Module 1 - Lesson 1: Critical Inquiry in Nursing (PDF)

Module 1 - Critical Inquiry: A Habit of Mind for Practice INTRODUCTION Overview No doubt that you are familiar with the term "critical thinking" as a foundational set of skills in your studies and nursing practice. However, many nurses would find it difficult to define critical thinking. Nurses a...

Module 1 - Critical Inquiry: A Habit of Mind for Practice INTRODUCTION Overview No doubt that you are familiar with the term "critical thinking" as a foundational set of skills in your studies and nursing practice. However, many nurses would find it difficult to define critical thinking. Nurses are even less likely to know and understand the concept of critical inquiry, a complementary yet distinct approach. Both concepts are fundamental skills to nursing practice and education and, therefore, important to fully grasp early in your journey to becoming a registered nurse.  This module focuses on critical inquiry as a cognitive process fundamental to competent nursing practice. Critical inquiry is an approach that prompts us to challenge assumptions, seek evidence, and consider diverse perspectives---skills that are essential to nursing practice given the complexities of today's healthcare system. Understanding critical inquiry and its relationship to critical thinking (addressed in Module 2) will enhance your practice and support your learning experience in the RPN to BScN Blended Learning program.  This module consists of two Lessons: Lesson \#1: Introduction to Critical Inquiry\ Lesson \#2: Exemplars of Critical Inquiry Essential Questions The following questions help guide your exploration of the critical inquiry  1. What is critical inquiry? What attributes (characteristics) are associated with critical inquiry? 2. How can critical inquiry help nurses navigate patient and care-related situations such as ethical dilemmas and patient advocacy? 3. Imagine a scenario where critical inquiry leads to a significant shift in nursing practice or healthcare policy. How might critical inquiry support and sustain this transformation over time? LESSON \#1 - Introduction to Critical Inquiry Estimated time to complete lesson: 30-45 mins. INTRODUCTION This lesson introduces the concept of critical inquiry and is intended to provide information and help you gain knowledge to build a basic understanding of the concept and how it operates in the nursing practice and healthcare context. Lesson Learning Objectives Learners will be able to: - Define the concept of critical inquiry. - Identify the attributes, antecedents and consequences of critical inquiry. - Explain the context of critical inquiry to nursing practice and education. - Discuss how critical inquiry can support nursing practice. - Identify examples of how critical inquiry can be applied in nursing practice. Pre-Learning Activities 1. Complete the readings for Module 1 on the reading list posted to the course LMS, Blackboard Learn Ultra. 2. Without looking up any information or the content of this module, write down what you think critical inquiry is.   CONTENT Definition When we explore, investigate, and discover to gain knowledge and understanding or find solutions to questions or problems, we are engaging in inquiry. Inquiry involves posing questions, gathering information, analyzing evidence, and drawing conclusions based on data/information and reasoned judgment. Inquiry can take various forms, but its fundamental purpose is to stimulate curiosity, foster critical thinking, and deepen understanding through active engagement with ideas and evidence. We use inquiry in everyday life. For example, in the situation where you are troubleshooting a malfunctioning household appliance, inquiry involves identifying the problem, researching possible solutions online or consulting manuals, and systematically testing different hypotheses until a resolution is found. Many processes undertaken in nursing use or are based on inquiry, such as nursing research (which we will discuss later in the course) and the nursing process. Critical inquiry is a particular type of inquiry that belongs to a category of inquiry called disciplined inquiry. Other types of inquiry that fall into this category include scientific inquiry. This category emphasizes a systematic and rigorous approach to exploring and investigating an issue or problem. It is characterized by critical thinking, skepticism, and rigorous evaluation of evidence and arguments. There are several definitions of critical inquiry within the literature and even more on online websites and blogs. Spires et al. (2021) note that the term critical inquiry is often used in many academic contexts to address power and inequity issues. Critical inquiry encompasses the same aspects of the general concept of inquiry discussed above. However, critical inquiry is distinct in its emphasis on questioning and challenging assumptions and ideas that sit at the surface.   Jennings and Smith (2002) highlight the foundations of critical inquiry, noting that it is related to Pablo Freire's notion of "praxis: reflecting and acting on the world to transform it\" (p. 547) and his emphasis on "a critical mode of inquiry, whereby the \[individuals\] burrow into the foundations, ideologies, and deeper meanings of things otherwise taken for granted and unquestioned. Only by uncovering these foundations can we see how we have created our social world,...