Definition Of Critical Thinking Skills In Nursing

Posted on by Nem
(Penny Heaslip, 1993, Revised 2008 Thompson Rivers University, Box 3010, 900 McGill Road, Kamloops, BC Canada, V2C 5N3 pheaslip@tru.ca )

To become a professional nurse requires that you learn to think like a nurse. What makes the thinking of a nurse different from a doctor, a dentist or an engineer?  It is how we view the client and the type of problems we deal with in practice when we engage in client care. To think like a nurse requires that we learn the content of nursing; the ideas, concepts and theories of nursing and develop our intellectual capacities and skills so that we become disciplined, self-directed, critical thinkers.


Critical thinking is the disciplined, intellectual process of applying skilful reasoning as a guide to belief or action (Paul, Ennis & Norris). In nursing, critical thinking for clinical decision-making is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process used to ensure safe nursing practice and quality care (Heaslip). Critical thinking when developed in the practitioner includes adherence to intellectual standards, proficiency in using reasoning, a commitment to develop and maintain intellectual traits of the mind and habits of thought and the competent use of thinking skills and abilities for sound clinical judgments and safe decision-making.

Intellectual Standards for Reasoning

Practitioners in nursing who are critical thinkers value and adhere to intellectual standards. Critical thinkers strive to be clear, accurate, precise, logical complete, significant and fair when they listen, speak, read and write. Critical thinkers think deeply and broadly. Their thinking is adequate for their intended purpose (Paul, Scriven, Norris & Ennis). All thinking can be examined in light of these standards and as we reflect on the quality of our thinking we begin to recognize when we are being unclear, imprecise, vague or inaccurate. As nurses, we want to eliminate irrelevant, inconsistent and illogical thoughts as we reason about client care. Nurses use language to clearly communicate in-depth information that is significant to nursing care. Nurses are not focused on the trivial or irrelevant.

Nurses who are critical thinkers hold all their views and reasoning to these standards as well as, the claims of others such that the quality of nurse's thinking improves over time thus eliminating confusion and ambiguity in the presentation and understanding of thoughts and ideas.


Elements of Reasoned Thinking

Reasoning in nursing involves eight elements of thought. Critical thinking involves trying to figure out something; a problem, an issue, the views of another person, a theory or an idea. To figure things out we need to enter into the thinking of the other person and then to comprehend as best we can the structure of their thinking. This also applies to our own thinking as well. When I read an author I'm trying to figure out what the author is saying; what problem or issue the author is addressing, what point of view or frame of reference he is coming from, what the goal or purpose is of this piece of writing, what evidence, data or facts are being used and what theories, concepts, principles or ideas are involved. I want to understand the interpretations and claims the author is making and the assumptions that underlie his thinking. I need to be able to follow the author's lines of formulated thought and the inferences which lead to a particular conclusion. I need to understand the implications and consequences of the author's thinking. As I come to understand the author in-depth I will also begin to recognize the strength and weakness of his reasoning. I will be able to offer my perspective on the subject at hand with a clear understanding of how the author would respond to my ideas on the subject.


The Elements of Thought

All thinking, if it is purposeful, includes the following elements of thought (Paul, 1990).

  1. The problem, question, concern or issue being discussed or thought about by the thinker. What the thinker is attempting to figure out.
  2. The purpose or goal of the thinking. Why we are attempting to figure something out and to what end. What do we hope to accomplish.
  3. The frame of reference, points of view or even world view that we hold about the issue or problem.
  4. The assumptions that we hold to be true about the issue upon which we base our claims or beliefs.
  5. The central concepts, ideas, principles and theories that we use in reasoning about the problem.
  6. The evidence, data or information provided to support the claims we make about the issue or problem.
  7. The interpretations, inferences, reasoning, and lines of formulated thought that lead to our conclusions.
  8. The implications and consequences that follow from the positions we hold on the issue or problem.

When nurses reason they use these elements of thought to figure out difficult questions and recognize that their thinking could be flawed or limited by lack of in-depth understanding of the problem at issue therefore, they critically monitor their thinking to ensure that their thinking meets the standards for intellectual thought.

