1996 OPEN FORUM Abstracts
CRITICAL THINKING IN RESPIRATORY CARE PRACTICE.
Shelley C.Mishoe, PhD, RRT, Medical College of Georgia, Augusta, Georgia.
Introduction: The purpose of this study was to identify and describe the critical thinking skills and traits of respiratory care practitioners using a descriptive qualitative research methodology. The reflective, communicative, practical and experiential aspects of critical thinking in respiratory care practice were identified. Critical thinking (CT) is described in terms of practical knowledge grounded within the actual performance, culture, and context of clinical practice. Methodology: The research methodology consisted of observations of 18 registered respiratory therapists (RRTs) followed by in-depth interviews. The purposeful sample was selected through nominations of experts using reputational-case selection. The observations served as a basis for identifying and describing context-bound situations that require CT, as well as the essential skills and related traits. Fieldnotes and interview transcripts were continuously analyzed throughout the study using the constant-comparative method described by Glaser and Strauss. Finding : The findings suggest that CT in respiratory care practice involves the abilities of prioritize, anticipate, troubleshoot, communicate, negotiate, reflect, and make decisions. When, how, and why respiratory therapists are able to use these CT skills is influenced by dispositional traits and organizational factors described in this study. The traits that affect CT in practice include willingness to reconsider and challenge others, appreciation of multiple perspective and continued learning. understanding of departmental and professional perspectives that impact the profession; and openness to continuing change in their personal and professional lives. This study was not designed to investigate the organizational factors that affect CT in clinical practice. However, it appears that the setting where the respiratory therapist works is another consideration that can either facilitate or inhibit critical thinking in practice. Additional findings from this study suggest that these organizational factors affect CT in respiratory care practice: involvement and level of support from the medical director and departmental administration. scope of practice, duties and responsibilities, and role delineations between RRts and certified respiratory technicians (CRTTs). The therapists were most likely to use CT and make recommendations regarding patient care at institutions where there was strong involvement and support from the medical director. The therapists in this study were also keenly aware of the level of support and expectations from management. The therapists' willingness to take risks and initiate change were most evident in progressive departments with supportive director. Opportunities for CT were determined in part by scope of practice. Every institution had differences and variations in duties and variations in duties and responsibilities which influenced CT. Performing technical skills in and of itself did not necessarily facilitate CT. However, if the therapists were able to perform tasks which increased the opportunities for decision making, then CT was enhanced. Finally, the role delineations between RRTs and CRTTs in practice affected CT in respiratory care It was found that RRTs had greater opportunities to communicate, negotiate and make patient care decisions when there were distinct roles in practice between RRTs and CRTTs. These role distinctions in practice appeared to be based on differences specified for accreditation of educational programs and credentialing for therapists and technicians. Conclusions: The interrelation and interaction of the essential skills for CT can be described. However, dispositional traits and organizational factors and their collective impact on CT in respiratory care practice must be considered. The summary of findings and discussion of literature builds substantive theory by proposing interrelationship among the skills, traits, and organizational factors that affect CT in clinical practices. The work context and the role of the organization. including managers, must be addressed when attempting to explain or facilitate Ct in respiratory care practice.