\[ including education and health care contexts\] and thus how we can consciously recreate them." (p. 458-9). Thus, critical inquiry involves reflection and consideration of situations and issues from multiple perspectives. Bermudez (2015) proposes that engaging in critical inquiry involves using 4 tools, "intellectual devices that can be used to process something raw in order to transform it into an elaborated product" (p. 106). These tools are problem-posing, reflective skepticism, multi-perspectivity, and systemic thinking. We will explore these further in the next section. Based on the above, we can define critical inquiry as a process characterized by a deliberate and structured approach to understanding complex phenomena, solving problems, and making informed decisions through reflection, seeking to question assumptions, perspectives, and biases within a particular context. Critical inquiry goes beyond surface-level understanding of aspects of the world around us to explore underlying assumptions, biases, and implications, aiming to develop a deeper understanding and generate new knowledge. It involves evaluating evidence and considering multiple perspectives for deeper insights and understanding. Critical inquiry requires actively engaging with ideas, challenging established beliefs and the status quo, and critically analyzing underlying assumptions and biases to arrive at well-informed conclusions. As an iterative process, critical inquiry encourages re-examining our conclusions and actions taken through further reflection and metacognition.  Critical inquiry is often conflated with critical thinking. As we will learn in this module, while the two are related and complimentary, they are not the same.  In summary, critical inquiry is the process of problem-posing and questioning, gathering, challenging, critically evaluating and reflecting on information, ideas, and assumptions from multiple perspectives, including our own, to produce well-reasoned analysis and understanding and lead to new ideas, applications, and questions. Scope  The scope of critical inquiry encompasses a wide range of cognitive processes and methodologies applied across various contexts, such as nursing education and practice and everyday life. To varying degrees, we all use the cognitive processes that are involved in critical inquiry. However, critical inquiry applies them in a systematic way using specific methods to support informed decision-making and actions leading to optimal outcomes. Initially, practicing critical inquiry may seem awkward and regimented. When done consistently, Critical inquiry becomes a habit of mind we can easily call upon when confronted with more complex problems and situations for which we do not immediately have a resolution.   Within the literature, there is some consensus that critical inquiry cannot be limited to a specific series of steps and methodologies. It can be applied flexibly across various contexts, including academic research, clinical practice, policy development, quality improvement initiatives, and everyday decision-making. Based on a review of the literature, Kaeophanuek, Na-Songkhla, and Nilsook (2019) identified a general approach for the critical inquiry method consisting of five phases. While the phases follow a sequence, the process is not linear. The diagram below illustrates the critical inquiry process. Questioning Raising thought-provoking questions intended to stimulate thinking and deep reflection, challenge assumptions underlying the problem or situation and foster a search for information to answer questions.  Questions raised should be challenging enough to drive the thinking process  Gathering Involves systematically collecting and exploring information, various forms of evidence, and perspectives that bear upon and illustrate the problem for a variety of possible solutions.   Analyzing In this step, the information gathered is analyzed. It involves carefully examining and evaluating information, evidence and data, corroborating it using different sources and identifying patterns, trends, and relationships. Analyzing ultimately leads to understanding and insight into the complexity of the issue or situation. Analyzing enables discernment of underlying assumptions, uncovering biases, and drawing informed conclusions to inform actions or decisions. Discussion This step supports expanding and validating knowledge and understanding. It involves engaging in collaborative dialogue about the issue and analysis findings, allowing for the exchange of ideas. Discussion enables further exploration of diverse perspectives and challenges one's assumptions and conclusions, leading to further understanding. Reflecting This step involves thoughtful introspection and examination of one\'s thoughts, experiences, and actions to uncover insights, identify biases, and enhance self-awareness, ultimately informing future inquiry and decision-making. Reflection can occur throughout the process and at the end to examine as the implications of one\'s decisions and actions. Bermudez (2015) identifies four thinking tools* *that can be used during critical inquiry. These tools correspond to the phases of critical inquiry. Problem-Posing Problem-posing is a tool to use to raise critical questions that invite further inquiry about claims, beliefs, and social practices that