Transcript Document

CRITICAL THINKING
Moving From Buzzwords to Indicators /
Strategies That Work
Rosalinda Alfaro- LeFevre, RN, MSN
First Annual DHMC
Conference on Nursing Excellence
April 21, 2008
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Thanks!
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Ground Rules
Feel free
Tell us about problems.
OK to Parallel Process
Have fun! (Keep it down.)
Stay on Task
We’re all experts / We’re Both Responsible
Check cell phones & egos at the door.
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EXPECTED OUTCOMES
1. Describe 7 key steps to promoting CT.
2. Use evidence-based critical thinking
indicators (CTIs) to promote critical thinking
(CT).
3. Use the 4-Circle CT Model to promote CT
4. Use specific tools & strategies to promote CT.
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You can download handouts, tools free
for personal use from:
www.AlfaroTeachSmart.com
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Another Great Resource for Tools
STAFFEDNET LISTSERV
Subscribe info:
https://lists.hsc.utah.edu/wws/info/staffednet
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Vested Interest
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Devil’s Advocate
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Coaching thinking is a privilege
not to be taken lightly.
You MUST get on the same page.
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Getting on The Same Page
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Critical Thinking
General Principles
& CT Skills (CTIs)
Problem-specific
Prevention &
Management
(PPM)
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4 Elements For Learner Success*
1.
2.
3.
4.
Clear outcomes & competencies up front
Continual feedback as to positives & negatives
Consistent application of the same criteria
Ability to give reasons behind the judgments
you make about performance (to avoid the idea
of being arbitrary or capricious, etc).
* Christianson, L (2005)
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WHAT’S IN YOUR HANDOUTS
Contest
Progress Work Sheet
Code of Conduct
Article Reprint
Evidenced-Based CTI Doc
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7 KEY STEPS
1.
2.
3.
4.
5.
6.
7.
Do groundwork - build the relationship
Agree to code of conduct
Address thinking and learning styles
Make CT explicit – use indicators (behavior)
Make expectations clear (verbally and in writing)
Give practice – encourage discussion
Evaluate - lots of ongoing dialogue & feedback –
keep checklists for competencies.
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Brain-based Learning
 Your brain can think faster than I can talk
 You can read faster than I can talk
 Looking at the same thing from various
perspectives = increased learning &
insight
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Brain-based Learning*
 Active participation = retention
 Humor reduces stress and helps you
learn. (Funderstanding)
*Hart, L. (2002) Human Brain, Human Learning, 3rd Ed. Covington, WA: Books for
Educators, Inc.
*On Purpose Associates. Brain-based Learning. Retrieved May 8, 2006:
http://www.funderstanding.com/brain_based_learning.cfm
*www.Funderstanding.com
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Think, Pair, Share*
* Developed by Professor Frank Lyman at the University
of Maryland in 1981. Read more at:
http://www.eazhull.org.uk/nlc/think,_pair,_share.htm
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Code of Conduct
People think better when they
like & trust one another.
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Describing CT
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Common CT Descriptions
•
A composite of knowledge, skills, &
attitudes (Watson and Glaser, 1980).
•
Knowing how to learn, reason, think
creatively, generate and evaluate ideas,
see things in the mind's eye, make
decisions and solve problems (SCANS, 1992).
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• Reasonable, reflective thinking that focuses
on what to believe or do. (Ennis, 1987)
• The ability to solve problems by making
sense of information using creative, intuitive,
logical and analytical mental processes…and
the process is continual (Snyder, 1993).
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• The art of thinking about your thinking, while
you're thinking, to make it better, more clear,
accurate, & defensible. (Paul, 1995)
• The process of purposeful, self-regulatory
judgment... the cognitive engine that drives
problem solving & decision-making.
(Facione & Facione, 1994)
• Knowing how to focus your thinking to get the
results you need (includes intuitive, logical, and
creative thinking). (Alfaro-LeFevre, 2004)
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Think, Pair, Share
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Hartman’s Color Code®
Red = Power
Blue = Intimacy
White = Peace
Yellow = Fun
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STRATEGIES
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4 Elements For Learner Success*
1.
