critical thinking nursing course

Nursing Continuing Education CEU

Klimes institute: convenient quality health, ethics, & statistics ce coures 3hr/$21, critical thinking.

About This Course

E40 Critical Thinking, 3 CE hours

Description: In critical thinking, we learn to ask questions to determine the facts, analyze the support for the various claims, evaluate the reliability of the various options, and infer the most reasonable conclusions.

Objective: At the end of this course, you will 1. Ask questions to determine the facts, 2. Analyze the support for the various claims, 3. Evaluate the reliability of the various options, and 4. Infer the most reasonable conclusions.

Meet Your Instructor

Rudolf E. Klimes, PhD, MPH

At the end of this course, if you are taking this course individually for 3 CEUs (rather than as a module of Care Ethics) you will need to take the self-correcting test to complete this course.

Introduction

Critical thinking is the reasonable and reflective thinking focused on deciding what to believe or do.

In critical thinking, we

• Ask questions to determine the facts,
• Analyze the support for the various claims,
• Evaluate the reliability of the various options, and
• Infer the most reasonable conclusions.

Read the following synopsis of a case study on critical thinking, “Developing Critical Thinkers: Challenging Adults To Explore Alternative Ways of Thinking and Acting” by Stephen D. Brookfield :

A variety of methods are presented for developing skills for critical thinking, which is described as reflecting on assumptions underlying actions and considering new ways of looking at and living in the world. Critical thinking is viewed as not just an academic exercise, but a productive process enabling people to be more effective and innovative in four key areas of adult life: personal relationships, workplaces, political involvements, and responses to the media. The book contains three main parts: (1) Understanding Critical Thinking in Adult Life, which covers what it means to think critically, recognizing critical thinking and learning to think critically in adult life, and how critical thinking sustains a healthy democracy; (2) Practical Approaches for Developing Critical Thinkers, including effective strategies for facilitating critical thinking, helping others examine the assumptions underlying their thoughts and actions, and techniques for developing alternative ways of thinking; and (3) Helping Adults Learn to Think Critically in Different Arenas of Life, including using the workplace as a resource for thinking and learning, analyzing political issues and commitments, developing critical judgments about television reporting, encouraging active learning through personal relationships, and being a skilled facilitator of critical thinking. An epilogue addresses the risks and rewards of helping others learn to think critically. 400 references. (LB)

Source: eric.ed.gov ED294480

1. Scientific Investigation Critical Thinking Indicators

Brainstorming Challenges assumptions Creates analogies or metaphors Differentiates between fact and opinion Recognizes more than one point of view Makes connections with prior learning experiences Makes connections between shared ideas Respectfully reflects on others’ ideas Distinguishes between measurable and nonmeasurable questions Constructs/formulates a measurable question or a purpose/problem Composes a purpose/problem from the selected measurable question Research Formulates reasonable questions related to the problem Locates information from a variety of resources Identifies and seeks additional materials Reads to find additional information related to an investigation Engages in self-directed research investigations Expresses interest in replicating the investigations of others Summarizes information to demonstrate understanding of facts Hypothesis Selects a plausible and measurable solution based on information gathered from research Procedure Designs a measurable test of the selected hypothesis Breaks down test into steps which can be sequenced Sequences steps Adjusts steps when necessary Rewrites steps to clarify Materials Compiles a list of all materials necessary to conduct the test Verifies and acquires necessary materials Modifies list of materials as adjustments are made in procedural steps Results Performs test(s) following the steps of the procedure Makes observations carefully, using all senses Gathers data in an organized manner Records data accurately in a written log Makes diagrams or photographs during the test Summarizes the data written form Chooses an appropriate graphic representation of the data collected Analyzes data Communicates results accurately to an audience Generalizes results to other investigations or applications Clarifies results when necessary Conclusions Evaluates the analysis of the data Judges data to assess whether it supports the hypothesis or not Draws conclusions in written form   Extensions

Interprets data when hypothesis is not supported by the conclusion and attempts to explain the reason for the failed hypothesis Redesigns procedures based on interpretation of test results Applies results to other learning opportunities Reflects on investigation and poses other relevant questions to be investigated Reflects on investigation and formulates a new purpose/problem that probes more deeply into the topic Creates variation(s) on the original problem Suggestions for Effective Use of Scientific Investigation Critical Thinking Indicators Input the indicators into a spreadsheet program and evaluate one investigation process (ex. brainstorming) at a time. Input the indicators into a spreadsheet program and evaluate students’ skills throughout the marking period and note the dates each indicator was investigated. Enlarge the list of indicators and attach it to a chart. Jot down student’s name and place a sticker next to each critical thinking indicator attained throughout the investigation, grading period, or year. Print out the entire list of  Scientific Investigation Critical Thinking Indicators  and highlight only those deemed appropriate for your classroom use. Generate a page of the selected indicators to be placed in the student’s science log for referencing during investigations. This page sets the standard that will be expected in future investigations and provides easy access to reference when in parent or student conferences.

