The Critical and

Reflective Thinking
Skills
CONTACT HOURS: 6
Purpose
Learner will develop and apply critical thinking skills in provision of
healthcare
Expected Learning Outcomes
Definition
Demonstrate self directed learning
Discuss critical thinking skills
Content to Cover
1. Self-directed learning
2. Critical thinking
3. Reflective thinking
Definition

Critical thinking in nursing is a discipline involving reflective reasoning

process that guides a nurse in generating, implementing and evaluating
approaches to dealing with client care concerns/problems and other
professional concerns.

Critical thinking is “the process of seeking, obtaining, evaluating,

analysing, synthesizing and conceptualizing information as a guide, to
develop self-conscious thinking and the ability to use this information
by adding creativity and taking risks”(Ozkahraman & Yildirim, 2018)
Critical thinking concept
Critical thinking is the art of thinking about your thinking while thinking
about how to make your thinking better.

A critical thinker is a habitually inquisitive, well informed, trustful of reason

and open minded.

Development of a critical thinker in nursing requires time and experience .

This starts once a student joins the nursing school
 Critical Thinking (CT)
concept

CT involves both thinking in action (which occurs while doing)

and reflective thinking (which occurs following doing). It is

reflective thinking that encourages the nurse to think about

practice issues and learning needs, through evaluation of a

practice event.
 Critical thinking concept

CT is linked with professionalism through development of

ethical reasoning.

Ethical reasoning is regarded as a fundamental aspect of

professional behavior.

Ethics is described as the heart of health care and associates

ethical reasoning with ethical behavior and professional
behavior.
4 elements of ethical
reasoning
Beneficence-doing good
Non-maleficence – do no harm
Autonomy – freedom to choose freely when able
Justice- ensuring fairness
Critical thinking concept
Critical thinking is fundamental to the ethics of
professionalism and should become ‘a mindset’
and ‘a habit’ in the context of professional values.
Critical thinking concept
CT in nursing is an essential component of professional
accountability and quality nursing care.

Critical thinkers in nursing exhibit these habits of the mind: -

confidence, contextual perspective, creativity, flexibility,
inquisitiveness, intellectual integrity, intuition, open-
mindedness, perseverance, and reflection.
Critical thinking concept

The development of critical thinking skills is

dependent on opportunities for professional
growth and development.
 THINKING

‘Thinking is hard work that is why so few people do it’ (Henry Ford)

Five modes of thinking in nursing

◦ T –Total recall

◦ H – Habits

◦ I – Inquiry

◦ N – New ideas/creativity

◦ K – Knowing how you think (meta-cognition)

Five modes of thinking in nursing

Total recall (T) means remembering facts or remembering where and

how to find them when they are needed.

Nursing ‘facts’ come from many sources such as: content taught in

class, information in books, those things told to the nurse by patient

or significant other, patient data collected through the senses,

instruments
Five modes of thinking in nursing

Habits (H) are thinking approaches that are repeated so often they
become second nature. They result in accepted ways of doing things
that work, save time, or are necessary.

Habits allow one to do things without having to figure out a new

method each time e.g. fundamental nursing procedures etc.

 In nursing, when actions are first learned (e.g. CPR, giving injections,
taking vitals) they are obviously not yet habits but as they are used
repeatedly, they become habits “doing without thinking”.
Five modes of thinking in nursing

Inquiry (I) means examining issues in depth and questioning those

that may seem immediately obvious.

The process of collecting and analyzing information to confirm or to

make additional conclusions beyond the obvious ones is the essence of
inquiry.

It involves digging and questioning in everything especially one’s own

assumptions in a given situation.
Five modes of thinking in nursing

New Ideas and Creativity (N) New ideas and creativity comprise a
thinking mode that is very special to the individual. This individualized
thinking goes beyond the usual to reconfigure the norm.

 It allows one to go beyond textbook ideas.

