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The CLER model: thinking through change. Configurations of social relationships. Linkages to carry communications. Environment(s) inside and around systems. Resources for enabling implementation for incorporating change.

The CLER model is presented to nursing professionals as a model for planning and implementing change in interpersonal, institutional and cultural settings. It is useful for generating other models by modeling reality as actually encountered by change agents and adopters. The CLER model is related philosophically to systems thinking (that there is interdependence among social entities), dialectical thinking (that there is mutual shaping among social processes) and constructivist thinking (that human beings take part in creating their own reality).

Communication↗

Primitive object love in Melanie Klein's thinking; early theoretical influences.

Melanie Klein's thinking on early object love is pivotal to her vision of development. Yet within her texts it is often enmeshed in complex formulations that obscure its full significance. A greater clarity in viewing Klein's concept of early object love is achieved through tracing some of its historical origins. The author notes that it was inspired by aspects of Ferenczi's theory, hence its similarities with the concept of 'primary love' formulated by another of Ferenczi's analysands, Michael Balint. Ferenczi's thinking on the subject formed part of a broader network of theoretical developments in the history of psychoanalytic ideas. These are shown to have origins in Freud's fluctuations between a 'passive' and a 'genital' characterisation of infantile sexuality. A dialectical tension between these two possibilities, as maintained in the Freudian texts, was partly embodied in the differing outlooks of Klein's two psychoanalysts, Abraham and Ferenczi. The author suggests that it is a mixture of their approaches that partly shaped Klein's thinking on the earliest experiences of love. After outlining these developments the author analyses the nature of early object love as it emerges from Klein's powerful, if intermittent descriptions in the texts. The analysis also tackles a textual ambiguity in Klein's formulations, showing that she explored two kinds of primitive ideal experience without explicitly differentiating them. Such differentiation is important inasmuch as it highlights negative and positive aspects of Kleinian theory at root.

Child↗

Clinical journal: a tool to foster critical thinking for advanced levels of competence.

Rapid changes in the health care system and the challenge of meeting complex patient care needs require that nurses function at the competent, or higher, levels of expertise. Advanced levels of competence are facilitated through development and application of critical thinking abilities. Journal writing is a tool that can be used by CNSs and other nurses to improve basic thinking abilities and application of critical thinking for clinical decision making. Guidelines are presented for writing this type of clinical journal and for providing feedback to others.

Clinical Competence↗

The relationship between critical thinking and how time is structured in the clinical setting for students in a baccalaureate nursing program.

This experimental study was undertaken to investigate the relationship between critical thinking and how time is structured in the clinical setting. A total of 93 respondents completed the Watson-Glaser Critical Thinking Appraisal (CTA) Form: 35 in the comparison group, 29 in the 2-hour/8-hour clinical groups, and 29 in the 5-hour/5-hour clinical groups. Results of the ANOVA test shows that, at Time 1, students in the comparison group had the lowest mean score (9.23) and the 2-hour/8-hour clinical groups had the highest mean score (10.94), suggesting that the three groups were not equal at Time 1 in terms of their critical thinking ability. Nevertheless, the within subjects effects shows that while all three groups indicate positive Time 1-Time 2 changes, only the 5-hour/5-hour groups show a substantial degree of improvement (10.04 to 10.75), i.e., the study groups x time interaction effect is significant (p < .001). This pattern of significance between subjects effects and differential changes in CTA scores over time, with the 5-hour/5-hour groups showing the largest degree of change is consistent among the fine sub-component of the Watson-Glaser Scale. Students in the 5-hour/5-hour groups showed the most improvement in their scores in the area of Interpretation and Evaluation of arguments which was 9.55 at Time 1 and 10.52 at Time 2.

Clinical Competence↗

Exploring schizophrenic thinking in older adolescents with the WAIS, Rorschach and WIST.

