Critical thinking is best described as the ability to consider in details, facts, generate and organize ideas, draw inferences, make comparisons, draw opinions, evaluate arguments and solve problems (Fascione 2013, pp 70-76). Critical thinking goes hand in hand with reflective practice which is best defined as the power to analyze one’s action and experience with the result of enhancing clinical knowledge and developing their practice. So as to qualify or be accepted as a professional nurse requires that you develop critical thinking skills. The main thing that makes nurses different from other health practitioners, is how we look at the client and handle the problems. Critical thinking demands that we gain knowledge on the content of nursing; theories of nursing, ideas, and concepts and also grow our intellectual capacities and skills so that we develop to be self-disciplined, self-directed and critical thinkers. The main objectives in this essay include the importance of critical thinking and reflective practice in nursing and the challenges that nurses face such as communicating bad news, working in teams, managing conflict, and satisfying patient’s needs.
Critical thinking
The most important function of a nurse is to assist an individual, ill or well, in performing function that will contribute to their health or recovery that he or she would perform unaided if he had the necessary strength, knowledge, and to do this in a way as to help him or her gain independence as rapidly as possible. To help a patient maintain, regain or improve their health one must think critically to problem solve and find a solution for patient’s health problem (Fascione 2013, pp 70-76).
A nurse would require critical thinking in the following areas; during the performance of nursing assessment, when coming with nursing diagnosis, when planning a nursing intervention, when executing nursing specialties like infection control and case management and lastly during the encounter of a problem that appears not to have no straightforward answer.
So as to advance into a critical thinker the nurse needs to apply reflection, and language.
Reflection is recalling a situation to discover its purpose or meaning. Looking back and reflecting on a patient situation assists the nurse in charge to have a clear or deep perception of a situation. It also helps a nurse to realize the relationship between the concepts learned in class and real-life clinical situations. Reflection allows the nurse to view the condition ethically and do some evaluation of the situation example, what was mentioned and how did I answer, how did the client react when I did the teaching and lastly how did the family react?
An individual’s ability to use language to express himself is a reflection on the ability to think meaningful. Nurses must be able to use language precisely and clearly and when language is not clearly spoken it is a sign of a sloppy thinking.
Helps in identifying crisis
For a hospital to run smoothly, health care workers have a responsibility to different aspects of clients care. In a day, a client may encounter various workers in the hospital, a phlebotomist, dietician, doctor, and physiotherapist. In some hospital, the facility requires that all the health care workers ware identifying scrubs or uniforms by color while for the students to wear name tags making it harder for the client to recognise them. This may lead to anxiety and stress since the patients may not know their treating physician. This can be achieved by introducing yourself to the patient, explain to the patient who you are and what your role in the hospital is (Rees 2013, pp 1-5). The act of connecting with the patient makes him or she feel more secure in a strange environment. Communication between the client and nurse also helps to collect information and develop a caring and supportive relationship.
Most people believe that there is a high chance of dying in a hospital than dying from an airplane crash due to an increased rate of medical errors. Clients who are not informed, included or updated about general knowledge concerning their health, procedures, and process is understandably lost and confused at the hospital (Nortson and Talerico 2013, pp 6-13).
Before entering a patient’s room, nurses use critical thinking by ensuring that they collect as much information about the client’s status and what is happening. If the nurse wants to perform a prep test, he explains the procedure to the client, if the nurse is giving medication, the nurse explains the type of medication that is being administered and the side effects of the drug. If a client asks a question and the nurse ends up not knowing the answer, he uses his critical thinking skills by explaining to the client that you will come to answer his question after the round, so as to avoid any mistrust from the client.
The nurse applies critical thinking by ensuring that he explain the medical condition to the patient in a lay man’s language and avoid the use of medical jargons that will leave the client confused. The nurse uses a positive tone during his explanation, this is to ensure that the patients do not panic or think he or she will die.
Every hospital usually has a system and a language of its own. Health care practitioners communicate with each other usually in hospital-speak, a language that patients do not understand. Example a nurse might walk in a patient room and ask for permission to take vital signs. If the client is illiterate he or she may have no clue of what the nurse is talking about or what vitals were. The other example is advising the patient to take his medicines four times a day- but he does not know what four times he should take them or when you tell a client that he or she cannot take anything by mouth but she does not understand that this means she cannot eat or drink anything.
Critical thinking helps the nurse find other alternative ways that may improve communication. The nurse may opt to use terms and expression that the patient may likely to know, call a translator so as to clear the misunderstandings or use sign language where necessary example showing the needle if an injection is required or showing the sphygmometer and thermometer if he wants to check for vitals.
The nurse may come across clients who are afraid that they may have the wrong limb amputated, get the wrong medication or be through unnecessary procedures. Some of the clients may not have experienced all this but gotten the information from the news and television programs about medical errors leading to mistrust between the client and nurse in charge.
The nurse applies critical thinking by explaining to the client how the medication distribution works. The nurse builds trust by letting the patient see the medication before he takes them so he can distinguish the pills from the colour of each. The nurse uses the same advice to clear other mistrust issues by ensuring the patient is on your side by teaching the client and letting him know that you are listening to his grievances. (Johns 2014, pp 236-234).
