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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Critical thinking is an integral part of nursing, especially in terms of professionalization and independent clinical decision-making. It is necessary to think critically to provide adequate, creative, and effective nursing care when making the right decisions for practices and care in the clinical setting and solving various ethical issues encountered. Nurses should develop their critical thinking skills so that they can analyze the problems of the current century, keep up with new developments and changes, cope with nursing problems they encounter, identify more complex patient care needs, provide more systematic care, give the most appropriate patient care in line with the education they have received, and make clinical decisions. The present chapter briefly examines critical thinking, how it relates to nursing, and which skills nurses need to develop as critical thinkers.
Critical thinking in nursing.
This painting shows a nurse and how she is thinking critically. On the right side are the stages of critical thinking and on the left side, there are challenges that a nurse might face. The entire background is also painted in several colors to represent a kind of intellectual puzzle. It is made using colored pencils and markers.
(Adapted with permission from the Association of Science and Art (ASA), Universal Scientific Education and Research Network (USERN); Painting by Mahshad Naserpour).
Unless the individuals of a nation thinkers, the masses can be drawn in any direction. Mustafa Kemal Atatürk
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Şefika Dilek Güven
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Güven, Ş.D. (2023). Critical Thinking in Nursing. In: Rezaei, N. (eds) Brain, Decision Making and Mental Health. Integrated Science, vol 12. Springer, Cham. https://doi.org/10.1007/978-3-031-15959-6_10
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(Write 2-3 paragraphs)
In literature ‘critical thinking’ is often used, and perhaps confused, with problem-solving and clinical decision-making skills and clinical reasoning. In practice, problem-solving tends to focus on the identification and resolution of a problem, whilst critical thinking goes beyond this to incorporate asking skilled questions and critiquing solutions.
Critical thinking has been defined in many ways, but is essentially the process of deliberate, systematic and logical thinking, while considering bias or assumptions that may affect your thinking or assessment of a situation. In healthcare, the clinical setting whether acute care sector or aged care critical thinking has generally been defined as reasoned, reflective thinking which can evaluate the given evidence and its significance to the patient’s situation. Critical thinking occasionally involves suspension of one’s immediate judgment to adequately evaluate and appraise a situation, including questioning whether the current practice is evidence-based. Skills such as interpretation, analysis, evaluation, inference, explanation, and self-regulation are required to interpret thinking and the situation. A lack of critical thinking may manifest as a failure to anticipate the consequences of one’s actions.
Critical thinking is that mode of thinking – about any subject, content, or problem — in which the thinker improves the quality of his or her thinking by skillfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them.
The Paul-Elder framework has three components:
Critical thinking can be defined as, “the art of analysing and evaluating thinking with a view to improving it”. The eight Parts or Elements of Thinking involved in critical thinking:
It is how we view the health care consumer or aged care consumer, and the type of problems nurses deal with in clinical practice when we engage in health care patient centred care. To think like a nurse requires that we learn the content of nursing; the ideas, concepts, ethics and theories of nursing and develop our intellectual capacities and skills so that we become disciplined, self-directed, critical thinkers.
As a nurse you are required to think about the entire patient/s and what you have learnt as a nurse including; ideas, theories, and concepts in nursing. It is important that we develop our skills so that we become highly proficient critical thinkers in nursing.
In nursing, critical thinkers need to be:
Nurses need to use language that will clearly communicate a lot of information that is key to good nursing care, for handover and escalation of care for improving patient safety and reducing adverse outcomes, some organisations use the iSoBAR (identify–situation–observations–background–agreed plan–read back) format. Firstly, the “i”, for “identify yourself and the patient”, placed the patient’s identity, rather than the diagnosis, in primary position and provided a method of introduction. (This is particularly important when teams are widely spread geographically.) The prompt, “S” (“situation”) “o” for “observations”, was included to provide an adequate baseline of factual information on which to devise a plan of care. and “B” (“background”), “A” “agreed plan” and “R” “read back” to reinforce the transfer of information and accountability.
In clinical practice experienced nurses engage in multiple clinical reasoning episodes for each patient in their care. An experienced nurse may enter a patient’s room and immediately observe significant data, draw conclusions about the patient and initiate appropriate care. Because of their knowledge, skill and experience the expert nurse may appear to perform these processes in a way that seems automatic or instinctive. However, clinical reasoning is a learnt skill.
To support nursing students in the clinical setting, breakdown the critical thinking process into phases;
This is a dynamic process and nurses often combine one or more of the phases, move back and forth between them before reaching a decision, reaching outcomes and then evaluating outcomes.
For nursing students to learn to manage complex clinical scenarios effectively, it is essential to understand the process and steps of clinical reasoning. Nursing students need to learn rules that determine how cues shape clinical decisions and the connections between cues and outcomes.
Start with the Patient – what is the issue? Holistic approach – describe or list the facts, people.
Collect information – Handover report, medical and nursing, allied health notes. Results, patient history and medications.
Process Information – Interpret- data, signs and symptoms, normal and abnormal.
Identify Problems – Analyse the facts and interferences to make a definitive diagnosis of the patients’ problem.
Establish Goals – Describe what you want to happen, desired outcomes and timeframe.
Take action – Select a course of action between alternatives available.
Evaluate Outcomes – The effectiveness of the actions and outcomes. Has the situation changed or improved?
Reflect on process and new learning – What have you learnt and what would you do differently next time.
(Write 3-5 paragraphs)
Some skills are more important than others when it comes to critical thinking. The skills that are most important are:
This skill is also needed to determine if outcomes have been fully reached.
Based upon those three skills, you can use clinical reasoning to determine what the problem is.
These decisions have to be based upon sound reasoning:
Errors that occur in critical thinking in nursing can cause incorrect conclusions. This is particularly dangerous in nursing because an incorrect conclusion can lead to incorrect clinical actions.
Illogical Processes
A common illogical thought process is known as “appeal to tradition”. This is what people are doing when they say it’s always been done like this. Creative, new approaches are not tried because of tradition.
All people have biases. Critical thinkers are able to look at their biases and not let them compromise their thinking processes.
Biases can complicate decision making, communication and ultimately effect patient care.
Closed Minded
Being closed-minded in nursing is dangerous because it ignores other team members points of view. Essential input from other experts, as well as patients and their families are also ignored which ultimately impacts on patient care. This means that fewer clinical options are explored, and fewer innovative ideas are used for critical thinking to guide decision making.
So, no matter if you are an intensive care nurse, community health nurse or a nurse practitioner, you should always keep in mind the importance of critical thinking in the nursing clinical setting.
It is essential for nurses to develop this skill: not only to have knowledge but to be able to apply knowledge in anticipation of patients’ needs using evidence-based care guidelines.
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Korn, M. (2014). ‘Bosses Seek ‘Critical Thinking,’ but What Is That?,’ The Wall Street Journal . https://www.wsj.com/articles/bosses-seek-critical-thinking-but-what-is-that-1413923730?tesla=y&mg=reno64-wsj&url=http://online.wsj.com/article/SB12483389912594473586204580228373641221834.html#livefyre-comment Accessed 5 May 2020.
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Paul And Elder (2009) Have Defined Critical Thinking As: The Art of Analysing And Evaluating …
https://www.chegg.com/homework-help/questions-and-answers/paul-elder-2009-defined-critical-thinking-art-analyzing-evaluating-thinking-view-improving-q23582096 Accessed 8 May 2020 .
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By Hannah Meinke on 07/05/2021
The nursing profession tends to attract those who have natural nurturing abilities, a desire to help others, and a knack for science or anatomy. But there is another important skill that successful nurses share, and it's often overlooked: the ability to think critically.
Identifying a problem, determining the best solution and choosing the most effective method to solve the program are all parts of the critical thinking process. After executing the plan, critical thinkers reflect on the situation to figure out if it was effective and if it could have been done better. As you can see, critical thinking is a transferable skill that can be leveraged in several facets of your life.