Source: https://web.archive.org/web/20111022223414/http://scifiles.larc.nasa.gov/text/educators/tools/eval/sci_critical.html

2. A consensus statement on critical thinking in nursing.

Scheffer BK ,  Rubenfeld MG .

Department of Nursing Education, Eastern Michigan University, Ypsilanti 48197, USA.

The purpose of this study was to define critical thinking in nursing. A Delphi technique with 5 rounds of input was used to achieve this purpose. An international panel of expert nurses from nine countries: Brazil, Canada, England, Iceland, Japan, Korea, Netherlands, Thailand, and 23 states in the U.S. participated in this study between 1995 and 1998. A consensus definition (statement) of critical thinking in nursing was achieved. The panel also identified and defined 10 habits of the mind (affective components) and 7 skills (cognitive components) of critical thinking in nursing. The habits of the mind of critical thinking in nursing included: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Skills of critical thinking in nursing included: analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting and transforming knowledge. These findings can be used by practitioners, educators and researchers to advance understanding of the essential role of critical thinking in nursing.

Source: PMID: 11103973 [PubMed – indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/11103973

 3. Critical Thinking: Promoting It in the Classroom

Prepared by: M. Carrol Tama IC Clearinghouse on Reading and Communication Digest #40 The NCTE Committee on Critical Thinking and the Language Arts defines critical thinking as “a process which stresses an attitude of suspended judgment, incorporates logical inquiry and problem solving, and leads to an evaluative decision or action.” In a new monograph copublished by the ERIC Clearinghouse on Reading and Communication Skills, Siegel and Carey (1989) emphasize the roles of signs, reflection, and skepticism in this process. Ennis (1987) suggests that “critical thinking is reasonable, reflective thinking that is focused on deciding what to believe or do.” However defined, critical thinking refers to a way of reasoning that demands adequate support for one’s beliefs and an unwillingness to be persuaded unless the support is forthcoming. Why should we be concerned about critical thinking in our classrooms? Obviously, we want to educate citizens whose decisions and choices will be based on careful, critical thinking. Maintaining the right of free choice itself may depend on the ability to think clearly. Yet, we have been bombarded with a series of national reports which claim that “Johnny can’t think” (Mullis, 1983; Gardner, 1983; Action for Excellence, 1983). All of them call for schools to guide students in developing the higher level thinking skills necessary for an informed society. Skills needed to begin to think about issues and problems do not suddenly appear in our students (Tama, 1986; 1989). Teachers who have attempted to incorporate higher level questioning in their discussions or have administered test items demanding some thought rather than just recall from their students are usually dismayed at the preliminary results. Unless the students have been prepared for the change in expectations, both the students and the teacher are likely to experience frustration. What is needed to cultivate these skills in the classroom? A number of researchers claim that the classroom must nurture an environment providing modeling, rehearsal, and coaching, for students and teachers alike, to develop a capacity for informed judgments (Brown, 1984; Hayes and Alvermann, 1986). TEACHER CHANGE Hayes and Alvermann found that coaching teachers led to significant changes in students’ discussion, including more critical analysis. The supervision model that was used allowed teachers and researchers to meet for preobservation conferences in order to set the purpose for the observation. Then, each teacher’s lessons were videotaped and observers made field notes to supplement the videotape. After the lesson, the researchers met to analyze the tape and notes and to develop strategies for coaching the teachers. In another post-observation meeting, the teachers and supervisors planned future lessons incorporating the changes they felt necessary to promote and improve critical discussion in the classes. Hayes and Alvermann report that this coaching led teachers to acknowledge students’ remarks more frequently and to respond to the students more elaborately. It significantly increased the proportion of text-connected talk students used as support for their ideas and/or as cited sources of their information. In addition, students’ talk became more inferential and analytical. A summary of the literature on the role of “wait time,” (the time a teacher allows for a student to respond as well as the time an instructor waits after a student replies) found that it had an impact on students’ thinking (Tobin, 1987). In this review of studies, Tobin found that those teachers who allowed a 3-5 second pause between the question and response permitted students to produce cognitively complex discourse. Teachers who consciously managed the duration of pauses after their questioning and provided regular intervals of silence during explanation created an environment where thinking was expected and practiced. However, Tobin concludes that “wait time” in and of itself does not insure critical thinking. A curriculum which provides students with the opportunity to develop thinking skills must be in place. Interestingly, Tobin found that high achievers consistently were permitted more wait time than were less skilled students, ndicating that teachers need to monitor and evaluate their own behavior while using such strategies. Finally, teachers need to become more tolerant of “conflict,” or confrontation, in the classroom. They need to raise issues which create dissonance and refrain from expressing their own bias, letting the students debate and resolve problems. Although content area classroom which encourages critical thinking can promote a kind of some psychological discomfort in some students as conflicting accounts of information and ideas are argued and debated, such feelings may motivate them to resolve an issue (Festinger, 1957). They need to get a feel for the debate and the conflict it involves. Isn’t there ample everyday evidence of this: Donahue, Geraldo Rivera, USA Today? Authors like Frager (1984) and Johnson and Johnson (1979) claim that to really engage in critical thinking, students must encounter the dissonance of conflicting ideas. Dissonance, as discussed by Festinger, 1957 promotes a psychological discomfort which occurs in the presence of an inconsistency and motivates students to resolve the issue. To help students develop skills in resolving this dissonance, Frager (1984) offers a model for conducting critical thinking classes and provides samples of popular issues that promote it: for example, banning smoking in public places, the bias infused in some sports accounts, and historical incidents written from both American and Russian perspectives. If teachers feel that their concept of thinking is instructionally useful, if they develop the materials necessary for promoting this thinking, and if they practice the procedures necessary, then the use of critical thinking activities in the classroom will produce positive results. Matthew Lipman (1988) writes, “The improvement of student thinking–from ordinary thinking to good thinking–depends heavily upon students’ ability to identify and cite good reasons for their opinions.” Training students to do critical thinking is not an easy task. Teaching which involves higher level cognitive processes, comprehension, inference, and decision making often proves problematic for students. Such instruction is often associated with delays in the progress of a lesson, with low success and completion rates, and even with direct negotiations by students to alter the demands of work (Doyle, 1985). This negotiation by students is understandable. They have made a career of passive learning. When met by instructional situations in which they may have to use some mental energies, some students resist that intellectual effort. What emerges is what Sizer (1984) calls “conspiracy for the least,” an agreement by the teacher and students to do just enough to get by. Despite the difficulties, many teachers are now promoting critical thinking in the classroom. They are nurturing this change from ordinary thinking to good thinking admirably. They are 1) promoting critical thinking by infusing instruction with opportunities for their students to read widely, to write, and to discuss; 2) frequently using course tasks and assignments to focus on an issue, question, or problem; and 3) promoting metacognitive attention to thinking so that students develop a growing awareness of the relationship of thinking to reading, writing, speaking, and listening. (See Tama, 1989.) Another new ERIC/RCS and NCTE monograph (Neilsen, 1989) echoes similar advice, urging teachers to allow learners to be actively involved in the learning process, to provide consequential contexts for learning, to arrange a supportive learning environment that respects student opinions while giving enough direction to ensure their relevance to a topic, and to provide ample opportunities for learners to collaborate.

