Critical Thinking

1
Critical Thinking

• Presented by
• Beth Edwards, RN, EMT-P
• Clinical Education Coordinator
• SMH Staff Development

2
Objectives

• To discuss reasons why we should use critical
  thinking
• Define the meaning of critical thinking
• Discuss applications to nursing practice
• Describe traits of a critical thinker
• Discuss factors that impede or enhance critical
  thinking
• Discuss how to improve critical thinking skills

3
Why Should We Critically Think?

• Widening Responsibilities as nurses
• Patients are increasingly ill
• Patients have multi-system health problems
• Complex working environments
• Rapid changes in healthcare

4
What is Critical Thinking?

• Critical Thinking has many different definitions
• Difficult to measure in nursing school
• Related to competent nursing practice
• Closely associated with nursing process, clinical
  judgment problem solving

5
Critical

• The word critical comes from the Greek word
  "kritikos," meaning "critic." To be critical
  means to question to make sense of something to
  analyze a situation. Although for many the word
  critical has become synonymous with negativity,
  it really is a positive opportunity to reach a
  favorable outcome.
• Critical, as defined in Webster's Dictionary,
  gives us some words to associate. These are
  "crucial, decisive, indispensable, and vital." It
  also is defined as "exercising or involving
  careful judgment or judicious evaluation."

6
Thinking

• Thinking can be divided into directed and
  non-directed thinking.
• Non-directed thinking
• when we engage our brains in habitual activities
  like grooming or driving to and from work.
• Directed thinking
• goal-oriented and purposeful
• searching for answers meaning, requires a
  conscious mental effort
• involves observation, memory, inquiry,
  interpretation, analysis, evaluation skills.
• Webster's Dictionary thinking is synchronous
  with "to have as an opinion," "to have as an
  expectation," "to mediate," "to form a mental
  picture of," and "to subject to the processes of
  logical thought."

7
Putting them together

• Putting the two terms together would indicate a
  mental process of putting together crucial,
  decisive, indispensable and vital information to
  provide careful judgment and judicious evaluation
  in formulating an opinion, mental picture,
  expectation and/or decision.

8
Definition

• From the Delphi Study of American Philosophical
  Association
• Critical thinking is a purposeful,
  self-regulatory judgment which results in
  interpretation, analysis, evaluation, and
  inference as well as the explanation of the
  rationale upon which the judgment is based.
  Critical thinking is reasonable, rational,
  reflective, autonomous thinking that inspires
  attitude of inquiry.

9
What else?

• Reasonable, reflective thinking focused on what
  to believe or do
• The tendency to engage in an activity with
  reflective skepticism
• Purposeful, goal-directed thinking
• Purposeful, self-regulatory judgment
• The art of thinking about thinking while thinking
  to make thinking better

10
What it is not!

• Common sense
• Spontaneous responses
• Regular or normal thinking
• Being critical or judgmental
• Disorganized
• Task-oriented

• Working in isolation
• Being competitive
• Inability to communicate with others
• Lack of concern with motives, facts, underlying
  reasons
• Emotion-driven

11
How does this translate into nursing?

• Reflective, reasonable thinking about nursing
  problems without a single solution
• Clinical decision making or diagnostic reasoning
  or Professional judgment
• Reflective practice

12
Why is it essential to be a critical thinker in
nursing?

• To manage complex dilemmas
• For empowerment and liberation
• To exchange views and information
• To broaden or change our thinking and learning
• For self-actualization

13
What are some factors that impede or enhance
critical thinking?

• Moral development (fair mindedness)
• Age, self confidence
• Dislikes, prejudices, biases
• Interpersonal skills
• Reading and writing skills
• Anxiety, stress, fatigue
• Time factors
• Environmental distractions or comforts
• Lack of motivation or positive reinforcement
• Past experiences
• Support systemsmentors, coaches, colleagues,
  family, friends

14
What are some key assumptions for critical
thinking?

• It is rational
• It involves conceptualization
• It requires reflection
• It is a nonlinear process that expands problem
  solving and nursing process
• It involves both cognitive and affective skills
• The skills can be taught, learned, and measured
• The skills need to be practiced and reinforced
• It involves creative thinking
• It requires basic and advanced nursing knowledge
• It is both a process and an outcome
• It is embedded in our practice

