critical thinking vickie fieler, phd, rn, aocn
Post on 22-Dec-2015
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Definition of Critical Thinking
• Critical thinking is the disciplined, intellectual process of applying skillful reasoning as a guide to belief or action (Paul, Ennis & Norris).
• In nursing, critical thinking for clinical decision-making is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process used to ensure safe nursing practice and quality care (Heaslip).
• Paul, R.W. (1990). Critical Thinking: What Every Person Needs to Survive in a Rapidly Changing World. Rohnert Park, California: Center for Critical Thinking and Moral Critique
• Norris, S. P. & Ennis, R.H. (1989). Evaluating critical thinking. Pacific Grove, CA: Midwest Publications, Critical Thinking Press
• Heaslip, P. (1993). Critical Thinking and Nursing. http://www.criticalthinking.org/pages/critical-thinking-and-nursing/834
Key Concepts
• Open-minded Inquiry
In times of constant change, we must be open to new ideas and be willing to revise
or abandon earlier ideas
Assumptions
• Beliefs we take for granted
• Man laying in gutter, only bums lay in the gutter, that man is a bum
Or• Man laying in gutter, man in a gutter
needs help, that man needs help
Bias
• Bias distorts inquiry– Factors such as: favoritism, ignorance,
omission, corruption, misplaced loyalty, threats, prejudice, etc., undermines a fair examination.
Expertise
• We are not experts in everything• We must sometimes rely on Experts• Experts are not infallible“When experts are agreed, the opposite opinion cannot be certain. When they are not agreed, no opinion is certain, When experts think the evidence is insufficient, we should suspend judgment.” Hare, W. (2001). Bertrand Russell and the ideal of critical receptiveness. Skeptical Inquirer, 25, 3:40-44.
Fallibility and Gullibility
• Our beliefs are subject to error and change
• The desire to be open-minded floods us with wishful thinking, persuasive advertising, ignorance, and naiveté.
• We need to balance open-mindedness with skepticism.
Uncertainty
• Deeply controversial issues, disagreement among experts, conflicting information
• The world we live in is not settled and finished
• We must have tolerance for ambiguity
Veracity
• A commitment to truth• Basing our views on an honest
assessment of the evidence• A passion to learn• Sabotaged by ulterior motives,
wishful thinking, hasty judgment, and resistance to ideas
Learning the Art of Critical Thinking
1. Clarify your thinking2. Stick to the point3. Question the questions4. Be reasonable
When we don’t practice critical thinking….
• Jump to conclusions
• Focus on the trivial• Ask irrelevant
questions• Base conclusions
on inaccurate info• Ignore important
info
• Distort data• Fail to notice
contradictions• Fail to think
through implications
• Poor problem solving
Analyzing our Thinking
• Inferences:An intellectual step in which one concludes something is true based on something else that is true.
• AssumptionsSomething we take for granted or presume and do not question. May be justified, unjustified, sound or not sound.
Advantages to Critical Thinking
• Gather & organize information
• Understand concepts
• Identify assumptions
• Deal with complexities
• Express logically
• Test and check for accuracy
• Consider other viewpoints
• Consider implications and consequences
• Improve patient care
The “What – IF” Game
1. What is the most common complication of this patient’s condition?
2. How would I know if this complication is occurring?
3. What would I assess in this patient first?
4. What would I do?
The “What – If” Game
• Patient with Pituitary tumor resection• Most common complication =
hemorrhage• Symptom of hemorrhage = loss of
visual field• Quick patient assessment = assess
visual fields
CT and the Nurse
• Recognizes changes in patient status• Anticipates changes in patient status• Voices concern about unsafe practice• Identifies improvement opportunities
• Explores multiple solutions• Understands rationale for action• Understands clinical implications• Asks for assistance when needed
• Prioritizes most urgent patients• Sequences patient care• Delegates effectively• Demonstrates accountability for
delegation• Establishes & adjusts plan of care• Implements nursing interventions• Communicates plan of care
• Applies knowledge from past experiences
• Reevaluates assumptions• Initiates professional dialogue• Debriefs following errors or near-
misses• Adjusts own practice based on
feedback
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