In this situation, lack of critical thinking can lead to the delivery of inappropriate care. This is an example of how a false belief can lead to a badly judged decision. You now find yourself reluctant to advise mothers in your care to send their children to nursery even when the social situation recommends that this is the best arrangement for the child concerned. Kida provides a summary of the most common thinking errors.
These include: being persuaded by personal experience rather than objective evidence and preferring evidence that supports our ideas rather than objective evidence.
Critical thinking, and in particular using reflection as we discuss in Chapters 4 and 5 , helps us to avoid these thinking errors. Critical thinking involves taking a step back and thinking logically about the evidence that you have. Facione 2 explains why critical thinking is important: Critical thinking is essential as a tool of inquiry.
While not synonymous with good thinking, critical thinking is a pervasive and self-rectifying human phenomenon. This is very important in health and social care.
You cannot help bringing your own experiences with you into practice. What is important is that you acknowledge these and examine your beliefs in a critical way. You will hear a large amount of professional dialogue and have access to a vast amount of professional literature, and you need to work out what is useful and relevant and what is not; you need to make sure you are using reliable information wisely, both in your academic assignments and to inform your practice. In this book we will explain how you do this.
Price and Harrington 8 have recently defined critical thinking as the gathering, sifting, synthesizing and evaluating of information which enables the practitioner to act as a: knowledgeable doer — someone who selects, combines, judges and uses information in order to proceed in a professional manner. Wade and Tarvis 7 define critical thinking as: the ability to assess claims and make objective judgements on the basis of well supported reasons and evidence rather than emotion and anecdote.
Critical thinkers are able to look for flaws in argument and resist claims that have no support. In other words, if you are a critical thinker, you think carefully about what you read, see and hear. When you hear a news story or listen to a discussion among friends, you question the quality of the evidence and the conclusions drawn from that evidence.
If the topic is important to you, you endeavour to find out more information which will help to make sense of the facts. This enables you to form an overall view and then apply it to the situation at hand.
Have you been a critical thinker in the past? Refer back to how you have used information in the past and consider the potential problems with your approach. Only use readily available sources? Listen to advice from colleagues without questioning? Copy what you observed without question?
Believe everything that you read without questioning the authority of the writers or the quality of the arguments or evidence? We need to ensure that we take into account all the facts before making judgements. This helps us personally and professionally to ensure we make considered and reflective decisions, considering the relevant evidence and not just following the actions of others. Is critical thinking a new idea? Critical thinking is not a new idea in health and social care and many professionals have always questioned what they read, see and hear.
The ancient roots of critical thinking date back to the ideas of the Greek philosopher Socrates, who is credited with pioneering a questioning and rational approach to problem-solving and encouraging people to reject statements made on the basis of confused meaning and inadequate evidence.
We can see then that the concept of critical thinking has stood the test of time, however, as shown by Examples 1 and 2 below, the the concept is neither universally nor routinely applied. Example 1: evidence of a lack of critical thinking Take for example a recent media story which was running in early January Newspaper and television reports Daily Mail, The Guardian, The Daily Telegraph, Channel 4 News, 3—6 January documented that: hundreds of women have become pregnant whilst using a particular contraceptive device Almost every newspaper and news programme in the UK carried this story at this time.
Media reports implied that the number of unwanted pregnancies associated with this device was excessively high and exceeded the number of unwanted pregnancies associated with other contraceptive devices. Despite the stated number of pregnancies associated with the device, researchers for the programme quoted a failure rate for Implanon of 0. This would seem to be a clear example of statistics being represented in a misleading way, and illustrates perfectly why it is so important to be critical of what you read and to look beyond the headlines of a newspaper report.
Critical thinking requires that you look beyond the initial headline that catches your eye. In the examples cited above, critical thinking was required to question the source of the evidence and look further afield, considering the huge numbers of people successfully using the device compared to those experiencing problems.