But why is it so important for nurses to use? We spoke with several experts to learn why critical thinking skills in nursing are so crucial to the field, the patients and the success of a nurse. Keep reading to learn why and to see how you can improve this skill.
You learn all sorts of practical skills in nursing school, like flawlessly dressing a wound, taking vitals like a pro or starting an IV without flinching. But without the ability to think clearly and make rational decisions, those skills alone won’t get you very far—you need to think critically as well.
“Nurses are faced with decision-making situations in patient care, and each decision they make impacts patient outcomes. Nursing critical thinking skills drive the decision-making process and impact the quality of care provided,” says Georgia Vest, DNP, RN and senior dean of nursing at the Rasmussen University School of Nursing.
For example, nurses often have to make triage decisions in the emergency room. With an overflow of patients and limited staff, they must evaluate which patients should be treated first. While they rely on their training to measure vital signs and level of consciousness, they must use critical thinking to analyze the consequences of delaying treatment in each case.
No matter which department they work in, nurses use critical thinking in their everyday routines. When you’re faced with decisions that could ultimately mean life or death, the ability to analyze a situation and come to a solution separates the good nurses from the great ones.
Nursing school offers a multitude of material to master and upholds high expectations for your performance. But in order to learn in a way that will actually equip you to become an excellent nurse, you have to go beyond just memorizing terms. You need to apply an analytical mindset to understanding course material.
One way for students to begin implementing critical thinking is by applying the nursing process to their line of thought, according to Vest. The process includes five steps: assessment, diagnosis, outcomes/planning, implementation and evaluation.
“One of the fundamental principles for developing critical thinking is the nursing process,” Vest says. “It needs to be a lived experience in the learning environment.”
Nursing students often find that there are multiple correct solutions to a problem. The key to nursing is to select the “the most correct” solution—one that will be the most efficient and best fit for that particular situation. Using the nursing process, students can narrow down their options to select the best one.
When answering questions in class or on exams, challenge yourself to go beyond simply selecting an answer. Start to think about why that answer is correct and what the possible consequences might be. Simply memorizing the material won’t translate well into a real-life nursing setting.
As you know, learning doesn’t stop with graduation from nursing school. Good nurses continue to soak up knowledge and continually improve throughout their careers. Likewise, they can continue to build their critical thinking skills in the workplace with each shift.
“To improve your critical thinking, pick the brains of the experienced nurses around you to help you get the mindset,” suggests Eileen Sollars, RN ADN, AAS. Understanding how a seasoned nurse came to a conclusion will provide you with insights you may not have considered and help you develop your own approach.
The chain of command can also help nurses develop critical thinking skills in the workplace.
“Another aid in the development of critical thinking I cannot stress enough is the utilization of the chain of command,” Vest says. “In the chain of command, the nurse always reports up to the nurse manager and down to the patient care aide. Peers and fellow healthcare professionals are not in the chain of command. Clear understanding and proper utilization of the chain of command is essential in the workplace.”
“Nurses use critical thinking in every single shift,” Sollars says. “Critical thinking in nursing is a paramount skill necessary in the care of your patients. Nowadays there is more emphasis on machines and technical aspects of nursing, but critical thinking plays an important role. You need it to understand and anticipate changes in your patient's condition.”
As a nurse, you will inevitably encounter a situation in which there are multiple solutions or treatments, and you'll be tasked with determining the solution that will provide the best possible outcome for your patient. You must be able to quickly and confidently assess situations and make the best care decision in each unique scenario. It is in situations like these that your critical thinking skills will direct your decision-making.
While critical thinking skills are essential at every level of nursing, leadership and management positions require a new level of this ability.
When it comes to managing other nurses, working with hospital administration, and dealing with budgets, schedules or policies, critical thinking can make the difference between a smooth-running or struggling department. At the leadership level, nurses need to see the big picture and understand how each part works together.
A nurse manager , for example, might have to deal with being short-staffed. This could require coaching nurses on how to prioritize their workload, organize their tasks and rely on strategies to keep from burning out. A lead nurse with strong critical thinking skills knows how to fully understand the problem and all its implications.
Their solutions will take into account all their resources and possible roadblocks.
They’ll weigh the pros and cons of each solution and choose those with the greatest potential.
Finally, they will look back on the issue and evaluate what worked and what didn’t. With critical thinking skills like this, a lead nurse can affect their entire staff, patient population and department for the better.
You’re now well aware of the importance of critical thinking skills in nursing. Even if you already use critical thinking skills every day, you can still work toward strengthening that skill. The more you practice it, the better you will become and the more naturally it will come to you.
If you’re interested in critical thinking because you’d like to move up in your current nursing job, consider how a Bachelor of Science in Nursing (BSN) could help you develop the necessary leadership skills.
EDITOR’S NOTE: This article was originally published in July 2012. It has since been updated to include information relevant to 2021.
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The characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice. Nurses’ ability to recognize and respond to signs of patient deterioration in a timely manner plays a pivotal role in patient outcomes (Purling & King 2012). Errors in clinical judgement and decision making are said to account for more than half of adverse clinical events (Tomlinson, 2015). The focus of the nurse clinical judgement has to be on quality evidence based care delivery, therefore, observational and reasoning skills will result in sound, reliable, clinical judgements. Clinical judgement, a concept which is critical to the nursing can be complex, because the nurse is required to use observation skills, identify relevant information, to identify the relationships among given elements through reasoning and judgement. Clinical reasoning is the process by which nurses observe patients status, process the information, come to an understanding of the patient problem, plan and implement interventions, evaluate outcomes, with reflection and learning from the process (Levett-Jones et al, 2010). At all times, nurses are responsible for their actions and are accountable for nursing judgment and action or inaction.
The speed and ability by which the nurses make sound clinical judgement is affected by their experience. Novice nurses may find this process difficult, whereas the experienced nurse should rely on her intuition, followed by fast action. Therefore education must begin at the undergraduate level to develop students’ critical thinking and clinical reasoning skills. Clinical reasoning is a learnt skill requiring determination and active engagement in deliberate practice design to improve performance. In order to acquire such skills, students need to develop critical thinking ability, as well as an understanding of how judgements and decisions are reached in complex healthcare environments.
As lifelong learners, nurses are constantly accumulating more knowledge, expertise, and experience, and it’s a rare nurse indeed who chooses to not apply his or her mind towards the goal of constant learning and professional growth. Institute of Medicine (IOM) report on the Future of Nursing, stated, that nurses must continue their education and engage in lifelong learning to gain the needed competencies for practice. American Nurses Association (ANA), Scope and Standards of Practice requires a nurse to remain involved in continuous learning and strengthening individual practice (p.26)
Alfaro-LeFevre, R. (2009). Critical thinking and clinical judgement: A practical approach to outcome-focused thinking. (4th ed.). St Louis: Elsevier
The future of nursing: Leading change, advancing health, (2010). https://campaignforaction.org/resource/future-nursing-iom-report
Levett-Jones, T., Hoffman, K. Dempsey, Y. Jeong, S., Noble, D., Norton, C., Roche, J., & Hickey, N. (2010). The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today. 30(6), 515-520.
NMC (2010) New Standards for Pre-Registration Nursing. London: Nursing and Midwifery Council.
Purling A. & King L. (2012). A literature review: graduate nurses’ preparedness for recognising and responding to the deteriorating patient. Journal of Clinical Nursing, 21(23–24), 3451–3465
Thompson, C., Aitken, l., Doran, D., Dowing, D. (2013). An agenda for clinical decision making and judgement in nursing research and education. International Journal of Nursing Studies, 50 (12), 1720 - 1726 Tomlinson, J. (2015). Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis. BMC Medical Education, 15(103)
Competing interests: No competing interests
Most nursing professionals have natural nurturing abilities, a desire to give others support, and an appreciation for science and anatomy. Successful nurses also possess a skill that is often overlooked: they can think critically.
A critical thinker will identify the problem, determine the best solution, and choose the most effective method. Critical thinkers evaluate the execution of a plan to see if it was effective and if it could have been done better.
