Lect 3 - Critical Thinking (N3113)
Terms
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- CRITICAL THINKING
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- the process of examining underlying assumptions about current evidence and interpreting & evaluating arguments for the purpose of reaching a conclusion from a new perspective
- [critical thinking asks the question, "Why"?]
- [ex. Nurse manager of post anesthetic care - nurses are upset that stretcher is broken and no one will fix it; nurse manager asks porter why he keeps bringing back stretcher - it was reported to maintenance. Maintenance ordered parts but parts were no longer available. Nurse gets to the bottom of the situation and understands the problem]
- [it is not just about memorizing lots of knowledge; you need an open mind & question underlying assumptions]
- What are the underlying assumptions? Certain values or beliefs and they may be inaccurate; wrong beliefs may be passed on if you are not critically thinking
- [ensure to follow policies but critically think about what is being done. Policies are located on the Intranet at the hospital]
- How is evidence interpreted? [Are the facts substantiated? Is there a bias or value laden information?]
- How are the arguments to be evaluated? [Objective evidence to support conclusions]
- What are the implications of your conclusion?
- critical thinking requires "open inquiry, ability to ask questions and examine underlying assumptions. Interpreting and evaluating insight/intuition/empathy and willingness to take action - FOSTERING CRITICAL THINKING:
- "All too often we are giving our young people cut flowers when we should be teaching them to grow plants. We are stuffing their heads with the products of earlier innovation rather than teaching them how to innovate. We think of the mind as a storehouse to be filled when we should be thinking of it as an instrument to be used."
- 3 PROCESSES OF CRITICAL THINKING:
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1. PROBLEM SOLVING
*Define
*Information
*Analyze
*Solutions
*Decision
*Implement
*Evaluate
2. CREATIVE THINKING
*Preparation
*Incubation
*Insight
*Verification
3. DECISION MAKING
*Purpose
*Criteria
*Weich criteria
*Alternative
*Test
*Trouble shoot
*Evaluate - BROOKFIELD'S THEMES:
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1. IMPOSTERSHIP
- awareness that at some level, nurses don't think they really deserve to be regarded as competent professionals [don't feel they are the best person to be doing this]
2. CULTURAL SUICIDE
- running the risk of cutting yourself off from your colleagues and from the organizational culture [start to question colleagues and challenge divisional manager - risk of being cut out of the group and isolated]
- nurses working critically remind those who are in a stasis of their own sloth. This is seen as breaking with good form.
3. LOST INNOCENCE
- the gradual realization that the more clinical practice we have, the more we are aware that learning is unfinished
- there is NO perfect nurse
[after graduating and being in the real setting, you realize there is a lot you don't know]
4. ROADRUNNING
- halting, jagged, incrementally fluctuating rhythm of learning critical thinking [may be doing very well and then hit a barrier; pick themselves up and go again]
5. COMMUNITY
- belonging to an emotionally, sustaining, peer learning community - TYPES OF DECISION MAKING:
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1. RECURRENT and routine problem solving
2. SATISFICING
- making decisions and trying to keep as most people happy as possible
3. MAXIMIZING or OPTIMAL MODE
- best reasons for making the decision - DECISION MAKING PROCESS:
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- a SYSTEMATIC process that begins with a need or problem and ends with evaluation. A risk taking and judgment activity
- takes courage (risk): sensitivity/energy/creativity
- willingness to take risks is one of the main components of the nurse manager role along with COMMITMENT, a sense of HUMOUR, a POSITIVE outlook and ORGANIZATIONAL skills
1. IDENTIFY the PURPOSE (an issue or problem usually exists); purpose of any decision is to reduce, remove or prevent adverse consequences or to accept desirable ones
2. SET the CRITERIA (alternatives are selected and evaluated)
***3 questions:
i. What do I want to ACHIEVE?
ex. good quality of care such; wean from the ventilator to transfer to floor ASAP
ii. What do I want to AVOID?
ex.cost and negative impact on care; Increased cost of ICU bed/LTC in ICU/complications
iii. What do I want to PRESERVE?
ex. high quality patient care; Alternatives: keep in ICU, sit up in the chair and plug 30 min QID until weaned
3. WEIGH THE CRITERIA:
- rank the alternatives in order of preferences 1-10; no right or wrong and this reflects individual needs and values
ex. 10 = send to floor weaned, 5=slow wean, 1= quick wean but then complications
[ex. cost of bed, good quality care]
4. SEEK ALTERNATIVES
- What are the best possible ways to fulfill each criteria?
