Thinking About Thinking

1. Thinking About Thinking Critical Thinking in Health Care Presented by Margi J. Schultz, RN, MSN

2. Definition of Thinking To reason � an intellectual (cognitive process) in which conclusions are reached. Critical Thinking for Nurses, 1999

3. �Real intelligence is a creative use of knowledge, not merely an accumulation of facts.� Kenneth Winebrenner, date unknown

4. �Thinking is hard work, that is why so few people do it.� Henry Ford, date unknown

5. A Historical Perspective To know where you�re going, you need to know where you�ve been.

6. Linda Anne Judsen-Richards America�s first professional, trained nurse. Graduated from the new England hospital for Women and Children in 1873. Introduced the concept of keeping patient records. Instituted the practice of nurses wearing uniforms. First stockholder in the American Journal of Nursing. (Kalisch & Kalisch, 1986)

7. Who is this Woman?

8. Florence Nightingale Evidence shows that Nurse Nightingale, the founder of modern nursing, subscribed to methods that definitely required critical thinking skills. (Hegge, 1990)

9. What were these methods? Students were required to keep case books on patients detailing treatments and responses. Ward activities were then discussed at meetings and evaluated. What does this remind you of?

10. Adelaide Nutting Published an analysis of nursing in America in 1898. Findings concluded that nursing schools did little to train students to observe, think, or reason. Nurse Nutting�s report had quite an impact � what do you think was the result?

11. Results By 1913, over 20 states had enacted laws with minimum requirements for nursing practice and education. These regulations included criteria related to thinking and decision making abilities. How are these concepts taught now?

12. Thinking in the 1920s During this time period, lecture was the primary way to teach nursing. Some nursing educators began to include discussion topics, written assignments, and allow time for thinking in their classes� Do you set aside some time to think? Is this purposeful? Useful? What do you think?

13. National League for Nursing Education (NLNE) � 1927 The NLNE published a Curriculum Guide for nursing schools that outlined important characteristics for nursing students. These were: Good judgment Keen insight Use of discrimination Ability to detect physical and mental changes Draw conclusions Make applications to other situations (NLNE, 1927)

14. NLNE Curriculum Guide Revisions of 1937 & 1942 Revisions and additions were made to the original document to further define what nurses actually DO. The additions to the characteristics were: Critical inquiry Independent thinking Good judgment Resourcefulness

15. What do these characteristics sound like to you?

16. Critical thinking! These are some of the components considered the cornerstone of critical thinking.

17. Nursing Process & Nursing Diagnosis Louise McManas, in 1953, proposed a set of functions unique to professional nurses � nursing process and diagnoses. Her premise was that nurses who were taught this process could be assumed to possess the ability to analyze and reflect, utilizing skills such as reasoning, judging, and drawing inferences.

18. Journal of Nursing Education, 1963 In 1963 an article appeared in the Journal of Nursing Education stating that nurses needed to be taught in ways that encouraged critical thinking skills. In spite of the movement to teach, encourage, or to facilitate critical thinking, widespread acceptance and implementation has been lacking.

19. National League of Nursing (NLN) Since the 1980s, the NLN has increased the requirements of nursing schools to provide evidence of student achievement in critical thinking skills. The need to provide instruction in critical thinking skills is no longer an option � it is a reality.

20. So what is critical thinking? There are many definitions of critical thinking, many of which are listed in your course book. A concise definition is: Critical thinking is reflective and reasonable thinking that focuses on what to believe and do (Ennis, 1985).

21. How is critical thinking different from problem solving? Problem solving: Often calls for the search for one correct answer. When called on to problem solve an issue, often policy guides the action and performance is dictated by standards of care. Critical thinking: Several alternatives unique to the situation are sought. When called on to critically think through an issue, you may never have seen the problem before and there is no set standard.

22. Critical Thinking Attitudes Ennis (1985) described critical thinking attitudes as dispositions. Paul (1990) called them traits of the mind. Attitudes motivate and justify the use of cognitive skills.

23. Seven attitudes of critical thinkers (see course book for complete definitions) Intellectual humility Intellectual courage Intellectual empathy Intellectual integrity Intellectual perseverance Intellectual sense of justice Faith in reasoning

24. Cognitive skills of critical thinking (see course book for complete definitions) Divergent thinking Reasoning Reflection Creativity Clarification Basic Support

25. Practice being a critical thinker You now have a general idea of critical thinking and it is time to flex your new muscle! As you practice these new skills, you will find additional ideas that will enhance your critical thinking abilities. Let the journey begin