Source and Footnotes: http://www.ericdigests.org/pre-9211/critical.htm

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The Value of Critical Thinking in Nursing

• How Nurses Use Critical Thinking
• How to Improve Critical Thinking
• Common Mistakes

Some experts describe a person’s ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as “necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation.”

“This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice,” he says.

How Do Nurses Use Critical Thinking?

Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.

Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:

“Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe.”

The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

“Nurses are at the patient’s bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider,” she explains.

Top 5 Ways Nurses Can Improve Critical Thinking Skills

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills.

In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. “What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?”

Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.

Practice Self-Reflection

Rhoads is an advocate for self-reflection. “Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help.” Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.

It’s important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

Develop a Questioning Mind

McGowan has learned that “critical thinking is a self-driven process. It isn’t something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive.”

To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .

However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient’s care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient’s mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.

Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

• Ask questions.
• Gather information.
• Implement a strategy.
• Evaluate the results.
• Consider another point of view.

These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what’s happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.

“We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care,” he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.

“Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient’s blood pressure because medication administration is a task that must be completed,” Slaughter says. “A nurse employing critical thinking skills would address the low blood pressure, review the patient’s blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld.”

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:

• Learn from their mistakes and the mistakes of other nurses
• Look forward to integrating changes that improve patient care
• Treat each patient interaction as a part of a whole
• Evaluate new events based on past knowledge and adjust decision-making as needed
• Solve problems with their colleagues
• Are self-confident
• Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.

By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient’s cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient’s overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Crystal Slaughter is a core faculty member in Walden University’s RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter’s clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.

Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.

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