Reference no: EM133272113

Scenario

You are an emergency room nurse. Kathy is present with her two children, Michael, and Susan. Michael fell off the slide at the playground two hours ago and hit his head resulting in a large, bluish-colored bump on the forehead. Kathy states she was caring for Susan when Michael fell and expresses guilt for Michael's injury. Kathy appears frightened and tearful stating she called her husband to come to the hospital 90 minutes ago, but he hasn't arrived yet. While Michael is being evaluated, you talk with Kathy and learn more about the family. Jack arrives after Michael is discharged home.

Jack and Kathy have been married for seven years. They have two children, Michael four years old, and Susan two years old. They recently moved to a new home in a suburban neighborhood that is close to an elementary school and a large park with a playground, swimming pool, and hiking paths. Kathy and Jack's families live six hours away in another state.

Kathy is a certified public accountant but is not currently employed. When Michael was born Kathy became a full-time stay-at-home mother and took over all responsibilities for managing the home and family. Kathy has found it increasingly difficult to spend time with friends or participate in volunteer work since Jack began teaching at the university. Kathy states that over the last few months Jack has been spending more time at the university working late into the evening and on many weekends. Kathy has been too busy settling into their new home to meet any of their neighbors and find a local babysitter. Kathy would like Jack to share more responsibilities for the home and to spend more time with her and the children.

Jack recently completed graduate school and began a position as a college professor at a local university two years ago. Jack goes to his office every day and spends time preparing his courses, teaching classes, meeting with students, and evaluating student work. He is also a member of two university committees and conducting a research study. Kathy states Jack told her that she does a wonderful job managing everything at home and with the cost of childcare he is happy that she wanted to stop working. Jack also told Kathy he would like to be home more to help her.

Application of Brookfield's Critical Thinking Process to the Scenario

Utilize Brookfield's Critical Thinking Process Steps (see below), reflect and critically analyze the situation with questions that fit the situation (see above). Briefly introduce Brookfield's model here.

Assumption Identification

Identify assumptions which involves probing, reflecting on, and questioning one's usual ways of thinking, as well as one's morals, beliefs, values, and stereotypical notions. This includes awareness of what is happening in the context of the situation including values, cultural issues, and environmental influences. Assumptions are unstated entities that are nevertheless perceived as being true and taken for granted. If we assume we know the reasons for people's behavior without trying to better understand them, then we put our patients into a box ("these people are like this") without really understanding them as individuals.

Reflect and respond to the following questions documenting as many assumptions within each category as possible:

Paradigmatic assumption: What is your point of view or a generally accepted point of view with respect to the issue Paradigmatic assumptions are typically written as statements of belief. For example, "All nurses are caring people."
Prescriptive assumption: What is your belief or what do you believe is important about this situation? (Consider a possible emotional response to the issue or value influencing your view of the situation). Prescriptive assumptions are typically written as "should" statements of what you believe should happen. For example, "All nurses should demonstrate caring."
Causal assumption: What may the cause/effect be with this situation? Causal assumptions are typically written as "if, then statements." For example, "If the nurse demonstrates caring, then a therapeutic relationship is more likely to occur."
Accuracy and Validity Check

Do the assumptions fit the situation and make sense? Look at the assumptions from multiple perspectives (consider the following questions) and eliminate any assumptions not accurate or valid.

What is the patient's point of view (preference) and values regarding this issue?
Are there any other points of view and values to consider?
Is my point of view/assumption valid and accurate in light of other's perspectives and does it make sense?
Is it ethical and moral?
My clinical expertise: Do I have past experience with this situation and, if so, does my assumption align with the previous outcome? (Consider and leverage your acquired nursing knowledge.)
Initial Perspective

What is your initial perspective about this situation?
Alternative Perspective Consideration

This involves thinking about and imagining other ways of looking at the situation, not just the first thing that comes to your mind. It involves exploring as many alternatives as you can think of for the given situation. Nurses in this step utilize acquired nursing knowledge.

Sample questions include:

What are other possibilities or alternatives?
Are there others (healthcare professionals and the patient and/or support system) that may be able to identify more alternatives? If so, what are they?
Do I have access to all of the information (clinical and evidence-based data) to identify alternatives? If not, how would I seek out this information.
Are there additional assumptions that need to be verified for accuracy?
How could I obtain needed information?
Take Informed Action

This step involves reflective skepticism, which is questioning, analyzing, and reflecting on the rationale for decisions. Reflective skepticism is not cynicism, but rather the belief that ideas and practices must be subjected to careful testing against experiences. A decision is made in this step based on judgment and confidence in the grounded assumptions.

What is my conclusion/decision?
What rationale supports or negates my assumptions?
Does the data support my conclusion?
Are there any other conclusions that data supports?
What are the implications and consequences of the decision?
Is there any aspect of the situation that requires more careful attention?
Incorporation of the Nursing Process

The nursing process steps are assessment, analyze assessment data, plan, implement, and evaluate. For example, if you were in the "assessment" step, the next step of the nursing process would be analysis. See this brief overview of the updated nursing process for more information regarding the new nursing process (must be logged-in to CSP Gmail to access the nursing process resource).

Identify the part of the nursing process utilized to support this situation.
Identify the next step of the nursing process/action required.
Incorporation of Patient Preferences

Discuss how patient preferences were included in your thinking process and if not, how they could be included.

Interprofessional Collaboration

Discuss how collaboration with other healthcare professionals was included in the situation/your actions, and if not, how it could have been.

Use of Evidence or Nursing Knowledge

Discuss how you did (or how you could) use evidence and/or nursing knowledge to support your clinical decision?

Reflection on Use of Brookfield's Critical Thinking Process

Provide an overall reflection of your experience analyzing a clinical situation you experienced through the Brookfield critical thinking lens.