International consensus definition of critical thinking in midwifery practice: A Delphi study

ProblemCurrently there is no discipline-specific definition of critical thinking in midwifery practice.BackgroundCritical thinking in midwifery practice is the cornerstone for safe, evidence based, and woman centred clinical decision-making. Available definitions of critical thinking in other disciplines do not align with midwifery practice which is distinctive, multidimensional and complex.AimTo develop an international consensus definition of critical thinking in midwifery practice.MethodsA two round Delphi study was used. Thirty-two international midwifery experts contributed to the first round which was qualitative in nature. Twenty one of these experts then ranked the relevance and clarity of concepts from round one.FindingsA consensus definition of critical thinking in midwifery practice was achieved. The expert panel identified and defined 14 ‘Habits of Mind’ and 12 Skills that are the core of critical thinking in midwifery practice. Skills included; analysis, constructive application and contextualisation of best available evidence, problem solving, discriminating, predicting, evaluation of care, collect and interpret clinical cues, collaboration/ negotiation, reflexivity, facilitates shared decision-making, communication, and transforming knowledge. Habits of Mind included; intellectual curiosity, reflective, holistic view, intellectual integrity, flexibility, questioning/challenging, participatory, open mindedness, listening with understanding and empathy, cultural humility, woman centred, being brave, confidence, and creativity.Discussion/conclusionThis study is an international first and delineates characteristics of critical thinking in midwifery. Development of a consensus definition provides a common and shared understanding of the skills and attributes required for critical thinking in midwifery practice and can also be applied in education and research.     

“带了镣铐的进军”:“且介亭杂文”的生成与艺术特征

鲁迅以“且介亭杂文”命名自己1934—1936年间的杂文，强调此间写作与“周围的情形”的密切关联。鲁迅用“且介亭”为题强调半租界的环境，不仅强调地理位置和文化环境上的杂糅与交叉，更强调资本市场与专制政府的合谋，尤其是其联手对革命文学进行的压制。在这样的压迫下，鲁迅的反抗也就具有了更明确的针对性和具体性。如何在“且介亭”中想方设法写出诗史般的杂文并使之与读者见面，如何“带着镣铐进军”,是鲁迅彼时最重要的任务。换句话说，“且介亭杂文”本身就是鲁迅在这一阶段反抗和突破文网的成果，它们既是“且介亭”处境的体现，也是这一处境的产物，因而独具一种特殊的历史意义与艺术特征。“且介亭杂文”一方面是“含胡”的，以迂回、智慧的斗争方式面对审查；另一方面，鲁迅在杂文和《故事新编》里都使用了借古论今的方式，取道历史而批判现实，这也成为其后期杂文的重要特征之一。