CRITICAL THINKING IN

NURSING
Yulius Tiranda, S.Kep., Ns., M.Kep., Ph.D
PSIK, FIKes, IKesT Muhammadiyah Palembang
2022/2023
CONTENT:

1 Definisi Berfikir Kritis

2 Tujuan Berfikir Kritis

3 Model Berfikir Kritis

4
Critical Thinking, Clinical Reasoning, and
Clinical Judgment

5 Personal Critical Thinking Indicators

 Definisi

 Critical thinking ability is highlighted as a key element of

competence for skill development for evidence-based practice
and learning to grow as a nurse and to undertake research.
 The ‘critical’ element is at the core of the stronger focus on
thinking skills and attitudes that support the nursing process
and nursing practice (Kusumi, 2015).
 Critical thinking is defined as “...reflective and reasonable
thinking that is focused on deciding what to believe or do
(Eniss, 1985).”
 Critical thinking is a complex process in any
circumstance and there are no right definitions
(Alfaro-LaFevre, 2017).
 The standards of the American Nurses Association (ANA,
2015) describe a competent level of nursing care within
the nursing process as demonstrative of critical thinking
model.
 The nursing process includes the components of
assessment, diagnosis, outcomes identification,
planning, implementation, and evaluation.
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Critical thinking doesn’t mean

simply being critical.
It means not accepting information
at face value without carefully
evaluating it
  Critical thinking is relevant to nursing
practice and can be used when situations
or problems arise whereby there is no
definitive answer or make it easier to find
To deal effectively with solutions.
 There is not always theoretical evidence
rapid change nurses
to support practice, therefore, nursing
need to become needs to incorporate into its practise
skilled in higher-level critical thinking processes to provide new
thinking and reasoning answers to practical questions, which
may not be answered with traditional
research methods.
 Nurses needs to be able to come up with
solutions, make decisions, solve unique
and complex problems.
Critical Thinking vs
Clinical Reasoning vs
Clinical Judgement
Critical Thinking vs Clinical Reasoning vs Clinical Judgement
Critical thinking is a cognitive
process used to analyze
empirics. It is knowledge based
and is not dependent on the
situation at hand, but rather
on the knowledge about the
subject that the nurse
possesses.
The process of critical thinking is
based on evidence and science
rather than ‘‘assumptions and/or
conjectures”
Simpson and Courtney’s analysis
of critical thinking laid the ground
work for the concept of clinical
reasoning.
Kuiper and Pesut noted that
critical thinking is one of the key
factors in the cognitive processes
of clinical reasoning.
Jones defines clinical reasoning
as a cognitive process used by
healthcare practitioners to
address patient issues.
Clinical reasoning requires both
a background of scientific
knowledge and a general case or
a particular instance in which to
apply this knowledge.
Alfaro-LeFevre emphasized the
imperativeness of developing
both critical thinking and clinical
reasoning skills in order to
practice sound clinical
judgment.
Clinical judgment is the
application of critical thinking in
clinical practice.
Tanner defines clinical judgment
as ‘‘an interpretation or
conclusion about a patient’s
needs, concerns, or health
problems, and/or the decision
to take action (or not), use or
modify standard
approaches, or improvise new
ones as deemed appropriate by
the patient’s response.
The terms critical thinking, clinical reasoning, and clinical judgment
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are interrelated concepts. Each represents an important set of
processes leading the nurse to sound, evidence-based practice.

Critical • Critical thinking can be measured through valid and reliable standardized
Thinking examinations not specific to the discipline of nursing

• Clinical reasoning is a necessary cognitive and metacognitive component of clinical

Clinical judgment in nursing.
• Clinical reasoning can be developed within the practice of nursing through the use of
Reasoning decision trees and algorithms,8 thinking aloud,9 and reflective journaling

• Clinical judgment in nursing is the cognitive, psychomotor, and affective processes

Clinical demonstrated through action and behaviors within the 4 phases of clinical
Judgement judgment: noticing, interpreting, responding, and reflecting
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The Purpose of Critical Thinking

Critical thinking involves the differentiation

of statements of fact, judgment, and opinion.
The process of critical thinking requires the
nurse to think creatively, use reflection, and
engage in analytical thinking
(Alfaro-LeFevre, 2013).
Develop Ability to Think Critically

1. Develop a critical thinking character. Hold yourself to high

standards. Make
a commitment to developing critical thinking characteristics such
as; honesty, fair- mindedness, creativity, patience, and confidence.
2. Take responsibility and seek out learning experiences to help you
get the theoretical and experiential knowledge to think critically.
Practice intellectual skills such as assessing systematically
and comprehensively. Just as practicing physical skills
improves your ability to perform physically, practicing thinking
skills improves your ability to perform intellectually.
3. Gain interpersonal skills such as teamwork, resolving conflict, and
being an advocate. Keep in mind that “being too nice” Alfaro-LeFevre’s 4-Circle Critical
problems (e.g., not giving constructive criticism because of Thinking Model (2014).
concerns of not offending someone) can be as bad as “not being
very nice” problems (e.g., demonstrating arrogance, sarcasm, and
or intolerance of other ways of doing things). Learn how to
give and take feedback. To improve you must get through the
negative aspects of criticism.
4. Practice related technical skills (e.g., using computers, managing
IV’s). Until these skills become like second natures, they create a
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HOW OTHER AUTHORS DESCRIBE CRITICAL
THINKING TRAITS

