Liz Ditzel teaches lateral thinking to students using "klinky boxes".

Experienced nurses engage in multiple clinical reasoning (critical thinking or problem solving) episodes for each person in their care, many times a day. Because of their knowledge, skill and experience the expert nurse may appear to perform these processes in way that seems automatic or instinctive, but clinical reasoning is a learned skill. The little things that noone else asks or notices could make a difference in diagnosis and treatment and health outcomes. 

To foster the development of student nurses’ critical thinking skills, lecturers Dr Liz Ditzel and Josie Crawley have developed a creative learning activity with a set of small wooden boxes and a children’s picture storybook. Students are placed in small groups and each group is presented with a box. There are four stages:

• Using only observational skills, they are asked to imagine what might be in the box. They use Post-It notes to record and organise different ideas.
• Second, students have a children’s story read aloud to them and are asked to reconsider the contents of the box. Listening to a story helps shift students' imagination. No idea is too ridiculous, but students are asked to think about how they could test their idea. 
• Then students are invited to examine the box through touch and sound, and reach a consensus about its contents using this information. These are "klinky boxes" - all make noise, but they make different noises. This challenges the students' assumption that because the boxes look the same the contents must be the same. 
• The activity concludes with a discussion of how to apply the skills used in this activity to a different nursing context that requires evaluation and judgment. The boxes are not opened at any stage.

This activity is undertaken with first year nursing students, and Liz Ditzel sees the improvement in critical thinking in their second year of study. While previously students introduced to the simulation suite used to go straight to the mannequin and touch it, now they are more likely to stop and think about possibilities first. Student feedback is also positive, with many students reporting they learned a lot from this exercise. Liz Ditzel and Josie Crawley are publishing their initiative nationally and internationally to inform the teaching of critical thinking more broadly.