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Critical Thinking and Theory Based Practice Chapter 29 Ellen Clark Birx , PhD, RN

Critical Thinking and Theory Based Practice Chapter 29 Ellen Clark Birx , PhD, RN. Jill Collins RN, BSN and Jerilyn Rodgers RN, BSN. Critical Thinking In Nursing. Is an essential and ongoing process in using theory to guide nursing practice (Cody, 2006)

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Critical Thinking and Theory Based Practice Chapter 29 Ellen Clark Birx , PhD, RN

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  1. Critical Thinkingand TheoryBased PracticeChapter 29Ellen Clark Birx, PhD, RN Jill Collins RN, BSN and Jerilyn Rodgers RN, BSN

  2. Critical Thinking In Nursing • Is an essential and ongoing process in using theory to guide nursing practice (Cody, 2006) • Involves asking: “what theory would be useful to guide me in the situation which I am in?” • Helps us gain awareness of how we are viewing and creating our world of practice. (Cody, 2006)

  3. What Is Theory In Nursing? • It involves seeing patterns that bring order to chaos (Cody, 2006) • It is an abstraction and not a reality itself • It’s purpose is the description, explanation, and prediction of phenomena within the domain of nursing with an ultimate aim of guiding practice (Cody, 2006)

  4. Critical Thinking • National League for Nursing (NLN) mandates nursing programs to emphasize development of critical thinking, however, there is a lack of clarity about what it entails (Cody, 2006) • Is an objective, rational, linear problem-solving process similar to the nursing process (Cody, 2006)

  5. Critical Thinking • Now trending toward integrating multiple types of thinking-empirical, ethical, aesthetic, and personal (Cody, 2006) • Ability to imagine an alternative which leads to questioning of the current system • By increasing awareness of different critical thinking processes, we increase our ability to use them in our complex practice

  6. Expert Definitions • Ennis- “reasonable reflective thinking that is focused on deciding what to believe or do”. • Smith- “a single, continual, all-embracing operation of the mind that never rests, not a collection of disparate skills” (a holistic view)

  7. The Ideal Critical Thinker • Uses “reasonable reflective thinking” (Cody, 2006) • Creative thinking • Imagines the alternatives • Intuitive • Inquisitive • Systematic • Analytic • Open minded • Challenges the assumptions • Seeks the truth

  8. (cont) • Well informed • Flexible • Fair minded • Honest • Prudent • Diligent • Willing to reconsider • Persistent • Mature

  9. Attitude of Inquiry and Openness • An attitude of doubt involves questioning what is happening within and around (Cody, 2006) • According to Smith, “Thought flourishes as questions are asked, not as answers are found.” (Cody, 2006) • Ask “what if….we could do it another way and not how we have always done it”

  10. Knowledge of the Discipline Nursing Fireman Hook hose up to a hydrant What type of spray to turn the nozzle to How to use air packs Understand fire science terminology • Put in a catheter • Start in IV • How to use a stethoscope • Understand medical terminology

  11. Graduate vs Experienced Nurse Graduate Experienced Familiarity Clinical experience Precept the new Think critically at an advanced stage Raise questions • Brings fresh vision • Most current knowledge • Youth (usually) • Excitement • Eagerness • Lots of questions

  12. Metacognition and Metatheory • Critical thinking processes used to select theories to guide clinical practice • Metacognition: refers to the process of thinking about thinking. (Cody, 2006) – being aware of the thought process you use • Metatheory: focuses on philosophical and methodological issues related to nursing theory (Cody, 2006)

  13. Integrating Multiple Levels of Theory Metatheory What type of theory do I need? Picking the overall house plan What are my broad goals and concepts r/t my concern? Framing the house What single phenomenon am I dealing with or what specific knowledge do I need to guide my action? Completing the walls by picking out windows, dry wall etc Grand Theory Midrange Theory

  14. Perspective Taking • Critical thinking means viewing a situation from multiple perspectives – yours, your patients’, families’ • Enhanced by dialogue with other nurses and disciplines.

  15. Empowerment • One must have the authority to be an independent thinker,-empowered • We, as nurses, have the authority, ability and responsibility to think critically for our patients. • Example of critical thinking in the ED (prioritizing, time management, ABC’s)

  16. Conclusion • Critical thinking is an ongoing process • Continually ask “What is going on here?” • Am I using the right theory to guide me or is it limiting me? • Through critical thinking, we continually become more open, more experienced, more reflective, more integrated, more sensitive,… more empowered. (Cody, 2006). Nursing at its best!!!

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