the key to a more responsive healthcare environment and a healthier patient population.
Learn more about the URI online Registered Nurse to Bachelor of Science in Nursing program .
Academy of Medical-Surgical Nurses: Evidence-Based Practice
The Online Journal of Issues in Nursing: The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas
Acta Informatica Medica: Critical Thinking: The Development of an Essential Skill for Nursing Students
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• Ask relevant questions • Justify opinions • Address and evaluate multiple points of view • Explain assumptions and reasons related to your choice of patient care options
5. Can I Be a Nurse If I Cannot Think Critically?
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Communication Skills, Problem-Solving Ability, Understanding of Patients’ Conditions, and Nurse’s Perception of Professionalism among Clinical Nurses: A Structural Equation Model Analysis
This study was intended to confirm the structural relationship between clinical nurse communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. Due to changes in the healthcare environment, it is becoming difficult to meet the needs of patients, and it is becoming very important to improve the ability to perform professional nursing jobs to meet expectations. In this study method, structural model analysis was applied to identify factors influencing the perception of professionalism in nurses. The subjects of this study were 171 nurses working at general hospitals in city of Se, Ga, and Geu. Data analysis included frequency analysis, identification factor analysis, reliability analysis, measurement model analysis, model fit, and intervention effects. In the results of the study, nurse’s perception of professionalism was influenced by factors of communication skills and understanding of the patient’s condition, but not by their ability to solve problems. Understanding of patient’s condition had a mediating effect on communication skills and nursing awareness. Communication skills and understanding of the patient’s condition greatly influenced the nurse’s perception of professionalism. To improve the professionalism of clinical nurses, nursing managers need to emphasize communication skills and understanding of the patient’s condition. The purpose of this study was to provide a rationale for developing a program to improve job skills by strengthening the awareness of professional positions of clinical nurses to develop nursing quality of community.
Changes in the environment related to climate and pollution are causing health problems and various diseases such as respiratory and circulatory problems, metabolic disorders, and chronic diseases. Moreover, access to modern healthcare facilities has created greater expectations among patients receiving personalized healthcare and high-quality healthcare. As the difficulty of satisfying the demands of patients increases, enhancing nursing capabilities has become increasingly important [ 1 ]. To improve this, hospitals are making efforts to change the internal and external environments so as to increase the number of nurses, reduce the length of hospital stays, and enable efficient nursing practice. Despite these efforts, the workloads of nurses and the demand for clinical nurses are continuously increasing [ 2 , 3 ]. As a result, nurses are developing negative attitudes and prejudices toward patients, as well as negative perceptions of professionalism. To address this, the cultivation and strengthening of nursing professionals’ capabilities is essential.
Nurses’ perception of professionalism is an important element influencing their ability to perform independent nursing, and a good perception of their profession results in a positive approach to solving patients’ problems [ 4 , 5 ]. In addition, the characteristics and abilities of individual nurses can influence the level of care and enable them to understand patients, solve problems, and provide holistic care, which is the ultimate goal of the nursing process [ 6 , 7 ]. Thus, patients expect nurses to not only have medical knowledge of the disease but to also be able to comprehensively assess the patient’s problems and be independent and creative in nursing [ 8 ]. This attitude can have a major impact on the quality of nursing services and can inspire pride in the nursing occupation and professional achievement. These findings can also be used by nurses to prevent burnout and maintain professionalism [ 9 , 10 ].
To respond to the increasing demands for diverse qualitative and quantitative nursing services and to strengthen the capabilities of nursing professionals, efforts have been made to move nursing education toward scientific and creative education. However, in point-of-care environments, not only are nurses prevented from making independent decisions regarding nursing, but also the diverse personal capabilities necessary for such independent behavior are not sufficiently developed [ 11 ]. Therefore, it is important to enhance clinical nurses’ perceptions of the nursing profession; maintain a balance of nursing capabilities; provide novel, high-quality nursing services; and identify assistive nursing education methods and obstructive environmental factors [ 10 ].
Communication skills involve a person’s ability to accurately understand (through both verbal and non-verbal indications) another person, and sufficiently deliver what the person desires [ 12 , 13 ]. Good communication skills are a primary requirement for providing professional nursing services because they enable an in-depth understanding of patients, solving of complicated problems, and reasonable and logical analysis of situations [ 14 , 15 , 16 ]. When effective communication takes place, nurses’ problem-solving abilities and perceived professionalism strengthen [ 17 , 18 ].
According to Park [ 19 ], nurses have difficulties in interpersonal relationships when social tension and interaction skills are low and communication is poor. In addition, these factors are negatively affected not only in the work of the nurse but also in the perception of the profession. Communication skills are associated with both the formation of relationships with patients and the ability to perform holistic nursing [ 20 ]. In order to improve and develop the overall nursing function of a clinical nurse like this, it is important to complement the relevant integrated nursing abilities [ 21 , 22 ].
Previous studies have investigated the importance of communication skills for nurses, and the relationships between nurses’ problem-solving ability and their understanding of the patients’ conditions. Nonetheless, data that can comprehensively explain the structural relationships between these qualities and how they affect the job perception of nurses remains insufficient.
Therefore, the present study aims to identify the structural model for the relationships between nurses’ communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. Additionally, the study provides basic data necessary for developing programs for improving nursing abilities.
The purpose of this study is to construct a theoretical model that explains the structural relationships among nurses’ communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. In addition, the study aimed to verify this model using empirical data.
2. Materials and Methods
2.1. study design.
To create and analyze the structural model for clinical nurses’ communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism, the theoretical relationships among the variables were developed based on related theories.
In this study, communication skills were set as the exogenous variables, whereas problem-solving ability, understanding of patients’ conditions, and perception of the nursing occupation were set as the endogenous variables. In addition, communication skills were set as the independent variables and nursing job perceptions as the dependent variable. This is because the ability of communication helps to maintain an intimate relationship with the patient and to assess the patient’s condition through each other’s relationship and to solve problems and develop correct understanding. Communication skills, problem-solving ability, and understanding of patients’ conditions were set as the parameters for determining causality. The research model is shown in Figure 1 .
2.2. Study Participants
The structural equation model has less than 12 measurement variables. The sample size usually requires 200 to 400 participants [ 23 ]. A total of 250 participants were selected for the study. In line with ethical standards and practices, participants received a full explanation on the purpose of the study. They were briefed that the information collected would be used for research purposes only. Furthermore, they were informed that they could withdraw from the study at any time.
2.3. Data Collection Method
Data collection for this study was performed by two researchers unrelated to the hospital from April 20 to May 1, 2019. A questionnaire was used to collect data from clinical nurses working in five hospitals in Seoul, Gyeonggi, and Gangwon provinces. Of the 250 questionnaires disseminated, we received 225 completed returns. However, 54 were considered inaccurate, inconsistent, or unsatisfactory for coding purposes. Thus, 171 fully completed valid questionnaires comprised the final dataset for analysis.
2.4. Research Instruments
2.4.1. communication skills.
In this study, the communication skill instrument developed by Lee and Jang [ 24 ] was used. Its contents were modified and supplemented to clearly understand the communication skills of nurses. Our questionnaire comprised 20 questions with five questions each concerning “interpretation ability,” “self-reveal,” “leading communication,” and “understanding others’ perspectives.” The answers were rated on a five-point Likert scale ranging from 0 = “strongly disagree” to 4 = “strongly agree.” For this study, the Cronbach’s alpha value was 0.81.
2.4.2. Problem-Solving Ability
The tool developed by Lee [ 25 ] was used to measure the problem-solving ability of clinical nurses. The survey comprised 25 questions, with five questions each concerning “problem recognition,” “information-gathering,” “divergent thinking,” “planning power,” and “evaluation.” Items were scored on a five-point Likert scale ranging from 0 = “strongly disagree” to 4 = “strongly agree.” The internal consistency confidence value Cronbach’s alpha was 0.79.
2.4.3. Understanding Patients’ Condition
To measure nurses’ understanding of patients’ conditions, we developed 10 questions by revising and supplementing items from an existing understanding-measurement tool [ 26 ]. With a total of ten questions, we measured “diagnostic name,” “patient-treatment planning,” and “nursing intervention processes.” Items were scored using a five-point Likert scale ranging from 0 = “strongly disagree” to 4 = “strongly agree.” The internal consistency confidence value Cronbach’s alpha was 0.81.
2.4.4. Nurse’s Perception of Professionalism
Nurse’s perception of professionalism was measured using a tool developed by revising the 25 questions created by Kang et al. [ 1 ]. With a total of ten questions, we measured “vocation” and “autonomy.” Items were scored using a five-point Likert scale. The internal consistency confidence value Cronbach’s alpha was 0.81.
