Critical Thinking in Nursing

Titin Andri WihastutiPSIK FK Unbraw

Why would nursing students need to be able to reason well ?

Professional decisions depend on a clear understanding of factors and their relationships.

Actual cases do not always resemble textbook examples; improvisational strategies are often required

Development of clinical Judgment

Expanding knowledge base

Critical thinking

Clinical experience

Clinical reasoning

Clinical judgment

Critical Thinking is ...

Vital to nursing. More than gathering facts and figures. A search for the best answer - not just

any answer. A systematic way of thinking.

Critical Thinking is ...

A multifaceted and complex concept based on reason and reflection, knowledge and instinct derived from experience.

Applying two theories of critical thinking

Bloom’s Taxonomy of Thinking Skills

Sternberg’s “Successful Intelligence”

Evaluation

Evaluate Choose Estimate Judge Defend Criticize

Benjamin Bloom’s Taxonomy of Thinking Skills

Bloom, B. S. (Ed.). (1956). Taxonomy of educational objectives, Vol.1: The cognitive domain. New York: McKay.

Table adapted from http://www.umuc.edu/prog/ugp/ewp/bloomtax.html

Knowledge

List Name Identify Show Define Recognize Recall State Visualize

Comprehension

Summarize Explain Interpret Describe Compare Paraphrase Differentiate Demonstrate Classify

Application

Solve Illustrate Calculate Use Interpret Relate Manipulate Apply Modify

Analysis

Analyze Organize Deduce Contrast Compare Distinguish Discuss Plan Devise

Synthesis

Design Hypothesize Support Schematize Write Report Justify

Robert Sternberg: Successful IntelligenceArticle: http://www.indiana.edu/~futures/r_stbg.html

Analytical

Thinking

Creative Thinking

Practical Thinking

MemoryRECALL RECOGNIZE MATCH VERIFY REPEAT

ANALYZE

EVALUATE

EXPLAIN

COMPARE/CONTRAST

JUDGE

CREATE

INVENT

EXPLORE

IMAGINE

SUPPOSE

PUT INTO PRACTICE

USE

IMPLEMENT

APPLY

RECALL RECOGNIZE MATCH VERIFY REPEAT

ANALYZE

EVALUATE

EXPLAIN

COMPARE/CONTRAST

JUDGE

CREATE

INVENT

EXPLORE

IMAGINE

SUPPOSE

PUT INTO PRACTICE

USE

IMPLEMENT

APPLY

Critical Thinkers ask...

What am I taking for granted ? Did I explore all points of view ? Do I understand the question ? What information do I need ? What are the implications ?

Standards for Critical Thinking

Clarity vs. Lack of Clarity Precision vs. imprecision Specificity vs.

Vagueness Accuracy vs. Inaccuracy Relevance vs.

irrelevance Adequacy vs.

inadequacy

Consistency vs. inconsistency

Logical vs. illogical Depth vs. superficiality Completeness vs.

incompleteness Significance vs. triviality Fairness vs. bias

Reading Listening Observing Analyzing Speaking Writing

The Six Critical Thinking Skills :The Six Critical Thinking Skills :

To Improve Critical Reading

Highlight the main ideas as you read. If most of the text is highlighted you are not reading critically.

Join a study group and see if your main idea is the same as fellow group member’s.

Dialogue with yourself to identify the main idea of your reading.

Try to state the main idea in your own words

To Improve Critical Listening

Restate the points made in a discussion with others to see if you understand them.

Focus on what a speaker is saying and listen for key points.

While listening, make note of anything you find confusing, and ask about it later.

To Improve Critical Observing

Remove any restrictions in your mind. Eliminate or decrease any distraction. Ask yourself if you understand the

most important points? Create new ways of looking at

situations Always look from outside the situation.

To Improve Critical Analyzing

Maintain clear and accurate logic. Take all details into consideration. Use systematic and scientifically-

based process. Use both cognitive and psychomotor

skills.

To Improve Critical Writing

Summarize, in your own words, what you’re going to write about.

Put your writing away for a day and then reread it.

Ask yourself if you understand the most important points?

Ask a friend for input.

To Improve Critical Speaking

Maintain clear and accurate logic. Avoid ambiguous statements. Listen to yourself for any personal

biases. Practice in front of a small group and

ask for feedback.

4 MAJOR CRITICAL THINKING PROCESSES

CONTEXTUAL AWARENESS & DECIDING WHAT TO OBSERVE AND CONSIDER

EXPLORING & IMAGINING ALTERNATIVES

ASSUMPTION RECOGNITION & ANALYSIS

REFLECTIVE SKEPTICISM / DECIDING WHAT TO DO

# 1 CONTEXTUAL AWARENESS & DECIDING WHAT TO OBSERVE AND CONSIDER

This includes an awareness of what’s happening in the context of the situation, including values, cultural issues, and environmental influences

Sample questions include: What was going on in the situation that may have

influenced the outcome? What factors influenced my behavior and others’ behavior

in this situation? What else was happening simultaneously that affected me

in this situation? What happened just before this incident that made a

difference?

# 1 CONTEXTUAL AWARENESS & DECIDING WHAT TO OBSERVE AND CONSIDER

What emotional responses influenced how I was reacting to the situation?

What else do I need to know? What information is missing? How do I go about getting the information I need? What about this situation have I seen before? What is

different / dissimilar? Who should have been involved in order to improve the

outcome? What’s important and what’s not important in this situation? What changes in behavior alerted me that something was

wrong?

# 2 Exploring and Imagining Alternatives

This involves exploring as many alternatives as you can think of for the given situation

Sample questions include: What is one possible explanation for [insert what is

happening?] What are other explanations for what is happening? What is one thing I could do in this situation? What are two more possibilities / other alternatives? What else would I want to know about this situation?

# 2 Exploring and Imagining Alternatives

Are there others who might be able to help me develop more alternatives?

Of the possible actions I am considering, which one is most reasonable? Why are the others not as reasonable?

Are there other resources that need to be mobilized?

# 3 Assumption Recognition and Analysis

This involves analyzing assumptions you are making about the situation as well as examining the beliefs that underlie your choices

Sample questions include: What has been taken for granted in this situation? Which beliefs / values are shaping my

assumptions? What assumptions contributed to the problem in

this situation? What rationale supports my assumptions? How will I know my assumption is correct?

# 4 Reflective Skepticism / Deciding What to Do

This critical thinking approach involves questioning, analyzing, and reflecting on the rationale for decisions.

Sample questions include: What else might work in this situation? Am I sure of my interpretation of the situation? What rationale do I have for my decisions? What aspects of this situation require the most careful

attention? Why was it important to intervene? What got me started taking some action? In priority order, identify what I would do in this situation

and why?

Reflective Skepticism / Deciding What to Do

What priorities were missed? Having decided what was wrong /

happening, what is the best response? What might I delegate in this situation? What was done? Why was it done? What would I do differently after

reflecting on this situation?