Critical thinking cards: An innovative teaching strategy to bridge classroom knowledge with clinical decision making (2022)

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Teaching and Learning in Nursing

Volume 11, Issue 3,

July 2016

(Video) 5 tips to improve your critical thinking - Samantha Agoos

, Pages 108-112

Abstract

Students and faculty in an obstetrics course were surveyed regarding the use of critical thinking cards as an active teaching strategy in the clinical setting. Critical thinking cards are the foundation for an active learning strategy that incorporates questioning, problem solving, coaching, and the think-aloud approach while using higher-order thinking to enhance clinical decision-making.

Introduction

In order to function as a professional nurse for the 21st century, students need to know how to think like a nurse and make clinical judgments and decisions about patient care situations as they arise. The act of linking what is taught in the classroom with direct patient care can enhance students' clinical decision-making (Benner, Sutphen, Leonard, & Day, 2010). Therefore, it is important to develop creative strategies to help students transfer classroom knowledge into the clinical setting. The purpose of this article is to discuss an active teaching strategy that is easy to implement, cost-effective, and does not require technical resources, yet clearly helps students use classroom knowledge to solve clinical problems.

A review of the literature included searching the terms: think like a nurse, clinical decision-making, clinical judgment, clinical reasoning, and critical thinking. Other terms searched included active strategies involved in the critical thinking pedagogy: questioning, coaching, and the think-aloud approach. All of the concepts searched are important effective strategies to teach the crucial skills of safe practice.

Critical thinking, clinical judgment, and clinical reasoning are essential for clinical decision-making and problem solving in the health care setting (Chamberland et al., 2015, Chang et al., 2011; Furze, Black, Hoffman, Barr, Cochran, & Jensen, 2015; Tanner, 2006, Wilson, 2012). These essential skills are imperative for nurses and other health care professionals to be successful in providing safe, quality care but can be very difficult for students to acquire (Baxter & Rideout, 2006; Furze et al., 2015; Lang, Beach, Patrician, & Martin, 2013). Effective clinical decision-making is actually learned in nursing school when students apply knowledge gained in the classroom to direct patient care in the clinical setting. However, lack of application often occurs because classroom and clinical are often viewed by students as two separate courses. It becomes imperative that educators find ways to connect the two components if students are to learn how to make sound clinical decisions using classroom knowledge to solve clinical problems.

The whole concept of “thinking like a nurse” involves critical thinking, clinical decision-making, and clinical judgment (Ashley and Stamp, 2014, Tanner, 2006). The goal of any nursing program is to graduate students who will be able to implement critical thinking and clinical judgment. The act of thinking like a nurse not only involves problem solving but also requires individuals to identify and evaluate patient responses, recognize patterns, and make alternate decisions based on data gathered (Ashley and Stamp, 2014, Tanner, 2006).

Section snippets

Active Strategies Designed to Bridge Classroom Knowledge

Faculty may use a variety of interactive teaching strategies in the clinical area to help students learn to apply knowledge to practice. By combining numerous teaching strategies, the result may be a new and innovative way to help students learn how to make the critical clinical judgments necessary for safe patient care. Active learning strategies engage students and produces better learning outcomes (Waltz, Jenkins, & Han, 2014). Active learning, which involves student engagement rather than

What Are Critical Thinking Cards?

Critical thinking cards were designed as a learning activity that combines the use of several different strategies linked to improving critical thinking and clinical decision-making. The cards, which include questions related to a specific clinical area, were created as an innovative active learning strategy to help students' bridge classroom knowledge with clinical practice. As an active learning strategy, use of the cards combines the use of questioning, coaching, and the think-aloud method.

