1. Critical Thinking in Nursing Author: Marisa Tapia MSN, RN ACNS-BC

2. Critical Thinking Nursing Education views or requires critical thinking as an educational outcome As a result of this outcome or EVALUATION there is new thinking or new processes or new ideas

3. What outcomes are generated? New ways of thinking New ideas New questions New decisions New conclusions New results

4. Critical Thinking Is: Systematic Habit forming A method or process to promote thinking regarding the thinking about new thinking that promotes an action on the new insight as it generates more thinking Is that clear as mud?

5. Why Critically Think? To make a critical analysis of factors associated with a problem Nurses need critical thinking skills to be: Safe Competent Skillful and Confident Aware and Ethical Generate and promote new ideas and knowledge in the Art and Science of Nursing

6. What is Critical Thinking? Is there such a thing? Haven’t we been doing it all along? How do we define it?

7. Defining Critical Thinking Method of Reasoning Problem Solving approach to finding an answer Reasonable reflective thinking that focuses on deciding what to do or what is to be done yet setting out to find alternatives within the answer

8. Characteristics of Critical Thinking Being rational and reflective Creative thinking (many ways to skin a cat) Healthy and constructive skepticism Autonomy “building your own algorithm” Fair and equitable thinking Focusing on what the belief is and act on it

9. 4 Stages in the Critical Thinking Process Preparation Incubation Insight Verification

10. Stage 1: Preparation Creative thinker gathers information related to a problem or concern How do we do this?

11. Stage 1: Preparation-How? Questioning Patient interview Gathering information/data Assessment data Identifying the Nursing Diagnosis based on the assessment findings either real or potential clinical problems

12. Stage 2: Incubation-Planning Thinking about the thinking: Formulating a plan of action to accompany the assessment finding  applying the plan (implementation) in order for your patient to meet his or her goals thus ensuring success which  Evaluates the plan and implementation as achieving the goal ensuring a postive patient experienceOutcome

13. Stage 3: Insight: Plan and Implementation Plan is put into place Solutions Emerge Solutions are developed Solutions are identified through a thoughtful process Once the solution is indentified it is then implemented

14. Stage 4: Verification Implementation phase begins Evaluation of the implemented solution is established Effectiveness of the implemented solution is established Outcomemeasured as successful or finding opportunities to improve

15. New approach to Critical Thinking and the Nursing Process T.H.I.N.K. T.H.I.N.K. incorporates the critical thinking piece to the nursing process and promotes positive outcomes in regards to nursing care

16. T.H.I.N.K. T: Total Recall: correlating a fact to experience H: Habits: forming habits facilitates thinking while the habit is undertaken I: Inquiry: Being curious. Questioning the obvious to promote more inquiry N: New ideas and creativity: teaching new things to different patients K: Knowing how you think: Recognizing that you know or do not know something and how you go about learning and teaching.

17. Critical Thinking: According to LeFevre (2002) Critical thinking is the process of figuring out what to believe or do about a situation, problem or controversy for which no single definitive answer or solution exists, but what is the proper way to deal with the situation at hand

18. How do we critically think? Thinking about the thinking while we are thinking Constant and consistent analysis of the doing Anticipating the needs of the patient or situation or process in order to make the outcome better

19. In Nursing: Nurses need to stay ahead of the situation, it may be that we have to stop and think….

20. Questions to Ask How will my anticipating of the needs better the patient and the outcome?

21. Questioning the Question What we may think is the right thing to do at that time may not be the correct way of handling the situation in the end

22. In Nursing: We should use systematic reasoning to clarify problems… Anticipate the needs Step back and think of all the possibilities to the resolution Explore different avenues to obtain the same positive effect (Outcome) Be confident in your choice of solutions and be assertive

23. Critical Thinking: Critical thinking in Nursing is an essential component of professional accountability and quality nursing care

24. Who are the critical thinkers? Attributes: Habits of the Mind Confidence competence creativity, flexibility, inquisitiveness integrity, intuition, open-mindedness perseverence and reflection

25. Skills in Creative Thinking Critical Analysis Questioning: Examining many points of view Play devil’s advocate: search for inconsistencies Differentiate what you know from what you believe Inductive reasoning Deductive reasoning Evaluating the credibility of sources Clarifying concepts

26. Attitudes of Creative Thinkers Independence of thought Fair-mindedness Insight into egocentricity and socioentricity Intellectual Humility Suspension of judgment Intellectual courage Integrity Perseverence Confidence in Reason

27. Attributes of Creative Thinkers Attributes: Skills Analyzing Applying standards Discriminating (recognizing differences) Information seeking Logical reasoning Predicting Transforming knowledge

28. Concept of Independence of Thought Think for yourself Serious consideration is taken to a wide array of ideaslearn from themand make your own judgments based on this insight (deductive and inductive reasoning)

29. Concept of Fair-mindedness Assess all points of view with the same standards and not basing the judgment on personal prejudices or personal opinions but rather on factual knowledge