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 Technique in Critical Thinking
1-Critical analysis:
menggunakan serangkaian pertanyaan terhadap situasi tertentu atau
gagasan untuk menentukan apakah situasi atau gagasan itu penting
atau di uang karena tidak berguna.

2-Inductive and deductive reasoning:

 Inductive reasoning= generalizations are formed from a set of
facts or observations (seperti konsep kebutuhan Activity Daily
Living terdiri dari personal hygiene, ganti pakaian, mobilisasi,
dll)
 Deductive reasoning= reasoning from the general to the specific
3-Statements differentiation:

4-Evaluating the credibility of information sources:

is an important step in critical thinking. We cannot always believe what
we read or are told.
The nurse must ascertain the accuracy of information by checking other
documents or with other informants. Hence, the expanding need for
evidence-based nursing practice.
5-Clarifying concepts:
To comprehend a client situation clearly, the nurse and the client must
agree on the meaning of terms.
For example, if the clients says to the nurse “I think I have a tumor,” the
nurse needs to clarify what the word means to the client—the medical
definition of a tumor (a solid mass) or the common lay meaning of
cancer—before responding.

6-Recognizing assumptions:
People also live their lives under certain assumptions. Some people
view humans as having a basically generous nature, whereas others
believe that the human tendency is to act in their own best interest.
The nurse may believe that life should be considered worth living no
matter what the condition, whereas the client may believe that quality
of life is more important than quantity of life.
 If the nurse and client recognize that they make choices based on
these assumptions, they can still work together toward an acceptable
plan of care.
Applying Critical Thinking
To Nursing Practice
Applying Critical Thinking to Nursing Practice

 Implementation of the nursing process provides nurses

with a creative approach to thinking and doing to obtain,
categorize, and analyze client data and plan actions that
will meet the client’s needs.
 Nursing process: is a systematic, rational method of
planning and providing individualized nursing care.
 It begins with assessment of the client and use of clinical
reasoning to identify client problems.
 The phases of the nursing process are assessing,
diagnosing, planning, implementing, and evaluating
Problem Solving
is a mental activity in which a problem is identified that represents an unsteady
state. It requires the nurse to obtain information that clarifies the nature of the
problem and suggests possible solutions. Throughout the problem-solving
process the implementation of critical thought may or may not be required in
working toward a solution.
The nurse carefully evaluates the possible solutions and chooses the best one
to implement. The situation is carefully monitored over time to ensure that its
initial and continued effectiveness returns the client to a steady state.
Trial and Error
 One way to solve problems is through trial and error, in which a number of
approaches are tried until a solution is found. However, without considering
alternatives systematically, one cannot know why the solution works.
 The use of trial-and-error methods in nursing care can be dangerous because the
client might suffer harm if an approach is inappropriate. However, nurses often use
trial and error in the home setting due to logistics, equipment, and client lifestyle.
 For example, when teaching a client to perform a colostomy irrigation, a bent coat
hanger hung on the shower curtain rod provides an appropriate height to perform
the irrigation. In the hospital setting a lowered intravenous (IV) pole is more likely
utilized.
Intuition
 Intuition is the perception and understanding of concepts without the
conscious use of reasoning. As a problem solving approach, as it is
considered by many, is a form of guessing and therefore is characterized as
an inappropriate basis for nursing decisions. But others see it as important
and legitimate aspect of the crisis gained through knowledge and
experience.
 Although the intuitive method of problem solving is gaining recognition as
part of nursing practice, it is not recommended for novices or students,
because they usually lack the knowledge base and clinical experience on
which to make a valid judgment.
Sikap yang Meningkatkan Kemampuan
Berpikir Kritis

Perawat ketika berhadapan dengan seorang klien, ia akan bertindak

sesuai dengan performa keperawatan yaitu proses keperawatan.
Di saat proses keperawatan itu berlangsung kemampuan berpikir
kompleks dari pengumpulan data atau pengkajian mensintesa data
atau membuat diagnosa, kemudian merencanakan tindakan
keperawatan selanjutnya melakukan tindakan keperawatan serta
mengevaluasi seluruh tindakan dan respons yang muncul dari klien.
Kozier, et al (2010), menerangkan orang yang selalu berpikir
kritis berupaya membentuk sikap sebagai berikut;
 Kemandirian berpikir,
 Berorientasi keadilan,
 Pemahaman terhadap egosentrisitas dan sosiosentrisitas,
 Kerendahan hati intelektual dan penundaan penilaian,
 Keberanian intelektual,
 Integritas,
 Ketekunan,
 Percaya kepada logika,
 Berminat menggali pikiran yang melandasi perasaan dan
 Perasaan yang melandasi pikiran, dan keingintahuan.
Keputusan Klinis dalam Praktik Keperawatan

Kegiatan berpikir kritis yang terstruktur untuk menyelesaikan

masalah merupakan cara terbaik untuk membuat
keputusan yang berkualitas, fokus pada pembuktian dan
mengaplikasikan model teori dalam menyelesaikan
masalah dan pengambilan keputusan.

