Open-mindedness : Having an appreciation of alternative perspectives and willingness to respect the right of other
Knowledge- depth and extent of knowledge influence the nurse’s ability to think critically about nursing problems Experience- Unless nurse has had the opportunity to practice and make decisions about client care, critical thinking skills will not develop. In practice the nurse learns from observing, practicing, talking with clients, families, peers, and reflecting they will stagnate and not grow in their ability to think. Book reminds us that the clinical experience is the laboratory for testing nursing knowledge. Critical thinking competencies- Look at all the general and specific competencies
Scientific – uses reasoning to solve problems, used by nurse researches identify the problem collect the data formulate the hypothesis – a way to study the problem test the hypothesis – see if it works evaluate Problem solving – obtain information and find a solution and then solve problem and evaluate the solution Decision making – end point of critical thinking define problem assess the options weigh all the factors make final decision Diagnostic reasoning – using the data you gather to determine plan of care Clinical decision making – making a decision based on a problem which has been identified involves determining the priority thing to do
Nurse educator faces challenges when teaching CT.
Am bi gue I ty ความกำกวม
Inquisitiveness/ curiosity ความอยากรู้อยากเห็น
Students were confronted with credible but antagonistic arguments. It challenge students to deal with the tension between the two arguments. Word chains category Ideas : i.e. Things made of glass : glass, plastic, metal, wood, cloth
http://biology.ipst.ac.th/index.php/article-year-2545/121-2009-12-21-10-23-38.html Background – Information is not all you need to solve a problem The amount of information is growing exponentially no one person can keep up Started in medical school 1913 Sir William Ossler (concerning the education of medical students) “ too great a reliance on lectures and on students’ capability of memorising a growing number of items of knowledge.” 1950’s integrated systems teaching in USA medical school 1960’s PBL introduced in Canadian medical school 1970’s many USA and worldwide medical schools adopted PBL 1990’s introduced into medical schools in UK by Manchester, Glasgow and Liverpool universities.
Wood, D.F. (2003) ‘ABC of learning and teaching in medicine: Problem based learning’ British Medical Journal 326: 328-330
Read more at http://i.nursegroups.com/nursing-article/evidence-based-nursing.html#W3bpWze4usfJvpRw.99 It involves several processes that can contribute to a better understanding of a patient’s condition as well as the effectiveness of a certain treatment method.
http://www.edtech.vt.edu/edtech/id/models/powerpoint/casebased.pdf http://www.materials.ac.uk/guides/casestudies.asp Explore case a particular participant to develop such an understanding by critical using nursing process.
Fry H, Ketteridge S and Marshall S (1999) A Handbook for Teaching and Learning in Higher Education, Kogan Page, Glasgow, pp408
According to the review, the evaluation of CT skill in nursing is a major difficult because a commercial CT are not specific in nursing.
Astleitner, H. (2002). Teaching Critical Thinking Online. Journal of Instructional Psychology, 29 (2), 53-77. Bruning, K. (2005). The Role of Critical Thinking in the Online Learning Environment. International Journal of Instructional Technology and Distance Learning, 2(5). Bruning, R., Zygielbaum, A., Horn, C., & Glider, W. (n.d.). Online Tools for Enhancing Student Learning and Extending Resources in Large Enrollment University Courses. Available from the Center for Instructional Innovation at the University of Nebraska. Collison, G. Elbaum, B., Haavind, S., & Tinker, R. (2000). Facilitating online learning: Effective strategies for moderators. Madison, WI: Atwood Publishing. Driscoll, M. P. (2005). Psychology of learning for instruction (3 rd ed.). Boston, MA: Allyn & Bacon. Dumke, G. 1980. Chancellor's Executive Order 338 . California State University, Chancellor's Office, Long Beach. Hanna, D. E., Glowacki-Dudka, M. & Conceicao-Runlee, S. (2000). 