30. Elements of Critical Thinking Applied to Nursing Assumptions Information Concepts Purpose of thinking Points of view Questions regarding an issue Interpretation and inference Implications Consequences

31. Assumptions Nursing applies scientific knowledge to caring for a patient Utilizes the caring components of human interaction while applying scientific knowledge base to facilitate wellness for the individual

32. Information Assessment data History (medical, surgical, family etc) Physical Labs/Procedures Subjective and objective findings from the patient

33. Concepts Theories Definitions Principles Examples: Lab values and their meanings AORN Standards and recommended practices Adult learning principles

34. Purpose of Thinking: Analysis and Synthesis Making decisions regarding the data being collected Diagnose problems and make clinical judgments Determining the goals and outcomes

35. Question of the Issue Determining the nature of the problem To identify the legal and ethical issues that are present within the nursing situation Examples: 90 y/o with COPD, O2 sats of low 80’s on BiPap and a fractured ankle

36. Points of View The nurse patient relationship The collaborative efforts among the multidisciplinary team and the patient The overall perception of the care being provided

37. Interpretation and Inference Determining diagnosis Putting the pieces together Formulating a plan of care Identifying interventions

38. Implications and Consequences Patient outcomes Modification of the plan of care dependant on the patient outcomes

39. Characteristics of Critical Thinkers Active Thinkers: Double check information for reliability and interpretation Knowledgeable about their biases and limitations “Intellectual humility” Know weaknesses and strengths Fair-minded: Aware of their own perceptions, values and beliefs but seek to treat all viewpoints alike

40. Characteristics of Critical Thinkers: Good communicators: Not methodical in relaying information and consistently ask for ideas to solutions. Mutuality of exchanging of ideas: is essential for positive outcomes and understanding the facts first and then finding the best solutions (Intellectual Empathy)

41. Characteristics of Critical Thinkers Open-minded: be aware of others values before disrupting harmony and making changes that may seem right at the moment but not positive in the long run (Positive Outcome) Independent thinkers: think for themselves Curious and insightful (the need to know)

42. Characteristics of Critical Thinkers Humility: Know your limitations and know when you are stepping way out of your league… Know the difference between the benefits of the “here and now” vs the effects of the “down the road implications”….the OUTCOMES Know that you will make mistakes Good listeners

43. Crucial in Critical Thinking: Honesty is Integrity Be honest with yourself: this assists you in knowing yourself first and then assisting in the steps to critically think something through When your integrity is lost in the eyes of others, honesty is lost and rarely regained thus any decision made will be viewed doubtful or negative

44. First Glance to Start Critically Thinking Be proactive Be organized Be flexible Be cognizant of rules of logic (weigh the risks and benefits of the long run versus the here and now) Be realistic Be a team player (Commit to excel)

45. How we do it in Nursing: Analyze Apply standards Differentiate practice Seek information Logical Reasoning Predicting and transforming knowledge

46. How Do We Become Better Critical Thinkers: We learn to synthesize and analyze information that leads us to a better understanding of the end result We improve our personal development How? Like what?

47. Areas of Personal Development View of knowledge: what you know and how you utilize what you know in daily working condition to make things better Approach to learning: Everyday we learn something new because everyday is different and every new day brings on new events that challenge us to learn more

48. Areas of Personal Development (continued) Dealing with uncertainty: can be topic specific, interpersonal skills, and/or professionally specific. Ways to facilitate uncertainties: Know your subject matter (Do your homework) Know your limitations and address them on a personal level…again…Do your homework…find ways for self-improvement to further develop your critical thinking skills

49. Creativity in Critical Thinking in Nursing Professional Development Commitment to professional development: Take every opportunity to learn more, this in turn facilitates better critical thinking skills because you are “doing your homework” and this further develops your skills as a professional nurse

50. Scholarship and Leadership By learning more we become more aware of our professional and personal surroundings This in turn assures us in the anticipation of needs of the situation When we anticipate we “think better” When we “think better” we lead better

51. Role of Experience When we learn more we become better at doing what it is that we do best Experience leads to success Success in nursing is critical in assuring positive patient outcomes With this in mind our critical thinking skills are further enhanced

52. Very Important!!!!! If we want to develop nurses to excel, we need our nurses to be cognitively equipped to deal with difficult situations associated with patient care decisions, interpersonal decisions and moral/ethical decisions, thus, we need to build on our professional development skills to enhance our critical thinking

53. Putting it all together Ask: What-if questions What-else questions Think out loud, write it down Compare and contrast Play Devil’s Advocate Organize and reorganize information Look for flaws in YOUR thinking Anticipate Ask an expert to listen to your thinking and see where your thoughts are and synthesize and analyze the process

54. Any questions?

55. References Harkreader, H. (2004) Fundamentals of Nursing: Caring and Clinical Judgment. Philadelphia: W.B.Saunders. LeFevre, R. (2002). Critical thinking in nursing: A practical approach. Philadelphia: W.B. Saunders.