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Critical Thinking in Clinical Practice: Improving the Quality of Judgments and Decisions
Contents
Preface
PART I: LAY OF THE LAND
Chapter 1: The Need for Critical Thinking in Clinical Practice
THE IMPORTANCE OF THINKING CRITICALLY ABOUT DECISIONS
HALLMARKS OF CRITICAL THINKING
BARRIERS TO MAKING SOUND JUDGMENTS
CLINICAL REASONING AS A TEACHABLE SKILL
THE COSTS AND BENEFITS OF CRITICAL THINKING
HOW SKEPTICAL SHOULD CLINICIANS BE?
SUMMARY
Chapter 2: Sources of Influence on Decisions That Clinicians Make
CHANGING VIEWS OF PROBLEMS AND THEIR PREVALENCE
POLITICAL, ECONOMIC, AND SOCIAL INFLUENCES ON PROBLEM DEFINITIONS AND PROPOSED REMEDIES
THE INFLUENCE OF AGENCY VARIABLES
TECHNOLOGY DEVELOPMENT
THE INTERACTION BETWEEN CLIENTS AND CLINICIANS
PSYCHOLOGICAL FACTORS THAT INFLUENCE CLINICAL JUDGMENTS
SUMMARY
Chapter 3: Reasons and Reasoning: The Heart of Making Decisions
VIEWS OF INTELLECTUAL COMPETENCE
REASONS
SOME HELPFUL DISTINCTIONS
ARGUMENTS
ANALYZING ARGUMENTS
KINDS OF ARGUMENTS
EXPLANATIONS
INDIVIDUAL AND CULTURAL DIFFERENCES
SUMMARY
Chapter 4: Different Views of Knowledge and How to Get It: Exploring Your Personal Epistemology
DIFFERENT VIEWS OF KNOWLEDGE AND HOW (OR IF) IT CAN BE GAINED
EVALUATING KNOWLEDGE CLAIMS
AVOIDING HARMING IN THE NAME OF HELPING
QUESTIONABLE CRITERIA
SCIENCE AND SCIENTIFIC CRITERIA
THE DIFFERENCE BETWEEN SCIENCE AND PSEUDOSCIENCE
ANTISCIENCE
QUACKERY
PROPAGANDA
FRAUD
KNOWLEDGE VALUED IN EVIDENCE-BASED PRACTICE
KNOWLEDGE VALUED IN AUTHORITY-BASED PRACTICE
CRITICAL APPRAISAL OF PRACTICES AND POLICIES AS AN ETHICAL OBLIGATION
THE BURDEN OF KNOWLEDGE
SUMMARY
GLOSSARY
PART II: COMMON SOURCES OF ERROR
Chapter 5: The Influence of Language and Persuasion Strategies
THE INFLUENCE OF LANGUAGE
FALLACIES RELATED TO LANGUAGE
THE INFLUENCE OF SOCIAL PSYCHOLOGICAL PERSUASION STRATEGIES
SUMMARY
Chapter 6: Formal and Informal Fallacies: Mistakes in Thinking and How to Avoid Them
FALSE EVEN THOUGH VALID
IRRELEVANT APPEALS
EVADING THE FACTS
OVERLOOKING THE FACTS
DISTORTING FACTS/POSITIONS
DIVERSIONS
THE USE OF CONFUSION
SUMMARY
A CATALOG OF FAULTY INFERENCES
Chapter 7: Classification, Pseudoauthority, and Focusing on Pathology
FALLACIES RELATED TO CLASSIFICATION
APPEALS TO PSEUDOAUTHORITY
FALLACIES RELATED TO A PATHOLOGICAL SET
THE RULE OF OPTIMISM
SUMMARY
PART III: DECISION AIDS
Chapter 8: Content and Procedural Knowledge
IS KNOWLEDGE IMPORTANT IN THE INTERPERSONAL HELPING PROFESSIONS?
DIFFERENCES BETWEEN NOVICES AND EXPERTS
WHAT COMPETENCIES CONTRIBUTE TO SUCCESS?
