2. By the end of this presentation, the learners will:
• Define critical thinking and reflection
• Recognize the factors affecting critical thinking
• Understand the importance of critical thinking and the
process of reflection
• Describe critical thinking in Nursing and in today’s
healthcare system
• Identify strategies that enhance critical thinking
• Accept the challenge to think critically in every class
LearningObjectives
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3. Scenario 1
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I have done a colostomy dressing a dozen of times; I followed
all the steps of the protocol exactly as I always do. Afterwards
I even checked out the text book the nursing student left on
the unit counter and it says to do exactly what I did. So I am
asking why it didn’t work and leaking again and again
(Marium, Senior RN).
• What concepts related to critical thinking are involved in this
situation?
• What did you learn from this scenario?
4. Scenario 2
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Mr. Akber is a 60 years old male. He was admitted to the hospital three
days ago for emergency surgery as a result of severe crash injury to his left
arm following an accident at industry. He was in a good health prior to the
accident but had smoked two to three packs of cigarettes a day for last 45
years. The amputation of arm and creation of stump for prosthesis was
successful. Nursing care included administration of pain medication,
monitoring for infection, and assistance with ADLs. Mr. Akber was expected
to be discharged in 2-3 days. On day two after surgery he developed
pneumonia and his hospital stay was extended for six more days.
• What concepts related to critical thinking are involved in this situation?
• What did you learn from this scenario?
5. Scenario 3
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Mrs. Amina, an obese 55 years old female is admitted with complaint of
high-grade fever, nausea, burning & frequent urination with incontinence
episodes. She looks tired & lethargic with flushed skin & dry mucosa. She
tells you that she has not been able to sleep for last three days due to
urgency of urine. Sometimes she wets the bed sheets and has to get up to
change or void again, which disturbs her sleep. Mrs. Amina reveals to you
that last year she was planned for Total hysterectomy for her fibroid
problem but due to financial problem, she refused and went back.
• What concepts related to critical thinking are involved in this
situation?
• What did you learn from this scenario?
6. Scenario 4
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Ahmed is a staff development nurse for a 30 beds step down unit in an
urban hospital. It is time to do his annual in-service on care of central
lines to meet JCIA standards. He has done this several times over the last
years. He pulls out his file with lecture notes, grabs the video off the shelf,
and runs to make copies of the quiz he designed when he first prepared
the material. During his presentation two nurses seemed to be napping,
but they scored fine on the quiz so he decides not to say anything. The
new staff member Laila, however did not scored well. He decides he had
better to meet her and review some of the material. When he talked with
Laila, she tells him that she learned to do central line dressing differently
in school and that’s why she answered the way.
Later in the weekly staff meeting, the unit manager shares the data of
central line infections where the frequency was increased.
• What concepts related to critical thinking are involved in this situation?
• What did you learn from this scenario?
7. Scenario 5
10/8/2012 7
A Chinese woman had to sign an informed consent form for a
hysterectomy. The patient spoke no English and the hospital staff
relied on her bilingual son to serve as the interpreter. When the
son explained the procedure to the mother, he appeared to be
translating accurately and indicating the proper body parts. His
mother signed the consent form willingly. The next day, however,
when she learned that her uterus had been removed and she could
no longer bear children, she became very angry and threatened to
sue the hospital.
• What concepts related to critical thinking are involved in
this situation?
• What did you learn from this scenario?
8. Scenario 6
In a secondary care govt. hospital of a
developing nation, 10 newborn died within 12
hours. The investigation lead that the facilities
are minimal and the location of the hospital is
very far from city site. The population there is
not that educated.
• What concepts related to critical thinking are
involved in this situation?
• What did you learn from this scenario?
9. • “Discipli
ned, self-
directed
thinking . . . ”
• “ (Thinking) . . . which
exemplifies the perfections of
thinking. . .”
The National Council for Excellence in Critical Thinking (1987,n.p)
What isCritical Thinking
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10. In “everyday” language:
Thinking “outside” the box
Thinking about thinking
“Unlimited” thinking
Divergent thinking
“The intellectually disciplined process of actively and
skillfully conceptualizing, applying, analyzing,
synthesizing, and evaluating information.”
The Miniature Guide to Critical Thinking (2008, n.p)
Conti….
10/8/2012 10
12. Why Healthcareprofessionalsthink critically?
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• Need to:
– Make accurate and appropriate clinical decisions
– Solve problems and find solutions
– Plan care for each unique client and client’s problem
– Seek knowledge and use it to make clinical decisions and
solve the problem
– Be able to think creatively when planning care for clients
14. Critical Thinking Competencies
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• General critical thinking competencies used by many
disciplines, in everyday situations.
