What is Critical Thinking?

A multifaceted and complex concept based on reason and reflection, knowledge, and instinct derived from experience. (Catalano, 2000) A discipline-specific, reflective reasoning process that guides a nurse in generating, implementing, and evaluating approaches for dealing with client care and professional concerns. (National League for Nursing, 2000) Essential to safe, competent, skillful nursing practice Critical thinking is a way of interacting with the world that is reflective, open and generative. - Fairfield University

Being insightful Drawing well-founded conclusions Continuously looking at and investigating ideas & perspectives Open

Flexible and open to new ideas Considers alternatives Creative Having intellectual curiosity Continually rethinking issues, perspectives, points of view

Top 10 Reasons to Improve Thinking 10. Things aren t what they used to be or what they will be. 9. Patients are sicker, with multiple problems. 8. More consumer involvement (patients and families). 7. Nurses must be able to move from one setting to another 6. Rapid change and information explosion requires us to develop new learning and workplace skills. 5. Consumers and payers demand to see evidence of benefits, efficiency and results. 4. Today s progress often creates new problems that can t be solved by old ways of thinking. 3. Redesigning care delivery and nursing curricula is useless if students and nurses

Interacting with the world Engaging with ideas and people Being curious Appreciating contextual influences Being broad, not narrow Being aware of one s own values Being involved Tolerates ambiguity & uncertainty No tunnel vision

Reflective Sound knowledge base Examining the whole Being thoughtful Examining assumptions

don t have the thinking skills required to deal with today s world. 2. It can be done it doesn t have to be that difficult. 1. Your ability to focus your thinking to get the results you need can make the difference between whether you succeed or fail in this fast-paced world. Nurses use critical-thinking skills in a variety of ways. Nurses use knowledge from other subjects and fields. - biologic and social sciences, humanities Example: The nurse might use knowledge from nutrition, physiology, and physics to promote wound healing and prevent further injury to a client with a pressure ulcer. Nurses deal with change in stressful environments

provider immediately and which can be noted in the client record for the primary care provider to address later, during a routine visit with the client. Critical Thinking Standards Critical thinking is precise, deep, logical, relevant, accurate & significant Creativity a major component of critical thinking thinking that results in the development of new ideas and products. Creativity in problem solving and decision making is the ability to develop and implement new and better solutions. required when the nurse encounters a new situation or a client situation in which traditional interventions are not effective. Example: 9-year-old who has ineffective respiration following abdominal surgery, on incentive spirometry, the nurse offers a bottle of blow bubbles and a blowing wand Generate many ideas rapidly Are generally flexible and natural; that is, they are able to change viewpoints or directions in thinking rapidly and easily Create original solutions to problems. Tend to be independent and selfconfident, even when under pressure Demonstrate individuality

- treatments, medications, and technology change constantly, and a client s condition may change from minute to minute. Example: Familiarity with the routine for giving medications does not help the nurse deal with a client who is frightened of injections or with one who does not Nurses make important decisions - collect and interpret the information needed to make decisions. Example: Nurses must use good judgment to decide which observations must be reported to the primary care

Intuition the understanding or learning of things without the conscious use of reasoning. A.k.a. sixth sense, hunch, instinct, feeling, or suspicion A form of guessing

Obtain relevant facts Evaluate the findings and form judgments

Attitudes that Foster Critical Think Independence Fair-mindedness Curiosity Courage to Challenge Status Quo and Rituals Confidence

Habits Creating Barriers to Critical Thinking Self-Focusing Mine is better Tunnel Vision Choosing only one

Humility (intellectual) Face-saving Egocentricity Resistance to change Perseverance Conformity Integrity Stereotyping Independence Self-Deception Critical thinking that individuals think for themselves Nurses should not be easily swayed by the opinions of others but to take responsibility for their own views.

