2. When was the patient’s last bowel movement?
3. Who is the patient’s emergency contact person?
4. Describe the patient’s current level of pain.
5. What information is in the patient’s medical record?
Critical thinking in nursing is the foundation that underpins safe, effective, and patient-centered care.
Critical thinking skills empower nurses to navigate the complexities of their profession while consistently providing high-quality care to diverse patient populations.
Potter, P.A., Perry, A.G., Stockert, P. and Hall, A. (2013) Fundamentals of Nursing
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4 min read • February, 09 2024
Critical thinking in nursing helps caregivers make decisions that lead to optimal patient care. In school, educators and clinical instructors introduced you to critical-thinking examples in nursing. These educators encouraged using learning tools for assessment, diagnosis, planning, implementation, and evaluation.
Nurturing these invaluable skills continues once you begin practicing. Critical thinking is essential to providing quality patient care and should continue to grow throughout your nursing career until it becomes second nature.
Critical thinking in nursing involves identifying a problem, determining the best solution, and implementing an effective method to resolve the issue using clinical decision-making skills.
Reflection comes next. Carefully consider whether your actions led to the right solution or if there may have been a better course of action.
Remember, there's no one-size-fits-all treatment method — you must determine what's best for each patient.
As a patient's primary contact, a nurse is typically the first to notice changes in their status. One example of critical thinking in nursing is interpreting these changes with an open mind. Make impartial decisions based on evidence rather than opinions. By applying critical-thinking skills to anticipate and understand your patients' needs, you can positively impact their quality of care and outcomes.
To assess situations and make informed decisions, nurses must integrate these specific elements into their practice:
Critical-thinking skills develop as you gain experience and advance in your career. The ability to predict and respond to nursing challenges increases as you expand your knowledge and encounter real-life patient care scenarios outside of what you learned from a textbook.
Here are five ways to nurture your critical-thinking skills:
Critical thinking in nursing is invaluable for safe, effective, patient-centered care. You can successfully navigate challenges in the ever-changing health care environment by continually developing and applying these skills.
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Academic writing: using literature to demonstrate critical analysis, kathleen duffy senior lecturer, school of nursing, midwifery and community health, glasgow caledonian university, glasgow, elizabeth hastie senior lecturer, school of nursing, midwifery and community health, glasgow caledonian university, glasgow, jacqueline mccallum senior lecturer, school of nursing, midwifery and community health, glasgow caledonian university, glasgow, valerie ness lecturer, school of nursing, midwifery and community health, glasgow caledonian university, glasgow, lesley price lecturer, school of nursing, midwifery and community health, glasgow caledonian university, glasgow.
When writing at degree level, nurses need to demonstrate an understanding of evidence by summarising its key elements and comparing and contrasting authors’ views. Critical analysis is an important nursing skill in writing and in practice. With the advent of an all-degree profession, understanding how to develop this skill is crucial. This article examines how students can develop critical analysis skills to write at undergraduate degree level. It highlights some of the common errors when writing at this academic level and provides advice on how to avoid such mistakes.
Nursing Standard . 23, 47, 35-40. doi: 10.7748/ns2009.07.23.47.35.c7201
This article has been subject to double blind peer review
Critical appraisal - Education: methods - Literature and writing - Student nurses - Study skills
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29 July 2009 / Vol 23 issue 47
TABLE OF CONTENTS
DIGITAL EDITION
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A critical analysis.
Kalaitzidis, Evdokia PhD; Jewell, Paul PhD
Reprinted from Kalaitzidis E, Jewell P. The concept of advocacy in nursing: a critical analysis. Health Care Manag. 2015;34(4):308-315. doi:10.1097/HCM.0000000000000079.
Author Affiliations: Health Sciences Medicine and Nursing, Flinders University, South Australia.
The authors have no conflicts of interest.
Correspondence: Evdokia Kalaitzidis, PhD, Health Sciences Medicine and Nursing, Flinders University, South Australia ( [email protected] ).
