Critical thinking is an important skill for nurses that involves actively and skillfully analyzing, evaluating, and applying information. It includes cognitive skills like interpretation, analysis, and evaluation, as well as attitudes like inquisitiveness and open-mindedness. Critical thinking can be developed in nursing education through various active learning strategies like simulations, problem-based learning, case studies, and evidence-based learning. These strategies encourage students to engage deeply with material and practice higher-order thinking.

1. Critical Thinking
In Nursing Education
Dr. Susheewa Wichaikull

2. Questions:
 What do you really know about “Critical thinking”?
 Why CT is important for the nurses?
 Where CT can be applied in nursing?
 How to apply CT in nursing education?
 What options are available to you?
 When does the nurses need to think critically?

3. Objectives
 To define CT
 The component of CT
 How to approach CT
 How to promote CT in nursing education

4. What is critical thinking?
An Introduction to Critical
Thinking

5. CT has been expressed
in several ways from
many theorist.

6. Critical Thinking Definition
 Rudd, (2002)
 Reasoned, purposive, and reflective thinking
used to make decisions, solve problems, and
master concepts.
 Profetto-McGrath and others (2003)
 Critical thinking is both a process for
resoning and set of skills.
 Chaffee (2002)
 Active, organized, cognitive process used
to examine one’s thinking and that of
others
 Settersten and Lauver (2004)
 Recognize, analyze, evaluate, and draw
conclusions

7. Critical Thinking is:
“Critical thinking is the intellectually disciplined
process of actively and skillfully conceptualizing,
applying, analyzing, synthesizing, and/or
evaluating information gathered from, or
generated by, observation, experience,
reflection, reasoning, or communication, as a
guide to belief and action. In its exemplary form,
it is based on universal intellectual values that
transcend subject matter divisions: clarity,
accuracy, precision, consistency, relevance,
sound evidence, good reasons, depth, breadth,
and fairness.”
Michael Scriven & Richard Paul (the National Council for
Excellence in Critical Thinking, 1987)

8. According to several definitions
above, CT is not the method of
learning, but rather a process
including, both cognitive and
affective domains.

9. Seven standards that critical thinkers should be
 According to the Foundation for Critical Thinking
(http://www.criticalthinking.org)

10. Critical thinking skills
According to literature reviews:
 There is no perfectly clarification
regarding Critical thinking skills.
 It depends on user and utilizing.
 However, Facione and Sanchez
(1994) recommended that being a
good critical thinker should employ
both cognitive critical thinking skills
and attitude critical thinking skills.

11. Cognitive Critical Thinking Skills
 Interpretation : accurate interpreting
topic/problem
 Analysis : Examining ideas/argument in
topic
 Inference : querying claim, reaching
conclusion to implement with the patient
 Explanation: clearly explaining and
defending the reason why using those
implementations
 Evaluation : evaluating information to
ascertain its probable trustworthiness
 Self-regulation : constantly monitoring
one’s own thinking using universal criteria
Facione, 1990
Frequently used in nursing

12. Critical thinking includes a complex combination skills
 Rationality
 Self-awareness
 Honesty
 Open-mindedness : Having an appreciation of
alternative perspectives
 Discipline or experiences
 Judgment

13. What the major components are:
 1) a set of information and belief
generating and processing skills, and
 2) the habit, based on intellectual
commitment, of using those skills to guide
behavior.

14. Critical Thinking Components
 Brookfield (1987) stated that there are four
components of CT;
 Identifying and Challenging
 Promoting the importance of
context
 Capacity to imagine and explore
alternative
 Reflective skepticism

15. Five components of critical thinking in Nursing
 Knowledge base
 Experience
 Competence
 Attitudes
 Standards
Joyce Smith : Critical Thinking
and Nursing Judgment

16. Critical Thinking Attitudes
 Confidence
 Thinking independently
 Fairness
 Responsibility and accountability
 Risk taking
 Discipline
 Perseverance
 Creativity
 Curiosity
 Integrity
 Humility

17. Standards
 Intellectual Standards-
 14 intellectual standards (Paul,1993)
Nurses use these when using the nursing process:
 1. Confidence 7. Perseverance
 2. Independence 8. Creativity
 3. Fairness 9. Curiosity
 4. Responsibility 10. Integrity
 5. Risk taking 11. Humility
 6. Discipline

18.  Professional standards
 Sound ethical standards
 When critically thinking must have a sense of their own
values, beliefs, feelings and their clients/ client’s family’s
values, beliefs, feelings
 Scientifically based practice with
standards developed by experts
 Evidenced based practice
 Standards developed as a result of evidence
 These are minimum requirements that are necessary to
give quality effective care

19. Critical Thinking Competencies
 Scientific method
 Problem solving
 Decision making
 Diagnostic reasoning
 Clinical decision making
 Nursing process

20. However, nursing’s effort to capture and
employ these concepts has resulted in some
confusion and uncertainty.

21. How it different from Problem solving
CT Problem solving
• goes beyond • Focus on problems
problem solving rather and finding solutions
than finding specific to solve the problems
solution.
•is not centred on • is nature expects an
seeking an answer answer
Facione(1993) described that CT as eventually a cognitive
engine driving problem solving and decision making

22. How it different from Decision making
CT Decision making
•The requisite of • a systematic process
decision making of assessment of a
collection of actions,
evaluation and
judgment contributing
to the achieve
outcome
CT is an important process to promote problem solving
and decision making.