are commonly taken for granted. It cultivates the purposeful, sensitive, sharp, and courageous spirit of a critical thinker. What does the tool do? - Recognizes when things are confusing or hard to figure out, or when there are difficult decisions to make. - Raises questions that invite further inquiry. - Why does it matter? Protects from deliberately misleading beliefs; Pushes back against just doing things because that\'s how they\'ve always been done; Helps learn things that actually matter and have a purpose; protects against subtle and hidden constraints that that prevent thinking deeply and making positive changes in society Driving Questions: Why does this matter? What does this mean? Does this make sense? How is this possible? What is missing here? Is this fair? Who does this serve and harm? Could it be different? Reflective Skepticism Reflective skepticism refers to a willingness to learn from past experience and to question the evidence. It is used to methodically scrutiny arguments and the way we think, examine underlying assumptions, and uncover analyze and correct distortions (e.g. biases and prejudices, absolute truths) in knowledge  What does the tool do - A tool to help monitor and adjust our thinking and understanding; Helps to consider what is true/accurate and what is not; Combines being skeptical but open-minded to make sure you believe in the right things; - Looks closely at arguments and thoughts to see if they make sense; - Checks if the ideas behind things are solid; - Finds and fixes mistakes or misunderstandings. - Why does it matter Addresses feeling uneasy about not knowing, rushing to quick solutions, and sticking to rigid beliefs; Finds and fixes mistakes in arguments, thinking, problem-solving, or decision-making; Encourages thinking for oneself and trusting critical judgment; Prevents making quick, unsupported, or uninformed decisions. Driving Questions Is this statement accurate? Is the data relevant? Is this explanation plausible? Is this account credible? Is this claim warranted? Is there evidence to support it? Does the story hang together? Multi-Perspectivity Multi-perspectivity is a tool used to identify, reconstruct, and coordinate different perspectives that are relevant for understanding a topic or problem. Critical inquiry strives to understand these perspectives, instead of dismissing, excluding or distorting.   What does the tool do - Tool helps us figures out different points of view and puts them together; Understands tough choices, social problems, and different accounts of events and situations. - Involves perspective-taking (initial acknowledgement of differing perspective from our own), perspective-coordination (putting perspectives together), and contextualization (understanding the contest of different perspectives. Why does it matter - Addresses problems caused by focusing too much on one thing (like yourself, your group, or your class). - Encourages being open to different ideas and talking things out. - Helps to be more understanding by talking and thinking about things. - Facilitates aware ness of what\'s going on and your sense of how you can effectively take action. - Gives explanations that are comprehensive, fair and without bias. - Driving Questions How did different actors experience these events? Who has a stake in this problem and its solution? What are other ways to think about this issue? How do others experience my ideas/choices? Systemic Thinking What does the tool do - This tool helps to breaks down systems and figure out how things work; - Shows all the parts and how they fit together; - Figures out why things happen and how they happen; - Balances how systems work with what people do; - Describes how things change in different ways. Why does it matter - Used to address short-sighted, fragmented and normalized view of the problem; - Recognize the connectedness of factors include yourself in the issue; understand the influence of broader factors; - Acknowledge the part you play in the problem/issue; recognize when solving problems doesn\'t treat everyone fairly. - Driving Questions Why did this happen? How does this work? Has it always been the same? How may it change? How does this fit in the bigger picture? What are the impacts? Who gains and who loses? Concept Attributes, Antecedents, and Consequences This section presents the defining characteristics of critical inquiry (attributes), what needs to happen before critical inquiry can occur (antecedents), and the outcomes resulting from critical inquiry (consequences). Examine these key aspects of the critical inquiry to support your understanding of its significance and implications. It's important to remember that these lists are not exhaustive, and all of them are not always present. For example, an individual who may not exhibit many of the antecedents of critical inquiry listed can be supported to develop these capacities while learning how to engage in critical inquiry, practicing its phases to develop the necessary skills to apply it successfully in practice. Attributes: - *Critical inquiry* encourages individuals to question assumptions, challenging underlying beliefs, biases, and preconceptions. Questioning involves actively seeking out alternative perspectives, considering diverse viewpoints, and scrutinizing the validity and reliability of assumptions. By questioning assumptions, individuals can