Characteristics of a Critical Thinker Strive for understanding Are honest with themselves Base judgment on evidence Are interested in other people s ideas Control their feelings/emotions Recognize that extreme views are seldom correct. Keep an open mind They are very observant Identify key issues and raise questions

Fair-Mindedness Assessing all viewpoints with the same standards and not basing their judgments on personal or group bias or prejudice Helps one to consider opposing points of view and to try to understand new ideas fully before rejecting or accepting them.

Curiosity

The mind of a critical thinker is filled with questions: Why do we believe this? What causes that? Does it have to be this way? Could something else work? What would happen if we did it another way? Who says that is so?

Critical thinkers are open to the possibility that their personal biases or social pressure and customs could unduly affect their thinking. Example: A nurse spends extensive time trying to teach a client how to prevent a future recurrence of some problem but is mystified when the client appears uninterested and does not follow the nurse s advice

Courage to Challenge the Status Quo and Rituals Willing to consider and examine fairly one s own ideas or views, especially those to which one may have a strongly negative reaction. Values and beliefs are not always acquired rationally

Perseverance This determination enables nurses to clarify concepts and sort out related issues, in spite of difficulties and frustrations.

Humility (intellectual) Integrity Having an awareness of the limits of one s known knowledge. Willingness to admit what one does not know Willingness to seek information and rethink conclusions in the light of new knowledge Never assuming what everybody believes to be right will always be right. the quality of possessing and steadfastly adhering to high moral principles or professional standards Requires that individuals apply the same rigorous standards of proof to their own knowledge and beliefs as they apply to the knowledge and beliefs of others.

Critical Thinking Vs. other concepts 1. Problem solving Uses knowledge and experience to address an immediate problem A correct answer exists; only limited approaches will work Long term perspective is not necessarily taken

Confidence Critical thinkers believe that wellreasoned thinking will lead to trustworthy conclusions. As the nurse gains greater awareness of the thinking process and more experience in improving such thinking, confidence in the process will grow.

Critical Thinking

Egocentricity (insight into it)

Reasoning about open-ended and ill-structured problems

People start asking questions and gathering more information.

2. Scientific method - Linear, objective approach in problem solving One is expected to minimize bias and involvement in the situation Critical Thinking It does not focus on solving a problem or answering a question Reflective, involves personal investment , nonlinear 3. Nursing process -A systematic linear approach Includes assessing situations, outlining plans, taking action, & evaluating results Critical Thinking No steps to follow, not linear, not specific to clinical situation, does not need an action Five Phases of Critical Thinking Phase 1: Trigger Event Usually an unexpected event that causes some kind of inner discomfort or confusion. The teacher role models critical thinking Answers the question only when the students are unable to do so A more effective strategy is when students think through the question they ask Using this as a learning strategy is unpredictable Only the most significant concepts are addressed From straight lecture to lecture w/ comments and questions Phase 4: Finding Alternatives Also called the transition stage when old ideas are either left behind and a new way of thinking begins.

Phase 5: Integration Involves fitting new ideas and information into everyday usage.

Critical Thinking enhancing it 1. Discussion Lecture should be limited to a small percentage of the class time That means:

depth of understanding > breadth of content

Phase 2: Appraisal A period of reflection and the need to find another approach to deal with the issue.

Phase 3: Exploration

It may turn the classroom in to a relatively chaotic affair but it is a controlled chaos Some answers of the students need to be corrected

Asking questions with many answers Neither of these two methods of questioning stimulates the student s use of critical thinking Questions should be one notch higher Questions with reasoned responses Questions that help student to explore and understand various points of view Probe thinking or clarity Hold individuals accountable of their thinking Questions that move learners from mere enactment of the nursing role to the internalization of questions they need to ask themselves 1. Socratic Questioning A technique one can use to look beneath the surface, recognize and examine assumptions, search for inconsistencies, examine multiple points of view, and differentiate what one knows from what one merely believes. Six Types of Socratic Questions Conceptual Clarification Questions Probing Assumptions Probing Rationale, Reason, Evidence Questioning Viewpoints & Perspectives Probe Implications & Consequences Questions about the Question