2.5. Data Analysis
To identify the relationships among the set variables, the data were computed statistically using the program included in IBM SPSS 24.0 and AMOS 23.0. (IBM Corp., Armonk, NY, USA). The analysis methods were as follows:
- Frequency analysis was conducted to identify the subjects’ demographic and general characteristics.
- The reliability of the questionnaire was verified using Cronbach’s α coefficients.
- Confirmatory factor analysis (CFA) was performed to verify the convergent validity of the selected measurement tool.
- The normality of the data was determined through analyzing the skewness and kurtosis of the measurement variables.
- The fitness of the model was verified using structural equation modeling (SEM).
- Bootstrapping was utilized to verify the mediating effect in the set study model, as well as the mediating effects of the nurses’ problem-solving ability and understanding of patients’ conditions.
3.1. Demographic Characteristics
The demographic and general characteristics of the study subjects are shown in Table 1 . Overall, 71 respondents were aged 25–29 years (41.5%), representing the most numerous age group. University graduates comprised 113 (66.1%) of the sample, while 50 (29.2%) held graduate degrees, with eight (4.7%) holding master’s degrees. Fifty-three respondents (31.0%) had over seven years of clinical experience, 43 (25.1%) had two to three years of experience, 42 (24.6%) had four to six years of experience, and 33 (19.3%) had less than two years of experience. Additionally, 121 respondents (70.8%) worked at secondary hospitals, while 50 (29.2%) worked at tertiary hospitals; 159 respondents (93.0%) reported that they were general nurses.
Participants’ general characteristics ( N = 171, %).
3.2. Technical Metrics of the Measurement Variables
The multivariate normality of the findings related to the factors of the latent variables was verified through standard deviations, skewness, and kurtosis. The present study meets the criteria for the skewness and kurtosis values mentioned by Hu and Bentler [ 27 ].
All sub-factors of the latent variables secured normality.
In this study, a normal distribution was obtained for each of the four sub-factors of communication skills, five sub-factors of problem-solving ability, three sub-factors for understanding the patient’s condition, and two sub-factors of the nurse’s perception of professionalism as shown in Table 2 .
Technical metrics of the measurement variables ( N = 171).
3.3. Correlations between the Measured Variables
The correlations between the measurement variables were analyzed using Pearson’s product–moment correlation coefficient analysis ( Table 3 ). The correlations among all individual measurement variables were found to show a positive correlation.
Correlations between the observed variables.
3.4. Confirmatory Factor Analysis of the Measurement Model
This study examined how well the measurement variables represented the latent variables in the measurement model. Each set path coefficient was evaluated using non-standardization factors, standardization factors, and standard errors. The path coefficients refer to the factor loadings in CFA. The standardization factors of the individual paths were shown to be at least 0.50 (except for vocation: 0.36), and the critical ratio (CR) was at least 1.96. This indicated that the measurement tool had good convergent validity ( Table 4 ).
Confirmatory factor analysis of the measurement model.
*** p < 0.001; CR: critical ratio.
3.5. Verification of the Structural Model
The structural model for relationships among clinical nurses’ communication skills, problem-solving ability, understanding of patients’ condition, and nurse’s perception of professionalism that would be suitable for predicting the influencing relationships was verified. Since the fitness index of the modified model was shown to be higher than that of the initial model, the final model for this study was set as shown in Figure 2 .
Final model. * χ 2 = 124.074 (df = 61, p <0.001), GFI(Goodness of Fit Index)= 0.90, RMSEA(Root Mean Square Error Approximation)=0.07, NFI(Normed Fit Index)=0.87, IFI(Incremental Fit Index)= 0.93, TLI(Tucker-Lewis Index)= 0.91, CFI(Comparative Fit Index)= 0.92.
3.6. Influencing Relationships between Variables of the Study Model
The standardization factors and CR values of the final model were examined to determine whether there were direct relationships between communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. The results are shown
For the relationship between communication ski in Table 5 .lls and problem-solving ability, the standardization factor was 0.85 and the CR value was 7.37; communication skills showed a statistically significant effect. Consequently. The relationship between communication skills and understanding of patients’ conditions also showed a statistically significant effect. Consequently, Hypothesis 1 was supported.
The relationships between the human effects of the measurement model.
* p < 0.05, *** p < 0.001; CR: critical ratio.
For the relationship between communication skills and nurse’s perception of professionalism, the standardization factor was 0.54, and the CR value was 2.02. Communication skills showed a statistically significant effect. Consequently. For the relationship between problem-solving ability and nurse’s perception of professionalism, the standardization factor was −0.056, and the CR value was −0.39. Problem-solving ability had no statistically significant effect. Consequently.
The relationship between nurses’ understanding of patients’ conditions and nurse’s perception of professionalism had a statistically significant effect. Consequently Figure 2 shows the influencing relationships between the study variables of the final study model, considering non-standardization and standardization factors of the relationships between the study variables.
3.7. Direct and Indirect Effects of the Variables
To grasp the significance of the mediating effect in the final study model, the direct and indirect effects of each variable were examined. To examine the mediating effect of the problem-solving ability and understanding of patients’ conditions variables, the bootstrapping method provided by the AMOS 23.0 program included in IBM was utilized. The results are shown in Table 6 .
Mediating effect analysis.
* p < 0.05, *** p < 0.001
The indirect effect of communication skills on nurse’s perception of professionalism through nurses’ understanding of patients’ conditions was statistically significant. That is, clinical nurses’ communication skills have an indirect positive effect on their nurse’s perception of professionalism, with nurses’ understanding of patients’ conditions acting as a parameter. We also found that the effect of communication skills on nurse’s perception of professionalism was statistically significant. Therefore, communication skills have a partially mediated effect on nurse’s perception of professionalism, with understanding of patients’ conditions acting as a parameter. However, communication skills were found to have no indirect positive effect on nurse’s perception of professionalism when problem-solving ability was set as a parameter.
In this study, we developed and analyzed a hypothetical model regarding clinical nurses’ communication skills, problem-solving ability, and understanding of patients’ conditions, and how these factors influence their nurse’s perception of professionalism.
4.1. Effect of Communication Skills on Nurses’ Perception of Professionalism
Communication skills were found to have statistically significant effects on their relationship with nurses’ problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. Nurses’ communication skills not only affected their problem-solving ability but also their understanding of patients’ conditions and nurse’s perception of professionalism. Good communication among nurses can reduce uncomfortable situations and improve interactions with patients, which can consequently enhance problem-solving [ 28 ]. Supporting our findings, Ancel [ 17 ] reported that communication skills afford the maintenance of amicable cooperative relationships with patients across diverse medical classes, thereby enhancing the efficiency of nursing-related problem-solving.
Nurses’ communication is also closely related to their understanding of patients’ conditions, particularly regarding the treatment processes. Nurses frequently experience difficulties as a result of poor communication with not only patients and their family members but also other medical personnel. Further, poor delivery of explanations and questions affects nurses’ understanding of patients’ situations and problems, and patients can also feel concern regarding whether nurses accurately understand their problems [ 29 ]. Nurses frequently experience psychological abuse when communicating with patients and develop stress or discomfort [ 30 ]; this can lead to distrustful relationships with and inhibited understanding of patients [ 31 , 32 ]. Vermeir et al. [ 18 ] reported that scientific approaches are required to understand patients in-depth. To accurately understand both oneself and others, the most important method is successful communication. Such findings support the present study’s indication that nurses’ communication is a basic means of solving nursing problems, with both actions being interrelated.
Our finding that nurses’ communication skills are structurally related to their nurse’s perception of professionalism supports the findings of many previous studies. Regarding nurse’s perception of professionalism, Adams et al. [ 33 ] as well as Lee and Kim [ 34 ] explained that a good perception leads to higher-level capabilities, fostering high-level nursing of patients and the development of autonomous vocation. The above studies reported that, since nurses’ communication skills are related to their nurse’s perception of professionalism, communication skills should be considered a predictor of success. Further, McGlynn et al. [ 35 ] recommended positively reinforcing communication skills to improve nurse’s perception of professionalism. This supports the findings of the present study, indicating that communication and nursing professional perception are interrelated.
