Concept analysis is fundamental in nursing theory development and provides a solid foundation with occurrence of progression. As nurses, it allows us to review, critique and further examine theories and its practical applications. Critical thinking is a concept exercised in nursing that was established through theories as it embodies holistic care. An example of such theory is Patricia Benner’s from novice to expert model that states a nurse should develop skills and understanding of optimal patient care through education and experiences (Thomas ; Kellgren, 2017). I will discuss the uses of this concept through definition and explanation of the concept, literature review, defining attributes, an antecedent and consequence, empirical referents, construct cases, and theoretical applications of the concept.
Definition/Explanation of Critical Thinking
Critical thinking is crucial to nursing, conceptually defined as “purposeful, self-regulatory judgment that results in interpretation, analysis, evaluation, and inference, as well as explanations of the considerations on which that judgment is based” (Abrami, Bernard ; Borokhovski, 2015). The ability to apply critical thinking to practice begins with the development of the skill through education, then through experiences. The ultimate goal is, the nurse’s ability to anticipate outcomes during stressful situations and that they are equipped to respond appropriately while providing patient care that is paramount. Critical thinking is part of the decision-making process where nurses are expected to resolve patient issues while providing safe, efficient and skillful nursing intervention (Papathanasiou, Kleisiaris, Fradelos, Kakou & Kourkouta, 2014). It is fundamentally important for a nurse to identify the elements to perform an analysis in order to construct the appropriate nursing interventions. This moment should also serve as an opportunity to improve patient care when applicable.
Literature Review
Literature review provides guidelines in a comprehensive manner that discuss evidence-based practices (EBP), the framework for success in nursing. This wealth of information illustrates how theories support the development of critical thinking and the foundation it provides. Development of critical thinking is an ongoing process throughout a nurse’s career. (Turkel, Marvelous, Morrison ; Singletary, 2016). The application of theory includes components that help construct appropriate nursing interventions. These components reveal the uniqueness of a nurse’s ability to critically think. Concepts are ideas and opinions of importance to nurses which are developed based on research, activities and personal experiences, (Papathanasiou et. al 2014).
It is imperative for the patient and the nurse to agree on the plan of care that is developed. This is crucial to patient satisfaction as the goal is to provide optimal patient care and a gratifying patient experience. With this in mind, the demand for nursing competency and performance is significant in nature. According to Kong, Qin, Zhou, Mou & Gao (2015), in order to become successful as a critical thinker a nurse must use theory to identify the necessary components. It is the collection of data through research and interview, analysis of that data, evaluation and application of theory to practice.
A study performed by Cui, Li, Geng, Zhang, and Jin (2018), supports how instrumental EBP served in the development of nursing students’ ability to critical think and nurse’s proficiency to identify, translate and formulate interventions to create a patient’s diagnosis and treatment, especially under stressful conditions that may impact their ability to make sound decisions.
A key aspect to critical thinking is self-confidence or self-efficacy. Assurance of a nurse’s ability to perform is essential as it can impact the use of critical thinking. According to Turkel, et. al (2016), a nurse that lacks self-confidence often has the inability to think critically, compromising optimal patient care and safety. A study conducted by Smaawi, Miller & Haras (2014) indicates that the use of simulation provides students with critical reflection and opportunites that promote and encourage self-confidence as it relates to nursing practice.
Using the above-mentioned simulation-based training as the example of a successful method, Cant & Cooper (2017), stated that simulation-based training experiences can improve student knowledge by contributing to the development of critical thinking. As experience builds, skills improve and progress toward perfection. In this controlled environment a nurse is afforded the opportunity to test his or her skills and learn from mistakes that may occur. It also prepares a nurse to effectively manage difficult situations that require quick decision-making while rendering safe interventions.
Defining Attributes
The defining attributes determine the applicability of the nurse in using critical thinking. These attributes consist of the ability to identify the issue and make decisions to rectify the issue through the application of knowledge and self-reflection. Flexibility is one attribute that it is important to critical thinking. According to Shoulders, Follet, & Eason (2014), individuals must possess several characteristics including “flexibility inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection”. A nurse must be flexible in critical thinking as part of their rational. Flexibility involves engaging in ideas or understanding the logical connection between those ideas which can improve patient care, comfort and outcomes through innovation. Nursing must have committed leaderships who can develop flexible organizational processes when embarking on organizational transformations and innovations (Schoemaker, Heaton & Teece, 2018).
A nurse must possess skills that use application of knowledge, another defining attribute, as the groundwork to effectively incorporate critical thinking into nursing practice. An example of this is the nurse’s ability to identify when to use cluster care. Clustering care is a vital part of patient care. It involves the consolidation of trips to the patient’s room by providing the necessary care in one instance. Time is saved and it allows the patient longer restful periods. An experienced nurse maybe more diligent in promoting sleep whereas a novice may focus on time-stamped orders. Theory and practice are vital to nursing through education where skills are acquired through experience and knowledge in the clinical setting, Maranon (2015).
The final attribute is self-reflection, also a crucial aspect and attribute that serves purpose in critical thinking. It helps nurses acquire vision and introspect into the decisions made regarding patient care and to determine if those decisions were appropriate to practice. The decisions also provide nurses with personal accomplishments based on those actions. Self-assessment and reflection impart the nurse with a broader understanding of their role and the opportunity to enhance critical thinking and reasoning (Siles-González and Solano-Ruiz, 2016).
Antecedent and Consequence
An antecedent of critical thinking is autonomy. A nurse must have a level of freedom to utilize their critical thinking skills as it is important in making crucial decisions. According to Shalriari, Mohammadi, Abbaszadeh & Bahrami Nibbelink (2013), Nurses should know their worth and how they can use their value to provide care as a core part of humanistic nursing.
