CHAPTER 8 — Critical Thinking & Clinical Judgment

Critical Thinking

The active, orderly, well-thought-out process of using knowledge, experience, problem-solving, logic, reasoning, and decision-making to make appropriate nursing judgments.

Clinical Judgment

The nurse's ability to use critical thinking and clinical reasoning to recognize important client information, determine what it means, decide what is most important, take appropriate action, and evaluate the results.

Experience

Decision-making ability developed through opportunities to observe, sense, and interact with clients, followed by active reflection.

Competence

The ability to apply the nursing process and perform nursing skills proficiently.

Commitment

The ability to make choices independently and fully accept responsibility for those choices.

Knowledge

Information specific to nursing that comes from basic nursing education, evidence-based practice, continuing education, and advanced degrees or certifications.

Confidence

Belief in one's own abilities and judgment.

Independence

The ability to analyze information and make logical decisions rather than simply relying on others.

Fairness

Being objective and nonjudgmental when evaluating a client or situation.

Responsibility

Following standards of nursing practice and accepting responsibility for one's actions.

Risk-Taking

Taking a calculated chance when trying to find a better solution to a client problem.

Discipline

Using a systematic, organized approach to thinking and problem-solving.

Perseverance

Continuing to work on a problem until an appropriate solution is found.

Creativity

Using imagination to develop unique solutions to client problems.

Curiosity

Wanting and seeking additional information about clients and their problems.

Integrity

Practicing truthfully and ethically.

Humility

Recognizing and acknowledging one's own limitations or weaknesses.

Basic Critical Thinking

A level of thinking in which the nurse follows established rules, procedures, and instructions and relies heavily on experts because of limited knowledge and experience.

Complex Critical Thinking

A higher level of thinking in which the nurse analyzes and examines information, considers alternatives, and becomes more independent in decision-making.

Commitment (Level 3)

The highest level described in this framework, where the nurse makes decisions independently and accepts responsibility for those decisions.

Reflection

Purposefully thinking back on or recalling a situation to discover what was learned and gain insight into the event.

Language

Using precise, clear communication to express focused thinking and avoid ambiguous messages or expectations.

Intuition

An inner feeling or sense about a situation that may not yet be supported by obvious facts or data.

Intellectual Standards

Standards that ensure the nurse applies critical-thinking processes thoroughly.

Professional Standards

Standards that guide professional nursing practice, including ethical nursing judgment, evidence-based evaluation, professional responsibility, and providing the highest possible level of nursing care.

Recognize Cues

Identify important information about the client's condition from assessment findings, history, observations, vital signs, laboratory results, and other data.

Analyze Cues

Interpret the collected information and determine what the findings mean in relation to the client's condition.

Prioritize Hypotheses

Determine which possible problem or explanation is the most important/urgent and requires attention first.

Generate Solutions

Identify possible interventions or actions that could address the client's priority problem.

Take Actions

Implement the appropriate intervention based on analysis and planning.

Evaluate Outcomes

Determine whether the intervention was effective by reassessing the client and comparing the results with the expected outcomes.

Assessment/Data Collection

Collecting information about the client's present health status, identifying needs, and gathering additional information based on findings.

Analysis/Diagnosis/Data Collection

Interpreting and examining collected information to identify client problems and determine appropriate nursing diagnoses.

Planning

Establishing priorities and determining goals, outcomes, and appropriate interventions.

Implementation

Providing nursing care based on the assessment, analysis, and plan of care.

Evaluation

Examining the client's response to nursing interventions and determining whether goals and outcomes were met.

Scientific Method

A systematic approach to investigating a problem using organized steps and evidence.

Problem-Solving

A systematic process used to identify a problem, consider possible solutions, implement an appropriate solution, and determine whether it worked.

Decision-Making

Selecting the best option from available alternatives.

Diagnostic Reasoning

Analyzing client information to determine the most likely explanation for a client's condition or problem.

Inference

A conclusion reached by connecting pieces of available information.

Clinical Decision-Making

Using assessment information, nursing knowledge, reasoning, and collaboration to determine appropriate care for a client.

Collaboration

Working with other health care professionals to share information, solve problems, and make decisions about client care.