uncover hidden biases, identify potential limitations in reasoning, and encourage a more open-minded and objective approach to nursing practice. - *Analytical thinking* involves systematically breaking down complex information into its parts for thorough examination. It includes skills such as identifying patterns, relationships, and underlying structures within data or arguments, facilitating deeper understanding and analysis. - *Reflective reasoning* is a cognitive process in which individuals thoughtfully consider and analyze their beliefs, actions, and decisions. It\'s about questioning where beliefs come from, evaluating past actions, and seeking improvement. In the context of nursing, it means reflecting on practice experiences and patient outcomes, engaging metacognitively (thinking about your thinking) to gain insights that lead to a deeper understanding of oneself or a situation, which can inform future actions and decision-making and foster considering professional growth. - *Evidence evaluation* requires individuals to assess the quality, relevance, and credibility of various types of evidence to inform decision-making. It involves critical appraisal, assessing the reliability of sources of information and evidence, and discerning between reliable and unreliable information. Evidence evaluation enables individuals to make well-informed judgments and draw sound conclusions in various contexts. - *Synthesis of information* involves integrating diverse sources of information to develop a comprehensive understanding. - *Open-mindedness* refers to a willingness to consider multiple perspectives and entertain new ideas. - *Intellectual curiosity* is reflected in the desire to seek knowledge and explore topics and issues in depth. Antecedents: - *Curiosity*: A natural inclination to ask questions, seek understanding, and explore new ideas or perspectives. - *Open-mindedness*: Willingness to consider alternative viewpoints, perspectives, and evidence without bias or preconception. - *Intellectual humility*: Recognition of one\'s own limitations, fallibility, and the potential for error in reasoning or judgment. - *Skepticism*: A healthy skepticism towards information, claims, or assumptions, prompting individuals to evaluate evidence critically and question assertions. - *Analytical skills*: Ability to assess information, data, or arguments systematically, identifying patterns, inconsistencies, or logical fallacies. - *Information literacy*: Competence in accessing, evaluating, and synthesizing information from diverse sources, including digital and traditional media. - *Communication skills*: Effective communication skills, including active listening, articulating ideas clearly, and engaging in constructive dialogue with others. - *Self-awareness*: Self-awareness is the ability to recognize and understand one's thoughts, feelings, motivations, and cognitive processes. It is necessary for self-correction and improvement. - *Ethical reasoning*: Ethical reasoning is the capacity to consider ethical implications and consequences of actions or decisions, recognizing moral responsibilities and obligations. Consequences (Relevance to Nursing Practice): - Enhanced problem-solving skills and decision-making abilities (enhanced clinical decision-making skills for providing optimal care) - Improved ability to analyze and evaluate information critically (Improved ability to critically analyze and evaluate situations and issues that emerge, care practices and research findings) - Increased capacity for independent and informed thinking (Increased capacity to advocate for patients and collaborate with interdisciplinary teams). - Strengthened communication and collaboration skills (effectively conveying complex information to patients and colleagues). - Greater awareness of bias, assumptions, and limitations in reasoning (greater awareness of personal bias, assumptions, and limitations in reasoning in the delivery of care) - Empowerment to challenge prevailing norms and advocate for change (Empowerment to challenge systemic barriers and advocate for health equity) - Promotion of lifelong learning and personal growth (and professional development). - Facilitation of more effective and ethical leadership practices. - Advancement of scientific inquiry and innovation (Advancement of nursing research and evidence-informed practice). - Promotion of social justice and equity through informed action (Promotion of patient safety and quality improvement initiatives through informed and reflective practice). - Reflective NOTE : Review the list of antecedents of critical inquiry. Which abilities do you possess? Excel in? Need to develop? Would like to improve? How can you improve upon those abilities?  Theoretical Links Theoretical links to critical inquiry are rooted in various philosophical and educational frameworks emphasizing the importance of questioning, analysis, and reflection to develop knowledge and understanding. These include constructivism, social constructivism, pragmatism, critical theory and epistemology of practice. Each is briefly described below, highlighting their relevance to critical inquiry.  