Nursing Process, Critical Thinking and Ethics

Chapter 3

Critical Thinking, Ethical
Decision Making, and the
Nursing Process

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Definition of Critical Thinking
• Multidimensional skill, cognitive or mental process, set of
procedures
• Critical thinking involves reasoning, purposeful
systematic, reflective, rational, outcome–directed
thinking based upon body of knowledge, examination of
all available information, ideas


Characteristics of Critical Thinking
• Systematic
• Organized
• Conscious
• Outcome oriented


Alofaro-LeFevre (2008) Says
• Critical thinkers are
– Active thinkers, fair-minded, open-minded,
persistent, empathic, independent in thought, good
communicators, honest, organized and systematic,
proactive, flexible, realistic, humble, cognizant of
rules of logic, curious and insightful, creative,
committed to excellence


Critical-Thinking Skills
• Interpretation
• Analysis
• Evaluation
• Inference
• Explanation
• Self-regulation


Critical Thinking in Action


Question
• What is the least effective decision-making process used
in critical thinking?
A.Analyzing the information
B.Maintaining an inflexible attitude
C.Formulating decisions
D.Considering available options


Answer
• B. Maintaining an inflexible attitude.
• Rationale: It is important to maintain a flexible attitude
that allows the facts to guide thinking. Analyzing the
information to determine what it means and to see
whether it forms clusters or patterns that point to certain
conclusions, formulating decisions that reflect creativity
and independent decision making, and considering
available options and examining each in terms of its
advantages and disadvantages are effective decision-
making processes used in critical thinking.


Ethics and Morality in Nursing
• Ethics: formal systematic study of moral beliefs
• Morality: individual’s adherence to informal personal
value systems
• Nursing ethics: form of applied ethics that addresses
moral situations specific to nursing profession, patient
care


Basic Ethical Principles

• Autonomy • Nonmaleficence
• Beneficence • Paternalism
• Confidentiality • Respect for persons
• Fidelity • Sanctity of life
• Double effect • Veracity
• Justice


Ethical Problem Solving
• ANA (American Nurse’s Association) Nursing’s Social
Policy Statement (2003): supports claim that nurses
must be actively involved in decision-making processes
surrounding health care, human responses
• American Nurses Association Code of Ethics for Nurses
• Steps of ethical analysis


Question
• Tell whether the following statement is true or false:
• Individual patient rights regarding freedom of choice and
the right to privacy are included under the ethical
principle of fidelity.


Answer
• False.
• Rationale: Individual patient rights regarding freedom of
choice and the right to privacy are included under the
ethical principle of autonomy. Autonomy includes
individual rights, privacy, and choice. It entails the ability
to make a choice free from external constraints.


Ethical Dilemmas
• Ethical dilemmas: occur when there is clear conflict
between two or more competing moral principles or
claims
– Example: Ethical dilemma occurs when nurse wishes
to be truthful with patient but family, physician
wishing to spare patient distress prohibit informing
patient about his condition


Steps of an Ethical Analysis
• Assess ethical/moral situations of problem
• Collect information
• List alternatives
– Compare alternatives with applicable ethical
principles, professional code of ethics
• Decide, evaluate decision


Ethical Theories
• Deontologic or formalist theory: ethical theory
maintaining that ethical standards or principles exist
independent of ends or consequences
• Teleologic theory or consequentialism: theoretical basis
of ethics, focuses on ends or consequences of actions,
such as utilitarianism


Nursing Process
• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation


The Nursing Process (cont’d)


Collaborative Problems
• Certain physiologic complications that nurses monitor to
detect onset or changes in status (Carpenito-Moyet,
2008)


Differentiating Nursing Diagnosis and
Collaborative Problems


Critical Thinking in Nursing Process
• Critical thinking goes beyond basic problem solving
– Results in comprehensive plan of care for patient
• Decision making, problem solving in nursing: increasingly
complex, require critical thinking as part of process
• Critical thinking is at center of process of clinical
reasoning, clinical judgment (Jackson, 2004)
• Nurses must use critical thinking to plan, provide nursing
care


Question
• Assessment begins with initial patient contact. Which
nursing activity is included during this component of the
nursing process?
A.Interviewing and obtaining a nursing history
B.Choosing a nursing diagnosis
C.Establishing expected outcomes
D.Determining nursing actions


Answer
• A. Interviewing and obtaining a nursing history
• Rationale: Choosing a nursing diagnosis is included
during the diagnosis component of the nursing process.
Establishing expected outcomes and determining nursing
actions are included during the planning component of
the nursing process.


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