Thus, communication skills are important for nursing patients. They enable nurses to accurately understand patients’ problems, serve (by forming patient trust) an important function in the process of administering nursing interventions, and positively affect nurses’ perception of their profession. As such, each concept is important. However, nurses working in the clinic are critically aware of their professionalism. In order to reinforce this, communication skills are required, and the emphasis is placed on strengthening the nurses’ ability to solve problems as well as assess and understand patients. As a result, communication skills play an important role in helping nurses understand patients’ problems accurately, build patient trust in nursing interventions, and create structural relationships that have a positive impact on the perception of nursing occupations. Therefore, efforts to improve nurses’ communication skills not only improve their problem-solving abilities and understanding of patients’ conditions but also improve their nurse’s perception of professionalism. To maintain the professionalism of nurses, “competency development programs” would be helpful, thereby emphasizing the need for their application in nursing colleges and clinical practice.
4.2. Relationship between Nurses’ Problem-Solving Ability and Nurse’s Perception of Professionalism
We found clinical nurses’ problem-solving ability to have no positive effect on their perception of professionalism. This contrasts with previous studies, which reported that problem-solving ability is helpful for such perception of professionalism [ 36 ]. We also found that problem-solving ability does not affect nursing professional perception through a mediating effect.
The present findings indicate that the distinctiveness of the fields of nursing should not be overlooked. In nursing organizations that have a culture of discouraging diversity, when negative results are obtained from attempts to solve nursing problems, confusion regarding the identity of nursing professionals means perception of the profession is not reinforced; in many cases, the opposite perception is formed. Furthermore, for those in lower-level positions, nurse’s perception of professionalism is thought to be low because they cannot voice their opinions and have difficulties such as excessive workloads. Although few previous studies have directly examined this, Vermeir et al. [ 18 ] explained that, as the role expectation for nurses increases, factors for job turnover increase as a result of a sense of confusion regarding the nurses’ role and increases in stress. These findings indicate that factors that degrade nurses’ problem-solving ability induce skepticism regarding nursing and possibly career change, thereby supporting the findings of this study.
However, in the present study, positive results with low levels of relevancy in the structural model but high correlations were found. It is expected that, if nurses’ environmental conditions are improved and their nursing capabilities are developed so that they can solve nursing problems with confidence, their nursing professional perception will improve.
4.3. Relationship between Nurses’ Understanding of Patients’ Conditions and Nurse’s Perception of Professionalism
Our findings indicated that the relationship between nurses’ understanding of patients’ conditions and nurse’s perception of professionalism was statistically significant. This supports Nilsson et al. [ 21 ] and Philip et al. [ 29 ], who reported that, in the fields of nursing, when patients accurately understand nurses’ instructions or explanations and health information, they can participate in, independently adjust, and engage in creative decision-making related to self-nursing.
McGlynn et al. [ 35 ] suggested that understanding patient problems is an important element in resolving negative situations; meanwhile, Heo and Lim [ 37 ] indicated that clinical nurses provide high-quality nursing services and develop self-efficacy when they apply professional knowledge and a desire to understand patients’ problems. These study findings accord with our own findings.
The aforementioned findings suggest that the development and application of programs that can enhance nurses’ understanding of patients’ conditions should be emphasized, and that studies of various patient types, the characteristics of patients by age group and hospital areas, as well as the introduction of simulation education programs to improve nurses’ understanding of patients’ conditions should be continuously implemented.
This study aimed to verify the structural relationships between clinical nurses’ communication skills and their problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. We also aimed to identify, through a structural model, the mediating effects of nurses’ problem-solving ability and understanding of patients’ conditions in the relationship between communication skills and nurse’s perception of professionalism.
The findings of this study are as follows (all significance levels = 0.05). In the relationship between communication skills and problem-solving ability, the value of the standardization factor was 0.85 and the CR value was 7.37, indicating that communication skills had a statistically significant effect. In the relationship between nurses’ communication skills and understanding of patients’ conditions, the value of the standardization factor was 0.61 and the CR value was 6.35, indicating that communication skills had a statistically significant effect. In the relationship between communication skills and nurse’s perception of professionalism, the value of the standardization factor was 0.54 and the CR value was 2.02, indicating that communication skills had a statistically significant effect. However, in the relationship between problem-solving ability and nurse’s perception of professionalism, the value of the standardization factor was −0.05 and the CR value was −0.39, indicating that problem-solving ability has no statistically significant effect. Finally, in the relationship between nurses’ understanding of patients’ conditions and nurse’s perception of professionalism, the value of the standardization factor was 0.56, and the CR value was 2.14, indicating that nurses’ understanding of patients’ conditions has a statistically significant effect.
There are some limitations to this study. First, as we only examined nurses at secondary and tertiary university hospitals, our findings may not be generalizable to all clinical nurses. Replication studies examining a range of levels of medical institutions and associated workers are necessary. Second, the structural relationship between problem-solving ability and the nurse’s perception of professionalism turned out to be insignificant or mediated. Subsequent studies on the various approaches to revisit this structural relationship should be performed. Third, theories should be systematically developed to establish the values of the nursing profession, and additional studies are necessary to explore other variables.
We would like to thank the staff nurses who participated in the survey and took the time to complete the initial assessment.
Conceptualization, A.Y.K. and I.O.S.; methodology, A.Y.K.; software, I.O.S.; validation, A.Y.K. and I.O.S.; formal analysis, A.Y.K. and I.O.S.; investigation, A.Y.K.; resources, A.Y.K.; data curation, A.Y.K.; writing—original draft preparation, A.Y.K.; writing—review and editing, A.Y.K. and I.O.S.; visualization, A.Y.K. and I.O.S.; supervision, I.O.S.; project administration, I.O.S. All authors have read and agreed to the published version of the manuscript.
This research received no external funding.
Conflicts of Interest
The authors declare no conflict of interest.
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- Research article
- Open Access
- Published: 07 October 2020
Impact of social problem-solving training on critical thinking and decision making of nursing students
- Soleiman Ahmady 1 &
- Sara Shahbazi ORCID: orcid.org/0000-0001-8397-6233 2 , 3
BMC Nursing volume 19 , Article number: 94 ( 2020 ) Cite this article
The complex health system and challenging patient care environment require experienced nurses, especially those with high cognitive skills such as problem-solving, decision- making and critical thinking. Therefore, this study investigated the impact of social problem-solving training on nursing students’ critical thinking and decision-making.
This study was quasi-experimental research and pre-test and post-test design and performed on 40 undergraduate/four-year students of nursing in Borujen Nursing School/Iran that was randomly divided into 2 groups; experimental ( n = 20) and control (n = 20). Then, a social problem-solving course was held for the experimental group. A demographic questionnaire, social problem-solving inventory-revised, California critical thinking test, and decision-making questionnaire was used to collect the information. The reliability and validity of all of them were confirmed. Data analysis was performed using SPSS software and independent sampled T-test, paired T-test, square chi, and Pearson correlation coefficient.
The finding indicated that the social problem-solving course positively affected the student’ social problem-solving and decision-making and critical thinking skills after the instructional course in the experimental group ( P < 0.05), but this result was not observed in the control group ( P > 0.05).
The results showed that structured social problem-solving training could improve cognitive problem-solving, critical thinking, and decision-making skills. Considering this result, nursing education should be presented using new strategies and creative and different ways from traditional education methods. Cognitive skills training should be integrated in the nursing curriculum. Therefore, training cognitive skills such as problem- solving to nursing students is recommended.
Peer Review reports
Continuous monitoring and providing high-quality care to patients is one of the main tasks of nurses. Nurses’ roles are diverse and include care, educational, supportive, and interventional roles when dealing with patients’ clinical problems [ 1 , 2 ].
Providing professional nursing services requires the cognitive skills such as problem-solving, decision-making and critical thinking, and information synthesis [ 3 ].
Problem-solving is an essential skill in nursing. Improving this skill is very important for nurses because it is an intellectual process which requires the reflection and creative thinking [ 4 ].
Problem-solving skill means acquiring knowledge to reach a solution, and a person’s ability to use this knowledge to find a solution requires critical thinking. The promotion of these skills is considered a necessary condition for nurses’ performance in the nursing profession [ 5 , 6 ].
Managing the complexities and challenges of health systems requires competent nurses with high levels of critical thinking skills. A nurse’s critical thinking skills can affect patient safety because it enables nurses to correctly diagnose the patient’s initial problem and take the right action for the right reason [ 4 , 7 , 8 ].
Problem-solving and decision-making are complex and difficult processes for nurses, because they have to care for multiple patients with different problems in complex and unpredictable treatment environments [ 9 , 10 ].
Clinical decision making is an important element of professional nursing care; nurses’ ability to form effective clinical decisions is the most significant issue affecting the care standard. Nurses build 2 kinds of choices associated with the practice: patient care decisions that affect direct patient care and occupational decisions that affect the work context or teams [ 11 , 12 , 13 , 14 , 15 , 16 ].