As health care professionals practice as a team, they take on responsibilities that are specific to their roles—responsibilities that are recognized and understood by the team and management as pertaining to their professional domain and expertise. Is advocacy part of the role of the nurse? Members of the nursing profession commonly maintain that it is, but is there a consensus on this issue, both within the profession and among other stakeholders? Is there a clear understanding of the term advocacy , and is this reflected in Codes of Practice and research into practice? An examination of significant documents and reports of empirical research reveals conflicting conceptions and opinions. There is potential for a common definition, but agreements need to be reached on whether advocacy is an essential function of nursing within the management of health care, and if so, what is advocacy’s importance, focus, and limits.
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The concept of advocacy in nursing: a critical analysis, shared vision in nursing: an evolutionary concept analysis revealing dualities..., cultural diversity training: the necessity of cultural competence for health..., a qualitative study of the change-of-shift report at the patients’ bedside, change management in health care.
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Azzam al-jundi.
1 Professor, Department of Orthodontics, King Saud bin Abdul Aziz University for Health Sciences-College of Dentistry, Riyadh, Kingdom of Saudi Arabia.
2 Associate Professor, Department of Oral and Maxillofacial Surgery, Al Farabi Dental College, Riyadh, KSA.
Evidence-based practice is the integration of individual clinical expertise with the best available external clinical evidence from systematic research and patient’s values and expectations into the decision making process for patient care. It is a fundamental skill to be able to identify and appraise the best available evidence in order to integrate it with your own clinical experience and patients values. The aim of this article is to provide a robust and simple process for assessing the credibility of articles and their value to your clinical practice.
Decisions related to patient value and care is carefully made following an essential process of integration of the best existing evidence, clinical experience and patient preference. Critical appraisal is the course of action for watchfully and systematically examining research to assess its reliability, value and relevance in order to direct professionals in their vital clinical decision making [ 1 ].
Critical appraisal is essential to:
Carrying out Critical Appraisal:
Assessing the research methods used in the study is a prime step in its critical appraisal. This is done using checklists which are specific to the study design.
Standard Common Questions:
The Critical Appraisal starts by double checking the following main sections:
I. Overview of the paper:
The presence of a peer review process in journal acceptance protocols also adds robustness to the assessment criteria for research papers and hence would indicate a reduced likelihood of publication of poor quality research. Other areas to consider may include authors’ declarations of interest and potential market bias. Attention should be paid to any declared funding or the issue of a research grant, in order to check for a conflict of interest [ 2 ].
II. ABSTRACT: Reading the abstract is a quick way of getting to know the article and its purpose, major procedures and methods, main findings, and conclusions.
III. Introduction/Background section:
An excellent introduction will thoroughly include references to earlier work related to the area under discussion and express the importance and limitations of what is previously acknowledged [ 2 ].
-Why this study is considered necessary? What is the purpose of this study? Was the purpose identified before the study or a chance result revealed as part of ‘data searching?’
-What has been already achieved and how does this study be at variance?
-Does the scientific approach outline the advantages along with possible drawbacks associated with the intervention or observations?
IV. Methods and Materials section : Full details on how the study was actually carried out should be mentioned. Precise information is given on the study design, the population, the sample size and the interventions presented. All measurements approaches should be clearly stated [ 3 ].
V. Results section : This section should clearly reveal what actually occur to the subjects. The results might contain raw data and explain the statistical analysis. These can be shown in related tables, diagrams and graphs.
VI. Discussion section : This section should include an absolute comparison of what is already identified in the topic of interest and the clinical relevance of what has been newly established. A discussion on a possible related limitations and necessitation for further studies should also be indicated.
Does it summarize the main findings of the study and relate them to any deficiencies in the study design or problems in the conduct of the study? (This is called intention to treat analysis).
Once you have answered the preliminary and key questions and identified the research method used, you can incorporate specific questions related to each method into your appraisal process or checklist.
1-What is the research question?
For a study to gain value, it should address a significant problem within the healthcare and provide new or meaningful results. Useful structure for assessing the problem addressed in the article is the Problem Intervention Comparison Outcome (PICO) method [ 3 ].
P = Patient or problem: Patient/Problem/Population:
It involves identifying if the research has a focused question. What is the chief complaint?