Implementation of Critical Thinking Cards

A deck of critical thinking cards was presented to each of the four faculty teaching in the course with instructions to utilize them in the clinical setting in any way they felt would be useful to student learning. Faculty used critical thinking cards at various times throughout the clinical day to provide opportunities for students to demonstrate application of classroom knowledge to actual patient situations. Students randomly selected a card from the deck, then responded to the question or

Student Perceptions

A convenience sample of 66 junior level students enrolled in the obstetrics course in the traditional bachelor of science in nursing program during the fall and spring semesters of one academic year volunteered to provide feedback. Students completed a survey, which utilized a 5-point Likert scale ranging from strongly agree to strongly disagree to elicit student perceptions related to the effectiveness of the critical thinking cards. Students were also asked to provide feedback about the

Discussion

Critical thinking cards are an interactive teaching strategy that can fulfill the goal of the Institute of Medicine report by bridging classroom content and clinical decision-making (Institute of Medicine, 2010). Critical thinking cards can be used in various ways in a variety of educational settings. The cards can be used with students in all levels of nursing education, including associate's, bachelor's, and master's-degree programs. All nurses need to “think like a nurse” so that newly

Summary

This project was a first step in using this innovative teaching strategy to help bridge the gap between the classroom and clinical area. Actual effectiveness versus perceived effectiveness is yet to be determined. We see outcomes from this project as a potential pilot for a more rigorous research study. Plans are to expand the strategy to other courses to enhance student clinical decision making in other areas.

(Video) Critical Thinking Bootcamp 2021 - SAGE Publishing

Suggestions are for faculty to be more actively involved in creative ways to use the

Acknowledgments

The authors would like to thank the faculty and students in the obstetrics course at Wright State University College of Nursing and Health for participating in this critical thinking card activity.

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    FAQs

    What are the steps to critical thinking and clinical reasoning? ›

    These techniques include critical analysis, inductive and deductive reasoning, making valid inferences, differentiating facts from opinions, evaluating the cred- ibility of information sources, clarifying concepts, and recognizing assumptions.

    Why is critical thinking important in nursing practice? ›

    Critical thinking is essential for nurses because it helps them make decisions based on the available information and their past experiences and knowledge of the field. It also allows nurses to plan before making any changes to be most effective as possible.

    How can nurses improve critical thinking? ›

    HOW TO IMPROVE CRITICAL THINKING IN NURSING?
    1. Demonstrate open-mindedness. ...
    2. Practice self-awareness. ...
    3. Avoid judgment. ...
    4. Eliminate personal biases. ...
    5. Do not be afraid to ask questions. ...
    6. Find an experienced mentor. ...
    7. Join professional nursing organizations. ...
    8. Establish a routine of self-reflection.

    What are the basic principles of critical thinking? ›

    Principles of Critical Thinking:
    • Gather complete information.
    • Understand and define all terms.
    • Question the methods by which the facts are derived.
    • Question the conclusions.
    • Look for hidden assumptions and biases.
    • Question the source of facts.
    • Don't expect all of the answers.
    • Examine the big picture.

    What is the difference between critical thinking and clinical decision-making? ›

    Critical thinking can occur in any situation in which a nurse finds themselves, whether that situation is of a clinical nature or not. Clinical reasoning, however, occurs specifically within the clinical context and, as Alfaro-LeFevre has concluded, relies upon critical thinking as a component of its success.

    What is an example of critical thinking in healthcare? ›

    Williams gives an example of this by saying, "a critically thinking nurse will hold a patient's blood pressure medicines and contact the physician when he or she notes that the patient's blood pressure is below an acceptable level." In this case, lack of critical thinking skills could put the patient in jeopardy by ...

    What is the importance of critical thinking? ›

    Critical thinking can help you better understand yourself, and in turn, help you avoid any kind of negative or limiting beliefs, and focus more on your strengths. Being able to share your thoughts can increase your quality of life.

    Why are critical thinking skills important for students? ›

    Critical thinking will let you make decisions by yourself. It will help you improve decision-making. For students, while making career decisions or making a new career move, it is crucial to make quick decisions, and hence critical thinking plays a vital role here.

    How do you develop critical thinking skills? ›

    How to improve critical thinking
    1. Become more self-aware. ...
    2. Understand your mental process. ...
    3. Develop foresight. ...
    4. Practice active listening. ...
    5. Ask questions. ...
    6. Evaluate existing evidence. ...
    7. Meeting with a mentor. ...
    8. Participating in team-building exercises.

    What strategies can nurse educators use to better promote critical thinking skills in students? ›

    Flexibility when considering opinions and alternatives. A willingness to be open-minded about differing worldviews and to understand the opinions of other people. The ability to be honest about one's own biases, prejudices, or stereotypes, Self-confidence in one's own reasoning abilities.

