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