The ability to think critically has multiple applications in your life, as you can see. But Why is critical thinking important in nursing? Learn why and how you can improve this skill by reading on.
Critical thinking is an essential skill for nursing students to have. It’s not something that it can teach in a classroom, and it must be developed over time through experience and practice.
Critical thinking is the process of applying logic and reason to make decisions or solve problems. The ability to think critically will help you make better decisions on your own and collaborate with others when solving problems – both are essential skills for nurses.
Nursing has always been a profession that relies on critical thinking. Nurses are constantly faced with new situations and problems, which they need to think critically about to solve.
Critical thinking is essential for nurses because it helps them make decisions based on the available information and their past experiences and knowledge of the field. It also allows nurses to plan before making any changes to be most effective as possible.
It is an essential skill for nurses to have to provide the best care possible. Critical thinkers can comprehend a problem and think about how they can solve it, rather than reactively or automatically.
Critical thinking is a crucial skill for doctors, nurses, and other health care providers.
As you know, learning doesn’t end when you graduate from nursing school. You must continue to grow as a professional and develop your critical thinking skills.
Critical thinkers are better problem solvers than others in the same situation because they examine all the facts before coming up with solutions. They can also take many different perspectives into account when solving problems.
It’s easy for people to come to conclusions too quickly, but those who think critically will avoid this trap by first looking at every possible angle.
When faced with difficult decisions, these nurses won’t just rely on their gut feelings or what seems right according to society’s norms; instead, they’ll analyze all available information carefully until they develop the best solution.
Critical thinking is also crucial because it helps nurses avoid making mistakes in their work by providing them with a way to examine each situation and identify any potential risks or problems that may arise from subsequent actions before they take place.
It’s not enough for you to have empathy if your compassion isn’t backed up by critical thought and understanding of how certain decisions might affect others in various circumstances, so keep learning ways to become more thoughtful about the world around you.
The skills involved in being a good nurse are many and varied, but one thing all nurses need, regardless of what specialty they choose, is critical solid thinking abilities.
Nurses’ experiences often include making life-altering decisions, establishing authority in stressful situations, and helping patients and their loved ones cope with some of the most stressful and emotional times of their lives. Critical thinking is an essential aspect of nursing.
Following are the reasons:
Further critical thinking is essential to nursing because nurses can establish authority in a stressful situation, such as issuing orders or administering care when needed.
This can be difficult because it may require balancing medical expertise with empathy and compassion towards patients’ feelings, leading them to question your judgment at some point in time.
Another reason this skill set is crucial involves making decisions that will have life-changing effects on a patient’s health and well-being.
These are often irreversible choices that only you know how much weight they carry within the context of each situation, so you need to make sure all factors are carefully considered before deciding what action must be taken next without hesitation.
When it comes to critical thinking, some skills are more important than others. Using a framework known as the Nursing Process, some of these skills are applied to patient care. The most important skills are:
Interpretation: Understanding and explaining a specific event or piece of information.
Analysis: Studying data based on subjective and objective information to determine the best course of action.
Evaluation: Here, you assess the information you received. Is the information accurate, reliable, and credible? The ability to determine if outcomes have been fully achieved requires this skill as well.
The nurse can then use clinical reasoning to determine what the problem is based on those three skills.
The decisions need to be based on sound reasoning:
Provide a clear, concise explanation of your conclusions. Nurses should provide a rationale for their answers.
Self-regulation – You need to be aware of your thought processes. As a result, you must reflect on the process that led to your conclusion. In this process, you should self-correct as necessary. Keep an eye out for bias and incorrect assumptions.
It can fall by the wayside when it’s not seen as necessary or when there are more pressing issues.
Sometimes nurses can’t differentiate between a less acute clinical problem and one that needs immediate attention. When a large amount of complex data must be processed in a time-critical manner, errors can also occur.
Conclusion:
Nurses cannot overstate the importance of critical thinking. The clinical presentations of patients are diverse. To provide safe, high-quality care, nurses must make rational clinical decisions and solve problems. Nurses need critical thinking skills to handle increasingly complex cases.
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Background: Research has consistently demonstrated that new graduate nurses do not possess sufficient critical thinking skills when they transition to clinical practice. Unfolding case studies encourage students to participate in a number of critical thinking skills including information-seeking, logical reasoning, and analyzing of clinical data.
Objective: The aim of this study was to determine how the use of unfolding case studies as a learning modality affected baccalaureate students' critical thinking skills in their Adult Health Theory course. The researcher compared course examination scores earned by nursing students who were taught using traditional case studies to scores obtained by nursing students who completed unfolding case studies.
Setting: The pilot study took place at a moderate-sized comprehensive university in Wisconsin.
Design: A non-experimental correlational design using course examination scores data was employed to examine how the use of unfolding case studies as a learning modality affected baccalaureate students' critical thinking skills in their Adult Health Theory course.
Participants: A total of 160 students comprised the intervention group while an additional 142 students represented the control group in the study.
Methods: An independent-samples t-test was performed to explore differences in mean scores between the intervention and control groups.
Results: Results of the t-test indicate that mean examination scores were significantly higher for the intervention group (M = 234.9, SD = 13.1) than for the control group (M = 228.2, SD = 13.3); t(299) =, p < .001.
Conclusions: Results of this study suggest that unfolding case studies more effectively develop students' critical thinking skills than do a more traditional, static case study.
Keywords: Baccalaureate education; Critical thinking; Nursing students; Unfolding case study.
Copyright © 2020 Elsevier Ltd. All rights reserved.
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Declaration of competing interest The author declares no conflicts of interest.
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Prioritization of patient care should be grounded in critical thinking rather than just a checklist of items to be done. Critical thinking is a broad term used in nursing that includes “reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.” [1] Certainly, there are many actions that nurses must complete during their shift, but nursing requires adaptation and flexibility to meet emerging patient needs. It can be challenging for a novice nurse to change their mindset regarding their established “plan” for the day, but the sooner a nurse recognizes prioritization is dictated by their patients’ needs, the less frustration the nurse might experience. Prioritization strategies include collection of information and utilization of clinical reasoning to determine the best course of action. Clinical reasoning is defined as, “A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.” [2]
When nurses use critical thinking and clinical reasoning skills, they set forth on a purposeful course of intervention to best meet patient-care needs. Rather than focusing on one’s own priorities, nurses utilizing critical thinking and reasoning skills recognize their actions must be responsive to their patients. For example, a nurse using critical thinking skills understands that scheduled morning medications for their patients may be late if one of the patients on their care team suddenly develops chest pain. Many actions may be added or removed from planned activities throughout the shift based on what is occurring holistically on the patient-care team.
Additionally, in today’s complex health care environment, it is important for the novice nurse to recognize the realities of the current health care environment. Patients have become increasingly complex in their health care needs, and organizations are often challenged to meet these care needs with limited staffing resources. It can become easy to slip into the mindset of disenchantment with the nursing profession when first assuming the reality of patient-care assignments as a novice nurse. The workload of a nurse in practice often looks and feels quite different than that experienced as a nursing student. As a nursing student, there may have been time for lengthy conversations with patients and their family members, ample time to chart, and opportunities to offer personal cares, such as a massage or hair wash. Unfortunately, in the time-constrained realities of today’s health care environment, novice nurses should recognize that even though these “extra” tasks are not always possible, they can still provide quality, safe patient care using the “CURE” prioritization framework. Rather than feeling frustrated about “extras” that cannot be accomplished in time-constrained environments, it is vital to use prioritization strategies to ensure appropriate actions are taken to complete what must be done. With increased clinical experience, a novice nurse typically becomes more comfortable with prioritizing and reprioritizing care.
A broad term used in nursing that includes “reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.”
A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.
Leadership and Management of Nursing Care Copyright © 2022 by Kim Belcik and Open Resources for Nursing is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.
