Resume os tables for critical thinking and refelective practice

Table 1. Best practice precepts for setting critical thinking and reflective practice assignment questions

Setting critical thinking questions	Setting reflective practice questions
Create a focus for the question, for example rehabilitation of the patient rather than patient care. Precision helps nursing students to decide what they should include in their essay.	Indicate any reflective frameworks that you require the student to use. If the student has a choice, signal this in the question.
Consider setting the question in sections, for example the first part requiring the student to demonstrate knowledge and later parts explaining what they do with such knowledge. Structure reduces the risk that answers become muddled.	Ask the student to separate a simple descriptive account of clinical events from their interpretation, their significance and importance for nursing responses. Combining the two makes it more difficult to judge student reasoning.
Indicate how you want the student to think, for example ‘Draw on research literature to critically examine whether patients may be successfully taught to self-care’.	Remind students about the differences between perceptions of what they believe others did or thought (speculation) and what they themselves thought or felt (reflection). Writing about the former, students share insights into their interpretation of events, what they take into account, explanations and counter explanations.
Make sure that the context is clear in which the nursing student is asked to provide their answer, for example ‘With regard to ethical principles, critically discuss the challenges of supporting patients in end of life care’. The context here is ethics, not anything else.	Signal clearly your interest in introspection, if this is what is sought in a question – for example ‘With reference to the clinical event that you have described in part A of the question, discuss how this has made you reconsider your beliefs and values regarding nursing care’.
Signal what is required as regards breadth versus depth of learning the student should demonstrate. This can often be done by indicating that you require a small number of carefully chosen discussion points, for example ‘Discuss the three most important points to make when advising colleagues on how best to explore the meaning of cancer with a newly diagnosed patient’.	Be clear what you accept as a clinical event. Reflection might focus on one episode of care, but it might also centre on a sequence of related care encounters that constitute the event. Students should understand how big an event they can discuss, and should be cautioned that large and complex events may require greater powers of analysis.
Review what can realistically be covered from the module syllabus within one question. A common problem with questions is to aim for syllabus coverage which confuses students, making it more difficult for them to demonstrate clear reasoning. Assess skills and reasoning processes that underpin knowledge used widely in the module.	Be clear how far the reflection is to be taken. If you wish to examine a nursing student’s ability to read situations and to think inductively, you might instruct: ‘With reference to the care encounter you outlined in section A, outline the possible explanations that you might consider when trying to understand the patient’s behaviour’. If you wish the student to reach a deduction, a different challenge might be set: ‘With reference to the care encounter outlined in section A, defend what you deduced you had to do next in response to the patient’s behaviour.’

Table 2. Foci for critical thinking

Focus	Definition	Example assignment task
Facts	Emphasis is on assessing what is known and what the facts establish.	Summarise how insulin regulates blood glucose levels.
Concepts	Emphasis is on the properties of the concept and how it operates.	Discuss what is meant by ‘patient rehabilitation’.
Procedural matters	Emphasis is on the sequence of work and the rationale for this. In healthcare courses this often centres on skills.	Discuss the way in which the nurse should take a patient history, focusing progressively on problems or needs recounted by the patient.
Strategic matters	Emphasis is on the overview, arrangements and co-ordination.	How does the multidisciplinary team collaborate to ensure that the patient with diabetes is enabled to self-manage the condition?
(Adapted from Heer 2012)

Table 3. Six levels in theory-related critical thinking

Level	Notes	Significance
Identifying and retrieving necessary information (lowest level)	At this level it is as if you survey the pieces of a puzzle before you. You know a number of facts about the subject in question, but they have not been classified or collated in a coherent form.	You know things that are relevant but have not connected them to each another. The ideas are not ordered, for example by a concept such as rehabilitation.
Understanding	You show an appreciation of what is at issue, what is important or necessary. This is not applied to a context. There is no indication of why this is so important.	You are starting to conceptualise. Concepts are understood and you are making connections between them.
Application	Abstract concepts are applied to a practice context. Understanding of the abstract is modified by contextual circumstances and need.	Standard ideas are modified by circumstance.
Analysis	The ability to see different explanations and options. The ability to draw in evidence that helps you to determine what seems most important, what is influential and what tends to affect outcomes.	Evidence selection, review and use are crucial to guide your speculations. To review explanations and options you require possible explanations of why things happen as they do.
Evaluation	The ability to take stock. Using your imagination to picture what might succeed, and what might determine whether a plan is working. Stock-taking should be nuanced, dealing with the particulars of the patient or circumstances of care.	Reaching a discerning judgement about the likely success of a proposal or the progress of a plan under way.
Creative (highest level)	The ability to reframe healthcare issues and problems. The ability to imagine innovative alternatives and provide solutions in ways that transform and liberate practice.	Caution must be exercised as regards patient safety. Having the courage to think differently about care is valuable and may help transform practice.
(Adapted from Heer 2012)