-Critical thinking is cognition or the intellectual work of the mind that involves reasoning and self-discipline using particular skills-critical thinking in the research literature is by Watson and Glaser, who define it as a composite of attitudes that enable a person to recognize problems, search for evidence to support truths, and accurately weigh logically determined evidence.
-Critical thinking guides nurses in assessing, assimilating, retrieving and/or discarding components of information that affect patient care. Shortened hospital stays, patient acuity, and advances in technology require nurses to think quickly to resolve problems. Decision-making under conditions of uncertainty, risk and complexity has become the norm of professional practice. It is critical thinking that enables nurses to make these decisions, typically without collaboration.-Critical thinking was established as an important educational outcome for nursing. Nurse educators set out to meet requirements for critical thinking by defining the concepts, creating measures, and designing curricula to demonstrate positive changes in the critical thinking skills of students.
-Nursing research revealed that novice nurses used more cognitive structuring and fewer analytic processing strategies when confronted with complex clinical information-This research shows that novices and experts have different levels of experience and domain specific knowledge, but use similar cognitive strategies to solve clinical problems. Novice nurses identify fewer patient cues, are limited in their ability to cluster these cues, have difficultyidentifying complex diagnoses, and do not reevaluate data as often as more experienced nurses. Another difference between novices and experts is that novices readily retrieve patient data, but important cues are often overlooked as the degree of uncertainty or decision complexity increases.-With increasing clinical experience, expert nurses use informal thinking or cognitive shortcuts to think about and reason through complex issues. These techniques enable nurses to review extensive patient information quickly.
-Benner adapted the Dreyfus model to nursing skills at different levels of practice, ranging from limited cue recognition and analyticthinking (novice) to comprehensive understanding and intuition (expert). The concept of critical thinking fits well in Benner’s model of skill acquisition in nursing. Essential concepts in her model are experience, knowledge, skills and caring.-Critical thinking skills are positively correlated with years of clinical experience, and usually have no relationship with clinical judgment or decision-making. Multiple variables affect this process in nursing, including cognitive ability, life experience, maturity and skill level withinpractice. Also, the amount of information available, degree of risk involved and level of uncertainty also affect outcome. Each nurse has their own set of personal traits that influence the process, as well.
Ask the class if they take time for reflective learning and critical thinking. Ask how they make time for it. Ask for examples of when they wish they could have had more time to reflect and think critically. Offer personal examples.
Quote by Albert Einstein. Good segway into metacognition.
-What is it?-Metacognition is defined as awareness and understanding one’s thinking and cognitive processes: thinking about thinking-The article defines Metacognition as the executive cognitive control knowledge used to monitor and manipulate cognitive processes and progress
-Metacognitive skill includes self-communication or internal dialogue, self-monitoring and self-regulation, and self-evaluation to influence reasoning when solving clinical problems.-Self-monitoring refers to the behavior used to attain goal progress, and it motivates improvement in learning.-Self-regulation includes goal setting, self-efficacy, knowledge use and thinking strategies. -Self-evaluation is a key component in reflective thinking which in turn influences critical thinking and the development of clinical reasoning skills.-Short staffing is a barrier to reflection as it can lead to routines in practice that are not questioned.-Example of personal use of metacognition. Exemplar story.-CLASS EXAMPLES
Not all people can reflect or find value in experiences in the same way. Its important to find the one that is best suited to you personality. The importance of this is to find a means to analyze what you can take away or learn from the experiences of that day. Don’t focus on the negative aspects but focus on what can be gained. Don’t hesitate to ask a more experienced nurse what their thoughts are or how you can improve. Sometimes the hardest thing to do is to take an honest look at yourself, find out what you need to change, then formulating a plan to improve. Does anyone use these ways to reflect or have another means that they use?
After giving the students time to answer then give them the information how the nurse took a few seconds to discuss it with physical therapy and look at the problem from a different angle and came up with the idea of muscle relaxants. Shared this with the PA who was receptive and the patient experienced a decrease in pain.
Reflective Learning andMetacognition in NursingAshley Fehnel, April Treible, and Rose Marsh
Barriers to Critical Thinkingo Personal resistance and attitudeo Inadequate timeo Resistance to different teaching styleso Lack of knowledgeo Institutional barriers
“You cannot solve problems with the same level of consciousness that created them” -Albert Einstein
Metacognitiono What is metacognition?o Thinking about thinkingo Executive cognitive control knowledge
Metacognition inNursingo Metacognitive skill o Self-communication o Self-monitoring o Self-regulation o Self-evaluationo Barrier to metacognitiono Examples
Reflective Learning“The process of internally examining and exploring an issue of concern, triggered by an experience, which creates and clarifies meaning in terms of self and which results in a changed conceptual perspective”Thorpe, 2004
Connection to metacognition Debate in literature: “critical thinking skills are fundamental to reflection” “Reflection is essential for critical thinking to occur”
Significance tonursingProfession vs. JobDesirable outcomesSupport clinical judgments and decisionsNovice vs. expert
How to Encourage Reflectionand Metacognition o Music o Poetry o Journaling o Debriefing
What needs to happen forreflective learning to take place? Trusting relationship honesty Adequate time Active participation Commitment
Stages of reflectionAwarenessCritical analysisNew perspective
Categories of reflectionNon-reflectorsReflectorsCritical Reflectors
Patient ScenarioA 57 year old woman has had a recent surgery tocorrect her severe kyphosis and scoliosis. She hasbeen receiving routine and PRN pain medication butstill rates her pain as a 7 out 10. Her abdomen is firmand tender and she has not experienced a bowelmovement in three days.The patient needs pain relief without promoting furtherconstipation.How do you proceed?
References Thorpe, K. (2004). Reflective learning journals: From concept to practice. Reflective Practice. 5(3), 327- 343. doi: 10/1080.1462394042000270655 Simmons, B. (2010). Clinical reasoning: Concept analysis. Journal of Advanced Nursing. 66(5), 1151-1158. doi: 10.1111/j.1365-2648.2010.05262.x