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This study analyzed the contents of critical reflective journals written by new nurses during their orientations using a text network. This study aimed to find ways to reduce turnover and improve clinical field adaptability among new nurses. The authors analyzed the content of reflective journals written by 143 new nurses from March 2020 to January 2021. Text network analysis was performed using the NetMiner 4.4.3 program. After data preprocessing, frequency of occurrence, degree centrality, closeness centrality, betweenness centrality, and eigenvector community were analyzed. In total, 453 words were extracted and refined, and words with high simple frequency and centrality were “incompetence,” “preparation,” “explanation,” “injection,” “time,” “examination,” and “first try.” “Medication” had the highest frequency of occurrence, and “incompetence” was the most important keyword in the centrality analysis. In addition, component analysis and eigenvector community analysis revealed three sub-theme groups: (1) basic nursing skills required for new nurses, (2) insufficient competency, and (3) explanation of nursing work. Significantly, this study is the first to use the text network method to analyze the subjective experiences of the critical reflective journals of new nurses. In conclusion, changes are needed to improve the education system for new nurses and promote efficient sharing of nursing tasks.
“New nurses” are nurses who work in hospitals within their first year of acquiring a nursing license. New nurses experience several challenges while adapting to the clinical environment because they often identify patient problems and make high-quality clinical decisions in rapidly changing clinical settings. Critical thinking ability is essential to overcoming difficulties in meeting these demands. 1 In particular, critical thinking ability positively affects clinical decisions through communication and may help new nurses adapt to their working environment. 2 However, new nurses tend to have lower critical thinking abilities than tenured nurses and require time to develop clinical competencies. 3 Because inadequate critical thinking skills may make it difficult for new nurses to provide optimal nursing care and thus may negatively affect patient safety, 3 new nurses must develop strong critical thinking skills.
Furthermore, critical thinking is a reflective thinking process that enables one to decide what to believe and what to do, 4 and reflection is essential to enhance critical thinking ability. 5 Reflective journaling is an approach to internalizing learned knowledge through reflective thinking and objectifying activities, 6 which in turn may strengthen critical thinking and clinical decision-making abilities. 3 Reflective thinking connects new knowledge with existing knowledge, enables abstract thinking, and enables individuals to use specific solution-oriented strategies based on their knowledge and experiences in response to new problems. 7 In the context of nursing education, reflective journaling crucially allows learners to observe their emotional and psychological states. 8 For new nurses, the process of transitioning from being a nursing student to working as a nurse may be confusing and difficult, and reflective journaling during this period may improve clinical decision-making skills, relieve the challenges associated with the transition process, and promote communication with preceptors and nursing managers. 9 , 10
Reflective journaling is a clinically viable educational method for the self-analysis of clinical decision making in residency programs for new nurses. 11 In particular, reflective journaling is a useful educational method for strengthening clinical adaptation capacity in new nurses. 8 – 10 Analyzing the content of these journals can reveal how best to shape pedagogy to strengthen the competencies of new nurses.
Many studies have been conducted to help new nurses adapt and decrease their turnover. These studies include research on the factors affecting the retention intention and turnover of new nurses, 12 , 13 qualitative research on the practical adaptation experience of new nurses, and literature reviews on new nurse education programs. 14 , 15 However, no study has yet analyzed the reflective journals written by new nurses; therefore, it is necessary to review these journals, which offer insights into the actual experiences of new nurses. Other disciplines, such as pedagogy, have applied text network analysis (TNA) for more objective document research by linking content analysis and social network analysis. 16 The TNA method is an analysis technique that interprets a phenomenon using a network that displays the relationships between the words appearing in the text as “links.” Notably, TNA is a useful analysis method to identify the relationship between core keywords and other keywords. 17 In addition, this method can enhance knowledge of related phenomena through quantitatively examining the words appearing in text and identifying words that co-occur with other specific words. 18 Recently, in the field of nursing, studies have used network analyses to uncover research trends and knowledge structures, 19 , 20 including by analyzing the contents of the practices of nursing students. 21
In response to the gap in the literature, the authors sought to uncover the clinical experiences of new nurses during the orientation period by analyzing their critical reflective journals using the TNA method. In particular, the authors examined the relationships between keywords and main words and experiences. This study's specific objectives were as follows:
In this quantitative content analysis study, the authors applied the TNA method to identify the core keywords from new nurses' critical reflective journals on their clinical experiences during their orientation period.
The authors analyzed the critical reflective journals written by 143 new nurses who joined a university hospital located in an urban area of Korea from March 2020 to January 2021. The nurses recorded their experiences in the critical reflective journals six times during the orientation period (8 weeks). The nurses were instructed to record, in the form of narration, the most memorable aspects of their nursing interactions with patients and list their performance strengths and shortcomings in each situation. The journal structure was configured to assist them in establishing and writing goals, as well as with developing plans to improve their shortcomings. The researcher obtained the nurses' consent to participate in the study after detailing the purpose and method of writing critical reflective journals for 30 minutes during the common orientation period. New nurses were introduced to critical thinking as a very important and necessary process for improving clinical judgment. In addition, clinical nurse educators prompted new nurses to reflect on the situations they experienced in the field when writing in their journals; in particular, they asked the nurses to contextualize these situations and consider alternative ways they may have solved problems they encountered in the field. The researchers explained to the new nurses that the journals would only be used to analyze basic data to uncover how best to help new nurses adapt to the field. Next, new nurses who voluntarily agreed to participate were provided with a journal before being assigned to a department. Research participants were notified they could withdraw from the study at any time, and they were asked to contact the clinical nurse educators with any difficulties or questions related to journaling. After orientation, the nursing education team collected the journals.
In the analysis of the collected data, the main semantic structure was visualized as a sociogram through preprocessing and network analysis. Analysis was performed using NetMiner 4.4.3 (Cyram Co. Ltd., Gyeonggi-do, Korea).
The journals were transcribed to Microsoft Office Excel (Microsoft Inc., Redmond, WA, USA) and converted into databases. Four researchers divided the reflective journals, copied them, and then went through the process of reconfirming each other's work. The data were extracted from long texts and included only nouns identified using the morpheme analysis function of NetMiner 4.4.3. Using the NetMiner's “import unstructured text” menu, the database data were read and morphemes were extracted. A thesaurus was created to unify words with similar meanings. While examining the extracted morphemes, meaningful morphemes were extracted using the thesaurus, defined words, and excluded words, and word purification was performed using the extraction results.
The thesaurus grouped words (phrases) with similar meanings, and the researcher designated the representative words for each group. 22 In Korean alphabet (Hangeul), words with the same meaning are often presented differently, 23 so the authors paid attention to the selection of representative words and their registration in the thesaurus. For example, “alcohol cotton” was made to represent “alcohol swab,” “disinfection cotton,” “cotton,” and “alcohol.” Phrases consisting of two or more words were also added to the dictionary to establish that the multiple words comprising the phrase should be read as a unit. 24 For example, the words “intravenous” and “injection” were registered within the dictionary as comprising “intravenous injection.” The dictionary of excluded words went through a refining process to exclude stop words, such as pronouns and adverbs without important meanings. The process of word refinement involved several rounds of consultation between joint researchers to reduce subjective bias. In addition, “frequency of appearance” refers to the number of times a keyword appears in an entire document. In order to exclude commonly used words that appear frequently in all documents, words with a term frequency–inverse document frequency (TF-IDF) value of 0.5 or less were excluded by referring to previous studies. 25 The frequency of words appearing in one document is called “term frequency,” and the number of documents in which a word appears is called “document frequency.” “Inverse document frequency” is the logarithmic expression of the inverse of document frequency. A high term frequency value may be recognized as a keyword due to a high frequency in one document, but if the term frequency value is equally high in other documents, it is considered a commonly used word in several documents, even if it may not be necessarily a keyword. Therefore, it should be excluded when extracting keywords by calculating inverse document frequency values of words. For this purpose, TF-IDF, which represents the importance of any word in a particular document, is obtained by multiplying term frequency and inverse document frequency, and used for word extraction. The larger the TF-IDF value, the higher the importance of any word in the document. 26 In this study, five words with a TF-IDF value of 0.5 or less (eg, “teacher,” “patient,” “work,” “think,” and “confirm”) were included in the dictionary of excluded words.
