Chapter 6Clinical Reasoning, Decisionmaking, and Action: Patricia Benner;1 Ronda G. Clinical reasoning and judgment are examined in relation to other modes of thinking used by clinical nurses in providing quality health care to patients that avoids adverse events and patient harm. The expert performance of nurses is dependent upon continual learning and evaluation of performance.
Translate this page from English Print Page Change Text Size: Critical thinking is a rich concept that has been developing throughout the past years. The term "critical thinking" has its roots in the mid-late 20th century.
We offer here overlapping definitions, together which form a substantive, transdisciplinary conception of critical thinking. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: It entails the examination of those structures or elements of thought implicit in all reasoning: Critical thinking can be seen as having two components: It is thus to be contrasted with: Critical thinking varies according to the motivation underlying it.
As such it is typically intellectually flawed, however pragmatically successful it might be. When grounded in fairmindedness and intellectual integrity, it is typically of a higher order intellectually, though subject to the charge of "idealism" by those habituated to its selfish use.
Critical thinking of any kind is never universal in any individual; everyone is subject to episodes of undisciplined or irrational thought. Its quality is therefore typically a matter of degree and dependent on, among other things, the quality and depth of experience in a given domain of thinking or with respect to a particular class of questions.
No one is a critical thinker through-and-through, but only to such-and-such a degree, with such-and-such insights and blind spots, subject to such-and-such tendencies towards self-delusion.
For this reason, the development of critical thinking skills and dispositions is a life-long endeavor. Another Brief Conceptualization of Critical Thinking Critical thinking is self-guided, self-disciplined thinking which attempts to reason at the highest level of quality in a fair-minded way.
People who think critically consistently attempt to live rationally, reasonably, empathically. They are keenly aware of the inherently flawed nature of human thinking when left unchecked. They strive to diminish the power of their egocentric and sociocentric tendencies. They use the intellectual tools that critical thinking offers — concepts and principles that enable them to analyze, assess, and improve thinking.
They work diligently to develop the intellectual virtues of intellectual integrity, intellectual humility, intellectual civility, intellectual empathy, intellectual sense of justice and confidence in reason.
They realize that no matter how skilled they are as thinkers, they can always improve their reasoning abilities and they will at times fall prey to mistakes in reasoning, human irrationality, prejudices, biases, distortions, uncritically accepted social rules and taboos, self-interest, and vested interest.
They strive to improve the world in whatever ways they can and contribute to a more rational, civilized society. At the same time, they recognize the complexities often inherent in doing so. They avoid thinking simplistically about complicated issues and strive to appropriately consider the rights and needs of relevant others.
They recognize the complexities in developing as thinkers, and commit themselves to life-long practice toward self-improvement. They embody the Socratic principle: The unexamined life is not worth livingbecause they realize that many unexamined lives together result in an uncritical, unjust, dangerous world.
The Problem Everyone thinks; it is our nature to do so. But much of our thinking, left to itself, is biased, distorted, partial, uninformed or down-right prejudiced. Yet the quality of our life and that of what we produce, make, or build depends precisely on the quality of our thought. Shoddy thinking is costly, both in money and in quality of life.
Excellence in thought, however, must be systematically cultivated. The Result A well cultivated critical thinker: Critical thinking is, in short, self-directed, self-disciplined, self-monitored, and self-corrective thinking.
It presupposes assent to rigorous standards of excellence and mindful command of their use. It entails effective communication and problem solving abilities and a commitment to overcome our native egocentrism and sociocentrism. Critical thinking calls for a persistent effort to examine any belief or supposed form of knowledge in the light of the evidence that supports it and the further conclusions to which it tends.Thinking Model provides a visual representation of critical think- ing abilities and promotes making meaningful connections between nursing research and critical thinking and practice (Figure 10–1 •).
Critical thinking underlies independent and interdependent decision making. Critical thinking includes questioning, analysis, synthesis, interpretation, Gordon M. Clinical judgment: an integrated model. Decisionmaking, and Action: Thinking Critically and Clinically - Patient Safety and Quality.
The Critical Thinking Model for Nursing Judgment builds upon the concepts of Miller and Malcolm, but expands to include components of nursing experience, competencies, and standards.
Critical thinking — in being responsive to variable subject matter, issues, and purposes — is incorporated in a family of interwoven modes of thinking, among them: scientific thinking, mathematical thinking, historical thinking, anthropological thinking, economic thinking, moral thinking, and philosophical thinking.
Clinical decision making is a balance of experience, awareness, knowledge and information gathering, using appropriate assessment tools, your colleagues and evidence-based practice to guide you.
Professional and regulatory bodies in nursing education have required that critical thinking be central to all nursing curricula, but they have not adequately distinguished critical reflection from ethical, clinical, or even creative thinking for decisionmaking or actions required by the clinician.