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PubMed1998

Critical thinking's role in perioperative patient safety outcomes.

Despite education, training, tools, and standards, patient safety issues continue to be of concern when it comes to perioperative care. The problem of intraoperative injuries, therefore, may lie in perioperative nurses' implementation of safety measures that require critical thinking. This qualitative study lends insight into the critical thinking or decision-making processes of nurses who implement these perioperative safety measures. Findings from this data analysis have led to perioperative recommendations that may enhance patient safety outcomes.

Humans↗

PubMed1998

Inquiry-based learning and critical thinking in an advanced practice psychiatric nursing program.

The advanced practice psychiatric nurse must be prepared to meet the changing demands being placed on the nursing profession. Some changes are the product of health care reforms, especially managed care. Others are more fundamental, because continuing scientific advances drive rapid changes in the knowledge base required of mental health nurses. Curricular reforms initiated earlier this decade were intended to equip nurses with the problem-solving and critical-thinking skills required to deal with novel and complex situations in a rapidly changing healthcare system. This article describes how the Inquiry-Based Learning tutorial method attends to the mental processes of graduate students and fosters critical-thinking skills.

Clinical Competence↗

PubMedDate not supplied

The "Think Aloud" seminar for teaching clinical reasoning: a case study of a child with pharyngitis.

The "Think Aloud" seminar is a group teaching method to assist pediatric nurse practitioner students to develop critical thinking and clinical reasoning skills. Seminar proceedings simulate the iterative clinical reasoning process that occurs in an actual clinic or office visit. Students' requests for subjective and objective data must be followed by the rationale as to why the information was requested. This method is effective for teaching and evaluating students' skills in differential diagnosis and management of common illness in children. The process will be demonstrated with the presenting symptom of a sore throat followed by a description of the procedures that are used. J Pediatr Health Care.

Child, Preschool↗

PubMed2002

Assessing disturbed thinking and cognition using the Ego Impairment Index in older schizophrenia patients: paranoid vs. nonparanoid distinction.

OBJECTIVE: We compared thought-disturbance via the Rorschach-derived Ego Impairment Index (EII) between DSM-IV paranoid vs. nonparanoid (undifferentiated and disorganized) subtypes of older schizophrenia patients. METHODS: 44 DSM-IV medically stable outpatients with schizophrenia (27 paranoid, 17 nonparanoid) and 45 normal comparison participants aged 45-100 years were assessed using the EII, a Rorschach-derived cognitive-based measure of disturbed thinking. Group differences on the EII and the relation of this measure to key demographic and clinical variables were examined. RESULTS: Nonparanoid schizophrenia patients demonstrated significantly greater impairment on the EII than their paranoid counterparts. The EII performance of paranoid patients was similar to normal comparison participants. Furthermore, the paranoid patients displayed better premorbid intellectual functioning, less negative symptoms, and better global cognitive performance than nonparanoid patients. Finally, greater impairment on the EII was correlated with poor performance on a global measure of cognitive ability. CONCLUSIONS: The present findings substantiate previous work suggesting that nonparanoid patients have a form of the illness characterized by worse premorbid functioning and greater disturbed thinking and cognition than their paranoid counterparts.

Aged↗

PubMed2003

The InterSePT scale for suicidal thinking reliability and validity.

BACKGROUND: The InterSePT Scale for Suicidal Thinking (ISST) is a 12-item instrument for the assessment of current suicidal ideation in patients with schizophrenia and schizoaffective disorders. We report the psychometric characteristics of this new scale based on two studies. METHOD: In Study 1, 22 inpatients with schizophrenia and schizoaffective disorders, who had recently attempted suicide or engaged in suicidal ideation, were rated by three trained independent raters to examine interrater reliability. In Study 2, a total of 980 patients with schizophrenia or schizoaffective disorder with a history of suicidal ideation in the past 36 months were enrolled in a 2-year industry-sponsored suicide prevention study. At baseline, these patients were administered the ISST and the Clinical Global Impression Scale for Severity of Suicidality (CGI-SS) by the Principal Investigator (PI) and by a blinded rater (BR), who also administered the Positive and Negative Symptom Scale (PANSS), the Calgary Depression Scale (CDS), and the Scale of Functioning (SOF). Indices of internal reliability, construct and discriminant validity were examined. RESULTS: The intraclass correlation coefficient (ICC) for the total ISST score for the 22 subjects in Study 1 was 0.90 and mean weighted item kappa coefficients ranged from 0.66 to 0.92. In Study 2, internal reliability (Cronbach alpha) was high, ranging from 0.86 to 0.89 for the individual items, and the overall Cronbach alpha coefficient for all items was 0.88. The ISST (PI) total score was highly correlated with the CGI-SS by the blind rater (r = 0.61, p < 0.0001). ISST total scores significantly differentiated the different levels of CGI-SS (F = 519.2; p < 0.0001). Results of construct and discriminant validity analyses are also presented. CONCLUSION: The ISST is a reliable and valid instrument for the assessment of current suicidal thinking in patients with schizophrenia and schizoaffective disorder by both clinicians and researchers.

