Critical Thinking

1. Critical Thinking Presented by Beth Edwards, RN, EMT-P Clinical Education Coordinator SMH Staff Development

2. Objectives • To discuss reasons why we should use critical thinking • Define the meaning of critical thinking • Discuss applications to nursing practice • Describe traits of a critical thinker • Discuss factors that impede or enhance critical thinking • Discuss how to improve critical thinking skills

3. Why Should We Critically Think? • Widening Responsibilities as nurses • Patients are increasingly ill • Patients have multi-system health problems • Complex working environments • Rapid changes in healthcare

4. What is Critical Thinking? • Critical Thinking has many different definitions • Difficult to measure in nursing school • Related to competent nursing practice • Closely associated with nursing process, clinical judgment & problem solving

5. “Critical” • The word critical comes from the Greek word "kritikos," meaning "critic." To be critical means to question; to make sense of something; to analyze a situation. Although for many the word critical has become synonymous with negativity, it really is a positive opportunity to reach a favorable outcome. • Critical, as defined in Webster's Dictionary, gives us some words to associate. These are "crucial, decisive, indispensable, and vital." It also is defined as "exercising or involving careful judgment or judicious evaluation."

6. “Thinking” • Thinking can be divided into directed and non-directed thinking. • Non-directed thinking • when we engage our brains in habitual activities like grooming or driving to and from work. • Directed thinking • goal-oriented and purposeful • searching for answers & meaning, requires a conscious mental effort • involves observation, memory, inquiry, interpretation, analysis, & evaluation skills. • Webster's Dictionary: thinking is synchronous with "to have as an opinion," "to have as an expectation," "to mediate," "to form a mental picture of," and "to subject to the processes of logical thought."

7. Putting them together • Putting the two terms together would indicate a mental process of putting together crucial, decisive, indispensable and vital information to provide careful judgment and judicious evaluation in formulating an opinion, mental picture, expectation and/or decision.

8. Definition • From the Delphi Study of American Philosophical Association: • Critical thinking is a “purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference as well as the explanation of the rationale upon which the judgment is based. Critical thinking is reasonable, rational, reflective, autonomous thinking that inspires attitude of inquiry.”

9. What else? • Reasonable, reflective thinking focused on what to believe or do • The tendency to engage in an activity with reflective skepticism • Purposeful, goal-directed thinking • Purposeful, self-regulatory judgment • The art of thinking about thinking while thinking to make thinking better

10. Common sense Spontaneous responses Regular or “normal” thinking Being critical or judgmental Disorganized Task-oriented Working in isolation Being competitive Inability to communicate with others Lack of concern with motives, facts, underlying reasons Emotion-driven What it is not!

11. How does this translate into nursing? • Reflective, reasonable thinking about nursing problems without a single solution • Clinical decision making or diagnostic reasoning or Professional judgment • Reflective practice

12. Why is it essential to be a critical thinker in nursing? • To manage complex dilemmas • For empowerment and liberation • To exchange views and information • To broaden or change our thinking and learning • For self-actualization

13. What are some factors that impede or enhance critical thinking? • Moral development (fair mindedness) • Age, self confidence • Dislikes, prejudices, biases • Interpersonal skills • Reading and writing skills • Anxiety, stress, fatigue • Time factors • Environmental distractions or comforts • Lack of motivation or positive reinforcement • Past experiences • Support systems—mentors, coaches, colleagues, family, friends

14. What are some key assumptions for critical thinking? • It is rational • It involves conceptualization • It requires reflection • It is a nonlinear process that expands problem solving and nursing process • It involves both cognitive and affective skills • The skills can be taught, learned, and measured • The skills need to be practiced and reinforced • It involves creative thinking • It requires basic and advanced nursing knowledge • It is both a process and an outcome • It is embedded in our practice