– Scientific method
– Problem solving
– Decision making
15. Who Thinks Critically
?
10/8/2012 15
• Parents
• Nurses
•Teachers
• Athletic coaches
• Doctors
• Air traffic controllers
• Military commanders
• Lawyers
• Judges
• Supervisors
• Accountants
• Day care providers
17. CriticalThinkingModel
10/8/2012 17
• Explains how nurses can be helped to make clinical
judgments/decisions in their clinical practice that result
in safe, effective, nursing care.
– Knowledge base
– Experience in nursing
– Critical thinking competencies
– Attitudes for critical thinking
– Standards for critical thinking
20. Conti…
10/8/2012 20
2. Professional standards
1. Sound ethical standards
• Critically thinking must have a sense of own values,
beliefs, feelings and their clients/client’s family’s values,
beliefs, feelings
2. Scientifically based practice with standards developed
by experts
• Evidenced based practice
• These are minimum requirements that are necessary to
give quality effective care
21. • “Returning to oneself, mirroring one’s actions, and
professional stance in relation to oneself (self-
reflection) and others (collegial reflection)”
(Bjork & Kirkevold, 2000,p. 223).
• Constructing and assigning meaning to experiences
gives the possibility of looking at experience from
another point of view.
• Reflection can show critical analysis and
evaluation of knowledge and skills for role
What isreflection?
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23. Why reflection?
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• Identify own learning needs
• Direct own learning and develop skills of self-responsibility
• Develop independence and accountability for clinical
practice
• Provides awareness about own thinking skills
• Helps to undertake self-evaluation
• Development of analytical, and critical thinking skill
• Enhances the ability of problem solving, and builds
curiosity and motivation
• Access own competencies
(Fonteyn & Cahill, 1998; Kok & Chabeli,2002;
Riley-Doucet & Wilson, 1997).
24. Gibb’s Reflective Cycle - 198825
ProcessforReflection
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Description
What has
happened
Feelings
What were you
thinking and
feeling
Evaluation
What was good
and bad
Analysis
What sense can
you make of
it?
Conclusion
What else
could be done
Action Plan
If it happen
again what can
be done?
25. What arethestrategiesfor
reflection?
10/8/2012 25
• Personal diaries or journals
• Clinical logs
• Case studies
• Discussion during pre and post-clinical conferences
• Critical Incident Analysis
• Process recording
(Burns & Bulman, 2000; Ling Lau et al., 2002; Nicholl & Higgins, 2004)
26. Reference
s
10/8/2012 26
• Burn, S., & Bulman, C. (2000). Reflective Practicein Nursing: the growthofprofessional practitioner (2nd
ed.). United Kingdom: Blackwell Sciences.
• Concepts And Tools The Foundation for Critical Thinking (2008). The Miniature Guide to
Critical Thinking.
• Fonteyn, M. E., & Cahill, M. (1998). The use of clinical logs to improve nursing students’
metacognition: a pilot study. Journal ofAdvanced Nursing, 28 (1), 149-154.
• Gibb’s Reflective Cycle (1988). http://www.brookes.ac.uk/services/upgrade/a-
z/reflective_gibbs.html
• Kok , J.,& Chabeli, M.M. (2002). Reflective journal writing: how it promotes reflective thinking
in clinical nursing education: a students' perspective. Curationis, 25 (3), 35-42. Retrieved March 31,
2007, from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool= abstractplus&db=
pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=12434637
27. Conti…
10/8/2012 27
• Ling Lau, A. K., Chuk, K.C., & Wie So, W.K. (2002). Reflective practice in clinical teaching.
Nursing and Health Sciences, 4, 201-208.
• Paule (1993)Care planning and delivery in intellectually disability nursing . Retrieved from
http://books.google.com.pk/books?id=QRysWk4TPlkC&pg=PA96&lpg=PA96&dq=14+i
ntellectual+standards+used+by+nurses+when+using+the+nursing+process+are+paul+19
93
• Riley-Doucet, C., & Wilson, S. (1997). A three-step method of self-reflection using reflective
journal writing. Journal of Advanced Nursing, 25, 964-968.
• Rubenfeld, M.G., & Scheffer, B.K. (2005). Critical thinking Tactics for Nurses. Boston: Jones
and Bartlett.
• The National Council for Excellence in Critical Thinking, 1987.
http://www.criticalthinking.org/aboutct/define_critical_thinking.cfm