Perawat mengambil keputusan dalam proses pemecahan

masalah pada setiap langkah proses keperawatan. Perawat
melalui proses berpikir kritis akan memilih tindakan terbaik
guna mencapai tujuan yang diharapkan.
Ketika perawat dihadapkan pada beberapa kebutuhan pada saat yang sama, ada
urutan langkah pengambilan keputusan:
1. Identifikasi tujuan, perawat mengidentifikasi mengapa keputusan perlu diambil
dan kebutuhan yang perlu ditentukan.
2. Tetapkan kriteria, tetapkan kriteria hasil yang diharapkan, dipertahankan atau
dihindari.
3. Timbang kriteria, pada tahap ini perawat menetapkan prioritas atau
mengurutkan aktivitas, dari yang terpenting sampai tidak.
4. Cari alternatif, untuk mengidentifikasi semua cara yang mungkin dilakukan
untuk memenuhi kriteria tersebut.
5. Kaji alternatif, perawat menganalisis alternatif untuk memastikan bahwa ada
penjelasan rasional objektif terkait kriteria yang ditetapkan
dibandingkan strategi lain.
6. Proyeksikan, perawat memakai pemikiran kreatif dan skeptis untuk
menentukan konsekuensi negatif yang mungkin terjadi, menyusun rencana
untuk mencegah, meminimalkan atau mengatasi semua masalah.
7. Implementasikan
8. Evaluasi hasil
Proses Keperawatan
Pengkajian
 Pengkajian adalah proses pengumpulan data klien secara
sistematis untuk menentukan status kesehatan dan
fungsional klien pada saat ini dan waktu sebelumnya,
juga untuk menentukan pola respons klien saat ini dan
sebelumnya.
 KARS (2017) mewajibkan rumah sakit dalam standar
mutunya untuk melakukan pengkajian awal keperawatan
terdiri dari riwayat kesehatan dan pemeriksaan fisik telah
dilakukan dan terdokumentasi dalam 24 jam masuk rumah
sakit sebagai pasien rawat inap.
 Pengkajian keperawatan mencakup empat aktivitas yang
berhubungan erat, yaitu 1) Pengumpulan data, 2)
Pengaturan data, 3) Validasi data dan 4)
Diagnosis Keperawatan
Potter dan Perry (2009); NANDA (2018) menerangkan
diagnosa keperawatan di tetapkan dari hasil analisis dan
respons klien terhadap hasil pengkajian yang telah
didapatkan.
Diagnosa keperawatan merupakan penilaian klinis tentang
respons manusia terhadap gangguan kesehatan atau proses
kehidupan atau kerentanan dari seorang individu, keluarga,
kelompok, atau masyarakat.
Rencana Asuhan Keperawatan
Perencanaan adalah proses keperawatan yang penuh
pertimbangan dan sistematis, mencakup pembuatan
keputusan dan penyelesaian masalah.
Kegiatan perencanaan keperawatan meliputi:
a. Memprioritaskan masalah/diagnosa,
b. Merumuskan tujuan,
c. Memilih intervensi keperawatan dan menulis program
keperawatan (Kozier, et al, 2010).
Implementasi dan Evaluasi
 Proses keperawatan berorientasi pada tindakan, setelah
dilakukan pengkajian, menegakkan diagnosa,
menyusun rencana keperawatan.
 Mengevaluasi hasil dari tindakan keperawatan, rencana
dapat dilanjutkan, dimodifikasi atau diakhiri.
 Kegiatan implementasi meliputi mengkaji kembali klien
sebelum tindakan, menentukan kebutuhan perawat
terhadap bantuan, mengimplementasikan intervensi
keperawatan, melakukan supervisi terhadap asuhan
yang didelegasikan, mendokumentasikan tindakan
keperawatan.
Dokumentasi

 Dokumentasi asuhan bertujuan sebagai sarana

komunikasi berbagai profesional kesehatan untuk
mencegah fragmentasi, repetisi dan keterlambatan
dalam perawatan.
 Dokumentasi juga bertujuan untuk merencanakan
asuhan, sebagai audit institusi kesehatan, untuk
penelitian dan pendidikan, dokumentasi yang sah,
analisis. layanan kesehatan dan penggantian
pembayaran.
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Thank you