1. Clinical Education Coordinator
Critical Thinking
Presented by
Beth Edwards, RN, EMT-P
Clinical Education Coordinator
SMH Staff Development

2. Objectives To discuss reasons why we should use critical thinking
Define the meaning of critical thinking
Discuss applications to nursing practice
Describe traits of a critical thinker
Discuss factors that impede or enhance critical thinking
Discuss how to improve critical thinking skills

3. Why Should We Critically Think?
Widening Responsibilities as nurses
Patients are increasingly ill
Patients have multi-system health problems
Complex working environments
Rapid changes in healthcare
A toddler learns to ride a tricycle after a few frustrating moments of trying to get his feet to peddle forward. A week later he races his tricycle forward and backward like a pro. An 18-year-old teen who started playing chess at 10 years of age wins the state championship, where strategy is tested to the brink. A student nurse struggles to organize the care of two patients assigned to her care. The experienced nurse effectively and competently manages the care of the eight patients in her care assignment, each with different needs.
What factors are responsible for the change in handling the above tasks? Are these examples of inherent abilities, natural reactions, or learned actions? Actually, these are all examples of a process known only to occur in human beings, the process of thinking critically. Critical thinking is a combination of our brain's ability to reason and remember, sprinkled with some natural reactions and with much experience based on learning situations. This course will describe how the healthcare professional develops the knowledge, skills and abilities to think critically through situations in order to apply the appropriate actions in patient care decision making.
The tools or principles of critical thinking can be taught, but implementing them is up to the individual; just as a doctor can prescribe medicine to a patient, but the patient must actually take the medicine for it to benefit him. Critical thinking is an ability, a potential within each of us. Yet it is the individual who must consciously use that potential, and, with the right tools, create critical thinking habits. Critical thinking then becomes an automatic process that will assist the nurse in providing patients, residents and clients the highest quality care possible.

4. What is Critical Thinking?
Critical Thinking has many different definitions
Difficult to measure in nursing school
Related to competent nursing practice
Closely associated with nursing process, clinical judgment & problem solving
Stop here to discuss what the nursing process is.

5. “Critical”
The word critical comes from the Greek word "kritikos," meaning "critic." To be critical means to question; to make sense of something; to analyze a situation. Although for many the word critical has become synonymous with negativity, it really is a positive opportunity to reach a favorable outcome.
Critical, as defined in Webster's Dictionary, gives us some words to associate. These are "crucial, decisive, indispensable, and vital." It also is defined as "exercising or involving careful judgment or judicious evaluation."

6. “Thinking”
Thinking can be divided into directed and non-directed thinking.
Non-directed thinking
when we engage our brains in habitual activities like grooming or driving to and from work.
Directed thinking
goal-oriented and purposeful
searching for answers & meaning, requires a conscious mental effort
involves observation, memory, inquiry, interpretation, analysis, & evaluation skills.
Webster's Dictionary: thinking is synchronous with "to have as an opinion," "to have as an expectation," "to mediate," "to form a mental picture of," and "to subject to the processes of logical thought."
Thinking is not as easy to define as one might think.

7. Putting them together
Putting the two terms together would indicate a mental process of putting together crucial, decisive, indispensable and vital information to provide careful judgment and judicious evaluation in formulating an opinion, mental picture, expectation and/or decision.

8. Definition
From the Delphi Study of American Philosophical Association:
Critical thinking is a “purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference as well as the explanation of the rationale upon which the judgment is based. Critical thinking is reasonable, rational, reflective, autonomous thinking that inspires attitude of inquiry.”
At the University of Indianapolis, a critical thinking assessment team was formed to identify how critical thinking could be defined, facilitated, and measured in their BSN program.

9. What else?
Reasonable, reflective thinking focused on what to believe or do
The tendency to engage in an activity with reflective skepticism
Purposeful, goal-directed thinking
Purposeful, self-regulatory judgment
The art of thinking about thinking while thinking to make thinking better

10. What it is not! Common sense Spontaneous responses
Regular or “normal” thinking
Being critical or judgmental
Disorganized
Task-oriented
Working in isolation
Being competitive
Inability to communicate with others
Lack of concern with motives, facts, underlying reasons
Emotion-driven

11. How does this translate into nursing?
Reflective, reasonable thinking about nursing problems without a single solution
Clinical decision making or diagnostic reasoning or Professional judgment
Reflective practice

12. Why is it essential to be a critical thinker in nursing?
To manage complex dilemmas
For empowerment and liberation
To exchange views and information
To broaden or change our thinking and learning
For self-actualization

13. What are some factors that impede or enhance critical thinking?
Moral development (fair mindedness)
Age, self confidence
Dislikes, prejudices, biases
Interpersonal skills
Reading and writing skills
Anxiety, stress, fatigue
Time factors
Environmental distractions or comforts
Lack of motivation or positive reinforcement
Past experiences
Support systems—mentors, coaches, colleagues, family, friends