23. Education strategies to
develop CT

24.  Bittner and Tobin (1998) suggested the
instructional method to enhance CT as
following:
 Creative approach to open nurse’
mind and to broaden alternative
argument in order to facilitate the
problem solving

25. Strategies to promote CT
Active learning has
eventually been used for the
teaching of critical thinking.

26. Active Learning - “students involved
in doing things & thinking about the
things they are doing”
Critical Thinking - “reasonable
reflective thinking that is focused on
deciding what to do and what to believe”
OR “interpreting, analyzing or evaluating
information, arguments or experiences
with a set of reflective attitudes, skills,
and abilities to guide our thoughts,
beliefs and actions” OR “examining the
thinking of others to improve our own”

27. Operational Procedures of Critical Thinking - 1
 Identifying key  Distinguishing fact
definitions from opinion
 Identifying ambiguity  Identifying
 Identifying variables assumptions
 Formulating questions  Identifying values
 Defining issue or  Noting missing
problem evidence
 Classifying  Identifying
information relationships
 Comparing &
 Sequencing
information contrasting
 Cause and effect
 Recognizing patterns
 Determining  Summarizing
credibility information
 Using analogies

28. Operational Procedures of Critical Thinking - 2
 Predicting trends  Identifying errors in
from data reasoning such as:
 Logical fallacies
 Predicting
 Errors in statistical
outcomes based reasoning
upon evidence  Alternative
 Translating conclusions that
between verbal satisfy evidence
and symbolic
 Identifying
conclusions

29. Dispositions to think critically(Attitude)
 Inquisitiveness/ curiosity
 Open mindedness
 Systematicity
 Analyticity
 Truth seeking
 Self-confidence
 Maturity
Stacy E. Walker (2003) Active Learning to promote CT

31. Learning Methods : Active Learning
 Classroom discussion and Debates
 Simulation
 Questioning tactic
 Written Assignment
 Problem based learning
 Inquiry based learning
 Factual based or Evidence based learning
 Games and Puzzles
 Encourage Creativity
 Word chains category Ideas
 Online based learning
 Case study or cased based learning
 Cooperative learning or participatory learning
 Integrated learning
 and so on i.e. community based, elective
based learning, virtual class

32. Active Learning

33. Student Centered Model
Teacher
Student
Student Content

34. Questionings
 Questions are the helpful to promote critical
thinking in every process of learning. It
depends on how a question is asked. The
useful questions are “Wh” questions i.e.
what, why, when, where, how.

35. Example of Questions Stacy E. Walker (2003)
Category Key Concepts Examples
Knowledge Memorization, description, What, When, Who, define,
Comprehension explanations, comparison describe,state,show,how
conclude, demonstrate,
rephrase, differentiate,
explain, give an example
Application Solution, application, Build, construct, solve,
analysis induction, deduction, demonstrate, how would
logical order you support your, what
assumptions, what
reasons, does the evidence
support the conclusion,
what behaviour
Synthesis Product thinking Think of a way, propose a
plan, develop, suggest,
formulate a solution
Evaluation Judgment, selection Choose, evaluate, decide,
defend, what is the most
appreciate, which would
you consider

36. Simulation in nursing education
 There is currently a widespread movement to
use simulations of all types in nursing
education as a teaching-strategy and/or as
an evaluation mechanism.
 In the past 40+ years, nursing educators
have conducted similar studies involving case
studies, computerized patients, standardized
patients, and have achieved similar results.

37. Virtual Simulation and Patient Care
Goal for using simulations: Optimal Student
Learning for High Quality Patient Care

38. Simulation Framework
OUTCOMES
• Learning
(Knowledge)
• Skill performance
• Learner satisfaction
• Critical-thinking
 Program
• Self-confidence
s
aphic  Level
 Demogr
 Age
DESIGN
CHARACTERISTICS
and SIMULATION
 Active learning  Collaboration (intervention)
 Feedback  High expectations
 Student/ faculty  Diverse learning  Objectives
interaction  Time on task  Fidelity
 Problem-solving
 Student Support
 Reflection
Jeffries & Rizzolo, 2004

39. Components of Inquiry Based
 Engage
 Explore
 Explain
 Elaborate
 Evaluation
Critical Skills
 Interpretation
 Analysis
 Evaluation
 Inference
 Explanation
 Self-regulation

40. Problem Based is
An instructional student-centered approach
which uses carefully constructed clinical
problems as a context for students to:
define their learning needs, conduct self-
directed enquiry, integrate theory and
practice, and apply knowledge and skills to
develop a solution to a defined problem.

