Critical thinking, problem-solving, and clinical judgment in nursing practice

¶ … Problem-solving and Decision-Making in Nursing and Explain How Clinical Judgments Are Outcomes of Critical Thinking in Nursing

The American Philosophical Association (APA) has "defined critical thinking as purposeful, self-regulatory judgment that uses cognitive tools such as interpretation, analysis, evaluation, inference, and explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations on which judgment is based" (Benner 1). In a nursing-specific context, nurses must be engaging their critical faculties at all times. They must analyze situations in a discriminatory fashion using logic, even while having enough confidence and "contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity" to be open-minded and use their intuition when needed (Benner, Hughes, & Sutphen 1).

In contrast to the scientific method, making clinical judgments is merely the use of objective reason. Nurses must use a problem-specific approach that is focused upon the here and now. "The goal of detached, critical objectivity used to conduct scientific experiments minimizes the interactive influence of the research on the experiment once it has begun... The scientist is always situated in past and immediate scientific history, preferring to evaluate static and predetermined points in time (e.g., snapshot reasoning), in contrast to a clinician who must always reason about transitions over time" (Benner, Hughes, & Sutphen 4-5). Nurses must learn how to apply reason to particular scenarios; they do not strive to make general laws. This intuition may not always be translated into formal guidelines. "Practical reasoning often takes the form of puzzle solving or the evaluation of immediate past 'hot' history of the patient's situation. Such a particular clinical situation is necessarily particular, even though many commonalities and similarities with other disease syndromes can be recognized through signs and symptoms and laboratory tests (Benner, Hughes, & Sutphen 5).

Effective problem-solving in a nursing context requires technical information combined with a less generalized, more grounded approach to dealing with patients that may not be an archetypal case study. Problem-solving requires a nurse to screen out what bits of information are relevant and which are not relevant, some of which may not be present in a medical textbook. Asking 'what is the problem' does not mean merely making a diagnosis (such as the fact that a patient has type II diabetes and is overweight) but also treating the patient's individual needs that contribute to creating the health consequences manifested before the nurse (such as poverty, environmental stressors, and a lack of knowledge).