Critical Thinking: How To Inspire It?

CRNA teacher · Jun 13, 2003

Complex topic, with lots of issues.

I like the reference to Warren Bennis-isn't he the business leadership expert? I am glad to see other nurse familiar with his work. I like his idea of the leader as facilitator, and not neccessarily the micromanager.

I also thought of Patricia Benner's work. If I remember, she documented the evolution of ICU nurses from novice to expert, and the role of "grey gorillas" as mentors to novices. I think it underscores, that while you cannot eliminate the "book work" and study aspect of learning good nursing concepts, much of what makes nurses experts is experience. And that experience is not taught in the traditional way, but is more intuitive.

So, while the recommendation to continue eduction is essential to the growth process, focusing on pure academic/classroom education may not be enough.

In the original example, two different teams of care providers failed (or nearly failed) to believe alarms and act accordingly. I find it difficult to believe that none of those involved had sufficient KNOWLEDGE. The broken link in the chain involved the processing of information and the decision to act.

I am not an expert on simulators in education, but is a hot topic at my school right now. We believe we have the institutional support to start a simulator program, and we have been exploring this relatively new technology. It is incredibly exciting. What was not too long ago only possible in the large academic centers, is beginning to become more available to other settings.

I believe simulators relate to this topic. The idea for simulation began with the aviation industry, as a way to teach crisis management. It is doing the same thing for health care. The value of simulation is it fills the gap between "book knowledge" and putting that knowledge into action in the "real world".

I know simulators are not widely available yet, but that is sure to change as technology marches forward. Anyone have experience with their role in education, and their influence on the development of critical thinking skills?

CRNA teacher

Team HPNI · Jun 13, 2003

Dear CRNA Teacher,

Thank you for a treasure trove of thoughts! Yes, Bennis is the business leadership expert. I liked reading about his response to an inquiry at one of his lectures:

Q: Do you love what you're doing?

A: A long silence. Followed by "I don't know."

Six months later, he quit his job as college president and moved to California, where he joined the University of Southern California and launched their graduate program in business administration.

It takes courage to say "I don't know" when facing an audience.

I plan to educate myself on:

1. Patricia Benner's work

2. Simulators

I remember AHRQ's article, Chapter 45,

Simulator-Based Training and Patient Safety - I'll revisit it, too.

Thank you for taking the time.

oramar · Jun 13, 2003

I was taught to think by my mom who just happen to have an intellectual bend even though she came from a poor blue collar back ground. I turned around and taught my kids to think. None of us were taught to think critically in school. I have to say that I think the colleges and universities my kids attended at just paid lip service to critical thinking but did not really promote it. Matter of fact I would go as far to say that most institutions are anti-thinking machines. OK, why you ask? Well THINK about it. HE HE.... All institutions by their very nature have built in goals and values and proceedures and laws and attitudes that become obsolete over time. These are replaced by the new rule....This institution exist to perpetuate itself. You don't have to be a member of any institution for very long to see what is being done wrong and what is going wrong. However, vocalizing these things are a threat to the institutions main goal of perpetuating itself. If you ask me, healthcare institutions are no exception. Nowhere is it more dangerous to point out inconsistencies in policies and proceedures. So until very recently education and professional nurse orginizations pretty much supported the status quo. I admit things have changed a bit in last 5 years.

Team HPNI · Jun 14, 2003

Dear Oramar,

Thank you for your insights. Back to the basics: Lead by example.

When parents think independently, children tend to do the same. My mother derived incredible benefits from a high school education. And, she helped me develop whatever intellectual capacity I may have.

Yes, institutions tend to target independent thinkers as "trouble-makers." That's why I appreciate Bennis's emphasis upon the need to encourage everyone to think: "The organizations that will succeed in the future are those in which everyone thinks." I hope his ideas take root and flourish.

Benner's extensive work on skill progression indicates the importance of experiential learning. According to one online summary, her recent book, Clinical Wisdom and Intervention in Critical Care: A Thinking-in-Action Approach, presents "strategies for teaching clinical judgement and critical thinking." "Thinking in action" is defined as "thinking linked to action in on-going situations."

