RET 1024 Introduction to Respiratory Therapy Module 6.0 Critical Thinking In Respiratory Care Based on Shelley C. Mishoe’s Critical Thinking and Problem-Based

RET 1024RET 1024Introduction to Respiratory Introduction to Respiratory TherapyTherapy

Module 6.0Module 6.0Critical Thinking In Respiratory CareCritical Thinking In Respiratory Care

Based on Shelley C. Mishoe’s Based on Shelley C. Mishoe’s Critical Thinking and Problem-Based Critical Thinking and Problem-Based Learning in Respiratory Care, Learning in Respiratory Care, as presented in Respiratory Care as presented in Respiratory Care Principles and Practice, W.B. Saunders Company, 2002Principles and Practice, W.B. Saunders Company, 2002

Critical Thinking In Respiratory Critical Thinking In Respiratory CareCare

For all medical professionals, For all medical professionals, information processing and decision information processing and decision making are at the core of clinical making are at the core of clinical practicepractice


To be an effective practitioner and a To be an effective practitioner and a vital, functioning member or today’s vital, functioning member or today’s health care team, respiratory therapists health care team, respiratory therapists need more than just a knowledge baseneed more than just a knowledge base


Respiratory practitioners must become Respiratory practitioners must become better thinkers, with the critical thinking better thinkers, with the critical thinking skills and traits necessary to make skills and traits necessary to make appropriate clinical decisionsappropriate clinical decisions


Common Definition of Critical ThinkingCommon Definition of Critical Thinking Cognitive problem solvingCognitive problem solving

Dressel and Mayhew, 1954Dressel and Mayhew, 1954

Thinking in order to believe or doThinking in order to believe or do Ennis, 1962Ennis, 1962

Logical reasoningLogical reasoning Hallet, 1984Hallet, 1984

Rational and purposeful attempt to use thought to move Rational and purposeful attempt to use thought to move toward a future goaltoward a future goal Halpern, 1989Halpern, 1989


Common Definition of Critical ThinkingCommon Definition of Critical Thinking Discipline-specific knowledge, skill and attitudes to solve Discipline-specific knowledge, skill and attitudes to solve

real problemsreal problems McPeck, 1990McPeck, 1990

An understanding of and an ability to formulate, analyze, and An understanding of and an ability to formulate, analyze, and assess the elements of thought assess the elements of thought Paul, 1993Paul, 1993

Logical reasoning, problem solving and reflectionLogical reasoning, problem solving and reflection Mishoe, 1995Mishoe, 1995


Essential Skills for Critical Thinking in Essential Skills for Critical Thinking in Practice:Practice: PrioritizationPrioritization AnticipationAnticipation TroubleshootingTroubleshooting CommunicationCommunication NegotiationNegotiation Decision MakingDecision Making ReflectionReflection


Essential Skills for CT in PracticeEssential Skills for CT in Practice PrioritizationPrioritization

The ability to arrange work according to the The ability to arrange work according to the importance of the taskimportance of the task

““Organized Think” Organized Think” - - Prioritizing work that is already Prioritizing work that is already scheduledscheduled

““Rapid Think” Rapid Think” – – Prioritizing work that unexpectedPrioritizing work that unexpected

Example:Example:STAT blood gas – Code Blue in ICU – Patient Transport – Asthmatic in EDSTAT blood gas – Code Blue in ICU – Patient Transport – Asthmatic in ED


Essential Skills for CT in PracticeEssential Skills for CT in Practice PrioritizationPrioritization

Respiratory therapists must quickly prioritize Respiratory therapists must quickly prioritize responsibilities and tasks and must responsibilities and tasks and must communicate quickly and effectively with others communicate quickly and effectively with others (e.g., nurses, physicians, other RTs) so that all (e.g., nurses, physicians, other RTs) so that all patients receive optimal care – patient lives patients receive optimal care – patient lives may depend itmay depend it


Essential Skills for CT in PracticeEssential Skills for CT in Practice AnticipationAnticipation

The ability to think ahead and envision possible The ability to think ahead and envision possible problemsproblems

““Future Think” Future Think” – – The ability to see the big pictureThe ability to see the big picture

RTs anticipate when they …RTs anticipate when they … Modify respiratory careModify respiratory care Expect a new patientExpect a new patient Plan ahead for equipment needsPlan ahead for equipment needs Prepare what they intend to discuss with physiciansPrepare what they intend to discuss with physicians Notice subtle changes in their patient’s condition that may Notice subtle changes in their patient’s condition that may

indicate problemsindicate problems


Essential Skills for CT in PracticeEssential Skills for CT in Practice TroubleshootingTroubleshooting

The ability to locate, correct, and process The ability to locate, correct, and process technical problemstechnical problems

““Technical Think”Technical Think”

