Critical Thinking in Health and Social Care

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Stella Jones-Devitt & Liz Smith

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    Dedication

    To Tre, Dave and Grace

    Stella Jones-Devitt

    To my parents Alan and Dorothy

    Liz Smith

    Foreword

    Critical Thinking: Some Observations

    Arguably, today's health and social care professionals – be they student aspirants or experienced practitioners – can be characterised as context-rich and time-poor. Why then might they wish to ‘think about critical thinking’? Is there a case to be made? Jones-Devitt and Smith demonstrate powerfully the ways in which the idea of ‘the professional’ can be deconstructed and reformed through critical thinking; how context can be explored, challenged, explained and understood by means of a channelled scepticism; and how time and tasks might be better aligned where traditional ways-of-doing are subject to reflective and systematic scrutiny.

    In a world where significant human endeavour (and ideology) turns on the quest for certainty and assertions of truth, the authors encourage the reader not simply to re-focus on the question itself; but also, more profoundly, they require us to question the question. Thereby, they take issue with what might be labelled, beyond postmodernism, as the ‘cult of certainty’.

    Through exposure to a well-articulated (but not unnecessarily burdensome) array of perspectives and tools, we are lured into new approaches to intellectual enquiry and innovation that will render such key activities as clinical decision-making or the design of care packages more robustly defensible in the changing context(s) of modern health and social care practice.

    Importantly, the authors develop simple pedagogical devices to prevent any artificial divide or hierarchical separation of theories and practice. Questions, issues and dilemmas permeate the text. They are directed at our everyday professional experiences in ways which engage and provoke response(s). This culminates, beyond some well-articulated case-study material, in a compelling set of claims that only by acquiring the skills to recognise and address critical uncertainties, drawing on the repertoire of critical thinking approaches, will we be equipped to influence future policy and practice for improved health and social care services.

    Accordingly, I believe the book will serve well a diverse audience – in policy formulation and practice determination at all levels – who are committed to the nation's health and well-being.

    DianneWillcocks, 28 February 2007

    Preface

    This book aims to explore key concepts of critical thinking and it considers their application to health and social care practice. The book helps the reader to examine the nature and relevance of critical thinking per se; it also seeks to familiarise the reader with a number of critical perspectives which can then be used to examine contemporary issues in health and social care. To contextualise the learning, workplace exercises and theoretical scenarios are suggested, in order to engage the reader in considering any implications for their own professional practice and operational effectiveness.

    So why is this book needed and why now? We drew upon our own sense of ‘muddling through’ and considered the critical uncertainties bound up in health and social care in the present day. We perceive that the pace of change and fragmentation has escalated across both sectors: throughout this book we allude to the prevailing perceptions of the emergent knowledge economy, based upon key neoliberal suppositions of flexibility, accountability and active consumerism; the growth of this economy appears to have gathered an irresistible momentum, spawning new types of ‘professional’ worker roles that are developing across many occupational sectors. This book seeks to help the practitioner make sense of this pace and fragmentation through developing an understanding and awareness of the wider ideological drivers for policy provision and change, whilst providing some tools that can help to reconnect and locate everyday practice in the emerging context.

    At the time of writing this book, we found little published material concerned with enabling health and social care practitioners at strategic/consultant level to conduct critical examination of their own practice, alongside applying some newer ways of thinking to specific contexts: we hope that this book begins to occupy that space.

    Given the shifting contexts and blurring of boundaries between health and social care domains, we have taken some liberties with the word ‘professional’ within this text: the term is used euphemistically to imply a professional approach via an implicit set of values, responsibilities and strategic obligations that being ‘professional’ involves. It is not our intention to delineate between the qualified and non-qualified; hence, we recognise that career development, professional roles and nomenclature are not only linked to profession-specific occupations in either domain. We also found that certain areas within health and social care are difficult to segregate as belonging wholly to one or other faction; thus within the book, public health examples are used to illustrate this shared agenda.