14. What are some key assumptions for critical thinking?
It is rational
It involves conceptualization
It requires reflection
It is a nonlinear process that expands problem solving and nursing process
It involves both cognitive and affective skills
The skills can be taught, learned, and measured
The skills need to be practiced and reinforced
It involves creative thinking
It requires basic and advanced nursing knowledge
It is both a process and an outcome
It is embedded in our practice

15. Are you a critical thinker?
Do you:
Explore underlying thinking and assumptions
Base judgments on facts and reasoning
Suspend judgment until you have all the data
Support views with evidence
Evaluate the credibility of sources
Turn mistakes into learning opportunities
Ask “Why?” and “Why not?”
Be open to possibilities
Seek themes, patterns, trends
Follow hunches

16. What are some traits of a critical thinker?
Truth-seeking – courageous about asking questions, honest and objective in pursuing inquiry
Open-mindedness – sensitive to own bias, respect rights of others to hold differing opinions
Analyst – alert to potentially problematic situations
Systematic – organized, orderly, focused, diligent inquiry
Self-confidence – trust in own reasoning
Inquisitiveness – intellectual curiosity, values being well informed
Mature – disposed to make reflective judgments
Reflection, Perseverance, Appropriate perspective, Creativity, Flexibility, Intuition
APA Delphi Study

17. What are some cognitive skills of critical thinkers?
Interpret – categorization, decoding significance, clarifying meaning
Analyze – examining ideas, detecting and analyzing arguments
Evaluate – assessing claims and arguments
Infer – question evidence, imagine alternatives, drawing conclusions
Explain – stating results, justifying procedures, presenting arguments
Self-monitor - self-examination and correction
Information seeking, Discriminating, Predicting, Applying Standards, Logical reasoning
APA Delphi Study

18. Who can critically think?
Anyone can and everyone should!
There is no research to support that a professional program of study increases critical thinking ability.
We can all critically think within our roles.
Nurses: Obviously managing numerous patients, medications, changes in status, lab results, family members, MD orders, etc.
Care techs: Managing numerous patients, monitoring for changes, prioritizing patient needs, family members, VS abnormalities, reporting to nurses
Unit secretaries: Entering orders, answering phones, directing family and healthcare workers, managing charts, looking up test results, locating nurses
Monitor techs: Monitoring strips, printing and analyzing, managing multiple screens and patient information, reporting results to nurses
Dietary: Delivering trays, managing customers, keeping food warm,
EVS: Which rooms to clean and when, priority rooms, shift management of time and duties to be accomplished
Engineering: Repairs that take priority, upkeep, schedules, tasks to be completed, how to accomplish these tasks.
Other departments give examples!

19. We must think about our thinking!
Critical thinking requires you to challenge your assumptions and think about consequences.
Think about it!
Pull from past experiences and knowledge base to expect and anticipate.
Consciously THINK about a situation and act on it.

20. Think about it!
How do you think about what you think you think about???

21. How do we improve on our critical thinking skills?
Communication!
Reflection!
After any incident or shift, meet with your co-workers and ask these questions:
What went well?
If you could do it over again, what would you do differently?
What are your plans for improvement that will help you be more successful in the future?
What help do you need to meet your goals?

22. Related Concepts Mind Map Logic and reasoning Creativity Intuition
Emotional intelligence
Problem solving
Nursing process
Decision making
Clinical or diagnostic reasoning
Reflective practice
Clinical judgment

24. Putting the pieces together (Mind Map)
Begin with Triggers or a particular event or dilemma or complex problem
Go to Starting Points or types of thinking that help us begin the process, i.e. brainstorming, intuition, thinking aloud, reflective thinking
Build on the Scaffolds or knowledge, skills and expertise that supports our ability to think critically
Lead into the Processes which involve different types of thinking that contribute to critical thinking, i.e. convergent and divergent thinking, reflection, nursing process, problem solving, creative thinking, diagnostic reasoning
Follow with Outcomes which may include problem resolution, alternative solutions, clinical judgments, reflective practice
Evaluate Triggers
Continuous and iterative loop—A Mind Map for Critical Thinking in Nursing

25. Final Reflections Critical thinking is both a process and an outcome
Critical thinking involves reflection in knowing and in action and self monitoring
Critical thinking is composed of specific traits or dispositions and cognitive skills.
Nursing utilizes critical thinking as diagnostic reasoning and professional or clinical judgment.
Nursing supports critical thinking in Reflective Practice
Critical thinking in nursing is based on a triggering event or situation, a starting point, scaffolds, processes, and outcomes that make up a continuous feedback loop

26. References
Cise, J., Wilson, C., Thie, M. (2004). A qualitative tool for critical thinking skill development. Nurse Educator, 29(4). Retrieved May 8, 2005 from Ovid database.
University of New Mexico Health Sciences Center College of Nursing (2005). What is critical thinking? Retrieved May 23, 2005 from
Nichols, M. (2003). Critical thinking process. Retrieved May 23, 2005 from