Autonomy also means that the nurse is acting independently from peers and therefore taking ownership of their actions as it pertains to patient care. Autonomy is essential to the nursing profession and practice as a core element of a healthy nurse work environment (Rao, Kumar & McHugh 2016). When hospitals operate with lower levels of nurse autonomy it impacts the nurses’ ability to critical think and their patients at an increased risk for longer stays and mortality.
A consequence of critical thinking development is competency. Perhaps the culture of competencies in nursing education truly creates a climate for the continued use of critical thinking as the overriding force, Tedesco-Schneck (2013). Competences in nursing when applied lead to better practices and better patient outcomes. Evidence-based practices provides a nurse with the tools to critical think and validate their competency through application of knowledge. (Cui, Li, Geng, Zhang, ; Jin, 2018).
Empirical Referents
Empirical referents are required tools used to measure the nursing concept. It is crucial to first, understand the concept then determine if the concept occurred. One empirical referent in concept of critical thinking is nursing competency. The correlation between critical thinking and nursing competency occurs when a nurse executes orders or interventions. Competency is then measured through patient outcomes and satisfaction by way of survey. Patient satisfaction surveys are essential sources of information for identifying disparities and developing plans for improvement in healthcare (Al-Abri ; Al-Balushi, 2014). According to Yanani, Talegahni, Alizadeh ; Khabaz-Mafinejad (2018), critical thinking is a fundamental skill that is essential in clinical decision making, which has implications regarding nursing competency in diagnostic accuracy, appropriate management of the nursing process and, ultimately, patient outcomes.
Another empirical referent is evaluating critical thinking and their successes. Education is the foundation of learning where the introduction to critical thinking occurs. As a student, development of skill can be assessed in the simulation by the instructor, who can grade you based on how good you perform skills. The novice and experienced nurse will go through an appraisal process, a graded system that provides data on how well you have performed on the floor. Ultimately, both methods can be used to demonstrate the effectiveness of critical thinking in practice (Kim, 2018).
Constructed Cases
Model Case
A model case is to demonstrate the theoretical application of the concept in a realistic situation. A nurse is caring for an 87 y/o obese patient with end stage COPD. With poor prognosis the doctor suggested hospice. The family now visibly upset want to transfer the patient to another hospital, causing a scene in the process. The nurse notifies the doctor then tries to deescalate the situation by offering herself as an outlet realizing that they maybe in shock from the news. The family proceeded to remove the patient from his room and the nurse accompanied them. As they tried to get the patient into the car he collapsed and become unresponsive. The nurse initiated the emergency response. Members of the response team were already present as the family created a scene with their failed attempts to fit the patient in the car. The patient was rushed to the emergency room where is was pronounced dead. The nurse and doctor summarized the events and devise a plan on how to better convey bad news to family members when death is inevitable. This case demonstrated application of knowledge, decision-making and self-reflection as the attributes. The nurse’s ability to identify the stressor and think critically how to deescalate the tension by offering to listen to the family’s discontentment. She also reiterated the suggestion for hospice through application of knowledge. When the patient was unresponsive, she made the decision to activate the emergency response system. Through self-reflection, reviewed if decisions were appropriate to practice and formulated ways to improve the process should a similar situation occur.
Borderline Case
A borderline case reflects most of the concepts where attributes are missing. A nurse requested help to start a heparin drip on her patient. A senior nurse accompanied the novice into the patient’s room and walked her through the appropriate steps of the medication administration. The senior nurse was able to assess competency through the novice nurse’s ability to follow instructions. The novice then reviewed what she had learned to ensure that she understood the procedure as future reference. The attribute of decision making is missing because the senior nurse provided instructions to the novice thus hindering her using her ability to critical think. Application of knowledge and self-reflection was used through the novice’s ability to follow instructions and reviewed what she had learned.
Contrary Case
A contrary case demonstrates the opposite of the concept and reflects a situation in which none of the identifiable attributes are present. For example: A nurse enters a patient room and identifies herself. The patient’s daughter is present and initiates a conversation with the nurse. They discover that the went to the same high school and began to reminisce about the fun they had in the dance program. There is no application of knowledge, decision-making or self-reflection demonstrated in relation to patient care.
Theoretical Applications of Critical Thinking
Theoretical application requires a concept analysis as an essential component of nursing principles Through analysis, we can streamline concepts to get an understanding of their overall importance and how to make improvements and implement those improvements into nursing practice. Critical thinking is a crucial requirement to the groundwork of patient care. Nurses have a responsibility to perform analysis, make decisions and exercise that knowledge through application (Williams ; Hopper, 2015). Patricia Benner’s theory from novice to expert model describes the nursing process which begins with the development of skills and understanding of optimal patient care through education and numerous experiences. Critical thinking compels nurses to provide optimal patient care in a manner similar to that of the novice to expert model; skills are developed through education and experience through practice. The attributes to critical thinking including the application of knowledge is similar in part to the novice to expert theory. The novice nurse may focus on mastering the technical aspects of care, where vital signs must be in a specific range, while the expert nurse caring for the same patient would incorporate knowledge of physiology and pathophysiology assessing signs and symptoms as a guide to better patient care where the patient may skin maybe cool to the touch where further assessment maybe required (Thomas & Kellgren, 2017).
Conclusion
Concept analysis is essential in nursing and provides the groundwork to theory. As part of analysis, critical thinking is vital to the nursing process and provides a nurse with opportunity to apply knowledge to practice. Concept analysis also aids in the examination of theory and further evaluation for its practical applications to the nursing process. Advanced nursing practice requires critical thinking and knowledge through education and learned experiences in order to equipped to prepare appropriate nursing interventions. As a future nursing information specialist, the ability to critical think will afford me the opportunity to educate staffers in their use of this attribute in the implementation of new technology.

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