Critical thinking is an important skill for nurses that involves actively and skillfully analyzing, evaluating, and applying information. It includes cognitive skills like interpretation, analysis, and evaluation, as well as attitudes like inquisitiveness and open-mindedness. Critical thinking can be developed in nursing education through various active learning strategies like simulations, problem-based learning, case studies, and evidence-based learning. These strategies encourage students to engage deeply with material and practice higher-order thinking.
2. Questions:
What do you really know about “Critical thinking”?
Why CT is important for the nurses?
Where CT can be applied in nursing?
How to apply CT in nursing education?
What options are available to you?
When does the nurses need to think critically?
3. Objectives
To define CT
The component of CT
How to approach CT
How to promote CT in nursing education
5. CT has been expressed
in several ways from
many theorist.
6. Critical Thinking Definition
Rudd, (2002)
Reasoned, purposive, and reflective thinking
used to make decisions, solve problems, and
master concepts.
Profetto-McGrath and others (2003)
Critical thinking is both a process for
resoning and set of skills.
Chaffee (2002)
Active, organized, cognitive process used
to examine one’s thinking and that of
others
Settersten and Lauver (2004)
Recognize, analyze, evaluate, and draw
conclusions
7. Critical Thinking is:
“Critical thinking is the intellectually disciplined
process of actively and skillfully conceptualizing,
applying, analyzing, synthesizing, and/or
evaluating information gathered from, or
generated by, observation, experience,
reflection, reasoning, or communication, as a
guide to belief and action. In its exemplary form,
it is based on universal intellectual values that
transcend subject matter divisions: clarity,
accuracy, precision, consistency, relevance,
sound evidence, good reasons, depth, breadth,
and fairness.”
Michael Scriven & Richard Paul (the National Council for
Excellence in Critical Thinking, 1987)
8. According to several definitions
above, CT is not the method of
learning, but rather a process
including, both cognitive and
affective domains.
9. Seven standards that critical thinkers should be
According to the Foundation for Critical Thinking
(http://www.criticalthinking.org)
10. Critical thinking skills
According to literature reviews:
There is no perfectly clarification
regarding Critical thinking skills.
It depends on user and utilizing.
However, Facione and Sanchez
(1994) recommended that being a
good critical thinker should employ
both cognitive critical thinking skills
and attitude critical thinking skills.
11. Cognitive Critical Thinking Skills
Interpretation : accurate interpreting
topic/problem
Analysis : Examining ideas/argument in
topic
Inference : querying claim, reaching
conclusion to implement with the patient
Explanation: clearly explaining and
defending the reason why using those
implementations
Evaluation : evaluating information to
ascertain its probable trustworthiness
Self-regulation : constantly monitoring
one’s own thinking using universal criteria
Facione, 1990
Frequently used in nursing
12. Critical thinking includes a complex combination skills
Rationality
Self-awareness
Honesty
Open-mindedness : Having an appreciation of
alternative perspectives
Discipline or experiences
Judgment
13. What the major components are:
1) a set of information and belief
generating and processing skills, and
2) the habit, based on intellectual
commitment, of using those skills to guide
behavior.
14. Critical Thinking Components
Brookfield (1987) stated that there are four
components of CT;
Identifying and Challenging
Promoting the importance of
context
Capacity to imagine and explore
alternative
Reflective skepticism
15. Five components of critical thinking in Nursing
Knowledge base
Experience
Competence
Attitudes
Standards
Joyce Smith : Critical Thinking
and Nursing Judgment
17. Standards
Intellectual Standards-
14 intellectual standards (Paul,1993)
Nurses use these when using the nursing process:
1. Confidence 7. Perseverance
2. Independence 8. Creativity
3. Fairness 9. Curiosity
4. Responsibility 10. Integrity
5. Risk taking 11. Humility
6. Discipline
18. Professional standards
Sound ethical standards
When critically thinking must have a sense of their own
values, beliefs, feelings and their clients/ client’s family’s
values, beliefs, feelings
Scientifically based practice with
standards developed by experts
Evidenced based practice
Standards developed as a result of evidence
These are minimum requirements that are necessary to
give quality effective care
19. Critical Thinking Competencies
Scientific method
Problem solving
Decision making
Diagnostic reasoning
Clinical decision making
Nursing process
20. However, nursing’s effort to capture and
employ these concepts has resulted in some
confusion and uncertainty.