HOW SHOULD WE ASSESS PROFESSIONAL COMPETENCE?
TO KEEP UP-TO-DATE OR NOT
DECIDING WHAT INFORMATION TO SEEK AND WHERE TO SEEK IT
ACTIVE VERSUS PASSIVE LEARNING
REMEMBERING WHAT WE READ
PROBLEM-BASED LEARNING
BECOMING A LIFELONG LEARNER
THE INFLUENCE OF PROFESSIONAL EDUCATION PROGRAMS
SUMMARY
Chapter 9: Taking Advantage of Research on Judgment, Problem Solving, and Decision Making
PROBLEM SOLVING IS UNCERTAIN
SITUATIONS CHANGE
STRUCTURING PROBLEMS IS A CRITICAL PHASE
OUR GOALS AND CONFLICTS AMONG THEM INFLUENCE OUR SUCCESS
OUR AFFECTIVE REACTIONS INFLUENCE DECISIONS
TASK DEMANDS INFLUENCE DECISIONS
SITUATION AWARENESS IS VITAL
CONFIRMATION BIASES ABOUND: PARTIALITY IN THE USE OF EVIDENCE
WE USE SIMPLIFYING STRATEGIES (HEURISTICS)
AVAILABILITY
REPRESENTATIVE THINKING: MISUSE OF RESEMBLANCE CRITERIA
MEMORY AS RECONSTRUCTIVE
MANY INFLUENCES LIE OUTSIDE OUR AWARENESS
THERE ARE DIFFERENT DECISION-MAKING STYLES
CREATIVITY AND INTUITION PLAY AN IMPORTANT ROLE
DOMAIN-SPECIFIC KNOWLEDGE AND SKILLS ARE IMPORTANT
WE TEND TO MAKE CERTAIN KINDS OF ERRORS
WE CAN LEARN THROUGH OUR MISTAKES
FAILURES ARE INEVITABLE
PERSPECTIVE MAKES A DIFFERENCE: SELF VERSUS OTHERS
THERE ARE CULTURAL DIFFERENCES
SELF-IMPOSED BARRIERS
WE CAN LEARN TO BECOME BETTER DECISION MAKERS
SUMMARY
Chapter 10: Evidence-Based Practice: A Philosophy and Process for Thinking Ethically and Critically about Decisions
ORIGINS OF EVIDENCE-BASED DECISION MAKING
HALLMARKS AND IMPLICATIONS OF THE PHILOSOPHY OF EVIDENCE-BASED PRACTICE AND CARE
ALTERNATIVES TO EVIDENCE-BASED PRACTICE
OBJECTIONS TO EVIDENCE-BASED PRACTICE, AND COUNTERARGUMENTS
CONTROVERSIES REGARDING EVIDENCE
SUMMARY
Chapter 11: Posing Questions and Searching for Answers
POSING WELL-STRUCTURED, ANSWERABLE QUESTIONS RELATED TO PRACTICE DECISIONS
SEARCHING EFFECTIVELY AND EFFICIENTLY FOR PRACTICE-AND POLICY-RELATED RESEARCH FINDINGS
CRITICALLY APPRAISING WHAT YOU FIND
USING CLINICAL EXPERTISE TO INTEGRATE EXTERNAL RESEARCH FINDINGS WITH OTHER RELEVANT INFORMATION AND APPLYING THE FINDINGS
EVALUATING AND LEARNING FROM WHAT HAPPENS
EVALUATING YOUR SKILLS IN EVIDENCE-BASED PRACTICE
THE QUESTION OF MOTIVATION
SUMMARY
Chapter 12: Critical Appraisal of Practice-Related Research: The Need for Skepticism
COMMON MYTHS THAT HINDER CRITICAL APPRAISAL
THE QUESTION OF BIAS
QUESTIONS TO ASK ABOUT RESEARCH
LEVELS OF EVIDENCE
