Critical Thinking Critical Thinking

How do I pass it on??

Theresa Heindlmeyer, BSN RN-BC
Laurie Schwartz, BSN
How do I pass it on??
Theresa Heindlmeyer, BSN RN-BC
Laurie Schwartz, BSN
-ectives -ectives
At the end oI this educational session, the
preceptor will -e a-le to:
To explain critical thinking.
To discuss Strategies to Iacilitate critical thinking
in new nurses.
To develop an action plan to improve the critical
thinking a-ilities oI the new nurse.
At the end oI this educational session, the
preceptor will -e a-le to:
To explain critical thinking.
To discuss Strategies to Iacilitate critical thinking
in new nurses.
To develop an action plan to improve the critical
thinking a-ilities oI the new nurse.
Roots oI Critical Thinking Roots oI Critical Thinking
Socrates -elieved all traditions and assumptions
were open to critical examination.
Plato -elieved that education should not only
provide inIormation -ut also aim to allow students
to question, examine and reIlect upon ideas and
values.
Arisotle asserted CT com-ined a-stract thinking
and logical thinking.
Socrates -elieved all traditions and assumptions
were open to critical examination.
Plato -elieved that education should not only
provide inIormation -ut also aim to allow students
to question, examine and reIlect upon ideas and
values.
Arisotle asserted CT com-ined a-stract thinking
and logical thinking.
"uote "uote
The uniquiring liIe is not the liIe Ior man.
--Socrates
The uniquiring liIe is not the liIe Ior man.
--Socrates
ne deIinition ne deIinition
'CareIul, deli-erate, outcome-Iocused (results-
oriented) thinking that is mastered Ior a context.
Critical thinking is -ased on scientiIic method; the
nursing process; a high level oI knowledge, skills,
and experience; proIessional standards; a positive
attitude toward learning; and a code oI ethics. It
includes elements oI constant reevaluation, selI-
correction, and continual striving Ior
improvement.
AlIaro-LeFevre, 1999.
'CareIul, deli-erate, outcome-Iocused (results-
oriented) thinking that is mastered Ior a context.
Critical thinking is -ased on scientiIic method; the
nursing process; a high level oI knowledge, skills,
and experience; proIessional standards; a positive
attitude toward learning; and a code oI ethics. It
includes elements oI constant reevaluation, selI-
correction, and continual striving Ior
improvement.
AlIaro-LeFevre, 1999.
Clear and Concise Clear and Concise
Thinking that is purposeIul, reasoned and
goal directed
(Halpern 1989)
Thinking that is purposeIul, reasoned and
goal directed
(Halpern 1989)
CT is a skill CT is a skill
Takes time to develop
35 oI new grad nurses studied met the
entry expectations Ior clinical udgment
Gap . can`t expect new grad to -e
completely competent -ut can expect saIe
entry expectations
Takes time to develop
35 oI new grad nurses studied met the
entry expectations Ior clinical udgment
Gap . can`t expect new grad to -e
completely competent -ut can expect saIe
entry expectations
orothy el-ueno orothy el-ueno
Can the nurse recognize the patient`s
pro-lem?
Can the nurse saIely and eIIectively manage
the pro-lem?
oes the nurse have a relative sense oI
urgency?
oes the nurse do the right thing, Ior the
right reason?
Can the nurse recognize the patient`s
pro-lem?
Can the nurse saIely and eIIectively manage
the pro-lem?
oes the nurse have a relative sense oI
urgency?
oes the nurse do the right thing, Ior the
right reason?