41. How it different from Problem solving
Problem based Problem solving
learning
the process of arriving at decisions
acquiring new based on prior
knowledge based on knowledge and
recognition of a need reasoning
to learn

42. Dr. Soha Rashed Aref Mostafa, 2010

43. Additional model

44. The Seven Step Model
 Step 1 Identify and clarify unfamiliar terms presented in the
scenario, (allocate a scribe and a chairperson, define rules)
 Step 2 Define the problem or problems to be discussed;
 Step 3 Ideas storming session to discuss the problem(s),
 Step 4 Review steps 2 and 3 and arrange explanations into
tentative solutions;
 Step 5 Formulate learning objectives;
 Step 6 Private study (all students gather information related
to each learning objective)
 Step 7 Reconvene - Group shares results of private study
(Wood, 2003)

45. The Seven Step Model
(Wood, 2003)

46. Inquiry based learning
“Inquiry implies involvement that leads to
understanding. Furthermore, involvement in
learning implies possessing skills and attitudes that
permit you to seek resolutions to questions and
issues while you construct new knowledge.”
(Veronica Robinson 2008)

47. Evidence based learning
 Evidence based nursing, or EBN, is a form of
clinical practice that relies on research findings to
manage the health problems of a patient.
 Evidence based usually begins with the formulation
of a question or topic concerning a patient’s
medical condition, and then, research is performed
to find answers to the question.
 It can be applied in the classroom.

48. Step of EBL
 Select a topic
 Collect appropriate and accurate data to generate
evidence for nursing practice.
 Analyze data from clinical practice.
 Design interventions based on evidence.
 Predict and analyze outcomes.
 Examine patterns of behavior and outcomes.
 Identify gaps in evidence for practice.
 Evaluate project to determine and implement best
practices.

49. E-learning/ web based learning
 Online tools provide an efficient means by which
instructors can shift the instruction of basic
concepts outside of class so that students are
prepared to fully engage in class activities
(Mandernach 2006).
 Online course can promote CT depending on the
design of learning within Asynchronous and
synchronous learning tool(Wichaikull 2007).
 Critical thinking appears to be best encouraged
among students when a more consistent emphasis
is placed on the discussions, and when instructor
facilitation is less frequent but more purposeful.
(Bridget Arend 2009)

50. Online Learning Tools
Links
Podcasts Lectures
Surveys Quizzes
Gradebook Discussion Boards
Announcements Wikis
Chat Rooms Email
Assignments Digital Video
Blogs

51. Case based or case study in nursing
 The case study approach is one way in which such active
learning strategies can be implemented in clinical setting.
 Fry et al (1999) describe case studies as complex
examples which give an insight into the context of a
problem as well as illustrating the main point.
 Case studies is defined as student centred activities based
on topics that demonstrate theoretical concepts in an
applied setting.

52. Benefits of cae study
 Convey knowledge, facts, information to
students
 Apply theory to a situation
 Enhance students’ decision making skills
 Improve students’ technical or behavioural
skills in analysing data
 Improve students’ self esteem
 Stimulate students’ interest in a subject
 Foster reflection
 Present a realistic picture of the complexities
in a situation

53. Factors influencing critical thinking outcomes
 Questions with one right answer
 Questions with no right answer
 Questions with better and worse answers

54. Critical thinking outcomes
Rudd & Irani, 2004
Individual factors
High
Quality
Critical
Thinking
Outcome
Stimulus High High High
Problem Critical Critical No Critical
Thinking Knowledge Thinking Thinking
Disposition Skill Outcome
Decision + +
Others…
Low
Quality
Low Low Low Critical
Thinking
Outcome
External factors

55. 8 Ways to Fail at Teaching CT
(Robert Sternberg, Yale University)
1. Teacher is teacher; student is
student.
2. Critical thinking is the students’
job.
3. Need to find the best program.
4. Program decisions are either or.
5. Right answer over rationale.
6. Discussion a means to an ends.
7. Mastery learning applies to CT.
8. Need to “teach” critical thinking.

56. Evaluating Your Teaching
 closed questions
 open-ended questions
 MEQ Test/ Rational for decision making/
problem solving ability
 Concept map
 Analysis of writing portfolio
 Interviews and discussion
 Observations
 Documentation of a situation analysis
 Potential solutions

57. Thank You