Structural elements of critical thinking of nurses in emergency care

Abstract

The objective of this study was to analyze the structural elements of critical thinking (CT) of nurses in the clinical decision-making process. This exploratory, qualitative study was conducted with 20 emergency care nurses in three hospitals in southern Brazil. Data were collected from April to June 2009, and a validated clinical case was applied from which nurses listed health problems, prescribed care and listed the structural elements of CT. Content analysis resulted in categories used to determine priority structural elements of CT, namely theoretical foundations and practical relationship to clinical decision making; technical and scientific knowledge and clinical experience, thought processes and clinical decision making: clinical reasoning and basis for clinical judgments of nurses: patient assessment and ethics. It was concluded that thinking critically is a skill that enables implementation of a secure and effective nursing care process.

Bases Teóricas De Pensamento Crítico Na Enfermagem Ibero-Americana: Revisão Integrativa Da Literatura

“…6 Some CT scholars, including Paul, were a reference for conducting research, 19 developed with emergency nurses, who applied a case study in order to analyze the structural elements of the CT of these professionals. The results revealed that the priority elements for clinical decision making are technical-scientific knowledge, patient assessment, clinical experience, clinical reasoning and ethics.…”

Referenciais teóricos e instrumentos para avaliação do pensamento crítico na enfermagem e na educação

“…Analysis of the international papers allowed the identification of the most cited authors that guided the theoretical frameworks of these publications: Facione (2)(3)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) , Ennis (2)(3)11,13,19,22) , Scheffer and Rubenfeld (3,20,(23)(24) , Paul, Elder and Bartell (19)(20)(25)(26) , and Alfaro--Lefevre (9,(27)(28) . Critical thinking is considered a fundamental component in professional responsibility and care quality in nursing (3,14,20,(23)(24) .…”

“…It is also construed as an essential element of the nursing process; it must follow standards, policies, and codes of ethics in problem solving, and involve logic, intuition and creativity, crucial characteristics that are enhanced by specific knowledge and clinical practice. In addition, it focuses on safety and quality by prioritizing the needs of patients, families, and communities (9,(27)(28) . In this sense, CT would not be a method to be learned, but a process, an orientation of the mind that incorporates emotional and cognitive domains (2)(3)9,11,13,19,(27)(28)(29) .…”

“…In this sense, CT would not be a method to be learned, but a process, an orientation of the mind that incorporates emotional and cognitive domains (2)(3)9,11,13,19,(27)(28)(29) . Critical thinking is described as a nurse's basic skill to organize the nursing process and solve patients' problems, contributing to a safe and effective care in different clinical settings (2)(3)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) . It is a fundamental tool to face successfully the complexity of modern life, which is scientifically and technologically (20,30) .…”

“…These features cause CT to be multidimensional, encompassing intellectual (logic, rationality), psychological (self-awareness, empathy), sociological (historical-social context), ethical (moral rules and evaluation) and philosophical (meaning of human nature and life) dimensions (25,(19)(20)26,31) . In addition to these characteristics, CT is defined as the rational and reflexive thinking, centered at the decision of what to believe in or do (13,22,(31)(32)(33) , the intentional judgment that results in interpretation, analysis, evaluation and inference, as well as the explanation of the evidence on which a decision was based (2)(3)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)34) . Critical thinking is considered a reflexive thinking that evaluates statements correctly and focuses on the decision of what to believe in (3,16,31,35) .…”