helps you to think critically.

1. Critical Thinking in Nursing
Prepared By:
Mrs. Babitha K Devu
Asstt. Professor
SMVDCoN
Katra.
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2. Intoduction
The principal goal of education is to create men
and women . . .who have minds which can be
critical, can verify, and not accept everything
they are offered.
-Jean Piaget
Nursing Education views or requires critical
thinking as an educational outcome. As a result
of this outcome or evaluation there is new
thinking or new processes or new ideas.
2Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

3. Objectives
 Describe the concept & skills of critical
thinking used in nursing practice.
 Sate the aspects of critical thinking.
 Discuss the critical thinking model.
 Explain the levels of critical thinking.
 Elaborate the various components of
critical thinking.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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4. Contin…
When caring for patients, you are responsible for
making accurate and appropriate clinical
decisions. Clinical decision making is a skill
that separates professional nurses from
nursing assistive personnel.
To help patients’ maintain, regain, or improve
their health you must think critically to problem
solve & find solutions for patients’ health
problems.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
4

5. Definitions
 Nursing is the unique function of the nurse
is to assist the individual, sick or well, in the
performance of those activities contributing
to their health or its recovery (or to peaceful
death) that he/she would perform unaided
if he had the necessary strength, will, or
knowledge, and to do this in such a way as
to help him/her gain independence as
rapidly as possible.
5Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

6. Definitions Contin…..
 Critical thinking is an active, organized,
cognitive process used to carefully
examine one’s thinking and the thinking of
others. - Chaffee (2002)
 It is the classic description, “reasonable
reflective thinking that is focused on
deciding what to believe or do.”
- Ennis’(1987)
6Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

7. 7Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

8. Why do we need to think critically?
Need to make accurate and appropriate
clinical decisions
Need to solve problems and find solutions
Need to plan care for each unique client
and client problem
Need to seek knowledge and use it to
make clinical decisions and problem solve
Need to be able to think creatively when
planning care for clients
8Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

9. Critical Thinking Skills
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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Inference
Critical Thinking Skills

10. Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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Concepts For A Critical Thinker

11. Aspects of Critical Thinking
To develop into an expert critical thinker the
nurse needs to use:
 Reflection
 Language
 Intuition
11Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

12. Reflection
Purposefully thinking back or recalling a situation
to discover its purpose or meaning. Looking
back and reflecting on a client situation helps
the nurse to have insight and meaning in the
situation.
It helps a nurse to seek & understand the
relationships between concepts learned in
class & real-life clinical situations.
12Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

13. Reflection is different for each individual.
Learning to be reflective takes practice
because it involves connecting clinical content
with thought processes & self awareness.
13Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
Reflection allows the nurse to look at a
situation honestly and do some self evaluation of
the situation, What was said and how did I
respond, How did the patient respond when I did
the teaching or the discharge instructions. How
did the family reacted, etc.

14. Language
The ability to use language and express yourself is a
reflection of the ability to think meaningfully.
Nurses must be able to use language effectively
(clearly and precisely). When language is not well
developed and the spoken word is not clear and
distinct it is a sign of sloppy thinking.
We must communicate (speak) clearly and distinctly
with all of those around us, peers, nurses, patients
and families. To critically think you must be able to
organize and focus your own thoughts.
14Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

15. Intuition
It is an inner sensing or gut feeling that something is so
about a situation. It acts as a trigger, leading the nurse
to consciously search for data that confirm the sense of
a change in a patients’ status.
This ability to have intuition about clients come with time
and experience. Book points out that intuition can be
the spark that starts the flame of analytical thinking.
Trust your intuition as a red flag that something is not
quite right, but do not take your intuition as an
automatic fact. Always combine intuition with objective,
scientific evidence.
15Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