In creative thinking, one must be willing to risk looking foolish

occasionally and not fitting the mold (being different from the crowd).
Five modes of thinking in nursing

Knowing How You Think (K) means thinking about one’s thinking.
Thinking about one’s thinking is called “metacognition” ‘meta’ means
‘among or in the midst of’ and ‘cognition’ means ‘the process of
knowing’

Self -reflection helps in exploring how one thinks.

Knowing how you think helps you select the kind of health care setting
that maximizes your thinking or helps you find ways to cope with
environments that hinder your thinking.
Enneagram –personality types
Enneagram helps people understand :
◦ Habits,

◦ relationships,

◦ thought processes etc

 The Nursing Process Applied to
Critical Thinking

The components of critical thinking relate to the problem

solving process and the nursing process.

Certain cognitive or mental activities can be identified as key

components of critical thinking.

When thinking critically, a person will do the following:

use acronym: ADPIE

When thinking critically, a person will do the
following

Ask questions to determine the reason why certain developments have

occurred and to determine any need for more information needed to
understand the situation accurately.
Assessment: Gather as much relevant information as possible to
consider as many factors as possible.
Validate the information presented to make sure that it is accurate, that
it makes sense, and that it is based on fact and evidence.
When thinking critically, a
person will do the following
Analysis and diagnosis: Analyze the information to determine what it
means and to see whether it forms clusters or patterns that point to
certain conclusions.

Draw on past clinical experience and knowledge to explain what is

happening and to anticipate what might happen, acknowledging
personal bias and cultural influences.

Maintain a flexible attitude that allows the facts to guide thinking and
takes into account all possibilities.
When thinking critically, a
person will do the following
Planning: Consider available options and examine each in terms of its
advantages and disadvantages.
Implementation: Formulate decisions that reflect creativity and
independent decision making.
Evaluation: Find out if the implemented plan effectively resolved the
problem and if the decision was successful and what might have made
it better.
Attitudes that foster critical
thinking
Certain habitual dispositions are needed by anyone who wants to be a
critical thinker to include:
Independence
Critical thinking requires that individuals think independently examining
their beliefs in the light of new evidence.
Nurses who are independent thinkers are careful not to allow the status
quo or a persuasive individual to control their thinking.
When confronted with an intellectual challenge, they proceed
cautiously, consulting with the patient and respected colleagues and
reviewing the literature as opposed to making a snap judgment.
Attitudes that foster critical
thinking
Fair-mindedness

Nurses who are fair-minded are open to different points of view and
hear all sides of an argument before making a judgment and they do
not base their judgment on personal bias or prejudice.

 A fair-minded thinker strives to be open to the possibility that new

evidence could change their thinking.
Attitudes that foster critical
thinking
Insight into egocentricity

A critical thinker recognizes the limits of being egocentric and

sociocentric.

They should examine all their bias any time they are required to make
decisions and not allow the personal bias and/or social pressure to
influence their decision making.
 Attitudes that foster critical
thinking
Intellectual humility

This means having an awareness of the limits of one’s own knowledge.

Critical thinkers are willing to admit what they don’t know, seek new
information and reconsider their decisions in light of new knowledge.
Intellectually humble nurses learn all the time, often from patients and their
nonprofessional caregivers, other colleagues, and the media.
Attitudes that foster critical
thinking
Intellectual challenge

Nurses who are intellectually courageous are not afraid to challenge the
status quo and “go against the flow.” This courage comes from
recognizing that beliefs are not always acquired rationally and they can
be sometimes false or misleading.
Attitudes that foster critical
thinking
Integrity-
What you do when no-one is watching/present.

Intellectual integrity requires that individuals apply the same standards

of proof to their own knowledge and beliefs as they do to others.

Commitment to integrity helps the nurses (critical thinkers) remain

sensitive to discrepancies in the way one reasons in different situations
and with different people.
 Attitudes that foster critical thinking
Perseverance and Discipline

Critical thinking is a life- long process so nurses should persevere in finding effective

solutions to client and nursing problems. Confusion and frustration are

uncomfortable but nurses who persevere intellectually resist “easy answers.’’ They

consult wise colleagues and are not afraid of doing the hard work of critical thinking.