Adolescent↗

PubMedDate not supplied

Critical thinking skills of baccalaureate nursing students.

The purpose of this study was to determine if a student will score higher on a critical thinking appraisal test on completion of a bachelor of science in nursing (BSN) program than on entry into the program. Students currently enrolled in a BSN program were given the Watson-Glaser Critical Thinking Appraisal Test in the first month of the program and repeated the test 1 month before graduation. BSN and BSN/registered nurse (RN) students were included in the study. Data analysis indicated there were no significant differences found in all of the classes of BSN/RN graduates and two of the classes of BSN graduates. There was a significant difference in the scores in one of the classes of BSN graduates. Implications for future research suggest additional comparative studies as well as using a different instrument along with expansion of the study to include master's students and nursing faculty.

Adult↗

PubMed1987

Distraction in neurotic and endogenous depression: an investigation of negative thinking in major depressive disorder.

The effects on depressive thinking and depressed mood of a brief, standardized distraction procedure were examined. In low endogenous patients (scoring 3 or less on the Newcastle Diagnosis Scale (NDS)), distraction significantly reduced the frequency of depressing thoughts. Consistent with Beck's cognitive model of depression, these patients were significantly less depressed after distraction than after a control procedure. In high endogenous patients (scoring 4 or more on the NDS), distraction produced less marked reductions in frequency of depressing thoughts, and no significant change in depressed mood. It is suggested that the relationship between negative thinking and depressed mood differs in the two patient groups.

Adolescent↗

PubMed2004

What might not have been: an investigation of the nature of counterfactual thinking in survivors of trauma.

BACKGROUND: Counterfactual thinking (CFT) refers to the process of reflecting on an event and changing aspects of it so as to alter the eventual outcome. Such thinking appears frequent in survivors of trauma (e.g. 'If only I had stayed at home then I wouldn't have had the accident'), but has received little systematic empirical investigation. Four studies examined the nature of CFT in both trauma survivors and non-traumatized controls. METHOD: Participants generated CFT to their own trauma or to written scenarios. RESULTS: Three key findings emerged. Firstly, trauma survivors overwhelmingly produced CFT that mutated aspects of their own behaviour during the traumatic event (self-referent CFT) and that improved the event's outcome (upward CFT; Studies 1 and 2). Secondly, self-referent CFT style in trauma survivors was generalized to non-autobiographical scenarios and was independent of how much control the protagonist in the scenarios had over the outcome. In contrast, never-traumatized controls tended to generate more self-referent CFT to scenarios where the protagonists had some control than to scenarios where the protagonist had little control (Study 3). Thirdly, this self-referent, upward CFT style of trauma survivors was not related to frequency of post-traumatic stress symptoms (Studies 1 and 3) or Posttraumatic Stress Disorder (PTSD) caseness (Study 2). CONCLUSIONS: These results are interpreted in terms of a self-referent, upward CFT style that is normative following trauma for all survivors, regardless of levels of trauma-related distress, and that is applied to any negative events that are encountered.

Adaptation, Psychological↗

PubMed2000

Promoting critical thinking in health care: phronesis and criticality.

This paper explores the notion of 'expert' health care practitioner in the context of critical thinking and health care education where scientific rather than philosophical inquiry has been the dominant mode of thought. A number of factors have forced a reappraisal in this respect: the challenge brought about by the identification of complex ethical issues in clinical situations; medicine's 'solving' of many of the simple health problems; the recognition that uncertainty is a common and perhaps innate feature of clinical practice; debate about the concepts of illness and disease; plus insights from psychology, sociology and medical anthropology. Together these have prompted alternative ways of thinking which have the aim of identifying the best rather than the right decision (where best equates to good and right equates to correct in the sense of true or approved). It is argued that phronesis adds a necessary corrective dimension to modern Western medicine's over-emphasis on techne and is one of the factors that differentiates novice from expert practitioner. However, this attracts certain conflicts of interest: phronesis can only be gained and assessed from experience of praxis; agencies with legitimate interests in medicine such as government and professional registering bodies require more substantive criteria.

