Identify the Problem
A key element of critical thought is problem solving. The first step in problem solving is to identify the problem. This step can be challenging, given that problems are often difficult to define. An unclear problem can cause frustration and discomfort. A situation or technique may not be working for you, and, as a student, you may have difficulty determining the cause.
Investigate the Problem
The next step is to investigate by undergoing an objective examination of a problem. What do you already know about the problem? Review and examine all aspects of the problem and the factors that might influence the outcome. What are the key elements of the problem? Who or what is or may be affected by this problem? What are the implications of the problem that might result in safety risks and liability? What are the technical considerations? Will more than one solution or type of solution be needed? Identifying the elements of the problem is important so that you can proceed with finding the solution.
Formulate Viable Solutions to the Problem
Consider, develop, and formulate all possible viable solutions to a problem. Be objective and base decisions on professional knowledge, ethics, and standards. Look to these professional standards, and modify them to fit the unique situation that the problem presents. Acquire any additional information or expertise as needed. Have you experienced similar problems that can guide you to possible solutions? Be sure to refer to your professional references or consult with an expert when necessary. Make sure your sources of information are reliable. Be creative and keep safety in mind when creating solutions.
Select the Best Solution
Finally, select and enact the best solution and action plan. Which solution will allow for the best care of the patient and is within professional ethical standards? Make sure that the chosen solution corresponds with the procedures and protocol for your institution. The most challenging problem solving and critical thinking occur when an immediate decision is required, when more than one appropriate solution to the problem exists, or when no clear viable solution exists. Be sure to follow up on the problem to see how your choices affected the outcome. Reflect on this experience for use in solving future problems.
Critical Thinking in the Classroom and Laboratory
The classroom and the laboratory provide valuable experiences that allow the student to develop critical-thinking and analysis skills that involve cognitive and psychomotor learning. Cognitive and psychomotor refer to thinking and doing, respectively. In the classroom or laboratory, students are given the freedom to develop alternative ideas, test the classics, solve new problems, and increase their understanding of old problems without endangering the health of a patient. Students can also repeatedly experiment to find the answer or examine what if questions without irradiating a human being. The classroom and laboratory are the best places for students to begin developing the ability to apply previous knowledge to new situations (Fig. 4-1). The classroom and laboratory also allow students to begin formulating independent judgments needed for critical thinking in the rapidly changing health care environment.
Development of critical thinking skills often involves problem-based learning (solving real-life complex problems) and team-based work. Formal teamwork is most effective with the establishment of group rules and group roles to foster effective group processes. Peer evaluations may also be part of the process. Research that supports evidence-based practice should be integrated in the decision-making process. Evidence-based practice involves an approach in which scientific evidence and expertise are used to provide improved patient care. These activities are effective in helping students develop alternative and creative modes of inquiry.
Critical Thinking in the Clinical Setting
The clinical setting is where the student can transfer knowledge into action in a real-world environment. Students are exposed to unique real-life experiences that can be reinforced by the supervising radiologic sciences professional. Understanding the why behind a standard procedure is the key to making future decisions when a situation is not routine. Making decisions based on professional knowledge as applied to the clinical situation is important. Clinical experience provides a variety of critical-thinking situations and allows for student learning to extend well beyond button pushing, it permits the student to demonstrate the ability to respond when the correct decision is not clear and obvious, and it may involve recognizing when a situation is inappropriate and determining how to proceed in a professional manner.
Students who are new to the clinical setting must consider that radiologic sciences professionals use many variations of the standard procedures taught in the laboratory and classroom. Each radiologic sciences professional has developed his or her own style based on experience. These variations in practice can create a sense of frustration for the student. The student must focus on combining the best elements of each supervising radiologic sciences professional and then develop his or her own appropriate practice habits and professional style.
At the beginning phases of clinical experience, critical thinking may involve decisions made by the student regarding which role models to emulate or when to go to program officials with concerns or problems. Early critical-thinking decisions may also involve determining whether to make independent judgments or to ask for help, or it may involve deciding when making a joke is appropriate and when not to do so. With experience and education, the student will be prepared to handle critical-thinking situations that may affect the life and well-being of a patient under the student’s care.
