Critical thinking and clinical judgement
Modus operandi thinking keeps track of the particular patient, the way the illness unfolds, the meanings of the patient’s responses as they have occurred in the particular time sequence. If the patient is agitated and uncomfortable, then attending to comfort needs in relation to hemodynamics will be a priority.
Critical thinking and judgement
Many qualitative distinctions can be made only by observing differences through touch, sound, or sight, such as the qualities of a wound, skin turgor, color, capillary refill, or the engagement and energy level of the patient. For example, less experienced nurses—and it could be argued experienced as well—can use nursing diagnoses practice guidelines as part of their professional advancement.
This is demonstrated in nursing by clinical judgment, which includes ethical, diagnostic, and therapeutic dimensions and research7 (p. Another example includes forecasting an accident victim’s potential injuries, and recognizing that intubation might be pation of crises, risks, and vulnerabilities for particular patientsthis aspect of clinical forethought is central to knowing the particular patient, family, or community.
He identified three flaws in the understanding of experience in greek philosophy: (1) empirical knowing is the opposite of experience with science; (2) practice is reduced to techne or the application of rational thought or technique; and (3) action and skilled know-how are considered temporary and capricious as compared to reason, which the greeks considered as ultimate practice, nursing and medicine require both techne and phronesis. The clinician’s ability to provide safe, high-quality care can be dependent upon their ability to reason, think, and judge, which can be limited by lack of experience.
Over time, the clinician develops a deep background understanding that allows for expert diagnostic and interventions al forethoughtclinical forethought is intertwined with clinical grasp, but it is much more deliberate and even routinized than clinical grasp. Intuition is characterized by factual knowledge, “immediate possession of knowledge, and knowledge independent of the linear reasoning process”68 (p.
The investigators are encouraged by teaching strategies that integrate the latest scientific knowledge and relevant clinical evidence with clinical reasoning about particular patients in unfolding rather than static cases, while keeping the patient and family experience and concerns relevant to clinical concerns and al judgment or phronesis is required to evaluate and integrate techne and scientific nursing, professional practice is wise and effective usually to the extent that the professional creates relational and communication contexts where clients/patients can be open and trusting. Evidence is missingin many clinical situations, there may be no clear guidelines and few or even no relevant clinical trials to guide decisionmaking.
Simulations cannot have the sub-cultures formed in practice settings that set the social mood of trust, distrust, competency, limited resources, or other forms of situated enceone of the hallmark studies in nursing providing keen insight into understanding the influence of experience was a qualitative study of adult, pediatric, and neonatal intensive care unit (icu) nurses, where the nurses were clustered into advanced beginner, intermediate, and expert level of practice categories. While some aspects of medical and nursing practice fall into the category of techne, much of nursing and medical practice falls outside means-ends rationality and must be governed by concern for doing good or what is best for the patient in particular circumstances, where being in a relationship and discerning particular human concerns at stake guide sis, in contrast to techne, includes reasoning about the particular, across time, through changes or transitions in the patient’s and/or the clinician’s understanding.
Consistency in interventions and responses of study participants) of rcts are addressed, the meaningfulness and generalizability of the study outcomes are very limited. Expert nurses do not rely on rules and logical thought processes in problem-solving and decisionmaking.
Future think governs the style and content of the nurse’s attentiveness to the patient. Scientific research in the natural and clinical sciences typically uses formal criteria to develop “yes” and “no” judgments at prespecified times.
In this kind of reasoning-in-transition, gains and losses of understanding are noticed and adjustments in the problem approach are found that teachers in a medical surgical unit at the university of washington deliberately teach their students to engage in “detective work. The proficient nurse learned to acknowledge the changing needs of patient care and situation, and could organize interventions “by the situation as it unfolds rather than by preset goals48 (p.
Attaining accurate and consistent interpretations of patient data and information is difficult because each piece can have different meanings, and interpretations are influenced by previous experiences. The direction, implication, and consequences for the changes alter the relevance of the particular facts in the situation.
Upon the student’s questioning, the nurse did not know why the patient was receiving the high dosage and assumed the drug was for heart disease. Well, while we were sharing information about their patients, what they did that day, i didn’t tell the student to say this, but she said, ‘i just want to tell you what i did today in clinical so you don’t do the same thing, and here’s what happened.
What is in the background and foreground of the clinician’s attention shifts as predictable changes in the patient’s condition occurs, such as is seen in recovering from heart surgery or progressing through the predictable stages of labor and delivery. Bittner and tobin defined critical thinking as being “influenced by knowledge and experience, using strategies such as reflective thinking as a part of learning to identify the issues and opportunities, and holistically synthesize the information in nursing practice”4 (p.
As expertise develops from experience and gaining knowledge and transitions to the proficiency stage, the nurses’ thinking moves from steps and procedures (i. When the student asked the patient, the student found that the medication was being given for tremors and that the patient and the doctor had titrated the dosage for control of the tremors.
The clinician must act in the particular situation and time with the best clinical and scientific knowledge available. And it is easier to get positive results published than it is to get negative results published.