Constructivism Constructivist theories, such as those proposed by Jean Piaget and Lev Vygotsky, highlight the active role of learners in constructing their understanding of the world around them through their interaction with their environment. In relation to critical inquiry, constructivism emphasizes the importance of actively engaging with information, questioning assumptions, and constructing knowledge through reflection and inquiry. Pragmastism Pragmatism emphasizes the practical and experiential aspects of learning. For example, pragmatist philosopher John Dewey\'s notion of \"learning by doing\" aligns with the active approaches of critical inquiry, such as hands-on exploration, experimentation, and problem-solving. Social Constructivism Social constructivist theories, influenced by Lev Vygotsky\'s work, emphasize the social and cultural aspects of learning. In critical inquiry, social constructivism highlights the collaborative nature of inquiry, where we engage in dialogue, exchange ideas, and construct knowledge together within a social context. Critical Theory Critical theory, rooted in the work of philosophers like Karl Marx and critical theorists like Paulo Freire, focuses on understanding and challenging power structures, inequities, and social injustices. In critical inquiry, it informs a critical stance toward how knowledge is produced, encouraging questioning dominant narratives, challenging assumptions, and critically analyzing underlying power dynamics. Epistemology of Practice As articulated by Donald Schön (2017), the American who developed the reflective practice model popularized in many disciplines, the epistemology of practice emphasizes the importance of reflection-in-action and reflection-on-action in professional practice. In critical inquiry, Schön\'s ideas highlight the iterative nature of inquiry, where practitioners engage in ongoing reflection, experimentation, and adaptation to address complex, real-world problems. Critical inquiry is grounded in theoretical frameworks that provide guidance on the cognitive processes involved in critical thinking and reasoning. Two prominent theoretical frameworks are: - Paul and Elder\'s Model of Critical Thinking: This model identifies elements of reasoning, including purpose, questions, assumptions, implications, and viewpoints. It emphasizes the importance of clarity, accuracy, precision, relevance, depth, breadth, logic, and fairness in critical thinking. In clinical practice, education, and research, it is used to systematically analyze and evaluate information, arguments, and decisions. - Bloom\'s Taxonomy of Cognitive Skills: Most learners are familiar with Bloom\'s taxonomy. It categorizes cognitive processes into levels of complexity, ranging from lower-order thinking skills (remembering and understanding) to higher-order thinking skills (applying, analyzing, evaluating, and creating). Engaging in practitioners can use activities that promote higher-order thinking, such as analyzing case studies, evaluating research articles, and synthesizing complex information to develop and refine the cognitive skills needed for critical inquiry.   Context to Nursing and Health Care To this point, links between critical inquiry and education have been made evident. You might be wondering how critical inquiry fits within the context of nursing practice and, more broadly, health care. Critical inquiry in nursing involves a deliberate, systematic and reflective approach to problem-solving and decision-making, integrating relevant skills with a structured inquiry process. Nurses actively question, investigate, and reflect to deepen their understanding and inform their practice. Critical inquiry encourages nurses to pose meaningful questions, challenge assumptions and taken-for-granted truths and reasoning, gather information and evidence, and explore multiple perspectives when faced with complex clinical issues to support well-thought-out decisions and actions to enhance patient outcomes. Critical inquiry in practice is iterative as it encourages reflecting on our thinking, decisions, actions, and outcomes to refine practice over time.  Critical inquiry is often at the core of interprofessional practice. Nurses use critical inquiry skills to facilitate open dialogue, advocate for patient preferences, and integrate diverse perspectives into decision-making. When interprofessional teams engage in critical inquiry, they foster exploration beyond the surface of complex patient issues, ask reflective and provoking questions, and use 360 thinking--- thinking in a way that allows for consideration of varying perspectives to 'see' the big picture, while also paying careful attention to the little fine details. Critical inquiry enables nurses and other professionals to get underneath a problem and work towards seeing it fully to develop depth of understanding and informed action. Interrelated Concepts Many concepts, themselves interrelated, have some relationship with critical inquiry. The concepts most relevant to critical inquiry in the context of this course are shown in the figure below. Hover over and click each concept with your cursor to learn how each relates to critical inquiry. Before revealing the relationship, pause and consider what the relationship might be. Information and Technology The concept of information and technology provides nurses with tools and resources to access a wide range of information sources, including electronic databases, online journals, and evidence-based practice guidelines. By leveraging technology to access timely and relevant information, nurses can enhance