Holistic critical thinking in times of covid-19 pandemic: unveiling fundamental skills to clinical nursing practice

The Covid-19 pandemic reinforced the importance of evaluating and developing critical thinking skills in the health area, especially in nursing, a profession so demand, as well as other professions of the multidisciplinary teams that are at the front line of care for victims of this overwhelming infectious disease.

The importance of training professionals capable of thinking and acting in adverse and complex scenarios, such as a pandemic, must be emphasized. Thus, we highlight the importance of teaching the essential cognitive, behavioral, and mind habits of critical thinking, such as: analysis, interpretation, inference, evaluation, explanation, and self-regulation. In addition to these skills, characteristic of strong critical thinkers, several vital habits of mind can be highlighted, such as: open mind, knowledge transformation, having organized thinking, trusting in reasoning, making mature decisions, anticipating consequences, being courageous to follow reasons and evidence wherever they may lead (also known as intellectual honesty), being inquisitive to seek new knowledge, adaptability, creativity, or resourcefulness in solving problems, perseverance, and contextual perspective1.

We live in difficult times, science mistrust, facts denial, intentional untruths spread on Internet, political polarization, competitive labor market, scarcity of resources in emerging countries, racial, religious, and gender intolerance, among many other social and economic problems infesting the world population.

In this context of adversity and countless challenges, the best nurses and health professionals will be those who undergo themselves to careful assessments and intentional training of their critical thinking and clinical reasoning habits skills. These professionals will bring better results to clinical practice2.

In a historical and cultural analysis of the current situation, the importance of rethinking the curriculum structure of basic and higher education is highlighted, considering critical thinking skills, habits of mind, respect for ethical, culture, religion, and values of populations to better enable individuals to live and be human with each other. Accepting differences and building together a better world to live - in this way, we want to highlight the importance of transforming. Work environments and teams with strong critical thinking, keeping more cohesive and stronger teams to face the challenges of practice, and this is no different in the health area.

The Covid-19 pandemic relighted the lamp and the ideals of Florence Nightingale regarding the performance and appreciation of nursing in different health services; human care and care focused on its environments and conditions were highly emphasized3.

It should be noted that in the challenging and troubled environment of practice in health services, sometimes we do not spend enough time to consider our best decisions. To reflect about our own decision-making is the most valuable practice for developing stronger critical thinking, the meta-cognition. With meta-cognition, we monitor and, where necessary, self-correct our problem-solving as individuals and as health care teams. We must do this with an open mind and with effort and courage to consider all relevant facts, including the expected outcomes. We cannot do this by insisting that we are always right, no human being is always right. It takes strong confidence in the power of reason and the value of teamwork to develop this vital habit4.

In addition, there must be enough internal motivation to learn and apply in the daily life, in the being and doing nursing, critical thinking skills to achieve the best health outcomes, bringing this premise to the pandemic scenario we are experiencing. We believe that nurses with strong critical thinking will contribute to a more effective and quick recovery in cases of hospitalizations for covid-19, because they will carry out careful assessment and will think with quality before making decisions that will impact the results to be obtained with the selected care plan and interventions2^,5^).

The nurses will apply the nursing process in its five stages, implementing the taxonomies of nursing diagnoses, results (NOC) and interventions (NIC) with accuracy, which is already known to be the best path to safe and quality nursing practices2. Also, they will have the strong critical thinking needed to make continuing refinements and resourceful adjustments as they monitor patient outcomes.

When nurses assess and develop their critical thinking skills, they will gain the essential habit of verifying if they have correctly analyzed the problem, whatever it is, before they attempt to address that problem. Getting the problem right - understanding exactly and fully the problem and the causes - is the first step in coming to a successful treatment. Nurses with strong critical thinking decide together with their colleagues and examine cases individually to assess what worked or not and how to do better in another situation1^,6.

Training in health and nursing denotes the need for competent professionals with high level of critical thinking, so they can meet the real and potential needs of the population when solving their health problems within the scope of health services and systems, in Brazil and worldwide. Training in critical thinking must be purposeful, focused, and intentional. It cannot be left to chance. Research shows that only where training specifically addresses critical thinking skills and their application in clinical reasoning we will find measurable gains in students test scores3.