RTs should be able to …RTs should be able to … Learn and introduce new equipmentLearn and introduce new equipment Adapt new technology for particular needsAdapt new technology for particular needs Correct equipment malfunctions or breakdownsCorrect equipment malfunctions or breakdowns


Essential Skills for CT in PracticeEssential Skills for CT in Practice CommunicationCommunication

Critical thinking in practice is very much Critical thinking in practice is very much dependent on communication with others as a dependent on communication with others as a primary means to give and receive information primary means to give and receive information necessary for patient care; necessary for patient care; poor poor communication leads to poor critical communication leads to poor critical thinkingthinking

““People Think”People Think”


Essential Skills for CT in PracticeEssential Skills for CT in Practice CommunicationCommunication

Poor communication skills result in the inability Poor communication skills result in the inability to …to …

Gather the appropriate information to interpret, Gather the appropriate information to interpret, analyze, evaluate, infer, judge, or explainanalyze, evaluate, infer, judge, or explain

Share information with other members of the Share information with other members of the healthcare teamhealthcare team

Educate patients and their familiesEducate patients and their families Reassure or explain care to patient’sReassure or explain care to patient’s Mentor respiratory therapy students and other new Mentor respiratory therapy students and other new

cliniciansclinicians


Essential Skills for CT in PracticeEssential Skills for CT in Practice NegotiationNegotiation

Is the initiation of discussion to influence othersIs the initiation of discussion to influence others ““Shared Think”Shared Think”

TeamworkTeamwork Use of influenceUse of influence Making recommendations for patient careMaking recommendations for patient care Contacting physicians to discuss a patientContacting physicians to discuss a patient



Practitioners must negotiate for what they Practitioners must negotiate for what they believe is best for a given situation in practicebelieve is best for a given situation in practice

Negotiation does not necessarily mean conflict, Negotiation does not necessarily mean conflict, confrontation, or difficultyconfrontation, or difficulty

If practitioners cannot negotiate, then their If practitioners cannot negotiate, then their patients have only limited access to their patients have only limited access to their expertise, including their cognitive critical-expertise, including their cognitive critical-thinking skillsthinking skills



Effective negotiatorsEffective negotiators Good communication skillsGood communication skills Good judgment/decision-making skillsGood judgment/decision-making skills Are able to explain how they came to their Are able to explain how they came to their

conclusions and suggestionsconclusions and suggestions Often phrase their suggestions as questionsOften phrase their suggestions as questions



Physicians have final authority regarding Physicians have final authority regarding medical orders and patient-care decisionsmedical orders and patient-care decisions

Respiratory therapists should understand that Respiratory therapists should understand that they have a responsibility to make appropriate they have a responsibility to make appropriate recommendations regarding respiratory care recommendations regarding respiratory care but should also realize their limitationsbut should also realize their limitations


Essential Skills for CT in PracticeEssential Skills for CT in Practice Decision MakingDecision Making

The ability to reach a conclusionThe ability to reach a conclusion ““Personal Think”Personal Think”

Reviewing evidence against and in favor of a Reviewing evidence against and in favor of a positionposition

Not ignoring disconfirming evidenceNot ignoring disconfirming evidence Recognizing errors or mistakes in thinkingRecognizing errors or mistakes in thinking Willingness to reconsider a position when Willingness to reconsider a position when

presented with conflicting alternatives in practicepresented with conflicting alternatives in practice


Essential Skills for CT in PracticeEssential Skills for CT in Practice ReflectionReflection

The ability to think about thinkingThe ability to think about thinking ““Inward Think” Inward Think” – – Introspective Introspective ““Past Think” Past Think” – – Retrospective Retrospective

Reflecting on work, patients, decisions, and the Reflecting on work, patients, decisions, and the professionprofession

Exploring assumptions, opinions, biases, and Exploring assumptions, opinions, biases, and decisionsdecisions

Learning from mistakes and problems; handling the Learning from mistakes and problems; handling the pain or errorspain or errors


Characteristics of Critical ThinkersCharacteristics of Critical Thinkers Critical thinkers demonstrate common affective Critical thinkers demonstrate common affective

qualities – characteristicsqualities – characteristics InquisitivenessInquisitiveness

A concern to be well-informedA concern to be well-informed

Alertness to opportunities to use critical thinkingAlertness to opportunities to use critical thinking

Trust in the process of reasoning inquiryTrust in the process of reasoning inquiry

Self-confidence in one’s own ability to reasonSelf-confidence in one’s own ability to reason


Characteristics of Critical ThinkersCharacteristics of Critical Thinkers Critical thinkers demonstrate common affective Critical thinkers demonstrate common affective

qualities – characteristicsqualities – characteristics Open-mindednessOpen-mindedness