their critical inquiry skills and make informed decisions grounded in evidence. Evidence Informed Practice Critical inquiry underpins evidence-informed practice by enabling nurses to critically appraise research findings, clinical guidelines, and quality improvement initiatives. Nurses engage in systematic questioning, analysis, and synthesis of evidence to inform their practice, enhance the quality of care, and promote positive patient outcomes. Clinical Judgement Clinical judgment refers to the process by which nurses make decisions in clinical practice, drawing on their critical thinking skills, knowledge, and experience. Critical inquiry is integral to clinical judgment, as nurses engage in systematic questioning, analysis, and reflection to assess patient needs, identify problems, and formulate appropriate interventions. Nurses enhance their clinical judgment and improve patient outcomes by critically evaluating evidence, considering alternative perspectives, and reflecting on outcomes. Caring Caring is central to nursing practice, encompassing compassionate and empathetic patient care. Critical inquiry informs nurses\' understanding of patients\' holistic needs, preferences, and values, guiding them to provide individualized, culturally sensitive care. By critically examining the social, cultural, and environmental factors that influence patients\' experiences, nurses can tailor their care approaches to promote comfort, dignity, and well-being. Patient-Centered Care Critical inquiry supports nurses in providing patient-centred care by encouraging critical reflection on their biases, assumptions, and communication styles. Nurses apply critical inquiry when engaging in open dialogue, active listening, and shared decision-making with patients. This ensures that care plans align with patients\' goals and priorities. Critical Inquiry Critical inquiry is essential for ethical decision-making in nursing practice. Nurses face ethical dilemmas and moral uncertainties in daily practice, requiring them to engage in thoughtful reflection and analysis to navigate these challenges. Critical inquiry prompts nurses to critically assess ethical principles, values, and norms and consider the implications of their actions on patient care and outcomes. Critical Inquiry & Critical Thinking Critical inquiry and critical thinking are closely intertwined processes that complement each other in nursing practice. We will further explore this relationship later in this module.  Information Literacy Critical inquiry is closely linked to information literacy. Information literacy involves accessing, evaluating, and using information effectively and ethically. Critical inquiry prompts nurses to critically appraise research findings, clinical guidelines, and healthcare policies to determine their relevance, reliability, and applicability to specific patient populations and settings. PULLING IT TOGETHER Reflective Note : Now that you have reviewed the content in this module, take some time to consider the information and practice abstracting up to identify conceptual understandings (key ideas) about information literacy and its conceptual relationships (generalizations) with the related concepts addressed.  Here are the key conceptual understanding and relationships that hopefully you have developed from this lesson. - Critical inquiry is a systematic process for developing a comprehensive and deep understanding of phenomena to inform decision-making and actions. It consists of the interconnected phases of questioning, gathering, analysis and interpretation, discussion, taking informed action and reflection. - Critical inquiry involves an ongoing process of exploration, questioning, and analysis. It emphasizes the importance of continuously challenging assumptions and beliefs, seeking new perspectives, and examining complex issues from multiple angles to deepen understanding and inform decision-making. - Critical inquiry involves meta-cognitive processes, including reflection, self-awareness, and self-assessment, enabling individuals to monitor and regulate their thinking processes and cognitive biases. Doing so enables nurses to identify areas for growth, challenge ingrained perspectives, and enhance their professional practice. - Post-Learning Activities Activity \#1: Questioning Problem-posing/asking questions that help to move beyond the surface of an issue or situation is the initial step in the critical inquiry process. In this reflective activity, you will practice the skill of asking critical questions. Read the news article about the recent changes to the policy regarding 2SLGBTQ+ health care in Alberta.  Generate 3 critical questions based on the article following the "good inquiry questions" guidelines below. When you're done, click continue to check out a few examples of the many critical questions that could be generated related to the story.  A good inquiry question should: - Come from a place of genuine curiosity or confusion. - Be complex and not simplistic in its answer(s). - Require a detailed analysis or investigation. - Have a clear, concise focus that naturally branches into further sub-questions. - Invite deep thinking in a way you may not have thought of before. - Require support, justification, investigation, and critical thinking. - Have long-term value and can be re-visited. - Generate discussion and multiple perspectives.