16. THINKING & LEARINING
Learning is a life long process. Intellectual
& emotional growth involves gaining new
knowledge & refining the ability to think,
problem solve, & make judgments.
Thinking about your practice as a nurse
requires vigilance, which involves
remaining alert & attentive to whatever
activity or task you are conducting.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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17. CRITICAL THINKING MODEL
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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18. Contin..
As critical thinking is a complex, a model helps
explain what is involved. Kataoka – Yahiro
and Saylor (1994) developed a model of
critical thinking for nursing judgement based in
part on previous work by others. The model
defines the outcome of critical thinking:
nursing judgement that is relevant to nursing
problems in a variety of settings.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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19. Levels of Critical Thinking
Kataoka-Yahiro and Saylor (1994)
developed a critical thinking model:
Basic Critical Thinking
Complex Critical Thinking
Commitment
19Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

20. Basic critical thinking
 Here learner is still trusting that the experts have the
answer to every problem and situation. Thinking is
concrete and based on book, principles, rules,
policies (whatever they can read or hear about). Lots
of the students follow the procedure step by step
without adjusting to meet the need of patient’s. At
this point there is very limited ability to think
critically, resources include instructors, books, other
nurses.
 Caution- Don’t let relying on resources because limit
ability to grow, use experiences, practice, and
knowledge to grow to next level of thinking.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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21. Complex Critical thinking
 As people grow and become more independent thinkers
the level of critical thinking will grow. Slowly will rely
less on their resource people and think before asking
them, come up with the answers themselves. As growth
occurs there is a realization that there can be more
than one alternative and perhaps solution. As nurses
begin to think in more complex ways they look at a
problem from many more angles and start weighing the
risks and benefits of each decision/ solution. They start
developing the ability to be creative, to think out of or
will be more willing to consider deviations from
standard protocols or procedures & to provide more
individualized care.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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22. Commitment
 The nurse starts anticipating patient needs
independently. A nurse does more than consider
the complex alternatives a problem poses. At this
level, the nurse makes a decision based on
alternatives and then stands by the decision.
The nurse assumes accountability/
responsibility for the decision and evaluates that
decision.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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23. Critical Thinking Components
 The model helps to explain how nurses make
clinical judgments/ decisions in their clinical
practice that result in safe, effective, nursing care.
There are 5 components in this model of critical
thinking:
 Knowledge base
 Experience in nursing
 Critical thinking competencies
 Attitudes for critical thinking
 Standards for critical thinking
23Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

24. Specific Knowledge Base
 Varies according to your educational experience.
 Reading the nursing literature to remain current in
nursing science.
 Use your knowledge base in a different way from
other health care professionals in regard to how
you think about patients problems.
 It gives you a holistic view of patients and their
health care needs.
 The depth & extent of knowledge influence your
ability to think critically.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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25. Experience In Nursing
 Nursing is a practical discipline.
 Clinical learning experiences are necessary for you to
acquire clinical decision making skills.
 Unless nurse has had the opportunity to practice and make
decisions about client care, critical thinking skills will not
develop.
 In practice the nurse learns from observing, practicing,
talking with clients, families, peers, and then reflecting
actively on your experiences alone & with faculty & fellow
students. Book reminds us that the clinical experience is
the laboratory for testing nursing knowledge.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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26. CRITICAL THINKING COMPETENCIES
It is the cognitive processes a nurse uses
to make judgements about patient’s
clinical care. There are three
competencies:
 General critical thinking
 Specific critical thinking in clinical
situations
 Specific critical thinking in nursing
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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27. Contin..
General critical thinking competencies are
not unique to the nursing profession. They
include:
 Scientific method
 Problem solving
 Decision making
27Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

