CRITICAL THINKING IN NURSING PRACTICE everything you remember about it.

• Critical thinking- the ability to think in a

This reflection allows you to gain new
systematic and logical manner with
knowledge and raise questions about your
openness to question and reflect on the
practice, which can lead to a search for better
reasoning process.
approaches using evidence for practice (Barksby
• Clinical reasoning- is the cognitive et al., 2015)
process that uses thinking strategies to
Three Levels of Critical Thinking in Nursing
gather and analyze client information,
evaluate the relevance of the 1. Basic Critical Thinking- is an early step in
information, and decide on possible developing reasons (Kataoka-Yahiro and
nursing actions to improve the client’s Saylor, 1994)
physiological and psychosocial
outcomes. • Beginning nursing students are task
oriented as they focus on performing
• It involves open-mindedness, continual skills and organizing nursing care
inquiry, and perseverance, combined activities. At the basic level of critical
with a willingness to look at each thinking a learner trusts that experts
unique patient situation and determine have the right answers to every
which identified assumptions are true problem.
and relevant.
• A basic critical thinker learns to accept
• A critical thinker considers what is diverse opinions and values of experts.
important in each clinical situation,
images and explores alternatives, 2. Complex Critical Thinking- thinkers begin to
considers ethical principles, and makes rely less on experts and trust their own
informed decisions about the care of decisions more.
patients. • Critical thinking combined with
• The aim of critical thinking is the ability creativity allows nurses to become more
to focus on the important issues at hand flexible and find original solutions to
in any clinical situation and make specific problems when traditional
decisions that produce desired interventions are not effective
outcomes (Raterink, 2011). (Papathanasiou et al., 2014)

Reflection- part of critical thinking that involves 3. Commitment- at this level you anticipate
purposefully reviewing a situation to discover its when to make choices without assistance from
purpose or meaning. others and accept accountability for decisions
made.
As you care for patients, you will often review • At the commitment level you choose an
your practice experiences to describe, analyze, action or belief that is based on the
and evaluate results (Barksby et al., 2015) available alternatives and support it.

reflection is like instant replay. It is not intuitive. Critical Thinking Competencies

It involves purposefully visualizing a past
• Critical Thinking Competencies are the
situation and taking the time to honestly review
cognitive processes a nurse uses to
 make judgment about the clinical care • Decision making- when
of patients (Kataoka-Yahiro and Saylor, you face a problem and
1994) choose a course of
actions from several
• These include the general critical
options, you are making
thinking, specific critical thinking in
a decision.
clinical situations, and specific critical
thinking in nursing. • Specific Critical Thinking

• General critical thinking • Diagnostic Reasoning- involves

being able to understand and
• Scientific method- is a
think through clinical problems,
methodical way to solve
look for clues, understand the
problems using reasoning. It is a
meaning of evidence, and know
systematic, ordered approach to
when there is enough
gather data and solve problems.
information to make an
• Use scientific method accurate diagnosis, consider
when testing research different causes of the problem,
questions. Five steps and the select interventions
that best meet the needs of a
• Identify the patient (Resnick, 2016;
problem Croskerry and Nimmo, 2011).
• Collect data • Clinical Decision Making- when
• Formulate a you face a clinical problem or
questions or situation with a patient and
hypothesis need to choose of action from
several options, you are making
• Test the a clinical decision making.
question or
hypothesis • Effective clinical decision
making requires inductive and
• Evaluate results deductive reasoning and
of the test or making valid inferences.
study
• Inductive reasoning-
• Problem Solving- moves from reviewing
effective problem specific date elements
solving requires one to to making an inference
obtain information that by forming a conclusion
clarifies the nature of a about the related
problem, suggest pieces of evidence.
possible solutions, and
try the solution over • Deductive reasoning-
time to make sure it is moves from the general
effective. to the specific.
 • Skilled clinical decision making • Reflective Journaling- is a tool for
occurs through knowing the developing critical thought and
patient. reflection by clarifying concepts
(Raterink, 2016)

• Meeting with Colleagues- a way to

Nursing process competency
develop critical thinking skills is to
• Nurses apply the nursing process as a regularly meet with colleagues to
competency when delivering patient discuss and examine work experiences
care (Kataoka-Yahiro and Saylor, 1994). and validate decisions.

• The ANA 2010 provide the framework • Concept Mapping- is a visual

necessary for critical thinking in the representation of patient problems and
application of the five step of nursing interventions that shows their
process. relationships to one another.

• The purpose of the nursing process is to

diagnose and treat human responses
(e.g., patient symptoms, need for
knowledge) to actual or potential health
problems.

Five elements of Critical thinking model for

clinical decision making

1. Competence

2. Specific Knowledge Base

3. Experience

4. The Nursing Process Competency

5. Attitudes for Critical Thinking

6. Standards for Critical Thinking

• Intellectual Standards

• Professional Standards

PRINCIPLES IN Developing critical

thinking skills