QUESTIONS ABOUT EFFECTIVENESS, HARM, AND PREVENTION
SYSTEMATIC REVIEWS AND META-ANALYSES
QUESTIONS ABOUT PREVALENCE AND INCIDENCE (FREQUENCY AND RATE)
QUESTIONS ABOUT CAUSES
QUESTIONS ABOUT DIAGNOSIS AND SCREENING
QUESTIONS CONCERNING PROGNOSIS, RISK, AND PROTECTIVE FACTORS (PREDICTION)
QUESTIONS ABOUT PRACTICE GUIDELINES
CONTROVERSIAL ISSUES
OBSTACLES
SUMMARY
PART IV: APPLYING CRITICAL THINKING SKILLS TO CLINICAL DECISIONS
Chapter 13: Making Decisions about Data Collection
FACTORS THAT INFLUENCE WHAT CLINICIANS SEE AND REPORT
DIFFERENT KINDS OF EVIDENCE
NOT FOR RESEARCHERS ALONE: CONCERNS ABOUT RELIABILITY AND VALIDITY
QUESTIONABLE ASSESSMENT METHODS
SOURCES OF DATA
WEIGHING THE VALUE OF DATA
RECORDING AND STORING INFORMATION
SUMMARY
Chapter 14: Discovering Causes of Clients’ Problems: Common Biases
DIFFERENT PRACTICE PERSPECTIVES EMPHASIZE DIFFERENT CAUSES
ASSESSING COVARIATIONS
CAUSAL ANALYSIS
SOURCES OF ERROR
A DISPOSITIONAL BIAS
USE AND MISUSE OF INTUITION
IMPROVING THE ACCURACY OF CAUSAL ASSUMPTIONS
SUMMARY
Chapter 15: Predictions about Clients and Treatment Effectiveness: Improving the Odds
CASE WORKER’S REPORT
ACTUARIAL VERSUS CLINICAL JUDGMENT
PREDICTION, CHOICE, AND PROBABILITY
CHALLENGES IN ASSESSING RISK
USING TEST RESULTS
OVERVIEW OF SOURCES OF ERROR
INCREASING THE ACCURACY OF PREDICTIONS
SUMMARY
Chapter 16: Enhancing the Quality of Case Conferences, Team Meetings, and Organizational Culture
CHARACTERISTICS OF CASE CONFERENCES THAT DECREASE THE QUALITY OF DECISIONS
CHEAP SHOTS
WHY IS THE QUALITY OF DISCUSSION IN CASE CONFERENCES OFTEN POOR?
DENUNCIATIONS AND PITCHES
AN EXAMPLE OF A CASE CONFERENCE
ENHANCING THE QUALITY OF CASE CONFERENCES AND TEAM MEETINGS
THE INFLUENCE OF ORGANIZATION CULTURE AND CLIMATE
SUMMARY
PART V: THE FUTURE
Chapter 17: Overcoming Personal Obstacles to Critical Thinking
ENCOURAGE VALUES COMPATIBLE WITH ETHICAL OBLIGATIONS TO CLIENTS
CHANGE A PREFERENCE FOR MYSTERY TO ONE FOR BEING WELL INFORMED
OFFER CLIENTS THE SAME QUALITY OF SERVICES YOU WOULD LIKE
REVIEW COMPROMISES AND RECOGNIZE SIGNS OF DEPLETION
INCREASE EFFECTIVE REACTIONS TO UNCERTAINTY AND AMBIGUITY
ACQUIRE FACILITATING VIEWS ABOUT KNOWLEDGE AND HOW TO GET IT
IMPROVE SELF-MANAGEMENT SKILLS
INCREASE RELATIONSHIP SKILLS
DECREASE UNREALISTIC EXPECTATIONS
AVOID SELF-HANDICAPPING REACTIONS AND DEVELOP POSITIVE ALTERNATIVES
WHAT ABOUT SELF-EFFICACY AND SELF-ESTEEM?