E.g.,: Disease status, previous ailments, current medications etc.,
I = Intervention: Appropriately and clearly stated management strategy e.g.,: new diagnostic test, treatment, adjunctive therapy etc.,
C= Comparison: A suitable control or alternative
E.g.,: specific and limited to one alternative choice.
O= Outcomes: The desired results or patient related consequences have to be identified. e.g.,: eliminating symptoms, improving function, esthetics etc.,
The clinical question determines which study designs are appropriate. There are five broad categories of clinical questions, as shown in [ Table/Fig-1 ].
Categories of clinical questions and the related study designs.
Clinical Questions | Clinical Relevance and Suggested Best Method of Investigation |
---|---|
Aetiology/Causation | What caused the disorder and how is this related to the development of illness. Example: randomized controlled trial - case-control study- cohort study. |
Therapy | Which treatments do more good than harm compared with an alternative treatment? Example: randomized control trial, systematic review, meta- analysis. |
Prognosis | What is the likely course of a patient’s illness? What is the balance of the risks and benefits of a treatment? Example: cohort study, longitudinal survey. |
Diagnosis | How valid and reliable is a diagnostic test? What does the test tell the doctor? Example: cohort study, case -control study |
Cost- effectiveness | Which intervention is worth prescribing? Is a newer treatment X worth prescribing compared with older treatment Y? Example: economic analysis |
2- What is the study type (design)?
The study design of the research is fundamental to the usefulness of the study.
In a clinical paper the methodology employed to generate the results is fully explained. In general, all questions about the related clinical query, the study design, the subjects and the correlated measures to reduce bias and confounding should be adequately and thoroughly explored and answered.
Participants/Sample Population:
Researchers identify the target population they are interested in. A sample population is therefore taken and results from this sample are then generalized to the target population.
The sample should be representative of the target population from which it came. Knowing the baseline characteristics of the sample population is important because this allows researchers to see how closely the subjects match their own patients [ 4 ].
Sample size calculation (Power calculation): A trial should be large enough to have a high chance of detecting a worthwhile effect if it exists. Statisticians can work out before the trial begins how large the sample size should be in order to have a good chance of detecting a true difference between the intervention and control groups [ 5 ].
Researchers use measuring techniques and instruments that have been shown to be valid and reliable.
Validity refers to the extent to which a test measures what it is supposed to measure.
(the extent to which the value obtained represents the object of interest.)
Reliability: In research, the term reliability means “repeatability” or “consistency”
Reliability refers to how consistent a test is on repeated measurements. It is important especially if assessments are made on different occasions and or by different examiners. Studies should state the method for assessing the reliability of any measurements taken and what the intra –examiner reliability was [ 6 ].
3-Selection issues:
The following questions should be raised:
Researchers employ a variety of techniques to make the methodology more robust, such as matching, restriction, randomization, and blinding [ 7 ].
Bias is the term used to describe an error at any stage of the study that was not due to chance. Bias leads to results in which there are a systematic deviation from the truth. As bias cannot be measured, researchers need to rely on good research design to minimize bias [ 8 ]. To minimize any bias within a study the sample population should be representative of the population. It is also imperative to consider the sample size in the study and identify if the study is adequately powered to produce statistically significant results, i.e., p-values quoted are <0.05 [ 9 ].
4-What are the outcome factors and how are they measured?
5-What are the study factors and how are they measured?
Data Analysis and Results:
- Were the tests appropriate for the data?
- Are confidence intervals or p-values given?
Confounding Factors:
A confounder has a triangular relationship with both the exposure and the outcome. However, it is not on the causal pathway. It makes it appear as if there is a direct relationship between the exposure and the outcome or it might even mask an association that would otherwise have been present [ 9 ].
6- What important potential confounders are considered?
7- What is the statistical method in the study?
Interpretation of p-value:
The p-value refers to the probability that any particular outcome would have arisen by chance. A p-value of less than 1 in 20 (p<0.05) is statistically significant.
Confidence interval:
Multiple repetition of the same trial would not yield the exact same results every time. However, on average the results would be within a certain range. A 95% confidence interval means that there is a 95% chance that the true size of effect will lie within this range.
8- Statistical results:
Are statistical tests performed and comparisons made (data searching)?