15. Are you a critical thinker? Do you: • Explore underlying thinking and assumptions • Base judgments on facts and reasoning • Suspend judgment until you have all the data • Support views with evidence • Evaluate the credibility of sources • Turn mistakes into learning opportunities • Ask “Why?” and “Why not?” • Be open to possibilities • Seek themes, patterns, trends • Follow hunches

16. What are some traits of a critical thinker? • Truth-seeking – courageous about asking questions, honest and objective in pursuing inquiry • Open-mindedness – sensitive to own bias, respect rights of others to hold differing opinions • Analyst – alert to potentially problematic situations • Systematic – organized, orderly, focused, diligent inquiry • Self-confidence – trust in own reasoning • Inquisitiveness – intellectual curiosity, values being well informed • Mature – disposed to make reflective judgments • Reflection, Perseverance, Appropriate perspective, Creativity, Flexibility, Intuition APA Delphi Study

17. What are some cognitive skills of critical thinkers? • Interpret – categorization, decoding significance, clarifying meaning • Analyze – examining ideas, detecting and analyzing arguments • Evaluate – assessing claims and arguments • Infer – question evidence, imagine alternatives, drawing conclusions • Explain – stating results, justifying procedures, presenting arguments • Self-monitor - self-examination and correction • Information seeking, Discriminating, Predicting, Applying Standards, Logical reasoning APA Delphi Study

18. Who can critically think? • Anyone can and everyone should! • There is no research to support that a professional program of study increases critical thinking ability. • We can all critically think within our roles.

19. We must think about our thinking! • Critical thinking requires you to challenge your assumptions and think about consequences. • Think about it! • Pull from past experiences and knowledge base to expect and anticipate. • Consciously THINK about a situation and act on it.

20. Think about it! • How do you think about what you think you think about???

21. How do we improve on our critical thinking skills? • Communication! • Reflection! • After any incident or shift, meet with your co-workers and ask these questions: • What went well? • If you could do it over again, what would you do differently? • What are your plans for improvement that will help you be more successful in the future? • What help do you need to meet your goals?

22. Related Concepts • Mind Map • Logic and reasoning • Creativity • Intuition • Emotional intelligence • Problem solving • Nursing process • Decision making • Clinical or diagnostic reasoning • Reflective practice • Clinical judgment

24. Putting the pieces together (Mind Map) • Begin with Triggers or a particular event or dilemma or complex problem • Go to Starting Points or types of thinking that help us begin the process, i.e. brainstorming, intuition, thinking aloud, reflective thinking • Build on the Scaffolds or knowledge, skills and expertise that supports our ability to think critically • Lead into the Processes which involve different types of thinking that contribute to critical thinking, i.e. convergent and divergent thinking, reflection, nursing process, problem solving, creative thinking, diagnostic reasoning • Follow with Outcomes which may include problem resolution, alternative solutions, clinical judgments, reflective practice • Evaluate Triggers • Continuous and iterative loop—A Mind Map for Critical Thinking in Nursing

25. Final Reflections • Critical thinking is both a process and an outcome • Critical thinking involves reflection in knowing and in action and self monitoring • Critical thinking is composed of specific traits or dispositions and cognitive skills. • Nursing utilizes critical thinking as diagnostic reasoning and professional or clinical judgment. • Nursing supports critical thinking in Reflective Practice • Critical thinking in nursing is based on a triggering event or situation, a starting point, scaffolds, processes, and outcomes that make up a continuous feedback loop

26. References • Cise, J., Wilson, C., Thie, M. (2004).A qualitative tool for critical thinking skill development. Nurse Educator, 29(4). Retrieved May 8, 2005 from Ovid database. • University of New Mexico Health Sciences Center College of Nursing(2005). What is critical thinking? Retrieved May 23, 2005 from http://hsc.unm.edu/consg/conct/whatis.shtml#translate. • Nichols, M. (2003). Critical thinking process. Retrieved May 23, 2005 from http://www.netce.com/course.asp?course=3119.