The utilization of nursing process guarantees the provision of professional and effective care. The nursing process provides nurses with the chance to learn problem-solving skills through teamwork, health management, and patient care. Problem-solving is at the heart of nursing process which is why this skill underlies all nursing practices. Therefore, proper training of this skill in an undergraduate nursing program is essential [ 17 ].
Nursing students face unique problems which are specific to the clinical and therapeutic environment, causing a lot of stresses during clinical education. This stress can affect their problem- solving skills [ 18 , 19 , 20 , 21 ]. They need to promote their problem-solving and critical thinking skills to meet the complex needs of current healthcare settings and should be able to respond to changing circumstances and apply knowledge and skills in different clinical situations [ 22 ]. Institutions should provide this important opportunity for them.
Despite, the results of studies in nursing students show the weakness of their problem-solving skills, while in complex health environments and exposure to emerging diseases, nurses need to diagnose problems and solve them rapidly accurately. The teaching of these skills should begin in college and continue in health care environments [ 5 , 23 , 24 ].
It should not be forgotten that in addition to the problems caused by the patients’ disease, a large proportion of the problems facing nurses are related to the procedures of the natural life of their patients and their families, the majority of nurses with the rest of health team and the various roles defined for nurses [ 25 ].
Therefore, in addition to above- mentioned issues, other ability is required to deal with common problems in the working environment for nurses, the skill is “social problem solving”, because the term social problem-solving includes a method of problem-solving in the “natural context” or the “real world” [ 26 , 27 ]. In reviewing the existing research literature on the competencies and skills required by nursing students, what attracts a lot of attention is the weakness of basic skills and the lack of formal and systematic training of these skills in the nursing curriculum, it indicates a gap in this area [ 5 , 24 , 25 ]. In this regard, the researchers tried to reduce this significant gap by holding a formal problem-solving skills training course, emphasizing the common social issues in the real world of work. Therefore, this study was conducted to investigate the impact of social problem-solving skills training on nursing students’ critical thinking and decision-making.
Setting and sample
This quasi-experimental study with pretest and post-test design was performed on 40 undergraduate/four-year nursing students in Borujen nursing school in Shahrekord University of Medical Sciences. The periods of data collection were 4 months.
According to the fact that senior students of nursing have passed clinical training and internship programs, they have more familiarity with wards and treatment areas, patients and issues in treatment areas and also they have faced the problems which the nurses have with other health team personnel and patients and their families, they have been chosen for this study. Therefore, this study’s sampling method was based on the purpose, and the sample size was equal to the total population. The whole of four-year nursing students participated in this study and the sample size was 40 members. Participants was randomly divided in 2 groups; experimental ( n = 20) and control (n = 20).
The inclusion criteria to take part in the present research were students’ willingness to take part, studying in the four-year nursing, not having the record of psychological sickness or using the related drugs (all based on their self-utterance).
At the beginning of study, all students completed the demographic information’ questionnaire. The study’s intervening variables were controlled between the two groups [such as age, marital status, work experience, training courses, psychological illness, psychiatric medication use and improving cognitive skills courses (critical thinking, problem- solving, and decision making in the last 6 months)]. Both groups were homogeneous in terms of demographic variables ( P > 0.05). Decision making and critical thinking skills and social problem solving of participants in 2 groups was evaluated before and 1 month after the intervention.
All questionnaires were anonymous and had an identification code which carefully distributed by the researcher.
To control the transfer of information among the students of two groups, the classification list of students for internships, provided by the head of nursing department at the beginning of semester, was used.
Furthermore, the groups with the odd number of experimental group and the groups with the even number formed the control group and thus were less in contact with each other.
The importance of not transferring information among groups was fully described to the experimental group. They were asked not to provide any information about the course to the students of the control group.
Then, training a course of social problem-solving skills for the experimental group, given in a separate course and the period from the nursing curriculum and was held in 8 sessions during 2 months, using small group discussion, brainstorming, case-based discussion, and reaching the solution in small 4 member groups, taking results of the social problem-solving model as mentioned by D-zurilla and gold fried [ 26 ]. The instructor was an assistant professor of university and had a history of teaching problem-solving courses. This model’ stages are explained in Table 1 .
All training sessions were performed due to the model, and one step of the model was implemented in each session. In each session, the teacher stated the educational objectives and asked the students to share their experiences in dealing to various workplace problems, home and community due to the topic of session. Besides, in each session, a case-based scenario was presented and thoroughly analyzed, and students discussed it.
In this study, the data were collected using demographic variables questionnaire and social problem- solving inventory – revised (SPSI-R) developed by D’zurilla and Nezu (2002) [ 26 ], California critical thinking skills test- form B (CCTST; 1994) [ 27 , 28 ] and decision-making questionnaire.
SPSI-R is a self - reporting tool with 52 questions ranging from a Likert scale (1: Absolutely not – 5: very much).
The minimum score maybe 25 and at a maximum of 125, therefore:
The score 25 and 50: weak social problem-solving skills.
The score 50–75: moderate social problem-solving skills.
The score higher of 75: strong social problem-solving skills.
The reliability assessed by repeated tests is between 0.68 and 0.91, and its alpha coefficient between 0.69 and 0.95 was reported [ 26 ]. The structural validity of questionnaire has also been confirmed. All validity analyses have confirmed SPSI as a social problem - solving scale.
In Iran, the alpha coefficient of 0.85 is measured for five factors, and the retest reliability coefficient was obtained 0.88. All of the narratives analyzes confirmed SPSI as a social problem- solving scale [ 29 ].
California critical thinking skills test- form B(CCTST; 1994): This test is a standard tool for assessing the basic skills of critical thinking at the high school and higher education levels (Facione & Facione, 1992, 1998) [ 27 ].
This tool has 34 multiple-choice questions which assessed analysis, inference, and argument evaluation. Facione and Facione (1993) reported that a KR-20 range of 0.65 to 0.75 for this tool is acceptable [ 27 ].
In Iran, the KR-20 for the total scale was 0.62. This coefficient is acceptable for questionnaires that measure the level of thinking ability of individuals.
After changing the English names of this questionnaire to Persian, its content validity was approved by the Board of Experts.
The subscale analysis of Persian version of CCTST showed a positive high level of correlation between total test score and the components (analysis, r = 0.61; evaluation, r = 0.71; inference, r = 0.88; inductive reasoning, r = 0.73; and deductive reasoning, r = 0.74) [ 28 ].
A decision-making questionnaire with 20 questions was used to measure decision-making skills. This questionnaire was made by a researcher and was prepared under the supervision of a professor with psychometric expertise. Five professors confirmed the face and content validity of this questionnaire. The reliability was obtained at 0.87 which confirmed for 30 students using the test-retest method at a time interval of 2 weeks. Each question had four levels and a score from 0.25 to 1. The minimum score of this questionnaire was 5, and the maximum score was 20 [ 30 ].
For analyzing the applied data, the SPSS Version 16, and descriptive statistics tests, independent sample T-test, paired T-test, Pearson correlation coefficient, and square chi were used. The significant level was taken P < 0.05.
The average age of students was 21.7 ± 1.34, and the academic average total score was 16.32 ± 2.83. Other demographic characteristics are presented in Table 2 .
None of the students had a history of psychiatric illness or psychiatric drug use. Findings obtained from the chi-square test showed that there is not any significant difference between the two groups statistically in terms of demographic variables.
The mean scores in social decision making, critical thinking, and decision-making in whole samples before intervention showed no significant difference between the two groups statistically ( P > 0.05), but showed a significant difference after the intervention ( P < 0.05) (Table 3 ).
Scores in Table 4 showed a significant positive difference before and after intervention in the “experimental” group ( P < 0.05), but this difference was not seen in the control group ( P > 0.05).
Among the demographic variables, only a positive relationship was seen between marital status and decision-making skills (r = 0.72, P < 0.05).
Also, the scores of critical thinking skill’ subgroups and social problem solving’ subgroups are presented in Tables 5 and 6 which showed a significant positive difference before and after intervention in the “experimental” group (P < 0.05), but this difference was not seen in the control group ( P > 0.05).
In the present study conducted by some studies, problem-solving and critical thinking and decision-making scores of nursing students are moderate [ 5 , 24 , 31 ].
The results showed that problem-solving skills, critical thinking, and decision-making in nursing students were promoted through a social problem-solving training course. Unfortunately, no study has examined the effect of teaching social problem-solving skills on nursing students’ critical thinking and decision-making skills.