Patients are either put in private rooms or wards. People co-exist peacefully in private rooms but the opposite occurs in the wards. Conflicts may arise in the ward rooms, for example, inconsiderate clients may talk on the phone loudly late at night, turn up the volume of the television, they may have rowdy visitors or eat smelly nauseating food that makes the other neighbor ill. The commotion may also be without deliberate intent example a client groaning of discomfort, pain, snoring or a noisy sanction machine. All these factors keep the roommates from getting enough rest that they need for them to recover quickly, making the hospital stay even more of a trial.
The nurse intervenes by using the critical thinking skills he or she acquired in nursing school. The first move is the nurse talks to the offending patient. The nurse speaks to the client slowly and deliberately. Speaking slowly has its own advantages which include allows the nurse to communicate their emotions to what their communicating, it sounds more professional and eloquent, it helps the patient to pay more attention to the discussion, it avoids miscommunication issues and misunderstandings and lastly it prevents diarrhoea of the mouth where one says everything that it’s on their mind. If speaking does not solve the conflicts, the nurse can decide moving one of them into another room (Huang, Newman and schwartzstein 2012, pp 95-102).
The intensive care unit is fast pasted, high acuity and a high staked environment in which critical thinking is unavoidable and where medical errors can lead to a serious harm. The process of critical thinking is taught in nursing school and sometimes applied by the individual, it uses cognitive biases, metacognition, reasoning, and planning strategies may help prevent cognitive errors. For example, a patient who has been admitted complaining of low-grade fatigue, sore throat, fatigue and mild shortness of breath. He has a history of hypertension and on arrival to the emergency, his heart rate was 110.
The nurse applies critical thinking by coming up with a clinical inference based on observed data or the cues existing in the patient situation. Thereafter the nurse can decide on appropriate treatment after forming a diagnostic conclusion. Clinical decision making requires a careful reasoning so that one can select the best patient result on the basis of the patient condition and priority of the problem.
Critical thinking assists the nurse to face the complex and stressful condition of the ICU. Critical thinking not only does it contain knowledge but also the ability to reason through complex, multifaceted situation to anticipate the needs, to professionally communicate with the team and recognize potential and actual complication. A nurse who is able to think critically will be able to give a better patient care.
Reflection is important for the growth of critical, autonomous and advanced practitioners. Nurses who take time to reflect on their daily experience have a better understanding of their action, provide enhanced nursing care which in return develops into a professional skill. Reflection is defined as the power to analyze one’s action and experience with the result of enhancing clinical knowledge and developing their practice (Gutstafsson and fagerberg 2012, pp 271-280).
An example of a reflective practice is the use of Gibbs reflective cycle. It advocates for an apparent explanation of the situation, evaluation of experience. In short Gibbs reflective cycle talks about a cycle of feelings, description, analysis, action plan and conclusion. Description talks about what had happened, accompanied by emotions got during the questioning. Evaluation explains what was good and not so good about the experience. The analysis explains what sense can be made of the situation and conclusion explains what else could have been done.
Reflection promotes development of each individual hence promoting self-awareness. If the reflection is directed to the betterment in the care of patients, it aids to grow and develop clinical information and skills. The course of action slackens activity increasing the period of time to process the learning materials and connect to other previous thoughts. It also facilitates more ownership of the learning taking place. Reflection has been considered to contribute to optimum effectiveness and efficiency in a complex health-care system through nursing auditing their own practice. Most reflections are on the things that went the wrong example failed procedure, postoperative complication, a dissatisfied patient and missed the diagnosis. This situation stays in one’s head and one begins to think if they could have done something different to improve the situation. Reflection can also build confidence and helps the nurse repeat it again on another occasion example, a difficult but well-performed procedure, a patient thank you later and lastly a well-managed cardiac arrest.
Communicating bad news
Bad news in a health care is any bad information that changes people expectation or perception on their present or future. Example of information that can be categorised as unpleasant information include telling the relatives that their loved one has died, informing the family members when the patient condition is worsening and lastly discussing the transition of care from curative care to palliative care and lastly end of life care (Cleary, Hunt and Escott 2018, pp 40-48).
Nurses may be unwilling to get into a discussion on a topic that will cause grief to the family and friends. The way family members will react to bad news is unpredictable. The unpredictable behaviour include anger, verbal abuse or give threats to the nurse delivering the information. Fears of such reaction are the reason why nurses are reluctant in engaging in the process of breaking bad news..
Other fears for providers of bad information include, not knowing what to say, controlling their own negative feeling during the discussion being unsure whether they will be able to answer all the questions correctly and anticipating when the right time is to initiate the subject. Another reason for unwillingness is the fear of causing harm by destroying hope.