Finally, 274 thesaurus, 301 defined words, and 1759 excluded words were registered in the user dictionary. As a result, a total of 453 words were extracted in the critical reflective journals written by the new nurses. In this study, the top 30 keywords' frequency of appearance was analyzed based on refined words to extract keywords. To intuitively represent keywords, frequency of appearance was generated by using NetMiner 4.4.3.
The network formation process generated a keyword co-occurrence matrix to reflect that the two keywords appeared next to each other in one sentence or were located among the other keywords. 27 Repeated co-occurrence can be interpreted as forming a semantic structure between the words. The higher the degree of connection, the more co-occurrence exists across different types of keywords, which yields a semantic structure in various contexts. In the one-mode matrix of the “keyword × keyword” relationship, the degree value was 1 to 48, 70.4% (1649) for less than 1 and 85.4% (1999) for less than 2.
To grasp the main phenomenon in network analysis, only keywords with an appropriate level of connection are included, but the reference value for the connection degree is not presented, 28 and the study result is determined considering ease of interpretation and network visualization. 27 In this study, a one-mode matrix composed of 401 keywords with a connection degree of two or higher was generated and used for network analysis.
Statistical analysis was performed and visualized using a one-mode network to discover the core keywords in the journals.
The centrality of the network was analyzed for degree centrality, closeness centrality, and betweenness centrality, which are indicators of centrality, and the average and concentration of each centrality were confirmed. Centrality indicators show that words with high centrality are considered core keywords to the extent that words in the network are centered. 29 The value of the centrality indicator exists between 0 and 1; the larger the value, the higher the centrality of the word. 28 The average centrality indicator refers to the center value of the entire network centrality indicator, and centralization represents the degree to which a network is structurally concentrated or distributed across a specific word. Thus, an intensive link flow in a small number of words indicates that the network is highly concentrated. 29
Degree centrality refers to the degree of connection between nodes (in this study, keywords used in the analysis) in the network; this indicates co-occurrence between words and indicates the number of connections between nodes. 28 Keywords with high connection centrality are often connected to other keywords, which means that they are important keywords. Closeness centrality refers to the degree to which a node is located close to another node in the network. 28 Keywords with high proximity centrality may be interpreted as keywords that play a central role in the network while reaching other keywords the fastest. Betweenness centrality refers to the degree to which other nodes and intermediaries play a role in the network. 28 Keywords with high mediation betweenness centrality serve as bridges that interconnect sub-keywords between networks. The top 30 words with high degree centrality, closeness centrality, and betweenness centrality were visualized as sociograms. The larger the node size, the larger the centrality index, and the thicker the link, the higher the co-occurrence frequency.
To identify the sub-theme groups, the authors first extracted the largest component based on cohesion in the NetMiner program and then performed an eigenvector community analysis. A component is a group in which keywords are connected without being broken. Communities refer to subgroups with relatively low modularity, high connection density inside the group, and relatively low connection density outside the group within the component structure. The modularity value is used to determine the optimality of the community structure; eigenvector community modularity can have a value between negative (−) infinity and “1”—the larger the value, the better the modularity. 30
This study was approved by the institutional review board (CNUH-2020-247) of the university hospital located in an urban area of Korea to protect the participants, where the current study was conducted. Participants were informed about the purpose of the study, their rights to anonymity and confidentiality, and their freedom to withdraw from the study. Written informed consent was obtained from those who wished to participate in the study.
The top 30 keywords by simple frequency, degree centrality, closeness centrality, and betweenness centrality were identified as core keywords in the journals (Table (Table1). 1 ). The simple frequency appeared in following order: “medication,” “intravenous (IV) cannulation,” “preparation,” “incompetence,” and “explanation.” In this study, the means of the degree centrality, closeness centrality, and betweenness centrality of the word networks were 0.216, 0.501, and 0.037, respectively, and the concentrations were 24.9%, 30.2%, and 14.0%, respectively. Regarding degree centrality, “incompetence,” “explanation,” “preparation,” “medication,” and “properly” were the most important keywords. Regarding closeness centrality, “incompetence,” “preparation,” “explanation,” and “time” were the most important keywords. Regarding betweenness centrality, “incompetence,” “preparation,” “first try,” “understand,” and “explanation” were the most important keywords. In the analysis of the most memorable events during the orientation period for new nurses, words such as “incompetence,” “preparation,” “explanation,” and “injection” were high in both frequency and centrality. Regarding the simple frequency, “medication” was the most frequent keyword. Regarding the centrality analysis, “incompetence” was the most important keyword.
Top 30 Keywords That Emerged From the Reflective Journal of New Nurses
Rank | Keyword | Frequency | Keyword | Degree Centrality | Keyword | Closeness Centrality | Keyword | Betweenness Centrality |
---|---|---|---|---|---|---|---|---|
1 | medication | 368 | incompetence | 0.448 | incompetence | 0.644 | incompetence | 0.172 |
2 | IV cannulation | 328 | explanation | 0.414 | preparation | 0.604 | preparation | 0.122 |
3 | preparation | 258 | preparation | 0.379 | properly | 0.592 | first try | 0.096 |
4 | incompetence | 252 | medication | 0.345 | explanation | 0.580 | understand | 0.094 |
5 | explanation | 249 | properly | 0.345 | time | 0.569 | explanation | 0.085 |
6 | injection | 248 | injection | 0.345 | injection | 0.569 | injection | 0.062 |
7 | time | 233 | time | 0.310 | medication | 0.547 | IV cannulation | 0.060 |
8 | first try | 222 | nursing | 0.276 | first try | 0.547 | properly | 0.055 |
9 | study | 203 | first try | 0.276 | nursing | 0.537 | time | 0.048 |
10 | nursing | 184 | understand | 0.276 | understand | 0.537 | examination | 0.046 |
11 | fluid | 182 | need | 0.276 | IV cannulation | 0.527 | need | 0.041 |
12 | operation | 174 | examination | 0.241 | examination | 0.518 | medication | 0.039 |
13 | examination | 173 | study | 0.241 | study | 0.518 | nursing | 0.033 |
14 | condition | 157 | IV cannulation | 0.241 | performance | 0.518 | EMR | 0.032 |
15 | blood | 154 | remember | 0.207 | organization | 0.518 | study | 0.021 |
16 | EMR | 154 | performance | 0.207 | administration | 0.518 | organization | 0.021 |
17 | understand | 152 | EMR | 0.207 | need | 0.518 | administration | 0.018 |
18 | remember | 148 | organization | 0.207 | remember | 0.500 | blood | 0.013 |
19 | blood glucose management | 146 | administration | 0.207 | EMR | 0.483 | remember | 0.011 |
20 | admission | 145 | blood glucose management | 0.138 | situation | 0.468 | performance | 0.010 |
21 | properly | 143 | caregiver | 0.138 | admission | 0.468 | admission | 0.009 |
22 | need | 134 | situation | 0.138 | caregiver | 0.460 | blood sampling | 0.007 |
23 | caregiver | 134 | blood sampling | 0.104 | blood | 0.446 | caregiver | 0.006 |
24 | blood sampling | 130 | fluid | 0.104 | blood glucose management | 0.439 | situation | 0.004 |
25 | organization | 128 | admission | 0.104 | fluid | 0.427 | night | 0.002 |
26 | night | 126 | blood | 0.104 | blood sampling | 0.414 | blood glucose management | 0.002 |
27 | suction | 123 | night | 0.069 | operation | 0.414 | fluid | 0.002 |
28 | administration | 121 | operation | 0.069 | night | 0.403 | condition | 0.000 |
29 | performance | 120 | condition | 0.035 | suction | 0.397 | operation | 0.000 |
30 | situation | 117 | suction | 0.035 | condition | 0.354 | suction | 0.000 |
Average | 0.216 | 0.501 | 0.037 | |||||
Centrality | 24.877% | 30.18% | 14.012% |
Figure Figure1 1 presents a sociogram, a graph consisting of nodes and links, of the top 30 keywords. The size of a node indicates the degree centrality, and the thickness of a link indicates the strength of the connection, that is, the frequency of co-occurrence. The researchers examined the semantic structure by focusing on five core topics: “medication,” which is strongly tied with “study,” “explanation,” “examination,” and “remember”; “preparation,” which is part of a semantic structure with “injection,” “operation,” “medication,” “time,” and “fluid”; “time,” which is strongly tied with “nursing” and “performance”; and “explanation,” which is part of a semantic structure with “caregiver,” “incompetence,” and “nursing.” Finally, “IV cannulation,” “fluid,” and “organization” formed the semantic structures; “first try,” “IV cannulation,” “admission,” and “night” appeared as meaningful structures; and “properly” and “explanation,” “need,” and “study” appeared as meaningful structures.