Example 2: further evidence of a lack of critical thinking The controversy over the measles, mumps and rubella vaccination MMR gives us another good example of why it is so important to be critical of what you read, see and hear — in other words, to critically appraise. The original research by Wakefield et al. This research paper has now been retracted by the publishing journal, The Lancet.
This was because the evidence presented was later found to be flawed. However, before it was retracted, it attracted wide publicity. The paper described how 12 children who had received the MMR vaccination also went on to develop either autism or bowel disease. Yet millions of children have had the MMR vaccination and suffered no ill effects.
Anyone looking critically at Wakefield et al. A critical thinker would have used rational judgement and critical appraisal to explore the quality of the paper and to expose its weaknesses.
Yet somehow, this paper was so well publicized, and not critically evaluated, that vaccination rates plummeted as parents feared for the safety of the vaccination.
In a further twist to this story, not only was the study very weak, but much later on it was found to be fraudulent — there is evidence that the details of some of the 12 children described in the study were fabricated Deer We have given the examples of the misleading newspaper headlines and misinterpreted poor quality journal article. Indeed there is evidence that many professionals do not always think critically about the evidence they use. When researchers Petrovic et al. This suggests that these health care professionals had either not read or thought critically about the evidence relating to this aspect of their practice.
Unfortunately there are many other such examples. Using a critical approach, he examines the minimal evidence on which many of these ideas are based and yet which attract huge popular interest. An example of critical thinking in action In order to be a critical thinker you need to be able to understand and make sense of what you read, see and hear.
As a professional, inundated with a vast amount of information, you are very likely to come across sources of information that conflict with each other. You need to understand why this is the case in order to make sense of what you read, see and hear. However, if you start off by developing the right skills, you will become more and more able to do this.
Facione describes the characteristics of a critical thinker as being someone who does not accept things at face value: The ideal critical thinker is habitually inquisitive, well-informed, trustful of reason, open-minded, flexible, fair-minded in evaluation, honest in facing personal biases, prudent in making judgements, willing to reconsider, clear about issues, orderly in complex matters, diligent in seeking relevant information, reasonable in the selection of criteria, focused in inquiry, and persistent in seeking results which are as precise as the subject and the circumstances of inquiry permit.
In Example 3 we will highlight the characteristics demonstrated from the above quote in bold. Example 3: critical thinking in action In this example we demonstrate how you can take a critical approach.
We will consider the information provided by a letter printed in a health care journal: Geleijnse, J. You read the letter. Inquisitive and open minded, you remember attending a lecture about food supplements and have heard about the potential benefits of omega 3 fat supplements. You remember that omega 3 fats are used to prevent or alleviate a variety of illnesses. This letter seems to question their benefits.
Feeling somewhat confused yourself, you promise to find out more information. You need further information. Indeed Facione tells us to be diligent in seeking further information. It does not provide sufficient evidence upon which to base any firm conclusions although it could trigger further action on your part.
The evidence that is generally most useful in guiding our professional practice is research evidence. When you read the letter more closely, you discover that it is referring to the use of omega 3 fats for the prevention of cardiovascular disease and cancer in particular.
Given that the letter itself is not good evidence upon which to base your practice, your next step should be to search for and find the article to which the letter is referring using subject-specific search engines we will discuss how to do this in Chapter 3. When you locate the research you find that it is a systematic review. A systematic review is usually very strong evidence indeed. Whereas one piece of research gives you results from one study, a review of results looks at the results of all studies that have been undertaken in a particular area.
In a systematic review, all the relevant papers that have been published on a particular topic are collated and reviewed so that all the evidence can be seen together — we will discuss more about this approach in the next chapter. In this case, the researchers examined research which explored the role of omega 3 fats in the prevention of cardiovascular disease, cancer and overall morbidity. The authors concluded that there is little evidence that omega 3 fats play an effective part in the prevention of these diseases.
