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UNIT 1 How Nurses Think
■ Fair-mindedness. Critical thinkers try to make impar- tial judgments, realizing that personal biases, customs, and social pressures can influence their thinking. ■ Confidence in reasoning. Critical thinkers rely on inductive and deductive processes to have confidence in their own reasoning. Critical thinking can be used in all aspects of your life. Whenever you are trying to reach an important decision, reasoned action (critical thinking) is called for. Everyday uses of critical thinking might include decid- ing where you should live or which job offer to accept. The rest of this chapter shows you why critical thinking is important to you in your chosen profession, nursing. Knowledge Check 2-5 ■ Define critical thinking in your own words. ■ List five skills or attitudes that reflect critical thinking.
would need to evaluate whether the adult requires care in the hospital or in a skilled care facility and what support services they will need as they conva- lesce. In the inpatient setting, nursing interventions might initially include assisting the client with eating, bathing, and toileting. Clients Are Unique Critical thinking is important because each client is unique. This means that the response to therapy may vary from client to client. Their differences (e.g., type of illness, comorbidities, culture, and age) make it impossi- ble to provide rigid rules for all client care. Individual Differences Research-based care plans and protocols identify guidelines for providing care; however, nurses must evaluate and modify these guide- lines to be appropriate for each client. Consider the following example: You may have been told to drink plenty of fluids when you have a cough, to keep the secretions moist. Now imagine you are caring for a client with renal failure. Your client no longer urinates and may need dialysis. When they develop a persistent cough, should you encourage them to drink as much fluid as possible? Do you see how you could cause harm to a client by unthinkingly doing as you have been told or what has worked well for another client? Key Point: Nurses must always think, “How will that work in this instance?” and “How is this similar or different from other client situations?” Client’s Personal Beliefs Ethnic, cultural, and spir- itual background affect a person’s view of health and the healthcare system, as well as their responses to health problems. Personal beliefs influence how people define sickness, at what point they seek healthcare, what type of healthcare provider they see, and the type of treat- ment they consider acceptable. Critical thinking enables the nurse to assess the client’s and family’s beliefs and adapt care so that it is culturally sensitive and respon- sive to their needs. Client’s Roles A person’s roles influence when, how, and why they seek healthcare. A single parent with young children may ask to be discharged from the hospital early to meet the needs of their family. Clients with extensive support from family or friends may be willing to take more time to convalesce when ill. Nurses take these things into consideration, for example, when determining whether a nursing inter- vention is appropriate or why it was (or was not) successful. Other Factors The following factors may also influence how a person responds to illness or to health- care intervention: ■ Age. Each of us was raised with a set of beliefs, values, and knowledge that was strongly influenced by the prevailing views of our times.
WHY IS CRITICAL THINKING IMPORTANT FOR NURSES?
Critical thinking helps you to know what is important about each client’s situation. Nurses use complex crit- ical-thinking processes (e.g., problem-solving, deci- sion making, clinical reasoning, and clinical judgment) in every aspect of their work. Because nurses care for a variety of clients with a multitude of concerns, a cli- ent’s response to therapy may not always be apparent. Key Point: You constantly assess your clients to deter- mine how they are responding to nursing interventions and medical treatments. Reasoning and reflection are required to determine what interventions to use and whether they worked—and if not, figure out why. Nurses Deal with Complex Situations Critical thinking is important for nurses because they deal with complicated situations. One such situation is that of caring for clients with comorbidities (more than one health problem occurring at the same time). Consider the following situations: ■ A healthy 9-year-old who fell and fractured their right arm; they have no comorbidities . They would experience pain and discomfort, but with proper cast- ing and time to heal, the child would recover. While recovering, they may have to limit the use of their injured arm and use their left hand to eat. The child would likely be discharged home from the urgent set- ting in the care of their parent(s) or guardian(s). The nurse’s primary interventions would be to teach the and recognize signs of complications. ■ An older adult who has fractured their right arm; they are also recovering from a stroke that limits the use of their left arm. Their expe- rience would be quite different from that of the 9-year-old. A right-arm fracture would severely affect this person's ability to provide self-care. The nurse
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