Altun (2018) believes that if the values of truth and human dignity are promoted in students, it will help them acquire problem-solving skills. Free discussion between students and faculty on value topics can lead to the development of students’ information processing in values. Developing self-awareness increases students’ impartiality and problem-solving ability [ 5 ]. The results of this study are consistent to the results of present study.
Erozkan (2017), in his study, reported there is a significant relationship between social problem solving and social self-efficacy and the sub-dimensions of social problem solving [ 32 ]. In the present study, social problem -solving skills training has improved problem -solving skills and its subdivisions.
The results of study by Moshirabadi (2015) showed that the mean score of total problem-solving skills was 89.52 ± 21.58 and this average was lower in fourth-year students than other students. He explained that education should improve students’ problem-solving skills. Because nursing students with advanced problem-solving skills are vital to today’s evolving society [ 22 ]. In the present study, the results showed students’ weakness in the skills in question, and holding a social problem-solving skills training course could increase the level of these skills.
Çinar (2010) reported midwives and nurses are expected to use problem-solving strategies and effective decision-making in their work, using rich basic knowledge.
These skills should be developed throughout one’s profession. The results of this study showed that academic education could increase problem-solving skills of nursing and midwifery students, and final year students have higher skill levels [ 23 ].
Bayani (2012) reported that the ability to solve social problems has a determining role in mental health. Problem-solving training can lead to a level upgrade of mental health and quality of life [ 33 ]; These results agree with the results obtained in our study.
Conducted by this study, Kocoglu (2016) reported nurses’ understanding of their problem-solving skills is moderate. Receiving advice and support from qualified nursing managers and educators can enhance this skill and positively impact their behavior [ 31 ].
Kashaninia (2015), in her study, reported teaching critical thinking skills can promote critical thinking and the application of rational decision-making styles by nurses.
One of the main components of sound performance in nursing is nurses’ ability to process information and make good decisions; these abilities themselves require critical thinking. Therefore, universities should envisage educational and supportive programs emphasizing critical thinking to cultivate their students’ professional competencies, decision-making, problem-solving, and self-efficacy [ 34 ].
The study results of Kirmizi (2015) also showed a moderate positive relationship between critical thinking and problem-solving skills [ 35 ].
Hong (2015) reported that using continuing PBL training promotes reflection and critical thinking in clinical nurses. Applying brainstorming in PBL increases the motivation to participate collaboratively and encourages teamwork. Learners become familiar with different perspectives on patients’ problems and gain a more comprehensive understanding. Achieving these competencies is the basis of clinical decision-making in nursing. The dynamic and ongoing involvement of clinical staff can bridge the gap between theory and practice [ 36 ].
Ancel (2016) emphasizes that structured and managed problem-solving training can increase students’ confidence in applying problem-solving skills and help them achieve self-confidence. He reported that nursing students want to be taught in more innovative ways than traditional teaching methods which cognitive skills training should be included in their curriculum. To this end, university faculties and lecturers should believe in the importance of strategies used in teaching and the richness of educational content offered to students [ 17 ].
The results of these recent studies are adjusted with the finding of recent research and emphasize the importance of structured teaching cognitive skills to nurses and nursing students.
Based on the results of this study on improving critical thinking and decision-making skills in the intervention group, researchers guess the reasons to achieve the results of study in the following cases:
In nursing internationally, problem-solving skills (PS) have been introduced as a key strategy for better patient care [ 17 ]. Problem-solving can be defined as a self-oriented cognitive-behavioral process used to identify or discover effective solutions to a special problem in everyday life. In particular, the application of this cognitive-behavioral methodology identifies a wide range of possible effective solutions to a particular problem and enhancement the likelihood of selecting the most effective solution from among the various options [ 27 ].
In social problem-solving theory, there is a difference among the concepts of problem-solving and solution implementation, because the concepts of these two processes are different, and in practice, they require different skills.
In the problem-solving process, we seek to find solutions to specific problems, while in the implementation of solution, the process of implementing those solutions in the real problematic situation is considered [ 25 , 26 ].
The use of D’zurilla and Goldfride’s social problem-solving model was effective in achieving the study results because of its theoretical foundations and the usage of the principles of cognitive reinforcement skills. Social problem solving is considered an intellectual, logical, effort-based, and deliberate activity [ 26 , 32 ]; therefore, using this model can also affect other skills that need recognition.
In this study, problem-solving training from case studies and group discussion methods, brainstorming, and activity in small groups, was used.
There are significant educational achievements in using small- group learning strategies. The limited number of learners in each group increases the interaction between learners, instructors, and content. In this way, the teacher will be able to predict activities and apply techniques that will lead students to achieve high cognitive taxonomy levels. That is, confront students with assignments and activities that force them to use cognitive processes such as analysis, reasoning, evaluation, and criticism.
In small groups, students are given the opportunity to the enquiry, discuss differences of opinion, and come up with solutions. This method creates a comprehensive understanding of the subject for the student [ 36 ].
According to the results, social problem solving increases the nurses’ decision-making ability and critical thinking regarding identifying the patient’s needs and choosing the best nursing procedures. According to what was discussed, the implementation of this intervention in larger groups and in different levels of education by teaching other cognitive skills and examining their impact on other cognitive skills of nursing students, in the future, is recommended.
Social problem- solving training by affecting critical thinking skills and decision-making of nursing students increases patient safety. It improves the quality of care because patients’ needs are better identified and analyzed, and the best solutions are adopted to solve the problem.
In the end, the implementation of this intervention in larger groups in different levels of education by teaching other cognitive skills and examining their impact on other cognitive skills of nursing students in the future is recommended.
This study was performed on fourth-year nursing students, but the students of other levels should be studied during a cohort from the beginning to the end of course to monitor the cognitive skills improvement.
The promotion of high-level cognitive skills is one of the main goals of higher education. It is very necessary to adopt appropriate approaches to improve the level of thinking. According to this study results, the teachers and planners are expected to use effective approaches and models such as D’zurilla and Goldfride social problem solving to improve problem-solving, critical thinking, and decision-making skills. What has been confirmed in this study is that the routine training in the control group should, as it should, has not been able to improve the students’ critical thinking skills, and the traditional educational system needs to be transformed and reviewed to achieve this goal.
Availability of data and materials
The datasets used and analyzed during the present study are available from the corresponding author on reasonable request.
California critical thinking skills test
Social problem-solving inventory – revised
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This article results from research project No. 980 approved by the Research and Technology Department of Shahrekord University of Medical Sciences. We would like to appreciate to all personnel and students of the Borujen Nursing School. The efforts of all those who assisted us throughout this research.
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SA and SSH conceptualized the study, developed the proposal, coordinated the project, completed initial data entry and analysis, and wrote the report. SSH conducted the statistical analyses. SA and SSH assisted in writing and editing the final report. All authors read and approved the final manuscript.
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Ahmady, S., Shahbazi, S. Impact of social problem-solving training on critical thinking and decision making of nursing students. BMC Nurs 19 , 94 (2020). https://doi.org/10.1186/s12912-020-00487-x
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Teaching Critical Thinking and Problem-Solving Skills to Healthcare Professionals
- Jessica A. Chacon 1 &
- Herb Janssen ORCID: orcid.org/0000-0001-8015-9369 1
Medical Science Educator volume 31 , pages 235–239 ( 2021 ) Cite this article
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Determining approaches that improve student learning is far more beneficial than determining what can improve a professor’s teaching. As previously stated, “Lecturing is that mysterious process by which the contents of the note-book of the professor are transferred through the instrumentation of the fountain-pen to the note-book of the student without passing through the mind of either” [ 1 ]. This process continues today, except that the professor’s note-book has been replaced with a PowerPoint lecture and the student’s note-book is now a computer.
In 1910, the Flexner report noted that didactic lectures were antiquated and should be left to a time when “professors knew and students learned” [ 2 ]. Approximately 100 years later, the Liaison Committee on Medical Education (LCME) affirmed Flexner’s comment and suggested that student learning must involve active components [ 3 ]: It seems somewhat obscured that almost 100 years separated these two statements.
Our strategy requires the following: student engagement in the learning process; a curriculum that develops a foundation for each student’s knowledge acquisition; focusing primarily on student learning instead of professor teaching; helping enable students develop critical thinking skills; and encouraging students to develop “expertise” in their chosen discipline.
Six fundamental topics that play a role in the development of a health sciences student’s critical thinking ability will be described. In “Section I,” these topics will be discussed independently, highlighting the importance of each. In “Section II: Proposed Curriculum and Pedagogy to Improve Student Learning,” the topics will be united into a practical approach that can be used to improve student learning, curriculum, pedagogy, and assessment.