Keyword network analysis of the reflective journal of new nurses.
Regarding degree centrality and closeness centrality, “night,” “operation,” “condition,” and “suction” showed low degree centrality and centered on “incompetent,” which demonstrated the highest centrality. Regarding betweenness centrality, “night,” “blood glucose management,” “fluid,” “condition,” “operation,” and “suction” showed low betweenness centrality and centered on “incompetent,” which again demonstrated the highest centrality.
The component analysis and eigenvector community analysis based on cohesion in the keyword network yielded three sub-thematic groups with an optimal modularity of 0.257 identified with sociograms (Figure (Figure2). 2 ). Group 1 was classified into “medication,” “preparation,” “IV cannulation,” “first try,” “administration,” “injection,” “examination,” “blood glucose management,” “operation,” “fluid,” “blood sampling,” “blood,” “night,” and “caregiver.” Group 2 was classified into “incompetence,” “time,” “nursing,” “properly,” “electronic medical record (EMR),” “understand,” “study,” “organization,” “performance,” “condition,” and “suction.” Group 3 was classified into “explanation,” “need,” “remember,” “situation,” and “admission.” The research topic groups were named based on the contexts in which the keywords of each subgroup were used. The three sub-themes were (1) basic nursing skills required for new nurses, (2) insufficient competency, and (3) explanation of nursing work.
Visualization of subgroup analysis from the reflective journal of new nurses.
This study sought to understand the work experiences of new nurses by using a TNA method to analyze the contents of the critical reflective journals they wrote during their orientation (the first 8 weeks after they began working in the hospital). The main semantic structure specifically showed the context of the core topic.
More specifically, the frequency and centrality analyses confirmed that, in terms of working directly with patients, the new nurses had the most difficulty with tasks related to medication. The contents of the analysis suggest that a new nurse must prepare drugs for patients and explain the medication to the patient while administering the drug through injection. The new nurses described their experiences with this process in their journals as follows: “When I went to the patient to inject the drugs, the patient asked a question about why the drug was being used, but I did not explain the reason properly” and “I don't know how to explain the efficacy and side effects of various types of drugs administered to patients.” These excerpts suggest that new nurses lack knowledge about medications and experience job stress and low confidence; if these problems are not resolved, they may lead to job turnover. 31 New nurses must learn to administer medications; this is a core basic nursing skill in nursing colleges. A practical training room in the hospital is necessary to provide systematic and sufficient opportunities for repeated practice to improve the confidence of new nurses in their core basic nursing skills and reduce work stress. 32
This study uncovered the following main semantic structures. First, new nurses experience a lack of clinical knowledge about medication and feel a need to study on their own. In addition, a lack of drug-related knowledge caused new nurses to feel burdened when teaching a patient or their caregivers about a medication before administering it. Additionally, new nurses felt that they should remember what they learned on their own and in clinical practice from their preceptors. They also felt the need to learn and study the drugs used in many tests. Medication errors are an important factor in patient safety and are the most frequent medical accidents. 33 Administering the correct drug to the correct patient, providing information about the drug to the patient, and confirming and reporting the side effects of a drug is necessary to reduce medication errors; therefore, it is crucial to emphasize this in nursing programs. 33 Because this study found that new nurses experienced many difficulties with medication, it is necessary to establish a protocol for clinical practice and improve systematic education through simulation. 34
Second, this study confirmed that new nurses must prepare to successfully give injections, oral medications, and fluids and to facilitate operations (eg, preparing dressing materials). 35 In addition, new nurses were frequently pressed for time while taking care of patients. The results were similar to those from a study in which new nurses reported that the confidence level for the item “I can completely care for a patient within the allotted time” was low at 20%–50%. 36 New nurses often work overtime at hospitals; for example, some nurses go to work 2 hours early and complete their records after work because they do not have enough time to complete their duties within their scheduled hours. 37 This suggests that nursing tasks should be more appropriately distributed. 36
Third, new nurses need skills to explain their care to patients or caregivers while working. Accordingly, new nurses need to have strong relationship and communication skills. 38 The journals revealed that new nurses feel their work requires them to be able to properly explain different elements of care to patients and their caregivers; however, they often felt that they did not have the knowledge or skills necessary to carry out this duty. Moreover, the new nurses themselves felt they needed to study to ensure that they were not ignorant in ways that may harm the patient. Therefore, a system should be established to help new nurses strengthen their skills by actively utilizing support resources at the hospital level; notably, this may reduce turnover. Along these lines, a simulation program related to communication should be used during orientation to increase the communication abilities of new nurses. 39
Fourth, new nurses reported difficulties with IV cannulation and their first inpatient admissions. They felt pressured to complete an IV cannulation for the first time and struggled to connect and arrange various fluids. Simulations that teach new nurses how to administer intravenous injections should be included in orientations in response to this trend. Most wards in this research institute use functional nursing, with different numbers of people per service. Therefore, new nurses completed different tasks during day and evening shifts, such as IV cannulation, injection, and vital sign and blood glucose testing during the former and overseeing patients, checking prescriptions, and entering records during the latter. Accordingly, they reported that night work was very complicated and that they felt that they were lacking in their skills to complete it successfully. Previous studies reported that new nurses in Korea experienced excessive workload, communication difficulties, and low confidence in their work, suggesting that active intervention is needed to improve clinical adaptation in new nurses. 36 Therefore, there is a need to develop various programs, such as communication programs and basic nursing skill simulations, for new nurses.
Finally, based on the analysis of the three sub-thematic groups, the first subject group was “basic nursing skills required for new nurses.” The ability to perform basic nursing skills is an essential element for new nurses to adapt to practice: when nursing skills are lacking, they experience overload in the clinical field; this leads to increased stress, which increases the resignation rate. 40 In 2019, Korean institutions began to ensure they were offering clinical nurse educator systems and training programs to reduce the resignation rate of new nurses by improving their competency. 41 Programs that intensively train new nurses in basic nursing skills at the initial stage of their employment are essential in hospitals to help new nurses adapt to practice. The second thematic group was “insufficient competency.” New nurses start clinical work with insufficient clinical experience and competency; experience difficulties in providing and selecting appropriate treatments for patients; and must cope with overload, which increases their role burden. 37 Therefore, it is necessary to reduce the amount of work assigned to new nurses and to develop educational programs that can identify problems by presenting various situations that can help them understand their work. The third topic group was “explanation of nursing work.” New nurses most frequently deal with patients and caregivers and thus feel pressured to properly explain things to them (eg, why patients are hospitalized, what medications they are receiving); this feeds their desire to remember what they have learned. In addition, new nurses often complain of communication difficulties 38 ; accordingly, clinical communication programs should be developed to overcome this problem.
Unlike previous studies, this study analyzed the experiences of new nurses by applying TNA to the critical reflective journals they wrote during orientation. However, the information was only collected over the course of a year, which limits the generalizability of the research results. In addition, the fact that the nursing manager reports and provides feedback on the journals may have limited direct expression. To overcome these limitations, a program for the in-depth analysis of new nurses' experiences should be implemented in the future. Ultimately, this study sets the foundation for further analysis of the experiences of new nurses by being the first to use a TNA to effectively explore the subjective experiences of new nurses.