[ex. trained nurses how to care for ventilators. Sent home and provided home care services]
5. TEST ALTERNATIVES
- examine weight and desirability of each pro and con
- reduce bias thinking
[ex. talk to nurses on the floor - they would not take the patient; need to rely on other options]
6. TROUBLESHOOT
- list all problems that could occur and the likelihood
- list preventative measures
7. EVALUATE the action
- did you achieve the desirable outcome? ex. moved to floor?
*Most times when you make a decision not everyone will agree with you but you need to justify and explain your decision; you also need to stick with your decision - PROBLEM-SOLVING PROCESS:
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- Deliberate and thoughtful search for information to clarify the problem and suggest alternatives
- A process used when a gap is perceived between existing state (what is going on) and a desired state (what SHOULD be going on)
1. DEFINE the problem
- departure from the present state of affairs. The problem should be in a descriptive statement and NOT a judgment
2. GATHER INFORMATION
- first hand if possible
- a search for information that clarifies the problem (valid, accurate, detailed descriptions in WRITING! Can be experiences too)
- the best form of information is in writing (rarely act on "he said", "she said" or "they said") [do not want to go on feelings, emotions or heresy]
- when is the best time to do nothing?
3. ANALYZE information
- is the information RELIABLE?
- can set in a TIME sequence (what happened first) or
- CAUSE AND EFFECT relationship
*THREE factors to consider
i. Human - personality/maturity
ii. Technical - skills
iii. Policy
4. Develop SOLUTIONS/ALTERNATIVES
- many solutions/examine alternatives
- remain OBJECTIVE
- use experience, literature, seminars, key informants, brainstorming
5. Make a DECISION
- most feasible alternative
- do you have the authority to implement?
- change process may need to occur.
6. IMPLEMENT a decision
- may need to inspire or motivate others
- "zone of acceptance" - fit with the staff
7. EVALUATE the solution
- compare actual results & benefits to those idealized
- periodic evaluation checkups
- mistakes? successes?
METHODS:
1. TRIAL AND ERROR: time consuming
2. EXPERIMENTATION: research, pilots and trials
3. EXPERIENCE: past experience and tuition (pos or neg)
4. SELF-SOLVING: run the natural course and solved by those involved
*know when to do nothing and stand by your decision - CREATIVE PROCESS:
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1. PREPARATION
- information gathering
- consciousness raising
- knowing that there is a problem that needs to be addressed
- may need to read literature or talk to others about it
2. INCUBATION
- unconscious work going on "sleep on it", "stewing"
- unconscious thinking and the answer comes to you after a period of time
3. INSIGHT
- the answer emerges
- new ways of looking at old problems
- be open to ALL possibilities
4. VERIFICATION
- evaluation, trial period, solutions are evaluated
- exposure, intuition and change all contribute to the creative process
- characteristics of creative people?
- Generate ideas rapidly, flexible, original solutions, complex thought process, independent judgment, accept authority and view it as CONVENTIONAL rather than absolute and accept authority as a matter of EXPEDIENCE, willing to entertain and express personal thoughts
**How can you see something from a new perspective if you don't allow creativity to come through? - VROOM AND YETTON MODEL:
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- 5 different decision styles
- Method of choosing among them (questions)
- Follow the flow chart from LEFT to RIGHT
- Small group and spokesperson
- Example: computerized patient records system
*For exam: when the style is determined, then figure out how you would achieve this (will be given decision tree - there is no right or wrong answer, it just needs to be justified)
****Use FIGURE VI-3 Decision Tree (can be found in modules)
ex. your supervisor called you in to discuss the disarray of materials in supply rooms, waiting rooms, and nurse stations on your unit. You argued that your unit has particularly fast paced duties and your staff is very competent. Your supervisor agrees but tells you to organize things quickly anyway) - 2 COMMON MISTAKES FOR TIME MANAGEMENT:
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1. UNDERESTIMATING daily planning
2. NOT ALLOWING TIME to do it
(see time management sheet HANDOUT!)
*fail to plan, plan to fail - STEPS FOR TIME MANAGEMENT:
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1. PRIORITY setting "To do list"
****Allow time for planning and establish priorities
- Don't do
- Do later
- Do NOW
2. Complet HIGHEST PRIORITY task first whenever possible
***finish one task before beginning another
- Delegate
- Procrastination
3. REPRIORITIZE
*****reprioritize based on the remaining tasks and on new information that may have been received
- Cyclic nature - 3 CYCLIC STEPS FOR TIME MANAGEMENT:
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- To do list
- Time inventory (date book)
- Based on engineering principles
1. GATHER supplies
2. GROUP ACTIVITIES in same location
3. Determine TIME ESTIMATES