What it IS

• Reasonable, reflective thinking focused on what to believe or do (Ennis & Milman, 1985)
• The propensity to engage in an activity with reflective skepticism (McPeck, 1990)
• Purposeful goal directed thinking (Halpern, 1989)
• The art of thinking about thinking while thinking to make thinking better (Paul & Heaslip, 1995)
• Purposeful, self-regulatory judgment (Facione, 1990)

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

What are some 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
• Convergent or divergent thinking

How does this translate to nursing?

• Reflective, reasonable thinking about nursing problems without a single solution
• Clinical decision making or diagnostic reasoning or Professional judgment
• Reflective practice

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

What are some factors which 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

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

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

What are some traits or dispositions of Critical Thinkers?

APA Delphi Study (Facione, 1990)

• 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
• Analyticity – alert to potentially problematic situations
• Systematicity – organized, orderly, focused, diligent inquiry
• Self-confidence – trust in own reasoning
• Inquisitiveness – intellectual curiosity, values being well informed
• Maturity – disposed to make reflective judgments
• Reflection, Perseverance, Contextual perspective, Creativity, Flexibility, Intuition (Nursing Delphi Study, Scheffer & Rubenfeld, 2000)

What are some cognitive skills of Critical Thinkers?

APA Delphi Study (Facione, 1990)

• Interpretation – categorization, decoding significance, clarifying meaning
• Analysis – examining ideas, detecting and analyzing arguments
• Evaluation – assessing claims and arguments
• Inference – querying evidence, conjecturing alternatives, drawing conclusions
• Explanation –stating results, justifying procedures, presenting arguments
• Self-monitoring -- self-examination and correction
• Information seeking, Discriminating, Predicting, Applying Standards, Logical reasoning (Nursing Delphi Study, Scheffer & Rubenfeld, 2000)

What are some Nursing Models or conceptual frameworks related to critical thinking?

• Novice vs. Expert or Struggling vs. Exemplary nurses (Benner, 1984; Beeken, 1997)
• T.H.I.N.K. Model (Rubenfeld & Scheffer, 1995)
• Critical Thinking Interaction Model (Miller & Babcock, 1996)
• Nursing judgment model (Kataoka-Yahiro & Saylor, 1994)
• Curricular model for evaluation (Videbeck, 1997)
• Conceptual framework based on consensus statement for evaluation of specific outcomes and competencies (Facione, 1990; Dexter et al., 1997; Colucciello, 1997)
• Four Steps for Problem Analysis and Positive Problem Solving (Jackson, 2004)

How do we put the pieces together to see the Big Picture and relate the concepts for nursing?
(see 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

What is a Holistic Approach to Critical Thinking?

• Critical Listening = monitoring how we listen
• Critical Thinking = disciplined, self-directed, thinking about thinking
• Critical Writing = requires disciplined thinking, expression of disciplined thinking
• Critical Reading = inner dialogue with writer, enter point of view of writer
• Critical Speaking = others gain in-depth understanding of speaker’s perspective

What are some 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 or iterative feedback loop

References for What is Critical Thinking