147 Practical Tips for Teaching Online Groups: Essentials of Web-Based Education. Atwood Publishing: Madison, WI. Horton, S. (2000). Web Teaching Guide: A practical approach to creating course web sites. Yale University Press: New Haven and London. Jones, D. (1996). Thinking Critically in an Online World. Retrieved Jan. 25, 2006 from http://www.library.ucsb.edu/untangle/jones.html. MacKnight, C. B. (2000). Teaching Critical Thinking through Online Discussions. Educause Quarterly, 4, 38-41. Muirhead, B. (2002). Integrating Critical Thinking into Online Classes. United States Distance Learning Association Journal. Retrieved Jan. 25, 2006 fromhttp://usdla.org. Murchu, D. & Muirhead, B. (2005). Insights into Promoting Critical Thinking in Online Classes. International Journal of Instructional Technology and Distance Learning, 2(6). Paul, R. & Elder, L. (2004). The Nature and Functions of Critical and Creating Thinking. The Foundation for Critical Thinking. Peirce, W. (2003). Strategies for Teaching Thinking and Promoting Intellectual Development in Online Classes. Electronic Communities: Current Issues and Best Practices. U.S. Distance Learning Association: Information Age Publishing. Pyle, R. (1997). Teaching Critical Thinking Online. Retrieved Jan. 25, 2006 from http://reach.ucf.edu/~aln/pyle/main.html. Savery, J. R. & Duffy, T. M. (1995). Problem based learning: An instructional model and its constructivist framework. Educational Technology 33(1) 31-38. Walker, G. (2005). Critical Thinking in Asynchronous Discussions. International Journal of Instructional Technology and Distance Learning, 2(6).
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Critical ThinkingIn Nursing Education Dr. Susheewa Wichaikull
Questions: What do you really know about “Critical thinking”? Why CT is important for the nurses? Where CT can be applied in nursing? How to apply CT in nursing education? What options are available to you? When does the nurses need to think critically?
Objectives To define CT The component of CT How to approach CT How to promote CT in nursing education
What is critical thinking? An Introduction to Critical Thinking
CT has been expressedin several ways frommany theorist.
Critical Thinking Definition Rudd, (2002) Reasoned, purposive, and reflective thinking used to make decisions, solve problems, and master concepts. Profetto-McGrath and others (2003) Critical thinking is both a process for resoning and set of skills. Chaffee (2002) Active, organized, cognitive process used to examine one’s thinking and that of others Settersten and Lauver (2004) Recognize, analyze, evaluate, and draw conclusions
Critical Thinking is: “Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness.”Michael Scriven & Richard Paul (the National Council forExcellence in Critical Thinking, 1987)
According to several definitionsabove, CT is not the method oflearning, but rather a processincluding, both cognitive andaffective domains.
Seven standards that critical thinkers should be According to the Foundation for Critical Thinking (http://www.criticalthinking.org)
Critical thinking skillsAccording to literature reviews: There is no perfectly clarification regarding Critical thinking skills. It depends on user and utilizing. However, Facione and Sanchez (1994) recommended that being a good critical thinker should employ both cognitive critical thinking skills and attitude critical thinking skills.
Cognitive Critical Thinking Skills Interpretation : accurate interpreting topic/problem Analysis : Examining ideas/argument in topic Inference : querying claim, reaching conclusion to implement with the patient Explanation: clearly explaining and defending the reason why using those implementations Evaluation : evaluating information to ascertain its probable trustworthiness Self-regulation : constantly monitoring one’s own thinking using universal criteria Facione, 1990 Frequently used in nursing
Critical thinking includes a complex combination skills Rationality Self-awareness Honesty Open-mindedness : Having an appreciation of alternative perspectives Discipline or experiences Judgment
What the major components are: 1) a set of information and belief generating and processing skills, and 2) the habit, based on intellectual commitment, of using those skills to guide behavior.
