THINK, ACT & CARE LIKE A NURSE: INTEGRATING CRITICAL THINKING AND CARING ASPECTS OF NURSING
SHEIRMA B. IBLAN, MAN
How do we make decisions? How do nurses make decisions about patient care? What do we rely on to help us in decision making?
What is Critical Thinking? CRITICAL THINKING is the study of clear, reasoned thinking. According to Beyer (1995) Critical thinking means making clear, reasoned judgments. While in the process of critical thinking, your thoughts should be reasoned and well thought out/judged.
Critical Thinking Purposeful, outcomedirected Essential to safe, competent, skillful nursing practice Based on principles of nursing process and the scientific method Requires specific knowledge, skills, and experience New nurses must question
Guided by Professional Standards and Ethic Codes Requires strategies that maximize potential and compensate for problems Constantly reevaluating, self-correcting, and striving to improve
Significance to Nursing Education • purposeful, outcome-directed thinking, which is driven by patients' needs and guided by professional standards • Clark and Hott (2001), critical thinking is essential for various elements of nursing, such as knowing, diagnosing, and bridging the gap between theory and practice • Thinking critically does not mean “knowing everything”.
Significance to Education • Nursing education and research has recently focused on promoting critical thinking through active teaching strategies (Chen and Lin, 2003) • Participation in self-assessment and evaluation makes it more likely that students will be able to set realistic personal learning goals (Billings and Halstead, 2005)
To develop to think Critically
Technical Skills/Competencies
CT characteristics
Intellectual Skills/Competencies
Interpersonal Skills/Competencies
Alfaro-LeFevre’s 4-Circle Critical Thinking Model, 2009
Asks pertinent questions Self-aware Is able to admit a lack of understanding or information Is interested in finding new solutions Listens carefully to others and is able to give feedback Examines problems closely
Formula for Critical Thinking
Start Thinking Why Ask Why Ask the Right Questions
Are you an expert?
Critical Thinking Skills (Scheffer & Rubenfeld, 2000) Analyzing Applying standards Discriminating Information seeking Logical reasoning Predicting Transforming Knowledge
Thinking and Learning
Lifelong process Flexible, open process Learn to think and to ANTICIPATE What, why, how questions Look beyond the obvious Reflect on past experience New knowledge challenges the traditional way
Components Of Critical Thinking
Scientific Knowledge Base Experience Competencies Attitudes Standards
Critical Thinking Competencies Scientific method Problem Solving Decision Making Diagnostic Reasoning and Inferences Clinical Decision Making Nursing Process
Attitudes That Foster Critical Thinking Independence Fair-mindedness Insight into ethnocentricity Intellectual humility Intellectual courage to challenge status quo Integrity Perseverance Confidence Curiosity
Clarity Accuracy Precision Relevance Depth Breadth Logic Significance Fairness
Techniques in Critical Thinking • • • •
Critical Analysis Socratic Questioning Inductive Reasoning Deductive Reasoning
Critical Thinking and Nursing Judgment Not a linear step by step process Process acquired through hard work, commitment, and an active curiosity toward learning
Decision making is the skill that separates the professional nurse from technical or ancillary staff
Critical Thinking and Nursing Judgment Good problem solving skills Not always a clear textbook answer Nurse must learn to question, look at alternatives
How to accomplish this? Learns to be flexible in clinical decision making Reflect on past experiences and previous knowledge Listen to others point of view Identify the nature of the problem Select the best solution for improving client’s health
Critical Thinking Can Lead To…
Sound clinical decisions Improved patient care Evidence-Based Practice (EBP)
Applying Critical Thinking to Nursing Practice Problem Solving Trial and Error Intuition Research Process Decision Making
Nursing Process Systematic approach that is used by all nurses to gather data, critically examine and analyze the data, identify client responses, design outcomes, take appropriate action, then evaluate the effectiveness of action Involves the use of critical thinking skills Common language for nurses to “think through” clinical problems