Literature that addresses the diagnosis of mental disorder in adolescents strongly suggests that it may not be possible to do so. Schizophrenic thinking, in particular, has been seen as generally characteristic of adolescents. Making judgments of specific responses from the Rorschach, the WAIS, and the WIST, 10 expert clinicians were able to make judgments with regard to 12 adolescents in the 16-19 age range that were surprisingly accurate in discriminating among schizophrenics, nonschizophrenic hospitalized adolescents, and a normal control group. Results indicate that schizophrenic thinking is not necessarily characteristic of adolescents and that information from the WIST may be helpful in identifying schizophrenic adolescents.

Adolescent↗

Systems thinking: a new lens for old problems.

This article introduces systems thinking and identifies its implications for practice-based learning and improvement. The article defines systems, identifies fundamental aspects of systems thinking, and provides strategies for creating more practice-based learning environments in medical contexts.

Attitude of Health Personnel↗

The psychology of thinking, animal psychology, and the young Karl Popper.

In the 1920s, Karl Popper wrote two large manuscripts on psychology that he never published. In his autobiography, Unended Quest, he attempts to reduce the importance of his work in psychology as much as possible, and in his philosophical work he is an antipsychologist. However, in this article, it is argued that Popper's early psychology has been pivotally important for the development of his philosophy. In particular, it is shown that Popper's views on psychology underwent a radical shift, one that paved the way for his characteristic deductive stance in philosophy. Popper's views shifted from an inductive and associationistic psychology toward a noninductive psychology of problem solving. Tracing the historical background of Popper's early work reveals how he integrated various parts of the psychology of Karl Groos into his analysis of the childish phenomenon of dogmatic thinking and how he shortly after appropriated various elements of the animal psychology of Hans Volkelt and Herbert Jennings in his biological approach to (dogmatic) thinking. In the monumental works of Otto Selz, however, Popper finally found the roots of a noninductive and biological approach to the growth of individual and scientific knowledge.

Animals↗

Divergent productive thinking factors and accuracy of nursing diagnoses.

Theories of diagnosis in nursing (Carnevali, 1983; Gordon, 1982) and a model of intelligence (Guilford, 1979) were integrated to provide a theoretical basis for this study. In contrast to previous studies, accuracy of nursing diagnoses was measured as a continuous variable. It was hypothesized that three factors of divergent productive thinking, fluency, flexibility, and elaboration, would correlate positively with accuracy of nursing diagnoses. The sample consisted of 86 female nurses, graduates of generic baccalaureate programs with 1 to 5 years experience, who met the criterion of knowledge. Three written case studies (CS1, CS2, CS3) served as the criterion for accuracy. With CS1, none of the hypotheses were supported. With CS2, the three hypotheses were supported (p less than .05) and 10% of the variance was explained by one factor, fluency (p less than .01). With CS3, elaboration and accuracy were correlated (p less than .05). The findings provide beginning support for inclusion of exercises for divergent thinking in nursing education and practice.

Adult↗

A model of a human recognition system with 'thinking'.

The human system of pattern recognition is explored. This system utilizes the method of syntactic feature comparison, activation of the patterns containing the feature, and sorting among the activated patterns. Both the pattern recognition process without thinking and with thinking are discussed, and examples are given. Contrary to the usual concept, the more complicated pattern has a better chance to be recognized correctly.

Computers↗

Magical thinking by inpatient staff members.

Magical thinking is a primitive form of mental activity which, nevertheless, the author contends, is common among mental health professionals. Four examples of magical thinking by inpatient staff members are presented and briefly explored, in order to shed light on our work and ourselves.

Health Occupations↗

A partnership in like-minded thinking-generating hopefulness in persons with cancer.

A conceptual model of a partnership in 'like-minded thinking' consists of the following components: a relationship, a shared goal with mutual agreement to work toward that goal, and reciprocal encouragement between two people. A like-minded alliance is a relationship that offers support while at the same time encourages hope and establishes a reciprocating emotional attitude of hopefulness. The discussion focuses on the principles of such a model that is designed primarily as a lay intervention for anyone who has a close friend with cancer and who wants to assist the friend in maintaining a hopeful attitude in the face of illness. While this model is not directed at healthcare professionals it may be transferable into psychosocial interventions to assist persons toward sustaining hopefulness in the context of the cancer trajectory. Much has been written in the literature about how hopelessness spawns despair for individuals who have cancer and in those near the end of life; it may even create a desire for hastened death (Breitbart W., Heller K.S.: 2003, 'Reframing Hope: Meaning-Centered Care for Patients Near the End of Life'. Journal of Palliative Medicine 6, 979-988; Jones J.M., Huggins M.A., Rydall A.C., Rodin G.M.: 2003, 'Symptomatic distress, hopelessness, and the desire for hastened death in hospitalized cancer patients', Journal of Psychosomatic Research 55, 411-418). Therefore, the aim of this paper is to explore how like-minded thinking for a person with cancer and his or her support person provides a framework for a personal shared worldview that is hope-based, meaningful and coherent.

