What is this thing, we call “critical thinking”?

The National Council of State Boards of Nursing (NCSBN) is currently working on the Next Generation NCLEX (NGN), which is projected to be rolled out in 2023. The project in part is attempting to accurately test Clinical Judgement in a way that is more like the way a nurse practices (Currier, J. 2019). In just under 5 minutes, Jacklyn Currier will review how the NCSBN defines the clinical judgement model and that they are working on ways to more accurately test Clinical judgement using context.

You can access this episode from this link: https://www.ncsbn.org/13534.htm. More about the NGN Project can be found on their website: ncsbn.org.

So… the question is...

How does the Next Generation NCLEX impact the expectations for the Clinical Nursing Instructor?

Students have long told us, that it is their Clinical Nursing Instructor that has been the one that helps them put it ALL together (Cangelosi, et al., 2009). Therefore, this means the instructor will need to continually seek out and implement teaching strategies that will help students improve their critical thinking (CT) skills as they build their competence with Clinical Judgement (CJ).

We need to look more closely at “how” clinical nursing instructors (CNI) can do this. How do CNI help students to not only bring things together but also teach CT, which is the process of thinking while CJ is the result-of our thinking?

I am sure we can all agree that having the ability to think critically is extremely important in Nursing. Long gone are the days of being “told” how to care for a patient. After all, isn’t this thing we call “Critical Thinking” embedded into “what we do or what we should be doing as nurses?

Of course! This is why it is so important that our students develop this skill of critical thinking (Von Colln-Appling & Guiliano, 2017).

What is this thing, we call “critical thinking” ?

Apparently, we don’t seem to have one universally accepted definition and not only that, the definition seems to be ever evolving (Popil, 2011). Educators seem to use different verbiage, such as, critical thinking, clinical reasoning, clinical decision making, and clinical judgement, which contributes to the confusion (Manetti, 2019). Through her research, Manetti (2019) helps to clarify the definitions for these terms, as well as defining more clearly the actions taken by a nurse when demonstrating “sound clinical judgement” not “just” clinical judgement. For these reasons, I am suggesting her article an important read. You can download the pdf from this link: https://onlinelibrary.wiley.com/doi/epdf/10.1111/nuf.12303

Tunnel Vision

Students, as well as, novice faculty have a bit of tunnel vision, often only seeing the clinical rotation as an opportunity for practicing psychomotor skills. However, instructors cannot fall into this “psychomotor skills only” trap with their students.

The clinical rotation has a larger purpose.

If we are to have new graduates up to speed in their abilities to see the bigger picture beyond the skills and tasks, we must work with them to develop their thinking skills.

No doubt nurses need to be able to perform psychomotor or kinesthetic skills. However, instructors must assist students with the ability to think more deeply about what they are doing in the big picture of patient care, which is so much more than performing a skill. And… the perfect place to learn “how” to think is during active learning, which could very well be through a psychomotor or kinesthetic skill.

Here the student is thinking about the procedure.

But, even more than the steps of the procedure, the student should be encouraged to think about more.

  • Does this patient fall into or out of the textbook version?

  • Do any of the steps of the procedure need to be individualize for this patient?

  • What are possible complications that could be encountered while performing the procedure?

  • What patient teaching is needed?

  • What aftercare will be needed (by the nurse or the patient), if any?

  • What future nursing observations/assessments will be needed?

Nurses need to be thinking ALL the time in a circular manner avoiding the linage trap. We need to be thinking about What We do, as well as, What OTHERS are doing as a part of the total patient care picture (the big picture).

Did you realize that YOU, the Clinical Nursing Instructor can be considered the most important strategy in teaching critical thinking?

How?

Through role modeling critical thinking leading to the patient care decisions, also known as, clinical judgement.

According to students, they learned best from an instructor that is a good role model. Students defined instructors as a good role model when they demonstrated the behaviors that were expected of them, such as being well organized, professional, familiar with the staff and routines of the clinical unit, and could multitask (Niederriter, Eyth, & Thoman, 2017). Therefore, if we expect it of them then instructors need to demonstrate that same behavior. Instructors need to make “their” thinking visible to the student through their behaviors.

The instructor’s presence and their interactions with students impacts a student’s ability to learn. Most specifically, their ability and the ability to think critically. Therefore, it behooves a clinical instructor to increase their own skills in thinking critically, as well as their ability to demonstrate their critical thinking visually to their students. Building critical thinking and judgement skills MUST be the underpinnings of the clinical instructors efforts throughout each clinical experience utilizing a variety of teaching and learning strategies.

I am anxious to hear about your ideas on how you are role modeling and teaching critical thinking and clinical judgement. If you are willing to share a strategy, I would love you read it.

References

Cangelosi, P. R. (2007). Accelerated second-degree baccalaureate nursing programs:

What is the significance of clinical instructors? Journal of Nursing Education, 46(9), 400-

5. Retrieved from http://search.proquest.com/docview/203928208?accountid=1099

Currier, J. (2019). NGN Talks: Clinical Judgement Model Episode 6 Video Transcript. National

Council of State Boards of Nursing, Inc. Retrieved from

https://www.ncsbn.org/13534.htm

Popil, I. (2010). Promotion of critical thinking by using case studies as a teaching method. Nurse Education Today. 31(2), 204-207. doi: 10.1016/j.nedt.2010.06.002.

Manetti, W. (2019). Sound clinical judgment in nursing: A concept

analysis. NursForum. 54(1).102– 110. https://doi.org/10.1111/nuf.12303

Niederriter, J. E., Eyth, D., & Thoman, J. (2017). Nursing Students’ Perceptions on Characteristics of an Effective Clinical Instructor. SAGE Open Nursing. https://doi.org/10.1177/2377960816685571

https://journals.sagepub.com/doi/pdf/10.1177/2377960816685571

Von Colln-Appling, C.V., & Giuliano, D. (2017). A concept analysis of critical thinking: A

guide for nurse educators. Nurse education today, 49, 106-109. doi:10.1016/j.nedt.2016.11.007

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