    The book is divided into three discrete sections. Section 1, ‘A Theoretical Overview’ provides an insight into how critical thinking skills knowledge is constructed, privileged and applied, covering: some of the key debates about definitions and use of critical thinking; the authenticity of knowledge and resonance for the contemporary social infrastructure; how assumptions effect thinking and influence professional stereotyping; alongside the nature of ‘evidence’ in which specific paradigms are presented, contrasted and debated.

    In Section 2, ‘Key Theoretical Tools of Critical Thinking’, we examine some of the conceptual tools available for sense making in the domain and consider the possible implications for practice. Where appropriate, chapters in this section examine theoretical similarities and differences amongst selected theories and assess their relationship to strategic application. All the conceptual tools are selected according to their relevance to current health and social care policy-making and practice. Five theoretical critiques were chosen by the contributing authors, but many more could have been selected. Given the plethora of potential tools, readers are encouraged to apply any theoretical tool of their own personal choosing, as they see fit for their own context.

    In Section 3, ‘Application to Health and Social Care Practice’, several case studies and scenarios are explored through the application of critical thinking skills, allowing the reader to actively apply the learning to the workplace and examine the implications and further resonance.

    It is worth noting that this book is about ‘applied’ critical thinking skills within the health and social care domain. Given these parameters, we decided to exclude mathematical notions of reasoning and exercises in numerical analysis, psychological theories of thought processing and developmental learning alongside ‘heavy’ philosophical theorising about the nature of thinking per se. Ideally, we are hopeful that the book provides the health and social care strategist with an array of tools that can be applied to first order practice; it is not aiming to be a comprehensive tome about critical thinking in all its forms, nor to fulfil any kind of purist academic agenda. We encountered some difficulties when trying to tease out the precise boundaries for health and social care respectively; consequently, fluid contemporary interpretations of both aspects have led us to assume a ‘blurred boundary’ position in the book on many occasions.

    Each chapter contains specific pedagogical features that comprise a concise introduction, learning objectives, an end-of-chapter summary, case studies (where appropriate), specific problem-solving scenarios, additional workplace exercises, and sources of further reading and exploration. The latter provide detail of specific print and web-based resources in critical thinking skills development, and are complementary to the exercises in the text.

    To use this book most productively, we suggest that all readers familiarise themselves with Section 1, which gives a good grounding in essential critical thinking debates, principles and concepts. Once completed, the reader can then selectively discern the most appropriate tools from Section 2 to apply to their own workplace context. Section 3 then acts as an aide-memoir of critical thinking skills analysis, in relation to some contemporary health and social care issues.

    We have enjoyed putting this book together for health and social care practitioners and our sincerest thanks go to all those who have contributed both directly and indirectly to its production. Specific thanks go to Peter Draper and Julie Dickinson for their well considered contributions to several chapters in this text. During the process, we have also extended our own knowledge and enthusiasm for using critical thinking approaches within health and social care, and trust that this book does the same for its readers.

    StellaJones-Devitt and LizSmith

    List of Illustrations

    Figures
    • 1.1 Critical thinking continua 8
    • 3.1 The assumption-inference process in public health 31
    • 5.1 Policy-making through political thought processes 60
    • 5.2 The linear axis of political perspectives 61
    Tables
    • 1.1 Definitions of critical thinking 7
    • 2.1 Traditional economy and knowledge economy: key differences 23
    • 2.2 Traditional economy and knowledge economy: disputed concepts 23
    • 3.1 Analysis of assumptions performance indicators 33
    • 5.1 Socialism and social democracy – underpinnings of political ideology 61
    • 5.2 Political wings: key differences 64
    • 5.3 Political ideologies applied to health and social care 65
    • 7.1 Feminist theories: key similarities and differences 94
    • 8.1 Key differences between positivism, post-positivism and critical realism 109
    • 8.2 Critical realism applied to wellbeing 111
    • 8.3 Critically ‘realistic’ public health? 115
    • 10.1 A comparison of modern and postmodern thinking 137
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