And Amazon.com cites one reader's review:

A wonderful reference book, May 9, 2001
Reviewer: Jennifer Salabsky (see more about me) from Whitehall, PA USA
I bought this book as a registered nurse that is fairly new to the critical care field, and the first night I had it, it came in handy. By reading a few pages before going to work about being a "detective" to find out the cause of changes in a pt's condition, I was able to avert a more serious complication. I enjoyed the narrative descriptions by nurses in various settings of the critical care field, how the situations were handled, and how they could have improved them. I highly recommend this book not only for the veteran nurse, but for all the new nurses out there!! It will better your thinking skills, and improve your care overall!! [/Quote]
Interesting concepts. Do others agree with Jennifer Salabsky's (the reviewer cited on Amazon.com) comments?
Thank you for sharing this odyssey . . . it's a welcome relief from daily banalities. Such as cleaning the floors and doing the laundry - next on today's agenda.
Happy Saturday!

Team HPNI · Jun 14, 2003

An interesting addendum, found while browsing Amazon.com's selection from Patricia Benner.

Three cheers for good mothers!

DESIGNING THE INSTRUCTIONAL PROCESS TO ENHANCE CRITICAL THINKING ACROSS THE CURRICULUM
Inquiring Minds Really Do Want to Know: Using Questioning to Teach Critical Thinking
Alison King California State University, San Marcos
I believe that the hallmark of a critical thinker is an inquiring mind. Simply put, good thinkers are good questioners. Whatever they see, hear, read, or experience, they are constantly analyzing it, puzzling over its significance, searching for explanations, and speculating about relations between that experience and what they already know. Good thinkers are always asking What does this mean?, What is the nature of this?, Is there another way to look at it?, Why is this happening?, What is the evidence for this?, and How can I be sure? Asking questions such as these and using them to understand the world around us is what characterizes critical thinking.
Isidor Rabi, the 1944 Nobel Prize winner in physics, told the story of how he learned to be a questioner as a very young boy. When he returned home from school each day, his mother, instead of asking him what he had learned in school that day (as most other mothers did), asked him what good questions he had asked that day. According to Rabi, this daily greeting from his mother had a profound influence on the development of his inquiring mind [emphasis added].
If good thinkers are good questioners, then is the reverse true? Are good questioners good thinkers? Do inquiring minds really want to know? If we could teach our students to ask good questions, would that improve their critical thinking? Results of my own program of research on inquiry-based learning ( King, 1989 , 1990 , 1991 , 1992 , 1994 a) suggest that the answer is yes.
Source:
Questia

wishingmary · Jun 15, 2003

Helen Harkreader writes about development of critical thinking in her text, Fundamentals of Nursing Caring and Clinical Judgement. She says, "critical thinking is a skill that develops over time and with conscious application of total recall, habits, inquiry, new ideas and creativity, and knowing how you think." She brings up Patricia Benner and her use of the Dreyfus Model of skill acquisition as a process in which a nurse advances through 5 stages of critical thinking. These being Novice - relies on rules to perform correctly; Advanced Beginner - Can recognize common patterns and develops professional habits; Competent - Able to recognize own thinking and analyze problems; Proficient - Intuitive thinking increases with experience; and Epert - Intuition becomes prominent in thinking" (p.119).

Those of us who are nursing students are just learning how to crawl and then how to walk. We are focused on tasks which is considered the "ground". Our ability to move is from theory and practice. Much of what an expert may act upon intuitively without missing a beat is a little beyond us. Still critical thinking is something that should be developed from childhood, yet we are raised in an educational system of wrong or right answers. Fear can then take hold without our even knowing it over time. After awhile, it seems as though one can even learn to not think.

I know you want to teach critical thinking to your students. One thing our nursing school has done is use test taking programs and the like. At the hospital I work, they have those simulators you spoke of earlier. Math can help. The best thing is recognize our need for time and experience to unlearn, to relearn, and to learn. Of course in nursing school everything is due NOW and hopefully not yesterday. You may not see a real development in critical thinking among some of your students but I think critical thinking is rewarded in the real world if not by money, at least by the respect you gain among those you spend your time with the most, your co-workers. And of course, no one likes to look stupid among their peers. What's nice in my workplace is it is safe to ask questions. It makes us safer and it shows respect to those we ask; of course, I'd probably seek out the answer first before asking something of sometimes very busy people as they tend to be.

Critical thinking is an issue for me because I am learning how to respond to my new (past October) diagnosis of ADHD. I do think differently and Strattera has been a blessing but still I'm somewhat hesitant. Sorry about the following letters, I can't seem to get my delete button to work. uekumust ets out j

wishingmary · Jun 15, 2003

P.S. I like Team HPNI's addendum about the rabbi who asked his child what good questions did you ask today. I'd like to try that with my children who are 8 & 5. Another like question might be, what did you find interesting today. My audience for such questions is my journal or my nursing journals we must turn in with our care plans. It helps me make sense of a world that sometimes isn't as obvious to me. jiies

CRNA teacher · Jun 16, 2003

I agree that asking questions is part of critical thinking.

