Final Journal in Reflection and Learning Mike Dugan April 8, 2012 In my initial journal in week three I started to develop

a definition of critical thinking (CT) in that I needed to be more aware of myself and what I am doing in relation to what is happening around me through information and data gathered. I would like to add to my definition in that part of critical thinking is listening to what others have to say. I have learned a lot in this class from listening to the feedback from my professor and to the critical thinking presented in discussions from my fellow students. By listening I have further questioned myself in terms of my beliefs and convictions which in turn has helped me understand why I am acting and thinking in relation to the information I am gathering around me. The biggest leap forward in my critical thinking in my workplace has been in enhancing my listening skills with my patients. I did listen to my patients before but I was just regurgitating to the physician what the patient said and letting the physician interpret what the patient wanted. Sometimes I didnt have enough information for a decision on action to be made. Now I try to ask more questions, listen more closely, take into account the physical data present at that time and before, and be more aware of my own bias or what I think the patient should want or have before I present the information to the physician. This has resulted in reduced physicians questions, fewer trips back to the patients rooms for clarification, and overall improvement in patient care. In week five I discussed how reading and learning about the nurse theorists helped me realize that I relate more to Peplau and Watson theories personally. I reflected how this influenced my being more aware of my relationship with my patients and how this helped improve my adjusting more to my patients differences than them adjusting to me. I continue to

work on my patient relationships and I continue improve in meeting their needs and concerns. I listen more to myself and am able to adjust my thinking and attitudes towards patients if I see that I am being too judgmental and/or not agreeing with the patient and/or family. I strive to develop that trusting relationship even if it is only for a short time. My beliefs and convictions still get in the way, my thinking is a work in progress, but I do see improvement in my relationships with my patients and the positive outcome that has. This relationship extends to the families and I do have a harder time with my relationships with the patients families. Family members can be emotional and fearful with a loved one being in the hospital. Sometimes these emotions come out in a negative way. I tend to take this negativity in a personal way but I find that I am improving on setting aside my thoughts and feelings until I am out of the situation and am better able to analyze and question what happened by gathering more information. In trying to understand the families situation and their needs I am using critical thinking to figure out how to meet those needs to make them feel their loved one is safe and being cared for in an appropriate manner. My critical thinking also extends into other areas affecting my nursing care such as the legal and ethical matters that direct my care. I touched on my legal critical thinking in the week 10 journal. I had not given much thought to the why, how, where, and what aspects of my work. In learning about legal and ethical items such as the ANA's standard of care and code of ethics, I felt like my brain had "woken" up as to how nursing care has gotten to where it is and the possibilities of where it can go. I am asking more questions and learning more on how the hospital works and why. I am paying more attention to the ethical matters in nursing care and healthcare in general and seeing where I can make a difference.

In self-evaluating my journals and reflecting on my critical thinking development during this course I would give myself a grade of B. I really feel that I am grasping the concept of critical thinking more and more as I become more self aware of what, why, and how I am doing my nursing care. It seems to be a skill that the more I practice the better and more efficient my thinking gets. I feel like I have a long way to go in terms of it coming more naturally to me and I feel that I have made great progress since starting this course and the BSN program. I would like to put the assessment questions listed in this assignment's description onto an index card and carry it with me at work. I can refer to it occasionally when things are slow to help me integrate the thinking process to where it becomes more automatic in situations that are busier and the time might not be there to slow down and reflect through the questions. Metacognition is a great tool in learning more about myself and my world in my nursing profession.