Teachers give up control so students discover flaws in their thinking Discussion actively holds the student s thoughts more than lecture does Irrelevant and passive thoughts occur more frequently with lecture Discussion can be most effective in promoting student s critical thinking

2. Text Interaction Think critically about what they are reading & comparing it with other things they have read or experienced Interact with the readings prior to class Raise questions about what is presented Note assumptions that are being made Point out conflicting information Recognizing unsupported conclusions Note questions unanswered by the text Text interaction helps students think about what they are reading Students eventually develop a questioning attitude or a spirit of inquiry

3. Asking Effective Questions Asking factual questions

II. Structured Controversy Controversy is purposely produced Learners argue for and against and issue Much like debate, but there is a second round They use reasoned judgment, not just factual knowledge Explore various issues facing the nursing profession Examination of patient care situation

Examine assumptions made about the concepts or the relationships among them Think carefully about how all the concepts fit together

Case Studies Provide an open-ended problem that has more than one desirable outcome Learners judge the advantages and disadvantages of various options, compare alternative solutions, justify choice of actions Based on an in-depth investigation of a single individual, group, or event Longitudinal examination including a systematic way of looking at events, collecting data, analyzing information, and reporting the results Help learners see more than one perspective and often points out assumptions in the face on incomplete information

Problem-Based Learning Students attempt to manage problems much like those that are found in clinical setting Students are compelled to learn medications or pathophysiology Can be used as a teaching/learning strategy for a course or the entire curriculum Students will learn in different speeds, sequences, learning circumstances

Concept Mapping Assist learners to see their own thinking and reasoning They develop relationships among factors, note causes and effects, identify predisposing factors, & formulate expected outcomes Require students to draw on an extensive knowledge

Collaborative Learning

Knowledge can be created where members actively interact by sharing experiences Rooted in the social nature of learning Provides opportunities to complete assignments Can be structured in an unlimited way Learners solve problems, critique each other s work, learn from each other Each individual depends on and is accountable to each other Microthemes

Feedback by the teacher should clarify areas of confusion, answer questions, and comment on the quality of responses For the teacher, this helps ascertain students understanding of a particular class or getting a sense of how students would rate the course This will help learners think about their thinking, ability to listen and understand, ability to process what they are hearing

One-Minute Papers One of the easiest and most enjoyable ways to think critically on a continuous basis At the start of each session, a single sheet of paper with statements are given The participants are asked to respond to each statement before the sessions ends and to submit them before leaving An example of writingto-learn strategies One- to two-page written analyses or thought papers about controversial topics Involve rigorous writing in restricted space Related to the course, repeated regularly, even on a weekly basis Initially, teacher critiques the thinking and arguments, but as time goes, learners

follow the example set made by the teacher and critique their own or each other s papers using preestablished standards of critical thinking Learners not only formulate positions on issues, but are challenged to evaluate the quality and soundness of thinking Can effectively enhance critical thinking

Self-Assessment/Evaluation More than mere completion of forms Help students to critique their own work, and form judgments about its strengths and weaknesses May mean harm to a person s self-concept through realizing that they have not achieved as highly as they may like, but in the long run, they would want to work harder in order to achieve greater things in the future Prompt people to seek information to confirm their uncertain selfconcept and use that to enhance their certainty of their own selfknowledge Usually associated with self-enhancement Learners are given guidance how to complete the form Helpful feedback and thoughtfulness of the assessment is given Completed periodically throughout an

Journals Excellent way to help learners reflect on their experiences, values, actions, and interactions with others Narrative form encourages to fuse concepts learned with personal experiences Offers a safe way to express oneself To be effective, feedback from the teacher is critical Feedback must be thoughtful, reflective, nonjudgmental, focused, and extensive, as a way to role model critical thinking

experience (e.g. clinical rotation) Asking learners to identify 5 strengths & weaknesses impacting their learning Asking them to discuss their growth from one point to the next Asking them to reflect on the quality of thinking displayed in their practice