1. Critical Thinking… What’s That?
Catherine Russell-McGregor, RN, MSN, FNS,C
Palliative Care RN Consultant

2. Thank you Outcome Resources!

3. Objectives: Define Critical Thinking
Explore the elements of critical thinking
Reflect on the critical thinking process through case studies

4. Thinking is the hardest work there is
Thinking is the hardest work there is. That is the reason so few engage in it.
Henry Ford
The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honors the servant and has forgotten the gift.
Albert Einstein

6. "A persistent effort to examine any belief or supposed form of knowledge in the light of the evidence that supports it and the further conclusions to which it tends."
Edward M. Glaser (1941).

7. Critical thinking employs not only logic but broad intellectual criteria such as clarity, credibility, accuracy, precision, relevance, depth, breadth, significance, and fairness.
So how do we learn to think critically?
One must learn to be flexible in decision making
Reflect on past experiences and previous knowledge
Listen to others point of view
Identify the nature of the problem
Select the best solution for improving the situation

8. People who think critically consistently attempt to live rationally, reasonably and empathically.
They are keenly aware of the inherently flawed nature of human thinking when left unchecked.

9. Is the disciplined, intellectual process of applying skill reasoning as a guide to belief or action
Critical thinking for clinical decision making is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process.
Fair-minded
Suspend judgments
Monitor quality of your thinking
Critical inquiry

11. Why Critical Thinking? Everyone thinks; it is our nature to do so.
But much of our thinking, left to itself, is:
biased
distorted
partial
uninformed
down- right prejudiced.
Yet the quality of our life and that of what we produce, make, or build depends precisely on the quality of our thought. Shoddy thinking is costly, both in money and in quality of life. Excellence in thought, however, must be systematically cultivated.

13. Self Reflection
Choices and Values Exercise

14. Case Studies

15. Case Study…
Mrs. Lutz is a 78 yr. old woman who has undergone radiation therapy and three surgeries for cancer.
She is not responding well to her treatment, cannot eat, and is losing weight.
The physician has decided to place a subclavian catheter to administer total parenteral nutrition.
The nurse takes the informed consent form to the patient to sign and explains to her that “the doctor will place a small tube in your vein to give you more nutrients to help you regain your strength and heal”.
Mrs. Lutz says, “I’m so tired of all this pain. I’m not sure I want anything else done, and I surely don’t want to be hurt again.”
Analyze/Assess
Define
Examine
Listen
Question
Reasoning
Synthesizing
What factors does the nurse need to assess that might affect Mrs. Lutz’s ability to consent?
Before she signs the consent form, how can the nurse be certain that her consent was truly “informed”?
What does the patient know about her disease?
How does she feel about it?
What is the patient saying?
What are her goals of care?
Is the nurse listening?
Has the physician spoken to the patient?
Has the physician explained the reason for the procedure?

16. Case Study
Mr. C is a 76 yr. old man with ESCD and standing CHF with edema
MI at 55, CABG at 58, repair of AAA at 62
Wife is a cancer survivor
Retired due to health problems after an active life working as an engineer
He has tried to take care of himself, engaging in social activities
He often says “I feel I have no ambition”, “I can’t do anything anymore. I am worthless”.
Increasing SOB, initially relieved with O2
Dyspnea progressed, developed dry cough, admitted to ED and to acute are
He has no AD, his MD is apposed to hospice.
He is back home now on O2

17. Case Study
Your patient is 86 years old with moderate to severe dementia, mild hypertension, and a history of osteoarthritis with hip and knee pain.
She does not have decisional capacity.
You are introducing the concept of advance care planning to the patient’s daughter .
The daughter states, “I know that she would not want any heroic measures, but I feel like I have to do everything.”
Tell me about your mother.
How do you know that she does not want heroic measures?
Have you talked to her about her health care preferences?
Does she have an Advance Directive?
What are heroic measures?

18. Case Study
You have admitted a patient with his third exacerbation of CHF.
He has been hospitalized twice in the last four months with the same diagnosis.
In a goals of care conversation, the patient says: “I want everything done—CPR, breathing tube, ICU, but the most important thing to me is I just want to be comfortable when I die.”

20. We did the best we could with what we knew, and when we knew better, we did better.
Maya Angelou