Fundamentals Success A Q&A Review Applying Critica PDF

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Fundamentals of Critical Thinking Related to Test Taking INTRODUCTION To prepare for writing this chapter we did what all writers should do. We performed a detailed search of the literature about critical thinking, we reviewed all the significant materials that related to test taking or nursing practice, and we wrote an outline for a comprehensive discussion of critical thinking in relation to nursing examinations. The introductory section of the chapter was to be titled “The Historical Perspective of Critical Thinking.” When we typed the chapter heading and reread it, we had written “Hysterical” instead of “Historical.” Having a relatively good sense of humor and the ability to laugh at ourselves, our response was peals of laughter. We realized that this was a Freudian slip! Loosely defined, a Freudian slip occurs when unconscious mental processes result in a verbal statement that reflects more accurately the true feelings of the speaker than does the originally intended statement. Being true believers in the statement that all behavior has meaning, we could not continue until we explored why we wrote what we wrote. When we looked up the word hysterical in the dictionary, its definitions were an uncontrollable outburst of emotion or out of control and extremely comical or hilarious. Associating the word “hysterical” with the concept of critical thinking raised two thoughts. Are we overwhelmed, frantic, and out of control when considering the relationship between critical thinking and nursing, or do we find this relationship funny, comical, and hilarious? If you feel overwhelmed, frenzied, or out of control when considering critical thinking, carefully read the section in this chapter titled Be Positive: You Can Do It! When we personalized the word to our own experiences, we recalled that when we believe that something is funny, our internal communication is “Isn’t that hysterically funny?” So, now we were faced with the task of exploring why we thought reviewing the historical perspective of critical thinking was so funny or why it could be overwhelming. We actually spent several hours pursuing this goal. At the completion of this process, we arrived at three conclusions:

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The words “critical thinking” are just buzzwords. Critical thinking is a skill that we all possess uniquely, and we use this skill routinely in all the activities of our daily living. It is funny to profess that critical thinking is something new and different. Who cares about the historical perspectives of critical thinking! Information about the abstract topic of critical thinking must be presented in a manner that the information learned today can be implemented tomorrow. Feelings of being overwhelmed can be conquered because critical-thinking abilities can be enhanced.

Definition of Critical Thinking As we sat back and reflected on our morning’s work in relation to Alfaro-LeFevre’s (1995) definition of critical thinking, we recognized and appreciated the fact that we had been thoroughly involved with critical thinking. We had: ● ● ●

Engaged in purposeful, goal-directed thinking. Aimed to make judgments based on evidence (fact) rather than conjecture (guesswork). Employed a process based on principles of science (e.g., problem solving, decision making). 1

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Used strategies (e.g., metacognition, reflection, Socratic questioning) that maximized our human potential and compensated for problems caused by human nature.

Critical thinking is a cognitive strategy by which you reflect on and analyze your thoughts, actions, and decisions. Critical thinking often is integrated into traditional linear processes. Linear processes usually follow a straight line, with a beginning and a product at the end. Some linear-like processes, such as the nursing process, are considered cyclical because they repeat themselves. Some formal reasoning processes include the following: ●

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Problem Solving involves identifying a problem, exploring alternative interventions, implementing selected interventions, and arriving at the end product, which is a solution to the problem. Decision Making involves carefully reviewing significant information, using methodical reasoning, and arriving at the end product, which is a decision. Diagnostic Reasoning involves collecting information, correlating the collected information to standards, identifying the significance of the collected information, and arriving at the end product, which is a conclusion or nursing diagnosis. The Scientific Method involves identifying a problem to be investigated, collecting data, formulating a hypothesis, testing the hypothesis through experimentation, evaluating the hypothesis, and arriving at the end product, which is acceptance or rejection of the hypothesis. The Nursing Process involves collecting information (Assessment); determining significance of information and making a nursing diagnosis (Analysis/Diagnosis); identifying priorities, goals, expected outcomes, and nursing interventions (Planning); carrying out nursing interventions (Implementation/Intervention); and assessing the patient’s response to interventions and comparing the actual outcomes with expected outcomes (Evaluation), ultimately to arrive at the end product of meeting a person’s needs.

Each of these methods of manipulating and processing information incorporates critical thinking. They all are influenced by intellectual standards, such as being focused, methodical, deliberate, logical, relevant, accurate, precise, clear, comprehensive, creative, and reflective. It is helpful to incorporate critical thinking into whatever framework or structure that works for you. The purpose of this discussion is to impress on you that you: ● ● ●

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Use critical thinking in your personal life. Will continue to use critical thinking in your professional life. Should enhance your critical-thinking abilities when studying. Can employ critical-thinking skills when taking a nursing examination.