    What are the characteristics of critical thinking? ›

    Wade (1995) identifies eight characteristics of critical thinking. Critical thinking involves asking questions, defining a problem, examining evidence, analyzing assumptions and biases, avoiding emotional reasoning, avoiding oversimplification, considering other interpretations, and tolerating ambiguity.

    What is a good example of critical thinking? ›

    Examples of Critical Thinking

    A triage nurse analyzes the cases at hand and decides the order by which the patients should be treated. A plumber evaluates the materials that would best suit a particular job. An attorney reviews evidence and devises a strategy to win a case or to decide whether to settle out of court.

    How a teacher can develop critical thinking skills in students? ›

    Ask questions

    Asking questions enhances your critical thinking in learning. You can often wait for your class to finish before personally approaching your teacher and clearing up your questions. One question may lead to another, and that will further help in clearing your concepts.

    What is the most commonly used critical thinking process? ›

    Analytical thinking

    Being able to properly analyze information is the most important aspect of critical thinking. This implies gathering information and interpreting it, but also skeptically evaluating data.

    Why is critical thinking important for teachers? ›

    Strong teachers think critically. They practice the thinking art of analyzing and evaluating as they consider both day-to-day activities and long-term teaching and learning goals. They evaluate what they have, determine what they will need, and decide how and when to assess student progress.

    What is the importance of critical thinking and problem-solving? ›

    Critical thinking skills are important because they enable students “to deal effectively with social, scientific, and practical problems” (Shakirova, 2007, p. 42). Simply put, students who are able to think critically are able to solve problems effectively. Merely having knowledge or information is not enough.

    What are critical thinking activities? ›

    10 Great Critical Thinking Activities
    • Attribute Linking—Building Community by Taking Perspectives. ...
    • Barometer—Taking a Stand on Controversial Issues. ...
    • Big Paper—Building a Silent Conversation. ...
    • Body Sculpting—Using Theatre to Explore Important Ideas. ...
    • Café Conversations. ...
    • Jigsaw—Developing Community and Disseminating Knowledge.
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    What is an example of critical thinking in school? ›

    For example, a high schooler may see a news item about climate change. They can apply critical thinking skills to reflect on the different arguments, learn more about the topic and come to a reasoned conclusion.

    How do you develop critical thinking and problem solving skills? ›

    How to Develop Critical Thinking
    1. Don't Believe Everything You're Told. The first step to critical thinking is to consider more than one point of view. ...
    2. Don't Believe Everything You Think. ...
    3. Ask Questions. ...
    4. Research Deeper. ...
    5. Evaluate Your Work.

    What are the different teaching methods and strategies for patient education? ›

    There are many ways to deliver patient education. Examples include one-on-one teaching, demonstrations, and analogies or word pictures to explain concepts. You can also use one or more of the following teaching tools: Brochures or other printed materials.

    What is the difference between clinical teaching and classroom teaching? ›

    In the classroom, learners attend to gain knowledge and need teachers who can keep them engaged. By contrast, on the Internal Medicine clinical service, learners are providing clinical care to complex medical patients and need teachers who can help them diagnose and manage these patients.

    What strategies can I use to advance my learning in the future? ›

    • Spaced Practice. Space out your studying over time. ...
    • Retrieval Practice. Practice bringing information to mind without the help of materials. ...
    • Elaboration. Explain and describe ideas with many details. ...
    • Interleaving. Switch between ideas while you study. ...
    • Concrete Examples. ...
    • Dual Coding.
    Dec 11, 2016

    Why is critical thinking so important in the 21st century? ›

    Arguably, Critical Thinking is now more important than ever. It gives young people the ability to distinguish reliable information from 'fake news' – an essential skill in our increasingly digitalised world. As teachers, you play a crucial role in encouraging your students to assess and evaluate what they see and read.

    What are the 4 benefits of critical thinking in the workplace? ›

    Critical Thinking in Business Management

    Anticipating problems and preventing them before they arise. Finding ways to cut expenses. Planning and implementing business strategies. Delegating tasks to qualified team members.