In summary, as a critical thinker, I am able to figure out by reading or listening critically what nurse scholars believe about nursing and on what basis nurses act as they practice nursing. To do this I must clearly comprehend the thinking of another person by figuring out the logic of their thinking. I must comprehend clearly the thinking of myself by figuring out my own thoughts on the subject at hand. Finally, I must use intellectual standards to evaluate my thinking and the thinking of others on a given problem such that I can come to a defensible, well reasoned view of the problem and therefore, know what to believe or do in a given circumstance. To do this I must be committed to developing my mind as a self-directed, independent critical thinker. I must value above all else the intellectual traits and habits of thought that critical thinkers possess.

Intellectual Traits and Habits of Thought

To develop as a critical thinker one must be motivated to develop the attitudes and dispositions of a fair-minded thinker. That is, one must be willing to suspend judgments until one truly understands another point of view and can articulate the position that another person holds on an issue. Nurses come to reasoned judgments so that they can act competently in practice. They continually monitor their thinking; questioning and reflecting on the quality of thinking occurring in how they reason about nursing practice. Sloppy, superficial thinking leads to poor practice.

Critical inquiry is an important quality for safe practice. Nurses must pose questions about practice and be willing to attempt to seek answers about practice. Nurses must be willing to attempt to seek answers to the difficult questions inherent in practice, as well as the obvious. Question posing presupposes intellectual humility and a willingness to admit to one's areas of ignorance as well as, intellectual curiosity and perseverance and willingness to seek answers. Critical thinkers in nursing are truth seekers and demonstrate open-mindedness and tolerance for others' views with constant sensitivity to the possibility of their own bias.

Nurse's who are critical thinkers value intellectually challenging situations and are self-confident in their well reasoned thoughts. To reason effectively, nurses have developed skills and abilities essential for sound reasoning.


Critical Thinking Skills and Abilities

Critical thinkers in nursing are skilful in applying intellectual skills for sound reasoning. These skills have been defined as information gathering, focusing, remembering, organizing, analyzing, generating, integrating and evaluating (Registered Nurse's Association of British Columbia, 1990). The focus of classroom and clinical activities is to develop the nurse's understanding of scholarly, academic work through the effective use of intellectual abilities and skills. As you encounter increasingly more complex practice situations you will be required to think through and reason about nursing in greater depth and draw on deeper, more sophisticated comprehension of what it means to be a nurse in clinical practice. Nursing is never a superficial, meaningless activity. All acts in nursing are deeply significant and require of the nurse a mind fully engaged in the practice of nursing. This is the challenge of nursing; critical, reflective practice based on the sound reasoning of intelligent minds committed to safe, effective client care.


To accomplish this goal, students will be required to reason about nursing by reading, writing, listening and speaking critically. By doing so you will be thinking critically about nursing and ensuring that you gain in-depth knowledge about nursing as a practice profession.

Critical Thinking...a Holistic Approach

Critical Listening: A mode of monitoring how we are listening so as to maximize our accurate understanding of what another person is saying. By understanding the logic of human communication - that everything spoken expresses point of view, uses some ideas and not others, has implications, etc., critical thinkers can listen so as to enter empathetically and analytically into the perspective of others.

Critical Thinking: 1) Disciplined, self-directed thinking which implies the perfection of thinking appropriate to a particular mode or domain of thinking. 2) Thinking that displays master of intellectual skills and abilities. 3) The art of thinking about your thinking while you are thinking in order to make your thinking better: more clear, more accurate, or more defensible.

Critical Writing: To express oneself in languages required that one arrange ideas in some relationships to each other. When accuracy and truth are at issue, then we must understand what our thesis is, how we can support it, how we can elaborate it to make it intelligible to others, what objections can be raised to it from other points of view, what the limitations are to our point of view, and so forth. Disciplined writing requires disciplined thinking; disciplined thinking is achieved through disciplined writing.