Clinical Competence↗

PubMed1997

An integration of hindsight bias and counterfactual thinking: decision-making and drug courier profiles.

Counterfactual thinking and hindsight bias have each generated separate, substantial bodies of research and provided insight into some areas of legal decision-making. An investigation of the relationship between counterfactual thinking and hindsight bias in a situation in which both are implicated is presented in a legal decision-making context utilizing drug courier profiles and illegal search and seizure. The findings, which demonstrate each of these cognitive processes and show a pattern of results that supports an integrative relationship between them, are discussed in the contexts of social cognition and of legal decision-making. A suggested causal model of decision-making in this context is also presented. Specific implications of these findings for civil actions to remedy illegal searches are discussed.

Analysis of Variance↗

PubMed2006

[Clinical decision making: Fostering critical thinking in the nursing diagnostic process through case studies].

Case studies, based on actual patients' situations, provide a method of clinical decision making to foster critical thinking in nurses. This paper describes the method and process of group case studies applied in continuous education settings. This method bases on Balints' case supervision and was further developed and combined with the nursing diagnostic process. A case study contains different phases: Pre-phase, selection phase, case delineation and case work. The case provider narratively tells the situation of a patient. This allows the group to analyze and cluster signs and symptoms, to state nursing diagnoses and to derive nursing interventions. Results of the case study are validated by applying the theoretical background and critical appraisal of the case provider. Learning effects of the case studies were evaluated by means of qualitative questionnaires and analyzed according to Mayring. Findings revealed the following categories: a) Patients' problems are perceived in a patient centred way, accurate nursing diagnoses are stated and effective nursing interventions implemented. b) Professional nursing tasks are more purposefully perceived and named more precise. c) Professional nursing relationship, communication and respectful behaviour with patients were perceived in differentiated ways. The theoretical framework is described in the paper "Clinical decision making and critical thinking in the nursing diagnostic process". (Müller-Staub, 2006).

Decision Making↗

PubMed2000

Clinical decision-making in restorative dentistry. Content-analysis of diagnostic thinking processes and concurrent concepts used in an educational environment.

CONTEXT: Dental practice is affected by variation in diagnosis and treatment planning between clinicians. The process underlying the decisions leading to management of dental caries is poorly understood. OBJECTIVE: To explore diagnostic thinking and identify information used in the diagnosis, management and treatment of caries. SUBJECTS/MATERIALS: 15 senior dental students (mean age, 23.1 years; 66% female) in Mexico City were interviewed using a Simulated Patient Model (SPM). METHODS: The SPM consultation session and its review, aimed at eliciting an introspective recall description of the Diagnostic Thinking Processes (DTP) and the pieces of information (concepts) employed, were transcribed and content-analyzed (CA). CA reproducibility coefficients were 0.53 to 0.64. The cognitive psychology Gale & Marsden (GM) model was used to structure DTP and concepts. Data were analyzed with chi-squared tests. RESULTS: DTP utilization was similar to the original report in endocrinology and neurology cases. A wide variety of concepts were combined with DTP to describe the strategies and information preferentially resorted to while addressing four areas identified in the consultation. CONCLUSIONS: Narrow arrays of concepts of restorative concern (mostly physical features present in/on teeth) were often investigated using DTP 1, 2 and 4 in combination with the use of dental explorers. The heuristics detected link features common to the GM model and to an indirect pattern-recognition model, whereby reliance on visual/tactile concepts facilitates the acquisition of a clinically meaningful image. Non-clinical factors believed to be at play in the application of strategies were not investigated but were controlled for in the SPM.

Adult↗

PubMed1997

Randomly sampling thinking in the natural environment.

Thought sampling, the experience sampling method (ESM), and descriptive experience sampling are 3 methods of randomly sampling thinking in participants' natural environments. All use beepers that signal participants to report aspects of their experience and behavior at random intervals. Thought sampling and ESM are quantitative methods, and standard validation studies have demonstrated them to be reliable and valid. They provide insights into human experience and behavior that are difficult or impossible to attain by nonsampling methods. Descriptive experience sampling is a nonquantitative method that provides provocative descriptions of phenomena such as "unsymbolized thinking"--thoughts that occur in awareness without words, images, or any other kind of symbols--and perception that has no figure--ground phenomena.

Awareness↗

PubMed1987

Depressive thinking and depression: relations with personality and social resources.

