CRITICAL THINKING

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CRITICAL THINKING
SOAR-RN
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New graduates level of development

• Unconsciously incompetent
• Consciously incompetent
• Consciously competent
• Unconsciously competent

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Appearance of critical thinkers

• Surprisingly enough, research has shown that most
  critical thinkers are
• women
• age of 53 to 57 years old
• heavy set
• fair skinned
• over 54.

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What does critical thinking look like?

• Name someone you know who is a great critical
  thinker

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Critical thinking skills sets

• Ability to recognize
• Normals
• Abnormals
• Red flags
• Ability to put the most important thing first
• Know the rational for interventions

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Why use critical thinking in clinical practice???

• Appropriate nursing interventions
• Complex, rapidly changing healthcare environment
• Patients that are not textbook
• Not always clear-cut protocols

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Barriers to Critical Thinking
Fear Anxiety Stress Fatigue Environment
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Clinical Judgment

• Way in which nurses come to understand the
  problems, issues, or concerns of patients
• Nursing decisions made about things related to
  the patient
• Nursing opinions made about a patients health at
  a point in time

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Critical Thinking in Action
Assessment Initial grasp of the situation Knowledge of person or routine response Clinical knowledge of similar individuals Textbook knowledge
Interpretation Intuitive response Analysis of data with hypothesis formation Rule/out hypothesis until consistent with data
Action Intervention
Evaluation Adjust interventions based on response to actions
Reflection on Action Assess what occurred as a result of action or lack of action
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Beckys Critical thinking experience

• Observation
• Interpretation
• Action

Observation Interpretation Action

• Observation
• Interpretation
• Action

Evaluation
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Beckys Critical thinking experience

• Reflection on action
• What happened as a result of my actions?
• What happened as a result of my inaction?

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Strategies to engage in critical thinking

• Ask Why?, What else? and What if?
• Restate findings in your own words
• Think out loud or write things down, draw
  pictures or concept maps
• Organize and reorganize information.

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More Strategies

• Substitute I dont know and Im not sure with
  Ill find out
• Ask an expert to think out-loud
• Look for flaws in your thinking, open your
  thinking to others for them to see the flaws

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Follow-up Actions

• Reframe Turn errors into learning opportunities
• Share your mistakes with others

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Strategies for Developing Clinical Judgment

• Fine tune your assessment skills
• Develop your knowledge base
• Normal vs abnormal assessment findings
• Lab results
• Disease process

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Strategies for Developing Clinical Judgment

• Use the nursing process, protocols, procedures,
  standards of care, best practice and understand
  the reasoning behind them
• Know why interventions are indicated, why they
  work, how they apply within the context of this
  patient situation

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Strategies for Developing Clinical Judgment

• Learn from experts
• Learn from others on the multidisciplinary team
• Use resources
• Experienced staff
• Physicians
• Written text

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Reflective exercise

• As a result of this situation
• I have learned how to..
• This situation gave me insights into
  collaborating with others because of..
• This situation shows I have more to learn
  about..

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Critical thinking exercise

• Scenario
• Common causes for this issue.
• List what additional information may be needed.
• List what the options are.
• Verbalize rationale for each of the options
• Identify what corse of action the RN should take.
• Identify what assumptions or biases could affect
  the critical thinking process.