think, act & care like a nurse: integrating critical...

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 thinkingmeans making clear, reasoned judgments.

While in the process of critical thinking, your thoughts should be reasoned and well thought out/judged.

Critical Thinking

Purposeful, outcome-directed

Essential to safe, competent, skillful nursing

practiceBased on principles of

nursing process and the scientific methodRequires 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

Alfaro-LeFevre’s 4-Circle Critical Thinking Model, 2009

CT characteristics

Intellectual Skills/CompetenciesTechnical Skills/Competencies

Interpersonal Skills/Competencies

Asks pertinent questionsSelf-aware

Is able to admit a lack of understanding or

informationIs interested in finding new

solutionsListens carefully to others

and is able to give feedbackExamines 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

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

Thinking and Learning

Scientific Knowledge Base

Experience

Competencies

Attitudes

Standards

Components Of Critical Thinking

Critical Thinking Competencies

Scientific methodProblem SolvingDecision Making

Diagnostic Reasoning and Inferences

Clinical Decision MakingNursing Process

Attitudes That Foster Critical Thinking

IndependenceFair-mindedness

Insight into ethnocentricityIntellectual humility

Intellectual courage to challenge status quo

IntegrityPerseveranceConfidence

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 viewIdentify the nature of the problem

Select the best solution for improving client’s health

Sound clinical decisions

Improved patient care

Evidence-Based Practice (EBP)

Critical Thinking Can Lead To…

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 skillsCommon 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 easyNot “either-or” phenomenon

Self-assessmentTolerating dissonance and

ambiguityCreating 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 role-playing, 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, & InterventionsEvaluate 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)

Duffy’s Attributes for Guiding Reflection

(2008)

Find the right guideCreate the framework

Be ready for the findingsReflect on the reflection

Recording thoughts using reflective journaling

“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/critical-thinking-at-the-bedside.aspx

• https://www.ceufast.com/courses/112/112.htm• http://www.learningdomain.com/MEdHOME2/RESEARCHnursing/C

linical.Juge.Review.pdf• http://v-

scheiner.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%2Fispub.com%2FIJANP%2F7%2F2%2F13270&ei=OWR3VJ_CFMbKaJnWgLAB&usg=AFQjCNEE9-3i4RtIz2_BrdHFShNU-Jf7lw&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&url=http%3A%2F%2Felsevier.ca%2Fproduct.jsp%3Fisbn%3D9781437727760&ei=Qs15VKOrMqvW7QaHtYGYAg&usg=AFQjCNFmkW16x33WbkWLlpfAYqOYObmKvA&bvm=bv.80642063,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&source=web&cd=3&cad=rja&uact=8&ved=0CDcQFjAC&url=http%3A%2F%2Fwww.open.uwi.edu%2Fsites%2Fdefault%2Ffiles%2Fbnccde%2Fbelize%2Fconference%2Fpapers2010%2Fparksetal.html&ei=wWB7VPvRD9TQ7AaxroDwCQ&usg=AFQjCNGSZbSM2pHnDdyfNzLPAHWEonxxwQ

• http://www.asrn.org/journal-nursing/198-critical-thinking-and-evidence-based-nursing.html