Evaluating critical thinking in clinical practice

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We know how to alter the course by identifying risk factors and intervening early. But, realize that today — thanks to health information technology HIT and hard work on the part of many expert clinicians and researchers — we have more reliable evidence addressing how to predict, prevent, and manage problems in various situations and populations.

Think about how many years we used X-rays after central venous line insertion to confirm placement. Today, with new evidence and technology, we are much more proactive, using live ultrasound to monitor how lines are inserted, thereby reducing risks of serious complications, such as a collapsed lung. At every patient encounter, think about how to promote function. For example, point out the benefits of walking daily and using stress-management techniques to promote optimal physical and mental function.

Keep patients active and engaged in their care as much as possible every day. Critical thinking versus clinical reasoning. You may find that clients and peers, who know the value of constant improvement and professional growth, will leave you behind. A holistic way to define critical thinking is a commitment to look for the best way, based on the most current evidence. This means asking questions such as: What are the outcomes? How can we do this better? How satisfied are our patients with their care? Are we applying the most up-to-date evidence?

CT and CR are outcome-focused thinking that: Are guided by standards, policies, ethics codes, and laws individual state practice acts and state boards of nursing Are based on principles of nursing process, problem-solving, and the scientific method requires forming opinions and making decisions based on evidence Focuses on safety and quality, constantly re-evaluating, self-correcting, and striving to improve Carefully identifies the key problems, issues and risks involved, including patients, families, and key stakeholders in decision making early in the process.

Problem-solving versus improvement. Thinking with electronic health records. Knowledge indicators: These are behaviors that indicate the healthcare provider has required knowledge e. Personal CTIs see below describe attitudes and characteristics seen in individuals who are critical thinkers. Read the rest of the course online and take the test. Critical thinking indicators. CTIs are divided into three categories: What do critical thinkers look like?

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Benefits that may surprise you. The award comes with perks for honored nurses. Join NursingCenter to get uninterrupted access to this Article. Objectives: The aim of this review is to identify and synthesize the best available evidence on the effectiveness of teaching strategies aimed at improving critical thinking CT in registered nurses who provide direct patient care. Specifically, the research question is: What are the best teaching strategies to improve CT skills in registered nurses who provide direct patient care?

Today, increasingly complex health care demands fast and effective decision making from nurses, which relies on strong critical thinking CT skills. Critical thinking is a concept that is in constant development. It is not so much a method to be learned as a process or orientation of the mind, which incorporates both the affective and cognitive domains.

It is developed through assessing the credibility of evidence; reflection on one's own thoughts, life, and values; and teaching strategies that mobilize logical and analytical reasoning, among others. The characteristics of a desirable critical thinker are the necessary skills and disposition, namely, a willingness to learn and practice the skills. In the nursing profession, the CT process is closely related to the assertive application of various cognitive, behavioral and instrumental aspects to pursue better results from patient care. The skills and prerequisites are the structural elements of CT, and when continuously practiced in nursing, ensure effective and safe patient care.

Critical thinking in nursing is particularly essential for correctly assessing, interpreting and analyzing information with discretion and without value judgments, with the goal of determining appropriate diagnostic and decision-making needs. These skills are desirable in all areas of nursing, especially direct patient care. A past study 10 conducted on nurses showed that the major CT skills are analysis, implementation of standards, discernment, research, logical thinking, knowledge prediction and transformation.

Critical Thinking in Nursing | American Mobile

Furthermore, the prerequisites of CT are confidence, contextual perspective, creativity, flexibility, inquisition, intellectual integrity, intuition, understanding, perseverance and reflection. It is noteworthy that, in order for CT to be a mediating tool in the improvement of care practices, effective clinical reasoning and decision making skills must be established. It is important to be able to predict diagnoses and validate obtained conclusions through constant critical review.

In a past randomized clinical trial RCT , 13 the effects of a case study program were tested separately and combined with conceptual maps to evaluate CT development in registered nurses who provide direct patient care. Those with the greatest CT skills and open-mindedness were identified and compared to case studies separately. The study supports the application of case studies combined with concept maps as a hospital-based teaching strategy to promote development of critical thinking skills and encourage the right disposition in nurses.

Studies 6,12,14 have also indicated that a good critical thinker in nursing can articulate clinical reasoning based on scientific evidence. This promotes higher diagnostic accuracy and appropriate decision making, thus ensuring quality nursing care and significantly reducing iatrogenic events. Numerous researchers have further shown that CT skills might be developed and improved through a continuous and dynamic process that involves the application of appropriate teaching strategies.

Strategy to assess, develop, and evaluate critical thinking.

Individuals have a number of sources and strategies, such as conceptual maps, 13 simulations, 25 problem-based learning PBL , 19,24 YouTube videos, 17 video vignettes, 18 and team-based learning TBL , 20 that can help in developing their CT skills. A meta-analysis 21,22 of 12 RCTs has been conducted, with the aim of evaluating the effectiveness of teaching strategies used for the development of CT in undergraduate nursing students.

The teaching strategies used and tested in the RCTs included: PBL, conceptual maps, simulation, reflective writing, role modeling and animated pedagogical agents. This suggests that it is essential for educators to update their teaching methods and develop novel ones. Therefore, this study will assess teaching strategies applied in courses, training and continuing education with registered nurses in health care settings.

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This will clarify which strategies are most effective for CT development in nurses who provide direct patient care, with the intention of improving clinical reasoning and decision making. This is important for achieving the goal of the continuous improvement of CT in nurses who provide direct patient care. Assessment of the efficacy of the strategies will be possible through our participation as researchers in an international research network on nursing education Red Iberomericana de Investigacion en Enfermeria [RIIEE].

In addition, this study is necessary because CT research is the current focus of our multi-center research project, and no systematic reviews in this area were found. Studies that include registered nurses RN will be considered. We will exclude studies that involve enrolled nurses, licensed practical nurses, unlicensed assistive personnel and nursing students.

There are several systematic reviews 22, that address the development of critical thinking in nursing students and studies indicate that the level of critical thinking is related to age and professional experience; for this reason we will include only registered nurses in this systematic review.

Learning Strategies for Critical Thinking in Nursing - Jean LaBauve

This review will consider studies that evaluate the effectiveness of teaching strategies, which may include conceptual maps, 13 simulations, 25 PBL, 19,24 YouTube videos, 17 video vignettes, 18 and TBI, 20 among others, with the aim of developing or enhancing the CT prerequisites and skills of registered nurses who provide direct patient care. The systematic review will examine studies that compare interventions based on certain teaching strategies with traditional teaching lectures or no specific intervention.

This review will consider studies that include CT as an outcome measure.

Critical Thinking for Nurses

Regarding CT skills, the psychometric parameters established for the following skills will be considered: inference, recognition of assumptions, deduction, interpretation and evaluation, analysis, induction, deduction and critical response development. Regarding CT prerequisites, the psychometric parameters established for the following will be considered: open-mindedness, fairness, willingness to determine the cause of a problem, curiosity, desire to be well-informed, respect and ability to consider other points of view.

The quantitative component of the review will consider both experimental and epidemiological study designs, including RCTs, non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case control studies, and analytical cross-sectional studies.