对护理来说，什么比批判性思维更重要？

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Introduction

Continuing professional development builds on basic professional learning. Even in programs not affiliated with the American Association of Colleges of Nursing (AACN), faculty look to that organization as one source of information about the future of nursing education. In The Essentials: Core Competencies for Professional Nursing Education (AACN, 2021), the AACN spells out the required elements of nursing education in every domain and at both the entry and advanced levels. A road map for those designing curricula, it also embodies a theory of how to form students who have internalized the values and habits of mind needed to do the work of nursing as well as to represent and promote the profession of nursing. At the very heart of this enterprise, in the author's view, is a commitment to liberal education (AACN, 2021, pp. 4, 5). So, it is worth considering the modes of thinking and practice that form the core of such an education and why they are so essential to nurses and those who educate them.

Liberal education has a long history, and its precise scope and purpose have been the subject of lively debate. The Essentials opts for a definition that highlights ways in which such an education broadens a person's perspectives, provides exposure to a variety of disciplines and methods of analysis, and fosters a commitment to acting ethically both interpersonally and in relationship to society at large.

However, I want to focus here on a different aspect of liberal education, one that is touched on but not especially emphasized in The Essentials, namely, critical thinking. The exact nature of critical thinking is also widely debated by philosophers and cognitive psychologists, but my experience as a teacher of undergraduates for more than 30 years has led me to emphasize four key components: exploring context, considering alternatives, weighing evidence, and investigating implications (or new applications) of what we know (Newman, 2023). Each of these components is multifaceted, but let me explain each briefly and reflect on the role they play in the practice of nursing.

Exploring context involves recognizing that every event, communication, and person can be understood only in relation to some other surrounding events, communications, or persons. A patient's condition could result from their previous behaviors or from a set of social and economic circumstances that prevented access to appropriate care. Providing the best care for the patient will require attending to these contextual factors. A mistake in patient care, for example, giving the wrong dose of a medication, might be the result of a clinic's culture, incomplete protocols, inconsistent education, multiple disruptions, or momentary absentmindedness. Addressing this error requires looking to the surrounding circumstances that made it possible. At every stage in nursing education and in every situation that nurses encounter, it is essential to pay attention to a range of contexts—personal, historical, cultural, economic, linguistic, and so forth. Critical thinkers are contextual thinkers.

Critical thinking also requires evaluation, and we can only evaluate the significance of things by comparing them with other things. This treatment option has been shown to produce better outcomes than an alternative. This new way of communicating with colleagues or patients is more respectful or more inclusive than other established modes of address. This health care delivery system is more efficient than that one. When we compare, we can see things more clearly because we see them in relation to alternatives, real or imagined. That enables us to make a rational decision about whether to maintain, adjust, or abandon every course of action we take. This is at the heart of quality improvement—we are open to some new approach that will be better than what we are doing now.

Weighing evidence is the crux of critical thinking. To be sure, emotional awareness is a key component of compassion and caring, two of the qualities that nurses need most. However, it is no less important to dispassionately consider the voluminous data that we collect on each of our patients. Does the evidence collected support a recommendation that the patient be moved to hospice care, that a different timing on a procedure be instituted, or that a nutrition consultation would improve the healing process? Ensuring that all the relevant evidence has been collected, recorded accurately, and then evaluated in accordance with accepted standards of care is essential to the work of nursing.

Finally, everything we know and do has implications; attending to them enables us to consider the consequences of what we do. Will this public policy undermine the integrity of our health care records systems? Will sharing this diagnosis right now with the patient support this patient's healing process or impede it? Could the procedure we regularly use to treat patients in this setting be applied effectively in a different one? When we consider new applications of our practices or raise questions about the implications of a decision, we come to appreciate the value (and perhaps the limits) of our ideas and actions.

No doubt there are innumerable additional examples of the ways in which critical thinking is woven into the daily work of nurses in every setting, but the point is clear. What students gain from a liberal education is not only a deeper appreciation of other cultures and perspectives, important as those are. They also gain a set of concrete skills of analysis, the ability to ask probing questions, and modes of thinking that inform everything they do. All those disciplines one is exposed to—history and economics, biology and physics, psychology and political science—are only in the service of producing graduates whose critical thinking skills have been honed through exposure to a wide range of subjects, data, and theories. After licensure, most nurses aren't exposed to many of those courses again. However, even as their ongoing professional development focuses more narrowly on nursing-specific knowledge, it is essential that these critical habits of mind are reviewed and practiced continually.

Exploring context, considering alternatives, weighing evidence, and investigating implications are the building blocks of critical thinking in every discipline, although of course the specifics will vary in different contexts. The education of nurses must likewise attend to these core habits of thought, introducing them in the foundational courses and reinforcing them repeatedly in more advanced degree programs and continuing professional development events. They provide the scaffolding on which are built all the other competencies that nurses must acquire. Thinking critically is surely the most critical component of nursing, and therefore also of nursing education.

