CRITICAL THINKING IN

NURSING PRACTICE

TITIH HURIAH
Critical Thinking and Nursing
Judgment

How do we make
decisions?
How do nurses
make decisions
about patient
care?
What do we rely
on to help us in
decision making?
Critical Thinking and Nursing
Judgment

Not a linear step by step process

Process acquired through hard
work, commitment, and an active
curiosity toward learning
Decision making is the skill that
separates the professional nurse
from technical or ancillary staff
Critical Thinking and Nursing
Judgment

Good problem
solving skills
Not always a
clear textbook
answer
Nurse must
learn to
question, look
at alternatives
How do nurse's accomplish
this?
Learns to be flexible in clinical
decision making
Reflect on past experiences
and previous knowledge
Listen to others point of view
Identify the nature of the
problem
Select the best solution for
improving clients health
 CRITICAL THINKING
Critical thinking is an active,
organized, cognitive process used
to carefully examine ones thinking
and the thinking of others (Pg. 216)
Recognize that an issue exists
Analyzing information about the
issue
Evaluating information
Making conclusions
Critical Thinking

It involves the use of the mind

in forming conclusions,
making decisions, drawing
inferences, and reflecting
Critical Thinking Requires

Cognitive skills
Ask questions
Remain well-informed
Be honest in facing personal
biases
Be willing to reconsider and
think clearly about issues
Attributes of a Critical
Thinker
Asks questions
Is able to admit a lack of
understanding or information
Is interested in finding new
solutions
Listens carefully to others and is
able to give feedback
Examines problems closely
Critical Thinking Can Lead
To

Sound clinical decisions

Using the Nursing Process to

guide patient care

Evidence-Based Practice (EBP)

Developing Critical Thinking
Skills

Reflection = the process of

purposefully thinking back or
recalling a situation to
discover its purpose or
meaning
Concept mapping
Critical Thinking in Nursing

Purposeful, outcome-directed
Driven by patient, family, and
community needs
Based on principles of nursing
process and the scientific
method
Requires specific knowledge,
skills, and experience
New nurses must question
Critical Thinking in Nursing

Guided by professional
standards and ethic codes
Requires strategies that
maximize potential and
compensate for problems
Constantly reevaluating, self-
correcting, and striving to
improve
Formula for Critical Thinking

Start Thinking

Why Ask Why

Ask the Right Questions

Are you an expert?

 Aspects of Critical Thinking

Reflection

Language

Intuition
Levels of Critical Thinking

Basic

Complex

Commitment
Critical Thinking Competencies

Scientific method
Problem Solving
Decision Making
Diagnostic Reasoning and
Inferences
Clinical Decision Making
Nursing Process
Thinking and Learning

Lifelong process
Flexible, open process
Learn to think and to ANTICIPATE
What, why, how questions
Look beyond the obvious
Reflect on past experience
New knowledge challenges the
traditional way
 Level 3
Commitment

Level 2
Complex
Level 1
Basic

Specific Knowledge Base

Experience

Competencies

Attitudes

Standards
Components Of Critical Thinking

Scientific Knowledge Base

Experience
Competencies
Attitudes
Standards
Professional Standards
Ethical criteria for Nursing judgment-
Code of Ethics
Criteria for evaluation- Standards of care
Standards of professional responsibility
that nurses strive to achieve are cited in
Nurse Practice Acts, Joint Commission
guidelines, institutional policy and
procedure, ANA Standards of
Professional Practice
Critical Thinking Synthesis

Reasoning process by which

individuals reflect on and
analyze their own thoughts,
actions, & decisions and those
of others

Not a step by step process

Model berfikir kritis :
Costa,dkk (1985) The Six R

Rememberingmenggunakan pengalaman
masa lalu
Repeating semakin sering berfikir kritis
semakin mudah mengambil keputusan
Reasoningkeputusan didasari atas
berfikir kritis/pertimbangan akurat
Reorganizingmengorganisasikan fakta yg
mendukung fenomena
Relatingmenemukan relasi antara
fenomena
Reflectingmenganalisa kembali secara
hati-hati.
Asumsi berfikir :
Komponen dasar kep. berfikir,
perasaan dan perbuatan sejalan.
Mengembangkan upaya berfikir kritis
adalah upaya yg disengaja.
Jangan hanya apa yang difikirkan,
tetapi bgmn berfikir.
Berfikir dalam keperawatan sama
dengan situasi pribadi.
Bentuk berfikir (THINK)

1. Total recall fakta kep.datang dari

berbagai sumber
2. Habits suatu tindakan biasa
dilakukan berulang akan secara
spontan dilakukan.
3. Inquiry keputusan akan lebh
baik/akurat bila dg.inquiry.
4. New ideas and creativity banyak
belajar/peroleh info baru.
5. Knowing how you think sadar
bahwa perawat sedang berfikir.
Penerapan Konsep Berfikir kritis
dalam keperawatan :

1. Penggunaan bahasa dalam

keperawatan
2. Argumentasi dalam keperawatan
3. Pengambilan keputusan
4. Penerapan dalam proses
keperawatan.
Penggunaan bahasa dalam kep.

Perawat menggunakan bahasa verbal dan

non verbal mengekspresikan
ide/fikiran/info/fakta/perasaan/keyakinan
dan sikap thd.klien/sesama
perawat/profesi lain.
Penggunaan bahasa :
1. Memberi info yg dapat diklarifikasi,
mis.info pentingnya kompres pada klien
2. Mengekspresikan perasaan dan sikap,
mis.pengumuman jam besk efektif
memberikan kesempatan klien istirahat.
3. Melaksanakan perencanaan kep/ide dalam
tindakan kep, mis.info diet rendah
kolesterol, info makanan yang
dianjurkan/dihindari.
4. Mengajukan pertanyaan dalam rangka
mencari info, mengekspresikan keraguan
dan keheranan, mis.mengapa Tn.A tiba-
tiba syok?.
5. Mengekspresikan pengandaian, mis. Bila
diberikan digitalis, gejala serangan
jantung tidak muncul.
Argumentasi dalam
keperawatan :

Perawat dihadapkan untuk

beradu argumentasi bersama
anggota timnya menemukan,
menjelaskan kebenaran,
mengklarifikasi isu,memberi
penjelasan, mempertahankan
thd tuntutan/tuduhan.
Badman and Badman (1988)
argumentasi terkait berfikir
dalam kep. :
a. Berhubungan dg.situasi
perdebatan/pertengkaran.
b. Debat tentang suatu isuKepala
Ruangan dg pimpinan RS tentang
kebijakan yan kep bermutu.
c. Upaya mempengaruhi
individu/kelompok untuk berbuat
sesuatu dalam rangka merubah
perilaku sehat, mis.iklan layanan
kesehatan tentang pemberantasan
sarang nyamuk u/mencegah
demam berdarah.
d. Berhubungan dg.bentuk
penjelasan yg rasional yg
memerlukan serangkaian alasan
perlunya keyakinan dan
pengambilan keputusan,mis.
Monitor kadar gula darah setiap
hari pada klien A.
TERIMA KASIH