15
Are you a critical thinker?

• Do you
• Explore underlying thinking and assumptions
• Base judgments on facts and reasoning
• Suspend judgment until you have all the data
• Support views with evidence
• Evaluate the credibility of sources
• Turn mistakes into learning opportunities
• Ask Why? and Why not?
• Be open to possibilities
• Seek themes, patterns, trends
• Follow hunches

16
What are some traits of a critical thinker?

• Truth-seeking courageous about asking
  questions, honest and objective in pursuing
  inquiry
• Open-mindedness sensitive to own bias, respect
  rights of others to hold differing opinions
• Analyst alert to potentially problematic
  situations
• Systematic organized, orderly, focused,
  diligent inquiry
• Self-confidence trust in own reasoning
• Inquisitiveness intellectual curiosity, values
  being well informed
• Mature disposed to make reflective judgments
• Reflection, Perseverance, Appropriate
  perspective, Creativity, Flexibility, Intuition
• APA Delphi Study

17
What are some cognitive skills of critical
thinkers?

• Interpret categorization, decoding
  significance, clarifying meaning
• Analyze examining ideas, detecting and
  analyzing arguments
• Evaluate assessing claims and arguments
• Infer question evidence, imagine alternatives,
  drawing conclusions
• Explain stating results, justifying procedures,
  presenting arguments
• Self-monitor - self-examination and correction
• Information seeking, Discriminating, Predicting,
  Applying Standards, Logical reasoning
• APA Delphi Study

18
Who can critically think?

• Anyone can and everyone should!
• There is no research to support that a
  professional program of study increases critical
  thinking ability.
• We can all critically think within our roles.

19
We must think about our thinking!

• Critical thinking requires you to challenge your
  assumptions and think about consequences.
• Think about it!
• Pull from past experiences and knowledge base to
  expect and anticipate.
• Consciously THINK about a situation and act on it.

20
Think about it!

• How do you think about what you think you think
  about???

21
How do we improve on our critical thinking skills?

• Communication!
• Reflection!
• After any incident or shift, meet with your
  co-workers and ask these questions
• What went well?
• If you could do it over again, what would you do
  differently?
• What are your plans for improvement that will
  help you be more successful in the future?
• What help do you need to meet your goals?

22
Related Concepts

• Mind Map
• Logic and reasoning
• Creativity
• Intuition
• Emotional intelligence
• Problem solving
• Nursing process
• Decision making
• Clinical or diagnostic reasoning
• Reflective practice
• Clinical judgment

23
(No Transcript)
24
Putting the pieces together (Mind Map)

• Begin with Triggers or a particular event or
  dilemma or complex problem
• Go to Starting Points or types of thinking that
  help us begin the process, i.e. brainstorming,
  intuition, thinking aloud, reflective thinking
• Build on the Scaffolds or knowledge, skills and
  expertise that supports our ability to think
  critically
• Lead into the Processes which involve different
  types of thinking that contribute to critical
  thinking, i.e. convergent and divergent thinking,
  reflection, nursing process, problem solving,
  creative thinking, diagnostic reasoning
• Follow with Outcomes which may include problem
  resolution, alternative solutions, clinical
  judgments, reflective practice
• Evaluate Triggers
• Continuous and iterative loopA Mind Map for
  Critical Thinking in Nursing

25
Final Reflections

• Critical thinking is both a process and an
  outcome
• Critical thinking involves reflection in knowing
  and in action and self monitoring
• Critical thinking is composed of specific traits
  or dispositions and cognitive skills.
• Nursing utilizes critical thinking as diagnostic
  reasoning and professional or clinical judgment.
• Nursing supports critical thinking in Reflective
  Practice
• Critical thinking in nursing is based on a
  triggering event or situation, a starting point,
  scaffolds, processes, and outcomes that make up a
  continuous feedback loop

26
References

• Cise, J., Wilson, C., Thie, M. (2004). A
  qualitative tool for critical thinking skill
  development. Nurse Educator, 29(4). Retrieved May
  8, 2005 from Ovid database.
• University of New Mexico Health Sciences Center
  College of Nursing (2005). What is critical
  thinking? Retrieved May 23, 2005 from
  http//hsc.unm.edu/consg/conct/whatis.shtmltransl
  ate.
• Nichols, M. (2003). Critical thinking process.
  Retrieved May 23, 2005 from http//www.netce.com/c
  ourse.asp?course3119.