2Objectives To discuss reasons why we should use critical thinking Define the meaning of critical thinkingDiscuss applications to nursing practiceDescribe traits of a critical thinkerDiscuss factors that impede or enhance critical thinkingDiscuss how to improve critical thinking skills
3Why Should We Critically Think? Widening Responsibilities as nursesPatients are increasingly illPatients have multi-system health problemsComplex working environmentsRapid changes in healthcareA 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.
4What is Critical Thinking? Critical Thinking has many different definitionsDifficult to measure in nursing schoolRelated to competent nursing practiceClosely associated with nursing process, clinical judgment & problem solvingStop 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 thinkingwhen we engage our brains in habitual activities like grooming or driving to and from work.Directed thinkinggoal-oriented and purposefulsearching for answers & meaning, requires a conscious mental effortinvolves 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.
7Putting them togetherPutting 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.
8DefinitionFrom 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.
9What else?Reasonable, reflective thinking focused on what to believe or doThe tendency to engage in an activity with reflective skepticismPurposeful, goal-directed thinkingPurposeful, self-regulatory judgmentThe art of thinking about thinking while thinking to make thinking better
10What it is not! Common sense Spontaneous responses Regular or “normal” thinkingBeing critical or judgmentalDisorganizedTask-orientedWorking in isolationBeing competitiveInability to communicate with othersLack of concern with motives, facts, underlying reasonsEmotion-driven
11How does this translate into nursing? Reflective, reasonable thinking about nursing problems without a single solutionClinical decision making or diagnostic reasoning or Professional judgmentReflective practice
12Why is it essential to be a critical thinker in nursing? To manage complex dilemmasFor empowerment and liberationTo exchange views and informationTo broaden or change our thinking and learningFor self-actualization
13What are some factors that impede or enhance critical thinking? Moral development (fair mindedness)Age, self confidenceDislikes, prejudices, biasesInterpersonal skillsReading and writing skillsAnxiety, stress, fatigueTime factorsEnvironmental distractions or comfortsLack of motivation or positive reinforcementPast experiencesSupport systems—mentors, coaches, colleagues, family, friends
14What are some key assumptions for critical thinking? It is rationalIt involves conceptualizationIt requires reflectionIt is a nonlinear process that expands problem solving and nursing processIt involves both cognitive and affective skillsThe skills can be taught, learned, and measuredThe skills need to be practiced and reinforcedIt involves creative thinkingIt requires basic and advanced nursing knowledgeIt is both a process and an outcomeIt is embedded in our practice
15Are you a critical thinker? Do you:Explore underlying thinking and assumptionsBase judgments on facts and reasoningSuspend judgment until you have all the dataSupport views with evidenceEvaluate the credibility of sourcesTurn mistakes into learning opportunitiesAsk “Why?” and “Why not?”Be open to possibilitiesSeek themes, patterns, trendsFollow hunches
16What are some traits of a critical thinker? Truth-seeking – courageous about asking questions, honest and objective in pursuing inquiryOpen-mindedness – sensitive to own bias, respect rights of others to hold differing opinionsAnalyst – alert to potentially problematic situationsSystematic – organized, orderly, focused, diligent inquirySelf-confidence – trust in own reasoningInquisitiveness – intellectual curiosity, values being well informedMature – disposed to make reflective judgmentsReflection, Perseverance, Appropriate perspective, Creativity, Flexibility, IntuitionAPA Delphi Study
17What are some cognitive skills of critical thinkers? Interpret – categorization, decoding significance, clarifying meaningAnalyze – examining ideas, detecting and analyzing argumentsEvaluate – assessing claims and argumentsInfer – question evidence, imagine alternatives, drawing conclusionsExplain – stating results, justifying procedures, presenting argumentsSelf-monitor - self-examination and correctionInformation seeking, Discriminating, Predicting, Applying Standards, Logical reasoningAPA Delphi Study
18Who 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 nursesUnit secretaries: Entering orders, answering phones, directing family and healthcare workers, managing charts, looking up test results, locating nursesMonitor techs: Monitoring strips, printing and analyzing, managing multiple screens and patient information, reporting results to nursesDietary: Delivering trays, managing customers, keeping food warm,EVS: Which rooms to clean and when, priority rooms, shift management of time and duties to be accomplishedEngineering: Repairs that take priority, upkeep, schedules, tasks to be completed, how to accomplish these tasks.Other departments give examples!
19We 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.
20Think about it!How do you think about what you think you think about???
21How 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?
22Related Concepts Mind Map Logic and reasoning Creativity Intuition Emotional intelligenceProblem solvingNursing processDecision makingClinical or diagnostic reasoningReflective practiceClinical judgment
24Putting the pieces together (Mind Map) Begin with Triggers or a particular event or dilemma or complex problemGo to Starting Points or types of thinking that help us begin the process, i.e. brainstorming, intuition, thinking aloud, reflective thinkingBuild on the Scaffolds or knowledge, skills and expertise that supports our ability to think criticallyLead 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 reasoningFollow with Outcomes which may include problem resolution, alternative solutions, clinical judgments, reflective practiceEvaluate TriggersContinuous and iterative loop—A Mind Map for Critical Thinking in Nursing
25Final Reflections Critical thinking is both a process and an outcome Critical thinking involves reflection in knowing and in action and self monitoringCritical 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 PracticeCritical 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
26ReferencesCise, 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 fromNichols, M. (2003). Critical thinking process. Retrieved May 23, 2005 from