Critical Thinking Components Brookfield (1987) stated that there are four components of CT; Identifying and Challenging Promoting the importance of context Capacity to imagine and explore alternative Reflective skepticism
Five components of critical thinking in Nursing Knowledge base Experience Competence Attitudes Standards Joyce Smith : Critical Thinking and Nursing Judgment
Standards Intellectual Standards- 14 intellectual standards (Paul,1993) Nurses use these when using the nursing process: 1. Confidence 7. Perseverance 2. Independence 8. Creativity 3. Fairness 9. Curiosity 4. Responsibility 10. Integrity 5. Risk taking 11. Humility 6. Discipline
Professional standards Sound ethical standards When critically thinking must have a sense of their own values, beliefs, feelings and their clients/ client’s family’s values, beliefs, feelings Scientifically based practice with standards developed by experts Evidenced based practice Standards developed as a result of evidence These are minimum requirements that are necessary to give quality effective care
Critical Thinking Competencies Scientific method Problem solving Decision making Diagnostic reasoning Clinical decision making Nursing process
However, nursing’s effort to capture andemploy these concepts has resulted in someconfusion and uncertainty.
How it different from Problem solving CT Problem solving • goes beyond • Focus on problems problem solving rather and finding solutions than finding specific to solve the problems solution. •is not centred on • is nature expects an seeking an answer answerFacione(1993) described that CT as eventually a cognitiveengine driving problem solving and decision making
How it different from Decision making CT Decision making •The requisite of • a systematic process decision making of assessment of a collection of actions, evaluation and judgment contributing to the achieve outcome CT is an important process to promote problem solvingand decision making.
Bittner and Tobin (1998) suggested the instructional method to enhance CT as following: Creative approach to open nurse’ mind and to broaden alternative argument in order to facilitate the problem solving
Strategies to promote CTActive learning has eventually been used for the teaching of critical thinking.
Active Learning - “students involved in doing things & thinking about the things they are doing”Critical Thinking - “reasonable reflective thinking that is focused on deciding what to do and what to believe” OR “interpreting, analyzing or evaluating information, arguments or experiences with a set of reflective attitudes, skills, and abilities to guide our thoughts, beliefs and actions” OR “examining the thinking of others to improve our own”
Operational Procedures of Critical Thinking - 1 Identifying key Distinguishing fact definitions from opinion Identifying ambiguity Identifying Identifying variables assumptions Formulating questions Identifying values Defining issue or Noting missing problem evidence Classifying Identifying information relationships Comparing & Sequencing information contrasting Cause and effect Recognizing patterns Determining Summarizing credibility information Using analogies
Operational Procedures of Critical Thinking - 2 Predicting trends Identifying errors in from data reasoning such as: Logical fallacies Predicting Errors in statistical outcomes based reasoning upon evidence Alternative Translating conclusions that between verbal satisfy evidence and symbolic Identifying conclusions
Dispositions to think critically(Attitude) Inquisitiveness/ curiosity Open mindedness Systematicity Analyticity Truth seeking Self-confidence MaturityStacy E. Walker (2003) Active Learning to promote CT
Learning Methods : Active Learning Classroom discussion and Debates Simulation Questioning tactic Written Assignment Problem based learning Inquiry based learning Factual based or Evidence based learning Games and Puzzles Encourage Creativity Word chains category Ideas Online based learning Case study or cased based learning Cooperative learning or participatory learning Integrated learning and so on i.e. community based, elective based learning, virtual class
Student Centered Model Teacher Student Student Content
Questionings Questions are the helpful to promote critical thinking in every process of learning. It depends on how a question is asked. The useful questions are “Wh” questions i.e. what, why, when, where, how.
Example of Questions Stacy E. Walker (2003)Category Key Concepts ExamplesKnowledge Memorization, description, What, When, Who, define,Comprehension explanations, comparison describe,state,show,how conclude, demonstrate, rephrase, differentiate, explain, give an exampleApplication Solution, application, Build, construct, solve,analysis induction, deduction, demonstrate, how would logical order you support your, what assumptions, what reasons, does the evidence support the conclusion, what behaviourSynthesis Product thinking Think of a way, propose a plan, develop, suggest, formulate a solutionEvaluation Judgment, selection Choose, evaluate, decide, defend, what is the most appreciate, which would you consider
Simulation in nursing education There is currently a widespread movement to use simulations of all types in nursing education as a teaching-strategy and/or as an evaluation mechanism. In the past 40+ years, nursing educators have conducted similar studies involving case studies, computerized patients, standardized patients, and have achieved similar results.