Students use mnemonics to provide a foundation for new information. Although mnemonics help students associate information that they want to remember with something they already know, students learn tads of information that is not placed into a practical, meaningful framework developed by the student [ 4 , 5 ]. This commentary highlights the problem of recalling facts when these facts are presented in isolation. The responsibility for this resides not with the student, but with a curriculum that teaches isolated facts, instead of integrated concepts.
A taxonomy for significant learning presented by Dr. Fink emphasizes the need to develop foundational knowledge before additional information can be learned in an effective manner [ 6 ]. He provides suggestions on developing specific learning goals in given courses. Two of his most important criteria are (1) the development of a foundation of knowledge and (2) helping students “learn how to learn” [ 6 ].
Learning Approaches and Abilities
Howard Gardner introduced the concept of multiple intelligences in the 1980s [ 7 ]. Gardner expanded this idea to include intelligence in the areas of (1) Verbal-linguistic, (2) Logical-mathematical, (3) Spatial-visual, (4) Bodily-kinesthetic, (5) Musical, (6) Interpersonal, (7) Intrapersonal personal, (8) Naturalist, and (9) Existential. He concluded that students gifted in certain areas will be drawn in that direction due to the ease with which they excel. While it is important to recognize these differences, it is crucial to not ignore the need for student development in areas where they are less gifted. For example, students gifted in mathematics who fail to develop intrapersonal and interpersonal skills will more likely become recluse, limiting their success in real-world situations [ 7 , 8 ]. Similar examples can also be found in the medical world [ 7 , 8 ].
Based on Gardner’s work, it seems evident that students admitted to our health sciences schools will arrive with different skills and abilities. Despite this, educators are required to produce graduates who have mastered the competencies required by the various accrediting agencies. Accomplishing this task demands sensitivity to the students’ different abilities. While the curriculum remains focused on the competencies students must demonstrate when training is complete. Creating this transition using a traditional lecture format is difficult, if not impossible.
In 1910, Flexner suggested that didactic lecture is important; however, it should be limited only to the introduction or conclusion of a given topic [ 2 ]. Flexner stated that students should be given the opportunity to experience learning in a context that allowed them to use scientific principles rather than empirical observations [ 2 ]. Active engagement of the student in their learning process has been recently promoted by the LCME [ 3 ]. This reaffirmation of Flexner’s 1910 report highlights the incredibly slow pace at which education changes.
Critical thinking is an active process that, when applied appropriately, allows each of us to evaluate our own activities and achievements. Critical thinking also allows an individual to make minor, mid-course corrections in thinking, instead of waiting until disastrous outcomes are unavoidable.
Educators in Allied Health and Nursing have included critical thinking as part of their curriculum for many years [ 9 ]. Medical educators, on the other hand, have not fully integrated critical thinking as part of their curriculum [ 10 , 11 ].
Bloom’s taxonomy has often been used to define curriculum [ 12 ]. The usefulness and importance of Bloom’s taxonomy is not to be underestimated; however, its limitations must also be addressed. As Bloom and his colleagues clearly stated, their taxonomy describes behavioral outcomes and is incapable of determining the logical steps through which this behavior was developed [ 12 ]. Bloom highlights this shortcoming in his initial book on the cognitive domain. He described two students who solved the same algebra problem. One student does this by rote memory, having been exposed to the problem previously, while the other student accomplishes the task by applying mathematical principles. The observer has no way of knowing which approach was used unless they have prior knowledge of the students’ background [ 12 ]. The importance of this distinction becomes apparent in medical problem-solving.
Enabling students to learn in context is critical; however, trying to teach everything in context results in a double-edged sword [ 13 ]. On the one hand, learning material in context helps the student develop a solid foundation in which the new information can be built. On the other hand, the educator will find it impossible to duplicate all situations the student will encounter throughout his or her career as a healthcare provider. This dilemma again challenges the educator to develop a variety of learning situations that simulate real-world situations. It seems that “in context” can at best be developed by presenting a variety of patients in a variety of different situations.
In the clinical setting, the physician cannot use a strict hypothesis-driven study on each patient, but must treat patients using the best, most logical treatment selected based on his or her knowledge and the most reliable information.
Development of Expertise
Several researchers have studied the characteristics required of expert performance, the time required to obtain these traits, and the steps that are followed as an individual’s performance progresses from novice to expert.
Studies involving expert physicians have provided data that can be directly used in our attempt to improve curriculum and pedagogy in the healthcare profession. Patel demonstrated that medical students and entry-level residents can recall a considerable amount of non-relevant data while the expert cannot [ 14 ]. Conversely, the expert physician has a much higher level of relevant recall, suggesting they have omitted the non-relevant information and retained only relevant information that is useful in their practice. Using these methods, the expert physicians produce accurate diagnosis in almost 100% of cases, while the medical students can achieve only patricianly correct or component diagnosis only [ 14 ].
In the healthcare setting, both methods are used. The expert physicians will use forward reasoning when the accuracy of the data allows this rapid problem-solving method. When the patient’s conditions cannot be accurately described using known information, the expert diagnostician will resort to the slower hypothesis-driven, backward reasoning approach. In this manner, the highest probability of achieving an accurate diagnosis in the shortest time will be realized [ 14 ].
Section II: Proposed Curriculum and Pedagogy to Improve Student Learning
The following section will outline several distinct but interrelated approaches to accomplish the six educational principles discussed above. The topics will be highlighted as they apply to the specific topic and each section will be comprised of curriculum, pedagogy, and assessment.
Developing a Knowledge Base Using Active Learning Sensitive to Students’ Abilities
Students admitted into healthcare training programs come from various backgrounds. This is both a strength for the program and a challenge for the educator. The strength is recognized in the diversity the varied backgrounds bring to the class and ultimately the profession. The challenge for the educator is attempting to provide each student with the material and a learning approach that will fit their individual ability and knowledge level. The educator can provide prerequisite objectives that identify the basic knowledge required before the student attempts the more advanced curriculum. Scaffolding questions can also be provided that allow students to determine their mastery of these prerequisite objectives. Briefly, scaffolding questions are categorized based on complexity. Simple, factual questions are identified with a subscript “0” (i.e. 1. 0 , 2. 0 , etc.). Advanced questions have a subscript suggesting the estimated number of basic concepts that must be included/combined to derive the answer.
Using technology to provide these individual learning opportunities online allows each student to address his or her own potential deficits. Obviously, those who find their knowledge lacking will need to spend additional time learning this information; however, using technology, this can be accomplished without requiring additional class time. This approach will decrease learning gaps for students, while excluding unnecessarily repeating material known by others.
The curriculum is divided into two parts: (1) content and (2) critical thinking/problem-solving skills. The basic knowledge and factual content can be provided online. Students are expected to learn this by actively engaging the material during independent study. This saves classroom or small-group sessions for interaction where students can actively learn critical thinking/problem-solving skills.
The curriculum should be designed so that students can start at their own level of understanding. The more advanced students can identify the level appropriate for themselves and/or review the more rudimentary information as needed. As shown by previous investigators, experts omit non-relevant information so that they can focus on appropriate problem-solving. Requiring students to learn by solving problems or exploring case studies will be emphasized when possible.
Technology can be used to deliver the “content” portion of the curriculum. Voice-over PowerPoints and/or video clips made available online through WebCT or PodCast will allow each student to study separately or in groups at their own rate, starting at their own level of knowledge. The content delivered in this fashion will complement the handout and/or textbook information recommended to the students. This will provide the needed basic information that will be used as a foundation for the development of critical thinking and problem-solving. The flipped classroom and/or team-based learning can both be used to help facilitate this type of learning. [ 15 ]
It is imperative for students to know whether they have mastered the material to the extent needed. This can be accomplished by providing online formative evaluations. These will not be used to determine student performance; however, the results will be provided to the educator to determine the class’s progress and evaluation of the curriculum.
Developing Critical Thinking Skills in the Classroom or Small-Group Setting
Critical thinking skills are essential to the development of well-trained healthcare professionals. These skills are not “taught” but must be “learned” by the student. The educator provides learning experiences through which the students can gain the needed skills and experience. Mastery of the content should be a responsibility placed on the student. Information and assistance are given to the students, but students are held accountable for learning the content. This does not indicate that the educator is freed from responsibility. In fact, the educator will most likely spend more time planning and preparing, compared to when didactic lectures were given; however, the spotlight will be placed on the student. Once the learning modules are developed, they can be readily updated, allowing the educators to improve their sessions with each evaluation.
