Acquisition of Nursing Critical Thinking Skills Strategies

Aims

Aims are general statements of the expected educational intentions of the subject taught (Butt, 2006). The aims of the lesson are:

1. To provide nursing students with opportunities to acquire critical thinking abilities necessary for distinguishing genuine patients

2. To enable students to apply and implement the learnt critical thinking strategies learnt in actual practice with human patients.

3. To provide opportunities for students to develop critical thinking skills and practice clinical decision-making with appropriate faculty guidance.

4. To equip the students with the necessary assessment skills required in identifying patient problems, analysing these problems in terms of their implications for the underlying disease processes and psychosocial needs, and taking actions to optimize the recovery situation.

Learning Objectives

Learning objectives are specific and measurable targets to be attained by students taught (Kerry, 2002). By the end of the lesson, the student shall be able to:

1. Recall knowledge and facts learnt in class.

2. Apply the comprehension thinking to articulate and establish the relationship among data.

3. Apply the concept learning new hypothetical situation to arrive at correct answer.

4. Apply the analysis in breaking problems into components and examine the components to establish trends and evidence generalization.

5. Present items or thoughts together in new ways-synthesis.

6. Evaluate arguments for validity or relative worth of a view point or process based on established criteria.

Teaching Philosophy

The teaching philosophy for lessons is derived from social and situational theories that put focus on relationships and interaction between individuals as basis for learning process (International Conference on Innovation and Entrepreneurship, Worasinchai & Ribiere, 2014). The theories hold that students must engage in meaningful discussions and conversation with one another in order to learn from them. I hold the view that students learn best from their peers. Consequently, peer learning shall be done in every teaching session. Teaching Strategies Teaching strategies are methods and processes the teacher uses to engage student and facilitate the learning process (Programme for International Student Assessment., & Organisation for Economic Co-operation and Development. 2010). These strategies are outlined below. 1. Peer learning. Peer learning is a learning strategy that entails students learning from themselves in pairs or groups (Frankland, 2007). For peer learning section, the teacher shall group students and provide task for each group to perform. Peers shall together to set up a support network for group learning and support. 2. Observation and feedback. The teacher provides clear, honest, detailed and objective feedback on the learner’s performance so they may identify areas in need of improvement or levels of achievement. 3. Demonstration Demonstration is a type of learning that involves exhibition and explanation of the concept, process, procedure, idea or experiment (Sankaranarayanan & Sindhu, 2012). A student will be allocated to perform as a patient with a scenario, and the students will talk to him while he answers them.

4. Reflection.

Reflection involves careful consideration of concepts, ideas, knowledge, beliefs, processes and information on the basis of its premises and conclusions that supports it (Suqerman, 2000). Time to make sense of things will be given after the performance of the human stimulator to make sense of everything. 5. Lecture A lecture is a method of teaching that involves the presentation of the subject through talking (Jarvis, 1995). The teacher will explain various concepts in class. Lecture time shall be used by the teacher to teach students about the topic for the session. 6. PowerPoint Presentation The teacher will make a short presentation to introduce the topic and key issues. Procedure The teacher makes a 15 minute PowerPoint presentation followed by a 15 minutes pre-test (multiple answer questions) given to students. Session begins, each having 120 minutes 1. The teacher gives a 15min lecture to students.

2. 15 minutes pre-test given to students (7 multiple answer questions). 3. Teacher asks one student to pretend as patient and the rest of students as the student question. The demonstration and practice on human stimulator as patient last for 20 min. 4. Students can ask reflection questions on the demonstration for 10 min. 5. Students give 10 min break. 6. Students placed in groups and asked to discuss the concept learnt with their peers for 20 min. 7. The teacher gives students observation feedback for 15 min.

8. 15 minutes post-test given to students (5 multiple answer question).