Disciplined nurses on the other hand are thorough and take the time necessary to

reach well-reasoned conclusions. When an initial conclusion or judgment does not

“feel right,” they are willing to go back to try to reason out a better judgment .
 Attitudes that foster critical
thinking
Creativity

Thinking critically might mean “thinking outside the box.” The solution to a

challenge might involve resources as yet untapped, effective, and cost-saving

interventions as yet undiscovered and untried.

The process of brainstorming might bring out, along with unworkable options,

one or two realistic suggestions that would not have surfaced otherwise
 Attitudes that foster critical
thinking
Confidence

Critical thinkers belief that well- reasoned thinking will lead to trust worthy
conclusions hence they cultivate an attitude of confidence in their reasoning
process.

Nurses who routinely think critically develop confidence in their judgments and
are not afraid to take and defend a position when challenged by a patient or
colleague.
 What makes the thinking of a nurse
different from a doctor, a dentist, or an
engineer?
It is how nurses view the patient/client and the type of problems nurses deal with
in practice when they engage in patient/client care.

To think like a nurse requires that one learns the content of nursing, the ideas,
concepts & theories of nursing, and develop intellectual capacities and skills so
that they become disciplined, self-directed, critical thinkers.

To develop as a critical thinker, one must be motivated to develop the attitudes

and dispositions (character, nature, temperament) of a fair-minded thinker.
What makes the thinking of a nurse
different from a doctor, a dentist, or an
engineer?
To think like a nurse, one must be willing to suspend judgments until
he/she 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.
Nurses continually monitor their thinking; questioning and reflecting on
the quality of thinking occurring in how they reason about nursing
practice. Sloppy (shoddy, slack, careless, poor) superficial thinking leads
to poor nursing 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.
 Model of Critical Thinking

Problem solving Creativity

Critical thinking

Decision making
 Obstacles to high quality thinking

Habits and ruts (channels)

One of the greatest obstacles to thinking is getting into a rut, and the most
common way of getting into a rut is to overuse the HABIT mode. Novices do not
have many nursing habits but they develop them quickly.

Habits provide security and comfort, so they have definite value. Nurses need
habits. Beginning nurses need to follow recipes at first to provide safe, basic
nursing care, however problems occur when nurses stop thinking after they have
developed some comfortable, secure, and safe habits of patient care.
 Obstacles to high quality
thinking
Anxiety

Increased anxiety turns down the burner on thinking and severely limits the I, N,
and K modes.

Nursing as a new field is probably scarier than other new experiences because
nurses deal with life and illness situations.

Anxiety decreases one’s thinking abilities even about simple things, like talking. It
therefore does worse on higher-order thinking like learning and problem solving.
 REFLECTIVE PRACTICE IN NURSING

Reflective thinking involves thinking over specific situations while in those situations
and afterward.

For learning to occur, it is important to reflect upon an experience while it is

occurring and make relevant adjustments. If reflection does not take place, it is
unlikely that learning will occur.
There are two aspects of reflection:-

1. Reflection upon practice or experience while or as it is occurring and

make relative adjustments as a result(INTROSPECTION)

2. Reflection after an experience has taken place. One explores various

aspects of the experience, his/her part in it and how changes can be
generated from the results(RETROSPECTION)
Nurses apply reflective process constantly to adapt their thinking to the ever-
changing contexts of patient needs and the health care arena.

The nurse tries to improve how he/she thinks and does by focusing on what they
thought, felt, and did in that particular situation.

As more and more situations are reflected upon, the nurse grows in the Knowing
How You Think mode (style, form, method).
 SUMMARY
A reflective practitioner is characterized by a range of personal qualities
and abilities such as the ability to:-
Engage in self –assessment
Criticize the existing state of affairs
Promote changes and adopt the changes, and
Practice as an autonomous professional
Refection can either be within a group or in a one-on-one situation.
In group context, the individuals who have participated in the experience
share with colleagues or peers what they saw and felt during the activity.