Critical Thinking in Nursing
Scott R. Heilmann
Teaching and research are the foundation of universities, and nursing. How that research is conveyed to the learner is just as important as the research itself. This paper analyzes the different teaching styles and the benefits of incorporating critical thinking into the education system.The byproduct of such an education is a nurse who will be able to project ideas into the patient care equation.
Some of the boundaries preventing critical thinking in the workplace are the education system that prevents the future nurse from critically thinking early on. Students are told from a young age that certain knowledge is absolute. It is also widely believed that knowledge is power. Students learn to listen to the teacher. For example, the information in the lecture will be on the test. This information is implied to be correct, regardless of other possibilities. To counter the information expressed by the teacher could ultimately lead to a lower grade.
Critical thinking on the other hand, is the ability to think outside the box. It is necessary to not only answer every question, but to question every answer. How one goes about teaching a post-modern theory is still up for debate. There lies a thin line in between seeming to make suggestions to follow, and necessary information. However, the most important lesson one can learn while critically thinking is that power is perceived; not innate. That lesson will ultimately translate in the nurses ability to confront doctors, other medical personal, families, and administrators ending with the patients best interest at the helm.
Nursing as a profession is not immune to that traditional one way of concrete thinking. The doctor gives an order. The nurse follows through completing the order by passing on the medication the patient must take. Most things seem to be black or white, with a direct cause and effect relationship. In an article A philosophy underlying excellence in research, discusses the impact of maintaining a traditional education system on nurses. The article also discusses the consequences regarding changes towards critical thinking.
To fully understand the concepts discussed the article we must first look at our roots of knowledge. Paradigms of knowledge will allow us to better understand how we think and how we view learning. Schools and professors educate students. These students then leave school with the knowledge the university system instilled in to them. The problem with such a learning model is best discussed by, Thomas Kuhn. In 1962 he wrote, The Structure of Scientific Revolution. The book discussed the knowledge paradigm as “…a constellation of concepts, values, perceptions and practices shared by a community which forms a particular vision of reality that is the basis of the way a community organizes itself” (Kuhn, n.d.).
The antiquated positivist teaching approach demonstrated throughout nursing schools has a major flaw.The flaw accepts all knowledge to be correct. The concepts passed on to the students demonstrate knowledge is not what is true, but what one believes is true.Hence, preventing the student from asking the most basic question of why.
Without the basic questioning underway, this ill repairs the new nurse to question assumptions in the work environment. For example the article points out the irony that ethically the nurse should empower the patients. However, most patients are viewed by the nurse as a passive participant in the practice of medicine (Nili, Livne, & Mali, 2003, p. 250).
Another potential problem exists when the doctor gives an order. The expectation is for the nurse read the order and complete the task. If the nurse thinks critically, and is not afraid to break the hierarchy of power, the order may be questioned. This question will ultimately lead to better patient outcomes.
To allow freethinking, with a critical approach in nursing practice, the first change must be to encourage the student to question the obvious instead of treating it as fact.This initial questioning of authority and knowledge will allow the development of a comfort zone in confronting obtrusive ideas (Nili, Livne, & Mali, 2003, p. 252).
One thing critical thinking does is it manages to break down the barriers in between student and teacher. This sets the future nurse to be comfortable to break down the doctor nurse barrier as well. Once the student questions the teacher, he or she is also questioning authority. Once authority is questioned, the power the teacher/doctor has over the student/nurse is also lessened. The reduction of power puts everyone on the same level. Translation the student who will become a nurse will be more open to empowering the patient (Nili, Livne, & Mali, 2003, p. 250).This future nurse will also be less likely to follow through on a bad plan of care.
The clinical aspect of critical thinking must begin in the education system. If the student does not feel comfortable confronting a professor, how is this nursing going to deal with the nurse-doctor struggle?
The article does point out a potential downside in viewing this post-modern teaching theory of critically thinking. The question becomes how to off set the power, and not disrupt the learning requirements, or job performance. One fear expressed is, should the playing field of power be leveled, research or knowledge may not be appreciated for its importance. Once knowledge is no longer respected, then research may not be as highly regarded. The risk then evolves into nursing becoming a stagnant profession (Nili, Livne, & Mali, 2003, p. 251).
Furthermore, every order cannot be arbitrarily followed. There does exist a hierarchy, and rules. The ultimate goal of critical thinking in the work place cannot be to eliminate the order. The goal should be to allow for a wider knowledge base and incorporate a collaborative approach towards patient care.
Just like a strong tree is supported by its roots, nursing is supported through teaching and research. Essentially, education plays a huge importance in how a nurse interacts with colleagues, and patients. A nurses job is both patient advocacy, and patient teaching. A nurses job is to educate the patient, and the patients family. It is hard to empower a person and still keep that him or her without power.
Through effective critical thinking, the nurse-patient bond, and the nurse-doctor relationship can only grow. In the end student who is educated in a critical thinking approach will be a better nurse in the workplace, because critical thinking is what good nurses do.
Kuhn, T. (n.d.). . In What is a paradigm?. Retrieved October 25, 2004, from http://www.cs.ucr.edu/khanhvo/paradigm.htm
Nili, T., Livne, A., & Mali, E. (2003). A philosophy underlying excellence in teaching. Nursing Philosophy, 4, 249-254. Retrieved October 22, 2004, from EBSCOhost Database, Article No. AN 11217681.