21. How it different from Problem solving
CT Problem solving
• goes beyond • Focus on problems
problem solving rather and finding solutions
than finding specific to solve the problems
solution.
•is not centred on • is nature expects an
seeking an answer answer
Facione(1993) described that CT as eventually a cognitive
engine driving problem solving and decision making
22. How it different from Decision making
CT Decision making
•The requisite of • a systematic process
decision making of assessment of a
collection of actions,
evaluation and
judgment contributing
to the achieve
outcome
CT is an important process to promote problem solving
and decision making.
24. Bittner and Tobin (1998) suggested the
instructional method to enhance CT as
following:
Creative approach to open nurse’
mind and to broaden alternative
argument in order to facilitate the
problem solving
25. Strategies to promote CT
Active learning has
eventually been used for the
teaching of critical thinking.
26. Active Learning - “students involved
in doing things & thinking about the
things they are doing”
Critical Thinking - “reasonable
reflective thinking that is focused on
deciding what to do and what to believe”
OR “interpreting, analyzing or evaluating
information, arguments or experiences
with a set of reflective attitudes, skills,
and abilities to guide our thoughts,
beliefs and actions” OR “examining the
thinking of others to improve our own”
27. Operational Procedures of Critical Thinking - 1
Identifying key Distinguishing fact
definitions from opinion
Identifying ambiguity Identifying
Identifying variables assumptions
Formulating questions Identifying values
Defining issue or Noting missing
problem evidence
Classifying Identifying
information relationships
Comparing &
Sequencing
information contrasting
Cause and effect
Recognizing patterns
Determining Summarizing
credibility information
Using analogies
28. Operational Procedures of Critical Thinking - 2
Predicting trends Identifying errors in
from data reasoning such as:
Logical fallacies
Predicting
Errors in statistical
outcomes based reasoning
upon evidence Alternative
Translating conclusions that
between verbal satisfy evidence
and symbolic
Identifying
conclusions
29. Dispositions to think critically(Attitude)
Inquisitiveness/ curiosity
Open mindedness
Systematicity
Analyticity
Truth seeking
Self-confidence
Maturity
Stacy E. Walker (2003) Active Learning to promote CT
30.
31. Learning Methods : Active Learning
Classroom discussion and Debates
Simulation
Questioning tactic
Written Assignment
Problem based learning
Inquiry based learning
Factual based or Evidence based learning
Games and Puzzles
Encourage Creativity
Word chains category Ideas
Online based learning
Case study or cased based learning
Cooperative learning or participatory learning
Integrated learning
and so on i.e. community based, elective
based learning, virtual class
34. Questionings
Questions are the helpful to promote critical
thinking in every process of learning. It
depends on how a question is asked. The
useful questions are “Wh” questions i.e.
what, why, when, where, how.
35. Example of Questions Stacy E. Walker (2003)
Category Key Concepts Examples
Knowledge Memorization, description, What, When, Who, define,
Comprehension explanations, comparison describe,state,show,how
conclude, demonstrate,
rephrase, differentiate,
explain, give an example
Application Solution, application, Build, construct, solve,
analysis induction, deduction, demonstrate, how would
logical order you support your, what
assumptions, what
reasons, does the evidence
support the conclusion,
what behaviour
Synthesis Product thinking Think of a way, propose a
plan, develop, suggest,
formulate a solution
Evaluation Judgment, selection Choose, evaluate, decide,
defend, what is the most
appreciate, which would
you consider
36. Simulation in nursing education
There is currently a widespread movement to
use simulations of all types in nursing
education as a teaching-strategy and/or as
an evaluation mechanism.