However, when you look at this piece of research in more detail, you find that the researchers included in their review not only studies of omega 3 fats but also of another acid linolenic acid, a vegetable oil not to be confused with alpha linolenic acid. In other words, the results of studies using non-omega 3 fats were combined with studies of using omega 3 fats only, and the review did not focus solely on omega 3 fats.
In order to establish the effectiveness of omega 3 fats in the prevention of disease, researchers would need to review research papers relating only to the effects of taking omega 3 fat supplements. You could go on to say that the benefits of omega 3 fats are still being explored. From Example 3, you can see why it is so important to be a critical thinker and a critical reader.
In working through this example, you have demonstrated that you can make sense of complex issues Facione This enables you to get behind the headlines to see what the evidence is really telling you.
You can see how a letter alone is not sufficient evidence upon which to base practice or recommendations to patients or clients. It is important to dig beneath titles and headlines to find out what the information is really about. It is also important to read and ask questions about what people tell you, and also to make sense of what you read, see or hear. You will often come across the following terms: Critical thinking is when you adopt a questioning approach and thoughtful attitude to what you read, see or hear, rather than accepting things at face value.
Critical thinking involves a critical appraisal of the information available to you. Critical appraisal is when you consider the strengths and limitations of the evidence you read see and hear, depending on the type of evidence you have. What is being said? How did they write this? Who is telling me this?
When was this written? Why has this been written? This means making a judgement about the facts and the quality of evidence on which these facts are based. Critical appraisal involves critical analysis. Critical analysis is when you break down or explore in depth all the information available relating to an issue or question. This may involve exploring what is happening and the reasons why see Examples 1, 2 and 3.
You may need to consider and access alternative perspectives, including theory. You can use these questions to help you consider the Six questions to trigger critical thinking Where did you find the information? Or did you access it through a systematic search?
Is their line of reasoning logical and understandable? If it is research or a review of research, how was it carried out, was it done well and do the conclusions reflect the findings? Is it a research study, professional opinion, discussion, website or other? Are they an expert in the topic? Could they have any bias?
How do you know? Older key information may still be valid, but you need to check if there has been more recent work. You can use these questions as a prompt to help you ask questions about any information you have; to make a judgement about its quality and therefore how you use it in your practice or academic work.
Unfortunately, there is no exact way to judge the relevance of information — this remains your judgement. However, as a general rule, research studies will provide you with stronger evidence than more anecdotal literature and information from experts will be stronger than information from people with less experience or who are less well known.
Also, recent high-quality literature will be stronger than older literature, but no literature is perfect. Identifying the type of information you use We suggest that you get used to citing some detail about the information that you use in your academic work and be prepared to present the information in your practice environment.
For example: if the information you use in an assignment is a research report, say this. If it is anecdotal information or professional opinion, say this as well. This lets your audience know that you are aware of the quality of the literature you use. In general, you can use as many different sources of information as you like in your written work as long as you let the reader know that you are aware of the strengths and weaknesses of each source of information and remember not to use weaker sources to make critical points.
The need to think critically has never been more important. There are two reasons for this. First, there has been a vast increase in our professional knowledge due to the rise in the concept of evidence-based practice and secondly, health and social care professionals are increasingly accountable for the practice they deliver.
Critical thinking and the increase in professional knowledge Many writers such as Moyer and Elliott have commented on the continual state of change in the modern world; the pace of change is so fast that what is published today may be out of date by the time you read it. This is just as true in health and social care as in any other setting. One reason why there is constant change is that we are continuously acquiring new information about health and social care topics and this is mostly due to the increase in evidence-based practice.
What is evidence-based practice? Evidence-based practice is about being able to provide a strong rationale for your health or social care practice. Aveyard and Sharp 7 The importance of the concept of evidence-based practice is that it emphasizes the need for the best possible evidence to underpin practice.
The concept of evidence-based practice has replaced the concept of practice based on tradition and ritual. Most definitions of evidence-based practice argue that in addition to evidence, professionals should use their professional judgement alongside consideration of patient or client preferences Aveyard and Sharp Information overload Along with the rise in interest in evidence-based practice, there has been a vast increase in knowledge and evidence relating to professional practice.