Affective Critical Thinking
Analyzing personal values and feelings and managing uncomfortable ethical situations are components of affective critical thinking. Students must value the professional knowledge that serves as the foundation for their chosen profession. Students benefit by examining the ways they learn best and then taking charge of their own education. Being a creative and active learner is important in the radiologic sciences. Students often have overwhelming feelings when they first enter the health care setting. They may observe and be involved in many situations they have not previously experienced. Feelings can be expressed through journal writing or discussions with program faculty, other students, or clinical supervisors. Students must be conscientious about maintaining patient confidentiality at all times during these types of discussions. Affective critical-thinking skills are also important when dealing with the patient and his or her family, communicating in challenging situations, and working as part of the health care team. Students also may need to apply problem-solving and critical-thinking skills to manage their personal problems and issues to ensure that these do not affect their educational progress or, more important, patient care in the clinical setting.
Clinical Applications of Critical Thinking and Problem Solving
Many situations arise that require a radiologic sciences professional to make a decision based on professional ethics. These situations require the radiologic sciences professional to act appropriately regarding patient safety and radiation safety of patients and other health care personnel. At all times the radiologic sciences professional is expected to act within the guidelines of the ARRT Code of Ethics (Appendix D). Chapter 24, Professional Ethics, provides specific examples and information about problem solving for ethical dilemmas, including potential situations that a radiologic sciences professional may face.
A patient rarely arrives in the department prepared and able to cooperate as needed for a procedure or treatment. Some patients cannot stand for an upright procedure, or they cannot lie face down (prone) for an examination that requires them to be in that position. A treatment plan may need to be altered to accommodate a patient’s condition or ability. In these situations, the radiologic sciences professional must evaluate and adjust the procedure or treatment according to the patient’s ability and still produce the same outcome—adequate treatment or a diagnostic radiographic image. Advanced technical critical-thinking skills of a radiologic sciences professional may involve handling patients in trauma or critical care situations or recognizing an inappropriate treatment plan (Fig. 4-2). The development of technical critical-thinking skills is an ongoing process that requires extensive knowledge of the profession. Students must learn the foundation of professional knowledge to develop future technical critical-thinking skills for use in practice.
A radiologic sciences professional is responsible for interacting with and caring for each patient until his or her procedure or treatment has been completed. He or she observes the patient and looks for physical and mental changes that may occur as a result of the treatment or procedure. While communicating with the patient, the radiologic sciences professional will need to consider any human diversity issues that may play a part in the care of the patient. Adapting to any emergency situation that may arise during the procedure or treatment is also necessary to ensure safe and successful completion.
The following decision-making scenarios have been created as examples of situations that call for critical thinking and problem solving. Keep in mind that these are only a few examples of situations that a radiologic sciences professional may encounter on a day-to-day basis. The first case scenario provides an example of how the steps are used.
Case 1: Human Diversity.
“Your next patient does not understand English.” You need to escort the patient from the waiting room and give her instructions for the procedure, including removing all clothing from the waist up and any metallic objects from the chest and abdomen area. You then need to take the patient into the examination room and place her in the correct position for the procedure. After completing the procedure, you need to give the patient exit information.
Identify the problem. You speak only English, and your patient does not.
Investigate the problem. What instructions will need to be given to the patient? What technical considerations must be evaluated? Does the patient speak any English? What are the cultural considerations?
Formulate possible solutions. You will need to develop a creative way to communicate your instructions to the patient. Can you identify someone else who can speak the language? Does anyone in the department speak the same language as the patient? Does the health care institution have an interpreter available? If the answer to all of these questions is “no,” what do you do next?
Select and enact the best solution. In this case, no interpreter is available, and the patient understands minimal English. You will need to use a variety of methods of communication, such as demonstration and pantomime, as well as maintain your composure and patience while performing the procedure. All aspects of cultural diversity education and communication skills must be used in this instance. This type of situation occurs often; therefore, keep in mind that it is just as frustrating for the patient as it is for the radiologic sciences professional.