28.  Scientific Method:
Is a way to solve problems using reasoning. It is the
systematic, ordered approach to gathering data and
solving problems. It is the foundation for research in
nursing practice. The steps are:
 Problem identification
 Collection of data
 Formulation of a question or hypothesis
 Testing the question or hypothesis
 Evaluating results of the study
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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29. Problem Solving
 It represents a higher level of cognitive
function. A systematic approach to problem
solving makes it more likely that you will find
an appropriate solution. Effective problem
solving involves evaluating the solution over
time to be sure that it is still effective.
 Having solved a problem in a situation adds to
your experiences in your practice and allow
you to apply that knowledge in future.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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30.  Decision Making
When you face a problem or situation and choose a
course of action from several options, you are
making a decision. Decision making focuses on
resolving a problem. Following a set of criteria
helps you to make a thorough and thoughtful
decision.
Decision making is an end point of critical thinking.
The pros/ cons or risks/benefits of each option
is weighed to make a final decision. If time is
taken to weigh each option appropriately then a
well informed decision will be the result.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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31. Contin..
 Specific critical thinking in clinical
situations used by physicians, nurses, and other
health care professionals.
 Diagnostic reasoning/Clinical inference
 Clinical decision making
31Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

32.  Diagnostic reasoning
It is a process of determining a client’s health status
after gathering data and making a clinical
judgment. Part of the process involves making
inferences given data such as s/s, lab data,
behaviours (Inference is the process of drawing
conclusions given related pieces of information or
data).
It involves the use of cognitive thinking, metacognition
(thinking about thinking), & assessment skills to
structure situations so you can apply knowledge.
Expert nurses make diagnostic conclusion in the
form of nursing diagnoses.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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33.  Clinical Inference
It is a skill in which you make tentative
conclusions based on observed data or
cues existing in patient situations. Your
ability to make clinical inference will lead
you to forming nursing diagnosis.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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34. Clinical Decision Making
 It is a problem solving activity that focuses on
selecting appropriate treatment after forming
diagnostic conclusions.
 Nurses make clinical decisions all the time in
an attempt to improve a patient’s health or to
maintain wellness.
 It requires careful reasoning so that you
choose the options for the best patient
outcomes on the basis of the patient’s
condition & priority of the problem.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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35. Contin.
 Over time, a combination of experience, time spent in
a specific clinical area, and the quality of
relationships formed with patients allow nurses to
know clinical situations and to quickly anticipate and
select the right course of action.
 When you care for several patients at one time, you
will need to use decision-making criteria. These
criteria include the clinical conditions of the patients,
Maslow’s hierarchy of needs, risk involved in
treatment delays, & the patient’s expectations of care
to determine which patient’s have the greatest
priorities of care.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
35

36. Contin..
Specific critical thinking competency
used in nursing practice is the
 Nursing Process
 Assessment
 Analysis (Nursing Diagnosis)
 Planning
 Implementation
 Evaluation
36Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

37. Paul (1993) identifies 11 attitudes that are
central features of a critical thinker.
37Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.

38. Contin..
 These attitudes defines how a successful
critical thinker approaches a problem.
 They are the guidelines for how to solve a
problem or make a decision.
 You must have a cognitive skills to think
critically, but is also important to use these
skills fairly and responsibly.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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39. Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
39
To be confident is to feel certain in your ability to
accomplish a task or goal, such as performing a
nursing procedure or making a nursing diagnosis. It
grows with experience in recognizing your strengths
and weakness. Confidence is not a feeling of
superiority, instead it is a balance between what we
know & don't know. Confidence builds trust & conveys
a sense of caring.
Application: speak with conviction when you begin with
any care. Don't let your patient think that you are not
sure. Always be prepared.

40. Thinking Independently
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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When thinking independently, you challenge the ways others
think & look for rational & logical answers to problems. An
independent thinker applies EBP when facing clinical
decisions & is essential to the improvement & expansion of
nursing knowledge & practice.

41. Fairness
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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 Deal situation in a just manner.
 Bias or prejudice does not enter into a
decision.
 Having a sense of imagination aids in the
development of fairness. Imagining what is
likely to be in the situation helps you to see
situations with new eyes and appreciate their
complexity.
 Listen to both sides in any discussion.

42. Responsibility & Accountability
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
42

43.  Risk taking is desirable, particularly when the result
is a positive outcome.
 Should be willing to take risks in trying different ways
to solve problems.
 Willingness comes with experience with similar
problems.
 In nursing, risk taking result in patient care
innovations.
 Nurses in the past has taken the risk as a result now
more effective interventions we are using.Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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44. Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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 A disciplined thinker misses few details and follows
an orderly approach when making decisions.
 Being disciplined will help you to select more
appropriate nursing interventions.
 It does not lessen your creativity but instead
ensures that your decision making is systematic,
accurate and comprehensive.