Adaptation, Psychological↗

Thinking through uncertainty: nonconsequential reasoning and choice.

When thinking under uncertainty, people often do not consider appropriately each of the relevant branches of a decision tree, as required by consequentialism. As a result they sometimes violate Savage's sure-thing principle. In the Prisoner's Dilemma game, for example, many subjects compete when they know that the opponent has competed and when they know that the opponent has cooperated, but cooperate when they do not know the opponent's response. Newcomb's Problem and Wason's selection task are also interpreted as manifestations of nonconsequential decision making and reasoning. The causes and implications of such behavior, and the notion of quasi-magical thinking, are discussed.

Choice Behavior↗

The differential effect of realistic and unrealistic counterfactual thinking on regret.

Research has established that realistic counterfactual thinking can determine the intensity and the content of people's affective reactions to decision outcomes and events. Not much is known, however, about the affective consequences of counterfactual thinking that is unrealistic (i.e., that does not correspond to the main causes of a negative outcome). In three experiments, we investigate the influence of realistic and unrealistic counterfactuals on experienced regret after negative outcomes. In Experiment 1, we found that participants who thought unrealistically about a poor outcome reported less regret than those who thought realistically about it. In Experiments 2a and 2b, we replicated this finding and we showed that the decrease in regret was associated with a shift in the causal attributions of the poor outcome. Participants who thought unrealistically attributed it more to external circumstances and less to their own behaviours than those who thought realistically about it. We discuss the implications of these findings for the role of counterfactuals as self-serving biases and the functionality of regret as a counterfactual emotion.

Adult↗

'To save the honour of thinking': a slightly petulant response to Griffiths.

This is a response (a reply? a riposte?) to Peter Griffiths (Int. J. Nurs. Stud., in press, ) that attempts to answer some of the charges, which he levels at our book 'Deconstructing Evidence-based Practice' (Routledge, London, 2004). It begins by countering Griffiths' mistaken assertion that, in deconstruction, 'anything goes'. It argues that Griffiths is wrong because he has literally mistaken the meanings of certain words; that is, he has taken them wrongly. His biggest mistake, on which all of his others rests, is to mistake the word 'deconstruction' to imply a form of extreme relativism in which there are no right or wrong readings. In this, he is simply wrong. He is wrong in his assumption that there are no wrong readings, and the fact (yes, fact) that he is wrong demonstrates that some readings can be wrong. In particular, he mistakes the word 'challenge' to mean 'deny', and the word 'authority' to mean 'legitimacy'. This is not simply our reading of what we took him to mean (which could, by our own argument, be mistaken). It is his reading and his writing, there on the page in black and white. And this misreading, this mistake, inevitably leads him to a wrong conclusion. Having clarified the small matter that, in deconstruction, anything does not go, and that deconstructionists are not constrained to accept everything that is written about them, we then attempt to point out some other mistakes in Griffiths' non-review. Most importantly, we reject Griffiths' accusation that postmodernism is a strategy to 'save us from thinking' and instead, with Lyotard, advocate it as an attempt 'to save the honour of thinking'.

Evidence-Based Medicine↗

Nurses' reasoning process during care planning taking pressure ulcer prevention as an example. A think-aloud study.