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持续专业发展建立在基础专业学习的基础上。即使在不隶属于美国护理学院协会（AACN）的项目中，教师也会将该组织视为有关护理教育未来的信息来源之一。在要点：专业护理教育的核心能力（AACN，2021），AACN阐明了每个领域以及入门级和高级护理教育的必要元素。为那些设计课程的路线图，它也体现了如何形成谁已经内化的价值观和思维习惯需要做护理工作，以及代表和促进护理专业的学生的理论。在这个企业的核心，在作者看来，是对自由教育的承诺（AACN，2021年，第100页）。4、5）。因此，值得考虑的是形成这种教育核心的思维和实践模式，以及为什么它们对护士和教育他们的人如此重要。

自由教育有着悠久的历史，其确切的范围和目的一直是激烈辩论的主题。该要领选择的定义，突出了这样的教育拓宽了一个人的观点，提供了接触各种学科和分析方法的方式，并促进了在人际关系和与社会的关系中道德行事的承诺。

然而，我想在这里集中讨论通识教育的另一个方面，即批判性思维，这一点在《精要》中有所涉及，但没有特别强调。批判性思维的确切性质也被哲学家和认知心理学家广泛讨论，但我作为本科生教师30多年的经验使我强调四个关键组成部分：探索背景，考虑替代方案，权衡证据，并调查我们所知道的含义（或新应用）（纽曼，2023）。每个组成部分都是多方面的，但让我简单地解释一下，并反思它们在护理实践中所扮演的角色。

探索上下文涉及到认识到每个事件，通信和人只能与其他一些周围的事件，通信或人相关联。患者的状况可能是由于他们以前的行为或一系列社会和经济环境导致无法获得适当的护理。为患者提供最好的护理将需要关注这些背景因素。病人护理中的一个错误，例如，给了错误的药物剂量，可能是诊所的文化，不完整的协议，不一致的教育，多次中断或瞬间心不在焉的结果。要解决这个错误，就需要看看周围的环境，使之成为可能。在护理教育的每一个阶段，在每一个情况下，护士遇到的，这是必不可少的要注意一系列的背景下，个人，历史，文化，经济，语言等。批判性思考者是情境性思考者。

批判性思维也需要评价，我们只能通过与其他事物的比较来评价事物的意义。这种治疗方案已被证明比替代方案产生更好的结果。这种与同事或患者沟通的新方式比其他既定的地址模式更尊重或更具包容性。这个卫生保健提供系统比那个更有效率。当我们比较时，我们可以更清楚地看到事物，因为我们看到它们与替代品，真实的或想象的。这使我们能够理性地决定是维持、调整还是放弃我们所采取的每一个行动。这是质量改进的核心-我们愿意接受一些比我们现在做的更好的新方法。

权衡证据是批判性思维的关键。可以肯定的是，情感意识是同情和关怀的关键组成部分，这是护士最需要的两种品质。然而，冷静地考虑我们收集的每个患者的大量数据同样重要。收集到的证据是否支持将患者转移到临终关怀的建议，是否支持制定不同的手术时间，或者是否支持营养咨询会改善愈合过程？确保所有相关证据都已收集，准确记录，然后根据公认的护理标准进行评估，这对护理工作至关重要。

最后，我们所知所做的一切都有其含义;关注它们使我们能够考虑我们所做的事情的后果。这项公共政策是否会破坏我们医疗记录系统的完整性？现在与患者分享这一诊断结果会支持还是阻碍患者的康复过程？我们在这种情况下经常使用的治疗方法是否可以有效地应用于不同的情况？当我们考虑实践的新应用或对决策的影响提出疑问时，我们开始欣赏我们的想法和行动的价值（也许是局限性）。

毫无疑问，还有无数的例子可以说明批判性思维是如何融入到护士的日常工作中的，但重点是明确的。学生从通识教育中获得的不仅仅是对其他文化和观点的更深层次的欣赏，尽管这些文化和观点很重要。他们还获得了一套具体的分析技能，提出探索性问题的能力，以及为他们所做的一切提供信息的思维模式。一个人所接触的所有学科历史和经济学、生物学和物理学、心理学和政治学都是为了培养那些批判性思维能力已经通过接触广泛的学科、数据和理论而得到磨练的毕业生。在获得执照后，大多数护士不再接触这些课程。然而，即使他们正在进行的专业发展更狭隘地集中在护理特定的知识，这是至关重要的，这些关键的思维习惯不断审查和实践。

探索背景，考虑替代方案，权衡证据和调查影响是每个学科中批判性思维的基石，当然，具体情况会因环境而异。护士的教育也必须关注这些核心思维习惯，在基础课程中引入它们，并在更高级的学位课程和持续的专业发展活动中反复加强它们。他们提供了一个脚手架，在这个脚手架上建立了护士必须获得的所有其他能力。批判性思维无疑是护理最重要的组成部分，因此也是护理教育的重要组成部分。

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