This paper reviews literature on the application of critical thinking in nursing. Precisely, the author identifies the role of critical thought to the ADPIE nursing process, which directs nurses to apply five steps that would allow them move from the known to the unknown while handling patient cases. The essay finds that the ADPIE process was developed according to the ANA scope and standards of practice, which the call for nurses to practice according to laid down principles as stated in their licensure terms. In meeting the objective of the paper, the author reviews the ADPIE nursing process in detail, appraises literature on the relationship between concept mapping and critical thinking, reports the ways of developing critical thought, and transiting from novice to expert thinkers before concluding with the relevance of the ANA scope and standards of practice.
The Nursing Process
In nursing literature, ADPIE is an acronym, which stands for assessment, diagnosis, planning, implementation, and evaluation (Ackley, Ladwig, & Makic, 2016). The cited author reports that the ADPIE process assists medical practitioners in remembering the processes and the order of the steps that they require to take in the provision of proper care for the persons that they are treating. The ADPIE process, therefore, is critical since it offers a throughout and useful framework in caring for patients through the development of problem solving and critical thinking skills (Ackley, Ladwig, & Makic, 2016). The step-by-step explanation of the process is presented subsequently.
Delegate your assignment to our experts and they will do the rest.
Assessment
In the ADPIE process, assessment is the initial step. During this stage of providing care, medical practitioners always strive to identify the problems and create a data base through interviewing patients and their families, observing the manner in which they behave, and undertaking examinations (Lippincott & Wilkins, 2013). Consequently, the cited literature suggests that the focus of the process is on the collection of data, validation of information, and listing any forms of anomalies in the collected data. In conducting the assessment, novice nurses should understand that they may collect both subjective—which cannot be measured directly—and subjective data—one that can be measured directly. The nurses are advised to collect as much information from their patients as possible to inform their decisions, especially when the information is accurate (Ackley, Ladwig, & Makic, 2016).
Diagnosis
During the diagnosis process, medical processions adopt a theory about the situation of the patients based on the information that shall have been gathered during assessment. As much as the nurses may not be able to undertake professional diagnoses of their patients, they have the ability to create their critical thinking and ensure that they communicate their assessment to the rest of the teams. It is important noting that nurses have their unique ways of communicating their clinical judgments of patients, which is defined by NADA international (Lippincott & Wilkins, 2013). For novice nurses, the diagnosis stage of the nursing process allows them to make determinations about their patients, and to form opinions concerning whether the condition is emotional, mental, or psychological. As much as nurses may not always offer professional diagnoses, they are always in a position to note the real or probable health risks that the patients could be facing. The diagnosis process would always be useful for the novice nurses who will always inform the care priorities for individual patients, which they will always conduct during the planning stage of the process.
Planning
While conducting the ADPIE nursing process, nurses always design care plans that always follow SMART goals that would be useful in the attainment of the desired care outcomes, such as pain reduction or bolstering cardiovascular functioning of the students (Lippincott & Wilkins, 2013). The set goals are also useful in developing a plan that could be measured and evaluated according to the patient conditions. Novice nurses should understand that the planning process is useful because it helps them in determining if the care goals developed are suitable for the patient conditions or if they are not.
Implementation
The implementation stage of the nursing process is the actionable element in which the medical teams and individuals implement their care plans, the set goals, and interventions that would allow the process to be measured. The care that is provided could be direct or indirect. According to In Bulechek et al. (2013) the implementation process may be useful for novice nurses because it allows them to develop and use critical judgment and question the care processes that would allow them to appropriately meet the concerns and demands of the persons receiving the care.
Evaluation
The last phase of the nursing process is evaluation, and it directs the medical professionals to assess the efficacy of their planning and implementation procedures. The objective of nursing is always to ensure that patients realize positive care outcomes, which is why all nursing processes are assessed according to positive health indicators of the patients. For novice nurse, the evaluation stage would provide useful lessons that would improve their practice in the future, especially while handling patients through the other stages.
Concept Mapping and Its Role in Critical Thinking
According to Schmehl (2014), critical thinking has three integral elements, which are asking questions, attempting to answer the questions through proper reasoning, and believing in the outcomes of the reasoning. The literature also suggests that the process relies a great deal on the ability of individuals to choose among alternatives before making their decisions. Concept mapping has been connected to critical thinking in many fields, including nursing (Schmehl, 2014). In conducting conceptual mapping, nurses or their leaders may apply graphical tools that are effective ways of organizing and presenting knowledge around specific issues related to their scope of practice. The concept maps direct help the nurses to identify potential solutions to issues that require their attention through establishing a series of connections among different factors. Through concept mapping, nurses may understand the effects of dealing with specific factors on the entire process or the outcomes of not handling the factors since the conceptual maps prompt them to approach problems with the cause-effect mentality (Hopkins, 2016). Consequently, it can be argued that concept mapping informs critical decision making through emphasizing the cause-effect approach to handling issues in nursing.
