Critical Thinking
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Critical Thinking






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Critical Thinking Critical Thinking Presentation Transcript

  • Critical Thinking in Nursing
    Author: Marisa Tapia MSN, RN
  • Critical Thinking
    Nursing Education views or requires critical thinking as an educational outcome
    As a result of this outcome or EVALUATION there is new thinking or new processes or new ideas
  • What outcomes are generated?
    New ways of thinking
    New ideas
    New questions
    New decisions
    New conclusions
    New results
  • Critical Thinking Is:
    Habit forming
    A method or process to promote thinking regarding the thinking about new thinking that promotes an action on the new insight as it generates more thinking
    Is that clear as mud?
  • Why Critically Think?
    To make a critical analysis of factors associated with a problem
    Nurses need critical thinking skills to be:
    Skillful and Confident
    Aware and Ethical
    Generate and promote new ideas and knowledge in the Art and Science of Nursing
  • What is Critical Thinking?
    Is there such a thing?
    Haven’t we been doing it all along?
    How do we define it?
  • Defining Critical Thinking
    Method of Reasoning
    Problem Solving approach to finding an answer
    Reasonable reflective thinking that focuses on deciding what to do or what is to be done yet setting out to find alternatives within the answer
  • Characteristics of Critical Thinking
    Being rational and reflective
    Creative thinking (many ways to skin a cat)
    Healthy and constructive skepticism
    Autonomy “building your own algorithm”
    Fair and equitable thinking
    Focusing on what the belief is and act on it
  • 4 Stages in the Critical Thinking Process
  • Stage 1: Preparation
    Creative thinker gathers information related to a problem or concern
    How do we do this?
  • Stage 1: Preparation-How?
    Patient interview
    Gathering information/data
    Assessment data
    Identifying the Nursing Diagnosis based on the assessment findings either real or potential clinical problems
  • Stage 2: Incubation-Planning
    Thinking about the thinking:
    Formulating a plan of action to accompany the
    assessment finding  applying the plan (implementation) in order for your patient to meet his or her goals thus ensuring success which  Evaluates the plan and implementation as achieving the goal ensuring a postive patient experienceOutcome
  • Stage 3: Insight: Plan and Implementation
    Plan is put into place
    Solutions Emerge
    Solutions are developed
    Solutions are identified through a thoughtful process
    Once the solution is indentified it is then implemented
  • Stage 4: Verification
    Implementation phase begins
    Evaluation of the implemented solution is established
    Effectiveness of the implemented solution is established
    Outcomemeasured as successful or finding opportunities to improve
  • New approach to Critical Thinking and the Nursing Process
    T.H.I.N.K. incorporates the critical thinking piece to the nursing process and promotes positive outcomes in regards to nursing care
  • T.H.I.N.K.
    T: Total Recall: correlating a fact to experience
    H: Habits: forming habits facilitates thinking while the habit is undertaken
    I: Inquiry: Being curious. Questioning the obvious to promote more inquiry
    N: New ideas and creativity: teaching new things to different patients
    K: Knowing how you think: Recognizing that you know or do not know something and how you go about learning and teaching.
  • Critical Thinking:
    According to LeFevre (2002)
    Critical thinking is the process of figuring out what to believe or do about a situation, problem or controversy for which no single definitive answer or solution exists, but what is the proper way to deal with the situation at hand
  • How do we critically think?
    Thinking about the thinking while we are thinking
    Constant and consistent analysis of the doing
    Anticipating the needs of the patient or situation or process in order to make the outcome better
  • In Nursing:
    Nurses need to stay ahead of the situation, it may be that we have to stop and think….
  • Questions to Ask
    How will my anticipating of the needs better the patient and the outcome?
  • Questioning the Question
    What we may think is the right thing to do at that time may not be the correct way of handling the situation in the end
  • In Nursing: We should use systematic reasoning to clarify problems…
    Anticipate the needs
    Step back and think of all the possibilities to the resolution
    Explore different avenues to obtain the same positive effect (Outcome)
    Be confident in your choice of solutions and be assertive
  • Critical Thinking:
    Critical thinking in Nursing is an essential component of professional accountability and quality nursing care
  • Who are the critical thinkers?