In an attempt to make the abstract aspects of critical thinking more concrete, we have schematically represented our concept of critical thinking by the Helix of Critical Thinking. In Figure 1–1, the Helix of Critical Thinking has been unwound and enlarged so that the components of the cognitive competencies and personal competencies can be viewed easily. The cognitive competencies are the intellectual or reasoning processes employed when thinking. The personal competencies are the characteristics or attitudes of the individual thinker. These lists of competencies represent the cognitive abilities or personal qualities commonly associated with critical thinkers. No one possesses all of these competencies, and you may identify competencies that you possess that are not on these lists. The lists are not all inclusive. Make lists of your own cognitive and personal competencies. Your lists represent your repertoire or inventory of thinking skills. As you gain knowledge and experience, your lists will expand. The more cognitive and personal competencies you possess, the greater your potential to think critically. The Helix of Critical Thinking, when wound (Fig. 1–2 ), demonstrates the integration of cognitive competencies and personal competencies essential to thinking critically. Not all of these competencies are used in every thinking situation. You can pick or choose from them as from a smorgasbord when you are confronted with situations that require critical thinking. Initially, you may have to stop and consciously consider what cognitive competencies (i.e., intellectual skills) or personal competencies (i.e., abilities, attitudes) to use. As you gain knowledge and experience and move toward becoming an expert critical thinker, the i Fundamentals Success : A Q&A Review Applying Critical Thinking to Test Taking /i

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use of these competencies will become second nature. The Helix will contract or expand depending on the competencies you use in a particular circumstance. In addition, there is constant interaction among cognitive competencies, among personal competencies, and between cognitive competencies and personal competencies. The interactive nature of the Helix of Critical Thinking and the Nursing Process is demonstrated in Figure 1–3. The Nursing Process is a critical thinking framework that involves assessing and analyzing human responses to plan and implement nursing care that meets patient needs as evidenced by the evaluation of patient outcomes. The Nursing Process provides a precise framework in which purposeful thinking occurs.

Figure 1–1. The Helix of Critical Thinking is schematically elongated to demonstrate the components of cognitive competencies and personal competencies. The more cognitive competencies and personal competencies a person possesses, the greater the potential the person has to think critically.

Nugent Patricia and Barbara Vitale

i Fundamentals Success : A Q&A Review Applying Critical Thinking to Test Taking /i

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Figure 1–2. The Helix of Critical Thinking demonstrates the interwoven relationship between cognitive competencies and personal competencies essential to thinking critically. Throughout the thinking process there is constant interaction among cognitive competencies, among personal competencies, and between cognitive and personal competencies.

Critical thinking is an essential component within, between, and among the phases of the Nursing Process. Different combinations of cognitive and personal competencies may be used during different phases of the Nursing Process. The interactive nature of the Helix of Critical Thinking and the Problem-Solving Process is demonstrated in Figure 1–4. The Problem-Solving Process is a dynamic, linear process that has a beginning and an end, with a resolution of the identified problem. It provides a progressive step-by-step method in which goal-directed thinking occurs. Critical thinking is an essential component within and between the steps of the Problem-Solving Process, and different combinations of cognitive and personal competencies may be used during the various steps involved. i Fundamentals Success : A Q&A Review Applying Critical Thinking to Test Taking /i

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Figure 1–3. The interactive nature of the Helix of Critical Thinking within the Nursing Process. The Nursing Process is a dynamic, cyclical process in which each phase interacts with and is influenced by the other phases of the process. Critical thinking is an essential component within, between, and among phases of the Nursing Process. Different combinations of cognitive and personal competencies may be used during the different phases of the Nursing Process.

Identify the Problem Explore Alternate Solutions Implement Selected Interventions Arrive at Solution

Figure 1–4. The interactive nature of the Helix of Critical Thinking within the Problem-Solving Process. The Problem-Solving Process is a dynamic, linear process that has a beginning and an end, with the resolution of the identified problem. Different combinations of cognitive and personal competencies may be used during the different steps of the Problem-Solving Process.

Nugent Patricia and Barbara Vitale

i Fundamentals Success : A Q&A Review Applying Critical Thinking to Test Taking /i

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MAXIMIZE YOUR CRITICAL-THINKING ABILITIES Be Positive: You Can Do It! Assuming responsibility for the care one delivers to a patient and desiring a commendable grade on a nursing examination raise anxiety because a lot is at stake: to keep the patient safe; to achieve a passing grade; to become a nurse ultimately; and to support one’s selfesteem. The most important skill that you can learn to help you achieve all of these goals is to be an accomplished critical thinker. We use critical-thinking skills every day in our lives when we explore these questions: “What will I have for breakfast?” “How can I get to school from my home?” “Where is the best place to get gas for my car?” Once you recognize that you are thinking critically already, it is more manageable to think about thinking critically. If you feel threatened by the idea of critical thinking, then you must do something positive to confront the threat. You must be disciplined and work at increasing your sense of control, which contributes to confidence! You can do it!