    What does teaching critical thinking mean? ›

    Critical thinking is a term used by educators to describe forms of learning, thought, and analysis that go beyond the memorization and recall of information and facts.

    What is the clinical reasoning process? ›

    Clinical reasoning The process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process.

    What are 3 specific action steps that you will take to develop your critical thinking skills as a health care professional? ›

    Steps for Thinking Critically
    • Be Aware of Personal Bias and Assumptions.
    • Learn from All Available Resources.
    • Reflect on Each Day.
    • Practice Critical Thinking Daily.
    • Maintain Flexibility.
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    How do you develop clinical reasoning skills? ›

    Top 10 Strategies for Building Clinical Reasoning Skills
    1. Prioritize. Apply. ...
    2. Use formative assessment. ...
    3. Work around clinical shortages. ...
    4. Personalize the experience. ...
    5. Tell a story. ...
    6. Maximize manikin-based simulations. ...
    7. Apply real-world, evidence-based scenarios. ...
    8. Flip the classroom and the sim lab.

    What is critical thinking in nursing process? ›

    Critical thinking is applied by nurses in the process of solving problems of patients and decision-making process with creativity to enhance the effect. It is an essential process for a safe, efficient and skillful nursing intervention.

    What are good clinical skills? ›

    The term 'clinical skills' involves history-taking, physical examination, clinical investigations, using diagnostic reasoning, procedural perfection, effective communication, team work and professionalism.

    What is pattern recognition in clinical decision-making? ›

    Pattern recognition occurs when the nurse compares the signs and presenting symptoms of a patient problem with patterns recognised from memory in order to match the presenting trend (Gordon, 1987).

    What are the three elements of clinical reasoning? ›

    Clinical reasoning may be characterized into three elements: scientific, ethical, and artistic.

    What is critical thinking and examples? ›

    Examples of Critical Thinking

    A triage nurse analyzes the cases at hand and decides the order by which the patients should be treated. A plumber evaluates the materials that would best suit a particular job. An attorney reviews evidence and devises a strategy to win a case or to decide whether to settle out of court.

    What are 3 examples of how a nurse would utilize critical thinking when performing client care? ›

    Some of the most important critical thinking skills nurses use daily include interpretation, analysis, evaluation, inference, explanation, and self-regulation.
    • Interpretation: Understanding the meaning of information or events.
    • Analysis: Investigating a course of action based on objective and subjective data.
    Aug 25, 2021

    How do you develop critical thinking and problem-solving skills? ›

    How to Develop Critical Thinking
    1. Don't Believe Everything You're Told. The first step to critical thinking is to consider more than one point of view. ...
    2. Don't Believe Everything You Think. ...
    3. Ask Questions. ...
    4. Research Deeper. ...
    5. Evaluate Your Work.

    How do you develop critical thinking skills? ›

    How to improve critical thinking
    1. Become more self-aware. ...
    2. Understand your mental process. ...
    3. Develop foresight. ...
    4. Practice active listening. ...
    5. Ask questions. ...
    6. Evaluate existing evidence. ...
    7. Meeting with a mentor. ...
    8. Participating in team-building exercises.

    What is the following requirements in critical thinking? ›

    The key critical thinking skills are: analysis, interpretation, inference, explanation, self-regulation, open-mindedness, and problem-solving.

    What is good clinical reasoning? ›

    Good clinical judgment is required to select the most relevant research evidence. The best clinical judgment, that is, reasoning across time about the particular patient through changes in the patient's concerns and condition and/or the clinician's understanding, are also required.

    Why is critical thinking so important? ›

    Critical thinking helps people better understand themselves, their motivations and goals. When you can deduce information to find the most important parts and apply those to your life, you can change your situation and promote personal growth and overall happiness.

    What is the importance of critical thinking? ›

    Critical thinking can help you better understand yourself, and in turn, help you avoid any kind of negative or limiting beliefs, and focus more on your strengths. Being able to share your thoughts can increase your quality of life.

    Why is critical thinking important for students? ›

    We use critical thinking skills every day. They help us to make good decisions, understand the consequences of our actions and solve problems. These incredibly important skills are used in everything from putting together puzzles to mapping out the best route to work.

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