In the past 40+ years, nursing educators
have conducted similar studies involving case
studies, computerized patients, standardized
patients, and have achieved similar results.
37. Virtual Simulation and Patient Care
Goal for using simulations: Optimal Student
Learning for High Quality Patient Care
38. Simulation Framework
OUTCOMES
• Learning
(Knowledge)
• Skill performance
• Learner satisfaction
• Critical-thinking
Program
• Self-confidence
s
aphic Level
Demogr
Age
DESIGN
CHARACTERISTICS
and SIMULATION
Active learning Collaboration (intervention)
Feedback High expectations
Student/ faculty Diverse learning Objectives
interaction Time on task Fidelity
Problem-solving
Student Support
Reflection
Jeffries & Rizzolo, 2004
40. Problem Based is
An instructional student-centered approach
which uses carefully constructed clinical
problems as a context for students to:
define their learning needs, conduct self-
directed enquiry, integrate theory and
practice, and apply knowledge and skills to
develop a solution to a defined problem.
41. How it different from Problem solving
Problem based Problem solving
learning
the process of arriving at decisions
acquiring new based on prior
knowledge based on knowledge and
recognition of a need reasoning
to learn
44. The Seven Step Model
Step 1 Identify and clarify unfamiliar terms presented in the
scenario, (allocate a scribe and a chairperson, define rules)
Step 2 Define the problem or problems to be discussed;
Step 3 Ideas storming session to discuss the problem(s),
Step 4 Review steps 2 and 3 and arrange explanations into
tentative solutions;
Step 5 Formulate learning objectives;
Step 6 Private study (all students gather information related
to each learning objective)
Step 7 Reconvene - Group shares results of private study
(Wood, 2003)
46. Inquiry based learning
“Inquiry implies involvement that leads to
understanding. Furthermore, involvement in
learning implies possessing skills and attitudes that
permit you to seek resolutions to questions and
issues while you construct new knowledge.”
(Veronica Robinson 2008)
47. Evidence based learning
Evidence based nursing, or EBN, is a form of
clinical practice that relies on research findings to
manage the health problems of a patient.
Evidence based usually begins with the formulation
of a question or topic concerning a patient’s
medical condition, and then, research is performed
to find answers to the question.
It can be applied in the classroom.
48. Step of EBL
Select a topic
Collect appropriate and accurate data to generate
evidence for nursing practice.
Analyze data from clinical practice.
Design interventions based on evidence.
Predict and analyze outcomes.
Examine patterns of behavior and outcomes.
Identify gaps in evidence for practice.
Evaluate project to determine and implement best
practices.
49. E-learning/ web based learning
Online tools provide an efficient means by which
instructors can shift the instruction of basic
concepts outside of class so that students are
prepared to fully engage in class activities
(Mandernach 2006).
Online course can promote CT depending on the
design of learning within Asynchronous and
synchronous learning tool(Wichaikull 2007).
Critical thinking appears to be best encouraged
among students when a more consistent emphasis
is placed on the discussions, and when instructor
facilitation is less frequent but more purposeful.
(Bridget Arend 2009)
51. Case based or case study in nursing
The case study approach is one way in which such active
learning strategies can be implemented in clinical setting.
Fry et al (1999) describe case studies as complex
examples which give an insight into the context of a
problem as well as illustrating the main point.
Case studies is defined as student centred activities based
on topics that demonstrate theoretical concepts in an
applied setting.
