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Critical Thinking


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Critical Thinking

  1. 1. Critical Thinking in Nursing <br />Author: Marisa Tapia MSN, RN<br /> ACNS-BC<br />
  2. 2. Critical Thinking<br />Nursing Education views or requires critical thinking as an educational outcome<br />As a result of this outcome or EVALUATION there is new thinking or new processes or new ideas <br />
  3. 3. What outcomes are generated?<br />New ways of thinking<br />New ideas<br />New questions<br />New decisions<br />New conclusions<br />New results<br />
  4. 4. Critical Thinking Is:<br />Systematic <br />Habit forming<br />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<br />Is that clear as mud? <br />
  5. 5. Why Critically Think? <br />To make a critical analysis of factors associated with a problem<br />Nurses need critical thinking skills to be:<br />Safe <br />Competent <br />Skillful and Confident<br />Aware and Ethical<br />Generate and promote new ideas and knowledge in the Art and Science of Nursing<br />
  6. 6. What is Critical Thinking?<br />Is there such a thing?<br />Haven’t we been doing it all along?<br />How do we define it?<br />
  7. 7. Defining Critical Thinking<br />Method of Reasoning<br />Problem Solving approach to finding an answer<br />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<br />
  8. 8. Characteristics of Critical Thinking<br />Being rational and reflective<br />Creative thinking (many ways to skin a cat)<br />Healthy and constructive skepticism<br />Autonomy “building your own algorithm”<br />Fair and equitable thinking<br />Focusing on what the belief is and act on it<br />
  9. 9. 4 Stages in the Critical Thinking Process<br />Preparation<br />Incubation<br />Insight<br />Verification<br />
  10. 10. Stage 1: Preparation<br />Creative thinker gathers information related to a problem or concern<br />How do we do this? <br />
  11. 11. Stage 1: Preparation-How?<br />Questioning<br />Patient interview<br />Gathering information/data<br />Assessment data<br />Identifying the Nursing Diagnosis based on the assessment findings either real or potential clinical problems <br />
  12. 12. Stage 2: Incubation-Planning <br />Thinking about the thinking:<br />Formulating a plan of action to accompany the <br />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<br />
  13. 13. Stage 3: Insight: Plan and Implementation<br />Plan is put into place<br />Solutions Emerge <br />Solutions are developed<br />Solutions are identified through a thoughtful process <br />Once the solution is indentified it is then implemented<br />
  14. 14. Stage 4: Verification<br />Implementation phase begins<br />Evaluation of the implemented solution is established <br />Effectiveness of the implemented solution is established<br />Outcomemeasured as successful or finding opportunities to improve<br />
  15. 15. New approach to Critical Thinking and the Nursing Process<br />T.H.I.N.K.<br />T.H.I.N.K. incorporates the critical thinking piece to the nursing process and promotes positive outcomes in regards to nursing care<br />
  16. 16. T.H.I.N.K.<br />T: Total Recall: correlating a fact to experience<br />H: Habits: forming habits facilitates thinking while the habit is undertaken<br />I: Inquiry: Being curious. Questioning the obvious to promote more inquiry<br />N: New ideas and creativity: teaching new things to different patients<br />K: Knowing how you think: Recognizing that you know or do not know something and how you go about learning and teaching. <br />
  17. 17. Critical Thinking:<br />According to LeFevre (2002)<br />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<br />
  18. 18. How do we critically think?<br />Thinking about the thinking while we are thinking<br />Constant and consistent analysis of the doing <br />Anticipating the needs of the patient or situation or process in order to make the outcome better<br />
  19. 19. In Nursing:<br />Nurses need to stay ahead of the situation, it may be that we have to stop and think….<br />
  20. 20. Questions to Ask<br />How will my anticipating of the needs better the patient and the outcome?<br />
  21. 21. Questioning the Question<br />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<br />
  22. 22. In Nursing: We should use systematic reasoning to clarify problems…<br />Anticipate the needs<br />Step back and think of all the possibilities to the resolution<br />Explore different avenues to obtain the same positive effect (Outcome)<br />Be confident in your choice of solutions and be assertive <br />
  23. 23. Critical Thinking:<br />Critical thinking in Nursing is an essential component of professional accountability and quality nursing care<br />
  24. 24. Who are the critical thinkers?<br />Attributes: Habits of the Mind<br />Confidence<br /> competence<br />creativity, flexibility, inquisitiveness <br />integrity, intuition, open-mindedness perseverence and reflection<br />
  25. 25. Skills in Creative Thinking <br />Critical Analysis<br />Questioning: Examining many points of view<br />Play devil’s advocate: search for inconsistencies<br />Differentiate what you know from what you believe <br />Inductive reasoning<br />Deductive reasoning<br />Evaluating the credibility of sources<br />Clarifying concepts<br />
  26. 26. Attitudes of Creative Thinkers <br />Independence of thought<br />Fair-mindedness<br />Insight into egocentricity and socioentricity<br />Intellectual Humility<br />Suspension of judgment<br />Intellectual courage<br />Integrity<br />Perseverence<br />Confidence in Reason<br />
  27. 27. Attributes of Creative Thinkers<br />Attributes: Skills<br />Analyzing<br />Applying standards<br />Discriminating (recognizing differences) <br />Information seeking<br />Logical reasoning<br />Predicting<br />Transforming knowledge<br />
  28. 28. Concept of Independence of Thought<br />Think for yourself<br />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)<br />
  29. 29. Concept of Fair-mindedness<br />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<br />