Critical Thinking in Nursing
Ways of Developing Critical Thinking
Several strategies are proposed in literature concerning how to create critical thinking skills among nurses. According to Schmehl (2014), nurses may learn critical thinking when they cultivate independence of thought. In elaboration, the cited author indicates that nurses are not supposed to remain with the levels of knowledge obtained from their training, and that they are supposed to be open to new ideas, especially those that would challenge their perspectives of problem solving. The second approach is to encourage impartiality in their thoughts through avoiding being biased such as through considering the perspectives of the rest of the group members and the patients. Nurses may also develop critical through paying perspicacity into social and personal factors, which means that they should always be sure to interpret the biases each time that are required to make decisions (Schmehl, 2014). Furthermore, nurses could develop skills of critical thinking through deferral crisis and humble cerebration, which means that they should always be aware of their knowledge limits. The nurses are further advised to adopt values of perseverance, integrity, and confidence if they are to develop critical decision making skills.
Levels of Critical Thinking
According to Hopkins (2016), critical thinking has three levels, which are grade 3, grade 2, and grade 1. At grade 3, the nurses may be filled with ignorance, hypocrisy, and prejudice. The same study suggests that at grade 2, individuals shall have made progress since they develop the capacity of detecting contradictions in their thought. Nevertheless, the thinker at this stage does not provide solutions for the contradictions that they note in their thought. Lastly, at grade 1, the thinkers have the capacity of identifying contradictions in their thought and formulating solutions that would deal with them.
Methods of Reasoning
Two approaches to reasoning have been advanced in critical thinking literature. Precisely, according to Hopkins (2016), deductive inductive reasoning are the approaches used in developing critical thought. Inductive reasoning, the author reports, starts from specific observations towards a generalized approach while deductive reasoning begins from general ideas and ends with a specific issue that should be solved.
Novice to Expert Thinking
Novice nurses may advance their critical thinking as they transit from professional training to practice. As much as the process may not be rapid in some of them, nurses learn to avoid using personal opinions, which often characterize intuitive reasoning to critical thinking skills. Usually, novice nurses work alongside experienced workmates who are useful in cultivating critical thinking skills using the ways described previously. The nurses also ascend the levels of critical thinking, especially when they learn to use the deductive and inductive methods of reasoning in place of their former intuitive reasoning approaches.
ANA Scope & Standards of Practice
The scope of practice developed by the American Nurses Association, ANA, defines the services that qualified health professionals should perform according to their competence, especially while keeping in terms with their licensure. Precisely, the nursing standards and scope of practice described the how, why, when, where, what, and who regarding nursing. Therefore, the standards and scope of practice play a role in regulating nursing practice through enforcing the terms of licensure (ANA, 2018).
Conclusion
The ADPIE nursing process was developed according to the ANA scope and standards of practice since it describes the approaches to nursing those registered nurses should adopt in their professional practice. The stepwise process of nursing ensures that nurses move from known to unknown while handling patients and their cases. The five processes discussed in this research paper highlight the need for nurses to apply and advance their critical thinking skills that uses inductive and deductive reasoning to solving problems as opposed to intuitive approaches to thinking. Concept mapping, as the essay has described, could be one of the best approaches to critical thinking that would accelerate the transition of novice nurse from amateur decision making to critical thinkers, from grade 3 to grade 1.
References
Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2016). Nursing Diagnosis Handbook-E-Book: An Evidence-Based Guide to Planning Care . Elsevier Health Sciences.
American Nurses Association (ANA) (2018). Nursing Scope of Practice . Retrieved 7 December 2018, from https://www.nursingworld.org/practice-policy/scope-of-practice/
Hopkins, J. (2016). Critical thinking: How to evaluate information and draw conclusions . Mount Kisco, N.Y: Guidance Associates.
In Bulechek, G. M., In Butcher, H. K., In Dochterman, J. M., & In Wagner, C. M. (2013). Nursing Interventions Classification (NIC) . New York: NY, Elsevier.
Lippincott W., & Wilkins, J. (2013). Nursing care planning made incredibly easy . Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.
Schmehl, P. (2014). Introduction to concept mapping in nursing: Critical thinking in action . Burlington, MA: Jones & Bartlett Learning.
