Critical Thinking and
Clinical & Health Sciences
Inaugural i2a Institute
May 29, 2009
Implementing the Paul Elder Model
Into Clinical
Nursing Courses
Presented by Pat Martin
Clinical Courses
• The anticipated outcome of a clinical
course is a student that combines
complex reasoning to a variety of
complicated situations
• But how do we really “get there”?
Paul Elder Model
Application
• Purposeful activities that incorporate the use of
Intellectual Standards applied to the Elements
of Thought result in clinical practice that
demonstrates Intellectual Traits
Therapeutic Nursing
Interventions
• FUNDAMENTAL & POWERFUL
DISCIPLINARY CONCEPTS:
1. The nursing process is the gateway to
promoting the psychosocial & physical well
being of clients.
• 2. Safe and effective application of nursing
skills improves client outcomes.
Intellectual Standards
• Benefit of adding intellectual standards
in course objectives & clinical
assessment:
– Provides direction for both the student & clinical
faculty member
– Encourages “deeper thought” in the clinical
environment
– Provides a better tool for measurement
Course
Objectives
Student
Learning
Objectives
Student
Learning
Activity
Assessment
Utilize the nursing
process
accurately to
select,
implement, and
evaluate nursing
interventions.
Identify and
perform
therapeutic
nursing
interventions with
precision &
accuracy that are
relevant to
promote quality
patient care
Clinical Care
Plans
Submits care plans
that:
* are logical for
the pts
condition.
* demonstrate a
nursing diagnosis in
PES format that is
relevant, clear, &
accurate.
* correctly &
accurately identifies
appropriate nursing
interventions
Course
Objectives
Utilize the
nursing process
accurately to
select,
implement, and
evaluate nursing
interventions.
Student
Learning
Objectives
Student
Assessment
Learning Activity
Identify and
perform
therapeutic
nursing
interventions
with precision &
accuracy that
are relevant and
sufficient to
promote quality
patient care
Clinical practice
Implements client
care from the care
plan that is
accurate, relevant,
logical and safe for
the patient and
reflects fairness in
nursing care
delivery.
Participates in
pre/post
conference to
actively engage in
accurate & precise
clinical decision
making.
Promoting Deeper Learning
• Post-conference activity
– Develop and write a scenario to illustrate a patient care
activity you completed today (5-10 minutes allowed)
• Questions to illicit Elements of Reasoning
– What was the purpose of this activity?
– What information did you have to collect before
implementing this activity? (Information)
– What assumptions did you make?
– Describe two possible approaches you could take.
(Information, Concepts, Inferences, etc)
Promoting Deeper Learning
• Other methods for classroom/clinical
– Focused Problem –write a memo
• Can address a number of questions discovered in a clinical
situation
– 1 Minute Question/Answer
• Teacher poses the question, students have 1 minute to think
about the answer
– Pass the Problem
• Teacher poses a problem, students work in small groups to
identify solutions then pass off to the next group that analyzes
the solutions.
Clinical Evaluations
• Provide a mechanism for clinical faculty
to measure the progress/achievement in
the clinical setting
• Provides the expectations and feedback
for clinical students
• Addition of Intellectual Traits provides a
benefit for both faculty and students.
Clinical Evaluations
• Adding components of the Intellectual
Traits promotes a deeper learning
experience and clear expectations for
faculty and students.
• Outcomes of clinical = Intellectual Traits
Clinical Objective
• Demonstrates Confidence in Reason
•
•
•
•
1. Performs accurate assessment of assigned patients
2. Accurately analyzes assessment data
3. Determines appropriate nursing diagnoses
4. Evaluates possible consequences of all interventions when
planning care based on assessment data and nursing diagnosis
• 5. Provides rationale for interventions which demonstrates
knowledge of nursing as an art and a science
• 6. Selects appropriate nursing interventions to promote quality
patient care
• 7. Evaluates effectiveness of nursing interventions and revises
plan of care accordingly for quality care
Demonstrates Professional Behavior
• Demonstrates Intellectual Perseverance
• Actively participates in the clinical experience and is
responsive to the needs of the patient & works
diligently to meet those needs
• Routinely evaluates clinical practice for quality and
effectiveness of nursing interventions
• Serves as an advocate for clients
• Actively shares knowledge and information with peers
and clinical instructor
• Identifies strengths and weaknesses and sets personal
goals accordingly
Infusing the Model into Clinical
teaching
• The use of the Paul Elder Model in clinical
teaching provides educators the opportunity to
provide the student with a rich and meaningful
clinical experience that promotes synthesis of
complex material in the clinical setting.