Some information is useful and some less useful. There is so much information available on any one health or social care topic that it can be difficult to read and comprehend everything related to your topic of study, let alone work out if the information is of good quality.
This is why you need to be a critical thinker; so that you can work out what is useful information and what is less useful for your practice and academic writing. Example Writing in the British Medical Journal in , Fraser and Dunstan cite the example of a cardiac surgeon who would need to read 40 papers each day, every day for 11 years to keep abreast of new developments in the field.
Of course, at the end of these 11 years, these developments are already out of date! If you do a quick internet search using a search engine such as Google or Yahoo! This will be far too many to make any sense of. This is why you need a more specific professional health or social care database which we will discuss in Chapter 3 rather than a general internet search engine when you are searching more seriously for health or social care topics.
Using a more specific database will reduce the number of unwanted hits you get; however, you will still access many thousands of hits unless you are very focused in your search. CINAHL is the abbreviated title of a well-used database containing references for health and social care. A general search for information about dementia using this subject-specific database will yield you over 18, hits.
If you are more specific and request only research papers about dementia, you will still get a few thousand hits. Reducing this further to a particular aspect of dementia care will reduce the number of hits further still, but they are still likely to run into many hundreds or a few thousand. Clearly this is a daunting number but it illustrates the point we are trying to make — the more focused your search is, the more you can narrow down your search and reduce the number of unwanted hits you get.
Enter the key phrase into a database or search engine and see how many results hits you get. How do you think this would compare with 10 or 20 years ago? You can see that if you are going to use evidence in your professional practice and academic writing you need to seek out the best available information for your studies and practice. You also need to focus on the specific aspect of the topic you are interested in so that you do not get sidetracked with more general information and therefore fail to find out what you really need to know.
You also need to be selective about what you read, see and hear and be able to recognize good quality evidence when you come across it. In general, research will be stronger evidence than more anecdotal sources and reviews of research will be stronger still.
We will discuss these in more detail in Chapter 3. Smith describes the responses from some health and social care workers to managing vast amounts of information.
This might include listening only to what they hear from colleagues in practice and not finding out more from a range of sources. In this book we argue that it is not good practice to accept the first thing you read, see or are told in practice without further investigation.
You need to be more critical than this. Professional knowledge is changing and expanding all the time. It is not possible to teach everyone how to respond in every given situation.
Professionals need skills to access and interpret the knowledge they require when they require it. We will not survive in professional life if we just try and remember facts or learn from experience, as we will quickly become out of date.
Not only that, but we will then be rolemodelling out of date practice for others to learn from. We need to be able to continue to keep up to date, and respond flexibly and creatively to solve problems in fast-changing health and social care environments. In response to this information overload, the best strategy is not only to keep reading and accessing up-to-date information but also to be critical of the information you read so that you know which information is useful to you and which is less useful.
The aim of this book is to show you how to do this most effectively. All of the professional bodies emphasize the importance of professional accountability for practice. As a practitioner, you must be able to justify and give a clear account of and rationale for your practice Dimond According to Griffiths and Tengnah , to be accountable is to be answerable for your acts and your omissions. A key component of accountability is using evidence-based practice as a justification for the care or practice you give.
One reason it is so important to make sense of the information you come across is because as a health or social care professional, you are accountable for the care you give. The complicated part comes when you consider that most aspects of care are informed by a wealth of information — recent developments, research, policy documents, standards of practice and so on. For any one aspect of care that you consider, there is a vast amount of related literature.
Not only is there a lot of reading to do, you also need to be critical of what you read and you need to make a judgement about it if you are to be able to account for your care or practice if called to do so. Who are you accountable to? See if you can identify any parts of it which require you to be a critical thinker. When you are called to account for your practice, you will only be able to do so if you have administered care that you can justify.