Correct statistical analysis of results is crucial to the reliability of the conclusions drawn from the research paper. Depending on the study design and sample selection method employed, observational or inferential statistical analysis may be carried out on the results of the study.
It is important to identify if this is appropriate for the study [ 9 ].
Clinical significance:
Statistical significance as shown by p-value is not the same as clinical significance. Statistical significance judges whether treatment effects are explicable as chance findings, whereas clinical significance assesses whether treatment effects are worthwhile in real life. Small improvements that are statistically significant might not result in any meaningful improvement clinically. The following questions should always be on mind:
9- What conclusions did the authors reach about the study question?
Conclusions should ensure that recommendations stated are suitable for the results attained within the capacity of the study. The authors should also concentrate on the limitations in the study and their effects on the outcomes and the proposed suggestions for future studies [ 10 ].
Do the citations follow one of the Council of Biological Editors’ (CBE) standard formats?
10- Are ethical issues considered?
If a study involves human subjects, human tissues, or animals, was approval from appropriate institutional or governmental entities obtained? [ 10 , 11 ].
Critical appraisal of RCTs: Factors to look for:
[ Table/Fig-2 ] summarizes the guidelines for Consolidated Standards of Reporting Trials CONSORT [ 12 ].
Summary of the CONSORT guidelines.
Title and abstract | Identification as a RCT in the title- Structured summary (trial design, methods, results, and conclusions) |
---|---|
Introduction | -Scientific background -Objectives |
Methods | -Description of trial design and important changes to methods -Eligibility criteria for participants -The interventions for each group -Completely defined and assessed primary and secondary outcome measures -How sample size was determined -Method used to generate the random allocation sequence -Mechanism used to implement the random allocation sequence -Blinding details -Statistical methods used |
Results | -Numbers of participants, losses and exclusions after randomization -Results for each group and the estimated effect size and its precision (such as 95% confidence interval) -Results of any other subgroup analyses performed |
Discussion | -Trial limitations -Generalisability |
Other information | - Registration number |
Critical appraisal of systematic reviews: provide an overview of all primary studies on a topic and try to obtain an overall picture of the results.
In a systematic review, all the primary studies identified are critically appraised and only the best ones are selected. A meta-analysis (i.e., a statistical analysis) of the results from selected studies may be included. Factors to look for:
[ Table/Fig-3 ] summarizes the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses PRISMA [ 13 ].
Summary of PRISMA guidelines.
Title | Identification of the report as a systematic review, meta-analysis, or both. |
---|---|
Abstract | Structured Summary: background; objectives; eligibility criteria; results; limitations; conclusions; systematic review registration number. |
Introduction | -Description of the rationale for the review -Provision of a defined statement of questions being concentrated on with regard to participants, interventions, comparisons, outcomes, and study design (PICOS). |
Methods | -Specification of study eligibility criteria -Description of all information sources -Presentation of full electronic search strategy -State the process for selecting studies -Description of the method of data extraction from reports and methods used for assessing risk of bias of individual studies in addition to methods of handling data and combining results of studies. |
Results | Provision of full details of: -Study selection. -Study characteristics (e.g., study size, PICOS, follow-up period) -Risk of bias within studies. -Results of each meta-analysis done, including confidence intervals and measures of consistency. -Methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression). |
Discussion | -Summary of the main findings including the strength of evidence for each main outcome. -Discussion of limitations at study and outcome level. -Provision of a general concluded interpretation of the results in the context of other evidence. |
Funding | Source and role of funders. |
Critical appraisal is a fundamental skill in modern practice for assessing the value of clinical researches and providing an indication of their relevance to the profession. It is a skills-set developed throughout a professional career that facilitates this and, through integration with clinical experience and patient preference, permits the practice of evidence based medicine and dentistry. By following a systematic approach, such evidence can be considered and applied to clinical practice.
Critical thinking, as described by Oxford Languages, is the objective analysis and evaluation of an issue in order to form a judgement.
Active and skillful approach, evaluation, assessment, synthesis, and/or evaluation of information obtained from, or made by, observation, knowledge, reflection, acumen or conversation, as a guide to belief and action, requires the critical thinking process, which is why it's often used in education and academics.