Infusing Critical Thinking in the Dental
Hygiene Program
Jackie Singleton, R.D.H., M.Ed.
Program Director
Periodontics, Endodontics & Dental Hygiene
The Paul-Elder Model in Action
Clinical and Health Sciences Exemplar
A Critical Thinking Summative Learning
Self-Assessment Exercise
(Skilled vs. Unskilled Reasoner Reflection)
A Concurrent Session Presentation
Given at the Inaugural i2a Institute
on Critical Thinking Across the Curriculum
University of Louisville
Louisville, KY
May 29, 2009
Presenter: Dr. Joe Moravec
Professor, Philosophy and Religion
Mercy College of Health Sciences
Des Moines, Iowa
Main Purpose
• To share one exemplary use of the PaulElder model in my courses at Mercy
College of Health Sciences that effectively
engages/prepares/equips collegians to be
more sound, critical thinkers and life-long
learners as healthcare practitioners.
Main Purpose (cont.)
In particular, I will share a Critical Thinking Summative Learning
Self-Assessment Exercise I have developed for my students to use
at the end of their unit of study on the fundamentals of the PaulElder critical thinking model that provides them with a summative,
self-assessment reflection activity. The exercise integrates the eight
universal, analytical elements of sound reasoning with the nine
fundamental
Main Purpose (cont.)
standards that are significant in evaluating their overall skills in
reasoning. Students specifically are expected to reflect on some
critical questions to better determine to what degree their current
critical thinking abilities approximate those of a skilled or an
unskilled reasoner. They then are asked to develop their own
specific, individual game plan and strategy for improvement.
Presentation Outline, 3 Parts:
I. Some Preliminary Considerations
II. Actual Exercise Design and Process
III. Some Consequences and
Implications
Presentation Outline, Part I:
Some Preliminary Considerations
• Some Key Questions
• Some Key Assumptions
• Some Key Terms/Concepts
Some Key Questions
• What exercise(s) can challenge and engage students in applying
and integrating the fundamentals of the Paul-Elder Model to their
personal and professional lives?
• What exercise(s) can assist students in analyzing and evaluating
their own level of reasoning skill?
• What exercise(s) can assist students in reconstructing their own
thinking in a more sound way?
Some Key Questions (cont.)
• What abilities characterize “Skilled
Reasoners” and “Unskilled
Reasoners”?
• What are some critical questions that
can serve the student in self-assessing
their own abilities as critical thinkers?
• What exercise(s) can assist students in
developing a personal plan to improve
their reasoning skills in practical and
strategic ways?
Some Key Assumptions
• Students need to understand how to think critically and reason
soundly in a holistic way (third-wave, Paul-Elder approach) in
order to empathically understand and relate to others in a Platinumplus way in healthcare.
• Students need to understand their own reasoning processes
(i.e. where they are skilled/unskilled) and why/how they can take
charge of improving them in order to improve the quality of their
personal and professional lives.
Some Key Assumptions (cont.)
• Students are able to grow and will want to accomplish the above
with sound theory, personal discovery, encouragement,
commitment, hard work and practice.
• Students cannot/will not change that which they don’t know.
• This reflective axiom is true:
– As a person thinks, so the person is
– As a person is, so the person thinks.
Some Key Terms/Concepts
• Students have been exposed to and understand the basic
terms/concepts of the Paul-Elder Model especially the following:
– What “Critical Thinking” is
– What “Sound Reasoning” involves
– What the traits of the disciplined and
undisciplined mind are and how are they
essential to sound reasoning
– The fundamental CT assessment
“Standards” relationship to the universal CT
analytical “Elements”
– The characteristic abilities of Skilled and
Unskilled Reasoners
What is “Critical Thinking”?
