Chapter 18 CRITICAL THINKING, PROBLEM-BASED LEARNING, AND REFLECTIVE PRACTICE
This chapter introduces student nurses to different approaches in the development of professional practice. While critical thinking, problem-based learning (PBL), and reflective practice have some components in common, they present different ways of acquiring knowledge and skills necessary for effective client care.
CRITICAL THINKING
Critical thinking presupposes a certain basic level of intellectual humility (e.g. acknowledging one’s own ignorance) and a commitment to think clearly, precisely and accurately and to act on the basis of genuine knowledge. When nurses direct critical thinking towards understanding and assisting clients in finding solutions to their health problems, the process becomes purposeful and goal oriented. Through critical thinking a person addresses problems, considers choices and chooses an appropriate course of action. It is clear that critical thinking requires not only cognitive and mental processing skills but a person’s habit to ask questions, to remain well informed, to be honest in facing personal biases, and to be always willing to reconsider and think clearly about issues (Alfaro-LeFevre 1999).
CLEAR LANGUAGE
An important aspect of critical thinking is the use of language. Thinking and language are closely related processes. The ability to use language is closely associated with the ability to think meaningfully. To become a critical thinker, a nurse must be able to use language precisely and clearly. When language is vague or inaccurate it reflects similar thinking. As nurses care for clients it becomes important not only to communicate clearly with clients and families but also to be able to clearly communicate findings to other health professionals. When a nurse uses incorrect terminology, jargon or vague descriptions, communication is ineffective. Critical thinking requires a framing of one’s thoughts so that the focus and resultant message are clear. It is helpful to reflect on your language and consider whether what you communicate expresses an idea, position or judgment precisely and clearly (Alfaro-LeFevre 1999).
INTUITION
Expertise in nursing involves the ability to think critically about the knowledge required for a client’s care and the knowledge the nurse brings to a nursing care situation. The expert nurse practises intuitively on a deep knowledge base that is applied in daily practice, and each clinical experience is a lesson for the next one. Intuition is the immediate feeling that something is so, without the benefit of conscious reasoning. It is a common experience that all people have after interacting repeatedly with their environment (Hood & Leddy 2005).
A nurse gains intuitive knowledge by learning to describe accurately in precise nursing language the common client responses in nursing care situations. However, it is important to remember that quality nursing practice does not depend solely on intuition. Just as it is critical for nurses to know what knowledge they have, it is even more critical to know what knowledge they do not have. If nurses do not recognise how much they do not know in relation to what they do know, they are endangering the health and wellbeing of their clients. Each clinical situation must be carefully thought through. Even if a nurse believes intuitively that a client is experiencing an expected change, it is important to confirm that finding through appropriate clinical observations and measurements. Thoughtful analysis of what the nurse knows, plus a review of the most current clinical data, allows the nurse to make an accurate and sound clinical decision. Prejudices, biases and failure to acknowledge one’s limitations do not result in thoughtful professional practice (Hood & Leddy 2005).
REFLECTION
One important aspect of critical thinking is reflection. This is a process of thinking back or recalling an event to discover the meaning and purpose of that event. For a nurse, reflection involves thinking back on a client situation or experience to explore the information and other factors that influenced the handling of the situation. Reflection requires adequate knowledge and is necessary for self-evaluation, to review one’s successes and mistakes. The process of reflection helps nurses seek and understand the relationships between concepts learned in the classroom and real-life clinical incidents. Reflection also helps the nurse judge personal performance and make judgments about standards of practice. It is a process that helps make sense out of an experience and facilitates the incorporation of the experience into the nurse’s view of themself as a professional (Rolfe, Freshwater & Jasper 2002).
Learning to be reflective takes practice. A nurse who chooses to reflect on a clinical experience must be open to new information and be able to look at the client’s perspective as well as their own. Reflecting on experience reveals behaviour significant to the nurse’s professional development. Through reflection the nurse recognises that the actions were either successful or unsuccessful. The next time a similar experience arises, the nurse uses approaches that were successful or revises an approach to ensure a successful outcome (Crisp & Taylor 2005).
PROBLEM-BASED LEARNING
Growing numbers of nursing faculties around the world believe that new models of education are required for nurses to develop the knowledge, skill and abilities to be critical thinkers, independent decision makers, lifelong learners, effective team members and competent users of information technologies. Problem-based learning (PBL) has emerged as the most promising approach to pursue when implementing a major shift in the philosophy, structure and process of nurse education curricula (Rideout 2001). PBL is a teaching–learning model that may take a variety of forms but which essentially places the student at the centre of the learning process and is aimed at integrating learning with practice.
In a normal lecture-based course an academic stands out front and ‘teaches’ students, that is, gives them information. Lecturers assume that students copy and learn from this information, which they are then able to regurgitate at examinations, as well as carry away to apply to work situations. PBL is different because it is based in the practical-work-type situation, where the onus is put on the students. Students need to identify what they need to know. Usually in small groups (about 10 students), students are given problem situations (usually case studies) and in that group students will discuss, research, process the material to work effectively, solve the problem, produce a report, and may sometimes make a verbal presentation for the benefit of other PBL student groups (Clinical Interest Box 18.1).
CLINICAL INTEREST BOX 18.1 A problem-based learning scenario
Information for students
Step 1: Preoperative assessment
Step 2: Postoperative assessment
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