I have noticed that in my own teaching style, I don't encourage this enough. I am too nurturing, I want to explain, and ANSWER questions. I have set a goal for myself to allow the student's questions to linger, and hang in the air awhile. Give them time to answer their own questions.

I just completed a course (as a student) in which the instructor was a master at this. She nudged our group process along, but did not inflence with our own discovery. When we verbalized our understanding of something, she just calmly nodded, as if to say "OK, you figured that out, now what is the next question you need to ask?". She was always miles ahead of us, and somehow she kept us on track with just the gentlest of guidance. It is difficult to describe, but it was a wonder to behold. I hope I can incorporate even the smallest bit of her techniques into my own teaching.

But it is certainly not an overnight change. It seems to be taking me some time to accomplish, and I am constantly having to remind myself about it. So I like this thread, as a way for us to share strategies about how to incorporate this into our teaching.

CRNA teacher

Team HPNI · Jun 16, 2003

Thank all of you for so many crystal-clear thoughts!

Wishingmary wisely observes:

The best thing is to recognize our need for time and experience to unlearn, to relearn, and to learn. . . . I think critical thinking is rewarded in the real world if not by money, at least by the respect you gain among those you spend your time with the most, your co-workers.

Learning is a life-long process which takes time + willingness to invest the energy, but is rewarded by the respect of one's peers. Theodore Roosevelt once thundered:

What do I want? I want RESPECT!"

He's not the only one.

These comments on teaching techniques reminded me of my administrative theory professor's explanation of a good teaching style. According to him, many instructors view their students as empty vessels. Take the "lid off the jar" and pour knowledge in. Not very effective.

In contrast, the "maieutic" method views students as dormant seeds, waiting for stimulation to flourish and grow. A good instructor is like sun, water and food - the seeds come to life. And each is a unique individual, with unique thoughts - not merely an echo of the instructor.

In my opinion, the instructor who was "always miles ahead of us, and somehow she kept us on track with just the gentlest of guidance" epitomizes the "maieutic" method in action. Encouraging students, and colleagues in the work situation, to ask questions and seek better solutions reflects the spirit of

Helen Harkreader's "conscious application of total recall, habits, inquiry, new ideas and creativity, and knowing how you think."

So . . . I'm going to put all of these exciting ideas to the test of empiricism. This week, I am going to make a conscious effort to ask questions and listen, as opposed to my natural propensity to talk, talk, and then talk some more. Embarking upon an empirical quest is exciting!

CRNA teacher · Jun 16, 2003

Maieutic, now there is a $50 word I never knew before!

Thanks for the insight. Now I just need to figure out more about it. So far, what I have found is pretty deep.

I need "Socratic maieutic method for dummies".

CRNA teacher

Team HPNI · Jun 16, 2003

Socrates, logic, dialectics . . . all of these deep concepts are way beyond my comprehension.

My administrative theory professor kept it very simple and down-to-earth. In his version, our minds were seeds, in a flower pot. He was the attentive gardener - watering, enriching the soil, and keeping the pots in sunshine. That I could understand.

Howard Barrows also brings the concept down-to-earth:

Excerpt from The Tutorial Process, by Howard S. Barrows (revised 1992).
Although the term "tutor" may not be ideal for a teacher employing a facilitatory or maieutic teaching style, it has become commonly used in this way. The ability of the tutor to use facilitatory teaching skills during the small group learning process is the major determinant of the quality and the success of any educational method aimed at 1) developing students' thinking or reasoning skills (problem solving, metacognition, critical thinking) as they learn, and 2) helping them to become independent, self-directed learners (learning to learn, learning management). Tutoring is a teaching skill central to problem-based, self-directed learning.
In this method, students learn to become self-reliant and eventually independent of the tutor. This method is particularly important in the education of professionals (medicine, business, law, engineering, social work, etc.) where students are eventually expected to become independent, problem solving, self-motivated learners.

CRNA teacher · Jun 17, 2003

Thanks for the Howard Barrows reference, I will look into that.

We started this thread about clinical teaching, and mentoring.

This Socratic, maieutic style of tutoring is very applicable for that setting.

I also do didactic/classroom teaching. I notice your Barrows quote refers to small groups. I am now wondering if another barrier to may effective use of this method is the size of the group I am dealing with.

With the shortages we are all facing, class size has steadily increased over the years. At some point the size of the group adds to the challenge of teaching critical thinking, and educating "independent, problem solving, self-motivated learners. "

CRNA teacher