CRITICAL THINKING

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CRITICAL THINKING
SOAR-RN

• Teresa Holbrook, MSN, RN

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Objectives

• Differentiate between critical thinking and
  reflective practice and how they enhance clinical
  practice.

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What does critical thinking look like?

• Name someone you know who is a great critical
  thinker
• What are their characteristics?
• A good critical thinker is.

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Why use critical thinking in clinical practice???

• Safe and effective nursing interventions
• Complex, rapidly changing healthcare environment
• Patients that are not textbook
• Evidence Based Practice
• Not always clear-cut protocols
• What we know and what we do are two different
  things

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What is critical thinking?

• Critical thinking is a process and cognitive
  skill that we apply to identify and define
  problems and opportunities for improvement to
  generate, examine and evaluate alternatives to
  reach conclusions and decisions, and to create
  and use criteria for evaluating our decisions
• Purposeful and goal-directed thinking that
  focuses on what to believe or do
• Thinking about your thinking, while you are
  thinking

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Components of Critical Thinking

• Characteristics
• Intellectual Skills
• Technical Skills
• Interpersonal Skills
• (Alfaro-LeFevre, 2001)

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Emotional Intelligence (EQ)

• 5 components
• Self-awareness
• Self-regulation
• Motivation
• Empathy
• Social skill

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Key intellectual traits

• Intellectual humility willingness to admit you
  dont know
• Intellectual integrity continual evaluation of
  your own thinking and willingness to admit when
  it may be flawed
• Intellectual courage awareness of the need to
  face and fairly address ideas, beliefs, or
  viewpoints about which you have negative feelings
  and havent given serious hearing
• Intellectual empathy a conscious effort to
  understand others by putting your own feelings
  aside and imagining yourself in their place.
• Paul, R. and Elder, L. Center for Critical
  Thinking in California

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Critical thinking skills sets

• Ability to recognize
• Ability to manage
• Ability to differentiate priority
• Ability to justify actions
• Del bueno

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Strategies to engage in critical thinking

• Anticipate questions others may ask
• Ask Why?, What else? and What if?
• Ask an expert to think out-loud
• Restate something in your own words
• Think out loud or write things down, draw
  pictures or concept maps

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More Strategies

• Organize and reorganize information
• Substitute I dont know and Im not sure with
  Ill find out
• Look for flaws in your thinking, open your
  thinking to others for them to see the flaws
• Reframe Turn errors into learning opportunities
• Share your mistakes with others

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Clinical Judgement

• 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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Components of Critical Thinking Clinical
Judgment

• Problem Identification
• Problem Clarification
• Problem Exploration
• Evaluate Integrate

• Noticing
• Interpreting
• Action
• Reflection in Action
• Reflection on Action

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Characteristics of Expert

• Complete self assessment tool

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New graduates level of development

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

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Socrates learned more from questioning others
that he did from reading books.--
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Strategies for Developing Clinical Judgment

• Develop your knowledge base and keep pocket
  guides or notes normal and abnormal assessment
  findings, physiology, pathophysiology
• Finely tune your assessment skills
• Use the nursing process, protocols, procedures,
  standards of care, best practice and understand
  the reasoning behind them

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More Strategies

• Know why your interventions are indicated, why
  they work, how they apply within the context of
  this patient situation
• Learn from your experts
• Learn from others on the multidisciplinary team
• Use your resources

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The Action-Reflection Cycle
Results

• Action
• Learning
• Reflection

Knowledge
There is no learning without action.
Shibley, 2000
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Reflection is what allows us to learn from our
experiences
Reflection is an assessment of where we have been
and where we want to go next
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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 course of action the RN should
  take.
• Identify what assumptions or biases could affect
  the critical thinking process.

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Barriers to Critical Thinking

• Situational Factors anxiety, stress, fatigue,
  environment
• Habits self-focusing, mine-is-better, tunnel
  vision, face-saving, resistance to change,
  conformity, stereotyping or self-deception

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DDATA

• What data (facts) do you have?
• What other data do you need?
• What assumptions have you made and what data
  might validate or negate them?

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EEMOTIONS

• What emotions (gut reactions) are there (your
  own, others)?
• Whats your intuition telling you,and what data
  might confirm or negate it?
• How are values affecting thinking (yours, others)?

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Aadvantages

• Whats the vision, benefit(s), and most important
  desired outcomes(s)?
• What are the specific advantages to others
  (benefits/outcomes)?
• What are the specific advantages to you
  (benefits/outcomes)?

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DDISADVANTAGES

• What could go wrong (what are the risks)?
• What are the specific inconveniences/risks for
  others?
• What are the specific inconveniences/risks for
  you?
• What problems or issues must be addressed to get
  results?
• How much work will it take and do you have the
  necessary resources?

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OOUT OF THE BOX

• Go out of the box-think of creative approaches!
• What can we do to decrease the disadvantages
  above?
• What can we do to increase the liklihood of
  seeing the benefits?
• How can technology help?
• What research is there that might apply?
• What human and professional resources can help?

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NNOW WHAT?

• What problems, risks, or issues must be
  addressed?
• Who are the key stakeholders (who will be most
  affected)?
• Whats the plan (what interventions do you need
  to get results and avoid reisks)?
• What does all of this imply?
• What did we miss when addressing the other balls?