Curriculum designed to help student students develop critical thinking/problem-solving skills should be learned in context. During the introductory portions of the training, this can be accomplished by providing problem-based scenarios similar to what will be expected in the later clinical setting. The transition to competency-based evaluation in many disciplines has made this a virtual necessity. Critical thinking/problem-solving skills should emphasize self-examination. It should teach an individual to accomplish this using a series of steps that progress in a logical fashion, stressing that critical thinking is a progression of logical thought, not an unguided process.
The methods of teaching critical thinking can be traced back to the dialectic methods used by Socrates. Helping the students learn by posing questions remains an effective tool. Accomplishing this in a group setting also provides each student with the opportunity to learn, not only from their mistakes and accomplishments, but from the mistakes and accomplishments of others. Scenario questions can be presented in a manner similar to those found in many board and licensure exams. This exposes students to material in a format relevant to the clinical setting and to future exams. In larger groups, PowerPoint presentation of scenario questions can be used. Team-based learning (TBL) is useful in encouraging individual self-assessment and peer-peer instruction, while also providing an opportunity for the development of critical thinking and problem-solving skills. After the Individual Readiness Assurance Test (iRAT) exam, students work together to answer the Group Readiness Assurance Test (gRAT). Following this, relevant material is covered by clinicians and basic scientists working together and questions asked using an audience response system. This has been useful in encouraging individual self-assessment and peer-peer instruction while also providing an opportunity for the development of critical thinking and problem-solving skills.
Formative assessment of the students will be given in the class session. This can be accomplished using an audience response system. This gives each individual a chance to determine their own critical thinking skill level. It will prevent the “Oh, I knew that” response from students who are in denial of their own inabilities. Summative assessment in the class will be based on the critical thinking skills presented in the classroom or small-group setting. As mentioned earlier, the students will be evaluated on their ability to think critically and to problem-solve. This will by necessity include evaluation of content knowledge—but only as it pertains to the critical thinking and problem-solving skills. This will be made clear through the use of objectives that describe both content and critical thinking.
Enhancing Critical Thinking Skills in Simulation Centers and Clinics
The development of critical thinking skills in healthcare is somewhat unique. In chess, students can start playing using the same tools employed by the experts (the chess board); however, in healthcare, allowing students to make medical decisions is ethically inappropriate and irresponsible. Simulations centers allow students to gain needed experience and confidence without placing patients at risk. Once the students have mastered simulation center experiences and acquired the needed confidence, they can participate in patient diagnosis under the watchful eye of the expert healthcare professional.
The student’s curriculum now becomes the entire knowledge base of each healthcare discipline. This includes textbooks and journal articles. Students are required to come well prepared to the clinics and/or hospital having developed and in-depth understanding of each patient in their care.
Each day, the expert healthcare provider, serving as a mentor, will provide formative evaluation of the student and his/her performance. Mentors will guide the student, suggesting changes in the skills needed to evaluate the patients properly. In addition, standardized patients provide an excellent method of student/resident evaluation.
Summative evaluation is in the form of subject/board exams. These test the student’s or resident’s ability to accurately describe and evaluate the patient. The objective structured clinical examination (OSCE) is used to evaluate the student’s ability to correctly assess the patient’s condition. Thinking aloud had been previously shown as an effective tool for evaluating expert performance in such settings [ 16 ]. Briefly, think aloud strategies require the student to explain verbally the logic they are using to combine facts to arrive at correct answers. This approach helps the evaluator to determine both the accuracy of the answer and if the correct thought process was followed by the student.
If the time required to develop an expert is a minimum of ten years, what influence can education have on the process?
Provide the student with a foundation of knowledge required for the development of future knowledge and skills.
Introduce the student to critical thinking and problem-solving techniques.
Require the student to actively engage the material instead of attempting to learn using rote memory only.
Assess the performance of the student in a formative manner, allowing the lack of information of skills to be identified early, thus reducing the risk of failure when changes in study skills are more difficult and/or occur too late to help.
Provide learning in a contextual format that makes the information meaningful and easier to remember.
Provide training in forward reasoning and backward reasoning skills. It can relate these skills to the problem-solving techniques in healthcare.
Help students develop the qualities of an expert healthcare provider.
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Chacon, J.A., Janssen, H. Teaching Critical Thinking and Problem-Solving Skills to Healthcare Professionals. Med.Sci.Educ. 31 , 235–239 (2021). https://doi.org/10.1007/s40670-020-01128-3
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DOI : https://doi.org/10.1007/s40670-020-01128-3
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While not every decision is an immediate life-and-death situation, there are hundreds of decisions nurses must make every day that impact patient care in ways small and large.
“Being able to assess situations and make decisions can lead to life-or-death situations,” said nurse anesthetist Aisha Allen . “Critical thinking is a crucial and essential skill for nurses.”
The National League for Nursing Accreditation Commission (NLNAC) defines critical thinking in nursing this way: “the deliberate nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, and evaluating information that is both factually and belief-based. This is demonstrated in nursing by clinical judgment, which includes ethical, diagnostic, and therapeutic dimensions and research.”
Why Critical Thinking in Nursing Is Important
An eight-year study by Johns Hopkins reports that 10% of deaths in the U.S. are due to medical error — the third-highest cause of death in the country.
“Diagnostic errors, medical mistakes, and the absence of safety nets could result in someone’s death,” wrote Dr. Martin Makary , professor of surgery at Johns Hopkins University School of Medicine.
Everyone makes mistakes — even doctors. Nurses applying critical thinking skills can help reduce errors.
“Question everything,” said pediatric nurse practitioner Ersilia Pompilio RN, MSN, PNP . “Especially doctor’s orders.” Nurses often spend more time with patients than doctors and may notice slight changes in conditions that may not be obvious. Resolving these observations with treatment plans can help lead to better care.
Key Nursing Critical Thinking Skills
Some of the most important critical thinking skills nurses use daily include interpretation, analysis, evaluation, inference, explanation, and self-regulation.
- Interpretation: Understanding the meaning of information or events.
- Analysis: Investigating a course of action based on objective and subjective data.
- Evaluation: Assessing the value of information and its credibility.
- Inference: Making logical deductions about the impact of care decisions.
- Explanation: Translating complicated and often complex medical information to patients and families in a way they can understand to make decisions about patient care.
- Self-Regulation: Avoiding the impact of unconscious bias with cognitive awareness.
These skills are used in conjunction with clinical reasoning. Based on training and experience, nurses use these skills and then have to make decisions affecting care.
It’s the ultimate test of a nurse’s ability to gather reliable data and solve complex problems. However, critical thinking goes beyond just solving problems. Critical thinking incorporates questioning and critiquing solutions to find the most effective one. For example, treating immediate symptoms may temporarily solve a problem, but determining the underlying cause of the symptoms is the key to effective long-term health.
8 Examples of Critical Thinking in Nursing
Here are some real-life examples of how nurses apply critical thinking on the job every day, as told by nurses themselves.
Example #1: Patient Assessments
“Doing a thorough assessment on your patient can help you detect that something is wrong, even if you're not quite sure what it is,” said Shantay Carter , registered nurse and co-founder of Women of Integrity . “When you notice the change, you have to use your critical thinking skills to decide what's the next step. Critical thinking allows you to provide the best and safest care possible.”
Example #2: First Line of Defense
Often, nurses are the first line of defense for patients.
“One example would be a patient that had an accelerated heart rate,” said nurse educator and adult critical care nurse Dr. Jenna Liphart Rhoads . “As a nurse, it was my job to investigate the cause of the heart rate and implement nursing actions to help decrease the heart rate prior to calling the primary care provider.”
Nurses with poor critical thinking skills may fail to detect a patient in stress or deteriorating condition. This can result in what’s called a “ failure to rescue ,” or FTR, which can lead to adverse conditions following a complication that leads to mortality.
Example #3: Patient Interactions
Nurses are the ones taking initial reports or discussing care with patients.
“We maintain relationships with patients between office visits,” said registered nurse, care coordinator, and ambulatory case manager Amelia Roberts . “So, when there is a concern, we are the first name that comes to mind (and get the call).”
“Several times, a parent called after the child had a high temperature, and the call came in after hours,” Roberts said. “Doing a nursing assessment over the phone is a special skill, yet based on the information gathered related to the child's behavior (and) fluid intake, there were several recommendations I could make.”
Deciding whether it was OK to wait until the morning, page the primary care doctor, or go to the emergency room to be evaluated takes critical thinking.
Example #4: Using Detective Skills
Nurses have to use acute listening skills to discern what patients are really telling them (or not telling them) and whether they are getting the whole story.
“I once had a 5-year-old patient who came in for asthma exacerbation on repeated occasions into my clinic,” said Pompilio. “The mother swore she was giving her child all her medications, but the asthma just kept getting worse.”