EXAMINE RATIONALIZATIONS/EXCUSES
EXCUSES AND SELF-DECEPTION
SUMMARY
Chapter 18: Maintaining Critical Thinking Skills
GENERALIZING AND MAINTAINING CRITICAL THINKING SKILLS
REVIEW PREFERRED PRACTICE THEORIES
TAKE OCCASIONAL TIME-OUTS TO REFLECT ON YOUR WORK
SUMMARY
Author Index
Subject Index
About the Author
Nội dung
Critical Thinking in Clinical Practice Improving the Quality of Judgments and Decisions Second Edition Eileen Gambrill John Wiley & Sons, Inc. [...]... are pertinent to critical thinking and evidence-based practice in clinical practice and to draw these together in a format that makes sense to clinicians and that can be used to enhance the quality of practice It does not attempt to offer incisive reviews of the many fields that are touched on here as they relate to clinical decision making The teaching of thinking is as old as philosophy itself, and entire... shown in Exhibit 1.5 Critical thinking involves using related knowledge and skills in everyday life and acting on the results (Paul, 1993) It requires flexibility and a keen interest in discovering mistakes in our thinking Truth (accuracy) is valued over “winning” or social approval Values and attitudes related to critical thinking include openmindedness, an interest in and respect 14 Lay of the Land... Progress and increases in critical thinking in clinical practice include the invention of the systematic review and the process and philosophy of evidence-based practice and policy in medicine and health care and its spread to other professions (Gambrill, 2006; Gibbs, 2003; Gray, 2001a; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000) There has been greater attention to pseudoscience and fads in the. .. fragmentary, and theory must be used to fill in the gaps Other errors result from ignorance on the part of individual clinicians— The Need for Critical Thinking in Clinical Practice 9 Exhibit 1.4 Examples of Types of Errors in Medicine Diagnostic Error or delay in diagnosis Failure to employ indicated tests Use of outmoded tests of therapy Failure to act on results of monitoring or testing Treatment Error in the. .. Internet is Preface xi both a source of accurate information and bogus claims and quackery It is perhaps this very growth and the absurdity of some of the claims and the revelations of fraud and the play of special interests that do not match those of clients (e.g., harming in the name of helping) that has resulted in the greater attention to propaganda, harm, and fraud in the helping professions—including... analysis, and fairminded versus deceptive practices Both value transparency (honesty) concerning what is done to what effect, including candid description of lack of knowledge (uncertainty and ignorance) Consider the statement by the editor of the British Medical Journal: The Need for Critical Thinking in Clinical Practice 13 The history of medicine is mostly a history of ineffective and often dangerous... illustrated by use of the term “evidence-based” without the substance (e.g., misrepresenting the philosophy and evolving technology of EBP, in ated claims of effectiveness, and not involving clients as informed participants; Gambrill, 2003a) RELATED VALUES, ATTITUDES, AND STYLES Critical thinking is independent thinking thinking for yourself Critical thinkers question what others view as self-evident They ask:... decision-making processes in case conferences provided a supplement to studies of clinical decision making by individuals Research and theory in the area of teaching people how to think more critically were also of value WHAT’S NEW AND WHAT’S NOT OVER THE PAST 15 YEARS The past years since the publication of the first edition are a fascinating mix of progress and challenges These are described in this book... well as the funders of the Hutto Patterson Chair in Child and Family Studies I extend a special note of appreciation to Sharon Ikami for her word-processing support and consistent warmth and good will And, warm thanks to Gail Bigelow for her support and encouragement PA R T I LAY OF THE LAND CHAPTER 1 The Need for Critical Thinking in Clinical Practice D ecision making is at the heart of clinical practice. .. result in misleading clients because of premature acceptance of faulty assumptions Reasoning is at the heart of clinical decision making—forming hypotheses about presenting concerns, gathering data to evaluate the accuracy of different views, offering arguments for assumptions, and evaluating the quality of these arguments Chapter 3 provides an overview of different kinds of reasons (for example, hot and . Progress and in- creases in critical thinking in clinical practice include the invention of the sys- tematic review and the process and philosophy of evidence-based practice and policy in medicine and. w2 h6" alt="" Critical Thinking in Clinical Practice