Conflict in a workplace is unavoidable. Conflicts may be amongst nurses, nurses and staff and nurse and patients. The most common triggers of the situation of conflict include lack of resources, lack of professional commitment, communication problem, and misunderstandings. In some situations, seeking to settle a workplace conflict may actually escalate it. This may happen when the parties involved deny any misconduct and attempt to accuse the other party instead (Fowler, Bushardt and Jones 2014, 25-29). Both parties may become aggressive and decide to protect themselves instead of resolving the issue. This situation may prevent health care workers from working together in the future, which can hinder productivity.
Teamwork in a hospital is important to patient safety, care, and treatment. The more health workers work together, the better they are able to provide the best quality patient care. The reason why nurses may be reluctant to work as a team can be due to a lazy team member. When working in a large group it’s easy to avoid work and leave it to others to complete (Hall and weaver 2013, pp 867-875). An individual can work in whatever way possible and also get recognized for work done by someone else, as it is teamwork and the person is part of the team.
Intrinsic conflict may also arise in the team. Each individual may have their own ideas which could oppose to what the other member has proposed. Some members of the group may also find it hard to accept a suggestion from another person. This conflict could as well put to an end the flow of work until the issue is settled.
Unequal participation may be the other reason why nurses may be reluctant in working as a team. In a group, some nurses may not do that much work, while others may work hard. This kind of inequality may cause chaos between the people in the group. It may also cause a feeling of deep and bitter anger amongst the group members, because some may be acknowledged for the work they have not even done (Hall and weaver 2013, pp 867-875).
Stress from family and friends is the reason why nurses become reluctant when satisfying patient’s needs. Some family members persistently give urgent requests or demands that negatively affect nurses as they give care to the patient. Some families give condition as to the type of treatment the nurse should give to their patient. In addition, some family members are easily angered, hysterical and possess disheartening emotions. The rage of emotions from family members make nurses inadequate and affect the way they give care to the patients (Gomez, Martinez and Blay 2013, pp 371-378).
Conclusion
Critical thinking is important in advanced nursing practice and interpreting complex issues in health care in the following ways, it helps identify crisis, enables the nurse to explain the medical condition to a client, helps to realize language barrier, enable the nurse to solve the conflict between the client and lastly to avoid medical errors in the ICU. Critical thinking goes hand in hand with reflective practice. Reflective practice promotes the development by contributing to self-awareness, builds confidence, and lastly, it contributes to optimum effectiveness and efficiency in a health care setting. Nurses also face challenges while in the hospital. They might find it difficult to deliver sad news to the patient’s family in fear of their reaction, conflicts may also arise due to a lack of misunderstanding and communication problem between nurses and patients. There is also some reluctance when working in teams because some of the team members may become lazy and may get acknowledgment for the work they did not do. The last challenge that nurses face is stress from family members leading to the nurse becoming reluctant in satisfying the patient’s needs.
References
Cleary, M., Hunt, G. and Escott, P. (2018). Receiving difficult news. Views of patients in an inpatient setting. Journal of Psychosocial Nursing and Mental Health Services, [online] 48(6), pp.40-48. Available at: https://rcni.com/sites/rcn_nspace/files/ns.28.45.51.e8935. [Accessed 12 Nov. 2018].
Fascione, P. (2013). Critical thinking: What it is and why it counts. The California Academic Press, [online] 24(4), pp.70-76. Available at: https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201612-1009AS [Accessed 12 Nov. 2018].
Fowler, A., Bushardt, C. and Jones, M. (2014). Retaining nurses through conflict resolution. Training staff to confront problems and communicate openly can improve the work climate. Health Prog, [online] 74(5), pp.25-29. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291328/ [Accessed 12 Nov. 2018].
Gomez, B., Martinez, M. and Blay, C. (2013). Identifying needs and improving palliative care of chronically ill patients: a community-oriented, population-based, public health approach. Current opinion in supportive and palliative care, 6(3), pp.371-378.
Gutstafsson, C. and Fagerberg, I. (2012). Reflection, the way to professional development. Journal of Clinical Nursing, 13, pp.271-280.
Hall, P. and Weaver, L. (2013). Interdisciplinary Education and Teamwork: a Long and Winding Road. Medical Education, 35(9), pp.867-875.
Huang, G., Newman, L., and Schwartzstein, R. (2012). Critical thinking in health professions education: summary and consensus statements of the Millennium Conference. Teach Learn Med, [online] 26, pp.95-102. Available at: https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201612-1009AS [Accessed 12 Nov. 2018].
Johns, C. (2014). Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. Journal of Advanced Nursing., [online] 22, pp.236-234. Available at: https://blogs.bmj.com/ebn/2017/01/30/the-power-of-reflection-in-nursing/ [Accessed 12 Nov. 2018].
Nortson, S. and Talerico, K. (2013). Facilitating end-of-life decision-making: strategies for communicating and assessing. Journal of Gerontological Nursing, [online] 26(9), pp.6-13. Available at: https://rcni.com/sites/rcn_nspace/files/ns.28.45.51.e8935. [Accessed 12 Nov. 2018].
Rees, K. (2013). The role of reflective practices in enabling final year nursing students to respond to the distressing emotional challenges of nursing work. Nurse Education in Practice, 13, pp.1-5.
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