Critical Reading: Critical reading is an active, intellectually engaged process in which the reader participates in an inner dialogue with the writer. Most people read uncritically and so miss some part of what is expressed while distorting other parts. A critical reader realizes the way in which reading, by its very nature, means entering into a point of view other than our own, the point of view of the writer. A critical reader actively looks for assumptions, key concepts and ideas, reasons and justifications, supporting examples, parallel experiences, implications and consequences, and any other structural features of the written text to interpret and assess it accurately and fairly. ( Paul, 1990, pp 554 & 545 )

Critical Speaking: Critical speaking is an active process of expressing verbally a point of view, ideas and thoughts such that others attain an in-depth understanding of the speaker's personal perspective on an issue. Monitoring how we express ourselves verbally will ensure that we maximize accurate understanding of what we mean through active dialogue and openness to feedback on our views. (Heaslip, 1993).


References:

Paul, R.W. (1990). Critical Thinking: What Every Person Needs to Survive in a Rapidly Changing World. Rohnert Park, California: Center for Critical Thinking and Moral Critique

Norris, S. P. & Ennis, R.H. (1989). Evaluating critical thinking. Pacific Grove, CA: Midwest Publications, Critical Thinking Press

1. Athari Z, Sharif M, Nematbakhsh M, Babamohammadi H. [Evaluation of critical thinking skills in isfahan university of medical sciences' students and its relationship with their rank in university entrance exam rank]. Iran J Med Edu. 2009;9(1):5–12.

2. Anajafi F, Zera'at Z, Soltan Mohammadi Z, Ghabchipour K, Kohan F. [Critical thinking skills of engineering and human sciences students]. Bimonthly Educ Strateg Med Sci. 2009;2(1):9–10.

3. Eslami-Akbar R, Moarefi F. [A comparison of the critical thinking ability in the first and last term baccalaureate students of nursing and clinical nurses of Jahrom University of Medical Sciences in 2007]. J Jahrom Univ Med Sci. 2010;8(1):37–45.

4. Khosravani S, Manoochehri H, Memarian R. Developing critical thinking skills in nursing students by group dynamics. Internet J Adv Nurs Prac. 2005;7(2):1–12.

5. Yildirim B, Ozkahraman S. Critical thinking in nursing process and education. Int J Hum Social Sci. 2011;1(13):257–62.

6. Simpson E, Courtney M. Critical thinking in nursing education: literature review. Int J Nurs Pract. 2002;8(2):89–98.[PubMed]

7. Popil I. Promotion of critical thinking by using case studies as teaching method. Nurse Educ Today. 2011;31(2):204–7. doi: 10.1016/j.nedt.2010.06.002.[PubMed][Cross Ref]

8. Khodamoradi K, Seyed Zakerin M, Shahabi M, Yaghmaie F, Alavi Majd H. [Comparing critical thinking skills of first-and last-term baccalaureate students of nursing, midwifery and occupational therapy of medical Universities of Tehran city]. Med Sci J Islamic Azad Univ. 2011;21(2):134–40.

9. Karadag M, Saritas S, Erginer E. Using the'Six thinking hats' model of learning in a surgical nursing class: sharing the experience and student opinions. Aus J Adv Nurs . 2009;26(3):59.

10. Alfaro-LeFevre R. Critical Thinking in Nursing: A Practical Approach. Saunders; 1999.

11. Bakalis N. Clinical decision-making in cardiac nursing: a review of the literature. Nurs Stand. 2006;21(12):39–46. doi: 10.7748/ns2006.11.21.12.39.c6386.[PubMed][Cross Ref]

12. Duchscher JE. Critical thinking: perceptions of newly graduated female baccalaureate nurses. J Nurs Educ. 2003;42(1):14–27.[PubMed]

13. Morrison S, Free KW. Writing multiple-choice test items that promote and measure critical thinking. J Nurs Educ. 2001;40(1):17–24.[PubMed]

14. Scheffer BK, Rubenfeld MG. A consensus statement on critical thinking in nursing. J Nurs Educ. 2000;39(8):352–9.[PubMed]

15. Magnussen L, Ishida D, Itano J. The impact of the use of inquiry-based learning as a teaching methodology on the development of critical thinking. J Nurs Educ. 2000;39(8):360–4.[PubMed]

16. Rezaei R, Saatsa S, Sharif Nia S, Molookzadeh S, Beheshti Z. [Evaluation of nursing Students, critical thinking skills in mazandaran university of medical sciences]. Biannual J Med Educ Babol Univ Med Sci . 2014;2(1):29–34.