Virtual Simulation and Patient CareGoal for using simulations: Optimal StudentLearning for High Quality Patient Care
Simulation Framework OUTCOMES • Learning (Knowledge) • Skill performance • Learner satisfaction • Critical-thinking Program • Self-confidence s aphic Level Demogr Age DESIGN CHARACTERISTICS and SIMULATION Active learning Collaboration (intervention) Feedback High expectations Student/ faculty Diverse learning Objectives interaction Time on task Fidelity Problem-solving Student Support ReflectionJeffries & Rizzolo, 2004
Problem Based isAn instructional student-centered approach which uses carefully constructed clinical problems as a context for students to: define their learning needs, conduct self- directed enquiry, integrate theory and practice, and apply knowledge and skills to develop a solution to a defined problem.
How it different from Problem solvingProblem based Problem solvinglearningthe process of arriving at decisionsacquiring new based on priorknowledge based on knowledge andrecognition of a need reasoningto learn
The Seven Step Model Step 1 Identify and clarify unfamiliar terms presented in the scenario, (allocate a scribe and a chairperson, define rules) Step 2 Define the problem or problems to be discussed; Step 3 Ideas storming session to discuss the problem(s), Step 4 Review steps 2 and 3 and arrange explanations into tentative solutions; Step 5 Formulate learning objectives; Step 6 Private study (all students gather information related to each learning objective) Step 7 Reconvene - Group shares results of private study (Wood, 2003)
Inquiry based learning“Inquiry implies involvement that leads to understanding. Furthermore, involvement in learning implies possessing skills and attitudes that permit you to seek resolutions to questions and issues while you construct new knowledge.”(Veronica Robinson 2008)
Evidence based learning Evidence based nursing, or EBN, is a form of clinical practice that relies on research findings to manage the health problems of a patient. Evidence based usually begins with the formulation of a question or topic concerning a patient’s medical condition, and then, research is performed to find answers to the question. It can be applied in the classroom.
Step of EBL Select a topic Collect appropriate and accurate data to generate evidence for nursing practice. Analyze data from clinical practice. Design interventions based on evidence. Predict and analyze outcomes. Examine patterns of behavior and outcomes. Identify gaps in evidence for practice. Evaluate project to determine and implement best practices.
E-learning/ web based learning Online tools provide an efficient means by which instructors can shift the instruction of basic concepts outside of class so that students are prepared to fully engage in class activities (Mandernach 2006). Online course can promote CT depending on the design of learning within Asynchronous and synchronous learning tool(Wichaikull 2007). Critical thinking appears to be best encouraged among students when a more consistent emphasis is placed on the discussions, and when instructor facilitation is less frequent but more purposeful. (Bridget Arend 2009)
Case based or case study in nursing The case study approach is one way in which such active learning strategies can be implemented in clinical setting. Fry et al (1999) describe case studies as complex examples which give an insight into the context of a problem as well as illustrating the main point. Case studies is defined as student centred activities based on topics that demonstrate theoretical concepts in an applied setting.
Benefits of cae study Convey knowledge, facts, information to students Apply theory to a situation Enhance students’ decision making skills Improve students’ technical or behavioural skills in analysing data Improve students’ self esteem Stimulate students’ interest in a subject Foster reflection Present a realistic picture of the complexities in a situation
Factors influencing critical thinking outcomes Questions with one right answer Questions with no right answer Questions with better and worse answers
Critical thinking outcomes Rudd & Irani, 2004 Individual factors High Quality Critical Thinking Outcome Stimulus High High High Problem Critical Critical No Critical Thinking Knowledge Thinking Thinking Disposition Skill Outcome Decision + + Others… Low Quality Low Low Low Critical Thinking Outcome External factors
8 Ways to Fail at Teaching CT(Robert Sternberg, Yale University)1. Teacher is teacher; student is student.2. Critical thinking is the students’ job.3. Need to find the best program.4. Program decisions are either or.5. Right answer over rationale.6. Discussion a means to an ends.7. Mastery learning applies to CT.8. Need to “teach” critical thinking.
Evaluating Your Teaching closed questions open-ended questions MEQ Test/ Rational for decision making/ problem solving ability Concept map Analysis of writing portfolio Interviews and discussion Observations Documentation of a situation analysis Potential solutions