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) 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?” 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) Helps us gain awareness of how we are viewing and creating our world of practice. (Cody, 2006)

What Is Theory In Nursing? It involves seeing patterns that bring order to chaos (Cody, 2006) It involves seeing patterns that bring order to chaos (Cody, 2006) It is an abstraction and not a reality itself 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) 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)

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) 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) Is an objective, rational, linear problem- solving process similar to the nursing process (Cody, 2006)

Critical Thinking Now trending toward integrating multiple types of thinking-empirical, ethical, aesthetic, and personal (Cody, 2006) 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 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 By increasing awareness of different critical thinking processes, we increase our ability to use them in our complex practice

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

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

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

Attitude of Inquiry and Openness An attitude of doubt involves questioning what is happening within and around (Cody, 2006) 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) 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” Ask “what if….we could do it another way and not how we have always done it”

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

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

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)

Integrating Multiple Levels of Theory Metatheory Grand Theory Midrange Theory 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

Perspective Taking Critical thinking means viewing a situation from multiple perspectives – yours, your patients’, families’ Enhanced by dialogue with other nurses and disciplines. Critical thinking Your perspective Nursing colleagues Other disciplines Patient’s perspective

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)

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!!!