45.  A critical thinker who perseveres is
not satisfied with minimal effort, but
constantly tries to achieve the
highest level of quality care.
 Be wary of an easy answer.
 Perseverance is important when
problems remain unresolved or
when they reoccur.
 Perseverance means to continue to
seek additional resources until you
find a successful approach.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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46.  It involves original thinking and is a great
motivator that helps you to think of options
and unique approaches.
 Find solutions outside of the standard
routines of care.
 Look for different approaches if
interventions are not working.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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47. Curiosity
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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48. Integrity
 Integrity is doing the right thing even when no
one is watching.
 Integrity is choosing your thoughts and actions
based on values rather than personal gain.
 A person of integrity is honest and willing to
admit to any mistakes or inconsistencies in his
or her own behaviour, ideas and beliefs.
 To be a strong professional you must follow
high practice standards even in difficult times.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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49. Humility
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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 Admit your limitations. It is very common for you to be an
expert in one area of clinical practice but novice is another
area. Patient is at risk if you cannot admit your inability.

50. Standards For Critical Thinking
The 5th component of the critical thinking model includes
standards and is identified by Paul (1993) consist of two types
of standards, namely:
Intellectual Standards Professional Standards
1. Ethical criteria for nursing
judgement
2. Criteria for evaluation
3. Professional Responsibility
50Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
Clarity Accuracy
Relevance Logicalness
Breadth Precision
Significance Completeness
Fairness Depth
Specific Plausible
Consistent Adequacy

51. Contin..
Intellectual Standards
An intellectual standard is a guideline or principle for
rational thought. When you consider a clinical
situation, it is important to apply the standards to
make sure that clinical decisions are just.
The use of intellectual standards involves a rigorous
approach to clinical practice & demonstrates that
critical thinking is not random.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
51

52. Contin..
 Clarity
Could you elaborate further?
Could you give me an example?
Could you illustrate what you mean?
 Accuracy
How could we check on that?
How could we find out if that is true?
How could we verify or test that?
 Precision
Could you be more specific?
Could you give me more details?
Could you be more exact?
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
52

53. Contin..
 Relevance
How does that relate to the problem?
How does that bear on the question?
How does that help us with the issue?
 Depth
What factors make this a difficult problem?
What are some of the complexities of this question?
What are some of the difficulties we need to deal with?
 Breadth
Do we need to look at this from another perspective?
Do we need to consider another point of view?
Do we need to look at this in other ways?
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
53

54. Contin..
 Logic
Does all this make sense together?
Does your first paragraph fit in with your last?
Does what you say follow from the evidence?
 Significance
Is this the most important problem to consider?
Is this the central idea to focus on?
Which of these facts are most important?
 Fairness
Do I have any vested interest in this issue?
Am I sympathetically representing the viewpoints
of others?
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
54

55. Contin..
 Specific
Was it clearly defined or identified?
Was it peculiar or proper to somebody or something?
Was it clearly and exactly presented ?
 Plausible
Does it have an appearance of truth or reason? (credible; believable)
Does it worthy of confidence or trust?
 Consistent
Is this possessing firmness or coherence?
Do I always acting or behaving in the same way & of the same quality?
 Adequacy
Is it sufficient to satisfy a requirement or meet a need.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
55

56. Contin..
Professional Standards
The standards of professional responsibility include
those standards you find from Nurse Practice Acts,
Institutional practice guidelines, polices and
procedures, and professional organizations’
standards of practice. Each institute has its own
manual.
Standards raise the bar for the responsibilities and
accountabilities that a nurse undertakes to
guarantee quality health care to public.
Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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57. Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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58. Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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59. Mrs. Babitha K Devu, Asstt. Professor,
SMVDCoN.
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