1. © 2008 www.AlfaroTeachSmart.com 1 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

2. © 2008 www.AlfaroTeachSmart.com 2 Thanks!

3. © 2008 www.AlfaroTeachSmart.com 3 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.

4. © 2008 www.AlfaroTeachSmart.com 4 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.

5. © 2008 www.AlfaroTeachSmart.com 5

6. 6 You can download handouts, tools free for personal use from: www.AlfaroTeachSmart.com

7. © 2008 www.AlfaroTeachSmart.com 7 Another Great Resource for Tools STAFFEDNET LISTSERV Subscribe info: https://lists.hsc.utah.edu/wws/info/staffednet https://lists.hsc.utah.edu/wws/info/staffednet

8. © 2008 www.AlfaroTeachSmart.com 8 Vested Interest

9. © 2008 www.AlfaroTeachSmart.com 9 Devil’s Advocate

10. © 2008 www.AlfaroTeachSmart.com 10 Coaching thinking is a privilege not to be taken lightly. You MUST get on the same page.

11. © 2008 www.AlfaroTeachSmart.com 11 Getting on The Same Page

12. © 2008 www.AlfaroTeachSmart.com 12 Problem-specific Prevention & Management (PPM) General Principles & CT Skills (CTIs) Critical Thinking

13. © 2008 www.AlfaroTeachSmart.com 13 4 Elements For Learner Success* 1.Clear outcomes & competencies up front 2.Continual feedback as to positives & negatives 3.Consistent application of the same criteria 4.Ability to give reasons behind the judgments you make about performance (to avoid the idea of being arbitrary or capricious, etc). * Christianson, L (2005)

14. © 2008 www.AlfaroTeachSmart.com 14 WHAT’S IN YOUR HANDOUTS Contest Progress Work Sheet Code of Conduct Article Reprint Evidenced-Based CTI Doc

15. © 2008 www.AlfaroTeachSmart.com 15 7 KEY STEPS 1.Do groundwork - build the relationship 2.Agree to code of conduct 3.Address thinking and learning styles 4.Make CT explicit – use indicators (behavior) 5.Make expectations clear (verbally and in writing) 6.Give practice – encourage discussion 7.Evaluate - lots of ongoing dialogue & feedback – keep checklists for competencies.

16. © 2008 www.AlfaroTeachSmart.com 16 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

17. © 2008 www.AlfaroTeachSmart.com 17 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 http://www.funderstanding.com/brain_based_learning.cfm *www.Funderstanding.com

18. © 2008 www.AlfaroTeachSmart.com 18 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

19. © 2008 www.AlfaroTeachSmart.com 19 Code of Conduct People think better when they like & trust one another.

20. © 2008 www.AlfaroTeachSmart.com 20 Describing CT

21. © 2008 www.AlfaroTeachSmart.com 21 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).

22. © 2008 www.AlfaroTeachSmart.com 22 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).

23. © 2008 www.AlfaroTeachSmart.com 23 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)

24. © 2008 www.AlfaroTeachSmart.com 24 Thinking…1 size doesn’t fit all.

25. © 2008 www.AlfaroTeachSmart.com 25 Think, Pair, Share

26. © 2008 www.AlfaroTeachSmart.com 26 Hartman’s Color Code ® Yellow = Fun Red = Power Blue = Intimacy White = Peace

27. © 2008 www.AlfaroTeachSmart.com 27 STRATEGIES

28. © 2008 www.AlfaroTeachSmart.com 28 4 Elements For Learner Success* 1.Clear outcomes & competencies up front 2.Continual feedback as to positives & negatives 3.Consistent application of the same criteria 4.Ability to give reasons behind the judgments you make about performance (to avoid the idea of being arbitrary or capricious, etc). * Christianson, L (2005)

29. © 2008 www.AlfaroTeachSmart.com 29 Getting on The Same Page

30. © 2008 www.AlfaroTeachSmart.com 30 EVIDENCE BASED CTI DOCUMENT

31. © 2008 www.AlfaroTeachSmart.com 31 CTI USE  Self improvement / Evaluation  Curriculum/Course Evaluation  Organizational impact  Risk management  Clinical preparation/reflection

32. © 2008 www.AlfaroTeachSmart.com 32 … 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…. Example

33. © 2008 www.AlfaroTeachSmart.com 33 … 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. Example

34. © 2008 www.AlfaroTeachSmart.com 34 4-Circle CT Model

35. © 2008 www.AlfaroTeachSmart.com 35 Digoxin 0.25 mg po OD1000 CIPRO 500 mg po BID1000 2000 KCl Elixir 20 mEq po OD1000 Multivitamin po OD1000 Ambien 5 mg po hs2000 MOM 30 cc po hs2000

36. © 2008 www.AlfaroTeachSmart.com 36 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:

37. © 2008 www.AlfaroTeachSmart.com 37 ____Remember TPE_ ____Remember TPE___ T= Teach P= Practice E= Evaluate

38. © 2008 www.AlfaroTeachSmart.com 38 _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

39. © 2008 www.AlfaroTeachSmart.com 39 Summary

40. © 2008 www.AlfaroTeachSmart.com 40 Progress Worksheet 80/20 Rule

41. © 2008 www.AlfaroTeachSmart.com 41Rewards Improved Confidence Good Habits Ability to change based on context & evidence Results

42. © 2008 www.AlfaroTeachSmart.com 42 Happy Nurses Week!

43. © 2008 www.AlfaroTeachSmart.com 43 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 (4 th ed.). Philadelphia: Elsevier - Saunders Alfaro-LeFevre, R. (2008). Evidence-based Critical Thinking Indicators. Available at: www.AlfaroTeachSmart.com. www.AlfaroTeachSmart.com

44. © 2008 www.AlfaroTeachSmart.com 44 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.

45. © 2008 www.AlfaroTeachSmart.com 45 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.

46. © 2008 www.AlfaroTeachSmart.com 46 Oermann, M. & Gaberson, K. (2006). Evaluation and testing in nursing education. 2nd Ed. New York: Springer. Oermann, M. (2005). Keynote Speech at NLN- Villanova 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.