AFACCT 2020 Conference Presentation

1. Transitioning Critical Thinking Skills
from the Academic Setting to the Global
World of Client Care
By: Rose Miller, Professor
College of Southern Maryland
Email: rmmiller2@csmd.edu
AFACCT 20 Conference, Baltimore City Community
College on January 9, 2020
Session: 4.9 from 3:05pm to 4:05pm 1

2. Learning Outcomes for this Session
Participants will be able to:
1. Identify different strategies for moving
critical thinking skills from the academic setting
to the global world of client care.
2. Discuss how to modify these teaching
strategies to enhance the critical thinking skills
of students in any client care setting.
2

3. Clinical judgment is defined as the
observed outcome of two mental
processes:
1. critical thinking
2. decision making
(Timken and Walls, 2019, NCSBN, 2019)
3

4. One of the main objectives of the RN NCLEX, is to
test candidates’ ability to critically think and make
appropriate clinical judgments.
Every three years NCSBN has completed a survey
of new nurses, educators, regulatory boards of
nursing and employers.
The next slide will attest to why NCSBN is working
on a new version of the NCLEX in hopes that the
statistics on the next slide will improve drastically.
(Brenton, Petersen – NCSBN Examination Department, 2019)
4

5. According to NCSBN Examination Department,
clinical judgment is important for public safety,
however the following concerns were found:
1. 50% of novice nurses are involved in nursing errors
2. 65% of errors are attributed to poor clinical decision
making
3. 20% of employers are satisfied with clinical decision-
making skills of novice nurses
(Brenton, Petersen – NCSBN Examination Department, 2019)
5

6. When to Teach Critical Thinking Strategies
Every skill/concept should be linked to critical
thinking:
*theory (cognition)
*lab/simulation (cognition/psychomotor)
*clinical (cognitive and psychomotor)
6

7. How to Teach Critical Thinking Strategies
Use multiple learning strategies
Always introduce the skill/concept in theory
In theory, always explain “why” something is
done, for example when pouring liquid
medications, always palm the label. Always
reinforce this step in lab and clinical.
7

8. Critical Thinking Strategies in the Theory
1. Real stories: always give a story to clarify a point
or concept, this will help students make the
connection to ‘real life’. Example – evisceration
2. Case studies – these should be realistic and have
real complications/problems present that students
will see in ‘real life’. Example, stage IV decubitus
ulcer
*Always take time to discuss with the entire class8

9. Theory continued:
3. Unfolding case studies: if you have more than
one day for a lecture topic, use unfolding case
studies. For example: three days of pharmacology –
use an unfolding case study
4. Use clickers in theory and lab settings. Be sure to
give rationale for right and wrong answers, don’t just
give the answer. This is also a great time to start
teaching students ‘how’ to read and answer
application and higher domains of questions. 9

10. Theory continued:
5. Props and models: when discussing
conditions, if possible, bring a model of the
condition to show students while you explain.
Example, model with colostomy or a stage I, II,
III, IV and unstageable wound.
(Visual, auditory and kinesthetic learning
styles)
10

11. Critical Thinking Strategies in the
Lab/Simulation
1. Critical thinking scenarios: should be
given for every skill. Identify situations that
can go wrong with the skill – discuss these
with the whole class, not at individual stations.
2. Every student performs an assessment on
a partner and documents in the EHR, before
going to clinical
11

12. Lab/Simulation continued:
3. Hand-off – this should be done with the
assessment check offs and with every
simulation
4. SBAR scenarios – should be done with
case studies and simulation. This can really
show you how well the student is pulling
everything together or alert you that the
student is not grasping the concept. 12

13. Lab/Simulation continued:
5. Simulation/Lab – always have a few
things ‘wrong’ when doing formative check
offs or simulations, for example oxygen
either off or wrong setting.
6. Reinforce anatomy and physiology with
all skills – use models and props for visual
learners.
13

14. Critical Thinking Strategies in the Clinical
Rose’s rules for doing clinical activities:
1. No more than three students in a group.
2. Always find time in post conference to discuss
the activities with the entire clinical group.
3. When possible, always use the agency’s
forms for assessing or gathering data. This is
usually much more realistic. 14

15. Critical Thinking Strategies in the Clinical
1. Vital sign assessment: take three clients,
assign these to students. Have students
compare the three clients’ vital signs. (They will
need to review charts for – last 24-hour vital
signs, medical diagnoses, pain, pre-existing
conditions, look medications up
{classifications, side effects, contraindications},
activity level, treatments, procedures, etc.
(Caputi, 2018)
15

16. Clinical continued:
2. Make staff assignments for your unit. Give
three scenarios based on limited staff – discuss
delegation too.
3. Managing potential complications:
assign three clients, identify two potential
complications, develop interventions to prevent,
how will you manage the complications should
they occur
(Caputi, 2018)
16

17. Clinical continued:
4. Ready client for discharge home:
Assign three clients being discharged, assess ADLs,
IADLS, stability on feet, assess senses, [vision, hearing,
tactile] and layout of home.
5. 24-hour report book/sheet: pick three clients and
perform appropriate assessments based on why they
are on report. Review charts for progress, are
interventions working or need revising, what is the
policy & procedure for putting these clients on report.17