The mechanisms by which social supports and personality variables may buffer against psychopathology are not well understood. We studied depression, depressive cognitions, social supports, and self-esteem in a sample of 68 spouse-caregivers of patients with Alzheimer's Disease in an attempt to identify possible buffering mechanisms of the latter two variables. Specifically, we hypothesized that the well-known relation of depressive cognitions to depression would vary as a function of satisfaction with social supports and with level of self-esteem. Hierarchical multiple regression analyses conducted to predict depression revealed significant and independent main effects for depressive cognitions (p less than .01), social supports (p less than .025), and self-esteem (p less than .001), with depressive cognitions associated with higher depression and the other two variables associated with reduced depression (R2 = .53 for the three main effects). In addition, the relation of depressive cognitions with depression varied substantially depending on the level of social supports (p less than .01); caregivers with high levels of depressive cognitions had high levels of depression only if social supports were low (R2 = .61 including interaction). Self-esteem and depressive cognitions showed a similar interaction, but it failed to reach significance. Analyses to determine whether self-esteem and social supports were directly associated with lower depressive cognitive activity yielded a main effect for self-esteem only (p less than .03). Thus, whereas social supports and self-esteem were directly associated with lower depression, only the social supports variable was further associated with reduced depression because it apparently buffered the impact of depressive thinking. Self-esteem was also indirectly associated with lower depression via its relation with lower depressive thinking. Implications of our results for cognitive theories of depression and for the psychosocial mechanisms of stress buffering are discussed.

Adult↗

PubMed1992

Thinking is for doing: portraits of social cognition from daguerreotype to laserphoto.

From the outset, perspectives on social cognition have taken an emphatically pragmatic stance, as evident in early writing by James, Allport, Bruner, Asch, Heider, Tagiuri, and Jones. After a hiatus, during which social cognition research neglected its proper attunement to social behavior, researchers again are emphasizing that thinking is for doing, that social understanding operates in the service of social interaction. Early and recent (but not intermediate) theories have reflected a pragmatic orientation in 3 recurring themes: People are good-enough social perceivers; people construct meaning through traits, stereotypes, and stories; and people's thinking strategies depend on their goals. The pragmatic viewpoint again opens up new areas for research and theory in social cognition.

Awareness↗

PubMed1993

Self-esteem and counterfactual thinking.

Two studies examined the relation between self-esteem and counterfactual thinking (consideration of "might-have-been" alternatives to reality). Ss imagined themselves in scenarios with another actor that resulted in either success or failure. Ss then "undid" the outcome by altering events that preceded the outcome. Following success, high self-esteem (HSE) Ss were more likely than low self-esteem (LSE) Ss to mutate their own actions. Following failure, LSE Ss were more likely than HSE Ss to mutate their own actions. Also, the structure of counterfactuals was influenced by outcome valence but not by self-esteem: Subtractive structures (in which antecedents are removed) were elicited by success, whereas additive structures (in which antecedents are added) were elicited by failure. The importance of the self and individual differences in self-esteem to counterfactual thinking is discussed.

Adult↗

PubMed1998

Unmasking a cognitive vulnerability to depression: how lapses in mental control reveal depressive thinking.

This research tested the idea that a cognitive vulnerability to depression can be concealed by thought suppression and revealed when cognitive demands undermine mental control. Depressive, at-risk, and nondepressive participants unscrambled sentences that could from either positive or depressive statements. Half of the participants also received a cognitive load. The results indicated that without a load, at-risk participants showed little evidence of depressive thinking, producing a similar rate of positive statements as did nondepressive individuals and a lower percentage of negative statements than did depressive participants. However, the cognitive load caused an increase in at-risk participants' production of negative statements, revealing a previously undetected tendency toward negative thinking that made them resemble depressive participants. As predicted, this effect was especially pronounced among individuals who routinely engaged in thought suppression.

Adult↗

PubMed1999

Counterfactual thinking and regulatory focus: implications for action versus inaction and sufficiency versus necessity.

Counterfactual thinking is associated with regulatory focus in a way that explains previous empirical incongruities, such as whether additive counterfactuals (mutations of inactions) occur more or less frequently than subtractive counterfactuals (mutations of actions). In Experiment 1, regulatory focus moderated this pattern, in that additive counterfactuals were activated by promotion failure, whereas subtractive counterfactuals were activated by prevention failure. In Experiment 2, additive counterfactuals evoked a promotion focus and expressed causal sufficiency, whereas subtractive counterfactuals evoked a prevention focus and expressed causal necessity. In Experiment 3, dejection activated additive counterfactuals, whereas agitation activated subtractive counterfactuals. These findings illuminate the interconnections among counterfactual thinking, motivation, and goals.

Adult↗