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POSITIVE MENTAL ATTITUDE

Supporting a positive mental attitude requires developing discipline and confidence. Discipline is defined as self-command or self-direction. A disciplined person works in a planned manner, explores all options in an organized and logical way, checks for accuracy, and seeks excellence. When you work in a planned and systematic manner with conscious effort, you are more organized and therefore more disciplined. Disciplined people generally have more control over the variables associated with an intellectual task. Effective critical thinkers are disciplined, and discipline helps to develop confidence. Confidence is defined as poise, self-reliance, or self-assurance. Confidence increases as one matures in the role of the student nurse. Understanding your strengths and limitations is the first step to increasing confidence. When you know your strengths you can draw on them, and when you know your limitations you know when it is time to seek out the instructor or another resource to help you with your critical thinking. Either way, you are in control! For example, ask the instructor for help when critically analyzing a case study, share with the instructor any concerns you have about a clinical assignment, and seek out the instructor in the clinical area when you feel the need for support. Failing to use your instructor is like putting your head in the sand. Learning needs must be addressed, not avoided. Although your instructor is responsible for your clinical practice and for stimulating your intellectual growth as a nursing student, you are the consumer of your nursing education. As the consumer, you must be an active participant in your own learning by ensuring that you get the assistance and experiences you need to build your abilities and confidence. When you increase your theoretical and experiential knowledge base, you will increase your sense of control, which ultimately increases your confidence. This applies not just to beginning nursing students but to every level of nursing practice because of the explosion in information and technology. When you are disciplined you are more in control, when you are more in control you are more confident, and when you are more confident you have a more positive mental attitude.

Be Reflective: You Need to Take One Step Backward Before Taking Two Steps Forward! Reflection is the process of thinking back or recalling a situation or event to rediscover its meaning. It helps you to seek and understand the relationships among information, concepts, and principles and to apply them in future clinical or testing situations. Reflection can be conducted internally as quiet thoughtful consideration, in a one-on-one discussion with an instructor or another student, or in a group. As a beginning nursing student, you are just starting to develop an experiential background from the perspective of a provider of nursing care. However, you have a wealth of i Fundamentals Success : A Q&A Review Applying Critical Thinking to Test Taking /i

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experiences, personal and educational, that influence your development as a licensed nurse. Your personal experiences include activities using verbal and written communication, such as delegating tasks to family members or coworkers, setting priorities for daily activities, using mathematics when shopping or balancing a checkbook, and so on. A nursing program of study incorporates courses from a variety of other disciplines, such as anatomy and physiology, chemistry, physics, psychology, sociology, reading, writing, mathematics, and informatics. Every experience is a potential valuable resource for future learning. Recognize the value of the “you” you bring to your nursing education and incorporate it into your reflective processes. Engaging in reflection is a highly individualized mental process. One form of reflection is writing a journal. A journal is an objective and subjective diary of your experiences. It is a chronicle that includes cognitive learning, feelings, and attitudes, and it requires you actively to develop skills related to assessing, exploring the meaning of critical incidents, documenting, developing insights into thoughts and actions that comprise clinical practice, and evaluating. Journal writing is a rich resource that provides a written record of where you have been, where you are, and where you are going. It helps you to incorporate experiences into the development of your professional being. After an examination, explore your feelings and attitudes regarding the experience. Be honest with yourself. Did you prepare adequately for the test? Did you find the content harder or easier than content on another test? Were you anxious before, during, or after the test and, if so, was your anxiety low, medium, or high? What would a low score or high score on the test mean to you? When you were confronted with a question that you perceived as difficult, how did you feel and how did you cope with the feeling? You do not necessarily have to ask yourself all of these questions. You should ask yourself those questions that have meaning for you. Another form of reflection is making mental pictures. Mental pictures are visual images that can be recalled in the future. For example, when caring for a patient who has Parkinson’s disease, compare the patient’s signs and symptoms with the classic clinical manifestations associated with the disease. Then make a visual picture in your mind. Visualize the pill-rolling tremors, mask-like face, drooling, muscle rigidity, and so on, so that in the future you can recall the visual picture rather than having to remember a memorized list of symptoms. Retrospective (after the event) reflection involves seeking an understanding of relationships between previously learned information and the application of this information in patient-care situations or testing experiences. This type of reflecti...