2.
3.
4.
Clear outcomes & competencies up front
Continual feedback as to positives & negatives
Consistent application of the same criteria
Ability to give reasons behind the judgments
you make about performance (to avoid the idea
of being arbitrary or capricious, etc).
* Christianson, L (2005)
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Getting on The Same Page
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EVIDENCE BASED CTI
DOCUMENT
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CTI USE





Self improvement / Evaluation
Curriculum/Course Evaluation
Organizational impact
Risk management
Clinical preparation/reflection
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Example
… When I see you skipping assessments
and making assumptions I know you’re
not thinking critically because a first
priority in CT is identifying assumptions
and verifying the facts….
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Example
… When you are able to explain reasons
behind procedures I know you are more
likely to be thinking critically because
critical thinking requires you to understand
underlying reasons and principles so that
you can adapt as needed.
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4-Circle CT Model
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Digoxin 0.25 mg po OD
CIPRO 500 mg po BID
KCl Elixir 20 mEq po OD
Multivitamin po OD
Ambien 5 mg po hs
MOM 30 cc po hs
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CLINICAL WORKSHEET
Name______________ Room_____
Age____ Religion___ Culture____
Diet____ Activity_______________
Neuro:
Resp:
Oxygen:
Cardiac:
Circ:
Skin:
GI:
Medical Dx_____________________
Dr.____________________________
Allergies_______________________
Medications/IV’s:
Potential Complications:
Nursing DX/problems:
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____Remember TPE___
T= Teach
P= Practice
E= Evaluate
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_Consider CT From 3 Perspectives _
1. Thinking Ahead (clinical preparation)
2. Thinking in Action (thinking on your feet)
3. Thinking Back (reflective thinking)
> Use specific tools to guide each of the above
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Summary
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Progress Worksheet
80/20 Rule
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Rewards
Improved Confidence
Good Habits
Ability to change based on
context & evidence
Results
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Happy Nurses Week!
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Bibliography
Alfaro-LeFevre, R. (2006). Applying nursing process: A
tool for critical thinking (6th ed.). Philadelphia:
Lippincott- Williams & Wilkins
Alfaro-LeFevre, R. (2008). Critical Thinking and Clinical
Judgment: A practical approach (4th ed.).
Philadelphia: Elsevier - Saunders
Alfaro-LeFevre, R. (2008). Evidence-based Critical
Thinking Indicators. Available at:
www.AlfaroTeachSmart.com.
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ANA (2004). Nursing scope & standards of performance
and standards of clinical practice . Washington, DC:
American Nurses Publishing
ANA (2001). Code of ethics for nurses with interpretive
statements. Washington, DC: American Nurses
Publishing.
Christensen, L. (2005). Email communication.
Ennis, R. (1987). A taxonomy of critical thinking
dispositions
and abilities. In J.B. Baron, J.J.
Sternberg (Eds.), Teaching thinking skills: Theory
and practice. New York, New York: Freeman.
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Facione, N., Facione, P., Sanchez, C. (1994). Critical
thinking disposition as a measure of competent
clinical judgment: The development of the
California Critical Thinking Disposition Inventory.
Journal of Nursing Education, 33(8), 345–351.
Gardner, H. (1993). Multiple intelligences. New
York, NY: Basic Books
Goleman, D. (1995). Emotional intelligence. New
York, NY: Bantam Books.
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Oermann, M. & Gaberson, K. (2006). Evaluation and
testing in nursing education. 2nd Ed. New York:
Springer.
Oermann, M. (2005). Keynote Speech at NLNVillanova University Faculty Development
Institute. Villanova, PA.
Paul, R. and Elder, L (2001). Critical thinking: Tools
for taking charge of your learning and your life.
Upper Saddle River, NJ: Prentice Hall
Snyder, M. (1993). Critical Thinking: A Foundation
for Consumer-Focused Care. The Journal of
Continuing Education in Nursing, 24(5): 206-210.
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