18. Clinical continued:
6. Fall prevention assessment: assign three
clients to perform a fall assessment. Use the
facility’s form.
7. Assistive device assessment: assign three
clients with assistive devices. Perform appropriate
assessment (NeuroVascular, MS and skin, etc.),
identify two potential complications and
interventions to prevent. Review chart for medical
diagnoses/history, medications and
contraindications for devices.
18

19. Clinical continued:
8. Lab test: assign three clients with similar lab
tests. Then compare the three clients’ lab test by:
* Reviewing charts for medical diagnose(s), client
history, diet, doctor’s orders and medications
*Perform appropriate assessments
* Discuss findings and comparisons
(Caputi, 2018)
19

20. Clinical continued:
9. Medications requiring therapeutic drug testing
- assign three clients with these lab tests. Have
students answer the following: (for example Lanoxin)
A. Is the level normal?
B. What is the normal range?
C. Explain what a high or low value means.
10. Focused assessments: assign three clients -
neurovascular, pain, Braden scale, etc. and compare
client’s findings with medical diagnose(s)/history.
Discuss findings and comparisons.
20

21. Clinical continued:
11. Activity statements from RN Test Plan:
review the activity statements, develop an ‘activity’
for your students in the clinical setting.
For example: assign three clients who are
incontinent of urine and have students assess
their skin. Identify three appropriate interventions
for the three clients, and then explain why the
interventions may be different for each.
(NCLEX Test Plan: Physiological Integrity, Basic Care and Comfort)
21

22. Clinical continued:
11. Activity Statement Continued: Dr. Eden
Kan has done this for our first semester
nursing students. Each clinical day has a
different focus from the activity statements.
12. MOLST/Advance Directive (health care
and financial POA): assign three clients and
have students research each client’s
MOLST/Advance Directive forms and compare
22

23. Clinical continued:
13. ADLs: assign three clients and have students
assess and compare each client’s ‘normal’ to their
medical diagnose(s)/history and to each of the
other two’s ‘normal’ ADLs. If the agency has a
form, use this form for this assessment.
14. Legal - Policy and Procedures (P&P): Assign
a group of students to research at least one P&P
for the semester. Discuss why P&P are so
important. For example, care and comfort. 23

24. Clinical continued:
15. Debriefing/Reflection: during post
conference each day, spend time
reflecting on events that happened during
the shift.
24

25. OADN
Another resource for critical thinking strategies is
the Organization for Associate Degree Nursing
(OADN).
You can find Quality and Safety Education for
Nurses (QSEN) teaching and practice strategies
on this site:
https://qsen.org/teaching-strategies/strategy-
search/ 25

26. Tanner Clinical Judgment Model
CSM’s clinical evaluation tool is based on Tanner’s
Clinical Judgment Model.
This is a good source to help you understand how to
be effective with critical thinking activities.
https://www.ncbi.nlm.nih.gov/pubmed/16780008
26

27. Reference List
Brenton, A., & Petersen, E. (2019). Next generation NCLEX - educator
webinar - part i. In Next generation NCLEX - educator webinar - part i
[Webinar]. Retrieved from https://www.ncsbn.org/
Caputi, L. (2018). Test item writing and the next generation NCLEX. In Test
item writing and the next generation NCLEX (Vol. 11/2018). Linda Caputi.
Ignatavicius, D. (2019). Using case studies to develop clinical judgment
and ensure next generation NCLEX (NGN) sucess. In Using case studies
to develop clinical judgment and ensure next generation NCLEX (NGN)
sucess (Vol. 11/19). Elsevier.
Kan, E. Z., & Stabler-Haas, S. (2018). Fast facts for the clinical nursing
instructor: Clinical teaching in a nutshell. New York, NY: Springer
Publishing Company. 27

28. Reference List Continued
NCLEX-RN examination test plan for national council licensure
examination for registered nurses. (2018). Retrieved December 22, 2019,
from NCSBN website: https://www.ncsbn.org/nclex.htm
NCSBN: NCLEX regional workshop for nurse educators. (2019). In
NCSBN: NCLEX regional workshop for nurse educators.
QSEN competencies . (2019). Retrieved December 22, 2019, from QSEN
website: https://qsen.org/competencies/pre-licensure-ksas/
Silvestri, L. A. (2019). Higher-cognitive-level test questions: A starting point
for creating next generation NCLEX (NGN) test items. In Higher-cognitive-
level test questions: A starting point for creating next generation NCLEX
(NGN) test items (Vol. 11/19). Elsevier.
28

29. Reference List Continued
Tanner, C. A. (2006, June). Thinking like a nurse: a research-based
model of clinical judgment in nursing. Retrieved December 22,
2019, from National Center for Biotechnology Information, U.S.
National Library of Medicine website:
https://www.ncbi.nlm.nih.gov/pubmed/16780008
Timken, M. (2019). Advancing clinical judgment in the nursing
classroom. In Advancing clinical judgment in the nursing classroom
(Vol. 10/19). Elsevier.
29

30. Thank you for attending!
Questions?
30