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This research received external funding from the European programme Eramus +2021-1-BE02-KA220-HED-000023194.
Conceptualisation, A.P.-P. and A.Z.; methodology, A.P.-P. and A.Z.; formal analysis, A.P.-P.; writing—original draft preparation, A.P.-P.; writing—review and editing, A.Z.; visualisation, A.Z.; supervision, A.Z. All authors have read and agreed to the published version of the manuscript.
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Data availability statement, conflicts of interest.
The authors declare no conflict of interest.
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Intended for healthcare professionals
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The characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice. Nurses’ ability to recognize and respond to signs of patient deterioration in a timely manner plays a pivotal role in patient outcomes (Purling & King 2012). Errors in clinical judgement and decision making are said to account for more than half of adverse clinical events (Tomlinson, 2015). The focus of the nurse clinical judgement has to be on quality evidence based care delivery, therefore, observational and reasoning skills will result in sound, reliable, clinical judgements. Clinical judgement, a concept which is critical to the nursing can be complex, because the nurse is required to use observation skills, identify relevant information, to identify the relationships among given elements through reasoning and judgement. Clinical reasoning is the process by which nurses observe patients status, process the information, come to an understanding of the patient problem, plan and implement interventions, evaluate outcomes, with reflection and learning from the process (Levett-Jones et al, 2010). At all times, nurses are responsible for their actions and are accountable for nursing judgment and action or inaction.
The speed and ability by which the nurses make sound clinical judgement is affected by their experience. Novice nurses may find this process difficult, whereas the experienced nurse should rely on her intuition, followed by fast action. Therefore education must begin at the undergraduate level to develop students’ critical thinking and clinical reasoning skills. Clinical reasoning is a learnt skill requiring determination and active engagement in deliberate practice design to improve performance. In order to acquire such skills, students need to develop critical thinking ability, as well as an understanding of how judgements and decisions are reached in complex healthcare environments.
As lifelong learners, nurses are constantly accumulating more knowledge, expertise, and experience, and it’s a rare nurse indeed who chooses to not apply his or her mind towards the goal of constant learning and professional growth. Institute of Medicine (IOM) report on the Future of Nursing, stated, that nurses must continue their education and engage in lifelong learning to gain the needed competencies for practice. American Nurses Association (ANA), Scope and Standards of Practice requires a nurse to remain involved in continuous learning and strengthening individual practice (p.26)
Alfaro-LeFevre, R. (2009). Critical thinking and clinical judgement: A practical approach to outcome-focused thinking. (4th ed.). St Louis: Elsevier
The future of nursing: Leading change, advancing health, (2010). https://campaignforaction.org/resource/future-nursing-iom-report
Levett-Jones, T., Hoffman, K. Dempsey, Y. Jeong, S., Noble, D., Norton, C., Roche, J., & Hickey, N. (2010). The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today. 30(6), 515-520.
NMC (2010) New Standards for Pre-Registration Nursing. London: Nursing and Midwifery Council.
Purling A. & King L. (2012). A literature review: graduate nurses’ preparedness for recognising and responding to the deteriorating patient. Journal of Clinical Nursing, 21(23–24), 3451–3465
Thompson, C., Aitken, l., Doran, D., Dowing, D. (2013). An agenda for clinical decision making and judgement in nursing research and education. International Journal of Nursing Studies, 50 (12), 1720 - 1726 Tomlinson, J. (2015). Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis. BMC Medical Education, 15(103)
Competing interests: No competing interests
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Aim: The aims of this study were to explore year two nursing students' perceptions toward critical thinking and clinical reasoning and to identify the barriers faced by the students in developing critical thinking and clinical reasoning.
Background: Critical thinking and clinical reasoning are core competencies emphasized in nursing practices. Nursing students are required to develop and practice these skills throughout their nursing programs to graduate as competent nurses. However, recent studies still report a lack of critical thinking and clinical reasoning in nursing students and fresh graduates. Hence, it is important to recognize the perceptions of nursing students and the barriers that they face in developing critical thinking and clinical reasoning skills.
Methods: An exploratory descriptive qualitative study design was adopted. Twenty nursing students were recruited from a university in Singapore. Individual face-to-face interviews, using semi-structured questions and an interview guide, were conducted in the academic year 2018/2019. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyze the data.
Results: Seven themes were emerged, namely: 1) essentials for nursing practices, 2) linking theory to practice, 3) individual thought process, 4) stimulating strategies, 5) classroom environment, 6) clinical environment, and 7) students' attributes. Nursing students perceived critical thinking and clinical reasoning as essential for nursing practices and described these skills as linking theory to practice. Strategies such as simulation, case studies, real clinical experiences, and guidance from clinical instructors/preceptors were found to stimulate critical thinking and clinical reasoning for the students. Barriers to developing critical thinking included classroom environments, such teaching methods and student-to-tutor ratios, ward environments/cultures, and students' attributes/attitudes toward learning.