  30. 30. Elements of Critical Thinking Applied to Nursing<br />Assumptions<br />Information<br />Concepts<br />Purpose of thinking<br />Points of view<br />Questions regarding an issue<br />Interpretation and inference<br />Implications <br />Consequences<br />
  31. 31. Assumptions<br />Nursing applies scientific knowledge to caring for a patient<br />Utilizes the caring components of human interaction while applying scientific knowledge base to facilitate wellness for the individual<br />
  32. 32. Information <br />Assessment data<br />History (medical, surgical, family etc)<br />Physical<br />Labs/Procedures<br />Subjective and objective findings from the patient<br />
  33. 33. Concepts<br />Theories<br />Definitions<br />Principles<br />Examples:<br />Lab values and their meanings<br />AORN Standards and recommended practices<br />Adult learning principles<br />
  34. 34. Purpose of Thinking: Analysis and Synthesis<br />Making decisions regarding the data being collected<br />Diagnose problems and make clinical judgments<br />Determining the goals and outcomes<br />
  35. 35. Question of the Issue<br />Determining the nature of the problem<br />To identify the legal and ethical issues that are present within the nursing situation<br />Examples:<br />90 y/o with COPD, O2 sats of low 80’s on BiPap and a fractured ankle <br />
  36. 36. Points of View<br />The nurse patient relationship<br />The collaborative efforts among the multidisciplinary team and the patient<br />The overall perception of the care being provided<br />
  37. 37. Interpretation and Inference<br />Determining diagnosis<br />Putting the pieces together<br />Formulating a plan of care<br />Identifying interventions<br />
  38. 38. Implications and Consequences<br />Patient outcomes<br />Modification of the plan of care dependant on the patient outcomes<br />
  39. 39. Characteristics of Critical Thinkers<br />Active Thinkers: Double check information for reliability and interpretation<br />Knowledgeable about their biases and limitations “Intellectual humility”<br />Know weaknesses and strengths <br />Fair-minded: Aware of their own perceptions, values and beliefs but seek to treat all viewpoints alike<br />
  40. 40. Characteristics of Critical Thinkers:<br />Good communicators: Not methodical in relaying information and consistently ask for ideas to solutions.<br />Mutuality of exchanging of ideas:<br /> is essential for positive outcomes and understanding the facts first and then finding the best solutions (Intellectual Empathy)<br />
  41. 41. Characteristics of Critical Thinkers<br />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)<br />Independent thinkers: think for themselves <br />Curious and insightful (the need to know)<br />
  42. 42. Characteristics of Critical Thinkers<br />Humility: Know your limitations and know when you are stepping way out of your league…<br />Know the difference between the benefits of the “here and now” vs the effects of the “down the road implications”….the OUTCOMES<br />Know that you will make mistakes<br />Good listeners<br />
  43. 43. Crucial in Critical Thinking: Honesty is Integrity<br />Be honest with yourself: this assists you in knowing yourself first and then assisting in the steps to critically think something through<br />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<br />
  44. 44. First Glance to Start Critically Thinking<br />Be proactive<br />Be organized<br />Be flexible<br />Be cognizant of rules of logic (weigh the risks and benefits of the long run versus the here and now)<br />Be realistic<br />Be a team player (Commit to excel)<br />
  45. 45. How we do it in Nursing:<br />Analyze<br />Apply standards<br />Differentiate practice<br />Seek information<br />Logical Reasoning<br />Predicting and transforming knowledge<br />
  46. 46. How Do We Become Better Critical Thinkers:<br />We learn to synthesize and analyze information that leads us to a better understanding of the end result<br />We improve our personal development<br />How? Like what?<br />
  47. 47. Areas of Personal Development<br />View of knowledge: what you know and how you utilize what you know in daily working condition to make things better<br />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<br />
  48. 48. Areas of Personal Development (continued)<br />Dealing with uncertainty: can be topic specific, interpersonal skills, and/or professionally specific.<br />Ways to facilitate uncertainties:<br />Know your subject matter (Do your homework)<br />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<br />
  49. 49. Creativity in Critical Thinking in Nursing<br />Professional Development <br />Commitment to professional development: <br />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<br />
  50. 50. Scholarship and Leadership<br />By learning more we become more aware of our professional and personal surroundings<br />This in turn assures us in the anticipation of needs of the situation<br />When we anticipate we “think better”<br />When we “think better” we lead better<br />
  51. 51. Role of Experience<br />When we learn more we become better at doing what it is that we do best<br />Experience leads to success<br />Success in nursing is critical in assuring positive patient outcomes<br />With this in mind our critical thinking skills are further enhanced<br />
  52. 52. Very Important!!!!!<br />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<br />
  53. 53. Putting it all together<br />Ask:<br />What-if questions<br />What-else questions<br />Think out loud, write it down<br />Compare and contrast Play Devil’s Advocate<br />Organize and reorganize information<br />Look for flaws in YOUR thinking<br />Anticipate<br />Ask an expert to listen to your thinking and see where your thoughts are and synthesize and analyze the process<br />
  54. 54. Any questions?<br />
  55. 55. References<br />Harkreader, H. (2004) Fundamentals of Nursing: Caring and Clinical Judgment. Philadelphia: W.B.Saunders. <br />LeFevre, R. (2002). Critical thinking <br />in nursing: A practical approach. Philadelphia: W.B. Saunders.<br />