Nursing concepts such as critical thinking and reflective practice are essential in developing the role of the advanced practice nurses.
Discuss the importance of critical thinking and reflective practice in advancing nursing practice and interpreting complex issues in healthcare.

Introduction

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The nursing career disposed to bewitch those who have natural nurturing abilities, an aspiration to help others and a knack for science or anatomy. However there is another substantial skill that successful nurses share and it’s often over-looked: the ability to think critically. Nursing concepts such as critical thinking and reflective practice are essential in developing the role of the advanced practice nurses.
Critical thinking is determined as the mental process of actively and skilfully perception, enquiry, synthesis and evaluation of collected information through observation, experience and communication that conducts to a decision for action. In fact, critical thinking is applied by nurses in the process of solving problems of patients and decision-making process with cleverness to enhance the effect. It is an essential course of action for an efficient, safe and skillful nursing intervention. Critical thinking is the mental active manner and subtle perception, analysis, synthesis and evaluation of information collected or derived from observation, experience, reflection, reasoning or the communication leading to conviction for action .
Reflective practice is considered as a crucial part of professional practice and it can be defined as the process of making sense of events, situations and actions in the work place. A bounds of dummy is available for nurses to use to sustain reflective practice in clinical practice. Effective reflection can take place individually, in facilitated groups, or a mix of both. Reflective Practice is associated with learning from experience, and is viewed as an important strategy for health professionals who enfold lifelong learning. Also, reflective practice is defined by Witmer as the process of using our practice . . . to self-assess and identify learning needs for continuous learning. Reflection . . . assists us to identify areas of strength and areas we may wish to develop further. It can help us develop new approaches to our practice . . . and better understand our values, beliefs, and the assumptions we make about situations, ourselves, and others.
In nursing education there is frequent reference to critical thinking and to the significance that it has in every time clinical nursing practice. Nursing clinical instructors know that students face difficulties in making decisions related to clinical practice
What the importance of critical thinking and reflective practice in advancing nursing practice ?
And how critical thinking and reflective practice support nurses decision making ?

