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
- Working in isolation
- Being competitive
- Inability to communicate with others
- Lack of concern with motives, facts, underlying reasons
What are some related concepts?
- Mind Map
- Logic and reasoning
- 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
- 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,
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
- Systematicity – organized, orderly, focused,
- 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
- Evaluation – assessing claims and arguments
- Inference – querying evidence, conjecturing alternatives,
- Explanation –stating results, justifying
procedures, presenting arguments
- Self-monitoring -- self-examination and
- 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 &
- Nursing judgment model (Kataoka-Yahiro & Saylor,
- 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
and relate the concepts for nursing?
- 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
- Follow with Outcomes which may include problem
resolution, alternative solutions, clinical judgments,
- 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
- Critical thinking is both a process and an
- 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
- 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
for What is Critical Thinking
Beeken, J.E. (1997). The relationship
between critical thinking and self-concept in staff nurses and the influence of
these characteristics on nursing practice. Journal of Nursing Staff
Development, 13(5), 272-278.
Benner, P. (1984). From novice to expert. Menlo Park, CA: Addison Wesley.
Colucciello, M.L. (1997). Critical thinking
skills and dispositions of baccalaureate nursing students—A conceptual model
for evaluation. Journal of
Professional Nursing, 13(4), 236-245.
Dexter, P., Applegate, M., Backer, J., Claytor,
K., Keffer, J., Norton, B., & Ross, B. (1997). A
proposed framework for teaching and evaluating critical thinking in nursing. Journal
of Professional Nursing, 13(3), 160-167.
Ennis, R., & Milman, J. (1985).
Cornell tests of critical thinking: Theory and practice.
Pacific Grove, CA: Midwest Publications.
Facione, P.A. (1990). Critical thinking: A statement of expert
consensus for purposes of educational assessment and instruction. Executive
Summary “The Delphi Report”. Millbrae, CA: California Academic Press.
Halpern, D.F. (1989). Thought and
knowledge: An introduction to critical thinking. Hillsdale, N.J.: Lawrence Erlbaum Associates.
Jackson, M. (2004). Critical thinking
models and their application. In M.
Jackson, D.D. Ignatavicius, & B. Case (Eds.), Conversations
in critical thinking and clinical judgment (pp. 49-67), Pensacola, FL: Pohl Publishing, Inc.
Kataoka-Yahiro, J., & Saylor, C. (1994). A
critical thinking model for nursing judgment. Journal of Nursing Education,
McPeck, J.E.(1990). Teaching critical
thinking. New York: Routledge.
Miller, M.A., & Babcock, D.E. (1996). Critical
thinking applied to nursing. St. Louis, MO: Mosby.
Paul, R.W. & Heaslip, P.
(1995). Critical thinking and intuitive nursing practice. Journal of
Advanced Nursing, 22, 40-47.
Rubenfeld, M.G., & Scheffer,
B.K. (1995). Critical thinking in nursing: An interactive approach. Philadelphia: J.B. Lippincott
Scheffer, B.K., & Rubenfeld,
M.G. (2000). A consensus statement on critical thinking in nursing. Journal
of Nursing Education, 39(8), 352-359.
Videbeck, S.L. (1997). Critical thinking. A
model. Journal of Nursing Education, 36(1), 23-28.