ongoing activity for
is the process that allows nurses to see the big
picture (envision the overall perspective) instead
of focusing only on details.
Ennis’(1987) classic description, “reasonable
reflective thinking that is focused on deciding
what to believe or do.”
Every day, nurses make decisions that are
derived through critical thinking.
Making clinical judgments relies on critical
Critical thinking is identified as an essential
nursing competency by the National League for
such as decision-making and
reasoning that are used to find or create
result of these mental operations is
appropriate problem solving.
Other cognitive operations involved in critical
strategizing (planning) and
evaluating one’s thinking
base that includes
1. declarative knowledge, (specific facts or
2. operative knowledge (an understanding of
the nature of that knowledge).
curricula assist the student in
learning specific facts about nursing and the
delivery of quality care.
order to think critically, to solve problems,
and to make decisions, nurses must develop
a broad base of knowledge. It includes;
from other disciplines such as science (anatomy,
physiology,biology), psychology, and philosophy
apply this knowledge to specific client
situations through critical thinking.
OF CRITICAL THINKERS
• Tolerance, open-mindedness, nonjudgmental
• Curiosity, proactive, flexible, organized
• Persistence, intellectual courage
• Respect for others’ perspectives
• Comfort dealing with ambiguity, uncertainty
• Intellectual humility (knowing that one does
not have all the answers)
• Self-confidence (belief in own ability to think
things through and make appropriate decisions)
(Data from: Beyer ; Ennis ; Krathwohl, Bloom, & Masia ; Paul, ;
and Rubenfeld & Scheffer .)
Trigger event: A problem that is reframed
as an opportunity for improvement
2. Appraisal of the situation: Selfexamination of one’s underlying assumptions
3. Exploration: Searching for new ideas,
solutions, and/or approaches
4. Integration: Incorporating new information
and new ways of thinking
Determine what knowledge is required.
Assess the margin for error.
Determine the amount of time available
for decision making.
Identify available resources.
Recognize factors (i.e., biases, fatigue)
that may influence decision making
thinkers are also creative thinkers.
Both types of thinking require assessment
and result in new discoveries (Paul & Ballin,
creative problem solving
is goal-directed thinking that leads to
achievement by using new ideas or methods.
is “the basic building block of
invention and thus innovation"
thinking is the foundation for
individualizing client care, in that the nurse
identifies unique needs of each client and
develops interventions specific to those
needs. Without creative thinking, nursing
care would become routine, that is, the
same for every client.
• Defines the parameters of a
• Defines the existing problem
• Sets reasonable criteria for
• Delays judgment or suspends
criticism of alternatives
appropriateness of an action
• Adapts one’s behavior as
• Exercises judgment in
selecting the best alternative
and/or norms change
• Transfers learning from one
situation to another
• Learns from mistakes
• Pays attention to the problem
• Breaks away from usual
problem-solving methods to
• Detects ambiguity or false inferences
• Analyzes interrelationships of ideas from
• Tests out inferences by considering
• Creates innovative solutions to complex problems
Ref:(Data from Gilmartin  and Paul .)
making a clinical decision, the nurse
determines action that will help move the
client toward achievement of the expected
Thus, decision making is defined as
considering and selecting interventions from
a repertoire of actions that facilitate the
achievement of a desired outcome (Pesut,