In the area of health, time is critical and the problems are numerous and varied. The challenge is to make the best diagnosis and find out which problem needs to be managed as a priority. The similarity with the application of the nursing diagnosis process is not a coincidence, the reasoning is similar. When nurses with strong critical thinking apply the nursing diagnosis process accurately, they bring better results for their patients and health services, reducing costs and hospitalization periods5.

In critical health care, with the advent of the pandemic, this premise was more easily observed, so, we highlight the importance of research using different instruments for the assessment of critical thinking in clinical practice, aiming to improve the performance of professionals on the front lines of Covid-19 care.

To develop nurses and other health professionals, it is necessary to know what is the level of their skills to make possible the effective implementation of teaching and learning strategies focused on the individual needs of students. And to assess the individual gains of the students in their critical thinking by using testing instruments, like the Health Sciences Reasoning Test (HSRT), Califórnia Critical Thinking Skills Test (CCTST) and Califórnia Critical Thinking Disposition Inventory (CCTDI) validated for the evaluation of critical thinking in nursing students and professionals throughout the world7^-8.

For the clinical educators of the 21st century, we left the following reflection: evaluating critical thinking skills allows the identification of strengths and weaknesses to be improved in the training path of critical and reflective professionals with high potential for clinical decision-making? This is the challenge!

REFERENCES

• Facione PA, Crossetti MGO, Riegel F. Holistic critical thinking in the nursing diagnostic process [editorial]. Rev Gaúcha Enferm. 2017;38(3):e75576. doi: http://doi.org/10.1590/1983-1447.2017.03.75576
  » http://doi.org/10.1590/1983-1447.2017.03.75576
• Winterhalter K. Critical thinking mindset for improving patient outcomes. 2021 [cited 2021 Aug 11]. In: Insight Assessment [Internet]. 2021. [about 5 screens]. Available from: Available from: https://www.insightassessment.com/blog/critical-thinking-mindset-for-improving-patient-outcomes
  » https://www.insightassessment.com/blog/critical-thinking-mindset-for-improving-patient-outcomes
• Riegel F, Crossetti MGO, Martini JG, Nes AAG. Florence Nightingale’s theory and her contributions to holistic critical thinking in nursing. Rev Bras Enferm. 2021;74(2):e20200139. doi: http://doi.org/10.1590/0034-7167-2020-0139
  » http://doi.org/10.1590/0034-7167-2020-0139
• Abrami PC, Bernard RM, Borokhovski E, Waddington DI, Wade CA, Persson T. Strategies for teaching students to think critically - a meta-analysis. Rev Educ Res. 2015;85(2):275-314. doi: http://doi.org/10.3102/0034654314551063
  » http://doi.org/10.3102/0034654314551063
• Facione NC, Facione PA. Critical thinking and clinical judgment. In: Critical thinking and clinical reasoning in the health sciences: a teaching anthology, 2008. Millbrae CA: Insight Assessment/The California Academic Press; 2008 [cited 2021 Aug 11]. p. 1-13. Available from: Available from: https://insightassessment.com/wp-content/uploads/ia/pdf/CH-1-CT-CR-Facione-Facione.pdf
  » https://insightassessment.com/wp-content/uploads/ia/pdf/CH-1-CT-CR-Facione-Facione.pdf
• Facione PA, Gittens CA. Think critically. 3. ed. Boston: Pearson; 2016.
• Riegel F, Martini JG, Bresolin P, Mohallem AGC, Nes AAG. Developing critical thinking in the teaching of nursing: a challenge in times of Covid-19 pandemic. Esc Anna Nery 2021[cited 2021 Aug 11];25(spe):e20200476. Available from: Available from: https://www.scielo.br/j/ean/a/RXP6dgjwt96FYg8gjFq7TJg/?lang=en&format=pdf
  » https://www.scielo.br/j/ean/a/RXP6dgjwt96FYg8gjFq7TJg/?lang=en&format=pdf
• Health sciences reasoning test. 2021 [cited 2021 Aug 11]. In: Insight Assessment [Internet]. 2021. [about 4 screens]. Available from: Available from: https://www.insightassessment.com/article/health-sciences-reasoning-test-hsrt-2
  » https://www.insightassessment.com/article/health-sciences-reasoning-test-hsrt-2

Publication Dates

• Publication in this collection
  29 Oct 2021
• Date of issue
  2021