17. Khalili H, Babamohammadi H, Hajiaghajani S. [The effects of two educational methods, classic and critical thinking strategies, on the stable learning of nursing students]. Koomesh. 2003;5(2):53–62.

18. McCarthy P, Schuster P, Zehr P, McDougal D. Evaluation of critical thinking in a baccalaureate nursing program. J Nurs Educ. 1999;38(3):142–4.[PubMed]

19. Karimi-naghadar M, Rahnema F, Gol- Afrooz M, Mohsenpoor M. [Assessment of critical thinking skill among senior student nurses]. J qual Res Health Sci . 2010;10(1):24–8.

20. Akhoundzadeh K, Ahmari Tehran H, Salehi S, Abedini Z. [Critical thinking in nursing education in Iran]. Iran J Med Educ. 2011;11(3):210–21.

21. Jamshidian TGS, Khomojani-farahani A. [The relationship between language, gender, age and level of critical thinking]. Foreign language Stud. 2009;55:71–81.

22. Barkhordary M, Jalalmanesh S, Mahmodi M. [The relationship between critical thinking disposition and self esteem in third and forth year bachelor nursing students]. Iran J Med Educ. 2009;9(1):9–13.

23. Babamohamadi H, Khalili H. [Critical thinking in nursing students in Semnan University of Medical Science]. Iran J Med Educ. 2004;4(13):23–31.

24. Gharib M, Sarmadi M, Ebrahimzadeh I, Zare H, Emami A, Gharib A. [Enhancing critical thinking in virtual medical education program: A qualitative study of faculty members' and students' experiences]. Strides Dev Med Educ. 2011;8(1):10.

25. Ranjba H, Esmaili H. [A study on the nursing and midwifery students' trend to critical thinking and its relation with their educational status]. J Urmia Nurs Midwif. 2006;4(1):11–20.

26. Ip WY, Lee DT, Lee IF, Chau JP, Wootton YS, Chang AM. Disposition towards critical thinking: a study of Chinese undergraduate nursing students. J Adv Nurs. 2000;32(1):84–90.[PubMed]

27. Zhang H, Lambert V. Critical thinking dispositions and learning styles of baccalaureate nursing students from China. Nurs Health Sci. 2008;10(3):175–81. doi: 10.1111/j.1442-2018.2008.00393.x.[PubMed][Cross Ref]

28. Noohi E, Karimi-Noghondar M, Haghdoost A. Survey of critical thinking and clinical decision making in nursing student of Kerman University. Iran J Nurs Midwifery Res. 2012;17(6):440–4.[PMC free article][PubMed]

29. Mahmoodabad SS, Nadrian H, Nahangi H. Critical thinking ability and its associated factors among preclinical students in Yazd Shaheed Sadoughi University of Medical Sciences (Iran). Med J Islam Repub Iran. 2012;26(2):50–7.[PMC free article][PubMed]

30. Bittencourt GK, Crossetti Mda G. [Critical thinking skills in the nursing diagnosis process]. Rev Esc Enferm USP. 2013;47(2):341–7.[PubMed]

31. Amini M, Fazlinejad N. [Critical thinking skill in Shiraz University of medical sciences students]. Hormozgan Med J. 2010;14(3):213–8.

32. Shamsaei F, Alhani F, Cheraghi F. [Teaching critical thinking in nursing]. Iran J Med Educ. 2008;10(3):312–6.

33. Hasanpour M, Oskouie F, Salsalei M. [Critical thinking in nursing education]. Iran J Nurs. 2005;18(41):7–16.

34. Borglin G, Fagerstrom C. Nursing students' understanding of critical thinking and appraisal and academic writing: a descriptive, qualitative study. Nurse Educ Pract. 2012;12(6):356–60. doi: 10.1016/j.nepr.2012.04.009.[PubMed][Cross Ref]

35. Moattari M, Abedi H. [Nursing students' experiences in reflective thinking: A qualitative study]. Iran J Med Educ. 2008;8(1):101–12.

Categories: 1

0 Replies to “Definition Of Critical Thinking Skills In Nursing”

Leave a comment

L'indirizzo email non verrà pubblicato. I campi obbligatori sono contrassegnati *