Dental students did not have formal courses in nursing or social work but began working with these individuals in team approach to care.
Critical Thinking for Nurses
A central theme is to develop a model with learning outcomes to guide IPP learning for the practitioner—patient interactions. It is assumed that development of a model will precede definitive assessment methodology. Thus, a more extended purpose is to offer an IPP learning model where the field is largely lacking and invite input and commentary on alternative models for more definitive study.
Because learning outcomes are largely lacking for IPP, it is logical that definitive competencies will be refined with development of definitive learning outcomes. A challenge for IPP is that there are several experts. To overcome this challenge, a synthesis of the thought processes of the experts in various disciplines was derived and described succinctly enough for application to a patient or case.
Subsequent refinements can include validation of the most important questions from team members. Primary care is defined as health care at a basic rather than specialized level for people making an initial approach to a doctor or nurse for treatment. Although the questions derived from respective team members reflect expertise, the resulting list of questions is largely common sense.
The authors are not aware of a comparable set of questions being published previously. Students were introduced to the IPP concept of systematically including the perspectives of each health care team member during their orientation to the rotation. Faculty offered guidance for case selection and documentation. A PowerPoint template was provided based on previous comments from the students to enhance student presentations.
Six patients were presented in each session. One faculty member Examiner 1 evaluated the performance of all the students, with a second assessment for 22 of the presentations. The assessment threshold means including the thinking of each team expert into patient planning. Although not an explicit purpose, the project was expected to offer feedback on how successful the penetration of different health perspectives was when moving from didactic courses to the minds of students during the formation of patient care plans. Thus, the learning guide served as the assessment instrument.
Each health team perspective is in the PowerPoint template.
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Thus each student at least minimally alludes to each of the perspectives. At this stage of model development, assessment is limited to whether the student goes beyond reading the perspective to incorporate the health perspective into patient planning. Students nearly all the time included some mention of each discipline because each was on the learning guide. Random corroborating assessments were done. A key assumption is that a practitioner repeatedly asking the right question will get better at answering the question with experience.
Implementation of the learning guide with the perspectives of each health team member was successful in that each student completed the presentation and considered each step. A surprising finding was the spectrum of penetration of health perspectives as will be expanded in Section 4.
One design feature of the exercise is the frequency of incorporating health perspectives into patient analysis. The result is that each student systematically incorporates eight health perspectives for their patient. In addition, each student observes five other students incorporating eight health perspectives for a total of 40 health perspectives being systematically incorporated into patient care in one session. The potential importance of the environment for repetitive and extensive exposure to the systematic approach will be in Section 4.
To analyze responses, 69 patients were presented by students in the Geriatrics Special Needs Clinic with each student expected to systematically incorporate the perspectives of eight health team members for each patient. The primary care perspective was most often included. As the course progressed, improvement was seen in the inclusion of the nursing and social work perspectives.
Developing Critical-Thinking Skills in Student Nurses
It is noted that pharmacy and nutrition have been formal courses in the college for decades. Nursing and social work have not had courses, but providers were added to the clinic in Calibration was performed by two dental faculty members. Although this is not the definitive model in establishing learning outcomes for the health care team in IPP, it is a step forward. We are not aware of a systematic collection of key perspectives for the health care team articulating what every member of the team is to do think in their next patient encounter.
We submit that systematic inclusion of each team member's thought process enhances the systematic improvement of planning and risk assessment for such patients. We further submit that this model is educationally sound and practical in guiding learning for team members. Although the emulation model applied to IPP was used by dental students, this skillset is practical for any member of the health care team. Penetration level, or lack thereof, for the perspectives of health care providers became clear in a way that may not have been possible without an explicit skillset.
The association suggests that students with formal instruction in a discipline are more likely to include the thinking and health perspectives into patient care. The perspectives with formal coursework in the students' curriculum were the ones more often included during this exercise. The association between the extent of inclusion for a health perspective and the extent of didactic curriculum experience may be a key finding.
As with previous critical thinking exercises, this one took multiple years to make it feasible and clinically relevant Marshall et al. As with previous critical thinking skillsets, the IPP skillset saw improvement over presentations that had no skillset as a learning guide Marshall et al.
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Health issues in this clinic include dementia, stroke, Parkinson's disease, and multiple medications with side effects that result in dry mouth, mental health issues, cancer treatment, organ transplants, diabetes, and trauma, just to give examples of the vast diagnoses of patients. The significantly higher penetration of some perspectives is interpreted as a reinforcement of the importance of formally including these perspectives in the didactic part of the students' curriculum.
For primary care, it seems logical that the course in physical assessment plus the daily review of each patient's health history will be associated with a more systematic inclusion of this perspective. Assessment is in the early stages of development. The threshold of inclusion into patient planning seems adequate for this stage of development—including demonstrating when a health perspective does not need to be used in patient planning.
Continued adjustments are planned for calibration and to ensure consistency in assessment.
Critical Thinking and Nursing
Future directions can also include the addition of perspectives for other team members, for example, the behavioral therapist. The skillset has limitations. An inherent limitation is that every critical thinking skillset is incomplete and in a constant state of revision. The next step is to include a fellow team member a social worker in the assessment process, which will likely increase the number of disagreements among those who evaluate the student presentations.
The current model does not have a formal remediation protocol. Although the geriatric clinic setting makes for a rich IPP experience, complicated patients rarely have clear treatment plans. These complicated patients can have several alternatives, making clear performance assessments by faculty equally challenging Marchini et al.
The emulation approach considered here offers a succinct and systematic way to integrate the perspectives of each health team member into learning outcomes. The focus is on learning and assessment using the same instrument. The emulation approach applied here follows educational concepts previously reported.
The exercise was successful in getting each student to consider the key perspectives of each health team member. The emulation approach revealed strengths and weaknesses of the curricula for each of the health perspectives. A student has met the assessment threshold when the student incorporates the perspective into patient planning—or demonstrates that the perspective will not change planning. Calibration efforts showed further refinements are needed to assess the depth of the student's grasp of each health perspective. The learning framework builds on previous work challenging the student to use judgment to coincide with the thought processes of the health team members.
In so doing, the model expands the body of scholarship in the critical thinking domain. Volume 5 , Issue 4. The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.
newadsmedia.com/components If the address matches an existing account you will receive an email with instructions to retrieve your username. Strong critical thinking skills will have the greatest impact on patient outcomes. So, what is critical thinking and how do we develop this? Simply put, critical thinking in nursing is a purposeful, logical process which results in powerful patient outcomes. This definition essentially covers the nursing process and reiterates that critical thinking builds upon a solid foundation of sound clinical knowledge.
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Critical thinking is the result of a combination of innate curiosity; a strong foundation of theoretical knowledge of human anatomy and physiology, disease processes, and normal and abnormal lab values; and an orientation for thinking on your feet. Combining this with a strong passion for patient care will produce positive patient outcomes. The critical thinking nurse has an open mind and draws heavily upon evidence-based research and past clinical experiences to solve patient problems.
How does one develop critical thinking skills?
A good start is to develop an inquisitive mind, which leads to questioning, and a quest for knowledge and understanding of the complex nature of the human body and its functioning. Critical thinking is self-guided and self-disciplined. Nursing interventions can be reasonably explained through evidence-based research studies and work experience.
A strong sense of focus and discipline is also important for critical thinking to work. If thinking is unchecked, nurses can be easily misguided and deliver flawed patient care.