This will not be seen as a good justification for your actions, and would certainly not be seen as a strong defence. It is not difficult to see where these points are taking us. There is an ever increasing amount of information available for health and social care professionals to make sense of, and each professional has an obligation to make decisions based on the best available evidence in order to provide optimum care and remain accountable to their professional body.
The best way to defend your practice is to provide appropriate evidence to justify your actions — you need to be able to think critically to be able to do this.
What about your legal responsibilities? All professionals owe a legal duty of care to those they look after and this duty involves delivering care that is based on the best available evidence. Recent case law has supported the role of evidence, and using the best available evidence, to determine the standard of care professionals have to deliver rather than allowing professionals to disregard evidence and set their own standards.
However, this has been the case only recently. Not many years ago, the standard of care was largely set by professionals. This norm was established in a case frequently referred to as the Bolam case Bolam v. This case focused on the care of a patient who was given electro-convulsive therapy ECT without the administration of muscle relaxant. He sustained an injury which he claimed was due to the failure to administer the muscle relaxant and the court considered whether there had been a breach of duty when the doctor decided not to administer the relaxant.
In other words, did the doctor owe a duty to the patient to administer the relaxant? In order to answer this question, the court referred to other psychiatrists to see what the common practice was in respect of the administration of muscle relaxant. Thus at the time, the standard of care was set by the opinion of professional groups who did not have to rely on evidence to defend their practice. It was enough that other professionals would back them up, irrespective of what the evidence advised was best practice.
Gradually this principle has been replaced by a requirement for professionals to be able to justify their actions with reference to evidence. In the case of Bolitho v. How critical thinking can help you in your academic assignments and professional decision-making We have illustrated how we are often inundated with information, but a lot of it is poor quality and we therefore need to think critically about the information we are presented with. If this is considered to be unfortunate within everyday life, it is far worse and potentially far more serious within health and social care practice as professionals risk making poor decisions if they are not critical about the information upon which they base their practice.
You can see how critical thinking is a skill that is essential to acquire and one which will enhance your academic writing and practice. We have illustrated this in Example 3. If you examine the marking criteria for your academic assignments, you will see that you are marked on your ability to demonstrate that you can be critical of the literature you include. This involves using the best available evidence relating to the points you are making.
In principle this generally means looking for research evidence rather than anecdotal sources. We also have to be aware of what constitutes good quality research and if at all possible look for reviews of research rather than single papers.
It is also necessary to make a judgement about the quality of the research, which we will explain in later chapters. In your professional practice, this means questioning what you are told and looking up information to inform your care.
The need to be able to think critically as a safe, effective and independent practitioner has never been greater. As professionals we need to be critical thinkers in order to plan and evaluate the effectiveness of the interventions we deliver rather than carrying out care unquestioningly.
Before you move on to the rest of the book, can you identify how you might become more critical? There are a variety of resources and web links.
Access to national guidance, benchmarking standards and policy relating to health and social care. This popular book demystifies literature reviewing and answers the questions students have about how to tackle the process. Aveyard, H. Milton Keynes: Open University Press.
A useful text on understanding critical thinking and writing Maidenhead: Open University Press. Bahn, D. This book offer a detailed understanding information of hemodynamics, cardiovascular and pulmonary medicine, and pharmacology. Easy approached to clinical and laboratory data, develop a differential diagnosis. The book is written by experienced teachers, and inspired toward self-directed, diligent reading to guide the student to learns best at the bedside.
This edition have constructed a collection of clinical vignettes to teach diagnostic and therapeutic approaches relevant to critical care medicine. Experience with clinical cases is key to mastering the art and science of medicine and ultimately to providing patients with competent clinical care. Case Files: Critical Care provides 42 true-to-life cases that illustrate essential concepts in critical care.
The book is authored by world-renowned contributors and edited by established consultants in the field of intensive care medicine. Shondipon K. A lot of time and effort went into the first edition of this book.
I suggest if you have the time, go down tom the local, yes, book shop they exist , and pick up a copy. Save my name, email, and website in this browser for the next time I comment.
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