Rationale

Critical thinking is an essential skill learnt by students studying to become nurses. It is defined as a process of intellectually and actively conceptualizing, using, analysing, synthesizing and assessing information to guide action or belief (Higgs, 2008). Critical thinking is based on intellectual competencies such as clarity, accuracy, breadth and precision and logic (White, Duncan & Baumie, 2013). Nurses use critical thinking skills to apply model and theories learnt in their studies to patients (Cody & Kenney, 2006). Nurses are required to make well-reasoned clinical decisions derived from reflection and critical thinking. To this end, they are taught critical thinking strategies equip them with skills needed to make decisions reasoning. Critical thinking enables the nurses to establish the needs of patients and make a decision on the most appropriate nursing action to take (Brunner &Smeltzer, 2010). Some nursing schools offer critical thinking course as a separate unit requirement. Others integrate its concepts in other related course subjects. Irrespective of how nursing schools approach the teaching of critical thinking skills, it remains important in nursing practice. Critical thinking according to Watson and Glaser has three elements. These elements are skills, knowledge and attitude (Hersen & Thomas, 2003). A critical thinker must be motivated to look at the problem and find solutions to it. He or she must also have good understanding and knowledge of the problem (Bradshaw & Lowenstein, 2011). More importantly the person must have the appropriate skill to apply and knowledge to resolve problems (Andrea, 2009). Nurses are confronted by problems that often need quick and appropriate solutions. For instance, a nurse is expected to make a decision on whether to call a doctor or ignore when the patient conditions deteriorates. His or her decision can either save the patient’s life or lead to death. Hence, they require training on critical skills to equip them with abilities to make independent judgement and assessment patient’s conditions (Lyer, 2006). Nurses apply critical thinking skills in various aspects of their work. In assessment, nurses use critical skills to gather relevant data from patients through interview, observation or from records (Comer, 2005). They must also have critical thinking skills to differentiate important from non-important data and validate the data using other data sources. In diagnosis, they use the skills to organize data into patterns, establish a relationship between data and make a comparison between patterns and theories (Wilkinson, 1996). Again, the skills are used to explore individual assumptions on patients’ conditions and make a judgment on patients’ health concern and explain those concerns to the clients. In planning, critical thinking skills are used to identify patient’s concerns, find out desired health outcome and choose suitable intervention. On the other hand, in the implementation, nurses use the skills execute interventions make comparison of baseline data and prevailing status. The teaching plan for the delivering the topic ‘Strategies for the Acquisition of Nursing Critical Thinking Skills’, Incorporates entrenched teaching practices and learning theories. The teaching plan is more students centred. Student-centred learning put emphasis on discovery of knowledge as opposed to passing information (Cook & Sittler, 2008). Only 50 minutes out of 120 session minutes are dedicated for teachers’ active involvement in class. The remaining time is taken up by student-centred teaching methods that include peer teaching, demonstration, and reflection. These student centred methods of teaching support social learning theories that focus on peer learning as most suitable method of acquiring knowledge. Given that the program involves the development critical thinking skills, students can learn better by applying what they have learnt by interacting with peers. The demonstration part of the teaching gives the student opportunity to identify a problem and use learnt skills to solve it. They are expected to extract useful information from the patient and use it to understand the patients’ concerns. These tasks require critical thinking skills. The course content for teaching critical thinking skills is very elaborate. It encompasses key areas of learning that include the development of critical thinking skills and characteristics of a thinker. Besides, the learning outcomes have all been considered in the development of the teaching plan. Consequently, the plan meets the key requirement of teaching plans. Teaching plans have aims, procedure and resources (Mariotti, 2009). This information is captured in the template and it relates to the main topic. Apart from course content, there are sections of the plan that are to provide information on situational factors that may have effects on the learning critical thinking skills. These sections include learners’ entry level and special needs.

Reflection in action

Reflection is a philosophical understanding of how one can pick up learning through experience and use distinctive methodologies to the same situation (Nairn et al. 2012). It is also the persistent process of active thinking and putting into consideration the supporting evidence that forms knowledge to a given scenario. Critical reflection is facilitated by a person’s mind and emotions. According to Vachon and Leblanc (2011), reflective practitioners are characterised by open-mindedness, whole heartedness and responsibility. Reflection prior to action is essential for impacting learning and teaching because it allows for the teaching plan to cater for individual learners based on theoretical conceptualisations of their needs and interests. I was, therefore, prepared to meet the students, interested and motivated to learn how to apply critical thinking in the field of nursing correctly. I also anticipated that the use of a variety of teaching strategies such as PowerPoint presentation, discussion questions, a brief demonstration, group work and group discussions would cater for the different learning styles of the participants. For the teaching and learning process to conform to how critical thinking is practised, I therefore saw it very vital to modify strategies and approaches during the presentation to meet demands that were not catered for in the planning phase. In delivering the lecture, I was quite confident as I have worked as a clinical nurse in hospital for three years, giving students necessary skills for working in a lab area, hospital or other working environment. The allotted time for my lecture was 15 minutes, but my teaching plan was structured to cover a slightly longer time frame. I, therefore, had to make a decision to adjust some of the strategies and to approach some aspects of the lesson differently from what was outlined in the teaching plan.