52. Benefits of cae study
Convey knowledge, facts, information to
students
Apply theory to a situation
Enhance students’ decision making skills
Improve students’ technical or behavioural
skills in analysing data
Improve students’ self esteem
Stimulate students’ interest in a subject
Foster reflection
Present a realistic picture of the complexities
in a situation
53. Factors influencing critical thinking outcomes
Questions with one right answer
Questions with no right answer
Questions with better and worse answers
54. Critical thinking outcomes
Rudd & Irani, 2004
Individual factors
High
Quality
Critical
Thinking
Outcome
Stimulus High High High
Problem Critical Critical No Critical
Thinking Knowledge Thinking Thinking
Disposition Skill Outcome
Decision + +
Others…
Low
Quality
Low Low Low Critical
Thinking
Outcome
External factors
55. 8 Ways to Fail at Teaching CT
(Robert Sternberg, Yale University)
1. Teacher is teacher; student is
student.
2. Critical thinking is the students’
job.
3. Need to find the best program.
4. Program decisions are either or.
5. Right answer over rationale.
6. Discussion a means to an ends.
7. Mastery learning applies to CT.
8. Need to “teach” critical thinking.
56. Evaluating Your Teaching
closed questions
open-ended questions
MEQ Test/ Rational for decision making/
problem solving ability
Concept map
Analysis of writing portfolio
Interviews and discussion
Observations
Documentation of a situation analysis
Potential solutions
Open-mindedness : Having an appreciation of alternative perspectives and willingness to respect the right of other
Knowledge- depth and extent of knowledge influence the nurse’s ability to think critically about nursing problems Experience- Unless nurse has had the opportunity to practice and make decisions about client care, critical thinking skills will not develop. In practice the nurse learns from observing, practicing, talking with clients, families, peers, and reflecting they will stagnate and not grow in their ability to think. Book reminds us that the clinical experience is the laboratory for testing nursing knowledge. Critical thinking competencies- Look at all the general and specific competencies
Scientific – uses reasoning to solve problems, used by nurse researches identify the problem collect the data formulate the hypothesis – a way to study the problem test the hypothesis – see if it works evaluate Problem solving – obtain information and find a solution and then solve problem and evaluate the solution Decision making – end point of critical thinking define problem assess the options weigh all the factors make final decision Diagnostic reasoning – using the data you gather to determine plan of care Clinical decision making – making a decision based on a problem which has been identified involves determining the priority thing to do
Nurse educator faces challenges when teaching CT.
Am bi gue I ty ความกำกวม
Inquisitiveness/ curiosity ความอยากรู้อยากเห็น
Students were confronted with credible but antagonistic arguments. It challenge students to deal with the tension between the two arguments. Word chains category Ideas : i.e. Things made of glass : glass, plastic, metal, wood, cloth
http://biology.ipst.ac.th/index.php/article-year-2545/121-2009-12-21-10-23-38.html Background – Information is not all you need to solve a problem The amount of information is growing exponentially no one person can keep up Started in medical school 1913 Sir William Ossler (concerning the education of medical students) “ too great a reliance on lectures and on students’ capability of memorising a growing number of items of knowledge.” 1950’s integrated systems teaching in USA medical school 1960’s PBL introduced in Canadian medical school 1970’s many USA and worldwide medical schools adopted PBL 1990’s introduced into medical schools in UK by Manchester, Glasgow and Liverpool universities.
Wood, D.F. (2003) ‘ABC of learning and teaching in medicine: Problem based learning’ British Medical Journal 326: 328-330
Read more at http://i.nursegroups.com/nursing-article/evidence-based-nursing.html#W3bpWze4usfJvpRw.99 It involves several processes that can contribute to a better understanding of a patient’s condition as well as the effectiveness of a certain treatment method.
http://www.edtech.vt.edu/edtech/id/models/powerpoint/casebased.pdf http://www.materials.ac.uk/guides/casestudies.asp Explore case a particular participant to develop such an understanding by critical using nursing process.
Fry H, Ketteridge S and Marshall S (1999) A Handbook for Teaching and Learning in Higher Education, Kogan Page, Glasgow, pp408
According to the review, the evaluation of CT skill in nursing is a major difficult because a commercial CT are not specific in nursing.
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