Critical Thinking in Nursing: A Critical Discourse Analysis of a Perpetual Paradox
The term ‘critical thinking’ has conflicting definitions in nursing. Controversy stems from debates about what is involved in the thinking process that makes it ‘critical’. For some, it is an analytical linear problem solving approach within defined parameters while for others it demands an engagement with underpinning theoretical and philosophical influences. Critical thinking is, however, considered crucial and is a compulsory requirement for all NZ nurses. It is believed to be essential for nurses to determine what knowledge to use, what care to provide, and how to decide the best way to deliver this care. Yet, exactly what is required when nurses critically think is not clearly articulated within nursing theory and practice.
A critical discourse analysis (CDA) methodology was used to examine five influential documents that impact critical thinking in nursing. Three professional documents that influence nursing in a prescriptive and pervasive way and two academic nursing texts were analysed. These documents guide the way in which critical thinking is defined and how its use is sanctioned in nursing theory and practice. Informed by the work of Fairclough (1995, 2003) and Huckin (1997), this CDA research adopted a thematic approach in which documents were analysed at a textual and discourse practice level. Following this, critical and social constructionist theory was utilised to provide a contextualised interpretation of the powerful discursive forces impacting on critical thinking. By focusing attention on the dominant professional, organisational and political discourses which impact critical thinking, this doctoral study identifies assumptions about critical thinking within nursing theory and clinical practice, and the way in which a number of discourses position and influence nurses’ professional identities.
The findings reveal how the documents construct the meaning of critical thinking in two significant ways. Critical thinking is predominantly defined within the documents as a cognitive problem solving approach and nurses are discursively positioned to comply with rules and regulations to guide their thinking and practice. However, there is also a requirement for the engagement with the philosophical aspects of critical thinking in order for nurses to provide safe and responsive care in highly complex and challenging health care environments. These two components of critical thinking are not always complementary. The findings highlight the perpetual paradoxes faced by a critically thinking nurse. This study argues that critical thinking, as used in nursing practice, is a social practice and more of a pseudo-critical thinking approach than a philosophical endeavour. A philosophical approach to critical thinking is shown to be required and yet challenging and indeed potentially compromising for nurses. Recommendations regarding potential support for nurse educators, nurses in practice, and students of nursing are made. The principle recommendation is that professional supervision is used to support critical thinking in nursing, alongside formal education about critical thinking at undergraduate and postgraduate levels.