Conclusion: The findings provided areas for improvement in the current nursing education and practices to better support nursing students in developing critical thinking and clinical reasoning skills.
Keywords: Clinical problem-solving; Clinical reasoning; Critical thinking; Nursing education; Nursing students; Perceptions; Qualitative study.
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Critical thinking in nursing is invaluable for safe, effective, patient-centered care. You can successfully navigate challenges in the ever-changing health care environment by continually developing and applying these skills. Images sourced from Getty Images. Critical thinking in nursing is essential to providing high-quality patient care.
The following are examples of attributes of excellent critical thinking skills in nursing. 1. The ability to interpret information: In nursing, the interpretation of patient data is an essential part of critical thinking. Nurses must determine the significance of vital signs, lab values, and data associated with physical assessment.
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 ...
Critical thinking is applied by nurses in the process of solving problems of patients and decision-making process with creativity to enhance the effect. It is an essential process for a safe, efficient and skillful nursing intervention. Critical thinking according to Scriven and Paul is the mental active process and subtle perception, analysis ...
Effective thinking in nursing involves the integration of clinical knowledge and critical thinking to make the best decisions for patients. For example, if a nurse was caring for a patient who presents with hypertension and new-onset left-sided weakness, it is important that the nurse be able to quickly consider potential causes for the ...
The development of critical thinking in nursing practice involves progressing through three levels: basic, complex, and commitment. The Kataoka-Yahiro and Saylor model outlines this progression. 1. Basic Critical Thinking: At this level, learners trust experts for solutions. Thinking is based on rules and principles.
Critical thinking allows nurses to double-check medication orders, consider potential drug interactions, and ensure the correct dosage is administered. This vigilance minimizes the risk of medication errors and enhances patient safety. 4. Developing and implementing care plans.
Critical Thinking. Nursing education has emphasized critical thinking as an essential nursing skill for more than 50 years. 1 The definitions of critical thinking have evolved over the years. There are several key definitions for critical thinking to consider. ... Every clinician must develop rigorous habits of critical thinking, ...
Critical thinking is an essential cognitive process that enables nurses to analyze, evaluate, and synthesize information to make informed decisions. In the context of nursing, it involves observing, interpreting, and responding to patient needs effectively. Critical thinking allows nurses to go beyond memorized facts and apply logical reasoning ...
2. Meeting with Colleagues: Collaborative Learning for Critical Thinking. Regular interactions with colleagues foster a collaborative learning environment. Sharing experiences, discussing diverse viewpoints, and providing constructive feedback enhance critical thinking skills. Colleagues' insights can challenge assumptions and broaden ...
Critical thinking in nursing refers to the analytical process that nurses use to solve clinical problems and make decisions regarding patient care. It involves gathering information, questioning, analyzing, and applying theory to ensure high-quality care delivery. Nurse Education in Practice, 2022. About this page.
develop and practice the critical thinking skills needed by successful students and competent nurses (Ward & Morris, 2016; Boso et al., 2020). Nursing students must begin learning critical thinking skills early in a nursing program, and the process of enhancing these skills should be reinforced and threaded throughout the
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. It could be said that they become a virtue of the nursing ...
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 ...
In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing care and nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. ... The importance of developing ...
4. IMPLEMENTATION OF CRITICAL THINKING IN NURSING PRACTICE In their shifts nurses act effectively without using critical thinking as many decisions are mainly based on habit and have a minimum reflection. Thus, higher critical thinking skills are put into operation, when some new ideas or needs are displayed to take a deci-sion beyond routine.
Clinical simulation was used to develop nursing students' clinical reasoning in evaluating wounds and their treatments , to evaluate and compare the perception of stressors, with the goal of determining whether simulations promote students' self-evaluation and critical-thinking skills , and also to evaluate the impact of multiple ...
Critical thinking is the process of gathering information, fully assessing it and then developing an opinion in response. Nurses use critical thinking to make informed decisions about a patient's medical care such as choosing which tests to run and communicating their opinions to doctors. Nurses often are the first to examine a patient in a ...
Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice. ... In order to acquire such skills, students need to develop critical thinking ability, as well as an understanding of how judgements and decisions are ...
Teaching Critical Thinking to Nurses. In 2015, a study in the Journal of College Teaching & Learning found a positive correlation between critical thinking skills and success in nursing school. The study said, "It is the responsibility of nurse educators to ensure that nursing graduates have developed the critical thinking abilities necessary ...
This study supports the need for different learning methods to develop nursing students' critical thinking and clinical decision-making levels. It is seen that there is a need for revision in the delivery of education and training in nursing schools, taking into account extraordinary situations (distance education, etc.) as in the COVID-19 ...
Aim: The aims of this study were to explore year two nursing students' perceptions toward critical thinking and clinical reasoning and to identify the barriers faced by the students in developing critical thinking and clinical reasoning. Background: Critical thinking and clinical reasoning are core competencies emphasized in nursing practices.