To ensure that students understood well this concept, I took the initiative of not following the teaching plan as initially outlined. The PowerPoint presentation was the first to be presented. However, there was no enough time for questions from the students, as well as discussion hence clarification of the unclear concept, was not successful. I went on to demonstrate the procedure of acquiring critical thinking while repeating the initial PowerPoint presentation. This demonstration helped to clarify any concerns the participants would have had from the initial presentation. This is because they had a chance to view the step-by-step procedure. My experience facilitated the quick movement through the procedure without neglecting relevant details and therefore the students were able to understand the process. I gave each student the opportunity to demonstrate the procedure. Each student constructed a checklist which he or she would use to perform the procedure. Thereafter, each student demonstrated the procedure while one of the other students explained to the students what was being done. The modifications I made to the teaching plan were important because they met the stated objectives within a given timeframe. The reflective process that I followed in order to make the adjustments was essential, and is terms as reflection in action (Ely & Scott, 2007).

Feedback played a key role in the process. From the comments made by the students in their fifteen-minute post-test, I believe that the process of reflection was successful. Although there were constraints such as non-adherence to the teaching plan and time shortage, the objectives of the teaching session were successfully met. The students reported that they got an understanding of how to perform the procedure, the steps to follow and the order in which those steps are followed. In addition to the students reporting that they are able to understand the procedure, I was able to estimate how well they understand the procedure based on the demonstration and narration that they exhibited. During each demonstration, I observed the student performing the procedure, and whenever a mistake was being made, I quickly pointed it out so that the correction could be made immediately. With these corrections, they were able to understand the procedure even better. The students themselves were able to reflect in action, revealing that in any learning situation all parties have to be actively involved in reflecting on and modifying practice (Rubenfeld & Scheffer, 2010). In general, the teaching session was a decent experience for me. I discovered that in conveying teaching sessions, the instructor must consider the needs of the understudies and that their individual learning styles must put into consideration.

Outcome criteria

The outcome criteria are another important process in nursing. In this process, what nurses have been learning and practicing is put into practice. To accomplish the objective of this process, the students demonstrated knowledge of the performance procedures, risks and precautions related to acquisition of critical thinking in nursing by producing a ten-minute reflective paper, earnestly taking part in group discussions , airing their views, coming up with reflective questions and comments, teaming up in the making of an itemized informative agenda on the most proficient method to perform the process and doing a demonstration of the technique.

Evaluation of teaching

Amid this stage, I measured how well the students had understood the procedure. The key purpose of this stage was to gather information to assess the nursing consideration. The stage is simultaneous or on-going on the grounds that I assessed and settled on a choice amid the usage period by the students of the methodology. One of the key exercises that I carried out at this stage was to measure the attainment of the objective of goal and the modification of the teaching plan because I found out that it did not achieve the objectives (Bradshaw & Lowenstein, 2011).

To ensure that the evaluation process was successful, I issued the students with post-test sixth week of the teaching session. The post-test comprised a fifteen minute questionnaire where they had to tick in the boxes next to what was useful to them during the session. Moreover, by completing the questionnaire, I was able to see that the teaching session was successful because it met the criteria that all the notes that I had given them were relevant. Moreover, I ascertain that the procedure for acquiring critical thinking was well described and performed satisfactorily. Interviewing was also another criterion that I used to evaluate the teaching session. After interviewing the students, they said that they had gained a vast knowledge in the field of nursing especially in the application of critical thinking. They also said that through the demonstration and presentations in the class, they were able to gain a lot of knowledge that they would apply in their future career.

I also picked two students who expressed a high level of performance as well as two who expressed a low level of performance and learning. I asked them to explain to me their views pertaining to the session, and they had different ideas. The high performing students said that the session went smoothly and that the objectives were successfully met. However, the other two students had some complaints. These complaints act as the basis for future recommendation in my teaching sessions. The students complained of inadequacy of time for discussion. This was quite a challenge because some students were not able to hear from each and every member of their group. This triggers me to allocate enough time in my next teaching session to avoid the issue of time constraint. The students also suggested that not all learning materials were available for the session hence recommended that in my next session that I ensure that they are in a capacity to access the internet.

They also recommended that to ensure they are in a capacity to meet their learning objectives well they should be taken to a hospital setup where they can observe how the skill is applied. In summation, in my next lecture, I will evaluate of the entire learning session in the form of peer review. Here, I will ensure that the students make comments on each other’s procedure, commending good techniques and highlighting errors or oversights. I will also make appropriate general comments on the students’ performance of the procedure by making any further clarifications. Finally, I will require the students to complete a feedback evaluation of the lesson.