This study applied a TNA to identify, group, and analyze core keywords in the critical reflective journals new nurses wrote during their orientation at tertiary general hospitals in Korea. New nurses' most memorable events during orientation were reflected by high-frequency and high-centrality words, such as “incompetence,” “preparation,” “explanation,” and “injection.”
This study's results can guide best practice for improving the field adaptability of new nurses and reducing their turnover rate. Currently, nursing students in Korea nursing mainly complete observation-oriented practicums; this increases the burden on their basic nursing skills. Being compelled to perform extensive duties beyond their competencies is causing exhaustion among new nurses. To mitigate these issues, changes should be made to the new nurse education system to better prepare new nurses and nursing duties should be more efficiently distributed.
This study was financially supported from Back Ui Association, Chonnam National University Hospital (2021).
The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
Ethical Approval: The study was approved by the Chonnam National University Hospital Institutional Review Board (approval number: CNUH-2020-247).
Hye Won Jeong: https://orcid.org/0000-0001-5664-8672
Shin Hye Ahn: https://orcid.org/0000-0002-1403-2711
Anyone can be placed in a leadership role, but to be good and thrive in that position requires solid leadership skills . Leadership skills are typically at the top of the list of competencies that recruiters focus on when hiring, or when managers are promoted from within an organization.
Effective leadership skills are crucial, both in a professional and personal capacity and are vital in facilitating effective team dynamics, driving success, managing change, and promoting personal and professional development.
Some of the world’s largest companies hunt for people with well-honed leadership skills to fill their most sought after executive positions.
Some leaders will say they that they do not need to be loved in the workplace to succeed. This may be true, but to build a cohesive and more engaged team, great managers need the leadership skills to forge strong working relationships with their employees.
Leaders with strong, trusting and authentic relationships with their teams know that investing time in building these bonds makes them more effective as a leader, and creates a foundation for success.
Good working relationships increase employee engagement and according to Gallup’s meta-analysis of employee engagement, business units with good employee engagement have 41% fewer quality defects and 37% less absenteeism. A 21% increase in productivity was also seen to result from higher employee engagement.
So even if you think you don’t need to be loved in the workplace, you will definitely need to be skilled in building good relationships in order to be an effective leader.
If your team is highly engaged and happy in the workplace, you are likely to be well respected as a leader with employees who love what they do, and hopefully the strong relationships you cultivate will help your team perform at their highest level.
Tips for leaders to navigate relationships in the workplace »
In a study conducted by Development Dimensions International in 2008, one of the most important leadership qualities, was the ability to facilitate change. Fast-forward to 2024, adaptability is one of the most important leadership skills.
Leaders need to contend with a hyper-competitive business environment, geo-politics, climate change, the changes advanced by the COVID-19 pandemic and many more factors, all of which require leaders to adapt and develop agility.
Effective leaders must be able to adapt to both internal, and external changes – even if that means working outside of your comfort zone. As a leader you need to develop a lifelong learning mentality to ensure that you are not left behind by shifts in your industry, and can give your business the competitive edge. This is where as a leader you need to be agile and adaptable, which is easier said than done.
One key way to develop leadership agility and adaptability is to be accountable and assume your responsibilities, making sure that you have laid out a plan on how you should respond to change.
This plan should contain an achievable timeline, allowing you to constantly check your progress on how well you are adapting to the change and how you are exemplifying this to your team.
Read IMD article on agile leadership in an age of digital disruption »
Innovation in leadership is of utmost importance for every company. Successful innovation begins with ideation — the phase where outstanding ideas are developed and become the foundation of innovation success.
Consider some of the industry leaders, what did it take for Apple to become a leader technology industry? They made innovations to products with their customers in mind.
Steve Jobs, and perhaps even more so Tim Cook led the innovation and creativity for Apple Inc. by continuously forging ahead of the competition, and this probably made them some of the most innovative leaders within the tech industry.
The increasing demand for creativity and innovation will continue to be a driving force for executives, as who must harness their leadership skills in these areas to be effective and competitive.
In close connection with relationship building, the ability to motivate your workforce is as important as keeping employee engagement high. One of the most effective leadership skills is knowing how to continuously motivate employees, which requires leaders to be connected to their teams and attentive to what is going on around them.
In a study done by the firm Interact on 10,000 employees in the US which cited that the number 1 complaint (63%) from employees concerning their managers is lack of appreciation, and, conversely, when managers appreciate their contribution, their engagement increases by 60%.
In another study by Westminster College, it was found that boosting morale is the top (32%) motivational technique employees prefer. If employees are not motivated, the company can be negatively affected (financially) with absenteeism, attrition and low productivity.
Motivated employees are much more engaged, they are also more self-confident in what they do, and can do. This leads them to know how to react in difficult situations and develop innovative ideas that could help optimize business performance.
A leader is tasked with making decisions all the time. To be an effective leader, those decision making skills need to be top notch. Critical decisions affecting your organization on a large scale need to be sound, rational and solid.
In reality, your decisions as a leader will determine your – and potentially your organization’s – success. Making decisions, however big or small, are a fundamental part of Leadership, as a leader you need to develop strong decision-making skills and have the conviction to stand by your decisions, whilst also recognizing the need to adapt when those decisions do not lead to the desired outcome. It is a unique balancing act.
Remember, some decisions may not always be favorable. Making an unpopular but necessary decision is probably one of the most difficult tasks as a leader, but it is vital that as a leader you are able to recognize your responsibilities and make clear decisions for your team or organization.
📝 Try an exercise for better decision making »
According to the American Management Association, managers spend at least 24% of their time managing conflict. Conflict can happen in any area of business.
A conflict is considered to be any issue between two or more individuals that can potentially disrupt work. Conflict in business may go beyond the workplace as it can involve customers, suppliers and even competitors.
When a conflict arises, an effective leader should be able to jump in and resolve or at least mitigate the conflict before it affects the business negatively. When properly dealt with, a conflict may even turn out to be positive for your organization, as it can often lead to stronger bonds or new ideas.
To be effective as a leader, you must be good at identifying conflict, and have foresight on how to resolve it. It is also essential to be rational when faced with confrontation. Conflict management is no doubt one of the most important leadership competencies but Robyn Short cited a study that found 60% of U.S. employees have not received any conflict management skills training.
As a leader, it is important that you are able to manage conflict, but developing these same skills in your team can help avoid conflict altogether.
How to manage conflict: Six essentials from a former FBI hostage negotiator »
Negotiation is a process where two parties with different ideals get together and mutually agree on what an outcome should be. According to Skills You Need, the process of negotiation involves 6 stages:
Good negotiations can be beneficial to an organization because they will build better relationships, both internally and externally. They will also help find the best long-term solution by getting the most out of two different sides. An effective leader must be well versed in his negotiation style to move an organization forward.
As a leader, negotiation is used to understand the interests of your employees and to find ways of satisfying those interests, in order to achieve organizational goals.
Tips on using negotiation to achieve positive outcomes »
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Leading a business is unquestionably challenging. To be successful, a leader must make a lot of difficult decisions, often under pressure. Research by the Brandon Hall Group shows that critical thinking is the most important skill required of leaders to successfully lead an organization.
Critical thinking is the ability to think clearly, whilst building a logical connection between different ideas. Critical thinkers are often intelligent decision makers, highly analytical and generally always rational. Critical thinking is a learned skill, and generally involves three steps:
Step 1 – Frame
Complex problems are rarely what they appear to be on first look. To better understand what you are dealing with, frame the problem by asking yourself “What is my problem?” Hint: you can safely assume that whatever you think your problem is right now probably isn’t your actual problem.
Step 2 – Explore
Do not rely on intuition. No matter how much faith you have in your own judgment, if you rely strictly on your instincts you will miss the opportunity to see things from an alternative perspective. Instead, explore potential solutions. That is, ask yourself “How may I solve my problem?” It is equally important to explore what matters to you; that is, the various attributes of a solution that would make it more attractive to you.