Pompilio asked the parent to keep a medication diary.
“It turned out that after a day or so of medication and alleviation in some symptoms, the mother thought the child was getting better and stopped all medications,” she said.
Example #5: Prioritizing
“Critical thinking is present in almost all aspects of nursing, even those that are not in direct action with the patient,” said Rhoads. “During report, nurses decide which patient to see first based on the information gathered, and from there they must prioritize their actions when in a patient’s room. Nurses must be able to scrutinize which medications can be taken together, and which modality would be best to help a patient move from the bed to the chair.”
A critical thinking skill in prioritization is cognitive stacking. Cognitive stacking helps create smooth workflow management to set priorities and help nurses manage their time. It helps establish routines for care while leaving room within schedules for the unplanned events that will inevitably occur. Even experienced nurses can struggle with juggling today’s significant workload, prioritizing responsibilities, and delegating appropriately.
Example #6: Medication & Care Coordination
Another aspect that often falls to nurses is care coordination. A nurse may be the first to notice that a patient is having an issue with medications.
“Based on a report of illness in a patient who has autoimmune challenges, we might recommend that a dose of medicine that interferes with immune response be held until we communicate with their specialty provider,” said Roberts.
Nurses applying critical skills can also help ease treatment concerns for patients.
“We might recommend a patient who gets infusions come in earlier in the day to get routine labs drawn before the infusion to minimize needle sticks and trauma,” Robert said.
Example #7: Critical Decisions
During the middle of an operation, the anesthesia breathing machine Allen was using malfunctioned.
“I had to critically think about whether or not I could fix this machine or abandon that mode of delivering nursing anesthesia care safely,” she said. “I chose to disconnect my patient from the malfunctioning machine and retrieve tools and medications to resume medication administration so that the surgery could go on.”
Nurses are also called on to do rapid assessments of patient conditions and make split-second decisions in the operating room.
“When blood pressure drops, it is my responsibility to decide which medication and how much medication will fix the issue,” Allen said. “I must work alongside the surgeons and the operating room team to determine the best plan of care for that patient's surgery.”
“On some days, it seems like you are in the movie ‘The Matrix,’” said Pompilio. “There's lots of chaos happening around you. Your patient might be decompensating. You have to literally stop time and take yourself out of the situation and make a decision.”
Example #8: Fast & Flexible Decisions
Allen said she thinks electronics are great, but she can remember a time when technology failed her.
“The hospital monitor that gives us vitals stopped correlating with real-time values,” she said. “So I had to rely on basic nursing skills to make sure my patient was safe. (Pulse check, visual assessments, etc.)”
In such cases, there may not be enough time to think through every possible outcome. Critical thinking combined with experience gives nurses the ability to think quickly and make the right decisions.
Improving the Quality of Patient Care
Nurses who think critically are in a position to significantly increase the quality of patient care and avoid adverse outcomes.
“Critical thinking allows you to ensure patient safety,” said Carter. “It’s essential to being a good nurse.”
Nurses must be able to recognize a change in a patient’s condition, conduct independent interventions, anticipate patients and provider needs, and prioritize. Such actions require critical thinking ability and advanced problem-solving skills.
“Nurses are the eyes and ears for patients, and critical thinking allows us to be their advocates,” said Allen.
Image courtesy of iStock.com/ davidf
Last updated on Oct 15, 2021 .
Originally published on Aug 25, 2021 .
The views expressed in this article are those of the author and do not necessarily reflect those of Berxi™ or Berkshire Hathaway Specialty Insurance Company. This article (subject to change without notice) is for informational purposes only, and does not constitute professional advice. Click here to read our full disclaimer
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1. Critical thinking is essential in providing quality nursing care. Understanding the process of critical thinking increases the nurse's efficiency in the skill of problem solving. 2. To employ the critical thinking process, the nurse must analyze and criticize a problematic or change situation, reason, make inferences, and reach conclusions. 3. The result of critical thinking is attaining goals, solving problems, and making decisions. 4. Critical thinking is a process and not an outcome.
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He defines critical thinking as "necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation." ... How does nursing school develop critical thinking skills? Nursing school gives students the knowledge ...
2. CRITICAL THINKING SKILLS. Nurses in their efforts to implement critical thinking should develop some methods as well as cognitive skills required in analysis, problem solving and decision making ().These skills include critical analysis, introductory and concluding justification, valid conclusion, distinguishing facts and opinions to assess the credibility of sources of information ...
Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. ... Critical thinking in nursing clinical practice, education ...
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.". Nursing students often find that there are multiple correct ...
Critical thinking in Nursing: Decision-making and Problem-solving WWW.RN.ORG® Reviewed December, 2021, Expires December, 2023 Provider Information and Specifics available on our Website Unauthorized Distribution Prohibited ©2021 RN.ORG®, S.A., RN.ORG®, LLC By Wanda Lockwood, RN, BA, MA The purpose of this course is to explain processes of
Nurses who have completed an online RN to BSN program learned how to draw upon their creative abilities and critical thinking skills to improve their practice. 844-221-5367; ... Nurses who employ problem-solving skills begin with critical thinking. When there are no clear answers or courses of action, nurses can rely on their creativity to come ...
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Nurse leaders perceive their role as a problem-solver, which is a necessary step in advocacy. 27 Problem-solving is a process that contains the elements of decision-making and critical thinking. 28. The theory that emerged from the core categories explicitly focused on the central phenomenon of LHV in the nursing work environment.
Therefore, the present study aims to identify the structural model for the relationships between nurses' communication skills, problem-solving ability, understanding of patients' conditions, and nurse's perception of professionalism. Additionally, the study provides basic data necessary for developing programs for improving nursing abilities.
Critical thinking, as described by Oxford Languages, is the objective analysis and evaluation of an issue in order to form a judgement. Active and skillful approach, evaluation, assessment, synthesis, and/or evaluation of information obtained from, or made by, observation, knowledge, reflection, acumen or conversation, as a guide to belief and action, requires the critical thinking process ...
In the present study conducted by some studies, problem-solving and critical thinking and decision-making scores of nursing students are moderate [5, 24, 31]. The results showed that problem-solving skills, critical thinking, and decision-making in nursing students were promoted through a social problem-solving training course.
The term 'critical thinking' is often used interchangeably with problem-solving and clinical decision-making in nursing literature. Problem-solving focuses on identification and resolution, whereas critical thinking goes beyond this and incorporates asking questions and critiquing solutions. The concept of clinical decision-making focuses ...
Critical thinking/problem-solving skills should emphasize self-examination. It should teach an individual to accomplish this using a series of steps that progress in a logical fashion, stressing that critical thinking is a progression of logical thought, not an unguided process. ... Alfaro-LeFevre R. Critical thinking in nursing: a practical ...
In literature 'critical thinking' is often used, and perhaps confused, with problem-solving and clinical decision-making skills and clinical reasoning. In practice, problem-solving tends to focus on the identification and resolution of a problem, whilst critical thinking goes beyond this to incorporate asking skilled questions and ...
Nurses applying critical thinking skills can help reduce errors. "Question everything," said pediatric nurse practitioner Ersilia Pompilio RN, ... Such actions require critical thinking ability and advanced problem-solving skills. "Nurses are the eyes and ears for patients, and critical thinking allows us to be their advocates," said Allen.
Abstract. Objectives: The aim of this study was to determine critical thinking dispositions and problem solving skills of nursing students at Dokuz Eylül University, School of Nursing and compare ...
Purpose: To determine the relationship between attitude towards nursing diagnosis, critical thinking motivation, and problem-solving skills of nursing students during distance learning. Method: The descriptive and correlational study was conducted with 450 first-year nursing students from four universities. The "Positions on Nursing Diagnosis Scale," "Critical Thinking Motivational Scale," and ...
In this answer, we will discuss some effective strategies for developing critical thinking skills in nursing students. Encouraging Active Learning Active learning is a process in which students engage in activities that encourage critical thinking, problem-solving, and decision-making.
One of the National Competencies of the Nursing Undergraduate Program is a nursing student's "use of lifelong learning, problem-solving and critical thinking skills". In this context, the student is expected that they will be able to think critically in nursing care, base nursing care on the problem-solving process, and operate the decision ...
1. Critical thinking is essential in providing quality nursing care. Understanding the process of critical thinking increases the nurse's efficiency in the skill of problem solving. 2. To employ the critical thinking process, the nurse must analyze and criticize a problematic or change situation, reason, make inferences, and reach conclusions. 3.
There are many actions that can help a nurse to think critically. Five important actions are: recognition. questioning. information gathering. evaluation. communication. In order to understand ...