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1

Define Problem Solving

- Working through the problem to find a solution

2

Define Clinical Reasoning

- Process during which we structure meanin, goals and health management strategies based on clinical data, pt preferences and values, knowledge and professional judgement

3

Deine Clinical Judgement

- Application of information based on actual observation of a pt combined with subjective and objective data that lead to a conclusion

4

Define Critical Thinking

- Clarifies goals, examines assumptions, uncovers hidden values, evaluates evidence, accomplishes actions and assess conclusions

5

Define Clinical Decision Making

- Complexprocessinvolvingobservation,information processing, critical thinking, evaluating evidence, applying relevant knowledge, problem solving skills, reflection and clinical judgement to select the best course of action

6

What are the three decision making theories

- Normative models

- Descriptive model

- Prescriptive model

7

What is a Normative Model

- The analysis of individual decisions, using logic, rationality, scientific evidence based decisions: eg clinical trials testing drug efficacy or ‘normal range’ SpO2 reading to minimize judgement error of physiological processes

What theory dictates people should do when making a decision

8

What is a Descriptive Model

- Examines how people make decisions in reality when choosing the options available to them

What people actually do when making a decision

9

What is a Prescriptive Model

- A combination of the theoretical aspect of normative theory and observations of descriptive theory. Provides a practical aid to decision making, whilst aspiring to rationality: eg. Frameworks, guidelines, algorithms designed to improve specific decision tasks

What people should/can do when making a decision

10

How do we explain decision making

- Combination of experience, knowledge, expertise of others, research and available
evidence

- Numerous frameworks and models used to explain the process of decision making with many overlapping themes.

11

What are the two opposing conceptual frameworks underpinning decision making

- The intuitive framework (also known as inductive framework (Hamm, 1988) Data is collected and leads to generation of a hypothesis

- The analytical framework (also known as deductive framework) Hypotheses are used to predict the presence/absence of data to confirm/deny hypotheses

12

What is Intuition

- Understanding without rationale’ (Benner and Tanner 1987)

- An irrational act

- Guessing

- Unfounded knowledge

- Supernatural inspiration Hunches Non-conscious process

13

What are the FIve Levels of the Benners Model and the explanations

- Novice = No experience Need rules

- Advanced Beginner = Demonstrate acceptable behaviour Principle- based

- Competant = Same role 2-3 years Deliberate planning

- Proficiant = Whole situations Holistic under standing

- Expert = Intuitive grasp Deep under standing

14

What are the 6 parts of the Dreyfus skill acquisition

-1. Patternrecognition
2. Similarityrecognition
3. Commonsenseunderstanding 4. Skilledknow-how
5. Senseofsalience
6. Deliberativerationality


15

Explain Similarity Recognitionin the Dreyfus Model

- Awareness that this patient
reminds you of a similar patient

- Sets up conditions for recognising dissimilarities as well

- This is despite objective features of past & current situations

- Helps the expert select the most relevant patients for comparison

16

Explain Common Sense Understanding in the Dreyfus Model

- Basis for understanding the illness experience in contrast to knowing the disease

- A deep grasp of the culture & language

- Allows flexible understanding in diverse situations

- The language of illness is a human language with emotions & lived experiences.

17

Explain Skilled know-how in the Dreyfus Model

- Two kinds of knowledge
Polanyi (1974) & Kuhn (1962)

- ‘Knowing how’
Practical knowledge -
learnt through skilled practice
Body taking over a skill e.g. how do you ride a bike?

- ‘Knowing that’
Theoretical knowledge

- Tacit knowledge
Meerabeau (1992)
Describes the expert knowledge
that professionals use, but find difficult to articulate

- Technical Rationality
Schon (1983)
Professional knowledge underpinned by rigorous application of scientific theory & technique

18

Explain Sense of salience in the Dreyfus Model

- Certain events or details stand out as more or less important

- In formal models of judgement, sense of salience is replaced by checklists

- Innate sense of what is happening around you

- ‘Insider’ knowledge

- Expert appraisal allowing
flexibility

19

Explain Deliberative Rationality in the Dreyfus Model

- The expert practitioner has learnt to expect certain events & selectively attend to certain aspects of the situation

- A means of clarifying the current perspective by considering how your interpretation of a situation would change if your perspective were changed

20

Explain Pattern Recognition in the Dreyfus Model

- Perceptual ability to recognise relationships without pre-specifying the components of a situation

- Patients present patterns of responses that expert practitioners learn to recognise

- Novices may require a list of features to identify patterns

- Recognition of subtle variations in the pattern

21

What are the two Analytical Frameworks

- The Hypothetic-Deductive Framework

- Cognitive Continuum Framework

22

Define the The Hypothetic-Deductive Framework

1. Cue acquisition – gathering information/clinical data

2. Hypothesis generation – Differential diagnoses

3. Cue interpretation – diagnostic testing/observations/history to confirm/refute diagnoses

4. Hypothesis evaluation – weighing up pros and cons, choosing evidence based interventions

23

Define the Cognitive Continuum Framework

- Matches cognitive tasks to the decisions and the clinicians competence

- This is based on all theories and models have different strengths and weaknesses

- Different decisions need different
approaches, so joined together intuition/experimental and analytical/rational to form the cognitive continuum

24

What can help the decision making process

- Protocols – rigid directions....

- Clinical Guidelines – UK Ambulance Services Clinical Practice Guidelines, NICE guidelines, UK Resuscitation Council – best practice, evidence based

- Algorithms – developed from research evidence and patient data

- Decision matrix – quantitative tool to rank/score options using set criteria to gain a total score – SADS score, APGAR, GCS . Can still remain subjective

25

How could we become better decision makers

- Maintain desirable attributes

- Inquisitiveness

- Be well informed

- Stay current – CPD

- Be open minded

- Ask for feedback

- Develop communication skills Use available decision matrices

26

What are the factors that effect decision making

- Confirmation bias

- Optimism bias

- Anchoring

- Information bias

- Selective perception

- Hindsight bias

- Belief/behavioural bias

27

Define Confirmation Bias

- misinterpretation of data to suit the decision maker

28

Define Optimisim Bias

- being over optimistic about what will happen as a result of decision

29

Define Anchoring

- relying heavily on a single piece of information

30

Define Information Bias

- seeking too much data which ‘swamps’ the decision process