Nursing is a challenging job and issues arise that are out of your control. Some are direct results of communication and interactions amongst Nurses that is why nurses must adopt positions that promote critical thinking – which is determined as the mental process of actively and skilfully perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that conducts to a decision for action. In fact, critical thinking is applied by nurses in the process of solving problems of patients and decision-making process with creativity to enhance the effect and critical thinking is particularly important in the nursing profession, given its potential impact upon the care that patients receive. The capacity of the nursing professional to achieve improvements in the quality of care depends , in large measure, upon developing criticak thiking skills so as to improve diagnostic decisions, it is an essential process for a safe, efficient and skillful nursing intervention- and refine skills of critical reasoning in order a serious assessment of both the previous and the new information and decisions taken every time on hospitalization and use of limited resources, forces you to think and act in cases where there are neither clear answers nor specific procedures and where opposing forces transform decision making in a complex process .
Some skills are more important than others when it comes to critical thinking. Some of these skills are applied in patient care via the Nursing method. The skills that are most important are interpreting which mean the understanding and explaining the meaning of information, or a particular event, also, the analysis which means the investigating a course of action, that is based upon data that is objective and subjective, moreover, the evaluation – This is how you assess the value of the information that you got. Is the information relevant, reliable and credible? This skill is also needed to determine if outcomes have been fully reached-.
Based upon those skills, the nurse can then use clinical reasoning to determine what the problem is. These decisions have to be based upon sound reasoning such as explication which should be clear and concisions in conclusions. The nurse needs to be able to give a sound rationale for her answers. In addition, the self-regulation in which we have to monitor our own thinking processes. In fact we must reflect on the process that lead to the conclusion. We should self-correct in this process as needed. Be on alert for bias and improper assumptions. In brief, ISn nursing, critical thinkers need to be precise, complete, clear and fair. Those attributes must be true, whether the nurse is talking, speaking or acting.
Nurses have to get rid of inconsistent, irrelevant and illogical thinking as they think about patient care. Nurses need to use language that will clearly communicate a lot of information that is key to good nursing care.
Reflection can play an important part in the method. Evidence based practice is a fundamental component of modern healthcare in Saudi Arabia and across the world because the importance of Evidence based practice for nursing has been very much influenced by the enormous amount of work that has been done within medicine . In this way, reflective practice is important for nurses because they are responsible for providing care to the best of their ability to patients and their families. In fact, they need to focus on their knowledge, skills and behaviour to ensure that they are able to meet the demands made on them by this commitment, also reflective practice is part of the requirement for nurses constantly to update professional skills. In other words, keeping a portfolio offers considerable opportunity for reflection on ongoing development. Annual reviews enable nurses to identify strengths and areas of opportunity for future development. Moreover, nurses should consider the ways in which they interact and communicate with their colleagues. In fact, the profession depends on a culture of mutual support. Nurses should aim to become self-aware, self-directing and in touch with their environment. In this way, Cottrell noted that good critical thinkers often have well-developed self-awareness and so developing this early is crucial to the acquisition of critical analytical skills .
Reflection is a key component of critical thinking. We believe that as students’ progress towards becoming professionals and develop their clinical judgement, they need to be able to reflect on the effectiveness of their decisions and on their practice.
Reflection can be reflection-on-action or reflection in action, the difference is that reflection-on-action is may be the most common form of reflection, in fact, it involves cautiously re-running in your mind events that have araised in the past. The endeavour is to value your strengths and to develop different, more effective ways of acting in the future. In some of the literature on reflection , there is a focus on identifying negative aspects of personal behaviour with a view to improving professional competence. This would involve making such observations as: ‘I could have been more effective if I had acted differently’ or ‘I realise that I acted in such a way that there was a conflict between my actions and my values. On other hand, reflection-in-action is the hallmark of the experienced professional. It means examining your own behaviour by being a participant observer in situations that offer learning opportunities, also attending to what you see and feel in your current situation, focusing on your responses and making connections with previous experiences, besides, being ‘in the experience’ and, at the same time, adopting a ‘witness’ stance as if you were outside it. In the same way, process of Reflective in action is composed of Mindfulness in which, purposefully pays attention to ones thought and feelings and Meditation which requires the belief that knowing oneself cans foster compassion. Singing and music. Dance and movement. In other words, reflection in action is determined as the competence of professionals to think about what they are doing while they do it. He regards this as a key skill. He asserts that the only way to manage the indeterminate zones of practice is through the ability to think on your feet and apply previous experience to new situations. To practice evidence based nursing it is imperative for all nurses to engage in reflective practice.
Critical thinking as a process of reflective thinking, it goes beyond logical reasoning to evaluate the rationality and justification for actions within context. It is a thinking method or process focused not on achievement of the answers, but on achievement of a coherent understanding within the context of a situation . Critical thinking gives us a way to look at the world and, thus, support the work we do. According to Paul and Nosich’s theory , critical thinking is the intellectually disciplined process of actively and skilfully conceptualizing, applying, analysing, synthesizing, and evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, and communication, as a guide to belief and action. Combining nursing theoretical work with critical thinking, we can find that critical thinking is essential in this era of theory utilization because theory provides the basis for nurses’ knowledge as well as a structure to guide caring actions
Reflective Practices have a lot of benefits such as enhancing self-esteem through learning and facilitating integration of theory and practices. Also, encouraging holistic, individualized and flexible approached of caring and developing individualised theories of nursing which influence practices and generate nursing knowledge. Besides, it conducts to acceptance of professional responsibility and enables nurses to understand and explore the Nature and boundaries of their own role and other health professionals. Reflective Practices can enhances opportunity to practice and improved skills and It also promotes opportunity to evaluate their own performance, to acknowledge their strength, and to identify own learning needs and ask for help. In addition,
It encourages critical thinking and encourages nurses to make a conscious attempt to identify and learn from what is happening, it allows nurses to view clinical situations from different perspectives and motivates nurses to be a more self-directed learner, as well as, it allows nurses to apply appropriate theory into nursing practice and it helps nurses to improve decision making . However, reflective practices may cause psychological stress and it usually reflect on negative issues also feeling frustrated when I am not able to solve problems that were identified during reflection.
Reflective Practice have a lot of Models, in fact, Broad frameworks for reflection have been offered by theorist for nurses to choose from such as Benner and Wrubel (1989), Gibbs (1998), Driscoll 2000 Or Johns (2000). Or Ghaye and Lilyman 2006
Many if not all, of these fundamentally encourage nurses to engage in reflective practice. For example, The Johns model determinate particular area of reflective practice first of all, describing an experience significant of the learner. Also, identifying personal issues arising from the experience. Moreover, pinpointing personal intentions. In addition, empathising with others in the experience. Furthermore, recognising one’s own values and beliefs. Then, linking this experience with previous experiences and creating new options for future behaviour. Finally, looking at ways to improve working with patients, families, and staff in order to meet patients’ needs.