BACKGROUND: Nurses' clinical reasoning is of great importance for the delivery of safe and efficient care. Pressure ulcer prevention allows a variety of aspects within nursing to be viewed. OBJECTIVE: The aim of this study was to describe both the process and the content of nurses' reasoning during care planning at different nursing homes, using pressure ulcer prevention as an example. DESIGN: A qualitative research design was chosen. SETTINGS: Seven different nursing homes within one community were included. PARTICIPANTS: Eleven registered nurses were interviewed. METHOD: The methods used were think-aloud technique, protocol analysis and qualitative content analysis. Client simulation illustrating transition was used. The case used for care planning was in three parts covering the transition from hospital until 3 weeks in the nursing home. RESULT: Most nurses in this study conducted direct and indirect reasoning in a wide range of areas in connection with pressure ulcer prevention. The reasoning focused different parts of the nursing process depending on part of the case. Complex assertations as well as strategies aiming to reduce cognitive strain were rare. Nurses involved in direct nursing care held a broader reasoning than consultant nurses. Both explanations and actions based on older ideas and traditions occurred. CONCLUSIONS: Reasoning concerning pressure ulcer prevention while care planning was dominated by routine thinking. Knowing the person over a period of time made a more complex reasoning possible. The nurses' experience, knowledge together with how close to the elderly the nurses work seem to be important factors that affect the content of reasoning.

Aged↗

Conspiratorial thinking in a 50-state survey of American adults.

Conspiratorial thoughts as a cognitive aspect are understudied outside small clinical cohorts. We conducted a 50-state non-probability internet survey of respondents age 18 and older, who completed the American Conspiratorial Thinking Scale (ACTS) and the 9-item Patient Health Questionnaire (PHQ-9). Across the 6 survey waves, there were 123,781 unique individuals. After reweighting, a total of 78.6&#xa0;% somewhat or strongly agreed with at least one conspiratorial idea; 19.0&#xa0;% agreed with all four of them. More conspiratorial thoughts were reported among those age 25-54, males, individuals who finished high school but did not start or complete college, and those with greater levels of depressive symptoms. Endorsing more conspiratorial thoughts was associated with a significantly lower likelihood of being vaccinated against COVID-19. The extent of correlation with non-vaccination suggests the importance of considering such thinking in designing public health strategies.

Humans↗

Study of critical thinking skills in nursing students and nurses in Japan.

The purpose of this study was to measure the dimensions of critical thinking (CT) of nursing students at baccalaureate nursing program and registered nurses at general hospital in Japan. Relevant literature on the current environment of Japanese nursing practice and education is reviewed as it provides the background to the key aspects of dimensions of Japanese nurses' and students' CT. The California Critical Thinking Disposition Inventory (CCTDI) was used to measure the dimensions of CT skills. The convenience sample consisted of three small groups: generic students (n=82) including freshmen and juniors; transfer students (n=16) at selected baccalaureate nursing program; and registered nurses (n=67) at selected general hospital were administered CCTDI. Descriptive statistic indicated that all groups had an ambivalent disposition towards CT in majority of sub-scale while they scored a positive disposition towards CT on several sub-scales. A one-way ANOVA indicated that registered nurses scored lower than other two groups of baccalaureate students on the total score and several sub-scale score. The outcomes of this study propose recommendations regarding curriculum review for Japanese nursing education and reflection on professional boundaries for Japanese nursing practice.

Adult↗

Critical thinking as an outcome of context-based learning among post RN students: a literature review.

Increasingly complex needs and expanding roles in the delivery of health care require professional nurses to be capable critical thinkers and self-directed learners. Problem-based learning (PBL) is promoted as a mean to facilitate critical thinking (CT) in nursing students attending generic and post RN baccalaureate programs. The authors summarize and analyze nursing research and theoretical literature (1992-2005) related to four key topic areas: critical thinking, nursing education, PBL, and post RN education, to determine what is known about the impact of PBL on CT among post RN students. CINAHL, ERIC, Medline and PsychINFO databases were searched and based on the literature retrieved, there is no strong research evidence to suggest changes occur in baccalaureate nursing students' CT during their educational programs, including those using PBL. Similar results were found among post RN students although the literature on this topic is sparse. There is a need for additional research and ongoing development of valid and reliable instruments to measure CT in nurses to guide teaching and learning strategies that effectively facilitate CT among nursing students.

Education, Nursing↗