Teaching and the development of critical thinking and clinical judgment skills Dr Jacqueline Baker
Definitions Judgement: assessment of alternatives Decisions: choosing between alternatives Thompson & Dowding, 2002
How should we approach the teaching of judgement and decision making skill development? 1. Noticing 2. Interpreting 3. Responding 4. Reflecting Tanner, 2006: 208
Noticing This is a function of: Expectation of the situation Knowledge of the patient Clinical/practical knowledge Tanner, 2006: 208
Interpreting and responding Hypotheticodeductive reasoning Immediate recognition Tanner, 2006: 208
Reflecting Reflecting-in-action Reflecting-on-action Tanner, 2006: 208
Teaching strategies Stretegies Modeling: Related to the Tanner model assisting the development of pattern recognition Articulation: reflection-in-action Reflection: reflection-in-action Exploration: assisting noticing Taylor & Care 1999
Teaching strategies Strategy case study Analysis Applying standards Discriminating Information seeking Predicting and transforming knowledge Related to the Tanner model Noticing and interpreting Responding Interpreting and responding Noticing and reflecting Reflecting Scheffer & Rubenfeld, 2000
Teaching strategies Strategy - simulation Stagnant models Interactive models connected to haemodynamic monitors Computer-based simulators, CD-ROM applications Related to the Tanner model Noticing and responding Noticing, responding, interpreting, reflecting Computer-based simulators that support Noticing, responding, interpreting, reflecting Rauen, 2004
Teaching strategies Strategy reflective writing Define their individual experience & validate their own unique experiences Be an active learner rather than a passive learner, being fully engaged in the experience of learning Grow, develop selfdetermination & be empowered Develop connections and linkages resulting in a more holistic understanding of practice Reflect upon clinical events and the attendant feelings Related to the Tanner model Reflection in- and on-practice Fonteyn & Cahill, 1998
Teaching strategies Questioning 1. Factual or descriptive questions: recall Eg: Which foods are high in fat? What are the signs & symptoms of infection? Low-order 2. Clarifying questions: convey thoughts & feelings Eg: What do you mean when you say? Low or Higherorder 3. High-order questions: require more than memory or perception Eg: Why does a low salt diet help to control blood pressure? What do you think will happen if you don t take action now? High-order Bastable, 2003: 384
Teaching strategies Sequencing Increasing complexity Increasing diversity Global skills before local skills
Points to consider Point number 1: In practical situations it is often taken for granted that students will learn if they do things
Points to consider Point number 2 Students need to engage with the content in a way that will help them understand
Points to consider Point number 3 Encourage creative thinking
Points to consider Point number 4 Teaching strategies should promote: pattern recognition similarity recognition common sense understanding skilled know-how sense of saliency deliberative rationality
Points to consider Point number 5 Learn to shut up!
Teaching Strategies Increase confidence Decrease dependence on others > increasing self-confidence Increase familiarity with clinical judgement and decision making Patient focused Practically based Promote critical reflective thought at work at more than the knowledge level
References Baker, J. (2001). Nurses perceptions of clinical decision-making in relation to patients in pain. Unpublished PhD Thesis, University of Sydney. Bandman, E.L. & Bandman, B. (1995). Critical thinking in nursing (2 ed.). Connecticut: Appleton & Lange. Bastable, S. (2003). Nurse as educator: Principles of teaching and learning for nursing practice (2 ed.). Boston: Jones and Bartlett Publishers. Benner, P. (1984). From novice to expert: Excellence and power in clinical practice. Menlo Park; Addison Wesley. Benner, P. & Tanner, C. (1987). Clinical judgement: how expert nurses use intuition. American Journal of Nursing, 87(1), 23-31. Benner, P., Tanner, C. & Chesla, C (1992). From beginner to expert: Gaining a differentiated clinical world in critical care nursing. Advances in Nursing Science, 14(3),13-28. Cioffi, J. (2002). What are clinical judgements? In C. Thompson & D. Dowding (Eds.). Clinical decision making and judgement in nursing (47-65). Edinburgh: Churchill Livingstone. Fonteyn, M. & Cahill (1998). The use of clinical logs to improve students metacognition: A pilot study. Journal of Advanced Nursing, 28(1),149-154. Hamm, R.M. (1988). Clinical intuition and clinical analysis: Expertise and the cognitive continuum. In J. Dowie & A. Elstein (Eds.). Professional judgment: A reader in clinical decision making (78-105). Cambridge: Cambridge University Press.
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