HonestyHonesty

Prudence in suspension of judgmentPrudence in suspension of judgment

Willingness to reconsiderWillingness to reconsider


Characteristics of Critical ThinkersCharacteristics of Critical Thinkers

Respiratory therapists are challenged not only Respiratory therapists are challenged not only to foster the development of their own critical to foster the development of their own critical thinking skills but also to develop the thinking skills but also to develop the dispositions of others in their personal and dispositions of others in their personal and professional livesprofessional lives

““Prioritization” is defined as which of the Prioritization” is defined as which of the following?following?a.a. The ability to arrange work according to the The ability to arrange work according to the

importance of the taskimportance of the task

b.b. The ability to think ahead and envision The ability to think ahead and envision possible problemspossible problems

c.c. The ability to locate, correct, and process The ability to locate, correct, and process technical problemstechnical problems

d.d. None of the aboveNone of the above

““Anticipation” is defined as which of the Anticipation” is defined as which of the following?following?a.a. The ability to arrange work according to the The ability to arrange work according to the





““Troubleshooting” is defined as which of Troubleshooting” is defined as which of the following?the following?a.a. The ability to arrange work according to the The ability to arrange work according to the





Which of the following is true regarding Which of the following is true regarding poor communication?poor communication?a.a. Leads to poor critical thinkingLeads to poor critical thinking

b.b. Results in the inability to do gather the appropriate Results in the inability to do gather the appropriate informationinformation

c.c. Results in the inability to share information with other Results in the inability to share information with other members of the healthcare team and/or patients and members of the healthcare team and/or patients and family membersfamily members

d.d. Results in the inability to mentor respiratory therapy Results in the inability to mentor respiratory therapy students and other new cliniciansstudents and other new clinicians

e.e. All of the aboveAll of the above

““Negotiation” is defined as which of the Negotiation” is defined as which of the following?following?a.a. Is the initiation of discussion to influence Is the initiation of discussion to influence

othersothers

b.b. The ability to reach a conclusionThe ability to reach a conclusion

c.c. The ability to think about thinkingThe ability to think about thinking


Which of the following statements is not Which of the following statements is not true regarding “Negotiation”?true regarding “Negotiation”?

a.a. Practitioners must negotiate for what they believe is best for a Practitioners must negotiate for what they believe is best for a given situation in practicegiven situation in practice

b.b. Negotiation, unfortunately, always involves some degree of Negotiation, unfortunately, always involves some degree of conflict, confrontation, or difficultyconflict, confrontation, or difficulty

c.c. If practitioners cannot negotiate, then their patients have only If practitioners cannot negotiate, then their patients have only limited access to their expertise, including their cognitive limited access to their expertise, including their cognitive critical-thinking skillscritical-thinking skills

d.d. An important point to remember when negotiating is that An important point to remember when negotiating is that physicians have final authority regarding medical orders and physicians have final authority regarding medical orders and patient-care decisionspatient-care decisions

It is essential that effective negotiators It is essential that effective negotiators possess good communication skills and possess good communication skills and are able to explain how they came to are able to explain how they came to their conclusions and suggestions.their conclusions and suggestions. TrueTrue FalseFalse

It is also essential that effective It is also essential that effective negotiators possess good negotiators possess good judgment/decision-making skills and judgment/decision-making skills and often phrase their suggestions as often phrase their suggestions as questions.questions. TrueTrue FalseFalse

““Decision Making” is defined as which of Decision Making” is defined as which of the following?the following?a.a. Is the initiation of discussion to influence Is the initiation of discussion to influence

othersothers




““Reflection” is defined as which of the Reflection” is defined as which of the following?following?a.a. Is the initiation of discussion to influence Is the initiation of discussion to influence

othersothers




Which is true regarding “Critical Thinkers” Which is true regarding “Critical Thinkers” a.a. Demonstrate inquisitiveness and are Demonstrate inquisitiveness and are

concerned with being well-informed.concerned with being well-informed.

b.b. Demonstrate the characteristics of honesty Demonstrate the characteristics of honesty and open-mindednessand open-mindedness

c.c. Demonstrate characteristics of prudence in Demonstrate characteristics of prudence in suspension of judgment and willingness to suspension of judgment and willingness to reconsiderreconsider

d.d. All of the aboveAll of the above

•“Critical Thinkers” demonstrate inquisitiveness and are concerned with being well-informed.1.True2.False

Respiratory therapists are challenged not Respiratory therapists are challenged not only to foster the development of their only to foster the development of their own critical thinking skills but also to own critical thinking skills but also to develop the dispositions of others in their develop the dispositions of others in their personal and professional lives personal and professional lives TrueTrue FalseFalse

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RET 1024 Introduction to Respiratory Therapy Module 6.0 Critical Thinking In Respiratory Care Based on Shelley C. Mishoe’s Critical Thinking and Problem-Based