Attri-utes oI Critical Thinkers Attri-utes oI Critical Thinkers
Asks pertinent questions
Assesses statements and
arguments
Is curious
Listens to others & gives
Ieed-ack
Looks Ior evidence / prooI
Examines pro-lems closely
Reects irrelevant inIormation
Evaluates policy
Asks pertinent questions
Assesses statements and
arguments
Is curious
Listens to others & gives
Ieed-ack
Looks Ior evidence / prooI
Examines pro-lems closely
Reects irrelevant inIormation
Evaluates policy
Wants to Iind the solution
Thinks independently
"uestions deeply
Has intellectual integrity
Is conIident in rationale Ior
actions
Analyzes arguments
Evaluates evidence and Iacts
Explores consequences Iore
taking action
Recognizes a contradiction
Wants to Iind the solution
Thinks independently
"uestions deeply
Has intellectual integrity
Is conIident in rationale Ior
actions
Analyzes arguments
Evaluates evidence and Iacts
Explores consequences Iore
taking action
Recognizes a contradiction
Scenario Scenario
ne day post op trauma patient
Suddenly displays:
SB, tachypnea
Pale, diaphoretic
Holding right side oI chest, c/o pain
ne day post op trauma patient
Suddenly displays:
SB, tachypnea
Pale, diaphoretic
Holding right side oI chest, c/o pain
Barriers to Critical Thinking Barriers to Critical Thinking
Reality oI practice
UnIamiliar with
environment
Lack oI proIessional
relationships
Lack oI clinical udgment
Institutional -arriers
Lack oI knowledge oI
concept
Reality oI practice
UnIamiliar with
environment
Lack oI proIessional
relationships
Lack oI clinical udgment
Institutional -arriers
Lack oI knowledge oI
concept
Student characteristics
(resistance/attitude)
Inadequate time
Perceived need to cover
content/disperse
inIormation
Resistance to teaching
styles
Student characteristics
(resistance/attitude)
Inadequate time
Perceived need to cover
content/disperse
inIormation
Resistance to teaching
styles
Creating an environment rich Ior CT Creating an environment rich Ior CT
Let them sink their Ieet in the sand Iaster is not
-etter
Make no assumptions a-out skills: ask these
questions:
Why does the pt need this:
How did you know the correct way to perIorm this:
Where did you Iind the inIormation:
How will tell iI this is helpIul:
What and where will you document:
Let them sink their Ieet in the sand Iaster is not
-etter
Make no assumptions a-out skills: ask these
questions:
Why does the pt need this:
How did you know the correct way to perIorm this:
Where did you Iind the inIormation:
How will tell iI this is helpIul:
What and where will you document:
Supporting CT Supporting CT
Invite them to participate in the odds and
ends
At hand-oII ask prompting questions
-serve their a-ility to prioritize and
organize their assignment
When they ask questions do they know
where to look Ior answers or ust expect an
answer
Invite them to participate in the odds and
ends
At hand-oII ask prompting questions
-serve their a-ility to prioritize and
organize their assignment
When they ask questions do they know
where to look Ior answers or ust expect an
answer
Preceptor Role Preceptor Role
Minimize the emphasis on a-ility to perIorm
tasks/skills
Maximize emphasis on a-ility to recognize when a
skill/task is needed.
Encourage a realistic time Irame and expectations
o not assume learner understands the what, why,
how, or when oI delivering nursing care!
Minimize the emphasis on a-ility to perIorm
tasks/skills
Maximize emphasis on a-ility to recognize when a
skill/task is needed.
Encourage a realistic time Irame and expectations
o not assume learner understands the what, why,
how, or when oI delivering nursing care!
Teacha-le Moments Teacha-le Moments
Take advantage oI:
Preparation oI assignment / organization during
shiIt
InIormation shared during shiIt report
Early identiIication oI patients in need oI
speciIic interventions that can involve learner
Prompting the what/why/how/when questions
Ior speciIic patient scenarios
Take advantage oI:
Preparation oI assignment / organization during
shiIt
InIormation shared during shiIt report
Early identiIication oI patients in need oI
speciIic interventions that can involve learner
Prompting the what/why/how/when questions
Ior speciIic patient scenarios
Levels oI ReIlection Levels oI ReIlection
Level I: a-sence oI reIlective thought
Level II: Awareness oI udgments,
o-servations, descriptions, evaluation oI
planning, assessment oI decisions.
Level III: Critical reIlection, assessment oI
need Ior Iurther learning, awareness oI
routines (adequate) and need Ior changes.
Level I: a-sence oI reIlective thought
Level II: Awareness oI udgments,
o-servations, descriptions, evaluation oI
planning, assessment oI decisions.
Level III: Critical reIlection, assessment oI
need Ior Iurther learning, awareness oI
routines (adequate) and need Ior changes.
Case Studies Promote CT Case Studies Promote CT
Have -een proven to direct learning
Allows Ior reIlection
one in supportive Iashion
Have -een proven to direct learning
Allows Ior reIlection
one in supportive Iashion
A Bad utcome? A Bad utcome?
Allow them to grieve
Review situation
Multiple opportunities to review
e-rieI supportively
Guilt trips won`t change anything
Assess Ior lack oI accounta-ility-warning
sign.
Allow them to grieve
Review situation
Multiple opportunities to review
e-rieI supportively
Guilt trips won`t change anything
Assess Ior lack oI accounta-ility-warning
sign.
Critical Thinking Critical Thinking
More than being 'checked off`
its an ongoing fourney,
not a destination.
More than being 'checked off`
its an ongoing fourney,
not a destination.
Examples/Role Play Examples/Role Play
h no! My patient`s pain is NT
controlled. Let`s call in the troops.
h no! My patient`s pain is NT
controlled. Let`s call in the troops.