Step 3 – Decide
In most cases, one solution isn’t consistently superior to all others on all attributes. To make your decision, answer your question, “How should I solve my problem?” Surface the trade-offs for each solution, identifying what you are ready to give away that you value so that you can get a little more of something else that you value even more.
Frame, explore, decide, or FrED, for short. For most complex problems, your understanding of the problem changes as you progress through the analysis. The three steps aren’t so much a linear sequence as they are elements of an iterative loop. Do not hesitate to revise previous conclusions as new evidence surfaces.
Typically, critical thinkers will rigorously question ideas and assumptions, they will always seek to determine whether the ideas, arguments and findings represent the true picture and are commonly able to recognize inconsistencies and errors in reasoning to achieve the desired outcome.
Sharpen your critical thinking skills with IMD »
Leadership is crucial to the success of individuals, teams, and organizations. It encompasses diverse skills, qualities, and approaches that empower individuals to guide and inspire others toward achieving common goals. As the business environment continues to evolve, so will the concept of leadership — adapting to meet the demands and challenges of a dynamic world. […]
Imagine navigating a ship through uncharted waters in the dark, with each crew member holding a piece of the map. That’s the challenge of leadership in today’s dynamic, ever-evolving business landscape. How do you, as a leader, unite these diverse pieces to chart a successful course? The answer lies in inclusive leadership. In a world […]
What if you could supercharge your leadership development in a way that’s tailored specifically to you? Today’s business leaders are under immense pressure to deliver. It’s not just about achieving quarterly targets; it’s about being a visionary, a strategic thinker, and a great manager. That’s where executive coaching comes in. Far from being a sign […]
Do you believe each team member has a unique strength that can fuel innovation and solve complex challenges? If your answer is yes, you might want to explore the landscape of laissez-faire leadership. Laissez-faire leadership, a term many have heard but few completely understand, is growing more relevant in today’s ever-changing, complex work environments. It […]
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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. Images sourced from Getty Images. Critical thinking in nursing is essential to providing high-quality patient care.
The following are examples of attributes of excellent critical thinking skills in nursing. 1. The ability to interpret information: In nursing, the interpretation of patient data is an essential part of critical thinking. Nurses must determine the significance of vital signs, lab values, and data associated with physical assessment.
Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood ...
There are many skills necessary to be an effective critical thinker. Decision-making and critical thinking need to happen together in order to produce reasoning, clarification, and potential solutions. To advance nursing practice, it is necessary to develop and evaluate strategies to help new nurses develop these essential critical thinking skills.
2. Meeting with Colleagues: Collaborative Learning for Critical Thinking. Regular interactions with colleagues foster a collaborative learning environment. Sharing experiences, discussing diverse viewpoints, and providing constructive feedback enhance critical thinking skills. Colleagues' insights can challenge assumptions and broaden ...
The development of critical thinking in nursing practice involves progressing through three levels: basic, complex, and commitment. The Kataoka-Yahiro and Saylor model outlines this progression. 1. Basic Critical Thinking: At this level, learners trust experts for solutions. Thinking is based on rules and principles.
Critical thinking is applied by nurses in the process of solving problems of patients and decision-making process with creativity to enhance the effect. It is an essential process for a safe, efficient and skillful nursing intervention. Critical thinking according to Scriven and Paul is the mental active process and subtle perception, analysis ...
Critical thinking enables nurses to develop comprehensive care plans that address all aspects of a patient's health. Furthermore, it ensures that these plans are continuously evaluated and adjusted based on the patient's progress and any new information that arises. Strategies to enhance critical thinking in nursing
Critical Thinking. Nursing education has emphasized critical thinking as an essential nursing skill for more than 50 years. 1 The definitions of critical thinking have evolved over the years. There are several key definitions for critical thinking to consider. ... Every clinician must develop rigorous habits of critical thinking, ...
Critical thinking is an integral part of nursing, especially in terms of professionalization and independent clinical decision-making. It is necessary to think critically to provide adequate, creative, and effective nursing care when making the right decisions for practices and care in the clinical setting and solving various ethical issues ...
Critical thinking in nursing is considered essential for delivering quality care and reflects the professional accountability of registered nurses (Chang et al., 2011 ). It is also a vital part of the clinical assignments and responsibilities nurses are expected to manage. Additionally, nurses' critical thinking has the potential to influence ...
Critical thinking skills are vital to keeping patients safe while maintaining an efficient nursing practice. In general, five components represent each aspect of critical thinking: Problem recognition. Prioritization. Clinical decision making. Clinical implementation. Reflection. Your critical thinking skills begins to develop in nursing school ...
To think like a nurse requires that we learn the content of nursing; the ideas, concepts, ethics and theories of nursing and develop our intellectual capacities and skills so that we become disciplined, self-directed, critical thinkers. ... Errors that occur in critical thinking in nursing can cause incorrect conclusions. This is particularly ...
Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student ...
Why Critical Thinking Skills in Nursing Matter (And What You Can Do to Develop Them) By Hannah Meinke on 07/05/2021. This piece of ad content was created by Rasmussen University to support its educational programs. Rasmussen University may not prepare students for all positions featured within this content.
Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing ...
Critical thinking is the process of gathering information, fully assessing it and then developing an opinion in response. Nurses use critical thinking to make informed decisions about a patient's medical care such as choosing which tests to run and communicating their opinions to doctors. Nurses often are the first to examine a patient in a ...
Nurses are critical thinkers. The characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice.
Clinical simulation was used to develop nursing students' clinical reasoning in evaluating wounds and their treatments , to evaluate and compare the perception of stressors, with the goal of determining whether simulations promote students' self-evaluation and critical-thinking skills , and also to evaluate the impact of multiple ...
Nurses' critical thinking has a significant impact on patient care. Recognizing changes in patient status is essential. It's essential to an honest and open exchange of ideas. It enables you to ensure patient safety. Nurses can find quick fixes with it. Improvements can be made through critical thinking.
The importance of nurses' critical thinking skills in improving clinical decision-making is well known (Lee et al., 2017; Ludin, 2018). ... This study supports the need for different learning methods to develop nursing students' critical thinking and clinical decision-making levels. It is seen that there is a need for revision in the delivery ...
Background: Research has consistently demonstrated that new graduate nurses do not possess sufficient critical thinking skills when they transition to clinical practice. Unfolding case studies encourage students to participate in a number of critical thinking skills including information-seeking, logical reasoning, and analyzing of clinical data.
To help new nurses develop critical-thinking skills, the professional development resources provider Lippincott Solutions recommended nurse educators focus on the following in the classroom: Promoting interactions. Collaboration and learning in group settings help nursing students achieve a greater understanding of the content.
Critical thinking is a broad term used in nursing that includes "reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow." [1] Certainly, there are many actions that nurses must complete during their shift, but nursing requires adaptation and flexibility to meet emerging patient needs.
Significantly, this study is the first to use the text network method to analyze the subjective experiences of the critical reflective journals of new nurses. In conclusion, changes are needed to improve the education system for new nurses and promote efficient sharing of nursing tasks. KEY WORDS: Critical thinking, Diary, In-service training ...
This complex dynamic has significant implications for nursing practice and patient care, as revealed by recent research we published in Critical Care Medicine. 1 Our study sheds light on the often-overlooked interdependencies among ICU patients on the same unit and highlights the need for creative thinking about how our approach to nurse ...
Algorithmic tools such as early warning systems (EWSs) have been embedded into clinical practice globally to facilitate the early recognition of patient deterioration and to guide the escalation of care. Concerns have been raised that the mandated use of these EWS tools may impact the development of nurses' higher-order thinking. However, the relationship between EWS tools and the development ...
8. Critical Thinking (understand the links between ideas) Leading a business is unquestionably challenging. To be successful, a leader must make a lot of difficult decisions, often under pressure. Research by the Brandon Hall Group shows that critical thinking is the most important skill required of leaders to successfully lead an organization.