• Critical Thinking is the disciplined art of thinking about
thinking while thinking to improve your thinking (Paul & Elder,
2006).
• The presenter contends that the third-wave approach and
philosophy of critical thinking, as espoused by Paul and Elder,
provides the most comprehensive and applicable model for
understanding and developing sound, ethical reasoning in
healthcare students.
What is involved in “Sound
Reasoning?
• Reasoning is the process of making sense of or figuring
something out whether in healthcare practice or in life.
• Sound reasoning involves four aspects:
– Art (Traits of the Disciplined, Ethical
Mind/Person)
– Analysis (Elements of thinking)
– Assessment (Standards of thinking)
– Abilities (Applied and practiced skills)
Presentation Outline, Part II:
I.
Some Preliminary Considerations
II. Actual Exercise Design and
Process
III. Some Consequences and
Implications
Actual Exercise Design
• Refer to Handout.
• Exercise Explanation
• Element Definition
• Primary Standards for Assessing Element
• Common Problems in Reasoning
Associated with the Element
• Key Principle for Masterful Reasoning
Actual Exercise Design (example)
Universal Element: Purpose
All reasoning has a purpose.
Primary standards: (1) clarity, (2) significance,
(3) achievability, (4) consistency, (5) justifiability
Common problems: (1) unclear, (2) trivial, (3)
unrealistic, (4) contradictory, (5) unfair
Principle: To reason well, you must clearly
understand your purpose, and your purpose must
be fair-minded.
Actual Assignment Description
• Consideration of the critical thinking abilities
described in each column box (Skilled vs.
Unskilled Reasoner) on pp.2-9.
• After reflection on the critical questions, boxes
are check “√” marked that best
characterizes your current skill level.
• Scores tallied for columns.
• Summary comments (2-3 sentences) of
findings.
• Overall summative reflection paper (1-2
pages) with personal game plan for
improvement.
Actual Exercise Design (example)
Skilled Reasoners √ Unskilled Reasoners √ Critical Questions
Take the time to state Are often unclear about + Have I made the
their purpose clearly. their central purpose.
purpose of my
reasoning clear?
+ What exactly am I
trying to achieve?
+ Have I stated the
purpose in several
ways to clarify it?
Total score:
Summary Comments:
Presentation Outline, Part III:
I.
II.
Some Preliminary Considerations
Actual Exercise Design and Process
III. Some Implications and
Consequences
Implications and Consequences
By completing this exercise, students will:
• Gain a more comprehensive understanding of
their current reasoning abilities.
• Have greater insight into how to analyze and
assess their own thinking as life-long learners
both personally and professionally.
• Be encouraged and better equipped to take
responsibility of and for reconstructing their own
thinking in a more sound way.
• Develop their own personal plan to improve
their own reasoning skills in practical and
strategic ways.
Implications and Consequences
(cont.)
• Be better able to communicate and relate to
others what they have learned about their own
thinking thus far in their lives.
• Become a more skilled reasoner who
understands why and how they can continually
take charge of improving their thinking in order
to improve the quality of their personal and
professional lives.
• Be prepared to live fair-minded, ethical lives as
individuals and professionals in our everincreasingly diverse world?
Conclusion
• We do not know what problems and
challenges our students will be facing
personally and professionally in the next 5-10
years; but if we can help them now know
how to continually analyze and improve the
quality of their thinking, learning and lives
everyday in everyway (and they choose to
practice doing so), then they will be best
prepared and able to successfully thrive (not
just survive) through all them, no matter
what.
Addendum Exemplars
See two additional handouts I developed based on the Paul-Elder
Model:
• Individual Project Guideline Reasoning Template Sheet (for PHI
301/302)
• Group Project/Presentation Reasoning Template Guideline Sheet
(for PHI 110/PHI 301)
Thank You!
Reference
Paul, R. & Elder, L. (2006). Critical thinking: tools for taking charge
of your learning and your life (2nd ed.). Upper Saddle
River, NJ: Prentice Hall.