I. PROBLEM: Registered nurses that transition/orientate into an intensive care unit do not receive enough orientation to develop the ability to clinically reason and key competencies/essentials needed to practice safely in critical care. Nursing education has understood the value of critical thinking as an essential nursing skill, throughout all the incarnations by which critical thinking has itself been defined over the course of the 19th and 20th centuries…
It is important not to distill the critical thought process as it pertains to clinical endeavors with simple, smart sounding labels, like wisdom or 'know-how'. II. DEFINITION OF CLINICAL REASONING Clinical reasoning must be more than a simple application of theory, because patients are individuals – and the therapist/nurse must adapt a treatment plan towards the individual, personal needs of each patient. Clinical reasoning under the perspective of certain researchers becomes a largely tacit phenomenon (Matingly, 1991). Our understanding of critical thinking as it pertains to the clinical setting has matured over the course of the decades. There are several key items for critical thinking for the professional to consider. 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' (APA, 1990). But there are other professional bodies that have also required a critical thinking mandate be added to curriculum, in many fields – not just nursing. ...
1995). In the dimension of nursing and clinical responsibility, critical thinking is the foundation of quality care, as well as professional standards of accountability. The professional must consciously cultivate the characteristics of efficient clinical mindset. This includes the ability to place events within the proper overall context, self-confidence in the nurse's ability to perform the necessary job functions, as well as a certain flexibility. The nurse must also cultivate creativity when time, resources, or both are limited, as well as a certain intellectual curiosity, leading to a state of mind that is always willing to learn more and adapt novel technologies and clinical modalities when and where they will prove effective in the practice of the individual medical professional. This dovetails with the ability for critical reflection on one's self, and on one's job performance. The nurse must be analytical in regards to new information, and the requirements with a willingness to seek out and verify potentially useful discoveries; vetting innovations for their clinical utility, as well as, ultimately, a long-suffering perseverance against adversity. More recently a comprehensive definition was also provided by the National League for Nursing Accreditation Commission: The deliberate nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, and evaluating information that is both factually and belief based. This is demonstrated in nursing by clinical judgment, which includes ethical, diagnostic, and therapeutic dimensions and research (NLNAC, 2007, p. 8). How then are we able to determine what thinking processes meet the critical thinking standard ...
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