Critical Thinking
Problem Solving
Critical Thinking
in Nursing
Clinical Reasoning
Priority Setting
Decision Making
Lipe, S. K. & Beasley, S., (2004). Critical Thinking in Nursing: A cognitive skills
workbook. Lippincott. Philadelphia, PA.
OBJECTIVES
Utilize critical thinking to develop
treatment plan in both simulated and
clinical situations.
 Discuss the process of critically
thinking.
 Identify common errors in utilizing
the critical thinking process.

OBJECTIVES

Discuss the characteristics of a critical
thinker and standards commonly applied
when critically thinking.

Explain how time management, client
care needs/activities, multitasking, and
nursing diagnoses are integral to the
prioritizing processes.
OBJECTIVES



Prioritize nursing diagnoses using patient
condition as the basis for decisions.
Formulate priorities for management and
delivery of nursing care in various
settings.
Apply critical thinking and prioritizing to
client scenarios and NCLEX-style
questions.
CRITICAL THINKING

Ennis – ‘reasonable, reflective thinking
that is focused on deciding what to believe
or do’
[Lipe & Beasley (Nosich, 2001, p.2)]

‘Critical Thinking is goal directed; it is
thinking with a purpose.’ (Lipe & Beasley,
2004, p. 3)
Decision Making
Problem Solving

Systematic approach
resulting in
formation of
solutions

Involves choosing
from options

It is a step in the
problem solving
process
Characteristics of a Critical Thinker








Independent thinker
Questioning
Recognizes biases &
assumptions
Observant
Organize/cluster data
Prioritizes
Open minded
Open to new ideas

Flexible-willing to
change
Innovative, creative
Analytical
Communicator
Assertive
Knowledgeable
Resourceful
Intuitive

“Out of the box”







thinker
Process of Critically Thinking
1. We think
for
a purpose
2. Seek other
points of view
In attempting
to answer
a question
7. Based on
concepts &
theories
6. Data, facts, &
experiences are
used to make
inferences &
judgments
Critical
Thinking
5. We use
data,
facts, &
experiences
3. Decisions
are
influenced by
assumptions
4. Reasoning
leads
to implications
&
consequences

http://www.criticalthinking.org/
CTmodel/CTModel1.cfm#
6 Essential Cognitive Skills of
Critical Thinking

Interpretation – ability to explain the meaning of
information

Analysis – examine subjective and objective, advantages,
disadvantages, and consequences

Evaluation – Is info source credible? Any bias? Is info
relevant?

Inference – draw a conclusion based on info

Explanation – ability to explain one’s conclusions

Self-regulation – reflecting on our own thinking; Did I
have all the facts? Are my assumptions correct/ incorrect?
Pitfalls in Critical Thinking

Illogical Process

Bias

Closedmindedness
SCENARIO







Situation: Frank Fellow, a 72-year-old patient admitted
for acute confusion presented in the emergency
department (ED) with a history of hypertension, diabetes
type 1, and arthritis. He lives in a single-family home with
his wife.
The client is slightly confused and has an unsteady gait. He
frequently forgets to use his walker and fails to call for
assistance from the nursing staff when ambulating to the
bathroom.
Interpretation - clarifying
Analysis - questioning
Outcomes – what do you expect?
Inference - conclusion
Self Regulation – what else?
INFLUENCING FACTORS

Emotions

Values

Perceptions

Social climate
Characteristics of an Effective
Decision Maker







Self Confident
Assertive
Proactive
Flexibility
Knowledgeable
Ability to accept responsibility
Ability to focus
 Priorities
first
Are these characteristics similar to the critical thinker?
Prioritizing
 Time
Management
 Maslow Hierarchy of
Needs
 Prioritizing Nursing
Diagnoses
 Priority Activities
 Multitasking
 Nursing Process
SelfAct
Self-esteem
Love and Belonging
Safety and Security
Physiologic Needs

The 34 yr. patient with cirrhosis is admitted for
dehydration and needs a central line for high volume fluid
replacement. Vital signs upon arrival on the unit at 2 pm
were temp 99, pulse 102, r 24, b/p 90/60. The nurse has
finished report and the physician is on the way to the unit
to place a central line. Which nursing activity is the
highest priority?
A.
B.
C.
D.
E.
Ensure consent signed
Take the patient’s vital signs
Notify the family
Listen to breath sounds
Assess urinary output
16-year-old boy transported to the emergency department
by ambulance following a MVA. Witnesses report his car
slid on ice, and the vehicle became airborne, throwing the
adolescent from his car. Initial assessment reveals that the
patient has a patent airway, is responsive to painful
stimuli, has a laceration to his left thigh that is covered
with a dressing, and has contusions to the left flank area.
Place the following activities in order of priority.
___Call the parents for consent to treat
___Immobilize head and neck
___Assess level of consciousness and neurologic deficits
___Assess left thigh and apply clean pressure dressing

PITFALLS IN PRIORITY SETTING
 Inadequate
Assessment and Evaluation
of Client Needs
 Failure to Differentiate Between Priority
and Non-priority Tasks
 Acceptance of Others’ Priorities Without
Assessing All the Variables
 Performance of Tasks with a “First
Identified, First Completed” Approach
 Completion of the Easiest Tasks First
 The
patient is resting quietly, breath sounds
clear, respirations easy and unlabored, skin
color pink. O2 @ 3 Liters, and O2 sat is 98%.
After eating dinner , the patient rings the
nurse. The nurse’s assessment reveals
respirations are 30 breaths/min and labored,
crackles are auscultated bilaterally, skin color
dusky, and the SpO2 82%.
 What
are you the nurse going to do?
 The
nurse intervenes by
 Elevating
the head of the bed
 Applying prescried O2 through a nonrebreather
 Notify Physician
…
…
…
CALLING THE PHYSICIAN
Change in status
 Pain w/o ordered mgmt
strategies
 Lack of treatment orders
 Lab values
 Risk to safety

LAB VALUES
Do not consider lab values in
isolation
 Evaluate data and compared to
patient’s clinical status
 Compare to age, medical diagnosis,
assessment data, physical status,
physical orders, current treatment,
previous labs


Failure to assess, monitor, and
report…

negligence





13. Which patient should the nurse see first?
A. a 40 yo 7 day postpartum female with
bright red vaginal bleeding and a hgb of 7.0
g/dL.
B. A diabetic patient with a blood sugar of
400 mg/dL and no orders for insulin
coverage.
C. A 46 yo ESRD patient who had an AV
fistula placement 2 days ago. No thrill or
bruit noted.
D. A 50 yo woman, 2 days after knee
replacement. She refuses to use CPM
machine due to pain
Critical
Thinking
Clinical
Reasoning
Prioritizing
Client
Care
Problem
Solving
Decision