Some even may view it as a backbone of modern thought.
However, it's a skill, and skills must be trained and encouraged to be used at its full potential.
People turn up to various approaches in improving their critical thinking, like:
Critical thinking can help in planning your paper and making it more concise, but it's not obvious at first. We carefully pinpointed some the questions you should ask yourself when boosting critical thinking in writing:
Usage of critical thinking comes down not only to the outline of your paper, it also begs the question: How can we use critical thinking solving problems in our writing's topic?
Let's say, you have a Powerpoint on how critical thinking can reduce poverty in the United States. You'll primarily have to define critical thinking for the viewers, as well as use a lot of critical thinking questions and synonyms to get them to be familiar with your methods and start the thinking process behind it.
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Affiliation.
As health care professionals practice as a team, they take on responsibilities that are specific to their roles-responsibilities that are recognized and understood by the team and management as pertaining to their professional domain and expertise. Is advocacy part of the role of the nurse? Members of the nursing profession commonly maintain that it is, but is there a consensus on this issue, both within the profession and among other stakeholders? Is there a clear understanding of the term advocacy, and is this reflected in Codes of Practice and research into practice? An examination of significant documents and reports of empirical research reveals conflicting conceptions and opinions. There is potential for a common definition, but agreements need to be reached on whether advocacy is an essential function of nursing within the management of health care, and if so, what is advocacy's importance, focus, and limits.
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COMMENTS
Critical analysis involves the examination of knowledge that underpins practice. Critical action requires nurses to assess their skills and identify potential gaps in need of professional development. Critical reflexivity is personal analysis that involves challenging personal beliefs and assumptions to improve professional and personal practice.
To be effective, critical analysis must be structured and organized. The following steps can help you format a critical analysis: 1) Identify the purpose of the critical analysis. 2) Identify the literature that will be used in the analysis. 3) distill the information from the literature into a clear, concise, and objective statement.
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Critical analysis is an important nursing skill in writing and in practice. With the advent of an all-degree profession, understanding how to develop this skill is crucial. This article examines how students can develop critical analysis skills to write at undergraduate degree level. It highlights some of the common errors when writing at this ...
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The Concept of Advocacy in Nursing A Critical Analysis. Kalaitzidis, Evdokia PhD; Jewell, Paul PhD. Author Information . ... There is potential for a common definition, but agreements need to be reached on whether advocacy is an essential function of nursing within the management of health care, and if so, what is advocacy's importance, focus ...
Therefore, the aims of this concept analysis are to 1) distinguish the use of the term in developing an operational definition, 2) to explore the concept of critical care as a possible space for care, cure and function and 3) develop a conceptual/theoretical model of critical care (Step 2). Furthermore, it may be possible to describe, define ...
Abstract. The four major methodological approaches to concept analysis (Wilson-derived methods, qualitative methods, critical analysis of the literature, and quantitative methods) are compared. The authors suggest that qualitative methods and methods that critically analyze the literature may be selected according to the level of the maturity ...
Critical Appraisal of Clinical Research - PMC
Critical thinking, as described by Oxford Languages, is the objective analysis and evaluation of an issue in order to form a judgement. Active and skillful approach, evaluation, assessment, synthesis, and/or evaluation of information obtained from, or made by, observation, knowledge, reflection, acumen or conversation, as a guide to belief and action, requires the critical thinking process ...
The Concept of Advocacy in Nursing: A Critical Analysis Health Care Manag (Frederick). 2020 Apr/Jun;39(2):77-84. doi: 10.1097/HCM.0000000000000292. ... There is potential for a common definition, but agreements need to be reached on whether advocacy is an essential function of nursing within the management of health care, and if so, what is ...
10.1542/6355450560112Video AbstractPEDS-VA_2023-0654316355450560112CONTEXT. Prognostic prediction models (PPMs) can help clinicians predict outcomes.OBJECTIVE. To critically examine peer-reviewed PPMs predicting delayed recovery among pediatric patients with concussion.DATA SOURCES. Ovid Medline, Embase, Ovid PsycInfo, Web of Science Core Collection, Cumulative Index to Nursing and Allied ...