آیا تفکر نقادانه بهتر در بین پرستاران مراقبت های ویژه به معنی تصمیم گیری ثمربخش آنهاست؟ یک بررسی مقطعی Does good critical thinking equal effective decision-making among critical care nurses? A cross-sectional survey

Introduction Critical thinking has been defined as “reasonable reflective thinking that is focused on deciding what to believe or do” (Ennis, 1987; p. 10). The American Philosophical Association (1990, p. 315) defined critical thinking as “purposeful, self-regulatory judgment that uses cognitive tools such as interpretation, analysis, evaluation, inference, and explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which judgment is based”. Critical thinking refers to the careful and precise thinking used to resolve a problem (McPeck, 2016).  Kataoka-Yahiro and Saylor (1994) defined critical thinking in nursing as “reflective and reasonable thinking about nursing problems without a single solution . . . focused on deciding what to believe and do”. Nurses face increasingly complex challenges in health care settings that require them to improve their critical thinking, problem-solving and decision-making skills. These skills are key nursing assets in health care delivery and enhance nurses’ proficiency (Hoffman et al., 2004). Rapid developments in nursing practice place greater emphasis on nurses’ autonomy in delivering health services, giving them more responsibility in determining the outcome of their nursing interventions (Martin, 2002). This responsibility increases with the level of care required. Thus, in critical care units, nurses undertaking intensive care and monitoring of patients with life-threatening health conditions face higher levels of responsibility. Critical care nurses in these units must be prepared for, and capable of dealing with, unpredictable changes in patients’ conditions or outcomes (Atkinson, 2013). Critical care nurses need the capacity to implement their critical thinking skills while providing care to their patients and have good clinical judgement to enable them to not only make decisions quickly, but to act on them. Critical thinking skills can be developed within individuals; however, factors that trigger critical thinking in some people more than others may affect the development of higher order thinking (Purvis, 2009). For example, social pressures and life habits may affect critical care nurses’ judgement, and good judgement is essential for safe, efficient and skilful nursing practice (Papathanasiou et al., 2014). While critical thinking and decision-making are generally accepted as two of the main and most emphasised components of nursing practice, the commonly accepted relationship between them identified by Shoulders et al. (2014) has not been researched in depth in critical care settings in some countries, including Malaysia. This paper reports a study that sought to address this shortfall in research by answering the question: “Does critical care nurses’ critical thinking reflect good decision-making?”