Nursing Process
Critical Thinking and Assessment Process Brings knowledge from biological, physical, & social sciences as basis for the nurse to ask relevant questions. Need knowledge of communication skills Prior clinical experience contributes to assessment skills Apply Standards of Practice Personal Attitudes
Developing Critical Thinking Attitudes & Skills Not easy Not “either-or” phenomenon Self-assessment Tolerating dissonance and ambiguity Creating environments that support critical thinking
comprehensive orientation programs mentoring preceptoring coaching
Youngblood and Beitz (2001) reported that active learning strategies promote critical thinking Case Studies/Case/Case Method/ Case Study Method Simpson and Courtney (2002) list roleplaying, debate, jigsaws, writing assignments, and simulations as teaching strategies purported to increase CT
Patient profiling Drug diary Research trail Problem based learning (PBL) Critical-thinking game called What If? What Else? What Then (Free, 1997) Patho-flow diagram (Reynolds, 1994) Evidence Based Practice
Concept mapping = uses graphic depiction; also known as mind mapping Reflection = the process of purposefully thinking back or recalling a situation to discover its purpose or meaning
Theoretical Basis of Concept Maps Roots in education and psychology Also known as mind maps, cognitive maps Concept mapping requires critical thinking New knowledge is built on preexisting knowledge, new concepts are integrated by identifying relationships
Steps in Concept Map Care Planning Develop a Basic Skeleton Diagram Analyze and Categorize Data Analyze Nursing Diagnoses Relationships Identifying Goals, Outcomes, & Interventions Evaluate patient responses
Reflection as a Tool for Enhancing Critical Thinking “an intentional mental processing, used primarily with complicated or uncertain situations or ideas in order to fulfill a particular purpose in the present or future” (Moon, 2004)
Recording thoughts using reflective journaling Duffy’s Attributes for Guiding Reflection (2008)
Find the right guide Create the framework Be ready for the findings Reflect on the reflection
“The function of education is to teach one to think intensively and to think critically” Martin Luther
• When thinking, acting & caring like a nurse, the nurse regards the patient as a whole person and bases care, treatment and recovery goals upon that point of view. • When thinking, acting & caring like a nurse, the nurse listens with empathy; that is, listens compassionately. • When thinking, acting & caring like a nurse, the nurse synthesizes all information about the patient in order to delegate duties and responsibilities to provide for safe and appropriate care of the patient
Critical thinking is thinking, acting & caring like a nurse; thinking, acting & caring like a nurse is critical thinking.
References • Berman & Synder, 2012, Kozier & Erb’s Fundamentals of Nursing, 9th Ed., Upper Saddle River, New Jersey • ursing.advanceweb.com/Continuing-Education/CE-Articles/criticalthinking-at-the-bedside.aspx • https://www.ceufast.com/courses/112/112.htm • http://www.learningdomain.com/MEdHOME2/RESEARCHnursing/C linical.Juge.Review.pdf • http://vscheiner.brunel.ac.uk/bitstream/2438/1399/3/CT%20paper.pdf • https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web& cd=3&cad=rja&uact=8&ved=0CC0QFjAC&url=https%3A%2F%2Fispu b.com%2FIJANP%2F7%2F2%2F13270&ei=OWR3VJ_CFMbKaJnWgLA B&usg=AFQjCNEE9-3i4RtIz2_BrdHFShNUJf7lw&sig2=Dkj8CtLuIoLQHYexplP5hw
• http://www.medscape.com/viewarticle/707855_6 • Todayhttps://www.google.com/url?sa=t&rct=j&q=&esrc=s &source=web&cd=5&cad=rja&uact=8&ved=0CDgQFjAE&ur l=http%3A%2F%2Felsevier.ca%2Fproduct.jsp%3Fisbn%3D97 81437727760&ei=Qs15VKOrMqvW7QaHtYGYAg&usg=AFQj CNFmkW16x33WbkWLlpfAYqOYObmKvA&bvm=bv.8064206 3,d.ZWU • Alfaro-LeFevre, R., 2004. Critical Thinking and Clinical Judgment: A Practical Approach. 3rd ed. Saunders, Philadelphia. • https://www.google.com/url?sa=t&rct=j&q=&esrc=s&sourc e=web&cd=3&cad=rja&uact=8&ved=0CDcQFjAC&url=http %3A%2F%2Fwww.open.uwi.edu%2Fsites%2Fdefault%2Ffile s%2Fbnccde%2Fbelize%2Fconference%2Fpapers2010%2Fp arksetal.html&ei=wWB7VPvRD9TQ7AaxroDwCQ&usg=AFQj CNGSZbSM2pHnDdyfNzLPAHWEonxxwQ
• http://www.asrn.org/journal-nursing/198critical-thinking-and-evidence-basednursing.html