    Attributes: Habits of the Mind
    creativity, flexibility, inquisitiveness
    integrity, intuition, open-mindedness perseverence and reflection
  • Skills in Creative Thinking
    Critical Analysis
    Questioning: Examining many points of view
    Play devil’s advocate: search for inconsistencies
    Differentiate what you know from what you believe
    Inductive reasoning
    Deductive reasoning
    Evaluating the credibility of sources
    Clarifying concepts
  • Attitudes of Creative Thinkers
    Independence of thought
    Insight into egocentricity and socioentricity
    Intellectual Humility
    Suspension of judgment
    Intellectual courage
    Confidence in Reason
  • Attributes of Creative Thinkers
    Attributes: Skills
    Applying standards
    Discriminating (recognizing differences)
    Information seeking
    Logical reasoning
    Transforming knowledge
  • Concept of Independence of Thought
    Think for yourself
    Serious consideration is taken to a wide array of ideaslearn from themand make your own judgments based on this insight (deductive and inductive reasoning)
  • Concept of Fair-mindedness
    Assess all points of view with the same standards and not basing the judgment on personal prejudices or personal opinions but rather on factual knowledge
  • Elements of Critical Thinking Applied to Nursing
    Purpose of thinking
    Points of view
    Questions regarding an issue
    Interpretation and inference
  • Assumptions
    Nursing applies scientific knowledge to caring for a patient
    Utilizes the caring components of human interaction while applying scientific knowledge base to facilitate wellness for the individual
  • Information
    Assessment data
    History (medical, surgical, family etc)
    Subjective and objective findings from the patient
  • Concepts
    Lab values and their meanings
    AORN Standards and recommended practices
    Adult learning principles
  • Purpose of Thinking: Analysis and Synthesis
    Making decisions regarding the data being collected
    Diagnose problems and make clinical judgments
    Determining the goals and outcomes
  • Question of the Issue
    Determining the nature of the problem
    To identify the legal and ethical issues that are present within the nursing situation
    90 y/o with COPD, O2 sats of low 80’s on BiPap and a fractured ankle
  • Points of View
    The nurse patient relationship
    The collaborative efforts among the multidisciplinary team and the patient
    The overall perception of the care being provided
  • Interpretation and Inference
    Determining diagnosis
    Putting the pieces together
    Formulating a plan of care
    Identifying interventions
  • Implications and Consequences
    Patient outcomes
    Modification of the plan of care dependant on the patient outcomes
  • Characteristics of Critical Thinkers
    Active Thinkers: Double check information for reliability and interpretation
    Knowledgeable about their biases and limitations “Intellectual humility”
    Know weaknesses and strengths
    Fair-minded: Aware of their own perceptions, values and beliefs but seek to treat all viewpoints alike
  • Characteristics of Critical Thinkers:
    Good communicators: Not methodical in relaying information and consistently ask for ideas to solutions.
    Mutuality of exchanging of ideas:
    is essential for positive outcomes and understanding the facts first and then finding the best solutions (Intellectual Empathy)
  • Characteristics of Critical Thinkers
    Open-minded: be aware of others values before disrupting harmony and making changes that may seem right at the moment but not positive in the long run (Positive Outcome)
    Independent thinkers: think for themselves
    Curious and insightful (the need to know)
  • Characteristics of Critical Thinkers
    Humility: Know your limitations and know when you are stepping way out of your league…
    Know the difference between the benefits of the “here and now” vs the effects of the “down the road implications”….the OUTCOMES
    Know that you will make mistakes
    Good listeners
  • Crucial in Critical Thinking: Honesty is Integrity
    Be honest with yourself: this assists you in knowing yourself first and then assisting in the steps to critically think something through
    When your integrity is lost in the eyes of others, honesty is lost and rarely regained thus any decision made will be viewed doubtful or negative
  • First Glance to Start Critically Thinking
    Be proactive
    Be organized
    Be flexible
    Be cognizant of rules of logic (weigh the risks and benefits of the long run versus the here and now)
    Be realistic
    Be a team player (Commit to excel)
  • How we do it in Nursing:
    Apply standards
    Differentiate practice
    Seek information
    Logical Reasoning
    Predicting and transforming knowledge
  • How Do We Become Better Critical Thinkers:
    We learn to synthesize and analyze information that leads us to a better understanding of the end result
    We improve our personal development
    How? Like what?
  • Areas of Personal Development
    View of knowledge: what you know and how you utilize what you know in daily working condition to make things better
    Approach to learning: Everyday we learn something new because everyday is different and every new day brings on new events that challenge us to learn more
  • Areas of Personal Development (continued)
    Dealing with uncertainty: can be topic specific, interpersonal skills, and/or professionally specific.
    Ways to facilitate uncertainties:
    Know your subject matter (Do your homework)
    Know your limitations and address them on a personal level…again…Do your homework…find ways for self-improvement to further develop your critical thinking skills
  • Creativity in Critical Thinking in Nursing
    Professional Development
    Commitment to professional development:
    Take every opportunity to learn more, this in turn facilitates better critical thinking skills because you are “doing your homework” and this further develops your skills as a professional nurse
  • Scholarship and Leadership
    By learning more we become more aware of our professional and personal surroundings
    This in turn assures us in the anticipation of needs of the situation
    When we anticipate we “think better”
    When we “think better” we lead better
  • Role of Experience
    When we learn more we become better at doing what it is that we do best
    Experience leads to success
    Success in nursing is critical in assuring positive patient outcomes
    With this in mind our critical thinking skills are further enhanced
  • Very Important!!!!!
    If we want to develop nurses to excel, we need our nurses to be cognitively equipped to deal with difficult situations associated with patient care decisions, interpersonal decisions and moral/ethical decisions, thus, we need to build on our professional development skills to enhance our critical thinking
  • Putting it all together
    What-if questions
    What-else questions
    Think out loud, write it down
    Compare and contrast Play Devil’s Advocate
    Organize and reorganize information
    Look for flaws in YOUR thinking
    Ask an expert to listen to your thinking and see where your thoughts are and synthesize and analyze the process
  • Any questions?
  • References
    Harkreader, H. (2004) Fundamentals of Nursing: Caring and Clinical Judgment. Philadelphia: W.B.Saunders.
    LeFevre, R. (2002). Critical thinking
    in nursing: A practical approach. Philadelphia: W.B. Saunders.